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© 2009 American Public Health Association
DOI: 10.2105/AJPH.2008.149146
RESEARCH AND PRACTICE |
Alicia L. Salvatore, Jonathan Chevrier, Asa Bradman, Meredith Minkler, and Brenda Eskenazi are with the Center for Children's Environmental Health Research, School of Public Health, University of California, Berkeley. José Camacho and Geri Kavanagh-Baird are with Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS) and Clínica de Salud del Valle de Salinas, Salinas, CA. Jesús López is with California Rural Legal Assistance, Salinas.
Correspondence: Correspondence should be sent to Brenda Eskenazi, Center for Children's Environmental Health Research, UC Berkeley School of Public Health, 2150 Shattuck Ave, Suite 600 MC 7380, Berkeley, CA 94704 (e-mail: eskenazi{at}berkeley.edu). Reprints can be ordered at http://www.ajph.org by clicking on the "Reprints/Eprints" link.
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ABSTRACT |
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 TOP ABSTRACT INTRODUCTIONMETHODSRESULTSDISCUSSIONHuman Participant ProtectionReferences |
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We evaluated a community-based participatory research worksite intervention intended to improve farmworkers' behaviors at work and after work to reduce occupational and take-home pesticide exposures. The workers received warm water and soap for hand washing, gloves, coveralls, and education. Self-reported assessments before and after the intervention revealed that glove use, wearing clean work clothes, and hand washing at the midday break and before going home improved significantly. Some behaviors, such as hand washing before eating and many targeted after-work behaviors, did not improve, indicating a need for additional intervention.
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INTRODUCTION |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONHuman Participant ProtectionReferences |
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Agricultural pesticide exposure among farmworkers is a long-standing occupational health and environmental justice concern.1–3 The importance of preventing farmworkers' pesticide exposures is underscored by research documenting exposures to farmworkers' children from agricultural pesticide residues brought home by parents4–11 and potential adverse neurodevelopmental effects.12–14 Although effectively preventing pesticide exposures at work is paramount for safeguarding the health of farmworkers and their families, few comprehensive worksite programs, including the Environmental Protection Agency's Worker Protection Standard,15 have been evaluated.16
We conducted a cluster-randomized, controlled trial of a community-based participatory research (CBPR) worksite intervention to reduce farmworkers' occupational and take-home pesticide exposures. To our knowledge, this was the first evaluated worksite intervention that integrated behavioral and environmental components and provision of protective clothing. Here we report the intervention's effect on farmworkers' behaviors; impact on exposure was reported previously.17
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METHODS |
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The worksite intervention and evaluation were jointly developed and conducted by university and community partners of the Center for Children's Environmental Health Research at the University of California, Berkeley.18,19 CBPR principles (e.g., that the work involve a participatory, colearning process, build community capacity, and balance research and action) were followed.20,21 The Center's Community Advisory Board, Farmworker Council, and field staff, many of whom were former farmworkers, participated throughout the project.
Intervention
Farmworkers (n = 130) employed at 2 Monterey County CA, strawberry farms participated in the intervention trial from July through October 2003. Spanish-speaking farmworkers who were 18 years or older and planned to work with their employer throughout the study period were eligible. Six crews were randomized to control or intervention groups.
Consistent with social ecologic theory, the worksite intervention included both individual (e.g., worker education) and environmental (e.g., availability of warm water, soap, and protective clothing) components.22 At the suggestion of community partners, warm water was made available in hand-washing facilities to reduce cultural barriers (i.e., the belief that washing hands with cold water causes arthritis). Propane water heaters and soap were provided, and water tanks were insulated. Workers received lightweight cotton–polyester coveralls, which they left for laundering at the end of the day in collection bins. Disposable nitrile gloves were available in the field. Four weekly field-based educational sessions were conducted to increase awareness of pesticide exposures, promote safe behavior at work and after work, and troubleshoot barriers to carrying out recommended behaviors. After final data collection, the control group received coveralls, gloves, and training about reducing pesticide exposures.
Data Collection and Analysis
Farmworkers' characteristics and behaviors were assessed before and after 2 months of intervention with a standardized interviewer-administered questionnaire similar to instruments used previously.8,23–25
We used multilevel mixed-effects linear, logistic, or Poisson regressions, accounting for clustering, to examine baseline-to-exit changes within and between groups. Final models included group (intervention versus control), time point (baseline versus exit), and an interaction term of group and time point. All observations were included, and we adjusted the models for gender. We considered P values lower than .10 for interaction statistically significant.
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RESULTS |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONHuman Participant ProtectionReferences |
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Sociodemographic characteristics and behaviors were balanced at baseline (Table 1). Study completion (63%) was similar in the intervention and control groups. Few significant sociodemographic differences were found between farmworkers who did and did not complete the study. Most dropouts (71%) moved or changed employers.
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Glove use, wearing clean work clothes, and hand washing at the midday break and before going home improved significantly (Table 2). Almost all (92%) intervention participants used coveralls. We observed few improvements in after-work behaviors.
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DISCUSSION |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONHuman Participant ProtectionReferences |
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Our results indicated that this intervention was effective in promoting several behaviors that may reduce occupational and take-home pesticide exposures. Absence of improvement in some hand-washing behaviors suggested a need for additional intervention. Decreasing the distance to hand-washing facilities (currently within a quarter mile per regulation), increasing break time (currently 2 breaks for 15 minutes and 1 for 30 minutes), and altering worker payment policies (from piece rate to hourly compensation) might increase hand washing. Difficulty in changing after-work behaviors encountered in this and other studies26 emphasizes the importance of preventing pesticide exposures at work.
The CBPR orientation and participation of growers and farmworkers in the development of the intervention likely strengthened the intervention's relevance.27 Although our findings are not generalizable to farmworkers in all crops or regions, applicability to real-world settings, an important facet of external validity, may have been enhanced by the inclusive study design.28 Study limitations included potential overreporting of behaviors, modest sample size, and relatively short study period. Additional research to assess the effects of this intervention is needed and may be improved by including systematic observation, increasing the number of worksites, and examining the sustainability of behavior change.
Preventing agricultural pesticide exposures to farmworkers and their families is imperative. CBPR, with its focus on engaging critical stakeholders and translating research into action, is a promising orientation through which to address this important environmental justice issue.
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Human Participant Protection |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONHuman Participant ProtectionReferences |
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This study was approved by the institutional review board of the University of California, Berkeley. Participants gave written informed consent
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Footnotes |
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Peer Reviewed
A. L. Salvatore coordinated the study, conducted the data analysis, and wrote the article. J. Chevrier assisted with analysis. A. Bradman contributed to the design of the study. J. Camacho, J. López, G. Kavanagh-Baird, and M. Minkler assisted with the study. B. Eskenazi designed and supervised all aspects of the study. All authors conceptualized ideas, interpreted findings, and commented on drafts of the manuscript.
Accepted for publication June 5, 2009.
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References |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONHuman Participant ProtectionReferences |
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