COVID-19 IMPACT ON AGRICULTURAL WORKERS
Note: NCFH typically relies on peer-reviewed research and government reports for its fact sheet series, but due to the urgent and constantly evolving nature of the pandemic, we have utilized reputable media sources as well.
Last updated: January 2022
Last updated: January 2022
Agricultural worker populations are disproportionately impacted by COVID-19 due to factors including lack of personal protective equipment (PPE), poor housing and working conditions, structural racism, discrimination, and barriers to health care. This fact sheet is updated quarterly, focused on peer-reviewed literature, to bring the most current information about the pandemic’s impact on agricultural workers.
COVID-19 PREVALENCE AMONG AGRICULTURAL WORKERS AND RURAL COMMUNITIES
DISPROPORTIONAL IMPACT
OCCUPATIONAL RISKS AND WORKING CONDITIONS ON U.S. FARMS
COVID-19 PREVALENCE AMONG AGRICULTURAL WORKERS AND RURAL COMMUNITIES
- As of December 20, 2021, there have been 1 million agricultural worker COVID-19 cases confirmed. This figure likely underestimates the number greatly since it excludes contracted and temporary labor.1
- As of December 15, 2021, over 7.8 million cases of COVID-19 and 138,060 deaths from COVID-19 have occurred in rural counties. The current prevalent case rate in rural counties is 1,700 cases per 10,000 residents and the current death rate is 29.96 per 10,000 residents. The prevalent case rate is now higher in rural counties than urban counties.2
DISPROPORTIONAL IMPACT
- Research by the Centers for Disease Control and Prevention (CDC) found that Hispanic or Latino workers employed in food production or agriculture have a substantially higher prevalence of COVID-19 compared to non-Hispanic workers in those industries. Among the 31 states that reported data, only 37% of workers in those industries were Hispanic or Latino but they represented 73% of laboratory-confirmed COVID-19 cases in food processing and agriculture industries.3
- Hispanics are disproportionately affected by COVID-19, experiencing significantly higher rates in positive cases and increased mortality from the virus than other ethnicities.4,5
- In a study comparing positivity rates from June 2020 to November 2020, agricultural workers were more likely to test positive than the general population.6
- Underlying health conditions can increase the severity of the impact of the COVID-19 virus.7 For example, diabetes is a risk factor for acute respiratory distress syndrome (ARDS) and mortality in patients hospitalized with COVID-19.3,5 Research suggests that agricultural workers have high rates of diabetes and obesity, with factors such as pesticide exposure increasing the odds of diabetes.8,9,10
- Social determinants of health, such as racism and discrimination, can lead to underlying health factors impacting the severity of COVID-19 cases.11 Agricultural workers report discrimination from employers based on their country of birth, legal status, and ability to speak English, that directly impacts their access to healthcare when injured.12The anti-immigrant narrative can be a factor of discrimination in the United States.12,13
- Indigenous language speaking agricultural workers lack access to translators, interpreters, or other resources within the U.S. health care system that could negatively impact their ability to access educational resources and care for COVID-19 related illness and prevention.14 This includes lack of translation of both testing results and medical recommendations.15
OCCUPATIONAL RISKS AND WORKING CONDITIONS ON U.S. FARMS
- Due to working conditions, agricultural workers are not able to keep a safe physical distance to prevent the spread of the COVID-19 virus. They work close to each other while harvesting and packing, and often ride together to and from work in buses or vans, increasing the risk for spread.16
- Agricultural workers have been reported being fearful of losing their job after taking time off to access health services because employers have been reported to threaten deportation or other retaliation to those who do take off work.17,18
- In Central Florida in June 2021, in a study of 92 agricultural workers, 75% reported losing work hours due to the pandemic or lost work completely due to being let go by their employer.16
- COVID-19 workplace safety precautions vary based on the employer. For example, out of the 92 agricultural workers in Florida, 87% of workers reported employer-enforced physical distancing, 34% reported mask-wearing, and 12% reported regular temperature checks.16 See Figure 1 below.
