Summary

As global temperatures rise, increasing numbers of individuals will work in hot environments. Interventions to protect their health are critical, as are reliable methods to measure the physiological strain experienced from heat exposure. The physiological strain index (PSI) is a measure of heat strain that relies on heart rate and core temperature but is challenging to calculate in a real-world occupational setting.

We modified the PSI for use in field settings where resting temperature and heart rate are not available and used the modified physiological strain index (mPSI) to describe risk factors for high heat strain (mPSI ≥ 7) experienced by agricultural workers in Florida during the summers of 2015 through 2017. mPSI was calculated for 221 workers, yielding 465 days of data.

A higher heat index (β = 0.185; 95% CI: 0.064, 0.307) and higher levels of physical activity at work (0.033; 95% CI: 0.017, 0.050) were associated with a higher maximum mPSI. More years worked in US agriculture (-0.041; 95% CI: -0.061, -0.020) were protective against a higher maximum mPSI. Out of 23 workdays that a participant experienced a maximum mPSI ≥ 7, 22 were also classified as strained by at least one other measure of high heat strain (core temperature [Tc] >38.5°C, sustained heart rate >(180 – age), and mean heart rate > 115 bpm).

This study provides critical information on risk factors for elevated heat strain for agricultural workers and suggests a practical approach for using PSI in field-based settings.

Citation

Mac, V. V., Elon, L., Smith, D. J., Tovar‐Aguilar, A., Economos, E., Flocks, J., Hertzberg, V., & McCauley, L. (2021). A modified physiological strain index for workplace‐based assessment of heat strain experienced by agricultural workers. American Journal of Industrial Medicine, 64(4), 258–265. https://doi.org/10.1002/ajim.23230

Summary

Agricultural workers perform intense labor outside in direct sunlight and in humid environmental conditions exposing them to a high risk of heat-related illness (HRI). To implement effective cooling interventions in occupational settings, it is important to consider workers’ perceptions. To date, an analysis of agricultural workers’ experience and perception of cooling devices used in the field while working has not been published.

Qualitatively data from 61 agricultural workers provided details of their perceptions and experiences with cooling interventions.

 The participants in the bandana group reported the bandana was practical to use at work and did not interfere with their work routine. Cooling vest group participants agreed that the vest was effective at cooling them, but the practicality of using the vest at work was met with mixed reviews.

The findings of this qualitative study support and extend existing research regarding personal cooling and heat prevention research interventions with vulnerable occupational groups. Personal cooling gear was well received and utilized by the agricultural workers. Sustainable heat prevention studies and governmental protection strategies for occupational heat stress are urgently needed to reduce the risk of heat-related morbidity, mortality, and projected climate change health impacts on outdoor workers.

Citation

Chicas, R., Xiuhtecutli, N., Dickman, N. E., Flocks, J., Scammell, M. K., Steenland, K., Hertzberg, V., & McCauley, L. (2021). Cooling interventions among agricultural workers: Qualitative field-based study. Hispanic Health Care International, 19(3), 174–181. https://doi.org/10.1177/1540415321993429

Summary

There is a compelling need to identify agricultural workers at risk for heat related illness (HRI). Data from Florida agricultural workers (N = 221) were collected over 3 summer workdays (2015 to 2017) to examine risk factors for exceeding NIOSH-recommended core temperature (Tc) thresholds (38 °C [Tc38] and 38.5 °C [Tc38.5]) using generalized linear mixed models.

On an average workday, 49% of participants exceeded Tc38 and 10% exceeded Tc38.5. On average, participants first exceeded both thresholds early in the day; the Tc38 threshold mid-morning (10:38 AM), and Tc38.5 about a half hour later (11:10 AM). Risk factors associated with exceeding Tc38 included years working in US agriculture, body mass index, time performing moderate-to-vigorous physical activity, increasing heat index, and field crop work.

The high prevalence of core temperatures exceeding recommended limits emphasizes the serious need for mandated HRI prevention programs for outdoor workers.

Citation

Mac, V., Elon, L., Mix, J., Tovar-Aguilar, A., Flocks, J., Economos, E., Hertzberg, V., & McCauley, L. (2021). Risk factors for reaching core body temperature thresholds in Florida agricultural workers. Journal of Occupational & Environmental Medicine, 63(5), 395–402. https://doi.org/10.1097/JOM.0000000000002150

Summary

Despite recent improvements in the quality and availability of educational materials to promote heat safety in agriculture, success in addressing the factors that inhibit the adoption of self-protective practices among farmworkers remains limited. Social marketing interventions can address gaps between safety knowledge and implementation by targeting segmented audiences with tailored behavioral products that compete with comfortable yet potentially harmful alternatives. The purpose of this study was to collect preliminary biological and survey data during a 5-day period in the spring of 2019 to identify hydration levels, perceptions, attitudes, knowledge, and behaviors associated with the prevention of heat-related illness (HRI) among 29 tomato harvesters in southwest Florida.

