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

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

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.

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

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

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

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

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

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

Summary Results, CAWHS, 1999 Dwellings enumerated11,876 Dwellings contacted 2,989 Dwellings with eligible residents 1,174 Acceptances 968 Response rate 82.4% Physical exams completed 652 Physical exam participation rate 67.4%

CAWHS Sample, 1999, N=968 CharacteristicCAWHS Sample Age - median34 years Gender36% female Place of birth92% foreign-born Marital status59% married 48% have children Educational attainment63%, six years or less Literacy51% read Spanish well; 5% read English well Income – median 1998$7,500 - $9,999

Does Your Employer Provide These EVERYDAY? N=968 Clean drinking water and disposable cups Yes - both 80% Yes - water only 5% No water, no cups 12% ToiletsYes 88% No 11% Wash waterYes 82% No 16%

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. 4.Overall, WPS appears relatively ineffective. 5.High rates of musculoskeletal complaints: 66% reported chronic M-S pain in past year. 6.Clear evidence of need for better eye protection: 22% report chronic eye irritation.

Conclusions: Access to Care and Chronic Disease 1.Strikingly high proportions of workers who have rarely or never been to doctor, dentist, or optom. 2.Major problems of access to preventative and primary care: Dental, musculoskeletal (back, etc.), vision are perhaps the most serious. 3.Little affordable employer-provided health insurance, low levels of MediCal participation. 4.Cultural traditions of health care are being confronted by emergence of new chronic diseases tied to dietary changes in Mexico and the U.S. 5.Genetic predisposition (diabetes) and high rates of obesity increase long-term risk to heart disease, hypertension, stroke, and diabetes. 6.Looming long-term health costs for county and state health system if access to preventative and primary care is not dramatically improved.