Review of the Knowledge, Barriers, and Facilitators of HPV Vaccination among Latino Migrant and Seasonal Farmworkers in the United States.

One subgroup of Latinos whose healthcare needs must be more thoroughly addressed is the roughly three million farmworkers pursuing seasonal agricultural work within the United States (U.S.). Latino migrant and seasonal farmworkers (MSFW) face compounded political, social, and personal contexts that complicate healthcare access. Although the human papillomavirus (HPV) vaccine prevents HPV infections and cancers, uptake among Hispanic adolescents remains suboptimal. Therefore, it is important to understand Latino MSFW's HPV knowledge, as well as barriers to and facilitators of vaccination so culturally appropriate measures can bolster vaccination. An integrative review was conducted in PubMed, Scopus, and Web of Science using key search terms. Results were evaluated for compatibility with inclusion/exclusion criteria, and selected articles were coded and evaluated via thematic analysis. Six studies of various designs were ultimately included in the review. While some Latino MSFW have baseline knowledge about HPV and the vaccine, knowledge gaps remain. Participants expressed curiosity about how the vaccine works, contents, side effects, dosing, recommended age, and information about prevented diseases. Although additional education and MSFW's receptiveness to provider's recommendations were cited as major facilitators, many barriers also need addressed. Providers must leverage MSFW's existing knowledge, provide education, and facilitate vaccination to protect farmworker families from HPV and related cancers. It must become standard practice for providers to recommend the HPV vaccine to MSFW, who are receptive to this conversation. Increasing vaccination can decrease the disproportionate burden of HPV-related cancers on patients and facilitate access to healthcare services.

Air Quality Monitoring and the Safety of Farmworkers in Wildfire Mandatory Evacuation Zones.

The increasing frequency and severity of wildfires due to climate change pose health risks to migrant farm workers laboring in wildfire-prone regions. This study focuses on Sonoma County, California, investigating the effectiveness of air monitoring and safety protections for farmworkers. The analysis employs AirNow and PurpleAir PM2.5 data acquired during the 2020 wildfire season, comparing spatial variability in air pollution. Results show significant differences between the single Sonoma County AirNow station data and the PurpleAir data in the regions directly impacted by wildfire smoke. Three distinct wildfire pollution episodes with elevated PM2.5 levels are identified to examine the regional variations. This study also examines the system used to exempt farmworkers from wildfire mandatory evacuation orders, finding incomplete information, ad hoc decision-making, and scant enforcement. In response, we make policy recommendations that include stricter requirements for employers, real-time air quality monitoring, post-exposure health screenings, and hazard pay. Our findings underscore the need for significant consideration of localized air quality readings and the importance of equitable disaster policies for protecting the health of farmworkers (particularly those who are undocumented migrants) in the face of escalating wildfire risks.

Pre and During COVID-19 Access to Rural Mental Health Care Among Agriculture Communities in the Rocky Mountain Region.

Death by suicide is the second leading cause of intentional injury incurred by foreign-born workers in the United States. Hispanic/Latino farmworkers are systematically excluded from important safety net programs. Drawing on interviews with 16 individuals representing various community organizations serving rural, agriculture-dependent regions in Colorado (n=9) and Utah (n=7), we describe Hispanic/Latino farmworkers' access to the mental health safety net in the Rocky Mountain Region post/during the COVID-19 pandemic. Findings inform the need for expanded safety net infrastructure and community collaborations to support farmworkers effectively now and in the case of future pandemics.

Assessing Stock Photos for Farmworker Health and Safety Education Materials.

