AMERICAN JOURNAL OF INDUSTRIAL MEDICINE

Review Article

Occupational Health Outcomes for Workers

in the Agriculture, Forestry and Fishing
Sector: Implications for Immigrant
Workers in the Southeastern US

Sara A. Quandt, PhD,1,2
Kristen L. Kucera, PhD,3 Courtney Haynes, MS,4

Bradley G. Klein, PhD,5 Ricky Langley, MD,6 Michael Agnew, PhD,4
Jeffrey L. Levin, MD,7 Timothy Howard, PhD,2,8 and Maury A. Nussbaum, PhD4

Background Workers in the Agriculture, Forestry, and Fisheries (AgFF) sector expe-
rience exposures directly related to the work itself, as well as the physical environment
in which the work occurs. Health outcomes vary from immediate to delayed, and from
acute to chronic.
Methods We reviewed existing literature on the health outcomes of work in the AgFF
sector and identified areas where further research is needed to understand the impact
of these exposures on immigrant Latino workers in the southeastern US.
Results Outcomes related to specific body systems (e.g., musculoskeletal, respiratory)
as well as particular exposure sources (e.g., pesticides, noise) were reviewed. The
most extensive evidence exists for agriculture, with a particular focus on chemical
exposures. Little research in the southeastern US has examined health outcomes of
exposures of immigrant workers in forestry or fisheries.
Conclusion As the AgFF labor force includes a growing number of Latino immi-
grants, more research is needed to characterize a broad range of exposures and health
outcomes experienced by this population, particularly in forestry and fisheries. Am. J.
Ind. Med. ß 2013 Wiley Periodicals, Inc.

KEY WORDS: immigrant; agriculture

1 8
Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Center for Genomics and Personalized Medicine Research, Wake Forest School of
Forest School of Medicine,Winston-Salem, North Carolina Medicine,Winston-Salem, North Carolina
2
Center for Worker Health, Wake Forest School of Medicine, Winston-Salem, North Contract grant sponsor: National Institute for Occupational Safety and Health; Contract
Carolina grant number: R13-OH 009744.
3
Division of Occupational and Environmental Medicine, Department of Community and Disclosure Statement: The authors report no conflicts of interests.
Family Medicine, Duke University, Durham, North Carolina *Correspondence to: Sara A. Quandt, PhD, Department of Epidemiology and Prevention,
4
Department of Industrial and Systems Engineering, School of Biomedical Engineering Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boule-
and Sciences,Virginia Tech, Blacksburg,Virginia vard,Winston-Salem, NC 27157. E-mail: [email protected]
5
Department of Biomedical Sciences and Pathobiology, Virginia-Maryland Regional
College of Veterinary Medicine,Virginia Tech, Blacksburg,Virginia Accepted17 January 2013
6
Division of Public Health, North Carolina Department of Health and Human Services, DOI10.1002/ajim.22170. Published online in Wiley Online Library
Raleigh, North Carolina (wileyonlinelibrary.com).
7
Department of Occupational Health Sciences, University of Texas Health Science Center
at Tyler,Tyler,Texas

ß 2013 Wiley Periodicals,Inc.

2 Quandt et al.

INTRODUCTION related to specific body systems and others related to

particular exposure sources (e.g., animals, noise). Each
The southeastern United States (US) has a long tradi- section presents a review of what is known about the par-
tion of production in the Agriculture, Forestry, and Fishing ticular health outcome or exposure source for the three
(AgFF) sector, which is among the largest industrial sec- industries in the US in the general worker population and
tors and employed over 1.2 million workers in 2010 [BLS, then for immigrant workers within the southeastern US in
2012a]. Immigrant labor accounts for about 37% of the particular. Where evidence is lacking, we extrapolate from
AgFF workforce [AFL-CIO, 2005]. In 2010, this sector research in other populations. Finally, we summarize find-
reported the highest rate of fatal work injuries [27.9/ ings and highlight major areas for future research.
100,000 workers], and an incidence rate for nonfatal inju-
ry of 4.5 per 100 workers, compared to 2.2 in mining and AGRICULTURE
3.9 in construction [BLS, 2011, 2012b].
The last several decades have seen a substantial in- General Worker Population
crease in the proportion of immigrant Latino labor in this
sector in the Southeast. Over the five years preceding the Acute trauma
2000 census, the southern US received more domestic La-
tino migrants and international Latino immigrants than Major mechanisms of traumatic injury and death in
any other region in the country [US Census Bureau, agriculture include falls, being struck by falling or rolling
2003]. This new labor force includes immigrants who objects, crush injuries, assault by animals, and being run
have established permanent residence in the US and work over or otherwise injured by machinery such as tractors,
either year-round or seasonally in AgFF jobs, as well as combines, and augers [Coury et al., 1999; Hard et al.,
migrants who move from place to place for their jobs. The 2002; Myers and Hendricks, 2010]. Commonly reported
latter include immigrants who move within the US and traumatic injuries on US farms are broken bones, cuts,
those who move back and forth across international bor- and lacerations [Mariger et al., 2009; Goldcamp, 2010],
ders for work. Within all these categories, only some of with the most often injured body parts being hands,
the workers have appropriate documents to be in the US shoulders, back, and chest [Goldcamp, 2010]. Eye injuries
(e.g., proof of citizenship, permanent resident alien work account for 8.2% of all injuries in the agriculture sector
permits, or H-2A or H-2B temporary worker visas). This [Gerberich et al., 1993]. These range from blunt trauma to
results in difficulty in accurately determining the number perforation to complete enucleation and have been caused
of immigrant Latino workers in the southeastern US, as by debris from sharpening or using tools, chemical burns,
discussed by Arcury et al. [2013]. and butting with an animal horn [Saari and Aine, 1984;
The health outcomes from work in the AgFF sector CDC, 1995; Mackiewicz et al., 2005; Sprince et al.,
arise from a complex set of exposures created in the work- 2008]. Burns, dislocations, and spinal damage are less fre-
place. These include: exposures related to the work envi- quent but important farming-related injuries [Mariger
ronment that are generated by the industries themselves, et al., 2009].
including the machinery, tools, and chemicals used; condi- Work involving livestock is the second-leading cause
tions produced by these exposures, such as noise or air- of nonfatal injuries on farms. In 1995, the greatest number
borne particulates; and industry products, including crops, of agriculture-related injuries (43.3%) occurred in beef,
livestock, fish, and timber. Such exposures occur within hog, or sheep operations [Myers, 2001a]. Contact with
the context of the natural environment, which itself creates livestock is more likely to result in fractures and crushing
exposures relevant to health outcomes, such as weather, injuries than other sources of injuries on farms. Risk fac-
soil, water, plants, animals, and insects. How workers ex- tors for animal-related injuries include age (both young
perience these exposures depends on contextual factors of and old), hearing loss, arthritis, male sex, working with
the industry and the worksites [Grzywacz et al., 2013], older farm equipment, living on beef farms, and taking
with examples that range from external contextual factors prescription medications [Stallones, 1990; Brison and
(e.g., market prices and laws) to employer-specific factors Lawrence, 1992; Zhou and Roseman, 1994; Layde et al.,
(e.g., pace of work, provision of safety gear) to task-spe- 1996; Sprince et al., 2003].
cific factors (e.g., repetition, worker control). Health out- Aquaculture has trauma risks unique to the aquatic
comes from this range of exposures can vary in the time environment [Myers, 2010]. Aquaculture workers are at
of occurrence from immediate to delayed, and in duration risk for stings, bites, and pinching injuries [Erondu and
from acute to chronic. Anyanwu, 2005]. Wet or icy surfaces pose the risk of slips
This article addresses each of three industries– and falls [Moreau and Neis, 2009], and operating a skiff,
agriculture, forestry, and fisheries. For each industry, eight maintaining cages, or feeding animals place workers at
specific types of outcomes are addressed, including those risk of falling into water where hypothermia or drowning
 Immigrant Worker Occupational Health Outcomes 3

