Identification of barriers to the prevention and treatment of heat-related illness in Latino farmworkers using activity-oriented, participatory rural appraisal focus group methods

BMC Public Health

June T Spector²  Helen Murphy-Robinson³  Martha Perla³  Maria Negrete³  Pablo Palmández³  Jennifer Krenz³  Michelle Lam¹ 

[1]School of Medicine, University of Washington, Seattle, WA, USA

[2]Department of Medicine, University of Washington, Seattle, WA, USA

[3]Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA 98105, USA

关键词: Cultural beliefs;    Farmworkers;    Agricultural workers;    Heat stroke;    Heat exhaustion;    Heat-related illness;   

Others  :  1161618
DOI  :  10.1186/1471-2458-13-1004

 received in 2013-06-25, accepted in 2013-10-23,  发布年份 2013

【 摘 要 】

Background

Heat-related illness (HRI) is an important cause of non-fatal illness and death in farmworkers. We sought to identify potential barriers to HRI prevention and treatment in Latino farmworkers.

Methods

We conducted three semi-structured focus group discussions with 35 Latino farmworkers in the Central Washington, USA area using participatory rural appraisal techniques. Interviews were audio taped and transcribed in Spanish. Three researchers reviewed and coded transcripts and field notes, and investigator triangulation was used to identify relevant themes and quotes.

Results

Although the majority of participants in our study reported never receiving formal HRI training, most participants were aware that extreme heat can cause illness and were able to accurately describe HRI symptoms, risk factors, and certain prevention strategies. Four main observations regarding farmworkers’ HRI-relevant beliefs and attitudes were identified: 1) farmworkers subscribe to varying degrees to the belief that cooling treatments should be avoided after heat exposure, with some believing that such treatments should be avoided after heat exposure, and others encouraging the use of such treatments; 2) the desire to lose weight may be reflected in behaviors that promote increased sweating; 3) highly caffeinated energy drinks are preferred to increase work efficiency and maintain alertness; and 4) the location of drinking water at work (e.g. next to restrooms) and whether water is clean, but not necessarily chemically-treated, are important considerations in deciding whether to drink the water provided at worksites.

Conclusions

We identified potential barriers to HRI prevention and treatment related to hydration, certain HRI treatments, clothing use, and the desire to lose weight among Latino farmworkers. Strategies to address potential barriers to HRI prevention and treatment in this population may include engineering, administrative, and health education and health promotion strategies at individual, workplace, community, and societal levels. Although farmworkers in our study were able to describe HRI risk factors, reported practices were not necessarily consistent with reported knowledge. Further study of potential knowledge-behavior gaps may uncover opportunities for additional HRI prevention strategies. Farmworkers and employers should be included in the development and evaluation of interventions to prevent HRI.

