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Agricultural Injury in California Hispanic Farm Workers:MICASA Follow-up SurveyStephen A. McCurdy MD MPH a , Hong Xiao PhD MPH a , Tamara E. Hennessy-Burt MS a , MariaT. Stoecklin-Marois PhD a , Daniel J. Tancredi PhD b , Deborah H. Bennett PhD a & Marc B.Schenker MD MPH aa Department of Public Health Sciences, University of California-Davis School of Medicine,Davis, California, USAb Department of Pediatrics and Department of Public Health Sciences, University ofCalifornia-Davis School of Medicine, Davis, California, USAVersion of record first published: 10 Jan 2013.

To cite this article: Stephen A. McCurdy MD MPH , Hong Xiao PhD MPH , Tamara E. Hennessy-Burt MS , Maria T. Stoecklin-Marois PhD , Daniel J. Tancredi PhD , Deborah H. Bennett PhD & Marc B. Schenker MD MPH (2013): Agricultural Injury inCalifornia Hispanic Farm Workers: MICASA Follow-up Survey, Journal of Agromedicine, 18:1, 39-49

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Journal of Agromedicine, 18:39–49, 2013Copyright © Taylor & Francis Group, LLCISSN: 1059-924X print/1545-0813 onlineDOI: 10.1080/1059924X.2012.743380

Agricultural Injury in California Hispanic Farm Workers:MICASA Follow-up Survey

Stephen A. McCurdy, MD MPHHong Xiao, PhD MPH

Tamara E. Hennessy-Burt, MSMaria T. Stoecklin-Marois, PhD

Daniel J. Tancredi, PhDDeborah H. Bennett, PhD

Marc B. Schenker, MD MPH

ABSTRACT. The authors report here results from the first follow-up survey of the MexicanImmigration to California: Agricultural Safety and Acculturation (MICASA) cohort of communi-ty-dwelling immigrant Hispanic farm workers in California’s Central Valley. Among 560 participantsthe authors observed cumulative 1-year injury incidence of 6.6% (all injuries) and 4.3% (agriculturalinjuries). Increased prospective injury risk was associated with males, US birth, years lived in the UnitedStates, family income, and poor self-rated health. Agricultural injuries were associated most frequentlywith being struck by an object, falls, and cutting instruments, whereas over two thirds of nonagriculturalinjuries involved motor vehicles. Prevention should focus on safe handling of tools and materials, falls,and motor vehicle safety.

KEYWORDS. Acculturation, agricultural workers, Hispanics, occupational injuries, occupationalsafety

INTRODUCTION

Agriculture is an important industry in theUnited States, and California leads the nationin productivity, with over 350 crops witha market value of $37.5 billion in 2010.1

California’s agricultural economy is particularly

Stephen A. McCurdy, Hong Xiao, Tamara E. Hennessy-Burt, Maria T. Stoecklin-Marois, Deborah H.Bennett, and Marc B Schenker are with the Department of Public Health Sciences, and Daniel J. Tancredi iswith the Department of Pediatrics and Department of Public Health Sciences, University of California-DavisSchool of Medicine, Davis, California, USA.

This work was sponsored by The California Endowment and the National Institute for Occupational Safetyand Health (NIOSH) grants 2U50OH007550 and 1R01OH009293. The authors thank the entire Mendotacommunity for its support and participation.

Address correspondence to: Stephen A. McCurdy, MD MPH, Department of Public Health Sciences,University of California–Davis School of Medicine, One Shields Avenue, Davis, CA 95616-8638, USA(E-mail: samccurdy@ucdavis.edu).

focused on high-value vegetable and fruit cropsrequiring significant input of specialized labor.In California, as in the nation, the majorityof this labor is provided by Hispanic immi-grant ethnic groups.2 The National AgriculturalWorker Survey (NAWS) reported that 95% ofcrop farm laborers in California were foreign

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40 INJURY IN CALIFORNIA HISPANIC FARM WORKERS

born, chiefly from Mexico.3 Immigrant farmworkers have several characteristics puttingthem at increased risk for injury and other occu-pational health conditions: work in an intrin-sically dangerous industry characterized byhard labor, dangerous machinery, large animals,chemicals, and other hazards; short but intensiveemployment periods determined by the agri-cultural production schedule; work in chang-ing environments according to season and task;and social, economic, and linguistic marginal-ization, often complicated by lack of workauthorization.4

The Mexican Immigration to California:Agricultural Safety and Acculturation(MICASA) Study is a population-basedstudy of over 400 hired farm worker familiesfrom Mendota, an agricultural communityin California’s Central Valley with a highproportion of Mexican and Central Americanimmigrants.5 The study’s purpose is to providelongitudinal data for assessing the incidenceand prevalence of injury and disease, with anemphasis on occupational health conditions.The study consists of periodic interviews,objective measurement of anthropometriccharacteristics and pulmonary function, andfield-based exposure measurements of respira-tory hazards. We present here the injury resultsof the first follow-up survey of this population.