may occur [MacGregor, 2004]. Operating heavy machin- and casual contact through drift and surface residues [Das
ery poses other risks such as entanglement, tripping, and et al., 2001; Kasner et al., 2012].
being struck by snapping cables. Collisions of forklifts Pesticide exposure can cause dizziness, confusion, ab-
with pedestrians and falling materials [Moreau and Neis, normal skin sensations, contact dermatitis, irritation of the
2009] and tractor rollovers have also been reported [Cole eyes, blurred vision, muscle twitching, increased bronchial
et al., 2009]. Use of heavy equipment (trucks and ATVs) and salivary secretions, chest tightness, diarrhea and other
on sea ice during harvesting presents additional drowning gastrointestinal problems, vomiting, convulsions, and even
risk if the vehicles fall through the ice [Moreau and Neis, death in cases of acute exposure [Krieger, 2001; Frank
2009]. Electrocution is a risk when using power tools et al., 2004; Costa et al., 2008]. The EPA estimates
near water [Cole et al., 2009; Moreau and Neis, 2009]. 10,000–20,000 pesticide poisonings occur among hired
Additionally, replacing the nets around aquaculture pens US agricultural workers yearly [NIOSH, 2010]. While poi-
requires workers to use SCUBA equipment and risk sonings comprise a relatively small portion of total agri-
becoming entangled under the water [MacGregor, 2004]. cultural worker occupational illness [Litchfield, 1999;
Kasner et al., 2012], this is likely underestimated due to
inadequate state surveillance programs, lack of physician
Musculoskeletal disorders
training to recognize poisonings, lack of health insurance
among farmworkers, and worker reluctance to report poi-
Low back disorders are common musculoskeletal
sonings [Das et al., 2001; McCauley et al., 2006].
injuries, particularly due to working in stooped postures
Agrochemical exposure also has been linked to di-
[Fathallah et al., 2008] and repeated exposures to vibra-
verse chronic conditions, including: dermatological sensi-
tions and jarring motions while operating mechanical
tivity; respiratory disease including lung fibrosis and
equipment [Hostens and Ramon, 2003; Mayton et al.,
chronic bronchitis [Eduard et al., 2009]; asthma-like syn-
2008]. Crop harvesting imposes prolonged and repetitive
dromes [Koksal et al., 2003]; non-Hodgkins lymphoma
stooping and often results in low back, hand, and wrist
[Chiu and Blair, 2009]; neurological symptoms [Kamel
pain [Fathallah, 2010], sprains and strains [Amshoff and
et al., 2005, 2007a]; neurobehavioral dysfunction [Ala-
Reed, 2005], and ligament tears [Goldcamp, 2010]. Farm-
vanja et al., 2004; Keifer and Firestone, 2007; Costa et al.,
workers’ exposure to repetition, high forces and loads, and
2008; Colosio et al., 2009]; and chronic nervous system
sustained postures [Fathallah, 2010] can lead to chronic
effects such as neurodegenerative disease [Frank et al.,
low back pain, degeneration of the spine, and deficits in
2004; Sharp et al., 1986; Dreiher and Kordysh, 2006], in-
postural stability [Mayton et al., 2008].
cluding Parkinson’s disease [Dick et al., 2007; Kamel
Dairy farm work entails routine and strenuous tasks
et al., 2007b; Bronstein et al., 2009; Costello et al., 2009;
[Innes and Walsh, 2010] associated with arthritis of the
Tanner et al., 2011]. Further, chronic exposure to agro-
hips and knees [Kirkhorn and Schenker, 2002], increased
chemicals has been linked to cancers, including leukemia,
risk for knee osteoarthritis in women [Holmberg et al.,
prostate cancer, multiple myeloma, soft tissue sarcoma,
2004], and musculoskeletal discomfort in the back, torso,
prostate cancer, gastric cancer, and lung and cervical can-
shoulders, neck, and head [Innes and Walsh, 2010]. In
cer [Dreiher and Kordysh, 2006; Mahajan et al., 2006;
aquaculture, musculoskeletal injuries occur due to repeti-
Andreotti et al., 2009; Blair and Freeman, 2009; Chiu and
tive lifting or hand feeding, lifting of heavy cages or bags
Blair, 2009; Delancey et al., 2009; Koutros et al., 2009;
of feed, prolonged non-neutral postures at workstations,
Lynch et al., 2009; Bonner et al., 2010]. Diesel exhaust
and tractor use [Moreau and Neis, 2009; Cole et al., 2009;
and solvent-related activities are associated with
Nonnenmann et al., 2010]. These general risks can be ex-
‘‘wheeze’’ [Hoppin et al., 2004] and prostate cancer
acerbated by exposure to extremely cold work environ-
[Richardson et al., 2008; Parent et al., 2009]. Farmworkers
ments [Cole et al., 2009; Moreau and Neis, 2009].
also can be exposed to heavy metals such as arsenic and
lead from several agrochemicals and from grinding or
Chemicals welding metal [Quandt et al., 2010b]. Such exposures
have been linked in other populations with cancer, repro-
Potential sources of hazardous chemicals in agricul- ductive problems, and neuropsychological and cognitive
ture include pesticides, fertilizers, organic solvents, met- effects [Tsai et al., 2003; Mahata et al., 2004; Wright
als, sterilization compounds, gasses from confined animal et al., 2006; Shih et al., 2007; Weuve et al., 2009]. Occu-
wastes and silos, and plant residues [Keifer et al., 2010]. pational pesticide exposure is associated with adverse
Farmworkers face routine pesticide exposures from: plant- reproductive outcomes [Hanke and Jurewicz, 2004; Farr
ing; harvesting; food and water contamination; mixing, et al., 2006; Perry, 2008; Rosas and Eskenazi, 2008;
loading, and applying pesticides; maintenance of mixing Jurewicz et al., 2009; Van Maele-Fabry et al., 2010;
and application equipment; spills, spray drift, and runoff; Sathyanarayana et al., 2010].
4 Quandt et al.

