Appendix G
An Examination of the Occupational Risks and Occupational Safety and Health Communication Needs of Spanish-Speaking Children Who Are Employed or Live on Farms

Martha Soledad Vela-Acosta, MD, MS, Ph.D.,

University of Texas, Health Sciences Center,

School of Public Health at Brownsville

Acknowledgment: My gratitude to Jimmy Perkins, CIH, Ph.D.

INTRODUCTION

Children’s health relies on the interaction between their environment (living and working conditions) and their developmental status. While agriculture provides work opportunities for children worldwide, these opportunities also lead to potential risks. Many Spanish-speaking children are working as farm laborers, and face a range of common occupational agricultural risks. They form an emerging occupational group in the United States agricultural industry. Children are present as family members on farms operated by farmers of Hispanic1 origin, as nomadic adolescent farmworkers2 traveling solo, and as part of migrant farmworker groups either as family members or as individuals. While the first two groups are increasing in number, health risks and outcomes are not yet clearly identified for the latter group (which is the largest and includes children). Children living on a Hispanic-owned farm3 face different occupational risks and perceive these risks differently than do adolescent farmworkers, recently arrived from Mexico or Central America, who are farm laborers. In both instances, children work along with their farmworker parents to contribute to their family income, but different risks may be involved for migrant farmworker children and for children on family owned farms. In either case, because children are physically immature, they are more susceptible than adults to work-related injury and disease.

Agricultural work poses exceptional injury risk factors for children (Castillo et al, 1998; Castillo et al, 1999; Villarejo and Baron, 1999). Repetitive lifting, bending, stooping, and movements of the hands and wrists in hand-intensive fieldwork expose children to additional hazards (Mobed et al., 1992). Trying to maintain a rapid work pace may place children at risk of future disability (Strong and Maralani, 1998). Being unaccustomed to the work increases the risk of musculoskeletal disorders for new workers, especially for children (Hakkanen et al., 2001). The effects of learning new skills under an unfamiliar environment need to be considered in Spanish-speaking children’s health. Children’s responses to the agricultural hazards and strenuous circumstances may predict their future disability, but we have no data on this.

In addition to the impact of physical labor, long-term effects of exposure to herbicides, pesticides and other chemicals on the well-being of farmworker children have not been described

1  

The term “Hispanic” includes all farm operators of Spanish, Hispanic, or Latino origin regardless of race.

2  

“Farmworker” refers to hired persons who leave their homes and migrate to work in agriculture in one or more states. “Farmworker” also includes people who are hired to work locally in seasonal agricultural jobs but do not leave their permanent residence. The term “adolescent” includes children 12 through 17 years old.

3  

The census of agriculture defines a farm as any place from which $1,000 or more of agricultural products were produced or sold during the reference year.



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Safety is Seguridad: A Workshop Summary Appendix G An Examination of the Occupational Risks and Occupational Safety and Health Communication Needs of Spanish-Speaking Children Who Are Employed or Live on Farms Martha Soledad Vela-Acosta, MD, MS, Ph.D., University of Texas, Health Sciences Center, School of Public Health at Brownsville Acknowledgment: My gratitude to Jimmy Perkins, CIH, Ph.D. INTRODUCTION Children’s health relies on the interaction between their environment (living and working conditions) and their developmental status. While agriculture provides work opportunities for children worldwide, these opportunities also lead to potential risks. Many Spanish-speaking children are working as farm laborers, and face a range of common occupational agricultural risks. They form an emerging occupational group in the United States agricultural industry. Children are present as family members on farms operated by farmers of Hispanic1 origin, as nomadic adolescent farmworkers2 traveling solo, and as part of migrant farmworker groups either as family members or as individuals. While the first two groups are increasing in number, health risks and outcomes are not yet clearly identified for the latter group (which is the largest and includes children). Children living on a Hispanic-owned farm3 face different occupational risks and perceive these risks differently than do adolescent farmworkers, recently arrived from Mexico or Central America, who are farm laborers. In both instances, children work along with their farmworker parents to contribute to their family income, but different risks may be involved for migrant farmworker children and for children on family owned farms. In either case, because children are physically immature, they are more susceptible than adults to work-related injury and disease. Agricultural work poses exceptional injury risk factors for children (Castillo et al, 1998; Castillo et al, 1999; Villarejo and Baron, 1999). Repetitive lifting, bending, stooping, and movements of the hands and wrists in hand-intensive fieldwork expose children to additional hazards (Mobed et al., 1992). Trying to maintain a rapid work pace may place children at risk of future disability (Strong and Maralani, 1998). Being unaccustomed to the work increases the risk of musculoskeletal disorders for new workers, especially for children (Hakkanen et al., 2001). The effects of learning new skills under an unfamiliar environment need to be considered in Spanish-speaking children’s health. Children’s responses to the agricultural hazards and strenuous circumstances may predict their future disability, but we have no data on this. In addition to the impact of physical labor, long-term effects of exposure to herbicides, pesticides and other chemicals on the well-being of farmworker children have not been described 1   The term “Hispanic” includes all farm operators of Spanish, Hispanic, or Latino origin regardless of race. 2   “Farmworker” refers to hired persons who leave their homes and migrate to work in agriculture in one or more states. “Farmworker” also includes people who are hired to work locally in seasonal agricultural jobs but do not leave their permanent residence. The term “adolescent” includes children 12 through 17 years old. 3   The census of agriculture defines a farm as any place from which $1,000 or more of agricultural products were produced or sold during the reference year.

