Development of a life events/icon calendar questionnaire to ascertain occupational histories and other characteristics of migrant farmworkers.

BACKGROUND: Specialized methods are necessary to collect data from migrant farmworkers for epidemiologic research. METHODS: We developed a questionnaire that collected lifetime occupational histories and other lifestyle risk factors via a life events/icon calendar, and administered the questionnaire to a convenience sample of 162 migrant farmworkers in nine areas of the U.S. RESULTS: The average duration of the interviews was about 1 h 30 min, with an average of 45 min for the work history section. The occupational histories covered a median of 27.6 years per person for men and 20.8 years per person for women. The median number of years spent in farm jobs was 11.3 for men and 5.8 for women. The median number of farm jobs (crop/task combination) per person was 59 among men and 27 among women. Many farmworkers performed the same crop/task combinations at multiple times throughout their lives, yielding a median of 13 unique farm jobs and 8 unique crops among men and 7 jobs and 5 crops among women. CONCLUSIONS: The project demonstrated that it is feasible to collect detailed work histories and other risk factor data from farmworkers, documented the complexity of work histories encountered among farmworkers, and yielded recommendations for refining a questionnaire that will facilitate future epidemiologic research on farmworkers.

A comparison of the perceived health needs of Amish and non-Amish families in Cashton, Wisc.

Cashton area residents were queried on past health care experiences and asked their opinions of services that could be provided at the Scenic Bluffs Community Health Center (SBCHC) in Cashton. A questionnaire addressed to both Amish and non-Amish residents featured five main areas: (1) additional services and health care providers that might supplement existing services at SBCHC; (2) opinions on establishing a birthing center; (3) mothers' past history with the birth and care of children, including immunization use; (4) respondents' past use of health care; and (5) perceived barriers to receiving health care. Both Amish and non-Amish respondents agreed that walk-in care, dental care, and 24-hour telephone access to a provider were important services to be added, and that a dentist, chiropractor, and pharmacist would be valuable. While both Amish and non-Amish favored the idea of a birthing center, their reasons for supporting it differed. It was also found that routine preventive care was used much more by the non-Amish than the Amish population. Common barriers to health care for both groups included cost of care, appointment availability, and waiting time for appointments.

Using a voucher system to extend health services to migrant farmworkers.

FAMILY HEALTH/LA CLINICA de los Campesinos, Inc., is a federally funded migrant health clinic in the heart of Wisconsin's farmland that has offered outpatient health care since 1973 and an accompanying "voucher" program since 1988. The charges for outpatient care are based on the ability to pay. The clinic issues vouchers not only to migrant workers living and working in remote parts of the State but also to patients needing services the clinic does not offer. Between 1 April 1992 and 30 March 1993, 677 participants submitted 1,794 vouchers that provided for $83,833 in partial health care payments. La Clinica paid a median amount of $22 for each voucher, its reimbursement value ranging from $1 to $979. Hospitals received the highest median payment and pharmacies the lowest. Voucher payments generally covered 60% of the bill, but dentists commanded a higher percentage(70%) and clinics and medical groups a lower one (42%). Most vouchers paid for procedures and services La Clinica could not provide. This program shows how a health care provider in one location, with a patient population scattered throughout a sizeable geographic area, can coordinate services not offered at its facility. With the national spotlight on health care reform, the concept of vouchers for people in outlying or underserved regions deserves further investigation.

Economic and health needs of Wisconsin migrant farm workers.

Migrant farm workers play an essential role in the planting and harvesting of crops in our agricultural production system. In the United States today, about 6 percent of the paid farm labor force "follow the crops" across the nation. This article reports on the economic and health care needs of migrant farm workers who travel from the border areas of Texas to Wisconsin each year. Surveys conducted in 1978 and 1989 show that this population remains in serious need of health care and access to financial assistance programs. During the 11-year interval between surveys, little change occurred in the health care status or use patterns of Wisconsin migrant workers, although housing and sanitary conditions in the work environment improved somewhat due to the passage of new federal regulations. This article discusses the problems and barriers that migrants continue to face and offers recommendations for government action.

Health status and needs of migrant farm workers in the United States: a literature review.