Aquaculture chemicals include pesticides, spawning parasites (e.g., giardiasis, mange, and trichinosis), fungi
hormones, and anesthetics, some of which are listed as (e.g. ringworm), and prions (e.g., bovine spongiform
hazards by NIOSH [2005]. Concern over the health effects encephalopathy). A recently recognized fish pathogen,
of aquaculture chemicals has focused more on the food Streptococcus iniae, can cause skin infections and even
consumer than on the producers [Erondu and Anyanwu, endocarditis among fresh fish aquaculture workers [CDC,
2005; Cole et al., 2009]. Very limited epidemiological 1996; Weinstein et al., 1997]. Envenomation can occur
evidence exists regarding aquaculture workers’ exposure when agricultural workers encounter venomous animals;
or health outcomes resulting from such exposures. and farmworkers have relatively high rates of nonfatal
insect and spider injuries and illnesses [Drudi, 2000].
Dust and particulates
Noise
Dust and particulate matter contribute to pulmonary
conditions. Dust and particulate matter can carry contami- Agricultural crops are often planted and harvested
nants such as allergens (e.g., animal dander, antigenic pro- using heavy machinery, which can involve substantial
teins from crops), organic (e.g., animal feces particles, noise exposure. While OSHA has mandated exposure lim-
crop and insect fragments), and inorganic (e.g., earth from its and requirements for hearing conservation programs in
tilling) matter [Schenker, 2000]. Agricultural workers in several industry sectors, agriculture is not included among
animal confinement facilities are particularly at risk for these. Roughly 10% of US farmers are exposed to noise
dust and particulate exposure [Iversen et al., 2000; Von that exceeds OSHA thresholds, and it is estimated that
Essen et al., 2010]. Workers in swine confinement facili- 25% and 50% of farmers at age 30 and 50, respectively,
ties have a two- to three-fold increased risk of developing have noise-induced hearing loss [Karlovich et al., 1988;
respiratory symptoms [Radon et al., 2000]. More general- Rein, 1992]. Only 30% of farmers report using hearing
ly, farmworkers face higher rates of rhinitis [Siracusa protection more than half the time [Carpenter et al., 2002;
et al., 2000], acute and chronic bronchitis [Zejda et al., Schenker et al., 2002].
1993], asthma-like syndrome [Bongers et al., 1987;
Haglind and Rylander, 1987], and organic dust toxic syn- Immigrant Workers
drome [Vogelzang et al., 1999]. Symptoms appear to be
linked to task and time of the growing season [Mirabelli Acute trauma
et al., 2010a].
AgFF is among the top four industrial sectors in the
Weather US in terms of reported work-related deaths for Hispanic
workers; and between 2003 and 2006, foreign-born His-
Farm work involves prolonged exposure to weather- panic workers experienced 2.4 more fatalities per 100,000
related risks. From 1995 to 2002, 129 work-related deaths workers compared to native-born Hispanic workers [Cier-
in the US were due to lightning strikes. Agriculture had pich et al., 2008]. Limited data exist on traumatic injuries
the highest number of fatalities and the second highest among immigrants in the southeastern US, and these data
fatality rate [Adekoya and Nolte, 2005]. Sun exposure may be underestimates. North Carolina and Georgia expe-
increases risks for sunburn and skin/lip cancer [Blair and rienced a large increase in the numbers of immigrant
Freeman, 2009]. From 1992 to 2006, AgFF workers, espe- workers between 1990 and 2000 [AFL-CIO, 2005], the
cially crop workers, had heat-related death rates substan- majority of whom were Latinos in North Carolina [Arcury
tially higher than other US workers [Luginbuhl et al., 2008]. and Marin, 2009]. From 1992 to 2006, three southeastern
states were among those indicated as having the highest
Infections and envenomations number of fatalities (Florida) or the highest fatality
due to animals rates (South Carolina and Georgia) for Hispanic workers
[Cierpich et al., 2008].
Agricultural workers are at risk of acquiring zoonotic Traumatic eye injuries among Latino farmworkers oc-
infections from disturbing the soil or working with ani- cur at rates exceeding those for overall US crop produc-
mals. Zoonotic infections account for 61% of infections in tion [Quandt et al., 2012]. Specifically, eye injuries may
humans [Taylor et al., 2001] and may be acquired from result from hydraulic fluid from ruptured hydraulic lines
aerosols, direct contact with an infected animal, or through in old machinery; airborne and loose soil; contact with
infection transmitted by substances such as bedding. Infec- plants when harvesting; chemical exposure; and being
tions associated with livestock and wild mammals are sprayed in the face by automated irrigation systems in the
caused by bacteria (e.g., E. colibacillosis and lyme dis- field [Lacey et al., 2007; Quandt et al., 2012]. Many of
ease), viruses (e.g., foot and mouth disease and influenza), these workers (70–81%) have not been properly trained to
 Immigrant Worker Occupational Health Outcomes 5