MATERIALS AND METHODS

Study Design Overview

Sampling of the population consisted of astratified area-sampling process comprising aninitial mapping of the community, enumerationof households in 74 randomly selected censusblocks within Mendota’s two census tracts, andinterview of the adult (age ≥18 years) headof household or spouse who self-identified asMexican or Central American and had workedat least 45 days in agriculture in the precedingyear. The sampling process has been previouslydescribed in detail.5 Enumeration identified897 eligible households containing 1039 adultsas head of household or spouse of head of house-hold. All eligible households were requested to

participate, and 467 (52.1%) agreed, providing843 (81.1%) adult participants who completeda baseline interview between January 2006 andApril 2007, including 759 (90.0%) who reportedever working in agriculture. There were nosignificant differences between the enumeratedfamily population and the MICASA sample interms of age, country of birth, and number ofyears living in the United States.5

Among the 759 subjects reporting prioragricultural work in the baseline interview,560 (73.8%) completed a follow-up interviewbetween November 2008 and February 2010 andare subjects of this report. We obtained heightand weight on 408 (72.9%) of these in thefollow-up examination. Participants completedinformed consent documents in accordance withthe University of California–Davis InstitutionalReview Board, which approved the study.Participants received a $15 gift certificate inappreciation for their time in completing theinterview.

Questionnaires

The baseline and follow-up questionnaireswere in Spanish and collected information ondemographic, occupational, and health charac-teristics, including injury experience. TrainedSpanish-speaking interviewers administered thequestionnaire in the participant’s home or atthe study headquarters. Sex and current agewere obtained from the follow-up survey, butother predictor or exposure variables were fromthe baseline questionnaire, in keeping with thecohort design.

A qualifying injury was defined as an unin-tentional event leading to bodily damage withinthe 12 months prior to follow-up interview dueto exposure to energy and requiring at least oneof the following: need for medical care, lossof consciousness, at least one-half day of lostwork time, or restriction from normal activities.All qualifying injuries, whether occupationallyrelated or not, were included in the analy-sis. Information on injuries included diagnosis,body part injured, crop and activity engagedin when injured, event or exposure leading toinjury, associated object, treatment, and lost andrestricted work time.

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McCurdy et al. 41

Acculturation scores were calculated forMICASA participants using a 12-item ver-sion of the Acculturation Rating Scale forMexican Americans-II (ARSMA-II) developedand validated by Cuellar and colleagues, demon-strating high correlation with the full 30-itemscale (r = .93).6,7 The scale has been validatedwith respect to health-risk behaviors in a ruralLatina population and shows high reliability(Cronbach’s α, .87).8 The ARSMA-II instru-ment provides an overall acculturation scorebased on measures of language use and prefer-ence, ethnic identity, ethnic behaviors, and eth-nic interaction through the use of two subscales,a Mexican-oriented scale (MOS) and an Anglo-oriented scale (AOS). Responses to items on theMOS and AOS range from “not at all” (responsescore = 1) to “extremely often or almost always”(response score = 5). The MOS and AOS ques-tions were summed separately and a mean cal-culated for each orientation subscale. The rawacculturation score was calculated by subtract-ing the MOS mean from the AOS mean. We cat-egorized subjects into Low and Medium/Highcategories based on their numerical score, asdescribed by Hennessy-Burt et al.9

Data Management and Analysis

Data from the paper questionnaires were dou-ble entered into a computer database; discrep-ancies were checked against the paper ques-tionnaire and corrected. Data were analyzedusing Stata 11.2 (StataCorp, College Station,TX). Distributions of continuous variables weresummarized with mean and standard devia-tions (for approximately bell-shaped distribu-tions) or with percentiles. Categorical variableswere summarized as percentages within eachcategory. Initial two-way tabular analyses iden-tified variables associated with injury. Groupcomparisons utilized the Pearson’s chi-square orFisher’s exact test and the Wilcoxon rank-sumtest or Kruskal-Wallis test (for continuous andordinal categorical variables). Logistic regres-sion analysis was employed to estimate injuryodds ratios for exposures adjusted for maineffects of age category (18–29, 30–39, 40–49,50+ years) and sex. In case unconditional max-imum likelihood estimates of adjusted odds

ratios were not computable, median unbiasedestimates were computed using exact logisticregression. Adjusted trend tests for ordinal cat-egorical variables were conducted by includingthem as quantitative predictors in multiple logis-tic regression models.10

RESULTS

Study Sample and DemographicCharacteristics

There were 560 subjects who reported work-ing in agriculture in the year preceding thebaseline survey and subsequently completed thefollow-up survey (Table 1). Approximately halfof the sample was male, and median age formen and women was 41 and 40 years, respec-tively. Two thirds were born in Mexico and 3%in the United States. Men had lived significantlylonger in the United States than women (median17.0 vs. 12.0 years; p < .001, Wilcoxon test)and had worked more years in agriculture at thebeginning of the study (median 16 vs. 9 years;p < .001, Wilcoxon test). Annual family incomewas associated with days worked in agriculture;the highest income group reported a median of204 versus 114 days in the lowest income group(p < .001, Kruskal-Wallis test).

