UC Agricultural Health & Safety Center at Davis
AgHealthNews
Issue Number 1998-01
Winter 1998
Published by the UC Agricultural Health & Safety Center at
Davis, University of California, Davis, Marc Schenker, M.D., M.P.H.,
Director, Produced by EditPros, Davis, CA
1998-01-01 TABLE OF CONTENTS
- 1998-01-01 Table of Contents
- 1998-01-02 Welcome and Introduction
- 1998-01-03 Investigators seek Childhood injury
prevention programs that work
- 1998-01-04 Wellness Lecture: Ag injury a
major health issue
- 1998-01-05 Cholinesterase Testing: Is affordable
procedure accurate?
- 1998-01-06 Educating migrant women at risk
of cervical and breast cancer
1998-01-02 WELCOME AND INTRODUCTION
Welcome to the UC Agricultural Health & Safety Center at Davis
AgHealthNews.
AgHealthNews is an electronic version of the Center's quarterly
newsletter. The Center has two electronic list servers that allow
automatic forwarding of e-mail to a list of subscribers. One server
is a forum for announcements and discussion of agricultural health
and safety issues and the other is a vehicle for the automatic distribution
of the Center's quarterly newsletter.
The e-mail addresses for the forum is: aghealth@epm.ucdavis.edu
(message forwarding address) and aghealth-request@epm.ucdavis.edu
(subscriber request address). The addresses for the newsletter are:
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By return e-mail you will receive confirmation of your request
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1998-01-03 INVESTIGATORS SEEK CHILDHOOD INJURY
PREVENTION PROGRAMS THAT WORK
By Martha C. Stiles
Every day more than 33,500 adolescents and young adults
are injured seriously enough to require medical treatment, a total
of 12.3 million each year in the United States. Some 20-25 percent
of all children sustain injuries requiring medical treatment, and
unintentional injuries are the leading cause of death in individuals
ages 1 to 21. In California, motor vehicle accidents and assault
are among the top five causes of fatal and non-fatal injuries to
youth between the ages of 1 and 20.
These startling injury rates provided the common ground for health,
law enforcement and community service professionals to come together
at the 11th Annual California Conference on Preventing Child and
Adolescent Injuries in October 1997. This year, conference sponsor,
San Diego State's Center for Childhood Injury Prevention, focused
on developmental and environmental factors that contribute to child
death and injury. Understanding the child, the injury and community
resources is critical to designing effective prevention programs.
An intervention designed for 10-year-olds will most likely be ineffective
in reaching adolescents.
For instance, one medical expert explained that, although not
fully developed, children 5 to 12 years old have a wide range of
motor skills and are able to recognize dangerous situations. However,
they often lack the experience to judge the severity of the situation
and, therefore, may fail to take appropriate actions to avoid injury.
Teens in the 13 to 15 age group are risk-takers. They seek peer
approval with little thought to consequences. While they possess
sophisticated motor skills, agility and safety knowledge, they tend
to place themselves in risky situations and to use fewer precautions
fearing disapproval from peers. As for 16- to 20-year-olds, inexperience
and immaturity are characteristics which contribute to injuries.
Thrill-seeking among this group is a common problem. Injuries and
fatalities occur due to the inability or failure to understand the
level of risk inherent in certain behaviors and to underestimate
one's mortality.
Workshop faculty agreed that children carry the same risk factors
with them wherever they go. That is, they are at risk in the home,
on the playground, on the street or on the job. In her keynote address,
Barbara Lee, director of the Children's Safety Network in Marshfield,
Wisc., focused on child agricultural occupational injury.
"Agriculture is the most common enterprise in which young children
are working, and is ranked among the three most dangerous industries
in our country....an estimated 100 children die and 150,000 children
are seriously injured annually on U.S. farms," Lee said.
In fact, these injury/fatality rates are dramatically underestimated
and data are inconsistent, according to researchers at the Labor
Occupational Health Program (LOHP), UC Berkeley. Data from 1996
showed that 5 percent of teen workers in the United States are involved
in agriculture and that 15- to 19-year-olds constituted 14 percent
of all hired farm labor. California employment statistics indicate
that 4 percent of working teens are involved in agriculture, yet
other national sources show that 2 percent of kids under the age
of 18 work on farms. LOHP researchers were also surprised to find
that the 1990 Census undercounted the number of hired farm workers
by 60 percent.