Figure 1: Source: COVID-19 and Agricultural Workers: A Descriptive Study (2021)
HOUSING CONDITIONS AND RISK
ACCESS TO CARE
COVID-19 VACCINATION
- Overcrowded and substandard housing conditions are a major concern for the potential of COVID-19 to spread through agricultural worker communities.23,24
- A single building may house several dozen workers or more, who often sleep in dormitory-style quarters, making quarantining or physical distancing efforts difficult if not impossible. Limited access to restrooms and sinks, at home and in the field, may complicate hygiene prevention efforts.25
- Several states and counties provide funding for emergency quarantine housing for agricultural workers suffering from COVID-19. Other state and counties added funds to pay for lost wages or assistance with bills for agricultural workers affected by COVID-19 in 2020.26,27,28
ACCESS TO CARE
- Health care services can be inaccessible due to lack of health insurance, sick leave policy, or transportation.17,29,30Services that are available may be culturally, medically, or linguistically inappropriate.17,30,31,32,33 Negative experiences with health care, including medical racism, and other significant barriers within the health care system has created a general mistrust that agricultural workers have for the U.S. health care system.17,30,32
- Extremely low annual incomes and a widespread lack of access to health insurance may limit health care-seeking behaviors among agricultural workers, even if they are experiencing symptoms of an illness.31,34
COVID-19 VACCINATION
- In 2020, Health Centers provided primary care to almost 1 million agricultural workers and their families.35 As of November 2021, almost 212,300 COVID-19 vaccine doses have been administered to agricultural workers through Migrant Health Centers.37
- HRSA conducts a bi-weekly survey of health centers. The data represent a two-week reporting period. Data available from December 17, 2021, reports 1,081 (79% of total) health centers responded. Out of 157,045 patients initiating vaccination during those two weeks, 44.58% self-identified as Hispanic or Latino (not including those reporting “one or more race”). Out of 435,809 patients who received additional vaccinations, 29.43% self-identified as Hispanic or Latino (not including those who have reported “one or more race”).36 Thirty-six percent of 1,081 health centers reported staffing challenges to administer the vaccine and 32.84% of health centers reported vaccine confidence challenges in the December 17th biweekly report. Thirty-five percent reported no challenges with administering vaccinations.36
- As part of the Health Center COVID-19 Vaccine Program, a total 18,227,259 vaccinations have been administered from February 26, 2021, to January 18, 2022. Approximately 68% of those patients self-identified as a racial and/or ethnic minority (including Hispanic/Latino).40
- Research suggests concerns about side effects and mistrust in the vaccine are the top two reasons leading to vaccine hesitancy among agricultural workers.16
- In July 2021, 53% of agricultural workers in Central Florida reported receiving a COVID-19 vaccine.16
- In a study among rural and urban adults, a greater percentage of urban residents (46%) received their first dose of a COVID-19 vaccine than rural residents (39%).38 See Figure 2 below.
Figure 2: Source: CDC The Morbidity and Mortality Weekly Report
Disclaimer: This publication is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $435,561 with 0% financed with nongovernmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government.