OBJECTIVES: The aim of this study was to analyze how farmworkers are represented in stock photos available in commercial libraries for use in agricultural health and safety education materials. METHODS: We searched for images in five commercial stock photo libraries using the terms "farmworkers" and "women farmworkers" in April 2022. We used quantitative content analysis. We coded each image for containing a visible face, age, gender, skin tone, work activity, mechanization, presence of hazards, technology use, and protective equipment/clothing after establishing inter-coder reliability. We used descriptive statistics to characterize the available stock photos. RESULTS: We identified stock photos (n = 127) in three databases (Adobe Stock Images, Canva, and Getty Images). Two databases (Microsoft Office Image Library and Pixabay) had no relevant images at the time of the search. Only half of the photos analyzed contained a face. Light skin tones and young or middle-aged adults were more common. A majority of farming activities represented in photos were manual tasks (e.g., harvesting) with few depictions of equipment, hazards, and protective equipment/clothing. CONCLUSIONS: Health and safety professionals tasked with developing materials for education in agricultural settings face a severe lack of imagery pertinent to the realistic conditions of farmworkers in the United States. In the databases we reviewed, photos displaying human faces, photos showing a range of skin tones and ages, and photos displaying an array of different farm hazards are likely not sufficient for material development. Health and safety professionals may benefit from sharing photos from their own work with other professionals and allocating resources for professional photo shoots in their material development projects.

Workplace Sexual Harassment in Waged Agricultural Employment: A Literature Review.

Workplace sexual harassment (WSH) is a systemic problem in agricultural employment. In the United States, where most research on the topic has been conducted, studies have suggested the rate of WSH against women farmworkers may be as high as 95%. Women who are immigrants, younger, have precarious immigration status, and come from indigenous communities are particularly vulnerable to WSH. The purpose of this study was to identify and describe the factors that contribute to such high rates of WSH in waged employment in the agricultural sector. To achieve this, we completed a systematic review of the empirical literature on sexual harassment in agricultural workplaces. Our review includes 29 empirical studies on WSH in agriculture, including 13 studies conducted in countries within the Global North and 16 from the Global South. The paper presents a typology of WSH in agriculture, categorizing its emotional and physical forms and describing what the literature reveals about its impacts on those who experience it. We then present our analysis of the structural and cultural factors contributing to high WSH rates in waged agricultural employment. We found that migration policies, the organizational and physical characteristics of agricultural work, the informality of employment relationships, traditional masculinity norms, and weak enforcement of workplace regulations were the principal factors facilitating high rates of WSH in agriculture. However, the study has limitations: it primarily focuses on literature in English and Spanish, risking geographical bias towards the Americas and potentially overlooking significant research in other languages or published in less accessible databases, including grey literature and regional reports. These limitations highlight the need for broader research to fill these empirical gaps, particularly from the Global South.

Precarious Work and Housing for Michigan Farmworkers During the COVID-19 Pandemic and Beyond.

OBJECTIVES: Farmworkers in Michigan face precarious and exploitative labor conditions that affect their access to affordable, fair, and quality housing, which are key social determinants of health. We sought to assess the health, working conditions, and housing access, affordability, and quality of farmworkers living in and outside of employer-provided housing during the COVID-19 pandemic. METHODS: We conducted a mixed methods cross-sectional study in collaboration with community partners from the Michigan Farmworker Project and the Michigan Department of Civil Rights. We assessed housing, labor conditions, and general health through in-depth phone interviews with seasonal, migrant, and H-2A farmworkers (n = 63) during the height of the COVID-19 pandemic (2020-2021) in Michigan. Descriptive analyses of these data included comparisons by type of farmworker and type of housing (employer-provided or other). RESULTS: The majority of farmworkers interviewed were women and seasonal farmworkers and spoke primarily Spanish. A significant share of farmworker participants reported living in poverty (38.3%) and had low or very low food security (27.0%). Nearly half of farmworkers (47.6%) rated their health as "fair" or "poor" during the year prior to the interview, and more than a third reported 3 or more chronic conditions (39.6%) and lack of health insurance coverage (38.7%). Among the 43 workers tested, 25.6% reported testing positive for COVID-19. Farmworkers reported experiences of objectification and dehumanization. Three-quarters of workers reported feeling that they were treated as less than human by supervisors and one-third reported verbal abuse. Farmworkers also experienced challenges exacerbated by their social vulnerability that impeded them from finding affordable, quality housing. Regarding housing quality, the majority of workers (80.6%) reported one or more environmental hazards around their residence, and about a third reported not having air conditioning (33.%) and lacking a functioning washing machine (33.9%). Concerns about the quality of drinking water accessible to workers and exposure to chemicals were shared by participants. CONCLUSION: This study adds valuable knowledge to the understanding of the systemic barriers to housing and work conditions for female and male seasonal, migrant, and H-2A farmworkers in Michigan. Shortcomings in the regulatory and policy environment result in precarious housing and work conditions, including exploitative labor practices. These conditions negate equality, fairness, and health equity, important tenants for public health.