【 授权许可】

   
2013 Lam et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]US Centers for Disease Control and Prevention: Heat-related deaths --- United States, 1999--2003. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5529a2.htm webcite
• [2]World Health Organization: Improving public health responses to extreme weather heat-waves EuroHEAT. Copenhagen; 2009.
• [3]Adam-Poupart A, Labrèche F, Smargiassi A, Duguay P, Busque M-A, Gagné C, Rintamäki H, Kjellstrom T, Zayed J: Climate change and occupational health and safety in a temperate climate: potential impacts and research priorities in Quebec, Canada. Ind Health 2013, 51:68-78.
• [4]Jackson LL, Rosenberg HR: Preventing heat-related illness among agricultural workers. J Agromed 2010, 15:200-15.
• [5]Cecchini M, Colantoni A, Massantini R, Monarca D: Estimation of the risks of thermal stress due to the microclimate for manual fruit and vegetable harvesters in central Italy. J Agric Saf Health 2010, 16:141-59.
• [6]Mirabelli MC, Quandt SA, Crain R, Grzywacz JG, Robinson EN, Vallejos QM, Arcury TA: Symptoms of heat illness among Latino farm workers in north Carolina. Am J Prev Med 2010, 39:468-71.
• [7]Anthony M, Williams JM, Avery AM: Health needs of migrant and seasonal farmworkers. J Commun Health Nurs 2008, 25:153-60.
• [8]Culp K, Tonelli S, Ramey S, Donham K, Fortes L: Preventing heat-related illness among Hispanic farmworkers. AAOHN 2011, 59:23-32.
• [9]Hansen E, Donohoe M: Health issues of migrant and seasonal farmworkers. J Health Care Poor Underserved 2003, 14:153-164.
• [10]Bureau of Labor Statistics, US Department of Labor: Injuries, illnesses, and fatalities. http://www.bls.gov/iif webcite
• [11]Bonauto D, Anderson R, Rauser E, Burke B: Occupational heat illness in Washington State, 1995–2005. Am J Ind Med 2007, 50:940-950.
• [12]Bureau of Labor Statistics, US Department of Labor: Occupational outlook handbook, 2012–2013 edition, career guide to industries: farming, fishing, and forestry occupations. http://www.bls.gov/ooh/about/career-guide-to-industries.htm webcite
• [13]US Department of Labor: Findings from the national agricultural workers survey (NAWS) 2001–2002: a demographic and employment profile of United States farm workers (Research Report No. 9). Washington DC: US Department of Labor; 2005.
• [14]Jackson E, Yost M, Karr C, Fitzpatrick C, Lamb B, Chung S, Chen J, Avise J, Rosenblatt R, Fenske R: Public health impacts of climate change in Washington State: projected mortality risks due to heat events and air pollution, Chapter 10. 2009. [The Washington Climate Change Impacts Assessment]
• [15]Patz JA, Campbell-Lendrum D, Holloway T, Foley JA: Impact of regional climate change on human health. Nature 2005, 438:310-7.
• [16]Scherzer T, Barker JC, Pollick H, Weintraub JA: Water consumption beliefs and practices in a rural Latino community: implications for fluoridation. J Public Health Dent 2010, 70(4):337-43.
• [17]Snipes SA, Thompson B, O’Connor K, Shell-Duncan B, King D, Herrera AP, Navarro B: “Pesticides protect the fruit, but not the people”: using community-based ethnography to understand farmworker pesticide-exposure risks. Am J Public Health 2009, 99(Suppl 3):S616-21.
• [18]Hobson WL, Knochel ML, Byington CL, Young PC, Hoff CJ, Buchi KF: Bottled, filtered, and tap water use in Latino and non-Latino children. Arch Pediatr Adolesc Med 2007, 161:457-61.
• [19]Fleischer NL, Tiesman HM, Sumitani J, Mize T, Amarnath KK, Bayakly AR, Murphy MW: Public health impact of heat-related illness among migrant farmworkers. Am J Prev Med 2013, 44:199-206.
• [20]Stoecklin-Marois M, Hennessy-Burt T, Mitchell D, Schenker M: Heat-related illness knowledge and practices among California hired farm workers in the MICASA study. Ind Health 2013, 51:47-55.
• [21]Chapter 296–307 WAC safety standards for agriculture. http://apps.leg.wa.gov/WAC/default.aspx?cite=296-307&full=true#296-307-097 webcite
• [22]California code of regulations, title 8, Section 3395 heat illness prevention. http://www.dir.ca.gov/Title8/3395.html webcite
• [23]Chambers R: The origins and practice of participatory rural appraisal. World Dev 1994, 22:953-969.
• [24]Mahmood MA, Khan KS, Kadir MM, Barney N, Ali S, Tunio R: Utility of participatory rural appraisal for health needs assessment and planning. JPMA 2002, 52:296-300.
• [25]Colucci E: “Focus groups can be fun”: the use of activity-oriented questions in focus group discussions. Qual Health Res 2007, 17:1422-33.
• [26]Cornwall A: Body mapping in health RRA/PRA. RRA Notes 1992, 16:69-76.
• [27]Paul R: Food and agriculture organisation of the United Nations; participatory rural appraisal manual. St. Lucia: Food and Agriculture Organization of the United Nations; 2006:10-11.
• [28]Rimal RN: Closing the knowledge-behavior gap in health promotion: the mediating role of self-efficacy. Health Commun 2000, 12:219-37.
• [29]Enander AE: Effects of thermal stress on human performance. Scand J Work Environ Health 1989, 15(Suppl 1):27-33.
• [30]Tawatsupa B, Yiengprugsawan V, Kjellstrom T, Berecki-Gisolf J, Seubsman S-A, Sleigh A: Association between heat stress and occupational injury among Thai workers: findings of the Thai cohort study. Ind Health 2013, 51:34-46.
• [31]Morabito M, Cecchi L, Crisci A, Modesti PA, Orlandini S: Relationship between work-related accidents and hot weather conditions in Tuscany (Central Italy). Ind Health 2006, 44:458-64.
• [32]OSHA Technical manual; Section III: Chapter 4. Heat Stress. http://www.osha.gov/dts/osta/otm/otm_iii/otm_iii_4.html webcite
• [33]Tripp-Reimer T, Choi E, Kelley L, Enslein J: Cultural barriers to care: inverting the problem. Diabetes Spectr 2001, 14:13-22.
• [34]Van Tulder MW, Jellema P, van Poppel MN, Nachemson AL, Bouter LM: Lumbar supports for prevention and treatment of low back pain. Cochrane Database Syst Rev 2006, (2):CD001823. DOI: 10.1002/14651858.CD001823.pub2.
• [35]Ziebarth D, Healy-Haney N, Gnadt B, Cronin L, Jones B, Jensen E, Viscuso M: A community-based family intervention program to improve obesity in Hispanic families. WMJ 2012, 111:261-6.
• [36]Shaw A: Field evaluation of protective clothing worn by pesticide applicators in hot climates. Int Pest Control 2008, 50:152-155.
• [37]US Occupational Safety and Health Administration: 1910.132 Personal protective equipment: general requirements. Department of Labor: US Department of Labor; 2008.
• [38]Wang SQ, Kopf AW, Marx J, Bogdan A, Polsky D, Bart RS: Reduction of ultraviolet transmission through cotton T-shirt fabrics with low ultraviolet protection by various laundering methods and dyeing: clinical implications. J Am Acad Dermatol 2001, 44:767-74.
• [39]Using the heat index: actions for high risk conditions: heat index is 103°F to 115°F. http://www.osha.gov/SLTC/heatillness/heat_index/protective_high.html webcite
• [40]Armstrong LE, Casa DJ, Maresh CM, Ganio MS: Caffeine, fluid-electrolyte balance, temperature regulation, and exercise-heat tolerance. Exerc Sport Sci Rev 2007, 35:135-40.
• [41]Kellawan JM, Stuart-Hill LA, Petersen SR: The effects of caffeine during exercise in fire protective ensemble. Ergonomics 2009, 52:1445-1454.
• [42]Ely BR, Ely MR, Cheuvront SN: Marginal effects of a large caffeine dose on heat balance during exercise-heat stress. Int J Sport Nutr Exerc Metab 2011, 21:65-70.
• [43]Practical solutions for pesticide safety. http://depts.washington.edu/pnash/files/09_featured/09_Practical_Solutions/PracticalSolutionsGuide_ENGLISH27Dec11.pdf webcite
• [44]Dahlberg L, Krug E: Violence-a global public health problem. In World report on violence and health. Edited by Krug E, Dahlberg L, JA M, Zwi A, Lozano R. Geneva, Switzerland: World Health Organization; 2002:1-56.