UC San Diego

Farmworkers face significant disease burden. Meanwhile, farmworker healthcare utilization is low. This study examined individual, environmental, and policy level correlates of U.S. farmworker healthcare utilization, guided by the Behavioral Model for Vulnerable Populations and the Ecological Model. The 2006-2008 administrations of the National Agricultural Workers Survey (NAWS) (N=4,891) provided the primary data for this cross-sectional study. Geographic Information Systems, the 2005 and 2006 Uniform Data System, and rurality/border proximity indices provided environmental variables. To identify factors associated with healthcare use, logistic regression was performed using Hierarchical Linear Modeling. Probability weights were applied in descriptive, bivariate, and multivariate analyses. The alpha level was set at .05 for all analyses. The majority of farmworkers were Hispanic (80.0%) and male (78.4%), with an average age of 35.6 (SE=.3) years. Annual family income (M=22,668.0; SE=304.9) and educational attainment (M=7.7; SE=.1) were low. Just over half (57.3%) used formal U.S. healthcare in the previous two years. Multiple factors were independently associated with healthcare use in multilevel models (all in the expected direction), including, at the individual level: sex, immigration and migrant status, English proficiency, access to transportation, and need; at the environmental level: total FQHC full-time equivalent medical professionals/staff and U.S.-Mexico border proximity; and, at the policy level: insurance status and payment structure. Findings were consistent with those from previous studies of Hispanic populations, as well as the limited literature documenting healthcare use correlates for farmworkers. Numerous individual and policy level moderators of associations between environmental level variables and healthcare use were identified. Using Stata, rates of healthcare use among farmworkers were compared to those among U.S. and other subpopulations with similar sociodemographic characteristics (from the 2006 Medical Expenditure Panel Survey). Rates of use were significantly lower for farmworkers than for the U.S. and low-income populations. However, they were significantly higher than rates for U.S. Hispanics and a comparison group (i.e., Hispanic, low income, and no educational degree). The low rate of use is concerning due to farmworkers' disproportionate disease burden. Multilevel recommendations for change, emphasizing change to the FQHC system, are made so that healthcare access can be improved for this vulnerable population