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Safety is Seguridad: A Workshop Summary or assessed. Biological and toxic chemicals may have different effects at different stages of physiological development and may be more damaging to children than to adults with similar exposures. Risks faced by Spanish-speaking children go beyond agricultural hazards. Motor vehicle crashes are the leading cause of injury-related deaths for Hispanics; poisonings are second (CDC, 1998). Hispanic children are at higher risk than non-Hispanic whites for injuries resulting from violence. Hispanics’ lower education levels and higher poverty levels, along with the family disruption and weak intergenerational ties caused by migration, have been shown to increase risk for violent behavior. The number of Spanish-speaking children working in agriculture is large and the likelihood of work-related injury and disease is high (Castillo et al., 1999; Kebebew, 1998; Stallones and Switzer, 1999). Some health and safety preventive measures have been developed to protect children on the traditional U.S. family farm (Lee and Marlenga, 1999; Lee, et al., 2002; NCASH, 1988; NCCAIP, 1996;). However, Spanish-speaking children in agriculture merit interventions developed and targeted especially at them: one size does not fit all. All efforts require thorough evaluation from the perspective of culture and the Spanish language. The diverse needs of Spanish-speaking children and their different environments must be considered. The integration of socio-cultural, developmental, and language circumstances will be a challenge for health and safety professionals. Occupational health risk interventions for Spanish-speaking children can begin with multiparty translations of existing intervention models and the targeting of suitable resources toward this new workforce. For the promotion of health and safety information to succeed in this multicultural and multilingual agricultural industry, the art and science of communication of health risks must be transformed to meet the special needs of children in agriculture. Communication of occupational risks to agricultural employers, parents, and especially Spanish-speaking children requires concentrated efforts to convey culturally appropriate messages to meet the needs of each target group (Finau, 2000). Adequate risk communications engage a tripartite interaction between the sender (health and safety professional), receiver (employer, parent, child) and the medium (hands on, written, visual) (Finau, 2000). The ultimate goal of health and safety professionals must be to provide the optimal environment for all these children to become healthy adults. AGRICULTURE: A DANGEROUS INDUSTRY FOR CHILDREN The National Institute for Occupational Safety and Health (NIOSH) reports more than 2.25 million full-time workers employed in agriculture. If unpaid farm workers and family members 14 and older are included, nearly 4.5 million persons work in agriculture (CDC, 2001). Even though the U.S. agricultural sector provides an increasing and affordable supply of food and fiber, agriculture continues to have the second highest fatal occupational injury and serious non-fatal injury rates for U.S. workers (DOL, 2000a,c). In 2000 the Bureau of Labor Statistics reported that nearly 6,000 workers were killed on the job from traumatic injuries and more than 6.3 million suffered other injuries or illnesses (Caswell et al., 2001; DOL, 2000a). The national cost of injury has been estimated to be more than $50 billion annually (Castillo et al., 1998; DOL, 2000a). Costs for job-related injuries and illnesses are higher than those for AIDS and Alzheimer’s disease and are on a par with those for cancer and circulatory disease, the two greatest causes of mortality (CDC, 2001). The exact number of children working by industry sector is unknown due to diversity in definitions and seasonal variations, particularly in agriculture. Data show that over half of children have held some kind of job in industry by the age of 14 (DOL, 2000c). There are approximately 1 million children (under 15 years of age) who reside in farm operator households,