Migrant farmworkers lead a hard life filled with strenuous work, stress, and anxiety about employment; live under substandard conditions; and rarely get the health care they require. Preventive care is a luxury they cannot afford. Year-round nutritious meals are rarely possible, due to long working hours, traveling, and living in housing without adequate cooking and refrigeration facilities. Children may attend up to six or more schools during the course of a school year. Crowded housing conditions support the invasion of parasites, infectious diseases, and viral infections. Dermatological conditions from working around a wide variety of plants, dirt, and in the sun are frequent. Exposure to pesticides, herbicides, and other chemical additives creates the likelihood of acute reactions, such as headaches and rashes, and also puts workers at risk of developing chronic diseases as the level of exposure rises because of accumulation and mix of various chemicals. Yet, we know little about the health status of this population. We are unable to estimate crude death rates, age-specific death rates, or prevalence rates of most common causes of death, such as heart disease,cancer and stroke. There is no information about occupational accident rates, infectious disease rates, or even postneonatal mortality. We do know that when migrants go to a clinic, they are often likely to have the chronic conditions of hypertension or diabetes. They present symptoms of acute conditions such as dental problems, dermatitis, otitis media among children, and acute upper respiratory infections. Women frequently need obstetrical care, reflected (ABSTRACT TRUNCATED AT 250 WORDS)

Psychiatric emergency services: evolution, adaptation and proliferation.

This paper traces the dramatic rise of psychiatric emergency services (PES) and crisis intervention services over recent decades. It examines three processes--the evolution of such services, their adaptation to diverse settings, and the striking increase both in the number of programs and their utilization. PES first evolved along three disparate lines--makeshift psychiatric emergency care in the emergency room of the general hospital, ad hoc after-care services in the psychiatric hospital, and the community mental health movement. Community mental health legislation of the 1960s not only provided funds for PES but led to the merging of the three lines. PES have adapted to and are found in a great variety of settings. The latter include small general hospitals and huge medical centers; county, state, and private mental hospitals; free clinics; telephone hot-lines, and others. Their adaptability appears due to their flexible personnel requirements and lack of need for an elaborate technology. Although fewer than 160 facilities were known to offer PES in 1963, their number exceeded 2000 by the early 1980s. Available piecemeal data indicate constantly increasing utilization of PES. This is a result of many factors, including deinstitutionalization. Although PES were initially visualized as resources for acute mental health care and continue to serve as such, they have become increasingly chronicized, consequent on the deinstitutionalized abandonment of many chronically ill persons. Changes are also occurring in the social and demographic characteristics of persons utilizing PES and in the ways in which the services are perceived and utilized. The early development of unlabeled and makeshift psychiatric emergency care in the general hospital's emergency room and the psychiatric hospital were instances of 'evolutionary planning'.(ABSTRACT TRUNCATED AT 250 WORDS)

Hispanics in Wisconsin, 1980.

PIP: Hispanics comprise 1.3% of Wisconsin's total population, making them the 3rd largest racial and ethnic group, following whites (94.4%) and blacks (3.8%). This note contains information on the demographic, social, and economic characteristics of Wisconsin's Hispanic population, based on 1980 Census of Population data. 2 factors have contributed to the growth of the Hispanic population in Wisconsin: 1) Hispanic women bear more children, on average, than other Wisconsin women--3.7 compared to 2.9; and 2) in-migration is large. Hispanics in Wisconsin, as in the US, live primarily in cities. Over 1/3 of all Hispanics are less than 15 years old, compared to 1/4 of the total population. Because of the large number of Hispanics in younger age groups, the proportion of single Hispanic persons is higher than the proportion of all single persons in the state, while the proportion of married persons is lower. 80% of Hispanic households are family households, compared to 73% of all Wisconsin households. Although higher education and full employment are important to meet the needs of the Hispanic population, Hispanics have lower levels of education and higher rates of unemployment than Wisconsin residents as a whole. Lack of education and high unemployment result in wide-spread poverty among Hispanics, especially amoung female-headed Hispanic families--nearly 1/2 wer lving in poverty in 1979. With regard to socioeconomic characteristics, there is consideralbe variation among Hispanic heritage groups.^ieng

Health and mortality of migrant farm children.