REFERENCES
1. FoodandAgVulnerabilityIndex. ag.purdue.edu. Accessed November 24, 2021. https://ag.purdue.edu:443/agecon/Pages/FoodandAgVulnerabilityIndex.aspx
2. CSSEGISandData. COVID-19 Data Repository by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. GitHub. Published March 1, 2021. Accessed December 29, 2021. https://github.com/CSSEGISandData/COVID-19
3. Waltenburg MA, Rose CE, Victoroff T, et al. Early Release - Coronavirus Disease among Workers in Food Processing, Food Manufacturing, and Agriculture Workplaces. Emerging Infectious Diseases. 2021; 27 (1): 243-249. doi:10.3201/eid2701.203821
4. CDC. Health Equity Considerations and Racial and Ethnic Minority Groups. Centers for Disease Control and Prevention. Published April 30, 2020. Accessed December 29, 2021. https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html
5. CDC. Racism and Health. Centers for Disease Control and Prevention. Published April 8, 2021. Accessed December 29, 2021. https://www.cdc.gov/healthequity/racism-disparities/impact-of-racism.html
6. Fielding-Miller RK, Sundaram ME, Brouwer K. Social determinants of COVID-19 mortality at the county level. PLoS One. 2020;15(10):e0240151. doi:10.1371/journal.pone.0240151
7. CDC. People with certain medical conditions. Centers for Disease Control and Prevention. Published February 11, 2020. Accessed December 29, 2021. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html
8. Moyce S, Hernandez K, Schenker M. Diagnosed and Undiagnosed Diabetes among Agricultural Workers in California. J Health Care Poor Underserved. 2019;30(4):1289-1301. doi:10.1353/hpu.2019.0102
9. Curl CL, Spivak M, Phinney R, Montrose L. Synthetic Pesticides and Health in Vulnerable Populations: Agricultural Workers. Curr Environ Health Rep. 2020;7(1):13-29. doi:10.1007/s40572-020-00266-5
10. Starling AP, Umbach DM, Kamel F, Long S, Sandler DP, Hoppin JA. Pesticide use and incident diabetes among wives of farmers in the Agricultural Health Study. Occup Environ Med. 2014;71(9):629-635. doi:10.1136/oemed-2013-101659
11. Handal AJ, Iglesias-Ríos L, Fleming PJ, Valentín-Cortés MA, O’Neill MS. “Essential” but Expendable: Farmworkers During the COVID-19 Pandemic—The Michigan Farmworker Project. Am J Public Health. 2020;110(12):1760-1762. doi:10.2105/AJPH.2020.305947
12. Snipes SA, Cooper SP, Shipp EM. “The Only Thing I Wish I Could Change Is That They Treat Us Like People and Not Like Animals”: Injury and Discrimination Among Latino Farmworkers. Journal of Agromedicine. 2017;22(1):36-46. doi:10.1080/1059924X.2016.1248307
13. Terrazas SR, McCormick A. Coping Strategies That Mitigate Against Symptoms of Depression Among Latino Farmworkers. Hispanic Journal of Behavioral Sciences. 2018;40(1):57-72. doi:10.1177/0739986317752923
14. Maxwell AE, Young S, Moe E, Bastani R, Wentzell E. Understanding factors that influence health care utilization among Mixtec and Zapotec women in a farmworker community in California. J Community Health. 2018;43(2):356-365. doi:10.1007/s10900-017-0430-8
15. Facebook, Twitter, options S more sharing, et al. Op-Ed: Indigenous farmworkers are being hit by COVID myths — and deaths. Los Angeles Times. Published December 27, 2021. Accessed January 7, 2022. https://www.latimes.com/opinion/story/2021-12-27/covid-indigenous-farmworkers
16. Chicas R, Xiuhtecutli N, Houser M, et al. COVID-19 and Agricultural Workers: A Descriptive Study. J Immigrant Minority Health. 2022;24(1):58-64. doi:10.1007/s10903-021-01290-9
17. Prado JB, Mulay PR, Kasner EJ, Bojes HK, Calvert GM. Acute Pesticide-Related Illness Among Farmworkers: Barriers to Reporting to Public Health Authorities. J Agromedicine. 2017;22(4):395-405. doi:10.1080/1059924X.2017.1353936
18. Liebman AK, Juarez-Carrillo PM, Reyes IAC, Keifer MC. Immigrant dairy workers’ perceptions of health and safety on the farm in America’s Heartland. American Journal of Industrial Medicine. 2015;59(3):227-235. doi:10.1002/ajim.22538
