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By Amy K. Liebman, MPA, MA, Melinda F. Wiggins, MTS, Clermont Fraser, JD, Jeffrey Levin, MD, MSPH, Jill Sidebottom, PhD, and Thomas A. Arcury, PhD

Background Immigrant workers make up an important portion of the hired workforce inthe Agricultural, Forestry and Fishing (AgFF) sector, one of the most hazardous industrysectors in the US. Despite the inherent dangers associated with this sector, workerprotection is limited.

Methods This article describes the current occupational health and safety policies andregulatory standards in theAgFF sector and underscores the regulatory exceptions and limitationsin worker protections. Immigration policies and their effects on worker health and safety arealso discussed. Emphasis is placed on policies and practices in the Southeastern US.

Results Worker protection in the AgFF sector is limited. Regulatory protections are generallyweaker than other industrial sectors and enforcement of existing regulations is woefullyinadequate. The vulnerability of the AgFF workforce is magnified by worker immigrationstatus. Agricultural workers in particular are affected by a long history of “exceptionalism”under the law as many regulatory protections specifically exclude this workforce.

Conclusions A vulnerable workforce and high-hazard industries require regulatoryprotections that, at a minimum, are provided to workers in other industries. A systematicpolicy approach to strengthen occupational safety and health in the AgFF sector mustaddress both immigration policy and worker protection regulations.

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This webinar is the third in a series of seven in our Clinician Orienatation to Migration Health.

DATE RECORDED: Wednesday, April 17, 2013
PRESENTED BY: Edward Zuroweste, MD, Chief Medical Officer, Migrant Clinicians Network

To view the recorded version of this webinar, click here.

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The West Virginia Rural Health Research Center (WVRHRC) pursues a multi-disciplinary research effort directed to improve environmental health for rural populations. Collaborators from public health, geographic information systems, nursing, pharmacy, environmental science, health policy and other disciplines work together to conduct policy-relevant research to achieve this goal.

This study, conducted by the West Virginia Rural Health Research Center, identified the availability and characteristics of agricultural medicine training opportunities for health care professionals.  Agricultural workers and their families face numerous threats to health and safety, and yet there is limited information on health care expertise in place to recognize and prevent threats, and to diagnosis and treat agriculturally-related injury and illness.

This webinar is the second in a series of seven in our Clinician Orientation to Migration Health.

DATE RECORDED: Wednesday, March 13, 2013
PRESENTED BY: Jennie McLaurin, MD, MPH, Specialist in Child and Migrant Health, Migrant Clinicians Network

To view the recorded version of this webinar, click here.

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Good article on cultural humility--basically the groundbreaking one used to propose the term

Journal of Health Care for the Poor and Underserved; May 1998; 9, 2; Research Library
Melanie Tervalon; Jann Murray-Garcia 

Objectives. We assessed implicit and explicit bias against both Latinos and

African Americans among experienced primary care providers (PCPs) and
community members (CMs) in the same geographic area.
Methods. Two hundred ten PCPs and 190 CMs from 3 health care organizations
in the Denver, Colorado, metropolitan area completed Implicit Association
Tests and self-report measures of implicit and explicit bias, respectively.
Results. With a 60% participation rate, the PCPs demonstrated substantial
implicit bias against both Latinos and African Americans, but this was no
different from CMs. Explicit bias was largely absent in both groups. Adjustment
for background characteristics showed the PCPs had slightly weaker ethnic/racial
bias than CMs.
Conclusions. This research provided the first evidence of implicit bias against
Latinos in health care, as well as confirming previous findings of implicit bias
against African Americans. Lack of substantive differences in bias between the
experienced PCPs and CMs suggested a wider societal problem. At the same
time, the wide range of implicit bias suggested that bias in health care is neither
uniform nor inevitable, and important lessons might be learned from providers
who do not exhibit bias. (Am J Public Health. 2013;103:92–98. doi:10.2105/AJPH.
2012.300812)

This article from the American Journal of Public Health is on implicit bias.

Authors: Irene V. Blair, PhD, Edward P. Havranek, MD, David W. Price, MD, Rebecca Hanratty, MD, Diane L. Fairclough, DrPH, Tillman Farley, MD, Holen K. Hirsh, PhD, and John F. Steiner, MD, MPH

Objectives. We assessed implicit and explicit bias against both Latinos and African Americans among experienced primary care providers (PCPs) and community members (CMs) in the same geographic area.

Methods. Two hundred ten PCPs and 190 CMs from 3 health care organizationsin the Denver, Colorado, metropolitan area completed Implicit Association Tests and self-report measures of implicit and explicit bias, respectively.

Results. With a 60% participation rate, the PCPs demonstrated substantial implicit bias against both Latinos and African Americans, but this was no different from CMs. Explicit bias was largely absent in both groups. Adjustment for background characteristics showed the PCPs had slightly weaker ethnic/racial bias than CMs.

