Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, R01-OH-008747, 2009 Jan; :1-31
This report summarizes the findings of a cross-sectional, population based survey conducted from August 2006 to February 2007 using a randomized proportionately representative household sample of farmworkers in the three communities of Somerton, Gadsden, and San Luis located along the US Mexico border in southern Yuma County, Arizona. This report aims to describe the process used to develop and carry out this study within the context of community-based participatory action research and to provide a demographic profile and descriptive analysis of farmworkers in Yuma County, Arizona. The study is an example of an innovative, public health collaboration between three partner organizations - Campesinos Sin Fronteras, Derechos Humanos, and the University of Arizona Mel & Enid Zuckerman College of Public Health and Mexican American Research Studies Center. Households were identified using community maps and randomly selected census blocks. Standardized Spanish instruments were developed collaboratively with MEZCOPH, MASRC, Derechos Humanos and Campesinos Sin Fronteras personnel based on reliable and validated surveys used by the California Hired Farmworker Health Survey in the California Agricultural Workers Health Survey (CA WHS), the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System Survey (BRFSS), prior mistreatment surveys developed for another study by MASRC and conducted in south Tucson in 1993, 2003 and again in 2006 (Border Immigration Interaction Survey), which included open ended and qualitative components to derive narratives of mistreatment episodes, previous and new measures of culturally-specific stressors, acculturation and ethnic identity and additional health information. The survey was conducted door-to-door. Individuals were identified as farmworkers prior to being asked to participate in the study. Interviewers articulated the purpose of their visit, stated they were conducting an anonymous survey of farmworkers in the Yuma area and were asked if someone in the household was over 21 years of age and working or had worked in the fields during the past year. If someone in the household met the criteria, they were invited to participate in the interview. If more than one adult in the household met the eligibility criteria, the interviewer would list in descending order of age, each man on one list, and each woman on another. Beginning with males, the interviewer would choose the one with the birth date closest to the interview date. If there were no males present in the household, then the woman with the birth date closest to the interview date would be invited to participate. The overall response rate was 92.7%. In addition to the household survey, two hundred opportunistic surveys were completed in order to capture the farmworker population that may have been missed in the household survey. The opportunistic survey was an abbreviated version of the household survey and was administered during a farmworker health fair hosted by Campesinos Sin Fronteras known as Dia Del Campesino Health and Information. The Dia Del Campesino Health and Information event was initiated 14 years ago to honor and demonstrate appreciation for the community's agricultural workers' hard work and immense economic contribution to the community. Farmworkers participating at the Dia Del Campesino Health and Information were recruited using the same criteria as the household survey with the exception of the birth date criterion. The most salient features of the Yuma County sample (299 household surveys and 200 opportunistic surveys) is a population of farmworkers that are young, married, men from Mexico who acquired little or no formal education and whose annual earnings are very low. Greater than 50 % of families are living below poverty level (59%), while 95% are living below 200% of the Federal Poverty Level. The median age of the household participants is 44 years of age and 49 years of age for the opportunistic survey. About 50% are foreign-born, 78% are married, and 62% have attained less than a 9th grade education. Greater than half of the participants in the household survey reported having health care insurance, forty one percent of whom conveyed they had acquired employer-sponsored health insurance in the US. In contrast, among opportunistic survey participants 60% had health insurance, 36% of whom acquired coverage within the US. In both groups, a small percentage (7%) received benefits from both the US and Mexico. In the household sample, approximately 21 % reported having a diagnosis of hypertension, 12% of arthritis and 16% diabetes. These figures were higher for men; 31 % reported a diagnosis of hypertension and 20% arthritis. In the opportunistic sample, 29% reported a diagnosis of hypertension, and 15% each of arthritis and diabetes. When asked to rate their health status, 37% of the household sample and 39% of the opportunistic sample classified their health as "regular" (or "fair"). Also very prevalent were ailments related to the musculoskeletal system. These finding are not surprising considering the intensive, repetitive and physically demanding nature of agricultural labor. Back pain was most prominent (36% in the household sample and 47% of the opportunistic group), followed by hands (29% and 44%, respectively), feet (31 % and 43%, respectively), and knees (27% and 42%, respectively). The higher figures reported by the opportunistic sample reflect the comparative demographics of respondents, who as a rule were an older group, and largely male. A high prevalence of depression and stress was found in our preliminary analysis of the 499 household surveys. Among those interviewed in their homes, 20% had experienced depression for more than 2 weeks in the previous 12 months, and 26% for more than a week during the previous 30 days. Stress related to farmworkers' migrant status, their foreign or racial minority position, and the current political environment were experiences reported by participants. The need to speak better English was cited as a stressor by 73% and 41 % experienced stress from the need to travel far from their families to earn a living. Moreover, greater than 40% reported stress caused by worry related to obtaining health services for their families, and many were worried about supporting themselves and their families in the long term. An additional 29 farmworkers and family members of farmworkers were invited to participate in a focus group to learn more about the underlying causes of stress. Focus group findings confirmed the results obtained through the household and opportunistic surveys. Participants described stress related to inadequate English skills and separation from families. Many also reflected on stress caused by abusive or discriminatory interactions with officials from Customs and Border Protection as well as with local police. Younger focus group participants in particular reported incidents of abuse. In addition, participants reported work-related stress, including abuse from foremen and supervisors. They further conveyed stress associated with agricultural work itself. Farmworkers in the focus group expressed a need for better working conditions, including higher salaries, health insurance and other benefits, and opportunities to develop their skills and learn English.