Background This article introduces some key labor, economic, and social policies that historicall... more Background This article introduces some key labor, economic, and social policies that historically and currently impact occupational health disparities in the United States. Methods We conducted a broad review of the peer-reviewed and gray literature on the effects of social, economic, and labor policies on occupational health disparities. Results Many populations such as tipped workers, public employees, immigrant workers, and misclassified workers are not protected by current laws and policies, including worker’s compensation or Occupational Safety and Health Administration enforcement of standards. Local and state initiatives, such as living wage laws and community benefit agreements, as well as multiagency law enforcement contribute to reducing occupational health disparities. Conclusions There is a need to build coalitions and collaborations to command the resources necessary to identify, and then reduce and eliminate occupational disparities by establishing healthy, safe, and just work for all.
Hispanic immigrants face numerous challenges in the US. In occupational settings, workers struggl... more Hispanic immigrants face numerous challenges in the US. In occupational settings, workers struggle between keeping their job, staying safe, and navigating the worker protection and health systems. As stated by David Michaels, OSHA Assistant Secretary, Latino workers face the most dangerous working conditions and the fewest protections. This is particularly challenging in high risk industries such as agriculture. Our comprehensive intervention is based on multiple approaches to reduce work-related injuries and diseases in dairy. It consists of a farm risk reduction component coupled with a worker educational component, and reinforced with a network of promotores de salud (PdS). The farm component consists of a hazard identification and remediation plan. The worker educational component addresses knowledge, attitudes and practices (KAP) and integrates concepts from the Health Belief Model, Risk Prevention, and the Taxonomy of Significant Learning. Finally, we applied the principles of...
Large animal agriculture is among the most hazardous agricultural activities and workers in dairy... more Large animal agriculture is among the most hazardous agricultural activities and workers in dairy face significant health and safety risks. The industrialization of diary has coincided with a growing immigrant workforce; immigrants now make up about half the hired workforce in dairy. Increasing immigrant workers with unaddressed language barriers and training needs add to the challenges of improving safety in dairy. Few resources address the health and safety needs of this changing workforce. The Seguridad en las Lecherias (Safety in Dairies) project bridges this gap by providing a workplace-based, bilingual safety intervention for immigrant dairy workers in Wisconsin. This program includes a training curriculum designed and tested to educate workers in reducing worksite hazards and improving health and safety knowledge and practices. It is delivered on the farm and engages workers using culturally appropriate education techniques to ensure understanding by workers with low literacy...
Dairy in Wisconsin and the nation is rapidly changing from the family owned and run, small herd f... more Dairy in Wisconsin and the nation is rapidly changing from the family owned and run, small herd farms to large, multi-thousand head operations with large hired workforces. In Wisconsin Hispanic immigrant workers represent some 50% of the hired workforce in dairy. Large animals, often extreme weather conditions and large powered machinery contribute to high rates of injury in one of the most dangerous industries in the US. Three separate and distinct dairy health and safety research projects employed a common needs assessment process to obtain formative data on language, key issues, clear needs and common understandings from among agricultural extension agents, farm owners, clinicians, farmworkers, trainers, insurance personnel and researchers. Structured interview guides were developed reflecting the data needs of the three projects. Key informant and focus groups were used to interview subjects. Qualitative analysis of data identified both solicited and spontaneously emergent theme...
Family dairy enterprises are becoming large dairy operations, replacing family labor with hired w... more Family dairy enterprises are becoming large dairy operations, replacing family labor with hired workers. This transition absorbs many immigrant, Hispanic, often undocumented workers into a high injury industry. En-route from family farm to medium-sized business, owners may carry internalized acceptance of hazards that make agriculture among the most dangerous US industries. Meanwhile, agricultural academic programs rarely train in safety management. Hispanic immigrant workers often have little experience handling large animals. With limited English and precarious legal status, they cannot or will not assert their rights to a safe workplace. Additionally, the federal Occupational Safety and Health Administration (OSHA) is bridled by congressional limits on applicable standards and workplace enforcement. Thus, this relatively unregulated industry has created little demand for a capable safety consulting workforce until now. In 2012, Region 5 OSHA sent tremors through the industry when...
