The California Agricultural Worker Health Survey

1. The California Agricultural Worker Health Survey Conducted by the California Institute for Rural Studies Funded by The California Endowment

2. Investigators and Key Staff • David Lighthall, Executive Director • Don Villarejo, Founder & Director Emeritus • Bonnie Bade, Co-investigator • Steve McCurdy, Co-investigator • Richard Mines, Co-investigator • Steve Samuels, Project Statistician • Daniel William III, Project Coordinator • Ann Souter, Senior Site Coordinator

3. Random Selection of Subjects • Communities – Five of six agricultural regions represented by randomly selected community sites. • Dwellings – Enumeration of ALL places (dwellings) in each community where farmworkers are found to reside; then randomly select dwellings to contact. • Residents – Enumeration of ALL eligible persons in randomly selected dwellings; then random selection of one or more residents to be subjects.

4. Qualifications of Subjects • Age 18 years or older • Performed hired farm work in the previous twelve months • No limit on duration of farm employment • Livestock & crop work of any type • Exclude off-farm food processing

5. CAWHS Survey Components • Main Survey Instrument, In Dwelling, 1 ½ to 2 hours, Interviewer • Physical Examination, At Clinic, 20 to 30 minutes, Medical Staff, By Appointment, Transportation Provided • Risk Behavior Instrument, At Clinic, 20 to 30 minutes, Interviewer, Private Room

6. CAWHS Main Instrument • Household Composition • Personal Demographics • Health Services Utilization • Self-reported Health Conditions • Doctor-reported Health Conditions • Work History • Income and Living Conditions

7. CAWHS Main Instrument (continued) • Workplace Health Conditions • Protective Equipment & Safety Training • Working With Pesticides in the U.S.A. • Field Sanitation • Work Related Injuries and Injury Module • Immigration Status

8. CAWHS Physical Examination • Biometric • Dental • Skin • Body • Screening • Blood Chemistry • Medical History

9. Risk Behavior • Health Habits (alcohol, tobacco) • Domestic Violence • Workplace Violence & Workplace Risks • Sexual Behaviors • Drug Use • Mental & Psychological Illness • Reproductive Health (female only)

13. Summary Results, CAWHS, 1999

14. CAWHS Sample, 1999, N=968

34. Does Your Employer Provide These EVERYDAY? N=968

39. Conclusions: Occupational Safety and Health 1. High level of non-compliance with Worker Protection Standard pesticide training regulations. 2. For workers who are trained, the quality of WPS training is questionable: Multiple sources of training with a high proportion of workers receiving inadequate training. 3. Evidence that lateral, airborne pesticide drift is common, suggesting weak compliance with WPS pesticide application rules. • Overall, WPS appears relatively ineffective. • High rates of musculoskeletal complaints: 66% reported chronic M-S pain in past year. • Clear evidence of need for better eye protection: 22% report chronic eye irritation.

40. Conclusions: Access to Care and Chronic Disease • Strikingly high proportions of workers who have rarely or never been to doctor, dentist, or optom. • Major problems of access to preventative and primary care: Dental, musculoskeletal (back, etc.), vision are perhaps the most serious. • Little affordable employer-provided health insurance, low levels of MediCal participation. • Cultural traditions of health care are being confronted by emergence of new chronic diseases tied to dietary changes in Mexico and the U.S. • Genetic predisposition (diabetes) and high rates of obesity increase long-term risk to heart disease, hypertension, stroke, and diabetes. • Looming long-term health costs for county and state health system if access to preventative and primary care is not dramatically improved.