COVID-19 Education and Resource Development for Punjabi-Speaking Sikh Farmworkers in California.

OBJECTIVE: While the vast majority of farmworkers in California are Latinx, a small proportion of the farmworkers are Asian Indian who primarily speak Punjabi. To date, there are few COVID-19 resources developed that specifically target Punjabi-speaking farmworkers. This study examines the COVID-19 educational needs of Punjabi-speaking farmworkers in California and aims to inform future development of educational materials for Punjabi-speaking farmworkers. METHODS: During early 2021, a two-phase qualitative study was conducted. In Phase 1, five key informant interviews were conducted using a semi-structured interview guide to assess the content, visual, and cultural relevance of current COVID-19 educational resources. Based on informant feedback, new agriculture-specific COVID-19 educational resources were developed in Punjabi. In Phase 2, three focus groups were conducted (in Fresno and Yuba Counties) with five participants in each group to evaluate the newly developed COVID-19 resources. RESULTS: Informant interviews showed that Punjabi-speaking farmworkers preferred printed handouts, videos, and radio messages to receive COVID-19 related information. Participants preferred 8-1/2"x11" sized printed handouts that were colorful and had culturally relevant photographs. Participant video preferences included live action videos that were short (1-3 mins) with characters representing the Punjabi community. A substantial majority of focus group participants approved the newly developed COVID-19 educational and safety resources. CONCLUSION: Current COVID-19 resources are not meeting the educational needs of Punjabi-speaking farmworkers. This community needs COVID-19 educational and safety materials that are culturally relevant and linguistically appropriate to be available in different formats: handouts, videos, and radio messages.

Real-time COVID-19 Education to Reduce Workplace Risks: Thematic Analysis of a COVID-19 Agricultural Employer Webinar Series.

OBJECTIVES: California's agricultural industry, an "essential industry" during the COVID-19 pandemic, required support to understand and implement changing public health knowledge and regulations in the workplace. The Western Center for Agricultural Health and Safety (WCAHS) transitioned from traditional in-person trainings with agricultural stakeholders to remote engagement, such as webinars. We aimed to assess the use of real-time webinar trainings and identify agricultural employer concerns about reducing the risk of COVID-19 in the workplace. METHODS: We conducted a thematic analysis of webinar chat from WCAHS' "Reduce the Risk of COVID-19 in Your Workplace" monthly webinar series held from December 2020-May 2021. De-identified chat transcripts were analyzed using a deductive approach to assess participant concerns as they related to prevention and response actions, employer responsibilities, and evolving public health knowledge. Codes were identified by an iterative process using semantic interpretation and summarized into four major themes. RESULTS: Our analysis reveals participants' concerns relating to (1) prevention of COVID-19 in the workplace, (2) response to COVID-19 in the workplace, (3) employer concerns, and (4) evolving, real-time knowledge. Participants shared multiple, overlapping concerns. Many also asked for information tailored to specific scenarios in their workplace. CONCLUSION: Providing industry-specific guidance and examples in an accessible means is critical for supporting agricultural employers and their highly vulnerable workers. Virtual trainings will likely continue to be an effective means of outreach with the agricultural industry. Future outreach and education efforts should consider virtual engagement and opportunities to document experiences amid changing work environments, social cultures, and learning activities.

Effectiveness of a worksite lifestyle intervention to reduce BMI among farmworkers in California: a cluster randomised controlled trial.

OBJECTIVE: To evaluate the effectiveness of PASOS SALUDABLES, a culturally tailored lifestyle intervention to prevent obesity and diabetes among Latino farmworkers, when implemented at large scale in the worksite. DESIGN: This study was a two-arm parallel group, cluster randomised controlled trial, where participants received either a twelve-session lifestyle intervention (intervention) or six-session leadership training (control) at their worksite. The intervention was delivered by Promotoras in Spanish. All sessions were conducted at the worksites (ranches) during meal breaks. Blinded, trained research assistants collected socio-demographic and outcome data (i.e. BMI as primary outcome and waist circumference, glycated Hb (HbA1c), cholesterol and blood pressure as secondary outcomes) at baseline and follow-up assessments (i.e. 3 months, 6 months, 1 year and 1·5 years). SETTING: Recruitment and intervention delivery occurred at twelve study ranches in Oxnard, California. PARTICIPANTS: We enrolled farmworkers hired by a large berry grower company, who were ≥18 years old, spoke Spanish and were free of diabetes at screening. RESULTS: A total of 344 workers were enrolled in the intervention and 271 in the control group. The intervention resulted in attenuated increase of BMI over time; however, the difference in trend between groups was not significant (ß = -0·01 for slope difference, P = 0·29). No significantly different trend by group was observed in secondary outcomes (P > 0·27). CONCLUSIONS: The worksite intervention, implemented during meal breaks, did not reduce BMI or other clinical indicators. Nevertheless, this study supports the feasibility of recruiting and engaging the Latino farmworker population in workplace health promotion interventions.