ABSTRACT Audience response systems (ARS) have long been used to improve the interactivity of educ... more ABSTRACT Audience response systems (ARS) have long been used to improve the interactivity of educational activities. Most studies of ARS have addressed education of literate trainees. How well these devices work with low-literacy subjects is not well studied. Information gathering on the training audience is an important use of ARS and helpful in improving the targeting of training information. However, obtaining demographic information from vulnerable populations with reasons to be concerned about divulging information about themselves has not been tested. In addition, a culturally competent method to effectively collect demographic and evaluation data of this growing population is essential. This project investigated the use of ARS to gather information from Hispanic immigrant workers, many of whom are socially vulnerable and have limited English proficiency (LEP) and low-literacy. Workers attended focus groups and were asked to use ARS devices or clickers to respond to questions....
Modern agricultural production depends on a global workforce that largely consists of immigrant w... more Modern agricultural production depends on a global workforce that largely consists of immigrant workers. Immigrant workers in agriculture is a global phenomenon. As the Wisconsin dairy industry modernizes, Hispanic immigrant workers play an increasingly important role. These workers, representing 40% to 60% of Wisconsin's dairy workforce, enter one of the most dangerous industries in the US. Large animals, mass animal production processes and machinery contribute to high rates of injury and illness in dairy. International, national and regional organizations partnered to design a culturally relevant intervention to improve health and safety in dairy. The design of this intervention involved a multifaceted needs assessment consisting of key informant interviews with 14 farmers, clinicians, industry representatives, five focus groups with 37 dairy workers and one with 17 agricultural extension agents. The assessment included a literature review and site visits to dairy farms. Find...
Mobile application softwares or “apps” are becoming ubiquitous in agriculture as much as in the g... more Mobile application softwares or “apps” are becoming ubiquitous in agriculture as much as in the general population. This reality has tremendous potential for improving the health and safety of the farming community. A plethora of apps for the assessment of workplace hazards and implementation of worker protection are readily available. However, very little guidance on the use and design of these apps exist. This project developed a framework for evaluating apps that have potential usefulness in the agricultural health and safety field through a formalized process. A literature search found no evidence that an app evaluation methodology exists for apps related to the health and safety of agricultural workers. Thus, the framework was developed based on guidance documents used to evaluate apps in other fields. The project developed an evaluation rubric with a simple formula to rate apps. It was tested by mobile app developers and agricultural health and safety experts and further refin...
Agricultural pesticide handlers are at an elevated risk for overexposure to organophosphate (OP) ... more Agricultural pesticide handlers are at an elevated risk for overexposure to organophosphate (OP) pesticides, but symptoms can be difficult to recognise, making biomarkers invaluable for diagnosis. Occupational monitoring programmes for cholinesterase depression generally rely on measuring activity of either of the two common blood cholinesterases which serve as proxy measurements for nervous-system acetylcholinesterase activity: red blood cell acetylcholinesterase (AChE) and plasma butyrylcholinesterase (BChE). These biomarkers, however, may be affected differentially by some OPs and the relationship between them has not been well characterised. We aim to determine the association between blood AChE and BChE activity levels and assess whether they produce comparable classifications of clinical cholinesterase depression among OP pesticide handlers. Using blood samples from 215 participants of the Washington State Cholinesterase Monitoring Program, we quantified changes in AChE and BChE activity from before and after exposure to OP pesticides and calculated Pearson correlation statistics for correlation of AChE and BChE changes in activity, as well as weighted κ statistics for agreement of classification of clinical cholinesterase depression based on AChE versus BChE measurements. AChE and BChE activity measurements are weakly negatively correlated in our study population. Reaching a clinical threshold for diagnosis of cholinesterase depression based on the AChE marker did not correlate with reaching clinical depression based on the BChE marker. Both AChE and BChE should be measured in monitoring programmes because they may both give potentially important but disparate classifications of clinical cholinesterase depression.