Demographic and Health Correlatesof Injury

There were 37 injuries from all causes(Table 1) reported in the year prior to the follow-up survey, including 24 (64.9%) associated withagricultural work, yielding 1-year cumulativeincidences of 6.6% (all injuries; 95% confi-dence interval [CI]: 4.7%, 9.0%) and 4.3% (agri-cultural injuries only; 95% CI: 2.8%, 6.3%).Women had an approximately 50% reduction inodds of injury compared with men. Participantsborn in the United States had over 5-foldincreased odds for agricultural injury comparedwith those foreign born. Years having lived inthe United States and annual family income,each as reported at the beginning of the study,showed significant trends for increasing odds ofinjury.

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42 INJURY IN CALIFORNIA HISPANIC FARM WORKERS

TABLE 1. Selected Demographic Characteristics and Injury Risk Among 560 California HispanicFarm Worker Immigrants, MICASA Study

All injuriesa Agricultural injuriesa

CharacteristicSubjects[n (%)]

One-yearcumulative injury

incidence[n (%)]

Adjustedb oddsratio and 95% CI

for injury[OR (95% CI)]

One-yearcumulative injury

incidence[n (%)]

Adjustedb oddsratio and 95% CI

for injury[OR (95% CI)]

Total subjects 560 (100.0) 37 (6.6) — 24 (4.3) —Sex

Male 277 (49.5) 24 (8.7) 1.00 16 (5.8) 1.00Female 283 (50.5) 13 (4.6) 0.49 (0.24, 0.98) 8 (2.8) 0.45 (0.19, 1.07)

Age category at follow-up18–29 years 81 (14.5) 5 (6.2) 1.00 4 (4.9) 1.0030–39 years 173 (30.9) 13 (7.5) 1.17 (0.40, 3.42) 7 (4.1) 0.76 (0.22, 2.69)40–49 years 182 (32.5) 15 (8.2) 1.29 (0.45, 3.69) 11 (6.0) 1.16 (0.35, 3.77)50+ years 124 (22.1) 4 (3.2) 0.45 (0.12, 1.75) 2 (1.6) 0.28 (0.05, 1.57)

Country of birthMexico 374 (66.8) 24 (6.4) 1.00 17 (4.6) 1.00Central American 169 (30.2) 10 (5.9) 0.89 (0.41, 1.93) 4 (2.4) 0.50 (0.17, 1.53)USA 17 (3.0) 3 (17.7) 3.79 (0.97, 14.7) 3 (17.7) 5.75 (1.40, 23.6)

Years living in USc

0–5 years 74 (13.2) 2 (2.7) 1.00 1 (1.4) 1.006–10 years 110 (19.6) 7 (6.4) 2.32 (0.46, 11.8) 5 (4.6) 3.60 (0.40, 32.3)11–20 years 123 (22.0) 5 (4.1) 1.52 (0.26, 8.74) 3 (2.4) 2.14 (0.20, 23.1)21+ years 251 (44.8) 23 (9.2) 6.00 (1.17, 30.8) 15 (6.0) 7.90 (0.85, 73.6)Not stated 2 (0.4) 0 (0.0) — 0 (0.0) —

Acculturation levelLow 531 (94.8) 35 (6.6) 1.00 22 (4.1) 1.00Medium/high 16 (2.9) 2 (12.5) 2.30 (0.49, 10.9) 2 (12.5) 3.88 (0.79, 19.1)Not stated 13 (2.3) 0 (0.0) — 0 (0.0) —

Marital statusSingle/divorced/widowed 21 (3.8) 1 (4.8) 1.00 0 (0.0) 1.00Married or cohabiting 539 (96.3) 36 (6.7) 0.87 (0.11, 7.13) 24 (4.5) 0.77 (0.11, ∞)

Family income (annual)d

$0–10,000 95 (17.0) 6 (6.3) 1.00 2 (2.1) 1.00$10,001–20,000 246 (43.9) 10 (4.1) 0.65 (0.23, 1.87) 7 (2.9) 1.50 (0.30, 7.47)$20,001–30,000 134 (23.9) 13 (9.7) 1.62 (0.57, 4.62) 8 (6.0) 3.43 (0.68, 17.4)$30,001+ 74 (13.2) 8 (10.8) 1.82 (0.58, 5.72) 7 (9.5) 5.42 (1.03, 28.4)Not stated 11 (2.0) 0 (0.0) — 0 (0.0) —

aQualifying injuries are those for which the subject sought treatment or reported to a hospital, emergency room, or clinicor became unconscious or had at least one-half day of lost work or school time or reduced normal activities. Agriculturalinjuries are those injuries occurring during the conduct of agricultural work.bAdjusted for main effects of age category (18–29, 30–39, 40–49, 50+ years) and sex.cTest for trend: p < .02 for all injuries; p < .05 for agricultural injuries.d Test for trend: p < .07 for all injuries; p < .01 for agricultural injuries.