19. Jett T. Despite new coronavirus outbreaks at its Iowa plants, Tyson Foods resumes attendance policy. Des Moines Register. Accessed December 29, 2021. https://www.desmoinesregister.com/story/money/business/2020/06/03/iowa-coronavirus-outbreaks-tyson-foods-resumes-attendance-policy-meatpacking-plants-covid-19/3137109001/
20. Farmworkers are getting coronavirus. They face retaliation for demanding safe conditions. The World from PRX. Accessed December 29, 2021. https://theworld.org/stories/2020-07-29/sick-covid-19-farmworkers-face-retaliation-demanding-safe-conditions
21. Coleman ML. Essential Workers Are Being Treated as Expendable. The Atlantic. Published April 23, 2020. Accessed December 29, 2021. https://www.theatlantic.com/ideas/archive/2020/04/farmworkers-are-being-treated-as-expendable/610288/
22. Why Scarfs, Bandanas, or Gaiters Are Not Used as Masks or Face Coverings at Southwest Tech | Southwest Tech News. Published October 16, 2020. Accessed January 5, 2022. https://www.swtc.edu/news/covid-19-coronavirus/mask-wearing/why-scarfs-bandanas-or-gaiters-are-not-considered-masks/
23. Arcury TA, Weir M, Chen H, et al. Migrant farmworker housing regulation violations in North Carolina. American Journal of Industrial Medicine. 2012;55(3):191-204. doi:10.1002/ajim.22011
24. Quandt S, Brooke C, Fagan K, Howe A, Thornburg T, McCurdy S. Farmworker Housing in the United States and Its Impact on Health. New Solutions. 2015;25(3):263-286. doi:10.1177/1048291115601053
25. Pena A, Teather-Posadas E. Field Sanitation in U.S. Agriculture: Evidence from NAWS and Future Data Needs. Journal of Agromedicine. 2018;23(2). Accessed April 22, 2020. doi:10.1080/1059924x.2018.1427642
26. Plevin R. Riverside County to consider providing housing, financial aid to farmworkers with COVID-19. The Desert Sun. Published August 25, 2020. Accessed August 25, 2020. https://www.desertsun.com/story/news/2020/08/21/riverside-county-could-provide-housing-financial-aid-farmworkers-covid-19/3413200001/
27. Melton J. FHDC Provides Support for Two New Oregon Worker Relief Funds. Published August 25, 2020. Accessed August 25, 2020. http://fhdc.org/2020/08/fhdc-provides-support-for-two-new-oregon-worker-relief-funds/
28. Farmworker Household Assistance Program (FHAP). Ventura County Community Foundation. Published August 25, 2020. Accessed August 25, 2020. https://vccf.org/fhap/
29. Ramos AK. A Human Rights-Based Approach to Farmworker Health: An Overarching Framework to Address the Social Determinants of Health. Journal of Agromedicine. 2018;23(1):25-31. doi:10.1080/1059924X.2017.1384419
30. Buckheit C, Pineros D, Olson A, Johnson D, Genereaux S. Improving Health Care for Spanish-Speaking Rural Dairy Farm Workers. J Am Board Fam Med. 2017;30(1):91-93. doi:10.3122/jabfm.2017.01.160174
31. Guild A, Richards C, Ruiz V. Out of Sight, Out of Mind: The Implementation and Impact of the Affordable Care Act in U.S. Farmworker Communities. J Health Care Poor Underserved. 2016;27(4):73-82. doi:10.1353/hpu.2016.0183
32. Arcury TA, Sandberg JC, Mora DC, Talton JW, Quandt SA. North Carolina Latino Farmworkers’ Use of Traditional Healers: A Pilot Study. Journal of Agromedicine. 2016;21(3):253-258. doi:10.1080/1059924X.2016.1180272
33. Hu R, Shi L, Lee DC, Haile GP. Access to and Disparities in Care among Migrant and Seasonal Farm Workers (MSFWs) at U.S. Health Centers. J Health Care Poor Underserved. 2016;27(3):1484-1502. doi:10.1353/hpu.2016.0107
34. JBS International. Findings from the National Agricultural Workers Survey (NAWS) 2015-2016: A Demographic and Employment Profile of United States Farmworkers. Published 2018. Accessed April 22, 2020. https://www.doleta.gov/naws/research/docs/NAWS_Research_Report_13.pdf