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Safety is Seguridad: A Workshop Summary while another 800,000 children live in households headed by hired farmworkers (CDC, 2001). During 1996–98, 2.9 million children (aged 15–17) worked during the school months, and 4 million during the summer months (DOL, 2001c). In 1996 working children were estimated to be 7.6 percent (262,000 children 16–19 years of age) of the workforce in the agriculture, forestry, and fishing industries (DOL, 2000a,b). Agriculture employs most of the world’s working children (DOL, 1995). All over the world children labor in occupations and industries that are dangerous or hazardous (CDC, 1995; DOL, 1995). They are exposed to hazards and often perform tasks that are beyond their physical capacity, such as lifting and carrying heavy loads and handling dangerous tools and equipment. Children encounter sharp and unwieldy tools, bites from insects and snakes. They are transported in unsafe vehicles and are regularly exposed to toxic chemical substances (fertilizers, and pesticides). Children often work without protective clothing and under extreme temperatures (Grainger, 1993). Children working in United States fields hold some of the lowest-paying jobs in the country (DOL, 2000c). They are paid less than the already low wages of their adult counterparts. The decision to have a child work is based on short-term economic considerations to the potential detriment of the child’s long-term health and development (DOL, 2000b). Because different laws govern employment of children in agriculture, most remain invisible to health and safety professionals. Many children in agriculture are not included in the population at risk, since only legally working children are recorded (McLaurin, 2000). This evidence suggests a need to redesign institutions to focus on children’s rights, to align the interests of their parents, the agricultural industry, labor, and professional organizations in order to provide the best environment to prevent harm. Agricultural injuries to children are documented as a public health problem (Castillo et al., 1998; NCCAIP, 1996;). The rates of agricultural work-related fatalities in children are disturbing (Castillo et al.. 1999). Child fatality rates are 2.4 times greater than the overall work-related fatality rate for the United States across all ages and all industries (Castillo et al., 1999; DOL, 2000a;). While this statistic is alarming, it may be only the tip of the iceberg. Most estimates indicate that occupational diseases account for far more fatalities than occupational injuries. Precise enumeration of occupational disease fatalities is difficult due to paucity of data, owing to an under-diagnosis of occupational diseases and the inadequacy of surveillance systems (Herbert and Landrigan, 2000). Spanish-speaking children working in agriculture are not a homogeneous group. There are children working on Hispanic family farms. There are an uncertain number of “invisible” children who migrate along with their parents or family members to work on U.S. farms. Spanish-speaking adolescent farmworkers (14–17 years old) are estimated to be 7 percent of the 2 million migrant and seasonal workforce (DOL, 2000b). And, there are other Spanish-speaking children not yet included in these agricultural statistics. For example, significant numbers of children work in the fishing industry. Children dive for fish, work on fishing platforms and boats, collect shellfish and shrimp larvae, peel shrimp, and clean fish. In performing these tasks they often spend long hours in the water and face such hazards as drowning, skin diseases, and attack by dangerous fish. They also risk injury from the tools used for cutting and cleaning fish and seafood. The nature of their work exposes them and their families to an exceptionally high risk of injury and illness (Grainger, 1993). The effects of children’s earnings and workload on their well-being, including mental health, have not been studied in detail. Not all work performed by children may be detrimental or exploitative (DOL, 1998). Children’s work can be viewed as beneficial to the child, family, and society in general. Children working in agriculture as part of a family unit may reduce their parents’ workloads, particularly if earnings are based on weight or piece. They may substitute for parents on domestic tasks, taking care of younger siblings or other family members, while parents are working in the fields for extended hours. Family dependence on children’s earnings may