Lack of reliable data contributes to the difficulty in identifying
risky environments and designing appropriate interventions for young
workers. Federal labor laws proscribe children from performing specific
jobs before the age of 18. However, agriculture is an exception.
Children as young as 12 are allowed to do work considered as non-hazardous.
Investigators across the country have asked the question "under
what circumstances are teen workers injured?" A bank of studies
demonstrate a handful of situations in which young workers get into
trouble. Most of these are activities commonly performed on farms,
including:
Since most California workers are Latinos born in Mexico (82 percent),
language and culture must be factored into the job safety intervention
equation. This is in addition to the age factors, that is, young
workers are inexperienced, take unnecessary risks, and lack specific
motor skills for certain jobs. According to a National Agricultural
Workers Survey (NAWS) report, almost half (47 percent) of the farm
workers (<17 years old) live independently (not with parents).
Within this group, 80 percent of the immigrant worker youth, born
outside of the United States, do not live with parents. Considering
the developmental issues described above, youth living without the
supervision or attention of parents, may be unaware of job hazards
and how to mitigate them. According to a recent survey of farm owners
in California, job training is rarely included as a component of
safety programs especially for seasonal labor. Youth working with
sharp tools, machines and heavy objects may enter and continue in
the workforce with few hours of skills training and even fewer skills
on how to avoid injury.
New and young workers are vulnerable. We know that of all California
farm workers hurt on the job, 47 percent have been with the employer
less than one year. Injuries and illness (17 percent) take place
in less than a month of service. In some farm jobs, 48 percent of
reported injuries and illness cases occur in the first year of employment
and 18 percent of these in less than one month.
Injury prevention specialists urge workers, employers and parents
to eliminate hazards through redesigning workplaces and/or processes.
A critical element of prevention is education of young workers,
parents and business owners about safeguards, rights and responsibilities.
A reliable source of injury data is paramount to understanding the
breadth of issues and factors contributing to work injuries among
children.
Center Investigator Martha C. Stiles is a research associate
in the UC Davis Department of Human and Community Development
1998-01-04 WELLNESS LECTURE: AG INJURY A MAJOR
HEALTH ISSUE
"If you ask someone on the street, `What do you think is the most
significant occupational health problem among farmworkers?' you'll
likely hear: `pesticides.' Yet, a much greater number of people
are affected by agriculture-related injuries than by pesticides,"
observed Center Research Coordinator Stephen A. McCurdy, M.D., M.P.H.,
during a talk he presented on the UC Davis campus in October as
part of the 1997 Wellness Lecture Series. "In California, 90 percent
of migrant farmworkers are Hispanic. This group is at special risk
because it is relatively marginalized socioculturally, linguistically
and economically. These circumstances increase their risk for occupational
injury, reduce their access to medical care, and decrease their
chances for inclusion in statistics and focused studies. The result
is an `invisible' epidemic of injury," he said.
Sponsored by the California Wellness Foundation and the University
of California, McCurdy's presentation titled "Occupational Injury
Among California Migrant Hispanic Farmworkers: Fighting the Invisible
Epidemic" was among six lectures on current issues in health promotion
presented at several UC campuses last fall. McCurdy noted that several
sources of information are available for occupational injury statistics
in agriculture. Data from the National Safety Council indicate a
total of about 35 injury fatalities occur per 100,000 persons per
year in the United States. Those include 1,100 work-related deaths
and 130,000 disabling injuries. Approximately 35,000 agricultural
injuries are reported each year in California, and more than half
are associated with lost work time.
Workers' Compensation Insur-ance data reveals an annual total
of 34,000 cases of injuries, including 47 deaths, with a medical
indemnity cost of $176 million, a figure that doesn't include the
loss in productivity for both the employer and the employee.
"So what can we do to help make sense of this? I feel the answer
lies in epidemiology, the search for patterns of disease in populations,"
asserts McCurdy. "Epidemiology is a very powerful tool because it's
reality-based and allows us to consider multiple factors." However,
McCurdy warns that epidemiology can be expensive, depending on the
size and scope of the study.