use eye protection and underestimate risks of eye injury Dust and particulates
[Verma et al., 2011].
No data could be found for health effects of dust or
Musculoskeletal disorders particulates among immigrant agricultural workers in the US.
Sprains and strains are frequently reported among
Weather
Hispanic orchard workers [Salazar et al., 2005]. A majori-
ty of immigrant nursery (55%) and vineyard (48%) work-
From 1995 to 2000, 41 out of 129 occupational fatali-
ers in the western US reported musculoskeletal pain, with
ties from lightning strikes occurred to Latino workers,
back pain being the most common symptom [Brumitt
with a fatality rate among these workers four times higher
et al., 2011; Faucett et al., 2001]. It is likely that such
than among non-Hispanic Whites [Adekoya and Nolte,
injuries are underreported [Dembe, 1999; Cooper et al.,
2005]. Of the 28 reported heat-related fatalities among US
2006; Castaneda, 2009]. At least five southeastern states
crop workers in 2003–2006, 20 were foreign-born workers
(Florida, Georgia, North Carolina, South Carolina, and
[Luginbuhl et al., 2008]. In a 2009 survey of Latino farm-
Virginia) are involved heavily in fruit and vegetable pro-
workers in North Carolina, 94% reported they had worked
duction [Arcury and Marin, 2009], so back, neck, and up-
in extreme heat in US agriculture, and 40% of those
per and lower extremity pain, as well as sprains and
reported having experienced symptoms consistent with
broken bones may occur at similar rates.
heat-related illness [Mirabelli et al., 2010b]. Among immi-
grant farmworkers in North Carolina, changes in work ac-
Chemical exposures
tivities and work hours during hot weather are associated
In North Carolina, urinary metabolites of immigrant with a lower prevalence of heat-related illness in H-2A
Latino farmworkers indicate exposure to multiple agro- but not non-H-2A workers [Mirabelli et al., 2010b]. Latino
chemicals as well as elevated levels of lead and arsenic farmworkers in California reported common personal sun
[Arcury et al., 2009a, b; Quandt et al., 2010a, b]. Many protection behaviors such as always wearing a hat, a long-
farmworkers had repeated detections in subsequent sam- sleeved shirt, or a collared shirt [Salas et al., 2005]. Use
pling. Children also are exposed to multiple pesticides of sunglasses or sunscreen or limiting sun exposure are
due to chemical contamination of farmworker residences much less common protective measures [Quandt et al.,
[Quandt et al., 2004; Arcury et al., 2005, 2007]. 2001; Salas et al., 2005; Luque et al., 2007].
Because agencies do not commonly assess immigra-
tion status [Calvert, 2010], characterization of acute pesti- Infections and envenomations
cide poisoning in Latino immigrant farmworkers often due to animals
relies on retrospective interview data from workers
recruited near the worksite or at farmworker aid organiza- Latino farmworkers in North Carolina report a high
tions. Among California Hispanic farmworkers, 7% prevalence of superficial fungal skin infections [Krejci-
reported previous chemical poisoning, 7–12% of workers Manwaring et al., 2006; Arcury et al., 2007]. No data
had been sprayed or experienced drift, and 6–10% were could be found on envenomation among immigrant agri-
told to taste unwashed grapes, which was significantly as- cultural workers in the US.
sociated with gastrointestinal pain and diarrhea [Villarejo
and McCurdy, 2008]. Pesticide contact among Latino Noise exposure
farmworkers is associated with irritated eyes and skin,
blurry vision, and headaches [McCurdy et al., 2003; Vil- In a cross-sectional survey of migrant and seasonal
larejo et al., 2010]. Specific crops and pesticides have farmworkers, more than half reported some hearing loss;
been associated with particular cancers among Latino and few reported using hearing protection [Rabinowitz
farmworkers in California [Mills et al., 2009]. Agrochemi- et al., 2005].
cal exposure also has been linked with adverse neurobeha-
vioral outcomes among Latino farmworkers and their FORESTRY
children [Reidy et al., 1992; Kamel et al., 2003; Rohlman
et al., 2005, 2007]. Among Latino women, maternal expo- General Worker Population
sures to pesticides are associated with adverse reproduc-
tive outcomes including decreased fecundability, increased Acute trauma
rate of autism spectrum disorders, neurodevelopmental
delays, decreased child IQ, and abnormal perinatal In the logging process, falls and being struck by or
reflexes [Young et al., 2005; Eskenazi et al., 2006; Roberts against an object are the primary causes of injury [Wang
et al., 2007; Harley et al., 2008; Bouchard et al., 2011]. et al., 2003; Mujuru et al., 2006]. Falls and crush injuries
6 Quandt et al.

can occur when body parts are pinned between logs or was found in Swedish forest care workers [Wiklund and
equipment [Wolf and Dempsey, 1978], while struck by in- Holm, 1986; Wiklund et al., 1988]. Evidence is mixed for
juries can result from falling trees or kickback from power an increased risk of non-Hodgkins lymphoma associated
saws, branches, or rolling logs. Logging injuries include with phenoxy herbicides in North American forestry work-
traumatic brain injuries; fractures of the spine, skull, and ers [Green, 1991].
legs; and eye injuries [Vayrynen, 1983; Saari and Aine,
1984; Johnson et al., 2002]. Mechanized operations, over- Dust and particulates
all, seem to result in a lower injury risk than for compara-
ble manual tasks [Laflamme and Cloutier, 1988]. Smaller, Most studies on respiratory effects in the forestry in-
less mechanized forestry operations are likely to sustain dustry have been conducted in Europe and Canada. Ap-
more crush injuries from splitting tools and cuts from proximately 2.0% of European workers are exposed to
blades and chain saws [Lindroos et al., 2008]. inhalable wood dust [Blot et al., 1997]. Most of these
workers are in the construction and furniture industries,
Musculoskeletal disorders with a much smaller percentage (9%) in the combined
sawmilling and forestry industries [Kauppinen et al.,
Forestry workers’ risk factors are related to trade- 2006]. Such exposure increases cancer, primarily nasal,
specific tool use. Manual tree planting requires prolonged risk [Blot et al., 1997].
and repetitive non-neutral postures. Planters in Ontario
reported feeling the greatest pain in their wrists and feet; Weather
back pain was the most consistently reported symptom,
and pain scores for almost all areas of the body increased Forestry involves high levels of physical exertion.
significantly over the course of a single planting season Heavy protective equipment, along with exposure to heat
[Slot and Dumas, 2010]. Chain saw operators experience and sun, can lead to dehydration and increased risk of
greater nerve damage compared with forestry workers heat illness [Wästerlund, 1998]. Among Japanese forestry
who primarily do heavy lifting tasks [Bovenzi et al., workers, fewer years of experience and heat were among
2000], and the severity of nerve damage is related to cu- factors associated with increased risk of heat stroke symp-
mulative vibration exposure. Exposure to cold conditions toms [Maeda et al., 2006]. However, compared to other
can further increase the risk of conditions such as vibra- causes, deaths attributable to heat in this industry are rela-
tion-induced white finger [Bovenzi et al., 1998; Bovenzi, tively low (<1%), with 14 deaths from environmental heat
2010]. in the US from 1992 to 2001 [Buckley et al., 2008].
Although forestry is often conducted in regions where
Chemicals exposure to cold and severe weather is also common, the
physical nature of forestry/logging work may provide
Forestry workers are exposed to chemicals including some protection from cold-related injury and hypothermia
fertilizers, pesticides, lubricants, diesel and gasoline fuels, [Conway and Husberg, 1999]. Lightning strike also is a
and their emissions [Athanassiadis, 2000; USNLM, 2010]. hazard for forestry workers. From 1992 to 2001, of 200
Fewer types of pesticides are used in forestry than in agri- deaths in the industry attributed to ‘‘Exposure to Harmful
culture, with herbicides being predominant [Michael, Substances and Environments’’, 7 were attributed to light-
2000; Oregon Department of Forestry, 2009]. ning [Buckley et al., 2008].
Pesticide exposure is reported among Canadian tree
planters; more limited evidence of herbicide exposure is Infections and envenomations
reported among Swedish and US seedling handlers [Lavy due to animals
et al., 1992; Robinson et al., 1993; Elfman et al., 2009].
Although forest herbicide sprayers demonstrate less effect As in agriculture, forestry workers are at risk of
of exposure than agricultural sprayers [Frank et al., 1985; acquiring zoonotic infections from disturbing the soil or
Knopp and Glass, 1991], pine foresters have greater expo- from contact with animals. Forestry workers are at risk of
sure than potato harvesters working with the same fungi- stings from sawflies, wasps, bees, and ants, especially
cide (dithiocarbamate) [Kurttio and Savolainen, 1990]. In when nests or mounds are disturbed [Copertaro et al.,
forestry, chemical hazards do not appear to be a significant 2006]. Up to 3–4% of people stung are at risk of develop-
source of acute injury [Helmkamp and Derk, 1999; ing an anaphylactic reaction [Giannandrea et al., 2003;
Navarro et al., 2004; Elfman et al., 2009]. Incorvaia et al., 2004]. This can be fatal if not treated
Compared to agriculture, less attention has been paid immediately, and is a challenge for forestry workers in
to the effects of long-term low-level exposure to forestry remote locations. Encounters with snakes in forests are
chemicals. An increased risk of non-Hodgkins lymphoma not unusual. In the US, copperheads, cottonmouths, coral
 Immigrant Worker Occupational Health Outcomes 7