Organophosphate (OP) and N-methyl-carbamate (CB) insecticides are used widely in agriculture to m... more Organophosphate (OP) and N-methyl-carbamate (CB) insecticides are used widely in agriculture to manage insect pests of economic importance. Agricultural workers are more likely to suffer exposure because of the widespread use of OP/CBs in agriculture, and pesticide-related illnesses among handlers may be more severe when compared to other farm workers. The goal of this study was to identify occupational and personal characteristics associated with butyrylcholinesterase (BuChE) inhibition in participants recruited from the Washington State Cholinesterase Monitoring Program from 2006 to 2011. We conducted a longitudinal study among agricultural pesticide handlers in Washington State during the OP/CB spray season (March-July) over a 6-year period (2006-2011). Linear mixed effects regression models were used to evaluate BuChE inhibition in relation to self-reported occupational and personal characteristics. Relative to pre-season baseline levels, the mean decrease in BuChE activity duri...
International Journal of Occupational and Environmental Health, 2004
An icon-calendar interview form (ICF) for a case-control study of childhood leukemias and parenta... more An icon-calendar interview form (ICF) for a case-control study of childhood leukemias and parental exposures to pesticides is described. It includes calendar sheets, icons for life events, crops, jobs, regions, non-agricultural jobs, application techniques and personal protection, markers for durations of exposure patterns, and checklists of pesticides. The ICF collects monthly data from two years before birth until diagnosis of cancer (index children) or until either the interview date or age 15 (controls). Data ascertainment was easy in 62% of interviews, moderately easy in 32%, and difficult in 6%. Seventy-eight subjects delivered data on specific pesticides with pesticide checklists, which improved identification of pesticides. ICF performs satisfactorily for crops, tasks, and other determinants of exposure. Data on pesticides will be further improved by introducing external data use on different crops, time periods, and regions, and by exposure modeling for 27 pesticides.
Responders such as firefighters and emergency medical technicians who respond to farm emergencies... more Responders such as firefighters and emergency medical technicians who respond to farm emergencies often face complex and unknown environments. They may encounter hazards such as fuels, solvents, pesticides, caustics, and exploding gas storage cylinders. Responders may be unaware of dirt roads within the farm that can expedite their arrival at critical sites or snow-covered manure pits that act as hidden hazards. A response to a farm, unless guided by someone familiar with the operation, may present a risk to responders and post a challenge in locating the victim. This project explored the use of a Web-based farm-mapping application optimized for tablets and accessible via easily accessible on-site matrix barcodes, or quick response codes (QR codes), to provide emergency responders with hazard and resource information to agricultural operations. Secured portals were developed for both farmers and responders, allowing both parties to populate and customize farm maps with icons. Data were stored online and linked to QR codes attached to mailbox posts where emergency responders may read them with a mobile device. Mock responses were conducted on dairy farms to test QR code linking efficacy, Web site security, and field usability. Findings from farmer usability tests showed willingness to enter data as well as ease of Web site navigation and data entry even with farmers who had limited computer knowledge. Usability tests with emergency responders showed ease of QR code connectivity to the farm maps and ease of Web site navigation. Further research is needed to improve data security as well as assess the program's applicability to nonfarm environments and integration with existing emergency response systems. The next phases of this project will expand the program for regional and national use, develop QR code-linked, Web-based extrication guidance for farm machinery for victim entrapment rescue, and create QR code-linked online training videos and materials for limited English proficient immigrant farm workers.