Conclusions. This research provided the first evidence of implicit bias against Latinos in health care, as well as confirming previous findings of implicit bias against African Americans. Lack of substantive differences in bias between the experienced PCPs and CMs suggested a wider societal problem. At the same time, the wide range of implicit bias suggested that bias in health care is neither uniform nor inevitable, and important lessons might be learned from providers who do not exhibit bias.

(Am J Public Health. 2013;103:92–98. doi:10.2105/AJPH.2012.300812)

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This webinar is the first in a series of seven in our Clinician Orienatation to Migration Health.

DATE RECORDED: Wednesday, February 13, 2013
PRESENTED BY: Deliana Garcia, MA, International Research and Development, Migrant Clinicians Network

To view the recorded version of this webinar, click here.

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University of Minnesota's Global Health training program is offering free short courses on immigrant and refugee health.

This website contains information on the 156 health centers that get federal funds to provide primary care to migrant and seasonal farmworkers regardless of immigration status. Most are part of community health centers that also receive additional federal funding to serve all low-income people. They offer services on a sliding fee scale.

A preliminary total of fatal work injuries recorded in the United States. According to results from the 
Census of Fatal Occupational Injuries (CFOI) program conducted by the U.S. Bureau of Labor
 Statistics.

The purpose of this course is to prepare providers to diagnose and treat acute pesticide poisoning and to increase their awareness of health problems associated with chronic pesticide exposure. While the focus of the course is on workers in agricultural settings, the course contents are also applicable for treating all pesticide related illness.

Children encounter pesticides daily and have unique susceptibilities to their potential toxicity. Acute poisoning risks are clear, and understanding of chronic health implications from both acute and chronic exposure are emerging. Epidemiologic evidence demonstrates associations between early life exposure to pesticides and pediatric cancers, decreased cognitive function, and behavioral problems.
In this policy statement, the American Association of Pediatrics outlines the symptoms and suggested course of treatment for acute exposure pesticides belonging to the eight most predominant classes of pesticides. The policy statement also makes recommendations for both pediatricians and government to take measures to improve pesticide safety.
© AAP - 2012; This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors.

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This archived webinar originally presented by Jennie McLaurin, MD and Tillman Farley, MD, provides an overview of effective strategies to integrate behavioral health into health center operations. The presenters come with many years of experience in providing culturally appropriate and high quality health care to migrants and other underserved populations. This page includes links to other SAMHSA-HRSA sponsored archived webinars in additional topics.

Webinar Presentation by Adam Hoverman, DO, DTM&H on Exploring the Intersection of Tropical Medicine and Migrant Health. Recorded on 4/18/2012.

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October 15, 2012

Spanish version

Background
The Centers for Disease Control and Prevention (CDC) with state and local health departments and the Food and Drug Administration (FDA)External Web Site Icon are investigating a multistate meningitis outbreak of fungal infections among patients who have received a steroid injection of a potentially contaminated product into the spinal area. This form of meningitis is not contagious. The investigation also includes fungal infections associated with injections in a peripheral joint space, such as a knee, shoulder or ankle.

Barbara C. Lee PhD, Susan S. Gallagher MPH, Amy K. Liebman MPA, MA, Mary E. Miller RN, MN & Barbara Marlenga PhD (2012)Journal of Agromedicine, 17:2, 88-93ABSTRACT. In 1996 the US launched a National Childhood Agricultural Injury Prevention Initiative, guided by an action plan generated by a 42-member multidisciplinary committee. A major update to the plan was released following the 2001 Summit on Childhood Agricultural Injury Prevention. From the year 2010 through 2011 a comprehensive assessment of progress to date was conducted followed by the drafting, review and finalizing of a new action plan—“The 2012 Blueprint for Protecting Children in Agriculture.” This paper briefly describes the purpose and process for generating the new action plan then provides a listing of the 7 goals and 26 strategies within the plan. These goals and strategies account for trends in childhood agricultural injuries, changes in agricultural production and the demographics of its workforce, effectiveness of interventions, and the increasing use of social media, marketing and social networking. Primary funding for this  project was provided by the National Institute for Occupational Safety and Health (NIOSH), which continues to serve as the lead federal agency for the national initiative.