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Safety is Seguridad: A Workshop Summary contribute to keeping those same children in poverty, since they are often deprived of educational and other opportunities (DOL, 1995; Otis et al., 2001). Children’s lack of developmental skills may increase the probability of agricultural injuries. Child workers are also more susceptible than adults to work hazards due to anatomical differences. The higher vulnerability of children to such environmental stressors as temperature changes, ionizing radiation, and chemicals place them at higher risk than adults for carcinogens, occupational injuries, permanent disabilities, and diseases (Bequele and Meyers, 1995). CHILDREN FROM HISPANIC FAMILY FARMS Hispanics are traditional agriculturalists. Since 1978 the number of farms operated by persons of Hispanic origin increased 58 percent while the total number of farms decreased 15 percent. In 1997 farms operated by persons of Hispanic origin sold commodities worth $3.3 billion, a total of 2 percent of total U.S. crop sold that year. In 1997 the value of vegetables, nuts, berries, and fruits was 22 percent of U.S. crops sold. In contrast, for the same year vegetables, nuts, berries, and fruits accounted for more than 50 percent of crops sold from operators of Hispanic origin. During the last few decades an increased demand for farmworkers to conduct labor-intensive agriculture has been tied to increasing U.S. production of fruits and vegetables (Villarejo and Runsten, 1993). Health outcomes for Hispanics working as hired farmworkers or operators have not yet been elucidated. Operators and hired farmworkers of Hispanic origin have been described as being at significantly increased risk of death from head injuries compared with non-Hispanics in the same job categories (Stallones and Sweitzer, 1999). Estimated injury rates for family workers (some of which are children) on all farms are higher (8.3 injuries per 200,000 hours) than rates for hired workers (4.9 injuries per 200,000 hours) (DOL, 2000c). Occupational risks for children of Hispanic operators are yet to be characterized. Hispanic family farms may provide working opportunities for children on a seasonal basis: full-time during planting and harvest seasons and part-time during the remainder of the year. Spanish-speaking children working on family farms face different situations than children (emancipated minors) working seasonally as hired farmworkers or migrant workers. For example, we do not know what concerns regarding preventing an injury, or disease process, would face a parent who previously was a migrant farmworker while assigning tasks for their children at their own farm? SPANISH-SPEAKING MIGRANT CHILDREN AND ADOLESCENT FARMWORKERS The agricultural industry employs about 2.5 million farmworkers. Hired farmworkers,4 some of whom are adolescents, are four times more likely to die from an occupational injury than to non-farm workers (Crandall et al., 1997). According to the Traumatic Injury Surveillance of Farmers Survey project, Hispanics account for the second highest number of injuries overall (16.8 percent). Hispanics accounted for 51.9 percent of the estimated 59,888 injuries among hired farmworkers (CDC, 2001). The National Agricultural Worker Survey (NAWS) is conducted for agriculture crop operations (DOL, 2000b). According to NAWS, more than 70 percent of the hired crop farmworkers are foreign born (from Mexico and Central America) (Gabbard, et al 1999). Spanish is the primary language of more than two-thirds of these foreign born farmworkers (94 percent of whom are Mexican nationals) (Villarejo and Baron, 1999). One-third of these foreign born 4   “Hired farmworker” is defined in the U.S. census as an occupation employed to perform on-farm tasks for the purpose of producing an agricultural commodity for sale.

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Safety is Seguridad: A Workshop Summary farmworkers do not have authorization to work in the U.S.; they have low education levels and many live in poverty. Mexicanization of the U.S. hired farm workforce, during the last few decades, has several implications for occupational health and safety. An estimated 126,000 farmworker children (14 to 17 years old) performed farm work each year from 1993 to 1997 (Gabbard et al., 1999). Children migrating along with their farmworker parents or relatives face the same hazards as their parents (DOL, 2000b; Villarejo and Baron, 1999). The NAWS data shows the number of children working in agriculture along with their parents has decreased over the last several years. In addition most children of farmworkers are very young (DOL, 2000b). These younger children can be exposed as bystanders to the same work environment and hazards in the fields as their adult family members (DOL, 2000c). Migrant farmworker children are found mostly at vegetable and fruit operations. Vegetable and fruit operations yield the third highest reported number of lost workdays as a result of injuries (Castillo et al., 1999). Nearly two-thirds of all farmworkers live below the poverty threshold, causing difficulty in accessing health care and education. Under-reporting of health conditions is significant as a result of limited access to health services. A small number (10 to 11 percent) of farmworkers receive health insurance through their employers (USDA, 1992; DOL, 2000b;). As a result, most farmworkers and their dependents do not seek regular health care services and look for services only in emergencies. Several studies have emphasized that farmworker families have different cultural concepts of health, injury, and disease (Meade and Calvo, 2001; Villarejo and Baron, 1999; USDA, 1992). Crop agriculture is increasingly the workplace of foreign-born children (CDC, 1995; DOL, 2000b). Adolescent farmworkers consists of unmarried, young males and emancipated minors traveling long distances to obtain temporary agricultural employment (Vela-Acosta and Lee, 2001). Most adolescent farmworkers come from Mexico as emancipated minors to work while living away from their home; they are recent arrivals who are not authorized to work in the U.S. (Gabbard et al., 1999). Their working and living conditions include an exceptional combination of hazards, made worse because they are already a disadvantaged group (Vela-Acosta and Lee, 2001). In addition to exposure to agricultural hazards, all adolescent farmworker are facing additional challenges such as extreme poverty; variable working and living conditions; loss of educational opportunities; separation from their familiar environment; and lack of parental supervision (Castillo et al., 1999). Because of the need to focus first on survival, adolescent farmworkers can jeopardize their own potential. Seasonal agricultural work often conflicts with children’s school attendance. Children frequently miss classes, and some are even forced to give up years of education. On the job children lack medical care, overtime pay, rest breaks, rest days, and formal education. Defenseless migrating children working in agriculture face numerous additional hazards, such as transportation in unsafe vehicles, risk of violence, and physical assault at unsecure locations (DOL, 1995). EFFORTS ADDRESSING OCCUPATIONAL HEALTH AND SAFETY FOR CHILDREN IN AGRICULTURE In 1995 NIOSH organized a national advisory group consisting of clinical, research policy experts to provide advice and direction on occupational health surveillance of adult farmworkers. The major priorities noted by this group are shown in Box 1. Note that children of farmworker families and adolescent farmworkers are working and living under the same conditions as adult farmworkers. All priorities outlined for farmworkers need to be considered in realistic ways for children as well.