There was a significant inverse trend betweenodds for all follow-up injuries and health self-rating from the baseline survey (Table 2). Fewerthan 10% of participants had body mass indexmeasured in the normal range at the follow-up survey, and there was no significant asso-ciation between body mass index and injuryodds.

Injury Characteristics

The most common qualifying criterion forinjury was seeking medical treatment, presentfor over 90% of all injuries (Table 3). Subjectswith agricultural injuries were more likelythan subjects with nonagricultural injuries tovisit a hospital, emergency room, or clinic

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TABLE 2. Selected Health Characteristics and Injury Risk Among 560 California Hispanic FarmWorker Immigrants, MICASA Study

All injuriesa (n = 30) Agricultural injuriesa (n = 22)

CharacteristicSubjects[n (%)]

One-yearcumulative

injuryincidence

[n (%)]

Adjustedb oddsratio and 95% CI

for injury [OR(95% CI)]

One-yearcumulative

injuryincidence

[n (%)]

Adjustedb oddsratio and 95% CI

for injury [OR(95% CI)]

Smoking statusNever 431 (77.0) 26 (6.0) 1.00 17 (3.9) 1.00Former 70 (12.5) 4 (5.7) 0.79 (0.25, 2.46) 2 (2.9) 0.58 (0.12, 2.70)Current 58 (10.4) 7 (12.1) 1.97 (0.77, 4.99) 5 (8.6) 2.19 (0.73, 6.56)Not stated 1 (0.2) 0 (0.0) — 0 (0.0) —

Health self-ratingc

Excellent/good 330 (58.9) 18 (5.5) 1.00 12 (3.6) 1.00Fair 200 (35.7) 15 (7.5) 1.73 (0.82, 3.64) 10 (5.0) 1.70 (0.69, 4.18)Poor 26 (4.6) 3 (11.5) 4.44 (1.08, 18.3) 1 (3.9) 2.16 (0.25, 19.0)Not stated 4 (0.7) 1 (25.0) — 1 (25.0) —

Body-mass index measured atfollow-up survey [kg/m2]

18.5 to <25.0 (Normal) 35 (6.3) 0 (0.0) 0.35 (0.00, 2.21) 0 (0.0) 0.54 (0.00, 3.61)25.0 – to <30.0 (Overweight) 153 (27.3) 9 (5.9) 0.88 (0.32, 2.27) 7 (4.6) 1.07 (0.33, 3.34)>≥ 30.0 (Obese) 220 (39.3) 14 (6.4) 1.00 9 (4.1) 1.00Data unavailable 152 (27.1) 14 (9.2) — 8 (5.3) —

Physician diagnosis of diabetesNo 512 (91.4) 33 (6.5) 1.00 21 (4.1) 1.00Yes 44 (7.9) 4 (9.1) 2.23 (0.68, 7.31) 3 (6.8) 2.89 (0.73, 11.5)Not stated 4 (0.7) 0 (0.0) — 0 (0.0) —

Prior injury (agricultural ornonagricultural) reported onbaseline survey

No 512 (91.4) 32 (6.3) 1.00 21 (4.1) 1.00Yes 48 (8.6) 5 (10.4) 2.00 (0.72, 5.57) 3 (6.3) 1.75 (0.49, 6.29)

aQualifying injuries are those for which the subject sought treatment or reported to a hospital, emergency room, or clinicor became unconscious or had at least one-half day of lost work or school time or reduced normal activities. Agriculturalinjuries are those injuries occurring during the conduct of agricultural work.bAdjusted for main effects of age category (18–29, 30–39, 40–49, 50+ years) and sex.cp < .03 test for trend for all injuries.

for treatment, yet had a shorter hospitalstay. Similarly, persons with agriculturalinjuries were more likely than persons withnonagricultural injuries to experience lostwork time due to the injury, yet had fewer lostworkdays and fewer reduced-activity days.

Open wounds were the most common injurydiagnosis, comprising over one fifth of allagricultural injuries (Table 3). Fractures andsprains each contributed over 10% of agricul-tural injuries. There were no significant differ-ences between men and women with respectto injury diagnosis (data not shown). The mostcommonly injured body parts for agricultural

injuries were the back; the leg; and fingers,wrist, or hand; each contributing five (20.8%)cases. Among nonagricultural injuries, the mostcommon site was the back (n = 7, 53.9%).