Data collected by the Department of Labor from the National Agricultural
Workers Survey show that a typical farmworker in California is male,
in his mid-30s and foreign-born, with Mexico being the most common
birthplace. Workers are not well educated-with a median sixth-grade
education-and Spanish is their primary language (only 10 to 11 percent
are fluent in English). "This survey indicates a median family income
of $10,000-12,000," said McCurdy. "More recent national data that
includes but is not restricted to California, shows family income
a notch lower ($7,500-10,000). The poverty rate for this group is
at about 50 percent. The rate increases for larger families, yet
the social services utilization rate is very low-only 13 percent
indicated they used social services."
McCurdy identified some of the problems migrant farmworkers face,
including
"These factors may reduce the visibility and access of this population
to the occupational health system and may, as well, increase their
risk for injury," he said.
WHAT THE CENTER IS DOING
--From his work with the California Occupational Mortality Study,
McCurdy's colleague James Beaumont noted that machinery and animals
are often involved in injury and death. His study revealed that
farmworkers have roughly a 13-fold increased risk of death related
to machinery and a 35-fold increased risk of death related to
animals.
--The CDC has estimated that up to 300 fatal and 27,000 non-fatal
injury cases occur in persons younger than 19 years old on the
farm. NIOSH recently received funding from Congress for a national
initiative to protect the safety and health of children on farms.
Center investigators are working with Farm Safety 4 Just Kids,
the Farm Bureau and other organizations to investigate further
the hazards to which California farm children and the children
of migrant and seasonal farmworkers are exposed. The Center will
continue working to develop age-appropriate educa-tional materials
and programs targeting children's needs.
--The Center's ongoing Farmworker Injury Study was developed for
several reasons including:
"As of now, we have interviewed 1,174 adults and 907 children
from six local migrant housing centers and the majority of the injuries
appear to be work-related," said McCurdy.
--Center investigators looking at ergonomic interventions continue
to develop innovative but simple tools to help reduce some of the
repetitive-motion injuries to workers in the nursery industry.
--Investigators involved in the Center's NURSE Project, an active
surveillance program for agricultural injuries in the counties of
Fresno and Monterey, have reviewed more than 5,000 Workers' Compensation
cases since 1994. "The picture is not that surprising," said McCurdy
referring to the statistics resulting from the NURSE Project. "Workers
are 80 percent male and 80 percent Hispanic, and the median age
is 30. Lacerations, sprains and strains are most common conditions
related to over-exertion and falls."
McCurdy concluded, "Migrant Hispanic farmworkers are essential
to California's agricultural industry--it can't survive without
them. Their circumstances reduce their visibility and access to
the occupational health system and may, as well, increase their
risk of injury. Continued research is necessary to identify problem
areas, to identify risk factors that will help us recommend ways
to reduce agricultural injuries, and to evaluate prevention strategies.
Education, for example, is a prevention strategy. We need to know
where education works best and how well.
Wellness Lectures are available in book form and on video or
audiotape. Visit the Wellness Lecture Series Web site at www.ucop.edu/ucophome/healaff/wellpgm/
for more information.
1998-01-05 CHOLINESTERASE TESTING: IS AFFORDABLE
PROCEDURE ACCURATE?
A lawsuit filed by agricultural workers seeking mandatory cholinesterase
monitoring is creating alarm among farmers in Washington state,
where cholinesterase testing costs up to $23 per sample (plus handling)
and lab results are not always reliable, according to Matthew Keifer,
M.D., M.P.H., an assistant professor of Medicine and Environmental
Health at the University of Washington. Visiting the Center in November,
Keifer presented a talk titled "A Field Validity Study of the EQM
Test-Mate OP Cholinesterase Kit."
A portable test kit offers the potential of dramatic cost reductions
for the prohibit-ively expensive test, but doubts about the accuracy
oftest results have clouded the issue. Keifer and his colleagues
in the state of Washington face many of the same issues that California
agricultural health and safety inves-tigators face due to similarity
in climate, type of farming and work population. "We encounter the
same tensions that you deal with in terms of the grower community
versus the worker community, so I'm very happy that we're able to
collaborate," said Keifer. Currently the state of Washington is
being sued by the Sierra Club on behalf of farmworkers to require
cholinesterase monitoring of workers who handle cholinesterase-inhibiting
chemicals.