Risk factors associated with indicators of dehydration among migrant farmworkers.

OBJECTIVE: Farmworkers are at increased risk of adverse health outcomes related to occupational heat exposure and inadequate access to water, shade, or rest breaks. Presently, there is a dearth of studies examining the prevalence of dehydration and related factors in U.S. farmworkers. Our objectives were to characterize hydration status during typical workdays and to identify risk factors associated with increased dehydration in migrant farmworkers employed in Florida. METHODS: Urine samples were collected and analyzed for urine specific gravity (USG) 2-3 times per person per day over five days in May 2021 and 2022. Data collection included demographic characteristics, wet-bulb-globe-temperature (WBGT), and information on working conditions (task type, duration, and crop units harvested), fluid intake, clothing worn, and heat safety behaviors. Multivariable mixed regression models were used to evaluate risk factors associated with change in USG levels (continuous) during a work shift. RESULTS: A total of 111 farmworkers participated in this study providing 1020 cumulative USG measurements, of which 96.8% of end-of-shift USG samples were above 1.020 indicating potential dehydration. In multivariable models, dehydration assessed using change in USG levels significantly declined with age (ß = -0.078; 95%CI: 0.150, -0.006) but showed significant increase with body mass index (ß = 0.016; 95%CI: 0.003, 0.028), WGBT (ß = 0.054; 95%CI:0.044, 0.064), mean shift duration, and state of primary residence. We did not find significant associations of dehydration with type of clothing worn, intake of employer-provided water, or crop units harvested during a shift in this sample of farmworkers. CONCLUSION: Our findings underscore the need for additional research to evaluate adverse outcomes related to dehydration and to better understand recovery patterns from chronic dehydration across workweeks and harvest seasons in migrant farmworkers.

PROGRESO-II: Developing Culturally Tailored Materials for a Social Network-Based Intervention to Promote HIV Pre-Exposure Prophylaxis Initiation Among Latina Seasonal Farmworkers.

Latina Seasonal Farmworkers (LSFW) in South Florida are a community affected by human immunodeficiency virus (HIV) due to cultural barriers, stigma, and lack of awareness of pre-exposure prophylaxis (PrEP). Building on the PROGRESO study, this study sought to: (1) develop and pre-test scientifically supported and culturally tailored PrEP materials for PROGRESO and (2) assess the acceptability of these PrEP materials by LSFW who use alcohol and/or drugs. PrEP messages were selected based on a literature review, feedback from experts working on PrEP programs, and recommendations from a four-member scientific expert panel through a two-level Delphi method. A culturally tailored PrEP presentation was developed and presented to sixteen LSFW, who engaged in four focus groups. Materials were modified based on participants' suggestions. Thematic analysis was used to assess the acceptability and usability of these materials in the LSFW community. Participants responded positively to the PrEP messages and understood their importance for Latinx communities. Participants felt empowered and comfortable enough with the information to distribute the messages to partners, children, and friends with the aid of a physical pamphlet or flyer. A strong cultural context of familialismo and confianza was present in comments made by our participants. This study has the potential to increase LSFW's PrEP awareness and initiation. Future studies may implement a hybrid-interview approach, allowing individuals to self-select into a virtual or in-person focus group. Such flexibility may increase participation and discussion by allowing participants to attend in a format they are most comfortable with, as noted by participants in this study.

Salivary Cotinine Levels of Hired Latino Youth Tobacco Workers in North Carolina.