Audience response systems (ARS) have long been used to improve the interactivity of educational a... more Audience response systems (ARS) have long been used to improve the interactivity of educational activities. Most studies of ARS have addressed education of literate trainees. How well these devices work with low-literacy subjects is not well studied. Information gathering on the training audience is an important use of ARS and helpful in improving the targeting of training information. However, obtaining demographic information from vulnerable populations with reasons to be concerned about divulging information about themselves has not been tested. In addition, a culturally competent method to effectively collect demographic and evaluation data of this growing population is essential. This project investigated the use of ARS to gather information from Hispanic immigrant workers, many of whom are socially vulnerable and have limited English proficiency (LEP) and low-literacy. Workers attended focus groups and were asked to use ARS devices or clickers to respond to questions. Questions were both categorical (multiple choice) and open-ended numerical (text entry), and varied from simple queries to more sensitive points regarding immigration. Most workers answered the one-key response categorical questions with little difficulty. In contrast, some participants struggled when responding to numerical questions, especially when the response required pressing multiple clicker keys. An overwhelming majority of participants reported that the clickers were comfortable and easy to use despite the challenges presented by the more complex responses. The error rate increased as question complexity increased and the trend across three ordered categories of response complexity reached statistical significance. Results suggest that ARS is a viable method for gathering dichotomous or higher-order categorical information from LEP and low-literacy populations in a group setting while assuring anonymity. However, it is recommended that clickers be developed and tested with fewer, bigger, and more widely separated buttons, and less printing on the buttons for these populations. Further research is needed to determine the effectiveness of using clickers with simplified configurations in the workplace as a tool to collect data for surveys and assessments and to better engage LEP and low-literacy workers in training sessions.
Background This article introduces some key labor, economic, and social policies that historicall... more Background This article introduces some key labor, economic, and social policies that historically and currently impact occupational health disparities in the United States. Methods We conducted a broad review of the peer-reviewed and gray literature on the effects of social, economic, and labor policies on occupational health disparities. Results Many populations such as tipped workers, public employees, immigrant workers, and misclassified workers are not protected by current laws and policies, including worker’s compensation or Occupational Safety and Health Administration enforcement of standards. Local and state initiatives, such as living wage laws and community benefit agreements, as well as multiagency law enforcement contribute to reducing occupational health disparities. Conclusions There is a need to build coalitions and collaborations to command the resources necessary to identify, and then reduce and eliminate occupational disparities by establishing healthy, safe, and just work for all.
Hispanic immigrants face numerous challenges in the US. In occupational settings, workers struggl... more Hispanic immigrants face numerous challenges in the US. In occupational settings, workers struggle between keeping their job, staying safe, and navigating the worker protection and health systems. As stated by David Michaels, OSHA Assistant Secretary, Latino workers face the most dangerous working conditions and the fewest protections. This is particularly challenging in high risk industries such as agriculture. Our comprehensive intervention is based on multiple approaches to reduce work-related injuries and diseases in dairy. It consists of a farm risk reduction component coupled with a worker educational component, and reinforced with a network of promotores de salud (PdS). The farm component consists of a hazard identification and remediation plan. The worker educational component addresses knowledge, attitudes and practices (KAP) and integrates concepts from the Health Belief Model, Risk Prevention, and the Taxonomy of Significant Learning. Finally, we applied the principles of...
Large animal agriculture is among the most hazardous agricultural activities and workers in dairy... more Large animal agriculture is among the most hazardous agricultural activities and workers in dairy face significant health and safety risks. The industrialization of diary has coincided with a growing immigrant workforce; immigrants now make up about half the hired workforce in dairy. Increasing immigrant workers with unaddressed language barriers and training needs add to the challenges of improving safety in dairy. Few resources address the health and safety needs of this changing workforce. The Seguridad en las Lecherias (Safety in Dairies) project bridges this gap by providing a workplace-based, bilingual safety intervention for immigrant dairy workers in Wisconsin. This program includes a training curriculum designed and tested to educate workers in reducing worksite hazards and improving health and safety knowledge and practices. It is delivered on the farm and engages workers using culturally appropriate education techniques to ensure understanding by workers with low literacy...