35. Uniform Data System. Published online 2020.
36. Health Center COVID-19 Survey. Bureau of Primary Health Care. Accessed December 29, 2021. https://bphc.hrsa.gov/emergency-response/coronavirus-health-center-data
37. Increasing MSAW Vaccine Access [Unpublished]. Published online 2021.
38. Murthy BP, Sterrett N, Weller D, et al. Disparities in COVID-19 Vaccination Coverage Between Urban and Rural Counties — United States, December 14, 2020–April 10, 2021. MMWR Morb Mortal Wkly Rep. 2021;70(20):759-764. doi:10.15585/mmwr.mm7020e3
39. FoodandAgVulnerabilityIndex. ag.purdue.edu. Published October 1, 2020. Accessed October 1, 2020. https://ag.purdue.edu:443/agecon/Pages/FoodandAgVulnerabilityIndex.aspx?_ga=2.49471334.1159720487.1600111458-250602208.1598985334
40. Health Center COVID-19 Vaccinations Among Racial and Ethnic Minority Patients. Accessed January 7, 2022. https://data.hrsa.gov/topics/health-centers/covid-vaccination
REFERENCES
1. FoodandAgVulnerabilityIndex. ag.purdue.edu. Accessed November 24, 2021. https://ag.purdue.edu:443/agecon/Pages/FoodandAgVulnerabilityIndex.aspx
2. CSSEGISandData. COVID-19 Data Repository by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. GitHub. Published March 1, 2021. Accessed December 29, 2021. https://github.com/CSSEGISandData/COVID-19
3. Waltenburg MA, Rose CE, Victoroff T, et al. Early Release - Coronavirus Disease among Workers in Food Processing, Food Manufacturing, and Agriculture Workplaces. Emerging Infectious Diseases. 2021; 27 (1): 243-249. doi:10.3201/eid2701.203821
4. CDC. Health Equity Considerations and Racial and Ethnic Minority Groups. Centers for Disease Control and Prevention. Published April 30, 2020. Accessed December 29, 2021. https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html
5. CDC. Racism and Health. Centers for Disease Control and Prevention. Published April 8, 2021. Accessed December 29, 2021. https://www.cdc.gov/healthequity/racism-disparities/impact-of-racism.html
6. Fielding-Miller RK, Sundaram ME, Brouwer K. Social determinants of COVID-19 mortality at the county level. PLoS One. 2020;15(10):e0240151. doi:10.1371/journal.pone.0240151
7. CDC. People with certain medical conditions. Centers for Disease Control and Prevention. Published February 11, 2020. Accessed December 29, 2021. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html
8. Moyce S, Hernandez K, Schenker M. Diagnosed and Undiagnosed Diabetes among Agricultural Workers in California. J Health Care Poor Underserved. 2019;30(4):1289-1301. doi:10.1353/hpu.2019.0102
9. Curl CL, Spivak M, Phinney R, Montrose L. Synthetic Pesticides and Health in Vulnerable Populations: Agricultural Workers. Curr Environ Health Rep. 2020;7(1):13-29. doi:10.1007/s40572-020-00266-5
10. Starling AP, Umbach DM, Kamel F, Long S, Sandler DP, Hoppin JA. Pesticide use and incident diabetes among wives of farmers in the Agricultural Health Study. Occup Environ Med. 2014;71(9):629-635. doi:10.1136/oemed-2013-101659
11. Handal AJ, Iglesias-Ríos L, Fleming PJ, Valentín-Cortés MA, O’Neill MS. “Essential” but Expendable: Farmworkers During the COVID-19 Pandemic—The Michigan Farmworker Project. Am J Public Health. 2020;110(12):1760-1762. doi:10.2105/AJPH.2020.305947
