Few studies have evaluated skin disease in migrant farmworkers. In one of the Wake Forest studies, 59 farmworkers from Nash and Johnston Counties were examined by a dermatologist with the goal of estimating the prevalence and predictors of skin disease. The results are reported in the May issue of the Journal of Agricultural Safety and Health.
A second study, which involved in-depth interviews with 30 farmworkers from across the state, was designed to determine workers' beliefs and perceptions about occupational skin disease. Results are reported in the April issue of the American Journal of Industrial Medicine.
"Farmworkers are particularly vulnerable to diseases of the skin and have the highest incidence of skin disorders of any industry," said Thomas Arcury, Ph.D., professor of family medicine at Wake Forest University School of Medicine and lead researcher. "These workers represent a medically underserved population that is at risk for both environmental and occupational health problems, as well as health problems associated with poverty."
An estimated 4.2 million seasonal and migrant farmworkers and their families live in the United States. Most farmworkers are Hispanic, with a majority being from Mexico. Due to language barriers - 44 percent indicate they speak no English - they have limited access to health education or safety warnings.
In the study involving skin exams of 59 workers, all five female workers had skin disease, while 78 percent of the 54 men did. The study was conducted during the 2004 growing season. For men, the most common diagnoses were nail fungus, foot fungus and acne. Among the women, diagnoses included excessively dry skin, foot fungus and acne.
"While these may not be a direct result of farmwork, it is likely a result of resources and living environment," said Arcury.
He explained that workers often must share shower facilities and often have limited access to washing facilities and to stores for detergents.
"The results suggest that services to diagnose and treat such diseases should be made readily available," he said.
The interview study - also conducted during the 2004 season - sought to learn more about workers' beliefs about skin disease.
"This information is essential to understanding farmworker health behavior and for improving health care and health education to these workers," said Arcury.
The researchers found that few workers mentioned skin cancer as a potential health problem, yet exposure to sunlight is a major risk factor for the disease. The interviews also revealed that a common belief among workers is that each individual's personal susceptibility determines whether they will be affected by a condition.
"Farmworkers do not acknowledge several skin diseases that should be of great concern, including skin cancer," said Arcury. "And personal susceptibility is used to differentiate one's self from others, usually to show superiority."
Arcury said these beliefs need to be challenged in any programs designed to reduce occupational skin disease.
"First, the notion that it affects only those who are susceptible needs to be dispelled," he said. "Second, the delayed effects of some risk factors, such as sunlight exposure, need to be stressed."
Co-researchers on the study to assess prevalence were Jennifer Krejci-Manwaring, M.D., Steven Feldman, M.D., Quriina Vallejos, M.P.H., Sara Quandt, Ph.D., Stephen Rapp, Ph.D., all from Wake Forest, and Mark Schulz, Ph.D., from the University of North Carolina at Greensboro.
Co-researchers on the study about perceptions were Vallejos, Antonio Marín, M.A., Feldman, and Quandt, Ph.D., all with Wake Forest, and Gerrell Smith, B.A., with the University of North Carolina at Greensboro.
Wake Forest University Baptist Medical Center is an academic health system comprised of North Carolina Baptist Hospital and Wake Forest University Health Sciences, which operates the university's School of Medicine. The system comprises 1,187 acute care, psychiatric, rehabilitation and long-term care beds and is consistently ranked as one of "America's Best Hospitals" by U.S. News & World Report.