BACKGROUND: Limited research has examined the health implications for youth working in United States tobacco production. Agricultural labor is hazardous, yet youth are legally permitted to be hired as farmworkers. Many youth farmworkers are members of the vulnerable Latino farmworker community. In North Carolina, youth work in many agricultural crops including tobacco. METHODS: A sample of 152 Latino youth farmworkers ages 12-20 years (M = 16.7, SD = 2.0) across 19 North Carolina counties completed a cross-sectional survey and provided saliva samples in 2019. Surveys detailed personal and work characteristics. Saliva samples were analyzed for salivary cotinine and reported in geometric means (ng/ml). Bivariate associations were used to delineate the relationship between personal and work characteristics with salivary cotinine levels. RESULTS: Cotinine levels ranged from 0.05 to 313.5 ng/ml. Older age and working in tobacco were significantly associated with higher salivary cotinine levels. For every one year increase in age, there was a 31% increase in mean salivary cotinine levels (b = 1.31; 95% CI = [1.15-1.50]; p < .0001). Youth tobacco workers' (n = 15) salivary cotinine levels were 890% higher than those not working in tobacco (n = 137) (13.26, 95% CI = [5.95-29.56] ng/ml compared to 1.34, 95% CI = [1.03-1.75] ng/ml (p < .0001)). CONCLUSIONS: Latino youth tobacco workers are exposed to nicotine through their work. This exposure presents serious risk of Green Tobacco Sickness (acute nicotine poisoning) and other health concerns given the growing evidence for risk of epigenetic changes negatively affecting long-term cognitive function. Policy is urgently needed to protect this vulnerable population of adolescent workers.

An ethnographic study of a community dentistry network serving Latine migrant farmworkers in Vermont: Barriers and access to care during the COVID-19 pandemic and beyond.

BACKGROUND AND OBJECTIVES: Primary dental healthcare services are not accessible for a majority of Latino/a/e migrant farmworkers in the United States. Unmet dental health needs are well documented in larger states like California, Florida and New York, but the dental healthcare picture in smaller states is not well understood. The goal of this qualitative ethnographic study was to understand the delivery model of a free dentistry network serving Latine farmworkers in rural Vermont and specific barriers experienced at the network during the COVID-19 pandemic. METHODS: Semi-structured ethnographic interviews were carried out with clinicians and transcripts were analysed using the constant comparison method to identify salient concerns and recommendations about barriers and delivery of care. RESULTS: Clinicians highlighted structural issues including farmworkers' lack of time off work and absence of transportation to attend appointments, concerns about COVID-19 safety, concerns about immigration surveillance and language barriers. Providers outlined steps for improved service delivery including mobile care at local farms, enhanced intercultural training for providers, recognizing dentistry as essential healthcare at the state level and the leverage of existing appointments for preventive health. Drawing on anthropological frameworks of place-based care and deservingness of healthcare, our ethnographic findings emphasize the role of community dentistry in bridging gaps in migrant healthcare during and beyond the COVID-19 pandemic.

Pesticide Exposure or Pesticide Poisoning and the Risk of Depression in Agricultural Populations: A Systematic Review and Meta-Analysis.

Evidence suggests that farm workers represent a high-risk population for the development of depression. The aim of the study was to clarify the association between pesticide exposure/poisoning and depression. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis were conducted in this systematic review and meta-analysis. Relevant studies were included through searching in PubMed, Scopus, Web of Science, ProQuest, CINAHL and pre-print services databases. A total of eight studies were included. A positive but non-significant association was observed between pesticide use and depression (OR = 1.123; 95% CI, 0.932-1.354, p-value = .221) while a significant positive association was observed between pesticide poisoning and depression (OR = 2.942; 95% CI, 1.791-4.831, p-value < .001). The present meta-analysis suggested clearly a significant positive association between pesticide poisoning and depression, confirming the hypothesis that pesticide poisoning is a risk factor of depression. It also revealed positive, yet non-significant association, between pesticide exposure and depression, a finding that enhances recent research but requires to be further supported by future cohort studies, including socioeconomic factors and biomarkers of depression.

Mobile Distribution of COVID-19 Vaccines to Migrant Farmworkers in Minnesota.

The COVID-19 pandemic has disproportionately impacted migrant farmworkers (MFWs). MFWs have experienced higher rates of infection and death than any other occupational group in the United States due to workplace exposure risks, overcrowded housing, and limited access to personal protective equipment. Barriers to accessing COVID-19 vaccines have also contributed to these disparities, especially in rural areas where the pandemic's impact has been devastating. Mobile health clinics, in partnership with community-based organizations, are an effective method for vaccine distribution to rural communities where many MFWs live and work. Between June 2021 and October 2022, the University of Minnesota's Mobile Health Initiative (MHI) organized health fairs in southern Minnesota to distribute vaccines to MFWs and their families. The success of these events can be attributed to partnering with trusted local organizations, bridging geographic barriers, ensuring language-concordant care, and offering multiple health services in one place. MHI's health fairs serve as a model for future mobile vaccination events. As the COVID-19 pandemic has ended as of this time, future pandemics may occur, and equitable vaccine access must be a priority for MFWs. Mobile health clinics are an essential tool to achieving this goal.