12. Snipes SA, Cooper SP, Shipp EM. “The Only Thing I Wish I Could Change Is That They Treat Us Like People and Not Like Animals”: Injury and Discrimination Among Latino Farmworkers. Journal of Agromedicine. 2017;22(1):36-46. doi:10.1080/1059924X.2016.1248307
13. Terrazas SR, McCormick A. Coping Strategies That Mitigate Against Symptoms of Depression Among Latino Farmworkers. Hispanic Journal of Behavioral Sciences. 2018;40(1):57-72. doi:10.1177/0739986317752923
14. Maxwell AE, Young S, Moe E, Bastani R, Wentzell E. Understanding factors that influence health care utilization among Mixtec and Zapotec women in a farmworker community in California. J Community Health. 2018;43(2):356-365. doi:10.1007/s10900-017-0430-8
15. Facebook, Twitter, options S more sharing, et al. Op-Ed: Indigenous farmworkers are being hit by COVID myths — and deaths. Los Angeles Times. Published December 27, 2021. Accessed January 7, 2022. https://www.latimes.com/opinion/story/2021-12-27/covid-indigenous-farmworkers
16. Chicas R, Xiuhtecutli N, Houser M, et al. COVID-19 and Agricultural Workers: A Descriptive Study. J Immigrant Minority Health. 2022;24(1):58-64. doi:10.1007/s10903-021-01290-9
17. Prado JB, Mulay PR, Kasner EJ, Bojes HK, Calvert GM. Acute Pesticide-Related Illness Among Farmworkers: Barriers to Reporting to Public Health Authorities. J Agromedicine. 2017;22(4):395-405. doi:10.1080/1059924X.2017.1353936
18. Liebman AK, Juarez-Carrillo PM, Reyes IAC, Keifer MC. Immigrant dairy workers’ perceptions of health and safety on the farm in America’s Heartland. American Journal of Industrial Medicine. 2015;59(3):227-235. doi:10.1002/ajim.22538
19. Jett T. Despite new coronavirus outbreaks at its Iowa plants, Tyson Foods resumes attendance policy. Des Moines Register. Accessed December 29, 2021. https://www.desmoinesregister.com/story/money/business/2020/06/03/iowa-coronavirus-outbreaks-tyson-foods-resumes-attendance-policy-meatpacking-plants-covid-19/3137109001/
20. Farmworkers are getting coronavirus. They face retaliation for demanding safe conditions. The World from PRX. Accessed December 29, 2021. https://theworld.org/stories/2020-07-29/sick-covid-19-farmworkers-face-retaliation-demanding-safe-conditions
21. Coleman ML. Essential Workers Are Being Treated as Expendable. The Atlantic. Published April 23, 2020. Accessed December 29, 2021. https://www.theatlantic.com/ideas/archive/2020/04/farmworkers-are-being-treated-as-expendable/610288/
22. Why Scarfs, Bandanas, or Gaiters Are Not Used as Masks or Face Coverings at Southwest Tech | Southwest Tech News. Published October 16, 2020. Accessed January 5, 2022. https://www.swtc.edu/news/covid-19-coronavirus/mask-wearing/why-scarfs-bandanas-or-gaiters-are-not-considered-masks/
23. Arcury TA, Weir M, Chen H, et al. Migrant farmworker housing regulation violations in North Carolina. American Journal of Industrial Medicine. 2012;55(3):191-204. doi:10.1002/ajim.22011
24. Quandt S, Brooke C, Fagan K, Howe A, Thornburg T, McCurdy S. Farmworker Housing in the United States and Its Impact on Health. New Solutions. 2015;25(3):263-286. doi:10.1177/1048291115601053
