Healthcare Utilization among Migrant Latino Farmworkers: The Case of Skin Disease

Abstract: Context: Skin diseases are common occupational illnesses for migrant farmworkers. Farmworkers face many barriers in accessing health care resources. Purpose: Framed by the Health Behavior Model, the purpose of this study was to assess health care utilization for skin disease by migrant Latino farmworkers. Methods: Three hundred and four migrant and seasonal Latino farmworkers in North Carolina were enrolled in a longitudinal study of skin disease and health care utilization over a single agricultural season. Self-reported and dermatologist-diagnosed skin condition data were collected at baseline and at up to 4 follow-up assessments. Medical visit rates were compared to national norms. Findings: Self-reported skin problems and diagnosed skin disease were common among farmworkers. However, only 34 health care visits were reported across the entire agricultural season, and none of the visits were for skin diseases. Nevertheless, self-treatment for skin conditions was common, including use of nonprescription preparations (63%), prescription products (9%), and home remedies (6%). General medical office visits were reported in 3.2% of the assessments, corresponding to 1.6 office visits per person year. Conclusions: The migrant farmworker population consists largely of young men who make little use of clinic services. Skin conditions are very common among these workers, but use of medical services for these conditions is not common. Instead, farmworkers rely primarily on self-treatment. Clinic-based studies of farmworker skin conditions will not account for most injury or disease in this population and have the potential for biased estimates. Article: Skin disease is a common form of occupational illness, and agricultural workers have the highest incidence of skin disorders of all industrial sectors with an annual incidence 4 to 6 times higher than the annual incidence for all private industry. 1 Migrant and seasonal farmworkers especially are exposed to numerous occupational and environmental risk factors (weather, mechanical devices, chemicals, plants, organic and inorganic dust, and fungi) that can result in skin disease or injury. 2 They also often live in crowded, substandard conditions that increase the risk for the spread of skin problems. 3-5 Farmworkers in North Carolina experience significant inflammatory and infectious skin diseases, including acne, irritant and allergic contact dermatitis, tinea pedis, and onychomycosis. 8 Similar to other immigrant Latino communities, farmworkers face many barriers to health care, including linguistic and cultural differences from the majority population, low educational attainment, mobility, inadequate transportation, financial strains, lack of health insurance, lack of documentation, fear of the US medical system, and a limited number of health care facilities. 9-12 However, very little research has examined health care utilization among farmworkers