No US Medical Care for Sick Farmworkers Louise S. Ward, CRNP, Ph.D. Postdoctoral Research Fellow International Center of Research for Women, Children and Families School of Nursing University of Pennsylvania

Problem Farmworker health important public health issue Population at risk for poor health outcomes Federally funded Migrant Health Centers available Many farmworkers do not use U.S. health services –May go without care –May self-treat –May return to country of origin

Purpose To describe factors that predict farmworkers’ not using U.S. medical care once health problem/ injury has been identified. –Biogenetic –Social –Cultural –Economic –Access-related

Model Model derived from literature; supported by dissertation research

Method: NAWS 1998 Public Access data from National Agricultural Workers Survey –Representative sample of US farmworkers –Trained interviewers –Recruit job site and home Hispanic workers who had identified health problems, pesticide problems, or injuries (n = 483)

Method: Variables Variables used directly from data or constructed from those available Two proxies for working conditions: pay for ride, pay for equipment US Medical care defined as public health department, Community Health Center, private physician, ER, hospital, or migrant clinic All others = “no US medical care when sick”

Findings: Sample Mean age 34.3 years 76% male 62% married Averaged 11 years in US farm work Highest grade % legally documented 41% spoke no English Family income $9,500

Findings: Logistic Regression Model

Findings Farmworkers were LESS likely to receive care if they were Men (half usage rate of women) Workers who follow crops (1.8X) Working with poor working conditions (2.5X) More literate Experiencing barriers Unaccustomed to using government services (Medicaid, WIC)

Discussion Special attention to outreach –To men –To “follow-the-crop” workers –To those at farms where working conditions known to be poor Nurses can reduce barriers –Language –Acceptance –Clinic hours Universal, federally funded health coverage

Acknowledgments Dissertation chair A. Serdar Atav, Ph.D. and committee members Joyce Ferrario, RN, Ph.D. and David Brown, Ph.D. for advice and encouragement T32 grant # T32 NR for support T32 fellows and faculty at Penn for review