Primary care clinicians may be the only source of occupational healthcare for many low-wage, high-risk workers who experience disproportionate occupational hazards. The authors explored barriers to providing occupational healthcare and recommendations for overcoming these challenges. The team conducted six focus groups and eleven key-informant interviews in two community health centers and among clinicians, community health workers, and other personnel from similar settings. Clinicians reported not utilizing occupational information during clinical encounters and identified competing priorities, limited appointment time, and lack of training as key barriers. They cited workers' compensation as a source of confusion and frustration. However, most participants recognized occupation as an important social determinant of health and expressed interest in additional training and resources. Participants agreed that referral mechanisms for occupational medicine specialists and worker centers and changes in quality performance measures and electronic health records would be useful and that workers' compensation and immigration policies need reform.
Access to safe, off-farm childcare is often a challenge for farmworkers with young children and is likely to become an increasingly salient barrier as more agricultural workers migrate together with families and as the number of women entering the agricultural workforce increases. Agriculture is one of the most hazardous industries, and the presence of young children in the workplace puts them at risk. To better understand the current nature of childcare for farmworker families and the challenges to accessing services, this project facilitated in-person surveys with 132 parents in three communities in Florida. A convenience sample that intentionally targeted parents living and working in areas with limited access to Migrant and Seasonal Head Start facilities was used to recruit participants. Most participants reported childcare access as a challenge. They expressed a desire to work in an area based on childcare availability. These findings offer agribusiness leaders important data to consider. They also suggest that industry support of childcare may be an important workforce investment. Findings indicate that high quality, affordable off-farm childcare services could serve as a means for attracting farmworkers to regions currently experiencing labor shortages. Additional research is warranted to explore this subject in diverse geographic areas.
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In the past few years health education has received national attention as a poorly financed and administratively neglected area. Many Two articles in this issue of the Journal raise a number of educational and ethical concerns.3' 4These center around where we place the burden for instituting changes in health education, what methods are used to influence behavior change, and who controls the decision making with regard to outcomes or goals. If health workers are truly interested in using an educational approach to influence behavior, they might wish to explore some of the ideas suggested in the references cited in this editorial.Individual responsibility for "moderating self-imposed risks"5 is a current theme in many publications, which raises both educational and ethical questions. White6 states that the "real malpractice problem in this country today is not one described on the front pages of daily newspapers but rather the malpractice that people are performing on themselves and on each other." White suggests that "in the battle to modify life style, a major enemy to be conquered is advertising" as well as a number of industries whose products are injurious to health.A different perspective on the changing of life styles is developed by Meenan7 who points out that "although the role of education is usually stressed, there is an implied role for sanctions against unhealthy practice.We as individuals and as a society must strike a balance between the value we place on health and that which we place on the freedom to make certain choices.In addition, Meenan points out that the traditional patient-doctor relationship is one of expecting the patient to comply with the prescriptions of the doctor. Thus, he questions the likelihood that "an educational program designed by the professional to promote individual responsibility" will emphasize the decision-making role of the patient. "Professionally dominated educational efforts to alter life styles will walk a thin line between informing and expropriating. The margin is apparent from recent discussions of such practices as the use of behavioral-modification technics in preventive medicine."The control of decision-making in behavior change and the potential effective use of behavioral sciences "in ways which will free, not control; bring about con-AJPH May, 1976, Vol. 66, No. 5 429
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