Urine samples were collected before and at the end of each workday. Survey data were collected at baseline and at the end of each workday. Reagent strips were used to assess urine specific gravity, a measurement of hydration status. Descriptive statistics, relative frequency distributions, and bivariate correlation analysis were used to summarize the data.

Results showed that a majority of study participants were slightly or not at all concerned about becoming ill from the heat while working despite the wide prevalence of HRI symptoms. On average, participants were hypohydrated both at the start and end of each workday. Certain cooling practices, such as consumption of electrolyte drinks, tended to be implemented at the onset of HRI symptoms. More than 75% of the harvesters typically avoided taking any rest breaks. Yet all had received some form of heat safety training; knowledge test scores averaged 78%. Findings suggest safety behaviors had more to do with the amelioration of HRI symptoms than with training and knowledge.

Citation

Morera, M. C., Monaghan, P. F., Tovar-Aguilar, J. A., & Roka, F. M. (2020). Developing a social marketing intervention for heat safety among Florida tomato harvesters: Preliminary findings of formative research. Journal of Agromedicine, 25(3), 245–246. https://doi.org/10.1080/1059924X.2020.1763752

Summary

Efforts to disseminate heat-related illness (HRI) prevention practices among Latino farmworkers represent a critical occupational safety strategy in Florida. Targeted initiatives, however, require understanding the workplace dynamics that guide agricultural safety behaviors.

This article reports focus group data collected in 2018 from citrus harvesters in central Florida and provides an in-depth perspective on the workplace culture that shapes their implementation of heat safety measures. Results indicate that citrus harvesters regularly suffered HRI symptoms yet rarely reported or sought treatment for their injuries. In some cases, the risks of developing HRI were accepted as a facet of agricultural work and harvesters blamed themselves for their illnesses. Implementation of safety practices hinged less on knowledge than on the availability of water and rest breaks and the quality of employer-employee relations and exchanges. Thus, trust was a determinant of workers’ attitudes toward management that contributed to a harvesting operation’s safety climate.

Results highlight the difficulties of putting into practice measures that are not rewarded by the workplace culture and suggest that the extent to which intervention strategies promote not only individual safety behaviors but organizational accountability may predict their effectiveness

Citation

Morera, M. C., Gusto, C., Monaghan, P. F., Tovar-Aguilar, J. A., & Roka, F. M. (2020). “We force ourselves”: Productivity, workplace culture, and HRI prevention in Florida’s citrus groves. Safety, 6(3), 41. https://doi.org/10.3390/safety6030041

Summary

With expected increases in extreme weather, there may be a greater risk of injury from extreme heat in outdoor worker populations. To plan for future adaptation measures, studies are needed that can characterize workers’ physiologic responses to heat in outdoor settings such as agriculture. The objective of this study was to characterize occupational heat exposure, key vulnerability factors (e.g., gender, energy expenditure), and physiologic heat stress response in a sample of fernery workers. Forty-three fernery workers over 86 workdays were examined regarding heat-related illness (HRI) during the summer months of 2012 and 2013.

The key outcome measure was whether a participant’s body core temperature (T_c) reached or exceeded 38.0°C (100.4ºF; T_c38). Participants’ T_c exceeded 38.0°C on 49 (57%) of the workdays, with 30 of 40 participants reaching or exceeding T_c38 on at least one workday. Adjusting for sex, there was a 12% increase in the odds of T_c38 for every 100 kilocalories of energy expended (OR: 1.12; 95% Confidence Interval [CI]: [1.03, 1.21]). Adjusting for energy expenditure, females had 5 times greater odds of T_c38compared with males (OR: 5.38; 95% CI: [1.03, 18.30]).

These findings provide evidence of elevated T_c in Florida fernery workers, indicating an increased risk of occupational HRI, and the need for policy and interventions to address this health risk.

Citation

Mac, V. V. T., Tovar-Aguilar, J. A., Elon, L., Hertzberg, V., Economos, E., & McCauley, L. A. (2019). Elevated core temperature in Florida fernery workers: Results of a pilot study. Workplace Health & Safety, 67(9), 470–480. https://doi.org/10.1177/2165079919849466

Summary

The aim of this study was to determine the effectiveness of curricula for improving knowledge and attitudes pertaining to pesticide exposure and heat illness among immigrant Latino farmworkers.

A pesticide safety curriculum informed by the revised Worker Protection Standard (WPS) was tested against an attention placebo-controlled curriculum (heat illness) in a sample of Latino farmworkers (N = 127).