snakes, and rattlesnakes are venomous species of concern. musculoskeletal injury is a significant health problem.
While rarely fatal, bites can lead to prolonged disability. H-2B guest workers make up 100% of work crews for the
Forestry workers are at increased risk of infection three largest tree-planting contractors in the southeastern
from several tick-borne diseases. In some countries, 20– US [McDaniel and Casanova, 2005]. Tree planting is a
30% of forestry workers are seropositive for Lyme disease highly repetitive process requiring long hours in stooped
[Buczek et al., 2009]. Other such diseases reported in for- postures and repeated use of small hand tools [McDaniel
estry workers include tick-borne relapsing fever, Colorado and Casanova, 2003].
tick fever, Rocky Mountain spotted fever, erhlichiosis, ba-
besiosis, and tularemia [Covert and Langley, 2002; Cisak Other health outcomes
et al., 2005]. Workers also may be at risk of viruses trans-
mitted by mosquitoes such as eastern equine encephalitis, No data could be found regarding the effects of chem-
western equine encephalitis, and St Louis encephalitis icals, dust and particulates, weather, infections or enveno-
[APHA, 2008]. Finally, workers may face exposure to mations due to animals, or noise exposures on immigrant
rabies or other infections if approached by wild animals. workers in forestry.

Noise exposure
FISHERIES
During 1997–1998, the logging industry in Washing-
ton State had the highest rate of hearing loss claims General Worker Population
reported to workers’ compensation at 70 claims per 1,000
worker years, twice as high as the rate for road construc- Acute trauma
tion [Daniell et al., 2002]. Logging tasks associated with
excessive noise levels include the use of chokers and chain Some exposures differ by region, but particular risks
saws [Neitzel and Yost, 2002]. exist for all fish industry workers. Vessel casualties result-
ing from sinking, capsizing, fires, explosions, or collisions
Immigrant Workers are substantial [Drudi, 1998; Jensen et al., 2005; Perez-
Labajos et al., 2009; Lincoln and Lucas, 2010]. Between
The immigrant worker population in forestry is large 2000 and 2009, over half of commercial fishing fatalities
and expanding [McDaniel and Casanova, 2003]. Between were a result of vessel disasters [Lincoln and Lucas,
1996 and 2001, the southeastern US led the country in the 2010]. Common hazards include falling overboard after
number of H-2B visas requested [McDaniel and Casanova, becoming entangled in gear, slipping or tripping on deck,
2003]. With over 100,000 H-2B visas issued, this is a fair- losing balance, or being washed overboard by large waves
ly well-documented immigrant worker population. Smaller [Drudi, 1998; Thomas et al., 2001; Lucas and Lincoln,
contractors, however, are more likely to employ undocu- 2007; Lincoln and Lucas, 2010]. A majority of deaths
mented immigrants. H-2B workers in the US move among after falling overboard occur when a crew member is
contract sites as dictated by their employer. This presents working alone on deck [Lucas and Lincoln, 2007].
a challenge for reporting immigrant worker population or Fishing gear use and maintenance cause the greatest
injury rates in specific states because employers do not number of injuries and the most severe injuries such as
necessarily employ workers in the state in which their broken bones and joint dislocations [Torner et al., 1995;
H-2B visas were issued [Sarathy and Casanova, 2008]. Jensen et al., 2005, 2006; Chauvin and Le Bouar, 2007].
More specific causes of injury include entrapment of up-
Acute trauma per limbs in ropes, cables, or chains; lacerations, bruises,
and fractures from breaking or snapping of cables; frac-
No evidence could be found documenting traumatic
tures and other injuries subsequent to falls on the deck or
injuries among immigrant workers specifically in the for-
between deck levels; crush or head injuries caused by
estry sector. However, some data exist for the overall for-
loaded nets or boxes falling onto the worker; entanglement
estry industry in the southeastern US. In Alabama, where
in the winch drum, tripping over the winch cable, or the
forestry operations are largely mechanized, struck by and
sudden snapping of the winch cable [Norrish and Cryer,
crush/run over injuries were responsible for the vast ma-
1990; MacGregor, 2004]; ocular and facial penetration
jority of fatalities during 1988–1997 [Bordas et al., 2001].
due to fishing hooks, lures, and weights [Erisen et al.,
2001; Alfaro et al., 2005]; cervical spine injury from har-
Musculoskeletal disorders
poons [Mouzopoulos and Tzurbakis, 2009]; and forcible
Although no data were found on immigrant forestry amputation due to entanglement in nets and lines [Nagesh
workers specifically, there is reason to believe that and Rastogi, 2007].
8 Quandt et al.