"At this point the lawsuit is based on farmworkers but the plaintiff
is broadly interpreting the suit to include anyone who works with
Class I or II carbamates or organophosphates." In an effort to explore
more economical testing options, Keifer and his Washington State
colleagues were enlisted by the Department of Labor and Industry,
and with some support from the Environmental Protection Agency and
the National Institutes for Occupational Safety and Health (NIOSH)
to test different aspects of the Test-Mate cholinesterase kit.
Keifer was first introduced to cholinesterase test kits in (1989)
as medical officer for a cholinesterase monitoring program in the
northwest region of Nicaragua. There he utilized some earlier versions
of the EQM Cholinesterase Kit and became eager to learn more about
its usefulness. It has since been modified several times and many
improvements have been made.
The Test-Mate OP Cholinesterase Kit is a battery-powered colorimeter.
While a new version is now available the last model is a self-contained
kit that sells for about $800 and analyzes samples for about $1
per test. The kit is portable, inexpensive and relatively easy to
operate, and designed to be taken into the field for on-site testing.
"A variety of people have participated at various stages of our
evaluation of the Test-Mate kit," said Keifer. "We wanted to determine
how precise the kit was and how valid the Test-Mate is, particularly
in a field situation. How would it perform in the field in general,
and what are the effects of capillary sampling?"
In the initial test of the basic function of the kit, Keifer used
his own blood, drawing from 10 different fingers to establish the
coefficients of variability. "In a follow-up study aimed to re-test
variability of capillary sampling over 15 days, a graduate student
and I participated in a study," explained Keifer. "The graduate
student spiked samples at various concentrations with oxons of diazinon
and parathion and found a relatively high R-square against the spectrophotometric
method."
After several laboratory studies, Keifer and colleagues took the
kit out into the field. Studies were mostly conducted in an apple-growing
area of Washington, testing thinners, pickers and handlers, but
collaboration was international including some work done in Mexico.
In one study conducted in the agricultural areas just outside of
Mexico City Keifer said, "When we tested the kit over a full day,
the response to temperature was almost linear. It was remarkable,"
he said. "We were told by the manufacturer that this kit self-adjusts
for temperature, but we questioned the accuracy due to the way the
kit measures temperature." One study involved cooling the kit to
about 40 degrees Fahrenheit and then placing it in a room that was
about 105 degrees Fahrenheit. "Two hours after making that change,
the kit was still reading only 88 degrees. So it's very slow to
respond to ambient temperature changes."
Keifer is now deliberating whether or not the Test-Mate qualifies
for use in the field as a laboratory for acetyl cholinesterase (AChE).
"We can't answer that question with this study because everyone
we tested had basically normal cholinesterase. We know how it reads
spiked samples, but that criterion alone does not constitute a field
test of the kit. One of the limitations of our study was the lack
of sufficient exposure among test participants." Keifer says he
is not convinced that testing for cholinesterase is the best way
to measure a person's exposure to chemicals. "Testing for something
like lead is a little more clear-cut. Cholinesterase testing requires
a baseline, which makes it much more complicated and expensive."
Keifer believes that a needs assessment of the costs and questionable
accuracy of current cholinesterase testing technology should be
resolved before a mandatory testing program is implemented in Washington
state.
1998-01-06 EDUCATING MIGRANT WOMEN AT RISK OF
CERVICAL AND BREAST CANCER/ PROFILE: FAITH BOUCHER
For more than 20 years, medical anthropologist Faith Boucher has
been working to educate and improve the lives of agricultural workers
and their families. A Peace Corps volunteer in India from 1966 to
1968, Boucher created a forum for farmers to meet and work with
professors of J. Nehru Agriculture College in Gwalior, an ancient
city south of New Delhi. She also started clubs similar to 4-H to
teach children vegetable gardening and animal raising.