25. Pena A, Teather-Posadas E. Field Sanitation in U.S. Agriculture: Evidence from NAWS and Future Data Needs. Journal of Agromedicine. 2018;23(2). Accessed April 22, 2020. doi:10.1080/1059924x.2018.1427642
26. Plevin R. Riverside County to consider providing housing, financial aid to farmworkers with COVID-19. The Desert Sun. Published August 25, 2020. Accessed August 25, 2020. https://www.desertsun.com/story/news/2020/08/21/riverside-county-could-provide-housing-financial-aid-farmworkers-covid-19/3413200001/
27. Melton J. FHDC Provides Support for Two New Oregon Worker Relief Funds. Published August 25, 2020. Accessed August 25, 2020. http://fhdc.org/2020/08/fhdc-provides-support-for-two-new-oregon-worker-relief-funds/
28. Farmworker Household Assistance Program (FHAP). Ventura County Community Foundation. Published August 25, 2020. Accessed August 25, 2020. https://vccf.org/fhap/
29. Ramos AK. A Human Rights-Based Approach to Farmworker Health: An Overarching Framework to Address the Social Determinants of Health. Journal of Agromedicine. 2018;23(1):25-31. doi:10.1080/1059924X.2017.1384419
30. Buckheit C, Pineros D, Olson A, Johnson D, Genereaux S. Improving Health Care for Spanish-Speaking Rural Dairy Farm Workers. J Am Board Fam Med. 2017;30(1):91-93. doi:10.3122/jabfm.2017.01.160174
31. Guild A, Richards C, Ruiz V. Out of Sight, Out of Mind: The Implementation and Impact of the Affordable Care Act in U.S. Farmworker Communities. J Health Care Poor Underserved. 2016;27(4):73-82. doi:10.1353/hpu.2016.0183
32. Arcury TA, Sandberg JC, Mora DC, Talton JW, Quandt SA. North Carolina Latino Farmworkers’ Use of Traditional Healers: A Pilot Study. Journal of Agromedicine. 2016;21(3):253-258. doi:10.1080/1059924X.2016.1180272
33. Hu R, Shi L, Lee DC, Haile GP. Access to and Disparities in Care among Migrant and Seasonal Farm Workers (MSFWs) at U.S. Health Centers. J Health Care Poor Underserved. 2016;27(3):1484-1502. doi:10.1353/hpu.2016.0107
34. JBS International. Findings from the National Agricultural Workers Survey (NAWS) 2015-2016: A Demographic and Employment Profile of United States Farmworkers. Published 2018. Accessed April 22, 2020. https://www.doleta.gov/naws/research/docs/NAWS_Research_Report_13.pdf
35. Uniform Data System. Published online 2020.
36. Health Center COVID-19 Survey. Bureau of Primary Health Care. Accessed December 29, 2021. https://bphc.hrsa.gov/emergency-response/coronavirus-health-center-data
37. Increasing MSAW Vaccine Access [Unpublished]. Published online 2021.
38. Murthy BP, Sterrett N, Weller D, et al. Disparities in COVID-19 Vaccination Coverage Between Urban and Rural Counties — United States, December 14, 2020–April 10, 2021. MMWR Morb Mortal Wkly Rep. 2021;70(20):759-764. doi:10.15585/mmwr.mm7020e3
39. FoodandAgVulnerabilityIndex. ag.purdue.edu. Published October 1, 2020. Accessed October 1, 2020. https://ag.purdue.edu:443/agecon/Pages/FoodandAgVulnerabilityIndex.aspx?_ga=2.49471334.1159720487.1600111458-250602208.1598985334
40. Health Center COVID-19 Vaccinations Among Racial and Ethnic Minority Patients. Accessed January 7, 2022. https://data.hrsa.gov/topics/health-centers/covid-vaccination
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