Dairy in Wisconsin and the nation is rapidly changing from the family owned and run, small herd f... more Dairy in Wisconsin and the nation is rapidly changing from the family owned and run, small herd farms to large, multi-thousand head operations with large hired workforces. In Wisconsin Hispanic immigrant workers represent some 50% of the hired workforce in dairy. Large animals, often extreme weather conditions and large powered machinery contribute to high rates of injury in one of the most dangerous industries in the US. Three separate and distinct dairy health and safety research projects employed a common needs assessment process to obtain formative data on language, key issues, clear needs and common understandings from among agricultural extension agents, farm owners, clinicians, farmworkers, trainers, insurance personnel and researchers. Structured interview guides were developed reflecting the data needs of the three projects. Key informant and focus groups were used to interview subjects. Qualitative analysis of data identified both solicited and spontaneously emergent theme...
Family dairy enterprises are becoming large dairy operations, replacing family labor with hired w... more Family dairy enterprises are becoming large dairy operations, replacing family labor with hired workers. This transition absorbs many immigrant, Hispanic, often undocumented workers into a high injury industry. En-route from family farm to medium-sized business, owners may carry internalized acceptance of hazards that make agriculture among the most dangerous US industries. Meanwhile, agricultural academic programs rarely train in safety management. Hispanic immigrant workers often have little experience handling large animals. With limited English and precarious legal status, they cannot or will not assert their rights to a safe workplace. Additionally, the federal Occupational Safety and Health Administration (OSHA) is bridled by congressional limits on applicable standards and workplace enforcement. Thus, this relatively unregulated industry has created little demand for a capable safety consulting workforce until now. In 2012, Region 5 OSHA sent tremors through the industry when...
ABSTRACT Audience response systems (ARS) have long been used to improve the interactivity of educ... more ABSTRACT Audience response systems (ARS) have long been used to improve the interactivity of educational activities. Most studies of ARS have addressed education of literate trainees. How well these devices work with low-literacy subjects is not well studied. Information gathering on the training audience is an important use of ARS and helpful in improving the targeting of training information. However, obtaining demographic information from vulnerable populations with reasons to be concerned about divulging information about themselves has not been tested. In addition, a culturally competent method to effectively collect demographic and evaluation data of this growing population is essential. This project investigated the use of ARS to gather information from Hispanic immigrant workers, many of whom are socially vulnerable and have limited English proficiency (LEP) and low-literacy. Workers attended focus groups and were asked to use ARS devices or clickers to respond to questions....
Modern agricultural production depends on a global workforce that largely consists of immigrant w... more Modern agricultural production depends on a global workforce that largely consists of immigrant workers. Immigrant workers in agriculture is a global phenomenon. As the Wisconsin dairy industry modernizes, Hispanic immigrant workers play an increasingly important role. These workers, representing 40% to 60% of Wisconsin's dairy workforce, enter one of the most dangerous industries in the US. Large animals, mass animal production processes and machinery contribute to high rates of injury and illness in dairy. International, national and regional organizations partnered to design a culturally relevant intervention to improve health and safety in dairy. The design of this intervention involved a multifaceted needs assessment consisting of key informant interviews with 14 farmers, clinicians, industry representatives, five focus groups with 37 dairy workers and one with 17 agricultural extension agents. The assessment included a literature review and site visits to dairy farms. Find...
Mobile application softwares or “apps” are becoming ubiquitous in agriculture as much as in the g... more Mobile application softwares or “apps” are becoming ubiquitous in agriculture as much as in the general population. This reality has tremendous potential for improving the health and safety of the farming community. A plethora of apps for the assessment of workplace hazards and implementation of worker protection are readily available. However, very little guidance on the use and design of these apps exist. This project developed a framework for evaluating apps that have potential usefulness in the agricultural health and safety field through a formalized process. A literature search found no evidence that an app evaluation methodology exists for apps related to the health and safety of agricultural workers. Thus, the framework was developed based on guidance documents used to evaluate apps in other fields. The project developed an evaluation rubric with a simple formula to rate apps. It was tested by mobile app developers and agricultural health and safety experts and further refin...