Pesticide safety knowledge increased in the overall sample, but did not differ by curriculum assignment. Pesticide safety behavioral intentions increased among participants in the pesticide safety curriculum but decreased among those in the other curriculum (P < 0.05). Heat illness knowledge and behavioral intentions increased more for farmworkers assigned to the heat illness than the pesticide safety curriculum.

The developed curricula show good promise for meeting the spirit of the revised WPS and for reducing the burden of heat-related fatality and morbidity among Latino farmworkers.

Citation

Grzywacz, J. G., Gonzales-Backen, M., Liebman, A., Marín, A. J., Trejo, M., Gudino, C. O., Economos, J., & Tovar-Aguilar, J. A. (2019). Attending to pesticide exposure and heat Illness among farmworkers: Results From an attention placebo-controlled evaluation design. Journal of Occupational & Environmental Medicine, 61(9), 735–742. https://doi.org/10.1097/JOM.0000000000001650

Summary

This study was designed to examine the associations between regional weather data and agricultural worksite temperatures in Florida.

Florida farmworkers (n = 105) were each monitored using iButton technology paired with simultaneous data from regional weather stations. Conditional inference tree models were developed for (1) regional environmental temperatures and iButton (worksite) temperatures, and (2) regional heat index (HI) and iButton HI.

Worksite temperatures were partitioned by regional temperature at the primary node of 29.1°C. Worksite HI was partitioned at nodes of 33.0°C, 36.0°C, 37.0°C, and 40.0°C. The nodes at 33.0°C and 40.0°C mirror the National Weather Service’s category entry points for “extreme caution” and “danger” regarding the risk of developing heat-related illness.

Regional weather data have the potential to provide estimations of worksite environmental conditions allowing employers to quickly implement strategies to protect workers.

Citation

Mac, V. V. T., Hertzberg, V., & McCauley, L. A. (2019). Examining agricultural workplace micro and macroclimate data using decision tree analysis to determine heat illness risk. Journal of Occupational & Environmental Medicine, 61(2), 107–114. https://doi.org/10.1097/JOM.0000000000001484

Summary

With expected increases in extreme weather, there may be a greater risk of injury from extreme heat in outdoor worker populations. To plan for future adaptation measures, studies are needed that can characterize workers’ physiologic responses to heat in outdoor settings such as agriculture. The objective of this study was to characterize occupational heat exposure, key vulnerability factors (e.g., gender, energy expenditure), and physiologic heat stress response in a sample of fernery workers. Forty-three fernery workers over 86 workdays were examined regarding heat-related illness (HRI) during the summer months of 2012 and 2013.

The key outcome measure was whether a participant’s body core temperature (T_c) reached or exceeded 38.0°C (100.4ºF; T_c38). Participants’ T_c exceeded 38.0°C on 49 (57%) of the workdays, with 30 of 40 participants reaching or exceeding T_c38 on at least one workday. Adjusting for sex, there was a 12% increase in the odds of T_c38 for every 100 kilocalories of energy expended (OR: 1.12; 95% Confidence Interval [CI]: [1.03, 1.21]). Adjusting for energy expenditure, females had 5 times greater odds of T_c38compared with males (OR: 5.38; 95% CI: [1.03, 18.30]).

These findings provide evidence of elevated T_c in Florida fernery workers, indicating an increased risk of occupational HRI, and the need for policy and interventions to address this health risk.

Citation

Mac, V. V. T., Tovar-Aguilar, J. A., Elon, L., Hertzberg, V., Economos, E., & McCauley, L. A. (2019). Elevated core temperature in Florida fernery workers: Results of a pilot study. Workplace Health & Safety, 67(9), 470–480. https://doi.org/10.1177/2165079919849466

Summary

Laboring in hot and humid conditions is a risk factor for heat-related illnesses. Little is known about the amount of physical activity performed in the field setting by agricultural workers, a population that is among those at highest risk for heat-related mortality in the United States.

We measured accelerometer-based physical activity and work activities performed in 244 Florida agricultural workers, 18 to 54 years of age, employed in the fernery, nursery, and crop operations during the summer work seasons of 2015-2017. Environmental temperature data during the participant’s workdays were collected from the Florida Automated Weather Network and used to calculate wet bulb globe temperature (WBGT). Generalized linear mixed model regression was used to examine the association between WBGT on physical activity, stratified by the agricultural sector.

Fernery workers had the highest overall volume of physical activity, spending nearly 4 hours in moderate to vigorous activity per workday. Activity over the course of the workday also differed by the agricultural sector. A reduction on average physical activity with increasing environmental temperature was observed only among crop workers.

The quantity and patterns of physical activity varied by the agricultural sector, sex, and age, indicating that interventions that aim to reduce heat-related morbidity and mortality should be tailored to specific subpopulations. Some workers did not reduce overall physical activity under dangerously hot environmental conditions, which has implications for policies protecting worker health. Future research is needed to determine how physical activity and climatic conditions impact the development of heat-related disorders in this population.