The type of injury-producing event or expo-sure differed significantly between the agri-cultural and nonagricultural injury groups(Table 3). Being struck by an object was mostcommon, occurring in more than one quarter ofall cases and nearly 5 times as likely among agri-cultural compared with nonagricultural injuries.Motor vehicles and falls each contributed nearlyone quarter of cases. Motor vehicle injurieswere responsible for more than two thirds

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44 INJURY IN CALIFORNIA HISPANIC FARM WORKERS

TABLE 3. Injury Characteristics Among 560 California Hispanic Farm Worker Immigrants,MICASA Study

CharacteristicAll injuriesa

(n = 37)Agricultural

injuriesa (n = 24)Nonagricultural

injuriesa (n = 13)

Qualifying characteristicb

Sought medical treatment [n (%)] 35 (94.6) 22 (91.7) 13 (100.0)Visited hospital/ER/clinicc [n (%)] 29 (78.4) 22 (91.7) 7 (53.9)

Median stay [days] 0 0 125th percentile 0 0 075th percentile 1 1 2

Loss of consciousness [n (%)] 0 (0.0) 0 (0.0) 0 (0.0)Loss of ≥1/2 day work 22 (59.5) 17 (70.8) 5 (38.5)

Median lost work time [days] 5 4 725th percentile 2 2 375th percentile 30 7 60

Reduced normal activities [n (%)] 16 (43.2) 11 (45.8) 5 (38.5)Median reduced-activity timed [days] 30 30 18025th percentile 10 7 6075th percentile 135 45 240

Treatment by: [n (%)]Physician 29 (78.4) 20 (83.3) 9 (69.2)Chiropractor 2 (5.4) 1 (4.2) 1 (7.7)Local healer 2 (5.4) 1 (4.2) 1 (7.7)Other 2 (5.4) 0 (0.0) 2 (15.4)Not stated 2 (5.4) 2 (8.3) 0 (0.0)

Injury diagnosis [n (%)]Displacement of intervertebral 4 (10.8) 2 (8.3) 2 (15.4)disc 4 (10.8) 3 (12.5) 1 (7.7)Fracture 3 (8.1) 3 (12.5) 0 (0.0)Sprain 6 (16.2) 5 (20.8) 1 (7.7)Open wound 1 (2.7) 1 (4.2) 0 (0.0)Abrasion of hip, thigh, leg, and ankle 5 (13.3) 1 (4.2) 4 (30.8)Contusion 1 (2.7) 1 (4.2) 0 (0.0)Foreign body, eye 2 (5.4) 1 (4.2) 1 (7.7)Unspecified head injury 4 (10.8) 2 (8.3) 2 (15.4)Injury of other sites of trunk Other 7 (18.9) 5 (13.6) 2 (15.4)

Body part injuredb [n (%)]Head 8 (21.6) 3 (12.5) 5 (38.5)Eye 1 (2.7) 1 (4.2) 0 (0.0)Neck 4 (10.8) 1 (4.2) 3 (23.1)Shoulder 8 (21.6) 3 (12.5) 5 (38.5)Back 12 (32.4) 5 (20.8) 7 (53.9)Chest or abdomen 4 (10.8) 3 (12.5) 1 (7.7)Fingers, wrist, or hand 6 (16.2) 5 (20.8) 1 (7.7)Arm 3 (8.1) 2 (8.3) 1 (7.7)Foot or toe 4 (10.8) 2 (8.3) 2 (15.4)Leg 5 (13.5) 5 (20.8) 0 (0.0)

Event or exposurec [n (%)]Fall 9 (24.3) 7 (29.2) 2 (15.4)Machinery 1 (2.7) 1 (4.2) 0 (0.0)Struck by object 10 (27.0) 9 (37.5) 1 (7.7)Cutting instrument 4 (10.8) 4 (16.7) 0 (0.0)Animal 1 (2.7) 1 (4.2) 0 (0.0)Motor vehicle 9 (24.3) 0 (0.0) 9 (69.2)Other 3 (8.1) 2 (8.3) 1 (7.7)

Associated object [n (%)]Pipe 8 (21.6) 8 (33.3) 0 (0.0)Automobile 7 (18.9) 1 (4.2) 6 (46.2)

(Continued)

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TABLE 3. (Continued)

CharacteristicAll injuriesa

(n = 37)Agricultural

injuriesa (n = 24)Nonagricultural

injuriesa (n = 13)

Tractor 1 (2.7) 1 (4.2) 0 (0.0)Ground 6 (16.2) 3 (12.5) 3 (23.1)Animals 2 (5.4) 1 (4.2) 1 (7.7)Power hand tools 1 (2.7) 1 (4.2) 0 (0.0)Non-power hand tools 4 (10.8) 4 (16.7) 0 (0.0)Other 8 (21.6) 5 (20.8) 3 (23.1)

aQualifying injuries are those for which the subject sought treatment or reported to a hospital, emergency room, or clinicor became unconscious or had at least one-half day of lost work or school time or reduced normal activities. Agriculturalinjuries are those injuries occurring during the conduct of agricultural work.bCategories are not mutually exclusive.cSignificant difference between agricultural and nonagricultural injury groups (p < .02, chi-square test).d Significant difference between agricultural and nonagricultural injury groups (p < .03, Wilcoxon test).

of nonagricultural injuries and occurred exclu-sively in this group. Falls were approximatelytwice as likely among agricultural injuries com-pared with nonagricultural injuries. Injuries withcutting instruments and animals occurred exclu-sively in agricultural injuries. The most commonassociated object causing injury among agricul-tural workers was pipe, contributing one third ofcases. Among nonagricultural injuries, the mostcommon associated object was an automobile,contributing nearly half of injuries.