Rapid Response to COVID-19 in Agriculture: A Model for Future Crises.

Objective: The Western Center for Agricultural Health and Safety (WCAHS) at the University of California, Davis implemented a multifaceted rapid response to COVID-19 in the western United States. This paper describes the center's response from mid-March through June 30, 2020. Methods: A comprehensive needs assessment was conducted with agricultural stakeholders. Agriculture-specific COVID-19 resources were developed and disseminated, and a farmer/employer survey was launched. Results: The WCAHS COVID-19 resources web page, worksite checklist, and training guide were shared on over 50 web pages nationally. As of June 30, 2020, 282 online surveys have been received. Ongoing informal discussions with agricultural stakeholders indicate a disconnect between the experiences of farmers/employers and farmworkers in relation to COVID-19 prevention at the worksite. Initial survey responses indicate that implementing social distancing is one of the greatest challenges at the worksite. Confusion over local, state, and federal guidelines and which to follow is another concern. Conclusion: The WCAHS response to COVID-19, in close collaboration with agricultural stakeholders, represents a useful model for a rapid response to a public health crisis by regional centers. Key elements to its success include rapid personalized communication with a wide range of agricultural stakeholders, an actively engaged External Advisory Board, the development of industry-specific resources and information, recurring and iterative engagement with stakeholders as new COVID-19 information emerged and resources were developed, and the identification of the unique gap WCAHS was positioned to fill. The multipronged dissemination approach enhanced the reach of WCAHS COVID-19 resources.

Wildfire Smoke Exposure: Awareness and Safety Responses in the Agricultural Workplace.

Objective: The study examines how wildfire smoke exposure may impact health and safety in the agricultural workplace. Methods: Semi-structured interviews were conducted with agricultural employers and focus group discussions were held with farmworkers in three regions of California. Results: Agricultural employers had varying knowledge about and experience responding to poor air quality due to wildfire smoke. Respirators or masks were not mentioned as a potential protective measure when describing their safety practices. Farmworkers reported experiencing poor air quality due to wildfire smoke, although knowledge of safety precautions varied. Farmworkers reported employer and supervisors' attitudes toward safety as having the greatest impact on the implementation of workplace safety measures. Conclusion: Adapting health promotion and workplace safety strategies to meet the multiple vulnerabilities and diverse needs of farmworkers is critical to successful implementation of workplace protection and safety measures. Given limited familiarity with the topic, wildfire smoke exposure resources are needed to assist employers and supervisors in their compliance with a new wildfire smoke safety regulation in California. To the best of our knowledge, this is the first study to explore agricultural employer and farmworker perceptions of the health and safety impacts of wildfire smoke and workplace exposure.

Editorial: Extreme Weather Resulting from Global Warming is an Emerging Threat to Farmworker Health and Safety.

A warming climate has been linked to an increase in the frequency and severity of extreme weather events, including heat and cold waves, extreme precipitation, and wildfires. This increase in extreme weather results in increased risks to the health and safety of farmworkers.

Protocol for a cluster randomized controlled trial to study the effectiveness of an obesity and diabetes intervention (PASOS) in an immigrant farmworker population.