Citation

Mix, J. M., Elon, L., Thein Mac, V. V., Flocks, J., Economos, J., Tovar‐Aguilar, A. J., Hertzberg, V. S., & McCauley, L. A. (2019). Physical activity and work activities in Florida agricultural workers. American Journal of Industrial Medicine, 62(12), 1058–1067. https://doi.org/10.1002/ajim.23035

Summary

Farmworkers working in hot and humid environments have an increased risk for heat-related illness (HRI) if their thermoregulatory capabilities are overwhelmed. The manifestation of heat-related symptoms can escalate into life-threatening events. Increasing ambient air temperatures resulting from climate change will only exacerbate HRI in vulnerable populations. We characterize HRI symptoms experienced by farmworkers in three Florida communities.

A total of 198 farmworkers enrolled in 2015-2016 were asked to recall if they experienced seven HRI symptoms during the previous work week. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between selected sociodemographic characteristics and reporting three or more symptoms. Latent class analysis was used to identify classes of symptoms representing the HRI severity range. We examined sociodemographic characteristics of the farmworkers across the latent classes.

The mean age (±SD) of farmworkers was 38.0 (±8) years; the majority were female (60%) and Hispanic (86%). Most frequently reported symptoms were heavy sweating (66%), headache (58%), dizziness (32%), and muscle cramps (30%). Females had three times the odds of experiencing three or more symptoms (OR = 2.86, 95% CI 1.18-6.89). Symptoms fell into three latent classes, which included mild (heavy sweating; class probability = 54%), moderate (heavy sweating, headache, nausea, and dizziness; class probability = 24%), and severe (heavy sweating, headache, nausea, dizziness, muscle cramps; class probability = 22%).

Farmworkers reported a high burden of HRI symptoms that appear to cluster in physiologic patterns. Unrecognized accumulation of symptoms can escalate into life-threatening situations if untreated. Our research can inform interventions to promote early recognition of HRI, on-site care, and appropriate occupational health policy. Administrative or engineering workplace controls may also reduce the manifestation of HRI.

This study advances the current knowledge of HRI symptoms in farmworkers and moves beyond reporting individual symptoms by utilizing latent class analysis to identify how symptoms tend to co-occur together in this population. It acknowledges multiple symptoms occurring as a result of occupational heat exposure and highlights the importance of symptom recognition.

Citation

Mutic, A. D., Mix, J. M., Elon, L., Mutic, N. J., Economos, J., Flocks, J., Tovar-Aguilar, A. J., & McCauley, L. A. (2018). Classification of heat-related illness symptoms among Florida farmworkers. Journal of Nursing Scholarship: An Official Publication of Sigma Theta Tau International Honor Society of Nursing, 50(1), 74–82. https://doi.org/10.1111/jnu.12355

Affordable measurement of core body temperature (Tc) in a continuous, real-time fashion is now possible. With this advance comes a new data analysis paradigm for occupational epidemiology. We characterize issues arising after obtaining Tc data over 188 workdays for 83 participating farmworkers, a population vulnerable to effects of rising temperatures due to climate change. We describe a novel approach to these data using smoothing and functional data analysis.

This approach highlights different data aspects compared with describing Tc at a single time point or summaries of the time course into an indicator function (e.g., did Tc ever exceed 38 °C, the threshold limit value for occupational heat exposure). Participants working in ferneries had significantly higher Tc at some point during the workday compared with those working in nurseries, despite a shorter workday for fernery participants.

Our results typify the challenges and opportunities in analyzing Big Data streams from real-time physiologic monitoring.

Citation

Hertzberg, V., Mac, V., Elon, L., Mutic, N., Mutic, A., Peterman, K., Tovar-Aguilar, J. A., Economos, E., Flocks, J., & McCauley, L. (2017). Novel analytic methods needed for real-time continuous core body temperature data. Western Journal of Nursing Research, 39(1), 95–111. https://doi.org/10.1177/0193945916673058

Summary

The objective of this study was to determine the feasibility of field-based biomonitoring of heat-related illness (HRI) phenomena in Florida farmworkers. We determined feasibility through participant interviews regarding acceptability, data capture, recruitment and retention, and observed barriers and challenges to implementation.

Study participants were employed in fernery operations in northeast Central Florida where ornamental ferns are grown and harvested in a seasonally high heat environment. In this pilot, a total of 43 farmworkers participated during Summers 2012 and 2013 and measurements included: body core temperature, heart rate, energy expenditure, urine and blood osmolality, and self-reported HRI symptoms.

Data capture was 90%. Participants reported that the study methods were non-obtrusive to their work, and that they were comfortable with study measures. Conclusions—These results open possibilities for characterizing heat-related illness utilizing physiologic biomonitoring in vulnerable occupational groups.