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American Journal of Public Health. October 2012, Vol 102, No. 10

Werner E. Bischoff, MD, PhD, Maria Weir, MAA, MPH, Phillip Summers, MPH, Haiying Chen, MD, PhD, Sara A. Quandt, PhD,
Amy K. Liebman, MPA, MA, and Thomas A. Arcury, PhD

Objectives. The purpose of this study was to assess water quality in migrant farmworker camps in North Carolina and determine associations of water quality with migrant farmworker housing characteristics. Methods. We collected data from 181 farmworker camps in eastern North Carolina during the 2010 agricultural season. Water samples were tested using the Total Coliform Rule (TCR) and housing characteristics were assessed using North Carolina Department of Labor standards. Results. A total of 61 (34%) of 181 camps failed the TCR. Total coliform bacteria were found in all 61 camps, with Escherichia coli also being detected in 2. Water quality was not associated with farmworker housing characteristics or with access to registered public water supplies. Multiple official violations of water quality standards had been reported for the registered public water supplies. Conclusions. Water supplied to farmworker camps often does not comply with current standards and poses a great risk to the physical health of farmworkers and surrounding communities. Expansion of water monitoring to more camps and changes to the regulations such as testing during occupancy and stronger enforcement are needed to secure water safety. (Am J Public Health. 2012;102: e49–e54. doi:10.2105/AJPH.2012.300738)

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Cancer statistics for Hispanics/Latinos, 2012 by Rebecca Siegel MPH, Deepa Naishadham MA, MS, Ahmedin Jemal DVM, PhD

Article first published online: 17 SEP 2012

Abstract

Hispanics/Latinos are the largest and fastest growing major demographic group in the United States, accounting for 16.3% (50.5 million/310 million) of the US population in 2010. In this article, the American Cancer Society updates a previous report on cancer statistics for Hispanics using incidence data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries and mortality data from the National Center for Health Statistics. In 2012, an estimated 112,800 new cases of cancer will be diagnosed and 33,200 cancer deaths will occur among Hispanics. In 2009, the most recent year for which actual data are available, cancer surpassed heart disease as the leading cause of death among Hispanics. Among US Hispanics during the past 10 years of available data (2000-2009), cancer incidence rates declined by 1.7% per year among men and 0.3% per year among women, while cancer death rates declined by 2.3% per year in men and 1.4% per year in women. Hispanics have lower incidence and death rates than non-Hispanic whites for all cancers combined and for the 4 most common cancers (breast, prostate, lung and bronchus, and colorectum). However, Hispanics have higher incidence and mortality rates for cancers of the stomach, liver, uterine cervix, and gallbladder, reflecting greater exposure to cancer-causing infectious agents, lower rates of screening for cervical cancer, differences in lifestyle and dietary patterns, and possibly genetic factors. Strategies for reducing cancer risk among Hispanics include increasing utilization of screening and available vaccines, as well as implementing effective interventions to reduce obesity, alcohol consumption, and tobacco use. CA Cancer J Clin 2012;. © 2012 American Cancer Society.

Latinas are experiencing high rates of sexually transmitted diseases (STDs), teen childbearing, and unintended pregnancy. This report presents nine recommendations for sexual and reproductive health clinics and providers to increase young Latina women’s access to reproductive health services. The recommendations are based on findings derived from 14 focus groups conducted by Child Trends in three cities in the United States with young adult Latina women (18-24 years-old) and with reproductive health care and social service providers serving large Latina populations.

New research out of Cornell University's College of Human Ecology found that low-income children of immigrants have much poorer health than low-income children of citizens, as reported in a special section of the journal Child Development.

Supportive Voice. Among The Most Vulnerable by Tina Castañares , MD. Fall 2008

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The Journal of Clinical Ethics. The Diagnosis of Dying by George F. Davis. Fall 2009. Volume 20, Number 3

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Webinar Presentation by Tina Castañares, MD George Davis, MD Jennie McLaurin, MD, MPH on Palliative and End-of-Life Care for Latino Migrants. Recorded on 8/22/2012.

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We are pleased to share that the Spanish version of the Traveling to Mexico and Latin America: A Guide for Persons Living with HIV/AIDS brochure. This brochure includes helpful tips for persons with HIV/AIDS traveling outside of the country. Also included is a listing of prominent HIV/AIDS organizations in various Latin American countries.

This resource (in English and Spanish) gives a basic overview of what breast cancer is and some of the general terms used to describe breast cancer.

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This resource includes some facts about skin cancer including risk factors and the signs and symptoms of skin cancer.

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This article describes an excellent integrated behavioral health program at a Federally Funded Health Center. The full abstract from the article is as follows: In a progressively complex and fragmented health care system and in response to the need to provide whole-person, quality care to greater numbers of patients than ever before, primary care practices throughout the United States have turned their attention and efforts to integrating behavioral health into their standard service-delivery models. With few resources and little guidance, systems struggle to gather the support required to establish effective integrated programs. Based on first-hand experience, we describe a working integrated primary care model, currently utilized in a large community health center system in Colorado, that encompasses universal screening, consultation, psychotherapy, and psychological testing. With appreciation for the way an organization’s unique circumstances inform the best approach for that particular organization, we highlight the clinical level and system-level variables that we consider necessary for successful practice development and address how our behavioral health program operates despite funding limitations. We conclude that organizations that aim for integrated primary care must mobilize leadership to implement systemic changes while making difficult decisions about program development, financing, staffing, and interagency relationships.