Examining the efficacy and feasibility of implementing an electrolyte hydration intervention among agricultural workers Public

Abstract

Background: Farmworkers are amongst one of the most vulnerable populations in the United States; a myriad of structural, social, and occupational conditions expose significant health disparities. Of these, occupational heat exposure is particularly concerning due to rising global environmental temperatures. These hot environmental temperatures place farmworkers at a significant risk for experiencing dehydration and consequently heat-related illness (HRI).

Objective: To estimate the prevalence of dehydration/HRI and current hydration practices among agricultural workers in central Florida. To determine the efficacy and feasibility of an electrolyte intervention to prevent dehydration and HRI.

Methods: Prevalence estimates were calculated from parent study sample (n=88). Pilot participants were randomized to a water group (n=16) or an electrolyte group (n=14) who received 169oz (5L) of the respective beverage. A logistical regression model was utilized to calculate odds ratios and a thematic analysis was conducted from post shift interviews to identify barriers/facilitators to beverage consumption.

Results: At post shift, 46% of the study sample was dehydrated or severely dehydrated and 42% experienced at least one HRI symptom (n=88). Among electrolyte group participants, the odds of dehydration were 13.4 (95% CI =(1.17,152.95) times higher and the odds of experiencing heat related illness was 0.72 (95% CI =(0.07, 7.27) lower. Taste, feelings of wellness/energy, and the beverage container were identified as facilitators to beverage consumption. Factors identified as barriers were taste, increased urination, and beverage temperature.

Discussion: Regional variations exist; however, prevalence estimates confirm that findings confirm that the prevalence of HRI and dehydration is high. Hydration practices were consistent with other study findings, consumption of sugar sweetened beverages during work is a significant concern. Findings surrounding hydration status and consumption of electrolyte beverages is inconsistent with other studies that have found electrolytes to maintain adequate hydration status in outdoor workers. Failure of randomization to control and water group, differences in explanatory variables, and the electrolyte solution formula could be contributing factors to the discrepancy. Findings suggest that electrolytes may be protective against experiencing HRI. Further research with a larger sample size should be conducted to identify the optimal rehydration formula for agricultural workers laboring in hot conditions.

Table of Contents

Chapter 1: Introduction                                                                        1

Rationale                                                                                                  1

Purpose Statement                                                                                 1

Research Questions & Aims                                                                 1

Significance Statement                                                                         2

Definition of Terms                                                                                2

Chapter 2: Review of the Literature                                                    4

Introduction                                                                                              4

Agricultural & Farmworker Situational Analysis                                5

Overview                                                                                                    5

Demographic Profile                                                                               5

Structural, Social, and Occupational Conditions                              6

Heat Stress & Kidney Disease                                                                8

Overview                                                                                                    8

Biological Mechanisms                                                                            8

Epidemiology of HRI, CKDu, and AKI Among Farmworkers             11

Existing Efforts                                                                                          12

Overview                                                                                                     12

Recommendations & Regulations                                                        12

Existing Hydration Studies                                                                      13

Local Context                                                                                             14

Introduction                                                                                               14

Florida Heat                                                                                               14

Farmworkers in Florida                                                                           15

Discussion                                                                                                   15

Chapter 3: Manuscript                                                                             17

Abstract                                                                                                       17

Introduction                                                                                               18

Methods                                                                                                      19

Results                                                                                                         21

Discussion                                                                                                   23

References                                                                                                  28

Appendix                                                                                                     34

Chapter 4: Conclusion and Recommendations                                  40

Introduction                                                                                               40

Mandates Not Guidance                                                                          40

Employer Accountability                                                                         41

Tailored Messaging                                                                                  42

Readily Available Data                                                                             44

Conclusion                                                                                                  44

References                                                                                                  45

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Occupational Health and Safety
Mot-clé	heat-related illness electrolyte agricultural worker dehydration
Committee Chair / Thesis Advisor	Webb Girard, Amy, Emory University
Committee Members	Chicas, Roxana, Emory University

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