Citation

Mac, V. V. T., Tovar-Aguilar, J. A., Flocks, J., Economos, E., Hertzberg, V. S., & McCauley, L. A. (2017). Heat exposure in central Florida fernery workers: Results of a feasibility study. Journal of Agromedicine, 22(2), 89–99. https://doi.org/10.1080/1059924X.2017.1282906

Summary

Farmworkers working in hot and humid environments have an increased risk for heat-related illness (HRI) if their thermoregulatory capabilities are overwhelmed. The manifestation of heat-related symptoms can escalate into life-threatening events. Increasing ambient air temperatures resulting from climate change will only exacerbate HRI in vulnerable populations. We characterize HRI symptoms experienced by farmworkers in three Florida communities.

A total of 198 farmworkers enrolled in 2015–2016 were asked to recall if they experienced seven HRI symptoms during the previous work week. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between selected sociodemographic characteristics and reporting three or more symptoms. Latent class analysis was used to identify classes of symptoms representing the HRI severity range. We examined sociodemographic characteristics of the farmworkers across the latent classes.

The mean age (±SD) of farmworkers was 38.0 (±8) years; the majority were female (60%) and Hispanic (86%). Most frequently reported symptoms were heavy sweating (66%), headache (58%), dizziness (32%), and muscle cramps (30%). Females had three times the odds of experiencing three or more symptoms (OR = 2.86, 95% CI 1.18–6.89). Symptoms fell into three latent classes, which included mild (heavy sweating; class probability = 54%), moderate (heavy sweating, headache, nausea, and dizziness; class probability = 24%), and severe (heavy sweating, headache, nausea, dizziness, muscle cramps; class probability = 22%).

Farmworkers reported a high burden of HRI symptoms that appear to cluster in physiologic patterns. Unrecognized accumulation of symptoms can escalate into life-threatening situations if untreated. Our research can inform interventions to promote early recognition of HRI, on-site care, and appropriate occupational health policy. Administrative or engineering workplace controls may also reduce the manifestation of HRI.

This study advances the current knowledge of HRI symptoms in farmworkers and moves beyond reporting individual symptoms by utilizing latent class analysis to identify how symptoms tend to co-occur together in this population. It acknowledges multiple symptoms occurring as a result of occupational heat exposure and highlights the importance of symptom recognition.

Citation

Mutic, A. D., Mix, J. M., Elon, L., Mutic, N. J., Economos, J., Flocks, J., Tovar-Aguilar, A. J., & McCauley, L. A. (2018). Classification of heat-related illness symptoms among Florida farmworkers: Classification of heat-related illness. Journal of Nursing Scholarship, 50(1), 74–82.  https://doi.org/10.1111/jnu.12355

During 2000–2009, 116 Gulf of Mexico (GoM) fishers were killed (23% of the US total) while working in the shrimp, finfish, oyster, clam, and crab fisheries. The purpose of this literature review is to identify injury-related risk factors to better assess the frequency and severity of injuries experienced by fish harvesters in the GoM.

The method of this study is a comprehensive narrative literature review of findings useful for the prevention of fatal and non-fatal injuries among GoM fish harvesters published since 2005. Search engine terms were used to identify relevant literature that included fatalities, injuries, fatigue, and several other terms in combination (e.g., string search with “fishing”).

We reviewed 48 articles; the most common cause of fish harvester deaths in the GoM is falls overboard with scant use of personal flotation devices and vessel disasters in which flooding and collision were the most lethal. The root cause of errors resulting in many disasters may have been operator fatigue, but fatigue is also an adverse health effect resulting from working conditions. Non-fatal injuries arise from multiple sources that include working with gears, slips and trips, struck-by or against objects, machine or line entanglements, and falls.

Principal risk factors are a lack of sleep aboard fishing vessels, vessel flooding and collisions, poor weather, slips on deck, contact with gear, not wearing personal flotation devices, poor swimming ability, and fishing alone on a vessel or the deck.

Citation

Myers, M., Durborow, R., & Kane, A. (2018). Gulf of Mexico seafood harvesters: Part 1. Occupational injury and fatigue risk factors. Safety, 4(3), 31.  https://doi.org/10.3390/safety4030031

During 2000–2009, 116 Gulf of Mexico (GoM) fishers were killed (23% of the US total) while working in the shrimp, finfish, oyster, clam, and crab fisheries. The purpose of this literature review is to identify injury-related risk factors to better assess the frequency and severity of injuries experienced by fish harvesters in the GoM.

The method of this study is a comprehensive narrative literature review of findings useful for the prevention of fatal and non-fatal injuries among GoM fish harvesters published since 2005. Search engine terms were used to identify relevant literature that included fatalities, injuries, fatigue, and several other terms in combination (e.g., string search with “fishing”).