Agricultural pesticide handlers are at an elevated risk for overexposure to organophosphate (OP) ... more Agricultural pesticide handlers are at an elevated risk for overexposure to organophosphate (OP) pesticides, but symptoms can be difficult to recognise, making biomarkers invaluable for diagnosis. Occupational monitoring programmes for cholinesterase depression generally rely on measuring activity of either of the two common blood cholinesterases which serve as proxy measurements for nervous-system acetylcholinesterase activity: red blood cell acetylcholinesterase (AChE) and plasma butyrylcholinesterase (BChE). These biomarkers, however, may be affected differentially by some OPs and the relationship between them has not been well characterised. We aim to determine the association between blood AChE and BChE activity levels and assess whether they produce comparable classifications of clinical cholinesterase depression among OP pesticide handlers. Using blood samples from 215 participants of the Washington State Cholinesterase Monitoring Program, we quantified changes in AChE and BChE activity from before and after exposure to OP pesticides and calculated Pearson correlation statistics for correlation of AChE and BChE changes in activity, as well as weighted κ statistics for agreement of classification of clinical cholinesterase depression based on AChE versus BChE measurements. AChE and BChE activity measurements are weakly negatively correlated in our study population. Reaching a clinical threshold for diagnosis of cholinesterase depression based on the AChE marker did not correlate with reaching clinical depression based on the BChE marker. Both AChE and BChE should be measured in monitoring programmes because they may both give potentially important but disparate classifications of clinical cholinesterase depression.
Organophosphate (OP) and N-methyl-carbamate (CB) insecticides are used widely in agriculture to m... more Organophosphate (OP) and N-methyl-carbamate (CB) insecticides are used widely in agriculture to manage insect pests of economic importance. Agricultural workers are more likely to suffer exposure because of the widespread use of OP/CBs in agriculture, and pesticide-related illnesses among handlers may be more severe when compared to other farm workers. The goal of this study was to identify occupational and personal characteristics associated with butyrylcholinesterase (BuChE) inhibition in participants recruited from the Washington State Cholinesterase Monitoring Program from 2006 to 2011. We conducted a longitudinal study among agricultural pesticide handlers in Washington State during the OP/CB spray season (March-July) over a 6-year period (2006-2011). Linear mixed effects regression models were used to evaluate BuChE inhibition in relation to self-reported occupational and personal characteristics. Relative to pre-season baseline levels, the mean decrease in BuChE activity duri...
International Journal of Occupational and Environmental Health, 2004
An icon-calendar interview form (ICF) for a case-control study of childhood leukemias and parenta... more An icon-calendar interview form (ICF) for a case-control study of childhood leukemias and parental exposures to pesticides is described. It includes calendar sheets, icons for life events, crops, jobs, regions, non-agricultural jobs, application techniques and personal protection, markers for durations of exposure patterns, and checklists of pesticides. The ICF collects monthly data from two years before birth until diagnosis of cancer (index children) or until either the interview date or age 15 (controls). Data ascertainment was easy in 62% of interviews, moderately easy in 32%, and difficult in 6%. Seventy-eight subjects delivered data on specific pesticides with pesticide checklists, which improved identification of pesticides. ICF performs satisfactorily for crops, tasks, and other determinants of exposure. Data on pesticides will be further improved by introducing external data use on different crops, time periods, and regions, and by exposure modeling for 27 pesticides.