This research examines preventive medical care, morbidity and mortality among children of migrant agricultural workers using a representative sample of migrant families in Wisconsin. Our findings support the view that this group is at substantially greater risk of health problems and early mortality than the general population. Fewer than half of migrant children under age 16 received the recommended annual physical checkup. Only one-third of migrant children under age 16 had received an annual dental checkup compared to 50% of children in the total population. A rough comparison between levels of chronic health conditions for migrant children and those reported for children in a national survey suggest that the incidence of chronic conditions is several times greater among migrant children. Childhood mortality appears to be 1.6 times higher than in the U.S. population. In analyzing variation in preventive care for migrant children, younger children are more likely to receive checkups, while older children are more likely to receive immunizations. In interpreting this finding, we suggest distinguishing between two types of preventive care: one under the direct control of the family, and the other controlled by the schools. Since immunizations are given to migrant children in schools, the older or school-age children are more likely to be immunized. In assessing reports of chronic conditions, we noted that mothers who spoke English were more likely to report that a child had a chronic condition. One possible interpretation is that women who do not speak English may not label various childhood conditions as chronic illnesses. Since a large proportion of women spoke only Spanish, the chronic conditions may be substantially under-reported among migrant children. The analysis of childhood mortality shows the level of mortality to be proportionally lower among women who spoke English, and higher among those who gave birth to a low birth weight child. But surprisingly, the most important characteristic related to loss of children was whether or not a mother smoked. Using smoking as one example of high risk behavior, we suggest that future studies should give closer attention to the impact of parental risk-taking behaviors on childhood morbidity and mortality experiences.

Medical utilization patterns of Hispanic migrant farmworkers in Wisconsin.

In a survey conducted in 1978 of a 10 percent stratified random sample of Wisconsin migrant agricultural workers, the self-perceived health status and the medical utilization patterns of the Hispanic workers in the sample (92 percent of the total group) were examined.Based on prior research with national populations, it was hypothesized that older, female, better educated, and English-speaking workers would have higher utilization levels. Utilization was measured by four variables: a physician or clinic visit in the preceding year and ever having had a general physical examination, a dental visit, or a vision checkup.The survey results, based on unverified self-reported data, indicated that in general the use by migrant workers of health services, especially preventive care, was low compared with other populations. Some of the hypotheses that were tested were confirmed by the survey data: older workers were more likely to have visited a physician in the preceding year and to have had a routine physical examination; women were more likely to have seen a physician in the preceding year and to have had a dental visit; workers who spoke English as well as Spanish (usually the younger workers) were more likely to have been to a dentist and to have had a vision checkup. Educational attainment was not related to any of the utilization measures.Besides the demographic factors related to medical utilization, the survey revealed barriers to care related to time, distance, language, and money. Access to a migrant health clinic and the availability of Medicaid were related to dentist visits and vision checkups. Thirty-eight percent of the migrants had used migrant health clinics; only 14 percent had used Medicaid to pay medical bills; about one in five had no means of payment except his or her own funds.

Food patterns in an urban population: age and sociodemographic correlates.

Age and sociodemographic differentials in food patterns were examined in a probability sample of 372 households in a midwest metropolitan county. Two aspects of food patterns were delineated: food intake and eating patterns. Food intake was measured by the 24 hr recall method, and eating patterns by frequency of eating, skipping meals, and foods consumed shortly after rising. Meat was the only food consumed with recommended frequency by all age groups. Dairy products were reported with less than one-half the recommended frequency by all age groups over 35. The elderly consumed less milk, but more fruits and vegetables, and more breads and cereals than younger groups. The aged reported fewer eating episodes on the recall day, although they tended to skip fewer meals. Multiple regression analysis indicated that food intake and eating pattern differences by age remained when the effects of income, education, household compostion, and gender were controlled.

The effects of social characteristics on the utilization of preventive medical services in contrasting health care programs.

This study, based on household interviews of employed individuals and their families, examines the effects of type of health insurance program and various sociodemographic factors on patterns of use of preventive medical services. A major concern of the paper is to explore the issue of whether participants in prepaid group practice use preventive services more than those in alternative insurance plans. The results show little differences in utilization among subscribers in a prepaid group plan as compared with a comparable sample of those in Blue Cross-Surgical Care plans. However, children in the prepaid plan, as compared with those in the more traditional Blue Cross plans, were more likely to receive general checkups and tuberculin skin tests in the prior year. Contrary to expectations, we found that in the employed population studied, black adults reported more preventive medical utilization than whites, and the black-white difference was the strongest single sociodemographic correlate of adult utilization of preventive care. The reporting of general checkups for children was highest among single-child families, for children under five years of age, and for those with better educated parents.