We reviewed 48 articles; the most common cause of fish harvester deaths in the GoM is falls overboard with scant use of personal flotation devices and vessel disasters in which flooding and collision were the most lethal. The root cause of errors resulting in many disasters may have been operator fatigue, but fatigue is also an adverse health effect resulting from working conditions. Non-fatal injuries arise from multiple sources that include working with gears, slips and trips, struck-by or against objects, machine or line entanglements, and falls.

Principal risk factors are a lack of sleep aboard fishing vessels, vessel flooding and collisions, poor weather, slips on deck, contact with gear, not wearing personal flotation devices, poor swimming ability, and fishing alone on a vessel or the deck.

Citation

Myers, M., Durborow, R., & Kane, A. (2018). Gulf of Mexico seafood harvesters: Part 2. Occupational health-related risk factors. Safety, 4(3), 27.  https://doi.org/10.3390/safety4030027

Fishers face many occupational hazards that include a high risk of fatal and nonfatal injuries and a variety of adverse health effects. Our purpose is to provide an overview of potential countermeasures for the control of hazards that threaten the health and safety of Gulf of Mexico (GoM) fish harvesters.

Search terms were used to identify relevant literature; two previous reviews regarding injuries and health risk factors also inform this review.

Countermeasures against these hazards include winch guards, lifting devices, job redesign, non-slip decks and vessel stability controls as well as using personal flotation devices, wearing gloves and high-friction footwear, increasing sleep time and using vessel motion to assist lifting. Knowledge about secondary prevention (such as rescue, first aid and making mayday calls) is also important. Learning through experience is a crucial factor that incorporates other fishers’ experiences with innovations. Fatigue and lack of sleep contribute to vessel disasters and injury-related errors.

The prevention of injuries and diseases among GoM fishers depends on a combination of focusing on work-processes, instilling a broader safety culture, engineering controls, identifying and sharing fisher innovations, promoting fall overboard prevention and protection and providing culture-based incentives, training and narrative outreach.

Citation

Myers, M., Durborow, R., & Kane, A. (2018). Gulf of Mexico seafood harvesters: Part 2. Occupational health-related risk factors. Safety, 4(3), 27. https://doi.org/10.3390/safeMyers, M., Durborow, R., & Kane, A. (2018). Gulf of Mexico seafood harvesters: Part 3. Potential occupational risk reduction measures. Safety, 4(3), 33. https://doi.org/10.3390/safety4030033

Globally, there is increasing recognition that agricultural workers are at risk for chronic kidney disease of unknown etiology (CKD u). Recurrent heat exposure, physical exertion, dehydration, muscle damage, and inflammation are hypothesized to contribute to the development of CKD u, but the relative importance of these processes and the interactions among them remain unclear. Moreover, there is a need to identify biomarkers that could distinguish individuals who are at greatest risk for kidney damage to target preventative interventions for CKD u.

In this study, we evaluated dehydration and markers of inflammation, muscle damage, and renal function in agricultural workers at a non-workday baseline assessment. Urine specific gravity and kidney function were measured before and after work shifts on three subsequent days, and heat index, core body temperature, and heart rate were monitored during the work shifts. A combination of direct comparisons and machine learning algorithms revealed that reduced levels of uromodulin and sodium in urine and increased levels of interleukin-6 and C-reactive protein in serum were indicative of dehydration at baseline, and that dehydration, high body mass index, reduced urine uromodulin, and increased serum interleukin-6, C-reactive protein, and lipopolysaccharide-binding protein at baseline were predictive of acute kidney injury on subsequent workdays.

Our findings suggest a method for identifying agricultural workers at greatest risk for kidney injury and reveal potential mechanisms responsible for this process, including pathways overlapping in dehydration and kidney injury. These results will guide future studies confirming these mechanisms and introducing interventions to protect kidney health in this vulnerable population.

Citation

Mac, V. V., Elon, L., Smith, D. J., Tovar‐Aguilar, A., Economos, E., Flocks, J., Hertzberg, V., & McCauley, L. (2021). A modified physiological strain index for workplace‐based assessment of heat strain experienced by agricultural workers. American Journal of Industrial Medicine, 64(4), 258–265. https://doi.org/10.1002/ajim.23230

For the past two decades, agricultural workers in regions of Central America have reported an epidemic of chronic kidney disease of undetermined etiology (CKDu) that is not associated with established risk factors of chronic kidney disease. Several hypotheses have emerged, but the etiology of CKDu remains elusive and controversial.