Trawl doors used in trawl fishing are large and heavy Fishing industry workers also have extensive exposure to
and pose considerable crush risk if a limb or body diesel and gasoline powered engines and exhaust [Kirrane
becomes pinched between a trawl door and the vessel et al., 2007]. The use of diesel fuel in pesticide dips for
[MacGregor, 2004]. Seine fishing involves the use of large traps may also place workers at risk of long-term exposure
booms and a skiff, increasing the chances of a ‘‘struck to unburned diesel fume vapors [Barre and Van Vleet,
by’’ injury or falling into the water. Seining also carries 1994].
the additional risk of being performed mostly at night un-
der low lighting conditions [MacGregor, 2004]. Long lin- Dust and particulates
ing, salmon trolling, and crab fishing present a high risk
for eye injuries from flying hooks on gear, the use of met- Fishery workers are exposed to aeroallergens pro-
al flashers with hooks, and the frequency of tossing the duced during processing and canning, which places them
catch into storage, respectively [AMSEA, 1999]. Eye inju- at risk of pulmonary disease. The primary pulmonary con-
ries can result from fish spitting out hooks or by workers dition observed is termed ‘‘occupational asthma’’ [Lucas
touching their face after handling the catch [AMSEA, et al., 2010]. Risk factors include exposure to aerosols
1999]. from arthropods, such as shrimp, crab, and lobster, during
The fish catch itself also exposes crew members to fishing or processing [Malo and Cartier, 1993; Ortega
pricks, pinches, cuts, bites, and stings from various species et al., 2001]. Predisposition toward developing allergic
of aquatic animals [MacGregor, 2004]. Although rare, fish reactions (atopy) is a risk factor for the development of
can bite or stab with their spines, which can lead to severe occupational asthma in fishery workers [Gautrin et al.,
injuries such as lacerations, amputations, and puncture 2010]. There is considerable variation in the prevalence
wounds. These penetrating wounds can also become estimates of asthma (2–36%), due largely to varying defi-
infected [Marshall et al., 2004]. Once the catch is on the nitions of the condition [Jeebhay and Cartier, 2010].
boat, injuries can occur from large fish ‘‘flopping’’ on
deck. Among commercial workers in the southeastern US, Weather
20% of hand injuries were due to contact with finfish,
shellfish, or other sea animals [Kucera et al., 2008]. Natural environment hazards for fishing industry
workers are similar to those in agriculture and forestry,
Musculoskeletal disorders but with the added factor of performing work on a moving
vessel. Severe weather compounds the effects of physical
Fishing exposes workers to heavy loads, forceful exer- demands due to boat motions [Petersen et al., 1989;
tions, non-neutral postures, repetitive tasks, and working Torner et al., 1988, 1994] and increases the risk of falls on
in moving environments [Fulmer and Buchholz, 2002; deck or overboard. Working in cold waters places laborers
Duncan et al., 2010]. Common musculoskeletal injuries at risk for cold-related mortality [Drudi, 1998] and mor-
include strains to muscles and injured tendons [Torner bidity [Conway and Husberg, 1999]. The combination of
et al., 1995; Chauvin and Le Bouar, 2007]. In lobstering, wet and windy environments with cold weather contrib-
as an example, where multiple traps are continuously set utes to conditions such as frostbite, trench foot, and hypo-
out rather than a single large net, the speed and high fre- thermia. In a person-overboard situation, workers are at
quency of work poses a risk for strain injury [Fulmer and risk of drowning as well as hypothermia. From 1990 to
Buchholz, 2002]. 1999, 186 out of 217 fishing industry worker deaths were
due to drowning or death from hypothermia as a result of
Chemicals vessel-related events and falls overboard [Conway et al.,
2002].
Principal acute chemical hazards in fisheries are expo-
sure to toxic gases and asphyxiation from catch decompo- Infections and envenomations
sition. Studies of Danish fishing vessels have found high due to animals
concentrations of several potentially poisonous gases (hy-
drogen sulfide, carbon dioxide, ammonia, and methyl- Workers in the fishing industry are at risk of enveno-
amines), as well as low oxygen concentrations. Exposure mations, infections, and allergic reactions due to marine
to toxic gases accounts for 1 in 25 fishing deaths among life [Burke, 1997; Ortega et al., 2001]. Venomous aquatic
Danish workers and 1.7% of fatalities among Alaskan animals include catfish, zebra fish, scorpion fish, stingrays,
workers [Dalgaard et al., 1972; Thomas et al., 2001; jellyfish, and the Portuguese man of war [Burke, 1997],
Laursen et al., 2008]. Chemical exposure can also result in with jellyfish being the most common source of injury
burns [Lawrie et al., 2003] and allergic and respiratory [Brown, 2005]. Fishing industry workers risk envenom-
reactions [Atkinson et al., 1993; Madsen et al., 2004]. ation when handling fish or when removing jellyfish that
 Immigrant Worker Occupational Health Outcomes 9

have become entangled in fishing nets. Although serious immigrant workers remains unclear. Previous research
injury and death can occur, most stings in US waters cause with Texas Gulf Coast commercial fishermen noted over
only minor injury [Brown, 2005]. half (52%) spoke little or no English, highlighting the im-
Fishing industry workers with open wounds from portance of delivering safety training in their native lan-
punctures or stings are subsequently at risk of acquiring a guage [Carruth et al., 2010; Levin et al., 2010]. Although
number of infections from the aquatic environment, usual- the immigrant worker population in fishing is poorly docu-
ly by the bacteria Staphylococcus and Streptococcus mented, there is some evidence regarding injuries specific
[Lehane and Rawlin, 2000]. The widespread bacterium to the types of fishing done in the southeastern US. In
Erysipelothrix rhusiopathiae causes skin dermatitis (also North Carolina, between 1977 and 1991, the fishing indus-
referred to as fish poison, crab poison, or shrimp pickers try reported the highest rate of fatalities due to environ-
disease) and can, rarely, cause endocarditis [APHA, mental working conditions compared to other industries
2008]. The bacterium Edwardsiella tarda can cause skin [Loomis et al., 1997]. Also in North Carolina, a high prev-
abscesses and serious life threatening infections [Har- alence of penetrating wounds occurs among small scale
greaves and Lucey, 1990; Slaven et al., 2001]. Mycobacte- fin-fishing and crabbing crews, affecting primarily the
rium marinum enters open skin and slowly grows into a hands, wrists, and fingers, and mainly attributable to con-
warty-like lesion that can spread along the lymph channels tact with fish or marine animals [Marshall et al., 2004].
and invade tendons, bones, and joints [Burke, 1997]. Gas- Hand injuries among commercial fishing industry workers
troenteritis as well as serious wound infections may result in the southeastern US are related to maintenance work on
from the bacterium Aeromonas hydrophila. Resulting the vessel and to using more than one type of fishing gear
wound infections can lead to muscle destruction and a [Kucera et al., 2008].
particularly deadly form of gangrene, gas gangrene [Ful-
ghum and Linton, 1978]. Various species of halophilic Musculoskeletal disorders
Vibrio organisms can also cause gastroenteritis, wound
infections, and septicemia [Blake et al., 1979; Burke, Evidence of risks specific to the immigrant worker
1997; APHA, 2008]. The bacteria Vibrio parahaemolyti- population in fishing could not be found. However, some
cus, Vibrio damsela, and Vibrio vulnificus can cause tissue studies have assessed the musculoskeletal impact of com-
inflammation and gas gangrene, which can lead to septic mercial fishing in North Carolina, and these are likely rep-
shock. Contact with certain algae, dinoflagellate organisms resentative of risks for fishing industry workers in the
(red tides), bryozoans, and even fish slime can cause aller- southeastern US. Low back symptoms are the most com-
gic reactions such as contact dermatitis in workers [Burke, monly reported among commercial fishers in North Caro-
1997]. lina, followed by symptoms in the hands, wrists, and
shoulders; and rates of musculoskeletal symptom onset
Noise exposure among workers with no prior symptoms are highest for
the lower back and shoulders [Lipscomb et al., 2004]. The
Fishing industry workers often work on vessels with rate of onset varies with hours spent fishing daily [Lips-
diesel engines and other equipment used to pull in gear comb et al., 2004; Kucera et al., 2009]. Among North Car-
and remove and process the catch. Workers often spend olina fin-fishing and crabbing crews, 25% of injuries are
several consecutive days on a boat and can thus be ex- strains and sprains, especially of the back and shoulders,
posed to excessive noise both during and outside of their and caused mostly by hauling gear and vessel loading or
work shifts. In a case study of Massachusetts fishing ves- unloading [Marshall et al., 2004].
sels, two of three vessels had noise levels close to US
Coast Guard threshold values [Fulmer and Buchholz, Chemicals
2002]. Catch processing vessels have high work-shift and
24-hr exposure levels. In an Alaskan study of injury aboard fishing vessels,
toxicity from chemical, liquid, or gas was noted in 0.74%
Immigrant Workers of non-fatal incidents, and burns comprised 5.3% of non-
fatal injuries. Immigrant workers made up 5% of the non-
Acute trauma fatal injury group [Thomas et al., 2001].