Responders such as firefighters and emergency medical technicians who respond to farm emergencies... more Responders such as firefighters and emergency medical technicians who respond to farm emergencies often face complex and unknown environments. They may encounter hazards such as fuels, solvents, pesticides, caustics, and exploding gas storage cylinders. Responders may be unaware of dirt roads within the farm that can expedite their arrival at critical sites or snow-covered manure pits that act as hidden hazards. A response to a farm, unless guided by someone familiar with the operation, may present a risk to responders and post a challenge in locating the victim. This project explored the use of a Web-based farm-mapping application optimized for tablets and accessible via easily accessible on-site matrix barcodes, or quick response codes (QR codes), to provide emergency responders with hazard and resource information to agricultural operations. Secured portals were developed for both farmers and responders, allowing both parties to populate and customize farm maps with icons. Data were stored online and linked to QR codes attached to mailbox posts where emergency responders may read them with a mobile device. Mock responses were conducted on dairy farms to test QR code linking efficacy, Web site security, and field usability. Findings from farmer usability tests showed willingness to enter data as well as ease of Web site navigation and data entry even with farmers who had limited computer knowledge. Usability tests with emergency responders showed ease of QR code connectivity to the farm maps and ease of Web site navigation. Further research is needed to improve data security as well as assess the program's applicability to nonfarm environments and integration with existing emergency response systems. The next phases of this project will expand the program for regional and national use, develop QR code-linked, Web-based extrication guidance for farm machinery for victim entrapment rescue, and create QR code-linked online training videos and materials for limited English proficient immigrant farm workers.
Audience response systems (ARS) have long been used to improve the interactivity of educational a... more Audience response systems (ARS) have long been used to improve the interactivity of educational activities. Most studies of ARS have addressed education of literate trainees. How well these devices work with low-literacy subjects is not well studied. Information gathering on the training audience is an important use of ARS and helpful in improving the targeting of training information. However, obtaining demographic information from vulnerable populations with reasons to be concerned about divulging information about themselves has not been tested. In addition, a culturally competent method to effectively collect demographic and evaluation data of this growing population is essential. This project investigated the use of ARS to gather information from Hispanic immigrant workers, many of whom are socially vulnerable and have limited English proficiency (LEP) and low-literacy. Workers attended focus groups and were asked to use ARS devices or clickers to respond to questions. Questions were both categorical (multiple choice) and open-ended numerical (text entry), and varied from simple queries to more sensitive points regarding immigration. Most workers answered the one-key response categorical questions with little difficulty. In contrast, some participants struggled when responding to numerical questions, especially when the response required pressing multiple clicker keys. An overwhelming majority of participants reported that the clickers were comfortable and easy to use despite the challenges presented by the more complex responses. The error rate increased as question complexity increased and the trend across three ordered categories of response complexity reached statistical significance. Results suggest that ARS is a viable method for gathering dichotomous or higher-order categorical information from LEP and low-literacy populations in a group setting while assuring anonymity. However, it is recommended that clickers be developed and tested with fewer, bigger, and more widely separated buttons, and less printing on the buttons for these populations. Further research is needed to determine the effectiveness of using clickers with simplified configurations in the workplace as a tool to collect data for surveys and assessments and to better engage LEP and low-literacy workers in training sessions.
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Papers by Matthew Keifer
States.
Methods We conducted a broad review of the peer-reviewed and gray literature on the effects of social, economic, and labor policies on occupational health disparities.
Results Many populations such as tipped workers, public employees, immigrant workers, and misclassified workers are not protected by current laws and policies,
including worker’s compensation or Occupational Safety and Health Administration enforcement of standards. Local and state initiatives, such as living wage laws and community benefit agreements, as well as multiagency law enforcement contribute to reducing occupational health disparities.
Conclusions There is a need to build coalitions and collaborations to command the resources necessary to identify, and then reduce and eliminate occupational disparities by establishing healthy, safe, and just work for all.
States.
Methods We conducted a broad review of the peer-reviewed and gray literature on the effects of social, economic, and labor policies on occupational health disparities.
Results Many populations such as tipped workers, public employees, immigrant workers, and misclassified workers are not protected by current laws and policies,
including worker’s compensation or Occupational Safety and Health Administration enforcement of standards. Local and state initiatives, such as living wage laws and community benefit agreements, as well as multiagency law enforcement contribute to reducing occupational health disparities.
Conclusions There is a need to build coalitions and collaborations to command the resources necessary to identify, and then reduce and eliminate occupational disparities by establishing healthy, safe, and just work for all.