The aim of this literature review was to describe the potential risk factors of CKDu in Mesoamerica and implications for the U.S. agricultural worker population. PubMed and CINAHL databases were searched for articles published between 2000 and 2018 that examined CKDu in Mesoamerica; 29 original studies were included in this review. CKDu is a multifactorial disease that is often asymptomatic with hallmark characteristics of elevated serum creatinine and blood urea nitrogen (BUN), low glomerular filtration rate, electrolyte abnormalities, and non-nephrotic proteinuria.

Reducing the global prevalence of CKDu will require more robust studies on causal mechanisms and on interventions that can reduce morbidity and mortality in vulnerable populations.

Citation

Chicas, R., Mix, J., Mac, V., Flocks, J., Dickman, N. E., Hertzberg, V., & McCauley, L. (2019). Chronic kidney disease among workers: A review of the literature. Workplace Health & Safety, 67(9), 481–490. https://doi.org/10.1177/2165079919843308

Recent findings suggest that laboring in hot occupational environments is related to kidney damage in agricultural workers. We examined hydration status and kidney function in 192 Florida agricultural workers.

Blood and urine samples were collected over 555 workdays during the summers of 2015 and 2016. Urine-specific gravity (USG), serum creatinine, and other kidney function markers were examined pre- and post-shift on each workday. Multivariable mixed modeling was used to examine the association of risk factors with hydration status and acute kidney injury (AKI).

Approximately 53% of workers were dehydrated (USG ≥1.020) pre-shift and 81% post-shift; 33% of participants had AKI on at least one workday. The odds of AKI increased 47% for each 5-degree (°F) increase in heat index.

A strikingly high prevalence of dehydration and AKI exists in Florida agricultural workers.

Citation

Mix, J., Elon, L., Vi Thien Mac, V., Flocks, J., Economos, E., Tovar-Aguilar, A. J., Stover Hertzberg, V., & McCauley, L. A. (2018). Hydration status, kidney function, and kidney injury in Florida agricultural workers. Journal of Occupational & Environmental Medicine, 60(5), e253–e260. https://doi.org/10.1097/JOM.0000000000001261

Summary

During the COVID-19 pandemic, attention has focused on outbreaks in meatpacking and other food production facilities. However, substantive problems have also arisen among agricultural worker populations, including temporary workers brought to the United States under H-2A visas.1,2 H-2A workers face the same environmental and occupational health risks as all farmworkers but may be even more vulnerable because they have less control over their living and working environments.

Here we report on a COVID-19 outbreak in a crew of more than 100 H-2A workers in north central Florida to characterize factors that may contribute to the spread of COVID-19 in this essential workforce.

Citation

Lauzardo, M., Kovacevich, N., Dennis, A., Myers, P., Flocks, J., & Morris, J. G. (2021). An outbreak of COVID-19 among H-2A temporary agricultural workers. American Journal of Public Health, 111(4), 571–573. https://doi.org/10.2105/AJPH.2020.306082

Summary

The disproportionate impact of COVID-19 on farmworker communities has been well documented by the media. The virus overlays existing health disparities among farmworkers, but the population is not homogenous. One group of workers that may be even more vulnerable to the transmission of COVID-19 is the H-2A temporary worker population, because they have less control over their physical environments than domestic farmworkers, who may obtain their own housing and transportation.

The H-2A program was recently altered at the federal level to ensure a steady flow of essential workers that can protect the nation’s food supply during a crisis. Yet, in spite of increasing numbers of COVID-19 cases in states with significant H-2A worker populations, the federal rule that temporarily expanded the H-2A program did not address needs to protect workers’ health. Although the CDC has developed recommendations for the agricultural industry to safeguard against COVID-19, most health and safety regulation for farmworkers are left to state and local agencies that may lack knowledge or resources to effectively address the needs of a specialized growing workforce such as H-2A workers.

More research is needed on the disparate health and safety needs of H-2A workers to assess how policy can be tailored to reduce the transmission of the COVID-19 virus among the population.

Citation

Lauzardo, M., Kovacevich, N., Dennis, A., Myers, P., Flocks, J., & Morris, J. G. (2021). An outbreak of COVID-19 among H-2A temporary agricultural workers. American Journal of Public Health, 111(4), 571–573. https://doi.org/10.2105/AJPH.20Flocks, J. (2020). The potential impact of COVID-19 on H-2A agricultural workers. Journal of Agromedicine, 25(4), 367–369. https://doi.org/10.1080/1059924X.2020.1814922

Summary

The aim of this study was to determine the effectiveness of curricula for improving knowledge and attitudes pertaining to pesticide exposure and heat illness among immigrant Latino farmworkers.

A pesticide safety curriculum informed by the revised Worker Protection Standard (WPS) was tested against an attention placebo-controlled curriculum (heat illness) in a sample of Latino farmworkers (N = 127).