Little information could be found on immigrant work- Dust and particulates

ers in the fishing industry. It is likely that immigrant work-
ers would experience similar types of traumatic injuries as In the southern US, Latinos are a large part of the
native-born workers, but the extent to which cultural or workforce in the crab processing industry [Selby et al.,
language barriers create additional occupational risks for 2001]. However, no studies could be found on rates of
10 Quandt et al.

occupational asthma, as seen elsewhere from aerosolized kin and both socially and physically isolated from the
proteins from these crustaceans [Ortega et al., 2001]. larger US society [Grzywacz et al., 2006]. These condi-
tions are potent threats to mental health. Studies of immi-
Weather grant workers in the southeastern US have found that
categories of stressors experienced include legality and
No previous studies could be found documenting logistics, social isolation, work conditions, family, and
weather-related events among immigrant workers in the substance abuse by others [Grzywacz et al., 2007, 2010;
fishing industry. A review of medical examiner death cer- Hiott et al., 2008].
tificates in North Carolina from 1977 to 1991 found that The largest body of research on workers in the AgFF
41 out of 2,524 work-related deaths were due to natural sector in the southeastern US has focused on farmworkers.
environmental conditions; relative to all industries, fishing, The farmworker population in this region has become pre-
agriculture, agricultural services, and logging occupied dominantly Latino in only the last few decades. In contrast
four out of the top five highest rates in this cause of death to the farmworker population elsewhere in the country,
category [Loomis et al., 1997]. Though cold-related mor- which consists largely of family groups, in the southeast-
tality and morbidity for this industry is highest among ern US agricultural workers include many single men or
northern states such as Alaska [CDC, 1993; Conway and men unaccompanied by their families. Evidence from
Husberg, 1999], risks may also be elevated in milder cli- studies on farmworkers throughout the US suggests that
mates having rapid temperature changes, such as North poor mental health among farmworkers is relatively com-
Carolina [Fallico et al., 2005], where poor or extreme mon [e.g., Magaña and Hovey, 2003]. A psychiatric sur-
weather conditions often are combined with inadequate vey among California workers found that one in five met
protective clothing and exposure to water and wind [Butts, lifetime criteria for at least one psychiatric disorder, with
1994; Beaman et al., 2000]. anxiety disorder, substance abuse, and mood disorder be-
ing the most common [Alderete et al., 2000]. Mexican
Other health outcomes folk illnesses such as nervios [nerves] and susto [fright]
also have been reported at high frequencies [Mines et al.,
No data were found on animal-related infections and 2001; Weigel et al., 2007].
envenomations or noise among immigrant fishery workers. In the southeastern US, a substantial number of male
farmworkers show indications of alcohol abuse [Kim-God-
PSYCHOSOCIAL EXPOSURES win and Fox, 2009]. Binge drinking has been reported by
AND OUTCOMES 27% of farmworkers, with 38% showing signs of alcohol
dependence. Anxiety and depression at levels resulting in
AgFF industries share characteristics that can lead to impairment affect farmworkers at rates of 18% and 42%,
distress and subsequent adverse mental health effects on respectively [Grzywacz et al., 2007; Hiott et al., 2008].
workers in these industries. Forestry and fishing can in- These levels are substantially higher than those reported
volve separation from family and social supports. For agri- among farmworkers in California [Alderete et al., 2000].
culture, this condition exists for immigrant workers, but Depressive symptoms in North Carolina tend to be highest
not for resident farming populations. All are industries early and late in the agricultural season [Grzywacz et al.,
where uncontrollable environmental conditions regularly 2010]. Few data exist for the southeastern US on folk
affect the ability of workers to make a living. These in- illnesses, though Baer and Penzell [1993] found that 20%
clude natural conditions such as storms, droughts, and of workers reported susto after exposure to pesticides.
crop and livestock disease, as well as human-caused disas-
ters such as fires or chemical contamination. Existing liter- FUTURE RESEARCH NEEDS FOR
ature suggests that workers in these industries respond to IMMIGRANT AgFF WORKERS IN THE
such stressors with increased levels of distress, including SOUTHEASTERN US
depression, anxiety, and symptoms of post-traumatic stress
syndrome [Picou, 1992; Palinkas et al., 1993; Freeman The AgFF sector is among the largest employers in
et al., 2008; Sartore et al., 2008; Taylor et al., 2008; Cald- the US as a whole, and the southeastern US specifically.
well and Boyd, 2009]. Work in this sector involves exposure to a broad range of
Immigrant workers in the AgFF sector experience risk factors for a broad range of adverse health outcomes.
work conditions that are frequently dangerous, monoto- This sector also employs a large, and in some cases in-
nous, and unpleasant. Many live in poor and unsanitary creasing, number of minority immigrant workers. Though
conditions [Arcury et al., 2012a, b]. They are socially evidence to date is quite limited, these workers appear to
marginalized, and subject to discrimination and threats have a disproportionate burden of occupational morbidity
due to their immigrant status. Many are separated from and mortality. This review demonstrates the uneven nature
 Immigrant Worker Occupational Health Outcomes 11

TABLE I. Summary of Existing Literature on Occupational Health and Safety in the Agriculture, Forestry, and Fisheries Sector, for Workers in the US in
General, Immigrant Workers Anywhere in the US, and Immigrant Workers in the Southeastern US, by Industry

Agriculture Forestry Fisheries

US SEUS US SEUS US SEUS
Outcomes or exposures USa immigrant immigrant USa immigrant immigrant USa immigrant immigrant















Acute trauma ^ ^ ^ ^















Musculoskeletal disorders ^ ^ ^ ^

















Chemicals ^ ^ ^










Dust andparticulates ^ ^ ^ ^ ^ ^















Weather ^ ^ ^ ^










Infections and envenomations dueto animals ^ ^ ^ ^ ^ ^












Noise ^ ^ ^ ^ ^















Psychosocial ^ ^ ^ ^

^, No studies available;


, multiple studies available;

, limited studies available.
a
Includes studies in any worker population in the US or from comparable industries in other countries.

