Southwest Center for Occupational and Environmental Health

On-Farm Health Screening Needs of Immigrant Dairy Workers in the Texas Panhandle and South Plains – a Q and A Session

HOUSTON (May 30, 2023) – Anabel Rodriguez, MPH, PhD, the Outreach Program Director for the Southwest Center for Occupational and Environmental Health (SWCOEH), has completed a pilot study to determine the health needs of dairy farm workers and the feasibility and best practices of on-farm health risk screenings in the Texas Panhandle and South Plains. The Southwest Center for Agricultural Health, Injury Prevention, and Education funded the study at The University of Texas at Tyler Health Science Center.

A cross-sectional study was used to collect survey responses concerning health needs and occupational and economic characteristics among 300 dairy workers between April 2020 and July 2021. Participants were predominantly immigrant Hispanic males of approximately 34 years of age, working six days a week and nearly 10 hours a day. Ninety-four percent of participants reported interest in attending on-farm health risk screenings, and 86 percent were interested in receiving a COVID-19 vaccine if it became available. Respondents ranked health service categories from most important to least important: Preventive care, Laboratory and diagnostic care; Nutritional and physical fitness support; Mental health care; and Workplace interventions. 

To dive deeper into the study, below is a Q and A with Dr. Rodriguez:

SWCOEH.org: “The majority of workers described their general health as “Very Good” (38.5%) and “Good” (33.8%). Did this high number of “good health” responses surprise you? Based on your observations, would you agree with these numbers or place them higher or lower?

Dr. Rodriguez: “It did not surprise me to see most workers perceived their health as “very good” and “good.” We call this phenomenon the ‘healthy worker effect’ in epidemiology. This refers to the idea that employed individuals, especially in occupations with labor-intensive tasks like agriculture, are generally healthier than individuals not employed. 

SWCOEH.org: “Half of the participants had health insurance (55.7%)—most of which was employer-provided (85.6%). Were you surprised by these numbers at all? Have these numbers improved in recent years? For example, if you did this survey ten years ago, what percentage of participants would have had health insurance?

Dr. Rodriguez: “A bit more than half of dairy farm workers surveyed had health insurance coverage compared to 92% of the general U.S. population in 2019. This is the first time our team has asked for health insurance coverage among dairy farm workers in the Texas Panhandle. We do not have data from 10 years ago to compare coverage. For the past nine years, anecdotal observations have led me to believe this coverage has increased. However, this is still an uphill battle with a gap of 36 percentage points to be at the level of the general U.S. population, which is not universally covered either.  

SWCOEH.org: “Given the unanimous interest in attending health screenings, what does this practically look like? Who conducts them? Who pays for them? Does insurance cover them?

Dr. Rodriguez: “Addressing known health barriers should be paramount to organizing on-farm health screenings. Health barriers include cost, transportation, communication and culture challenges, conflicting work schedules, lack of childcare, and fear of law and immigration enforcement. Our team used findings from this study to host on-farm vaccine clinics for more than 4,000 agricultural workers and their families during the COVID-19 pandemic and vaccine (booster) launch (2021 – 2023). To host clinics, we leveraged funds and partnerships with local health departments, community-based organizations, and dairy farm leadership. Moving forward, Drs. Dave Douphrate (overall PI; Texas A&M University), David Gimeno Ruiz de Porras (Co-I; UTHealth/SWCOEH), Brett Perkison (Co-I; UTHealth/SWCOEH), and myself (PI at UTHealth/SWCOEH) will be leading an on-farm health screening feasibility study for 600 dairy workers in the Texas-Eastern New Mexico milk shed.

SWCOEH.org: “Are blood draws at a health screening common? This seems the easiest way to get a large snapshot of the farmer’s health.”

Dr. Rodriguez: “On-farm health screenings can include full blood draws. However, for farm efficiency, our team suggested point-of-care (POC) testing that requires a simple fingerstick. POC testing can include testing for diabetes, hypertension, hypercholesteremia, kidney function, and mental health and musculoskeletal symptoms screenings."

SWCOEH.org: The respondents listed which categories are most important. Did anything in this order surprise you?

Dr. Rodriguez: “The ranking of the top five service categories did not surprise me. Preventive health includes many common routine services like vision, dental, chronic disease management, and vaccinations that are highly valued and desired; but, unfortunately, not easily accessed or afforded by this working population. What surprised me was the immense interest in ‘nutrition classes’ under the Nutritional & Physical Fitness Support and the interest in ‘anxiety treatment’ under the Mental Health Care service categories. While not surprised by the need, I was surprised by the vulnerability to admit these needs—a usual underestimation in previous studies due to reporting bias. This speaks to the trust we have built over the years with the dairy farm community in the Panhandle and the high-quality training and standards we hold our project team members to.

SWCOEH.org: Interestingly, most injuries occur with milkers. How often do you believe health screenings occur for these types of workers?

Dr. Rodriguez: Milkers work 8 to 12-hour day or night shifts in conditions that often lead to injuries caused by cow kicks, slips, trips, or falls in the milking parlor. While milking is the most hazardous task on the dairy farm, all tasks have inherent health, safety, and well-being hazards that warrant annual physicals and health screenings. 

SWCOEH.org: Anything else that you found interesting with the results?

Dr. Rodriguez: “Immigration status in the U.S. is a historical barrier to health and a strong predictor of morbidity and mortality. Immigration status is also a social determinant of health rooted in public health, economic and political inequities. As an occupational epidemiologist, I feel obligated to dismantle systemic barriers to health among agricultural workers one research study at a time. The least we can do as public health professionals is ensure the people who feed us daily feel healthy and safe regardless of their immigration status in this country.”

The SWCOEH provides graduate-level training opportunities for occupational and environmental health professionals through our industrial hygiene, occupational and environmental medicine, occupational epidemiology, and Total Worker Health^®.