Everyone who works in agriculture is exposed to numerous environmental risk factors (weather, mechanical devices, chemicals, animals, wild plants, organic and inorganic dust, fungi) that can result in occupational injury and illness. Occupational skin disease (OSD) is a widely acknowledged, but poorly documented, occupational illness among all agricultural workers. Environmental risks are especially great for migrant and seasonal farm-workers. Most farm-workers are Latino immigrants, with the vast majority being from Mexico. Due to their lack of workplace control and limited treatment options, OSD among farm-workers must be examined in a health disparities and environmental justice framework. This study will employ in-depth interviews, surveillance, and a clinic-based study to: 1) delineate farm-worker interpretations of OSD symptomatology, etiology, self-care behaviors, and barriers to prevention and treatment seeking; 2) estimate the prevalence of OSD across the work season; 3) determine the risk factors for (a) the presence and severity of OSD symptoms, including work activities and exposures, environmental factors, farm-worker biological and personal characteristics, preventive behaviors, and treatment behaviors, and (b) skin-related quality of life; and 4) determine the predictors of OSD severity and specific diagnoses among farm-workers who present to migrant health clinics. Guided by a biopsychosocial model that acknowledges the multiple factors that determine the presence and severity of skin symptoms, and the impact of symptom severity on quality of life, this project will produce the first prospective data on occupational skin disease and its risk factors among migrant and seasonal farm-workers. The results of this project will be used in subsequent projects to address our long-term goal of reducing environmental risk for OSD among all agricultural workers. The project will be completed in an area of eastern North Carolina in which a large number of farm-workers are employed. There are 3 research components for this 4- year project. First, in-depth interviews will be used to elicit farm-workers' Explanatory Models for OSD. Second, a prospective surveillance study will follow 225 farmworker at 8 points during an agricultural season to delineate farm-worker perceptions of OSD symptoms, dermatological quality of life, and OSD risk factors. Finally, a clinic study will use telemedicine procedures to diagnosis OSD among 150 farm-workers who present at migrant clinics and delineate the risks associated with these diagnoses. ? ?
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