of occupational health research in this sector. In general, The need for more research on immigrant workers is
the literature is most extensive for agriculture, covering all most evident in the fishing industry. The literature is lack-
the outcomes or exposures included in this review ing regarding the number of immigrant workers employed
(Table I). The literature for forestry and fisheries is, over- in fishing in any region of the US, and no data could
all, much sparser. Some topics have little or no research; be found that are specific to the southeastern region. An
and risk factors presented are speculative, based on the immediate research need is to identify the proportion of
nature of exposures. The literature for immigrant workers immigrant fishermen in the US, their distribution among
in the US is most robust for agriculture, though several the various types of fishing, their occupational roles, and
exposures have not been studied among immigrants. their injury rates. As with prior research in agriculture,
Almost no research has been conducted on occupational such evidence will help identify how immigrant workers
health of immigrant labor in forestry and fisheries in the are contributing to overall occupational injuries reported
US. Research on occupational health among immigrant in the fishing industry and may distinguish injury risks
workers in the southeastern US is limited to agriculture. that are disproportionately high for immigrant workers.
Much of this has been conducted in North Carolina and Determining injury rates of immigrant workers with
focuses on chemical exposures, heat, and psychosocial disabilities may also be of interest. Xiang et al. [2010]
factors. The uneven nature of the research suggests several reported that, for forms of disability, immigrants are more
areas where further study of health and safety of immi- likely to be employed than US-born adults with an equiva-
grant workers in the US as a whole and the southeastern lent disability. Additionally, AgFF, along with most other
US, in particular, is needed. industries, employs a similar percentage of immigrants
with and without disabilities.

Acute Trauma and Musculoskeletal

Disorders Chemicals

Due to the prevalence of documented H-2B guest More work should be directed at quantitative assess-
workers, the forestry industry arguably has the greatest po- ment of chemical exposures to pesticides for immigrant
tential for in-depth injury risk analysis for immigrant workers in the southeastern US region, other than North
workers in the southeastern US. Musculoskeletal injury Carolina, to determine if there are geographic differences.
analysis may be the most relevant given the high number More work should be devoted to analyses of health
of immigrants performing highly repetitive tree-planting outcomes (e.g., psychiatric disorders, neurodegenerative
work. However, because of the difficulty of obtaining disease) and to identifying common combinations of pesti-
H-2B visas, there may still be a fairly large population of cide exposures. Genetic variants for susceptibility to pesti-
undocumented workers, especially among smaller forestry cide-induced pathology in workers should be further
contractors that need to be accounted for when determin- explored. The consequences of long-term exposure to haz-
ing injury risk. ardous non-pesticide chemicals, and their interaction with
12 Quandt et al.

pesticides, should not be ignored in farmworkers or forest- cats in these camps determined. Work is needed to deter-
ry workers. mine factors that influence the use of insect repellants in
agriculture and forestry workers. The frequency of contact
Weather with wild animals has not been well studied in forestry
workers.
Recent US deaths during heat waves in 2005, 2007, The frequency of occupational allergy to shellfish
and 2008 have brought attention to the safety of agricul- needs to be determined in fishing industry workers and
tural workers. Weather-related injuries, such as heat ill- shellfish processing workers in the southeastern US. Sur-
ness, hypothermia, and struck-by-lightning are amenable veys of health care providers among coastal communities
to intervention in this industry given appropriate informa- on the risks of unusual infections that can result from ma-
tion and work practices (e.g., appropriate clothing, work rine water or fish contact need to be implemented and ed-
organization). California and Washington have enacted ucational programs designed.
state legislation requiring employers to take steps to pre-
vent heat illness among outdoor employees [Washington Psychosocial Exposures
Department of Labor and Industries, 2008; California
Department of Industrial Relations, 2010]. Despite regula- The dearth of mental health research in forestry and
tion, it is unclear whether employers abide by the regula- fishing in the southeastern US calls for future research.
tions or whether they are enforceable [Burke, 2008; Rural Both are sectors where the risk factors created by immi-
Migration News, 2009]. Studies of intervention diffusion grant status and social and physical isolation are likely to
and effectiveness are an area for future research. be substantial. The sectors include exceedingly dangerous
Immigrants present a particular challenge and empha- jobs that can be made more dangerous by inattention due
size the importance of safety messages being provided in to mental illness. Although farmworker research exists, it
both English and Spanish native languages and in a format is largely limited to North Carolina, with a focus on men.
that will reach the most workers (e.g., lay providers, tail- Broader foci including other areas in the southeastern US
gate talks). Heat safety interventions currently being and on women is needed. In addition, research on interac-
implemented include programs such as Project Fresco, a tions with specific exposures (e.g., organophosphorus pes-
bilingual educational program delivered to Texas farm- ticides) known to be associated with mental illness
workers door-to-door by lay health workers [Gonzales, [Stallones and Beseler, 2002] is needed. Finally, studies of
2010]. Future studies can provide needed information mental health issues such as suicide that have been dem-
about immigrant workers in forestry and fishing. onstrated to occur at higher than expected rates among
farmworkers [Hovey and Magaña, 2003] should be con-
Noise ducted in the southeastern US.
Given the difficulty of monitoring and enforcing noise
RECOMMENDATIONS
levels in traditional industrial settings, and the fact that
employees reported wearing hearing protection only 62%
Addressing the burden of occupational health and
of the time when exposed to noise [Daniell et al., 2006],
safety among immigrant workers in the southeastern US
the AgFF sector presents a particular challenge for inter-
will require new efforts on several fronts. Based on the
vening where oversight is more limited. Intervention effec-
current review, the following are recommended as near-
tiveness and compliance present areas for fruitful research.
term research needs and directions.
Future studies among immigrant populations are needed in
forestry and fishing.
 Obtain improved estimates of the population and dis-
tribution of immigrant workers in the diverse jobs
Infections and Envenomations Due to
comprising the AgFF sector.
Animals
 Compile improved estimates of morbidity and mortali-
Updated national surveys of animal-related injuries on ty rates among immigrant workers in the AgFF sector.
farms are needed. Rates of injuries from farm animals dif-  Identify specific jobs and/or work tasks that involve
fer by race and region of country, and studies are needed substantial exposures of immigrant workers to diverse
to determine factors responsible for these differences. Na- categories of risk factors.
tional serosurveys of zoonotic diseases that are not cur-  Continue to identify the relationships between expo-
rently reportable need to be undertaken to determine the sures and health outcomes among immigrant workers.
prevalence in various populations. The frequency of do-  Document and describe specific challenges involved
mestic and wild animals kept in migrant camps needs to in controlling risk factor exposures among immigrant
be assessed and the use of rabies vaccination in dogs and workers.
 Immigrant Worker Occupational Health Outcomes 13

 Develop and test intervention methods tailored to Arcury TA, Weir M, Chen H, Summers P, Pelletier LE, Galván L,
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Arcury TA, Weir MM, Summers P, Chen H, Bailey M, Wiggins MF,
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Arcury TA, Grzywacz JG, Sidebottom J, Wiggins M. 2013. Report
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