Farm and Farm Work Characteristics

The most common crop associated with agri-cultural injury (Table 4) was tomato, contribut-ing one quarter of cases. The most frequenttasks associated with agricultural injury wereirrigation and driving a tractor or truck, eachcontributing four injuries. Persons with agri-cultural injuries reported more days workingin agriculture in the prior year than did per-sons with nonagricultural injury or no injury(median 231 vs. 122 vs. 155 days; p < .01,Kruskal-Wallis). There were no significant dif-ferences between the uninjured, those withnonagricultural injuries, and those with agricul-tural injuries for days worked in the precedingyear at specified tasks or crops. Days workingin agriculture in the prior year did not materi-ally confound the associations between injuryand sex, birth in the United States, years livingin the United States, family income, or self-ratedhealth (Tables 1, 2).

TABLE 4. Circumstances of Agricultural Injurya

(n = 24) Among 560 California Hispanic FarmWorker Immigrants, MICASA Study

CharacteristicFrequency

[n (%)]

Crop or commodity associated with injuryCotton 2 (8.3)Lettuce 2 (8.3)Melon 3 (12.5)Nuts 4 (16.7)Tomatoes 6 (25.0)Other 7 (29.2)

Task associated with injuryCleaning produce 1 (4.2)Cutting pipe or welding 3 (12.5)Driving tractor or truck 4 (16.7)Irrigation 4 (16.7)Loading 3 (12.5)Packing/sorting produce for transport 3 (12.5)Picking 1 (4.2)Pruning/cutting 2 (8.3)Weeding 1 (4.2)Other 2 (8.3)

aQualifying injuries are those for which the subject soughttreatment or reported to a hospital, emergency room, orclinic or became unconscious or had at least one-half dayof lost work or school time or reduced normal activities.Agricultural injuries are those injuries occurring during theconduct of agricultural work.

DISCUSSION

We report here the results of our firstfollow-up survey for injuries among 560 pre-dominantly immigrant Hispanic farm workers

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46 INJURY IN CALIFORNIA HISPANIC FARM WORKERS

in a rural California agricultural community.Agricultural injuries comprised nearly twothirds of all reported injuries, manifesting a1-year cumulative incidence of 4.3% (6.6% forall injuries), comparable to that seen in otherstudies of agricultural workers,11,12 includingCalifornia immigrant Hispanic farm workers.13

Agricultural injuries were most commonly asso-ciated with being struck by an object andfalls, whereas over two thirds of nonagriculturalinjuries involved motor vehicles. Male sex, birthin the United States, years living in the UnitedStates, and family income were associated withincreased odds of injury. Self-assessed healthstatus, as indicated on the baseline survey, wasalso associated with increased odds of injuryin the subsequent follow-up year. Agriculturalinjuries were significantly more likely thannonagricultural injuries to be seen in a hos-pital, emergency room, or clinic setting andto be associated with a shorter stay. Similarly,agricultural injuries were associated with fewerlost-work and reduced-activity days than werenonagricultural injuries.

We noted markedly increased odds of injuryamong persons born in the United States.A recent national study of employed US cropworkers by Wang et al. also noted a higher occu-pational injury risk among US-born Hispanics(6.9/100 full-time equivalent [FTE]) comparedwith Mexican-born Hispanics (4.2/100 FTE)and other non-US workers (1.1/100 FTE).12

Consistent with this finding are the increas-ing injury odds with years living in the UnitedStates and among the small group of partic-ipants with higher acculturation index scores,although the latter finding was not statisticallysignificant. Acculturation has been associatedwith increased risk for various adverse healthoutcomes,14 although not, to our knowledge,with injury. Data from the Census of FatalOccupational Injuries (CFOI) for 2010 sug-gest that foreign-born Latino workers have adisproportionately large share of fatal injuriescompared with US-born Latinos,15 in con-trast to Wang et al.’s findings of increasedinjury risk among US-born Latinos.12 However,the CFOI data include only fatalities for allindustry, whereas Wang et al. examined non-fatal injuries among crop workers. Neither

the CFOI nor Wang et al.’s data addressacculturation.

All three of these factors—birth in the UnitedStates, years living in the United States, andacculturation index score—likely reflect over-all acculturation, or level of integration intothe dominant society. The mechanism underly-ing increased occupational injury risk with suchintegration, if confirmed in subsequent work,may involve confounding according to job andrisk environment; that is, persons with greateracculturation may have a wider range of activ-ities and risks than others. Acculturation mayalso affect use of protective measures, as hasbeen shown for sun-safety behaviors amongLatinos.16 Low acculturation may also con-tribute to reduced reporting of injuries due toconcern over potential loss of employment andunfamiliarity with the US workers’ compensa-tion system. Further studies could address thesehypotheses through careful assessment of workexposures and practices.