BACKGROUND: Studies have shown that the prevalence of overweight, obesity and diabetes are higher in the largely Hispanic, immigrant farmworker population in California. Though to date, few interventional studies have focused on these issues in this at-risk population. The objective of this paper is to describe the study design of a cluster randomized controlled trial aimed at evaluating the effectiveness of an obesity and diabetes work place intervention in an immigrant farm worker population. METHODS: PASOS is an obesity and diabetes intervention program that will be implemented on ranches where immigrant farmworkers spend a considerable amount of time each day. This cluster randomized controlled study will enroll approximately 600 farmworkers. Using a uniform distribution for random number generation, ranches are randomized using a 1:1 ratio as either control or intervention. Baseline data will be taken from eligible participants and analyzed against data collected at the post-intervention, 6-month, 1-year, and 1.5-year follow-ups. The enrollment period is 1.5 years. DISCUSSION: Few studies have been conducted that aim to evaluate the effectiveness of a worksite intervention for obesity and diabetes prevention in a largely Hispanic, farmworker population. This study has been tailored to this population in order to enhance the feasibility of implementation and retention. If successful in reducing obesity and increasing healthy lifestyle choices to reduce diabetes, this study design can be implemented on a larger scale. TRIAL REGISTRATION: NCT02480244 . Registered 24 June 2015.

Preventive care for low-income women in massachusetts post-health reform.

BACKGROUND: Before enacting health insurance reform in 2006, Massachusetts provided free breast, cervical cancer, and cardiovascular risk screening for low-income uninsured women through a federally subsidized program called the Women's Health Network (WHN). This article examines whether, as women transitioned to insurance to pay for screening tests after health reform legislation was passed, cancer and cardiovascular disease screening changed among WHN participants between 2004 and 2010. METHODS: We examined claims data from the Massachusetts health insurance exchange and chart review data to measure utilization of mammography, Pap smear, and blood pressure screening among WHN participants in five community health centers in greater Boston. We conducted a longitudinal analysis, by insurance type, using generalized estimating equations to examine the likelihood of screening at recommended intervals in the postreform period compared to the prereform period. RESULTS: Pre- and postreform, we found a high prevalence of recommended mammography (86% vs. 88%), Pap smear (88% vs. 89%), and blood pressure screening (87% vs. 91%) that was similar or improved for most women postreform. Screening use differed by insurance type. Recommended mammography screening was statistically significantly increased among women with state-subsidized private insurance (odds ratio [OR] 1.58, p<0.05). Women with unsubsidized private insurance or Medicare had decreased Pap smear use postreform. Although screening prevalence was high, 31% of women required state safety-net funds to pay for screening tests. CONCLUSION: Our results suggest a continued need for safety-net programs to support preventive screening among low-income women after implementation of healthcare reform.

Lessons learned obtaining informed consent in research with vulnerable populations in community health center settings.

BACKGROUND: To improve equity in access to medical research, successful strategies are needed to recruit diverse populations. Here, we examine experiences of community health center (CHC) staff who guided an informed consent process to overcome recruitment barriers in a medical record review study. METHODS: We conducted ten semi-structured interviews with CHC staff members. Interviews were audiotaped, transcribed, and structurally and thematically coded. We used NVivo, an ethnographic data management software program, to analyze themes related to recruitment challenges. RESULTS: CHC interviewees reported that a key challenge to recruitment included the difficult balance between institutional review board (IRB) requirements for informed consent, and conveying an appropriate level of risk to patients. CHC staff perceived that the requirements of IRB certification itself posed a barrier to allowing diverse staff to participate in recruitment efforts. A key barrier to recruitment also included the lack of updated contact information on CHC patients. CHC interviewees reported that the successes they experienced reflected an alignment between study aims and CHC goals, and trusted relationships between CHCs and staff and the patients they recruited. CONCLUSIONS: Making IRB training more accessible to CHC-based staff, improving consent form clarity for participants, and developing processes for routinely updating patient information would greatly lower recruitment barriers for diverse populations in health services research.

Lack of access due to costs remains a problem for some in Massachusetts despite the state's health reforms.

Did the Massachusetts health reforms, which provided near-universal insurance coverage, also address problems of unmet need resulting from the cost of care and of inadequate preventive care for diverse patient groups? We found that nearly a quarter of adults who were in fair or poor health reported being unable to see a doctor because of cost during the implementation of the reforms. We also found that state residents earning less than $25,000 per year were much less likely than higher earners to receive screening for cardiovascular disease and cancer. The state needs to implement new strategies to build on the promise of universal coverage and address specific needs of vulnerable populations, such as limiting out-of-pocket spending for this group. Also, more data are needed on the social determinants of health to identify specific barriers related to cost and access for vulnerable groups that general insurance reforms may not address.