During the 1980s, Boucher served as director of refugee/immigrant
services for San Joaquin and Stanislaus counties, working with Mexicans,
Cubans and Southeast Asians. "The situation faced by Cambodian,
Hmong and Vietnamese refugees was very serious because many spoke
no English, were illiterate in their own languages, and had no job
skills besides farming," said Boucher. "I started an ag program
to capitalize on the agricultural skills and family-based work organizations
that the people already possessed. Contrary to welfare-reform rhetoric,
you can't make electronics technicians out of everyone, nor should
this be the primary goal of acculturation and education in these
populations."
With three students from the Graduate Group in International Agricultural
Development at UC Davis, two of whom were former Peace Corps volunteers,
and refugee Mutual Assistance Organizations, families determined
to farm were assisted to rent land, obtain seed and fertilizer loans
and contact agricultural technical assistance organizations. "Marketing
their produce was a problem, so we began with the farmers' market
circuit. The families got a lot of help from the Quakers' Rural
Economic Alternatives Program to help sell their goods," said Boucher.
"Now if you go to farmers' markets anywhere in Northern California,
you'll see Hmong, Cambodian and Vietnamese families selling their
produce."
Subsequently, Boucher administered medical, public health and
dental programs serving 45,000 Hmong and other Lao hilltribes in
Northern Thailand, and integrated traditional herbalists and other
practitioners into treatment activities. She also formed and headed
Community Services of Bangkok, a State Department-funded project
providing mental health and other services to expatriates.
Boucher is currently involved in a two-year study that began in
September to determine the knowledge of and utilization of preventive
health care services for cervical and breast cancer in migrant and
seasonal farmworker women. During interviews, investigators asked
women if they are aware of and utilize preventive screening methods
available to them, including Pap smears and mammograms. They also
seek to identify the socioeconomic, educational and cultural barriers
that prevent migrant women from accessing services.
To begin to address these barriers and lack of knowledge of preventive
behaviors and services, the project will train lay health advisors
(consejeras) to conduct education in the migrant camps. The approach
of training community volunteers has been shown to be very effective
both in Latin America and with farmworkers in other parts of the
United States. The project will serve the community by giving volunteers
responsibility to design and conduct education on cervical cancer
and environmental health issues of concern to farmworkers.
Boucher is working with Center Director Marc Schenker, principal
investigator for the project, alongwith Steven Samuels, associate
adjunct professor in the Department of Epidemiology and Preventive Medicine, Rina Alcalay, associate professor of rhetoric and communication,
specialists in Hispanic health care and education issues, and several
UC Davis students who are involved in the lay health advisor training.
"Our main goal is to document knowledge of and utilization of cancer
prevention services to enumerate the barriers they encounter in
obtaining preventive care and to address some of those barriers
through education and community organization. We also intend to
inform the provider community about possible outreach strategies
that will increase the rate of Pap smears, mammograms and other
preventive services in this population," explained Boucher.
Born in downtown Chicago and raised in the lake region of northern
Illinois, Boucher said she initially wanted to be a cowgirl, but
when she found her first arrowhead and her first fossil invertebrate,
she became interested in archaeology. Then she explained, "the first
time I was exposed to myths of the Greeks and the Native Americans,
I became enthralled by what we now call cultural anthropology."
Boucher received her bachelor's degree in anthropology from CSU
Hayward in 1970, and her Ph.D. in medical anthropology from UC Davis
in 1980. Her dissertation explored the practice of religious healing
in Mexican, Filipino and white communities in San Joaquin and Sacramento
counties.
She initially joined UC Davis in 1987 as an administrator for
the Area Health Education Center program in the Department of Family
Practice. With funding from the Federal Department of Health and
Human Services, the program provided continuing medical education
in rural areas. In 1990, Boucher became a community health program
representative in the Department of Community Health, where she
remained for three years before leaving to work for the California
Public Health Foundation. She returned to UC Davis in 1995 as a
postgraduate researcher in the Department of Epidemiology and Preventive Medicine.
After living in the Sacramento River Delta for many years, Boucher
now lives in Sacramento, where she sings alto with the Sacramento
Chorale Society, formerly known as the Sacramento Symphony Chorus.
She also enjoys traveling, hiking, biking, and gardening, specializing
in growing orchids indoors. She speaks and reads Spanish as well
as Thai and Hindi-Urdu (the language of Northern India).
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