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Safety is Seguridad: A Workshop Summary Box 1 Workgroup Reported Priorities for Surveillance and Research of the Occupational Safety and Health of Hired Farmworkers Surveillance Ergonomics, pesticides, traumatic injuries, water quality, respiratory, dermal, eye, infectious diseases, cancer and mental health Research Pesticides, ergonomic, injuries, effect of protective measures, cancer, comparison population and mental health Project Design Methods Regional and local studies, national and international studies, special populations Source: CDC, 2001. In response to children being injured while living, working, or visiting agricultural work environments (primarily traditional English-speaking farms) the National Committee for Childhood Agricultural Injury Prevention reached consensus on research, education, policy, and other interventions aimed at the reduction of agricultural injuries among children; in October 1996 NIOSH announced support of these recommendations (see Box 2). As a result North American Guidelines for Children’s Agricultural Tasks (NAGCAT), supported by NIOSH, developed non-regulatory guidelines for children working under parental supervision (Lee and Marlenga, 1999). Overall, preventive initiatives to protect children working in agriculture have not been directed at issues affecting Spanish-speaking children, particularly migrant children. Work has focused only on children who reside on family farms, and for the most part only on injury prevention (Lee and Marlenga, 1999; Lee et al., 2002; NCASH, 1988; NCCAIP, 1996). Health care for migrant children demands special consideration by health professionals. In 2000 the American Academy of Pediatrics joined efforts with the Migrant Clinicians Network and completed guidelines for the care of migrant farmworker children (McLaurin, 2000). This manual assists clinicians in becoming familiar with the risks and characteristics of migrant farmworker children. Some guidelines from the manual are clearly linked to the occupational health of Spanish-speaking children (see Table 1) (McLaurin, 2000). Health care experts serving Spanish-speaking children are urged to work to provide a hazard-free environment at worksites, home and schools. The National Adolescent Farmworker Occupational Health and Safety Advisory Committee (NAFOHSAC) (see Box 3) is the first national effort to address adolescent farmworkers as a population at risk (Vela-Acosta and Lee, 2001). The multidisciplinary committee consisted of farmworker parents, adolescent farmworkers, researchers, non-government organizations, health care providers, federal and state agency representatives, and agricultural employers. The committee gathered information from published literature, external sources, committee discussions, focus groups, and a committee workshop. The report review involved input from committee members and peer reviewers across the United States (Vela-Acosta and Lee, 2001). NAFOHSAC has the potential to create a foundation for improving the working conditions of adolescent farmworkers (Lee et al., 2002).

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Safety is Seguridad: A Workshop Summary Box 2 Recommendations from the National Committee for Childhood Agricultural Injury Prevention Establish and maintain a national system for childhood agricultural injury prevention. Ensure that childhood agricultural injury prevention is supported with sufficient funding and cooperation from the public and private sectors. Establish guidelines for children’s and adolescent’s work in the industry of agriculture. Ensure that the public is aware of general childhood agricultural safety and health issues. Establish and maintain a comprehensive national database of fatal and non-fatal agricultural injuries. Conduct research on costs, risk factors, and consequences associated with children and adolescent who participate in agricultural work. Use systematic evaluations to ensure that educational materials and methods targeted toward childhood agricultural safety and health have demonstrated positive results. Ensure that farm and ranch owner/operators and parents understand relevant agricultural safety and health issues that pertain to children and adolescents. Ensure that rural safety and health professionals understand the issues relevant to children and adolescents exposed to agricultural hazards. Influence adult behaviors that affect protection of children and adolescents through the use of incentives and adoption of voluntary guidelines. Provide a protective and supportive environment for children exposed as bystanders to agricultural hazards. Source: NCCAIP, 1996. TABLE 1 Recommendations for Pediatricians about the Health Care of Migrant Farmworker Children Health Care Guidelines Policies Affecting Migrant Farmworkers 1. Well-Child Visits 2. School Readiness 3. Immunizations 4. Adolescent Care 5. Oral Health 6. Environmental Concerns: Lead, pesticides, groundwater contamination 7. Child Maltreatment 8. Injuries: Machinery, fatal injuries, animal-related, falls Violence, legal, and socio-cultural factors 9. Infectious Diseases: Tuberculosis, acquired immunodeficiency virus (AIDS), parasitic infestation, protozoan infections, zoonosis (Leshmaniasis), malaria, congenital syphilis 1. Fair Labor Standards Act 2. Migrant Health Programs 3. Medicaid 4. Vaccines for Children 5. Supplemental Nutrition Program for Women, Infants, and Children (WIC) 6. Foster Care, Adoption and Children with Special Needs 7. State Children’s Health Insurance Program (SCHIP) 8. School Entry   Source: McLaurin, 2000.