Annual family income was positively associ-ated with increased injury odds, especially foragricultural injury. It is likely that several factorscontribute to this finding. First, subjects report-ing more family income also worked more daysin agriculture than persons with lower incomes;thus, the income represents greater opportunityfor injury. However, inclusion of days worked inmultivariate models did not materially affect themagnitude of the association between incomeand injury and thus is unlikely to be entirelyresponsible for the association. It is also pos-sible that persons with higher income performmore dangerous tasks than persons with lowerincomes, a factor not captured by our surveyinstrument. Finally, persons with higher incomemay have greater security of employment—alsonot captured by our survey—and thus be morewilling to report injuries.

Agricultural injuries were significantly morelikely than nonagricultural injuries to be seenin a formal medical setting and by a physi-cian. Licensed medical personnel treated over80% of the reported occupational injuries, com-parable to the approximately 70% reported byWang et al. for occupational injuries amongUS crop workers.12 Although we did notobtain information on insurance status, it is

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possible that the increased likelihood of formalcare for occupational compared with nonoc-cupational injuries reflects improved accessfor the former through the use of workers’compensation insurance, which is universallyrequired in California, including for agricul-tural workers. Persons with agricultural injuriesalso had a shorter hospital stay and fewerlost-work or restricted-activity days than didthose with nonagricultural injuries. It is unclearwhether this reflects better care, more effi-cient reporting, or decreased injury severity foroccupational compared with nonoccupationalinjuries.

Characteristics of reported agriculturalinjuries are similar to those reported by otherauthors, with a plurality of open wounds, mostoften involving the hand, and associated withbeing struck by an object, falls, and cuttinginstruments. Pipe, most frequently used for irri-gation, was the associated object for one third ofagricultural injuries. In contrast, nonagriculturalinjuries most commonly involved motor vehi-cles. There was no predominant task or cropassociated with agricultural injuries, althoughtomato was the most commonly cited crop. Thesmall proportion of animal-related injuries islikely due to the fact that vegetable and fruitcrops predominate locally. Number of daysworked in agriculture in the preceding yearwas unsurprisingly a risk factor for agriculturalinjury, but there was no increased risk asso-ciated with days worked at specified tasks orcrops.

Self-assessed health status, as indicated onthe baseline questionnaire, demonstrated a sig-nificant inverse dose-response trend for allinjuries, with those reporting poor health sta-tus reporting greater than 2-fold increased oddsfor agricultural injuries. This finding comportswith previous studies showing increased occu-pational injury risk among farmers with priorhealth conditions17,18 and a recent nationalstudy of employed US crop workers12 not-ing increased occupational injury risk for per-sons reporting at least one health condition(6.4/100 FTE vs. 3.9/100 FTE for persons notreporting a health condition).

The MICASA study has several importantstrengths. First, it focuses on an important health

outcome in a large yet marginalized populationin one of California’s and the nation’s mostimportant industries. Second, the study is lon-gitudinal, allowing us to look at prospectiverisk associated with demographic and other riskfactors as reported in the baseline survey, aswell as cross-sectional associations. The study iscommunity based and has been in place for sev-eral years, such that the community has cometo know and embrace the effort, leading tohigh participation. Finally, we employed carefulquality control and data monitoring to maximizevalidity and precision.

The study also has several important limi-tations. First, the study population comprisesrelatively stable community-dwelling Hispanicfarm workers. Persons who move to find work,in particular young men traveling without fam-ily, were unlikely to have been included inthe study, and our findings may not applyto that group. Moreover, the study popula-tion is from a single agricultural community inCalifornia’s Central Valley, and results may notapply to groups in different locations with dif-ferent agricultural crops and practices. Second,low response rate, especially at the level ofhouseholds, could have resulted in selectionbias in our final sample. However, participatingand nonparticipating households did not dif-fer demographically, making significant selec-tion bias unlikely. Third, study data representquestionnaire responses for which validationwas impractical. Thus, misclassification is pos-sible, as for all questionnaire-based studies.We focused on understandability, interviewertraining, and monitoring to minimize this poten-tial source of error. Finally, the study was rela-tively small, limiting power, especially for sub-groups with few reported injury outcomes. Forexample, the power for detecting the observeddifference in agricultural injury risk accordingto acculturation level was 27%; for detectinga doubling of risk for subjects with history ofprior injury the power was 22%. Future studiesshould include larger samples to improve preci-sion and power. Despite study limitations, ourfindings are consistent with those of other inves-tigators and are biologically plausible, forminga reasonable basis for our conclusions and rec-ommendations.

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48 INJURY IN CALIFORNIA HISPANIC FARM WORKERS

CONCLUSION

We report here the first follow-up injuryexperience of community-dwelling immigrantHispanic farm workers living in a small agricul-tural community in California’s Central Valley.Their overall injury experience is quantitativelyand qualitatively similar to that observed amongother farm worker groups, including Californiaimmigrant Hispanics. We found several corre-lates of injury risk that identify persons who maybenefit from increased attention on prevention,including male sex, birth in the United States,years living in the United States, family income,and poor self-assessed health status.

