OBJECTIVES. We conducted a clinic-based study of erythrocyte cholinesterase levels, pesticide exposures, and health effects among farmworkers and nonfarmworkers to determine risks for exposure and associated morbidity. METHODS. Two hundred two farmworkers and 42 nonfarmworkers were recruited sequentially at two community health centers. Erythrocyte cholinesterase levels were measured colorimetrically. Questionnaires obtained data on demographics, occupational history, exposures, and symptoms. RESULTS. Cholinesterase levels were significantly lower among farmworkers (30.28 U/g hemoglobin) than among nonfarmworkers (32.3 U/g hemoglobin). Twelve percent of farmworkers, but no nonfarmworkers, had very low levels. Farmworkers applying pesticides also had lower cholinesterase levels. One half of farmworkers reported being sprayed by pesticides and working in fields with an obvious chemical smell. Of reported symptoms, only diarrhea was associated with cholinesterase levels. Reported exposures, however, were strongly associated with symptoms. CONCLUSIONS. Farmworkers reported many pesticide exposures that violate state and federal regulations. Farmworkers had cholinesterase levels significantly lower than those of nonfarmworkers, although only spraying pesticides was associated with very low levels.

A two-year study of the microbiological quality of drinking water in 27 randomly selected North Carolina migrant labor camps yielded total and fecal coliform prevalences of 44 percent and 26 percent, respectively in 1988 and similar but higher prevalences in 1989. Preoccupancy testing by county sanitarians had found virtually no total coliform contamination. These findings suggest that a potential source of contamination existed and that current testing protocols which rely on preoccupancy testing may be inadequate.

Although tuberculosis (TB) has been recognized as a significant health problem of migrant farm workers, the nature and extent of the problem have been poorly defined. We report the first population-based study of TB in a random sample of farm workers (n = 543) and the first use of recall antigens in an epidemiologic study of TB. Purified protein derivative positivity ranged from 33% in Hispanics to 54% in US-born blacks and 76% in Haitians. Active tubercular disease occurred in 3.6% of US-born blacks and 0.47% of Hispanics. Among US-born blacks, risk factors associated with farm work were most significant. Blacks born in the United States also had the highest prevalence of anergy. The use of recall antigens made possible a better description of the epidemiology of TB by excluding false negatives and clarifying associations between infection and risk factors. We conclude that TB among farm workers represents a serious public health problem with previously unrecognized risk factors. Additional resources for migrant health care, improvements in health care access, and fundamental changes in the system of migrant labor are all necessary to reduce the transmission of TB.

A population-based cross-sectional study of occupational injuries among a random sample of 287 migrant farmworkers demonstrated frequent obstacles to health care; 65% (11/17) of the more seriously injured subjects did not receive prompt care or never received care. Subjects not receiving prompt care were twice as likely to have incomplete recovery. Employers covered medical expenses for only 5/13 (38%) of the injured workers, and only 3/15 were compensated for lost work. This study indicates that comprehensive Workers' Compensation coverage is urgently needed in North Carolina.

All locatable subjects (n = 94) for whom tuberculosis prevalence had been determined in an earlier study were tested with purified protein derivative (PPD) and control antigens, sputum sampling, and chest x-rays. Of the 46 who had been tuberculin negative (confirmed with control antigens) 3 years earlier, 2 had developed active tuberculosis in the interim and 14 (30%) were tuberculin positive. All had been engaged continuously in migrant farmwork. Lack of access to health care, an institutional feature of migrant farmwork, was significantly associated with primary infection.