title: Health care utilization among migrant Latino farmworkers: the case of skin disease.
abstract: BACKGROUND
  Skin diseases are common occupational illnesses for migrant farmworkers. Farmworkers face many barriers in accessing health care resources.
  
  
  OBJECTIVE
  Framed by the Health Behavior Model, the purpose of this study was to assess health care utilization for skin disease by migrant Latino farmworkers.
  
  
  METHODS
  Three hundred and four migrant and seasonal Latino farmworkers in North Carolina were enrolled in a longitudinal study of skin disease and health care utilization over a single agricultural season. Self-reported and dermatologist-diagnosed skin condition data were collected at baseline and at up to 4 follow-up assessments. Medical visit rates were compared to national norms.
  
  
  RESULTS
  Self-reported skin problems and diagnosed skin disease were common among farmworkers. However, only 34 health care visits were reported across the entire agricultural season, and none of the visits were for skin diseases. Nevertheless, self-treatment for skin conditions was common, including use of non-prescription preparations (63%), prescription products (9%), and home remedies (6%). General medical office visits were reported in 3.2% of the assessments, corresponding to 1.6 office visits per person year.
  
  
  CONCLUSIONS
  The migrant farmworker population consists largely of young men who make little use of clinic services. Skin conditions are very common among these workers, but use of medical services for these conditions is not common. Instead, farmworkers rely primarily on self-treatment. Clinic-based studies of farmworker skin conditions will not account for most injury or disease in this population and have the potential for biased estimates.
authors.affiliation: Department of Dermatology, School of Medicine, Wake Forest University, Winston-Salem, NC 27157-1071, USA. sfeldman@wfubmc.edu
authors.forename: Steven R
authors.initials: SR
authors.lastname: Feldman
authors.forename: Quirina M
authors.initials: QM
authors.lastname: Vallejos
authors.forename: Sara A
authors.initials: SA
authors.lastname: Quandt
authors.forename: Alan B
authors.initials: AB
authors.lastname: Fleischer
authors.forename: Mark R
authors.initials: MR
authors.lastname: Schulz
authors.forename: Amit
authors.initials: A
authors.lastname: Verma
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Arcury
mesh_terms: D000293:Adolescent; D000328:Adult; D000382:Agricultural Workers' Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000208:ethnology*; D003880:Dermatology / Q000706:statistics & numerical data; D004522:Educational Status; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008519:Medicine, Traditional; D008875:Middle Aged; D004366:Nonprescription Drugs / Q000627:therapeutic use; D009657:North Carolina / Q000453:epidemiology; D009819:Office Visits / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000208:ethnology* / Q000706:statistics & numerical data; D055553:Prescription Drugs / Q000627:therapeutic use; D015995:Prevalence; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012871:Skin Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000208:ethnology*; D014171:Transients and Migrants / Q000145:classification / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D004366:Nonprescription Drugs; D055553:Prescription Drugs