Injury prevention can be advanced at severallevels based on our findings. First, the demo-graphic characteristics associated with injury areuseful for identifying persons at increased riskwho may benefit from more intensive educationor other injury prevention measures. Second,the injury experience reported here suggests thatprevention for agricultural injuries should focuson falls and safe handling of tools and mate-rials, especially irrigation pipes, whereas pre-vention for nonagricultural injuries should focuson motor vehicle safety. Third, the wide rangeof exposures, tasks, associated objects, and cir-cumstances of injury confirms that reducingfarm injury requires a multifactorial approach.Assessment at the farm level could identify localhazards and lead to consideration of preventivemeasures, especially those based on engineeringor work-practice changes. For example, movableirrigation systems are commonly used in localagriculture. Irrigation pipings are made of alu-minum and are 6 to 8 inches in diameter andup to 30 feet long. Pipe sections are often car-ried by single individuals over muddy fields.Injuries with irrigation pipes could be reducedby requiring gloves and two persons to carrypipes. Piece-work payment schemes for irriga-tion work may incentivize workers toward speedrather than safety and should be avoided.

REFERENCES

1. California Department of Food and Agriculture.Agricultural Statistical Overview. 2012. Available at:

http://www.cdfa.ca.gov/statistics/. Accessed August 2,2012.

2. California Employment Development Department.California’s Agricultural Employment, 2008. Sacramento,CA: CEDD; 2008.

3. Aguirre International. The California Farm LaborForce: Overview and Trends from the National AgriculturalWorkers Survey. Burlingame, CA: Aguirre International;June 2005.

4. Donham KJ, Thelin A. Agricultural Medicine:Occupational and Environmental Health for the HealthProfessions. 1st ed. Ames, IA: Blackwell Publishing;2006.

5. Stoecklin-Marois MT, Hennessy-Burt TE,Schenker MB. Engaging a hard-to-reach populationin research: sampling and recruitment of hired farmworkers in the MICASA study. J Agric Saf Health.2011;17:291–302.

6. Cuellar I, Arnold B, Maldonado R. AcculturationRating-Scale for Mexican-Americans II—a revisionof the original ARSMA scale. Hisp J Behav Sci.1995;17:275–304.

7. Cuellar I, Bastida E, Braccio SM. Residency inthe United States, subjective well-being, and depressionin an older Mexican-origin sample. J Aging Health.2004;16:447–466.

8. Kasirye OC, Walsh JA, Romano PS, et al.Acculturation and its association with health-risk behaviorsin a rural Latina population. Ethn Dis. 2005;15:733–739.

9. Hennessy-Burt TE, Stoecklin-Marois MT,Meneses-Gonzalez F, Schenker MB. A pilot binationalstudy of health behaviors and immigration. J ImmigrMinor Health. 2011;13:1142–1149.

10. Agresti A. An Introduction to Categorical DataAnalysis. 2nd ed. Hoboken, NJ: Wiley-Interscience; 2007.

11. McCurdy SA, Carroll DJ. Agricultural injury. AmJ Ind Med. 2000;38:463–480.

12. Wang S, Myers JR, Layne LA. Injuries to hiredcrop workers in the United States: a descriptive anal-ysis of a national probability survey. Am J Ind Med.2011;54:734–747.

13. McCurdy SA, Samuels SJ, Carroll DJ, BeaumontJJ, Morrin LA. Agricultural injury in California migrantHispanic farm workers. Am J Ind Med. 2003;44:225–235.

14. Lara M, Gamboa C, Kahramanian MI, MoralesLS, Bautista DE. Acculturation and Latino health inthe United States: a review of the literature and itssociopolitical context. Annu Rev Public Health. 2005;26:367–397.

15. Bureau of Labor Statistics. Census of FatalOccupational Injuries. 2012. Available at: http://www.bls.gov/iif/oshwc/cfoi/cfch0009.pdf. Accessed August 3,2012.

16. Andreeva VA, Unger JB, Yaroch AL, CockburnMG, Baezconde-Garbanati L, Reynolds KD. Acculturation

Dow

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avis

] at

09:

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2013

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and sun-safe behaviors among US Latinos: findings fromthe 2005 Health Information National Trends Survey. Am JPublic Health. 2009;99:734–741.

17. Lewis MQ, Sprince NL, Burmeister LF, WhittenPS, Torner JC, Zwerling C. Work-related injuries amongIowa farm operators: an analysis of the Iowa Farm Family

Health and Hazard Surveillance Project. Am J Ind Med1998;33:510–517.

18. Sprince NL, Zwerling C, Lynch CF, et al. Riskfactors for agricultural injury: a case-control analysis ofIowa farmers in the Agricultural Health Study. J Agric SafHealth. 2003;9:5–18.

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