"Valorar el trabajo de farmworkers": A thematic analysis of input from farmworkers, advocates, and students in a community documentary project about the future of farm work.

Farm work is one of the nation's most hazardous occupations, and migrant and seasonal farmworkers face significant health inequities. Awareness and understanding of the needs of this population are crucial in assuring they receive appropriate support. Documentary programs can raise awareness of community member views to better inform services and advocacy efforts. Visions for the future of farm work were collected from farmworkers and persons supporting them through a community-based, participatory documentary project led by Student Action with Farmworkers (SAF) from 2021 to 2022. Seventy-nine submissions from participants in North and South Carolina, including text responses and file uploads, were collected and thematically analyzed. Five themes were identified: (1) employment benefits and conditions, (2) living conditions, (3) health access and quality, (4) dignity and visibility of farm work, and (5) policy change for a better future. The visions for the future of farm work expressed by these agricultural workers, advocates, and students raise important implications for agricultural communities, public health practitioners, researchers, funders, and policymakers. Application of these findings in the development and delivery of public health services for farmworkers has the potential to positively impact the morbidity and mortality rates of this at-risk population.

The Influence of Organizational Aspects of the U.S. Agricultural Industry and Socioeconomic and Political Conditions on Farmworkers' COVID-19 Workplace Safety.

Farmworkers in the U.S. experienced high rates of COVID-19 infection and mortality during the COVID-19 pandemic. Their workplace may have been a significant place of exposure to the novel coronavirus. Using political economy of health theory, this study sought to understand how organizational aspects of the agricultural industry and broader socioeconomic and political conditions shaped farmworkers' COVID-19 workplace safety during the pandemic. Between July 2020 and April 2021, we conducted and analyzed fourteen in-depth, semi-structured phone interviews with Latinx farmworkers in California. Findings show that regulatory oversight reinforced COVID-19 workplace safety. In the absence of regulatory oversight, the organization of the agricultural industry produced COVID-19 workplace risks for farmworkers; it normalized unsafe working conditions and the worker-rather than employer-responsibility for workplace safety. Under these conditions, farmworkers enacted personal COVID-19 preventative practices but were limited by financial hardships that were exacerbated by the precarious nature of agricultural employment and legal status exclusions from pandemic-related aid. Unsafe workplace conditions negatively impacted workplace camaraderie. Study findings have implications for farmworkers' individual and collective agency to achieve safe working conditions. Occupational safety interventions must address the organizational aspects that produce workplace health and safety inequities and disempower farmworkers in the workplace.

Contending With Precarity: Health and Multi-Sectoral Supports for Migrant Agricultural Workers in Southern Ontario.

Research has long-documented how Canada's temporary foreign worker programs (TFWP) foster workers' precarity through their status as non-citizens and living and working conditions, ultimately, impacting their health. While studies point to limited supports and services for workers, their role in reinforcing or alleviating the precarious conditions that migrant agricultural workers experience remains largely unexplored. This paper draws on interviews with 35 service providers in three migrant-intensive regions in southwestern Ontario, to explore how service providers describe and construct support. We explore the barriers workers face in accessing services, challenges providers experience in supporting workers, and strategies employed to surmount these barriers. We argue that this multiregional analysis is important to illuminate how support shapes and is shaped by the larger structural context, namely common features of Canada's TFWP. A more comprehensive understanding of support moreover, provides direction for sustainable interventions that can promote the health and wellbeing of this population.

A qualitative community health assessment of HIV prevention awareness in a semi-rural Latinx seasonal farm working community in South Florida.