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Safety is Seguridad: A Workshop Summary Box 3 Goals from the National Adolescent Farmworker Occupational Health and Safety Advisory Committee Goal I: Identify profiles of hired adolescent farmworkers employed in production agriculture across the United States. The Department of Labor (DOL) and the National Institute for Occupational Safety and Health (NIOSH), with the cooperation of migrant non-profit organizations, state health departments, and the Migrant Clinicians Network (MCN), should be funded to develop and maintain a regional ongoing database of occupation demographics. Wage and hour divisions at state levels, in coordination with migrant agencies, DOL, NIOSH, and the U.S. Department of Agriculture (USDA) should coordinate efforts to assess occupational risks at adolescent farmworkers’ worksites and housing locations, which often are separate. Worksites where adolescent farmworkers are employed should provide facilities and resources that address adolescents’ needs, including personal hygiene, emergency contact information, telephone communications, and adult supervision. Goal II: Identify occupational risks that are potentially unique and specific to hired adolescent farmworkers. Congress should allocate funds to the Centers for Disease Control and Prevention (CDC), designating NIOSH to plan, implement, and evaluate intramural and extramural research to promote best work practices and to improve the health and safety of hired adolescent farmworkers. NIOSH can convene a group of agricultural safety specialists, agricultural producers, and occupational health care providers who work with hired adolescent farmworkers to evaluate progress to improve their working conditions. Information gathered by these experts on ways to minimize risk factors should be disseminated to health professionals, agricultural employers, and others serving adolescent farmworkers to help them understand agricultural risks by commodity groups. Congress should allocate funds to the CDC, designating NIOSH as the leading agency along with the DOL and the USDA, to establish data collection methodologies that will identify major sources of occupational risks, disease, and injury among adolescent farmworkers by crop, region, and type of employer. Comprehensive analysis of exposure to work hazards should integrate environmental conditions, ergonomic hazards, and physiological factors for adolescents. Research efforts need to be targeted to regions where adolescent farmworkers are concentrated. The Environmental Protection Agency (EPA), DOL, migrant health professionals, agricultural health and safety professionals, agricultural employers, and others should provide language-and culture-appropriate access (e.g., toll-free telephone) for adolescent farmworkers to express their work questions and concerns about occupational hazards. Goal III: Plan, implement, and evaluate interventions to eliminate or minimize occupational health and safety risks of hired adolescent farmworkers. Congress should fund the NIOSH Agricultural Centers and the USDA Cooperative Extension Services, through the Risk Management Education Division (RMED), to support agricultural employers’ associations in the establishment of systems to educate agricultural employers, supervisors of adolescent farmworkers, and farm labor contractors about adolescent farmworkers’ occupational risks and prevention strategies. Agricultural employers’ organizations and others should facilitate discussions among members and researchers to promote best work practices helping agricultural employers to identify practical solutions for occupational hazards among adolescent farmworkers. They can provide time during regional, state, and national meetings for major presentations and group discussions to report innovative and effective interventions.