Pesticide safety knowledge increased in the overall sample, but did not differ by curriculum assignment. Pesticide safety behavioral intentions increased among participants in the pesticide safety curriculum but decreased among those in the other curriculum (P < 0.05). Heat illness knowledge and behavioral intentions increased more for farmworkers assigned to the heat illness than the pesticide safety curriculum.

The developed curricula show good promise for meeting the spirit of the revised WPS and for reducing the burden of heat-related fatality and morbidity among Latino farmworkers.

Citation

Grzywacz, J. G., Gonzales-Backen, M., Liebman, A., Marín, A. J., Trejo, M., Gudino, C. O., Economos, J., & Tovar-Aguilar, J. A. (2019). Attending to pesticide exposure and heat Illness among farmworkers: Results From an attention placebo-controlled evaluation design. Journal of Occupational & Environmental Medicine, 61(9), 735–742. https://doi.org/10.1097/JOM.0000000000001650

Summary

Agricultural workers’ exposure to pesticides is a substantial public health and social advocacy issue. The scientific underpinnings of the issue are exceedingly more complex than the simple ideological position that ‘pesticides are poison’.

In this chapter the authors elaborate the state of the evidence repository on pesticide exposure among farmworkers and the health-related consequences of that exposure. Then the chapter summarizes the literature on farmworker exposure to pesticides, including both a comparison of exposure among farmworkers relative to non-farmworkers, and studies of within-occupation variability in pesticide exposure. Next, given the complexity of pesticides and human health, the chapter provides a broad overview of evidence linking pesticide exposure to health outcomes.

This broad overview is necessarily offset by a clear case study that typifies the debate about the scientific underpinnings of the pesticide–health linkage, and ends with important areas for future research in the field.

Citation

Grzywacz, J. G., Luque, J. S., & Becker, A. (2019). Pesticide exposure and the health effects among Latino and other farmworkers. In R. Burke & A. Richardsen, Increasing Occupational Health and Safety in Workplaces (pp. 177–200). Edward Elgar Publishing. https://doi.org/10.4337/9781788118095.00018

Summary

To review the experimental and epidemiologic evidence for the association between exposure to Mancozeb and reproductive and developmental health outcomes using an adaptation of the National Toxicology Program’s Office of Health Assessment and Translation (OHAT) systematic review framework.

Four databases (PubMed, TOXNET, Web of Science, Google Scholar) were searched for published studies on Mancozeb. Of 403 identified articles, 30 met our inclusion criteria for systematic review.

Results from in vitro studies provide evidence that Mancozeb may indirectly disrupt or impair reproduction at the cellular level and should be regarded as a reproductive toxicant. Animal studies confirm reproductive and developmental toxicity in mammals and suggest that males chronically exposed to Mancozeb experience significant changes in physiological, biochemical, and pathological processes that may lead to infertility. Epidemiological studies were limited to indirect methods of exposure assessment and examined the effect of fungicides more broadly during pre-conception, pregnancy, and birth, yielding mixed results.

High confidence ratings from in vitro and animal studies, in combination with moderate confidence ratings from epidemiologic studies employing indirect methods of exposure assessment, provide evidence that Mancozeb should be regarded as a suspected developmental hazard and a presumed reproductive hazard in humans. More population-based studies linking direct measures and/or biomarkers of exposure to adverse effects on male and female fertility, as well as in utero and early life development, are needed to improve the quality of the evidence base concerning the human reproductive and developmental consequences of Mancozeb exposure.

Citation

Runkle, J., Flocks, J., Economos, J., & Dunlop, A. L. (2017). A systematic review of Mancozeb as a reproductive and developmental hazard. Environment International, 99, 29–42. https://doi.org/10.1016/j.envint.2016.11.006

Summary

Family science has been doing translational science since before it came into vogue. Nevertheless, the field has been subjected to the same forces in the broader academy that have created a widening chasm between discovery and practice. Thus, the primary objective of this article is to translate the principles, concepts, and models of translational science to solidify an identity for family science and help the field move forward in broader academic, care delivery, and policy arenas.

Alternative models of translational science, primarily from biomedicine but also from other disciplines, are reviewed and critically analyzed, and core concepts and principles are isolated, elaborated, and applied to family science. Family science’s long-standing commitment to the doctrine of evidence-based practice, and its ongoing endorsement of the principles of scientific duality and multidisciplinary utility, places it in a preeminent position for using the zeitgeist of translational science to move forward.

Nonetheless, the field has important epistemological, practical, professional, and curricular steps to complete to better position itself as a distinct and valued body of scientists. Ultimately, we argue that embracing the principles, concepts, and models of translational science should be leveraged by family science to help brand itself as a unique and essential social science field for enhancing the human condition.

Citation

Grzywacz, J. G., & Allen, J. W. (2017). Adapting the ideas of translational science for translational family science. Family Relations, 66(4), 568–583. https://doi.org/10.1111/fare.12284