This article explores HIV awareness and prevention in a Latinx seasonal farmworker community of south Miami-Dade County in the USA. The study took place as part of a larger community assessment that aimed to determine community needs and resources related to substance abuse, violence and HIV in the Latinx seasonal farmworker communities of south Miami-Dade County, with a particular focus on fathers' and their male sons' relationships. The study collected data on HIV knowledge and prevention, healthcare-seeking behaviours, cultural norms, and communication barriers about HIV prevention between fathers and sons. Data were collected through in-depth interviews with community leaders, two focus groups with social and health services providers, and four focus groups involving fathers and their adolescent sons. A deductive approach to data analysis was undertaken. Five major themes were identified: (1) HIVrelated knowledge and perception; (2) HIV prevention strategies; (3) barriers and needs for tailored preventive health and care services in the community; (4) stress over sex-related communication; and (5) the dominance of traditional masculine gender norms in the household and the community.

An Evaluation of a Pesticide Training Program to Reduce Pesticide Exposure and Enhance Safety among Female Farmworkers in Nan, Thailand.

BACKGROUND: Although exposure to chemical pesticides is known to cause negative effects on human health, farmers in Ban Luang, Nan, Thailand, continue to use them regularly to protect crops. This study focused on mothers who were engaged in farm tasks and had children between the ages of 0 to 72 months, with the objective of reducing pesticide exposure. METHODS: This study was conducted from May 2020 to October 2020 in the Ban Fa and Ban Phi sub-districts in Ban Luang due to the high use of pesticides in these areas. A systematic random sampling technique was used to recruit 78 mothers exposed to pesticides. Thirty-nine mothers from Ban Fa district were randomly assigned to the intervention group and 39 from Ban Phi to the control group over a 3-month period. This study applied a pesticide behavioral change training program for the intervention group. To assess the effectiveness of the program, the study compared the results of a questionnaire regarding knowledge, attitude, and practice (KAP) and health beliefs related to pesticide exposure as well as the levels of acetylcholinesterase (AChE) and butyryl cholinesterase (BChE) enzymes, biomarkers of exposure to pesticides, before and after the intervention using ANCOVA statistical test. Furthermore, to evaluate the effectiveness of the intervention program, a paired t-test was used to investigate the in-home pesticide safety assessment. RESULTS: After the intervention, we observed no significant change in AChE; however, a significant improvement in BChE (p < 0.05), a marker of short-term recovery, was observed. Pesticides can cause a reduction in AChE and BChE, however, after eliminating pesticides, BChE takes a shorter time (about 30-50 days) to recover than AChE (around 90-120 days). Therefore, increases in the measured concentrations of AChE and/or BChE suggest the presence of less chemicals from pesticides in the human body. The study also found a significant improvement in KAP and beliefs about chemical pesticide exposure after the intervention (p < 0.05). Furthermore, using a paired t-test, we found a significant increase in pesticide safety practices (p < 0.05) in the intervention group and a borderline significant increase regarding in-home safety (p = 0.051) in the control group. CONCLUSIONS: Based on the results, the constructs of the intervention program were effective and could be applied in other agricultural areas in less developed countries. However, due to time limitations during the COVID-19 pandemic, further studies should be conducted to enable data collection over a longer time, with a larger number of subjects providing the ChE levels for the non-agricultural season.

"When there is no money, that is when I vomit blood": the domino effect and the unfettered lethal exploitation of Black labor on Dominican sugar plantations.

BACKGROUND: In this article, I utilize the concept of the Plantationocene as an analytical framework to generate a holistic and historical understanding of the present-day struggles of a mostly Haitian migrant workforce on sugar plantations in the Dominican Republic. METHODS: Inspired by Paul Farmer's methodology, I combine political economy, history, and ethnography approaches to interpret the experiences of sugarcane cutters across historical and contemporary iterations of colonial, post-colonial, and neo-colonial practices over the course of five centuries. RESULTS: My findings elucidate the enduring power of capitalism, implicating corporate and state elites, as the structural scaffolding for acts of racialized violence that condition the life-and-death circumstances of Black laborers on Caribbean plantations to this day. Although today's sugarcane cutters may suffer differently than their enslaved or wage labor ancestors on the plantation, I argue that an unfettered racialized pattern of lethal exploitation is sustained through the structural violence of neoliberalism that links present conditions with the colonial past. CONCLUSIONS: Ultimately, this paper contributes understandings of the plantationocene's enduring effects in the global south by demonstrating how imperialist arrangements of capitalism are not a distant memory from the colonial past but instead are present yet hidden and obscured while relocated and reanimated overseas to countries like the Dominican Republic, where American capitalists still exploit Black bodies for profit and power.