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Safety is Seguridad: A Workshop Summary NIOSH should be funded to provide agricultural employer-targeted evaluation studies to determine the cost-effectiveness of intervention programs aimed at preventing occupational disease and injury among adolescent farmworkers. The American Academy of Pediatrics (AAP), North American Agromedicine Consortium, NIOSH, and other relevant organizations should provide advanced training for health professionals on occupational health and safety conditions in agriculture, with a special focus on adolescent farmworkers. NIOSH should evaluate the impact of the agricultural media in enhancing public awareness to effectively promote best work practices involving adolescent farmworkers among agricultural employers. A coordinated, regional approach should be established to address adolescent farmworkers’ occupational health and safety needs. Funding should be available to universities, NIOSH Agricultural Centers, and others to provide adolescent farmworker educational health and safety interventions. Those actions will (1) maximize collaborative efforts with current initiatives; (2) develop language and culturally appropriate materials; (3) assess adolescent farmworkers’ safety risk perceptions; (4) account for cultural beliefs about safety practices; and (5) be tailored specifically to adolescent learning needs and not just a part of a general session for all workers. Congress should create a Farmworker Adolescent Network (FAN) and designate the DOL, the USDA, NIOSH, and the EPA to lead and coordinate a multi-organization network for addressing adolescent farmworkers’ occupational health and safety research and program activities. Organizations representing agricultural employers, migrant health professionals, migrant advocates, adolescent farmworkers, and agricultural safety professionals should be represented in this new FAN. Joint venture funds from public and private sectors should be encouraged to support FAN to fund regional and national initiatives, including data collection, research, training, and innovative prevention programs based on significant research findings from convened groups and FAN. Source: Vela-Acosta and Lee, 2001. The Childhood Agricultural Injury Prevention Progress Report and Updated National Plan (NCCAIP, 1996) has reviewed and updated the progress by the National Committee for Childhood Agricultural Injury Prevention (see Box 4) (Lee et al., 2002). The report emphasizes that education is not enough to deal with childhood injuries. The update recommends a multifaceted approach that incorporates systematic evaluations in addition to empowerment of agricultural key players (farm families, rural schools, farm and community groups, agribusinesses, and agricultural trainers). Concerns expressed in the report, include the lack of efforts to address children at risk in agriculture other than those on traditional family farms. In addition, the adoption of programs by agricultural employers needs to be cost effective and advantageous to them if they are to be used. FUTURE DIRECTIONS FOR COMMUNICATING RISKS TO SPANISH-SPEAKING CHILDREN Many factors need to be considered in reducing risks for Spanish-speaking children who work in the agricultural industry (see Box 5). Children’s basic necessities (nutrition, education, rest, adult guidance, support for development, and recreation) in addition to agricultural work demands, financial, and socio-cultural needs should be considered. Interventions for Spanish-speaking children should be matched to their unique requirements. NIOSH expertise in agriculture can provide the necessary leadership to improve the health and safety of Spanish-speaking children.

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Safety is Seguridad: A Workshop Summary Box 4 Goals of the Childhood Agricultural Injury Prevention Progress Report and Updated National Plan from the 2001 Summit Adults will ensure that young children and non-working youth can grow, play, learn, and rest in protective environments that are free of agricultural hazards. Young workers will receive agricultural safety training, guidance, personal protective equipment and adult supervision based on child development principles. A strong public and private infrastructure will be maintained to ensure the vision, leadership, and national commitment necessary to prevent agricultural injuries. Source: Lee et al., 2002. Appropriate interventions must be based on collective efforts by government, health and safety professionals, agricultural employers, parents, and educators (CDC, 2001). Cost-effective measures need to be implemented to promote the adoption of best work practices for Spanish-speaking children. How can a parent, educator, or agricultural employer affect the occupational risks and health outcomes at the worksites for Spanish-speaking children? Interventions have been concentrated on educational materials, assessments, and evaluations for English-speaking children who reside on family farms (NCASH, 1998; NCCAIP, 1996; Lee and Marlenga, 1999; Lee et al., 2002). Safety guidelines, which can be used as a starting point, are available for children performing agricultural tasks (Lee and Marlenga, 1999). Spanish-speaking children are a unique population at risk, and careful evaluation for the appropriateness of these guidelines to their situation needs to be considered. Are those resources suitable for parents who supervise their Spanish-speaking children? How can a parent, educator, or agricultural employer prevent adverse health outcomes in the work experiences for Spanish-speaking children? Agricultural tasks performed by Spanish-speaking children, particularly by migrant and adolescent children, warrant serious consideration by NIOSH. Communication of occupational risks must be tailored for each audience (see Box 5). Lack of understanding of the importance of culture has been reported as a major obstacle in addressing health disparities (Kritek et al., 2002). Culturally appropriate program goals can be attained by integrating the unique perceptions of risk for Spanish-speaking children. While advertisements, written materials, and the media may be helpful, community efforts should include employers as partners in order to make materials accessible at sites where the young Spanish workers may receive the information (Ford et al., 2001). As noted earlier, exposures to agricultural hazards may lead children to injury, disease, or permanent disability (Bartels et al., 2000; Kebebew, 1998; Rittichier and Bassett, 2001). Rarely in any occupational setting is there an exposure to a single agent. Rather, it is a mixture of hazards that may act antagonistically, synergistically, or additively. Children are exposed to work hazards which vary in agricultural workplaces, and hazards are changing as the result of new technologies. Once occupational risks are identified for each group of Spanish-speaking children by commodity and region, clear messages to address these risks need to be developed. Straightforward, practical messages in their own languages are the means to empower Spanish-speaking children about the best ways to protect themselves from physical (heat, noise, vibration), biological (infectious agents), and chemical hazards (see Box 5). Risk factors for Spanish-speaking child populations are more complex than those traditionally seen in agriculture (see Boxes 3 and 5). Messages for the children need to be consistent with their reality. For example, farmworker populations, including their children, often