Provision of HIV prevention and care services to farmworkers in sub-Saharan African countries.

OBJECTIVES: To summarise data on human immunodeficiency virus (HIV) services available to farmworkers in sub-Saharan Africa (SSA). METHODS: We conducted a systematic review to understand which HIV prevention and care services were accessed by farm workers in SSA. MEDLINE (PubMed), Embase, CINAHL (EBSCO Host), Cochrane library, African Index Medicus, Scopus, Google Scholar, Open Grey, and Web of Science Proceedings Citation Index were searched. Studies were eligible for inclusion if they measured or reported on the presence of HIV workplace policy frameworks, guidelines, or programmes for HIV prevention, treatment and care services, and other treatment modalities specifically targeting farmworkers. RESULTS: Nine studies published between 2005 and 2019 were included in the review. Six themes emerged from included studies, which include HIV policy, HIV prevention (awareness, education, and condom supply), voluntary counselling and testing, antiretroviral therapy (ART), linkage to care, and mobile clinic. Though availability of an HIV policy was inadequate, a significant positive impact of the HIV policy in influencing behaviour change was reported. Most of the farm workers could access HIV education and condom supply in their places of work. Access to ART, treatment support, and linkage to care was inadequate, but community outreach programmes and mobile clinics showed success in reaching a high number of workers with HIV testing and treatment. A majority of farm workers faced barriers in accessing government health facilities. CONCLUSIONS: The findings suggest that there is poor access to HIV services for farmworkers in SSA. There is a dire need to scale up HIV services and programmes, including mobile health facilities, in agricultural settings. Due to high labour migration patterns among farmworkers, we recommend cross-country HIV programmes that allow continuity of care across borders.

Integrating NHANES and toxicity forecaster data to compare pesticide exposure and bioactivity by farmwork history and US citizenship.

BACKGROUND: Farmworkers in the United States, especially migrant workers, face unique barriers to healthcare and have documented disparities in health outcomes. Exposure to pesticides, especially those persistent in the environment, may contribute to these health disparities. OBJECTIVE: Quantify differences in pesticide exposure bioactivity by farmworker category and US citizenship status. METHODS: We queried the National Health and Nutrition Examination Study (NHANES) from 1999-2014 for pesticide exposure biomarker concentrations among farmworkers and non-farmworkers by citizenship status. We combined this with toxicity assay data from the US Environmental Protection Agency's (EPA's) Toxicity Forecaster (ToxCast). We estimated adverse biological effects that occur across a range of human population-relevant pesticide doses. RESULTS: In total, there were 844 people with any farmwork history and 23,592 non-farmworkers. Of 12 commonly detectable pesticide biomarkers in NHANES, 2,4-dichlorophenoxyacetic acid (OR = 3.76, p = 1.33 × 10-6) was significantly higher in farmworkers than non-farmworkers. Farmworkers were 1.15 times more likely to have a bioactive pesticide biomarker measurement in comparison to non-farmworkers (adjusted OR = 1.15, 95% CI: 0.87, 1.51). Non-U.S. citizens were 1.39 times more likely to have bioactive pesticide biomarker concentrations compared to people with U.S. citizenship (adjusted OR 1.39, 95% CI: 1.17, 1.64). Additionally, non-citizens were significantly more exposed to bioactive levels of ß-hexachlorocyclohexane (BHC) (OR = 8.10, p = 1.33 × 10-6), p,p-DDE (OR = 2.60, p = 0.02), and p,p'-DDT (OR = 7.75, p = 0.01). IMPACT STATEMENT: Farmworkers are a vulnerable population due to social determinants of health and occupational exposures. Here, we integrate US population chemical biomonitoring data and toxicity outcome data to assess pesticide exposure by farmwork history and citizenship. We find that farmworkers and those without US citizenship are significantly more likely to be exposed to concentrations of pesticides which are bioactive in toxicological assays. Thus, farmworkers employed in the US but who are not citizens could be at increased risk of harm to their health due to pesticides. These findings are important to shape evidence-based policies in regulatory science to promote worker safety.