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Safety is Seguridad: A Workshop Summary Box 5 Factors to Consider in Addressing and Communicating Occupational Risks to Spanish-Speaking Children At-risk groups People living on Hispanic farms Traveling with migrant farmworkers: Bystanders Working Adolescent farmworkers Still ‘invisible’: fishing industry Hazards Physical (transportation, noise, heat) Chemical (pesticides, insecticides, fertilizers, lead) Mechanical (motor vehicle, farm tools, Biological (sanitation, infectious agents, immune response) Psychosocial (ddevelopmental stages, cultural background, financial need, substance abuse) Ergonomic (appropriateness, body size) Risk Factors Age Gender Language skills Education Cultural beliefs Perception of risk Financial need Family influence Work experience Adult supervision Geographical location Agricultural task Agricultural crop Migration Labor law Legal status Mental health Developmental status Agricultural contractor Housing Audiences for Reducing Risk Hispanic farm families Migrant and seasonal farmworkers Adolescent farmworkers Community based organizations Government and federal organizations Health and safety professionals Agricultural employers Educators and trainers Note: In this table, “hazard description” is not all-inclusive but is intended to highlight overlying effects and hazards of particular concern for children. These hazards are specific to the constantly changing agricultural work environment.

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Safety is Seguridad: A Workshop Summary have no control over the provision of sanitary facilities in the fields or at labor camps. Lack of access to decontamination facilities exacerbate their exposure to chemical and biological hazards due to prolonged skin contact (EPA, 1993; Vela-Acosta, 1999a,b; Vela-Acosta et al., 2002).Carefully designed safety messages are ineffective for the adoption of safety behaviors when work and living environments do not support the suggested modified behavior (Vela-Acosta, 1999a,b; Vela-Acosta et al., 2002). Strategies to increase adequate environment and adoption of safe behaviors in agriculture must be cost effective for both workers and employers. Clear benefits need to be communicated to children, agricultural employers, parents, and educators. Access to receptive audiences can start with community organizations, agricultural employer organizations, migrant organizations, and others reaching this population. Comprehensive, coordinated efforts are necessary to prevent agriculture-related injuries and diseases for all Spanish-speaking children and adolescents (see Boxes 3 and 5). Communicating benefits of safety and health provisions to each audience is very important. For example, operators of the 2.75 million farms and ranches need to embrace appropriate preventive innovations. Safety interventions often have a low rate of acceptance when benefits will occur in the future and are directed to protect renewable human resources while not directly increasing farm profits (Caswell et al., 2001). Additional efforts at agricultural childhood initiatives must include an extraordinary population at risk: Spanish-speaking children. Health and safety professionals are obligated to provide better guidance to agricultural employers and parents after evaluating work exposures and work benefits for children in agriculture. The most effective methods for communicating occupational risks should be identified by researchers and taught to agricultural employers, educators, and parents. Clear risk communications are required to have a significant impact on changing the environment provided for children. Public health professionals and policy makers should be informed about the risks children face in their communities. All changes in communicating occupational risks must take effect through collaboration between government, industry, labor, and academia. Each message being disseminated to a particular audience needs to be functional. Practical and theoretical reference materials should be emphasized. Research findings and new technology should be readily transferred from scientists to health and safety professionals, employers, educators, and parents to ensure reduction of occupational injuries and diseases resulting from exposures to each agricultural work environment. The first step in decreasing occupational risks is to adequately communicate the risk in the words of the population in need. Adequate interventions are needed to modify living and working farm environments to decrease disease and injuries and ensure healthy young adults. Ideally, this work to improve safety needs to be regional and international. Multinational health and education outreach programs need to be developed and funded in order to serve the best interest of the health of all future working adults (Villarejo and Baron, 1999). Goals from previous childhood initiatives, relevant to Spanish-speaking children, such as recommended actions from the NAFOHSAC (particularly under Goal II and III, Box 3), and other relevant initiatives can set preliminary objectives to be supported by NIOSH throughout partnerships with universities, agricultural research, and health centers to minimize the occupational health and safety risks of all Spanish speaking working children (Lee and Marlenga, 1999; Lee et al., 2002; McLaurin, 2000; NCCAIP, 1996; Vela-Acosta and Lee, 2001). In addition, efforts are needed to eliminate risks for all working children regardless of their native language. Regional approaches are required to involve community organizations, private initiatives, and all interested parties to protect the future well-being of Spanish-speaking children.

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