Ventura County, California is home to 41,600 farmworkers. Of these, 90.5% are from Mexico, 53% speak only Spanish, and 81% are not U.S. citizens (CAUSE 2015). Ventura is additionally home to over 20,000 indigenous southern Mexicans, many of whom speak only their native languages and work primarily in agriculture (MICOP 2021).

Of concern to farmworker leaders and advocates, is the county’s recent warming trend. Farmworkers are 20 times more likely to die from heat stress than the U.S. civilian workforce overall (CDC 2008). This is because farmworkers carry out extended, strenuous labor under direct sunlight, potentially increasing “feels like” temperatures by up to 15 °F (Ferguson et al. 2019). Moreover, farmworkers typically wear long sleeves and multiple layers of clothing to protect against pesticides, which can increase “feels like” temperature by an additional 12 °F (Ferguson et al. 2019).

Despite the passage of workplace heat protection laws in California in 2005, state enforcement remains limited due to funding and staffing challenges at the California Occupational Health and Safety Administration, and at least 73 workers have died because of HRI since the standard’s enactment (Edwards and Margolis 2021).

The California Tracking Program (CA Tracking) is a founding partner in the Achieving Resilient Communities (ARC) project. Launched by the Public Health Institute in Ventura County in 2020, ARC seeks to make measurable community-driven improvements in resilience to climate change. ARC is working with farmworker leaders and advocates from the Central Coast Alliance for a United Sustainable Economy, the Mixteco Indigenous Community Organizing Project, and Lideres Campesinas—an organization of women farmworkers. CA Tracking is the overall fiscal lead and provides core staffing for all aspects of the project.

The ARC team used mapping and CA Tracking’s pesticide and air quality data, as well as data on heat, wildfires, and drinking water from other sources, to highlight multiple potential climate-related health threats in Ventura County. Health and social data, such as the percentage of insured adults and asthma rates, were also mapped. The team then conducted focus groups with farmworkers who highlighted HRI prevention as a top priority, based on the data presented and experiences in their work environment.

Guided by a farmworker advisory committee, the team developed and led resilience and leadership training for farmworkers on climate change and workplace protections, created digital wildfire and heat stories, analyzed data on workplace inspections and violations, and conducted local community heat monitoring (CDPH et al. 2021; Carlson 2021). ARC is now supporting a farmworker-led campaign for an audio-based emergency alert system that will include indigenous Mexican languages, such as Mixteco, and a streamlined workplace complaint hotline. The team is also working with agricultural leaders in the county to create a set of heat-related best practices, increase and improve heat protection training, and monitor heat in agricultural greenhouses and hoop houses (Ramirez and Krist 2021).

The CA Tracking partnership developed a network of engaged farmworker leaders committed to community climate resilience. The partnership is making progress on substantive local changes to counter HRI at work. Next, they will focus on policy development and will track long-term gains for the farmworker community in Ventura County while expanding the farmworker engagement model into Kern and Fresno counties in California’s San Joaquin Valley.

Uranium is a naturally occurring contaminant found in the bedrock of New Hampshire (NH), putting the 42% of NH residents that rely on domestic wells for drinking water at risk for exposure (Flanagan et al. 2014; NH EPHT 2022). The Biomonitoring New Hampshire (BiomonitoringNH) Program is coordinating the EMPoWER-U (Evaluating Metals in Private Wells and People for Exposure Reduction-Uranium) Study to assess uranium and other metals in groundwater and in the residents who use that water. This project is supported by the United States Geological Survey and the NH Tracking Program (NH Tracking).

Approximately 200 households from areas with potential risk for uranium in groundwater were recruited to participate in the study. Urine specimens from study participants and private well water samples from each household were collected and tested for metals and metalloids. Home indoor air samples were also tested for radon, a breakdown product of uranium. Data on other potential exposure sources were collected, including occupational history, residential history, drinking water source, and hobbies.

The workplace can be an important source of metal exposure. Therefore, NH Tracking, in collaboration with the Biomonitoring NH Program and the NH Occupational Health Surveillance Program, developed job-related questions to be included on the EMPoWER-U Study exposure questionnaire, by NIOSH-accepted best practices (NIOSH 2022b). They included a focus on current and previous work history, separate industry and occupation questions for each job, and metals exposure in the workplace. The survey design included looping logic to capture multiple current jobs and asked about the longest-held job to account for metals with longer half-lives. The work information will be converted to standardized codes for comparison across different studies and jurisdictions.

This is an ongoing project. The next phase is data analysis, in which the hazards, exposures, and biological measurements will be evaluated fromabout an occupational perspective. The technical assistance provided by NH Tracking will allow the BiomonitoringNH Program to explore differences in exposure by industry and occupation to evaluate the body burden of metals and the impact of workplace exposures. The study results will also provide insight into how NH residents are exposed to chemicals and how their levels compare to the levels in the U.S. population. This work stands out as an exemplary model for integrating environmental health, biomonitoring, and occupational health into exposure assessments.

Local health departments in Maryland receive questions and concerns about cancer from the public, including cancer concerns related to potential exposures to substances. Since 2006, Maryland’s Tracking Program (MD Tracking) has worked closely with the Maryland Center for Cancer Prevention and Control (CCPC) to address these concerns. Over the years, those have included cancer concerns among workers in schools, hospitals, and other workplace settings.

MD Tracking and CCPC jointly developed a framework that has been used successfully to address cancer questions, including cancer in the workplace. The first step involves a structured interview to evaluate the concerns (e.g., number and types of cancers, demographics of the employee population or surrounding community, detailed description of the workplace setting). MD Tracking, CCPC, and the local health department then agree on the next steps, which can include a review of the facility history, the environmental history of the property and surrounding area, and an analysis of relevant cancer frequencies in the community by the Maryland Cancer Registry (MCR), usually in the area where most of the employees live.

Where possible, the investigating team meets with employees to explain the investigation process, review the facility operations, and answer questions. The meeting with employees is used to evaluate potential exposures; occupational exposure assessments are not usually available through the employer, particularly if the exposed persons include current and former employees. MD Tracking epidemiologists are involved in the framing of the overall exposure assessment, particularly if it involves an understanding of occupational and community exposures or community rates of cancers.

MD Tracking and the CCPC have generally been able to address questions raised about cancer clusters in the workplace by engaging directly with the concerned individuals or groups and describing what is known and knowable and what types of approaches would be required to answer the questions. For example, in diverse settings (e.g., law enforcement, schools, and healthcare) with similar concerns of indoor air quality and cancers observed in their populations, a thoughtful approach to indoor air quality exposure assessment, the biology of different cancers, and a careful occupational and environmental history have been critical elements of successful engagements. In many cases, a successful resolution depends less on a finding that there is or is not a cluster of cancers and more on determining whether there is an exposure or set of exposures that can be corrected or mitigated.

One difference between occupational and community cancer investigations is the relative lack of data in the MCR about the occupation, industry, or employer of the patient (Freeman et al. 2017; Silver et al. 2018). This lack of occupational history and the small population typically affected limits the statistical and epidemiological analyses possible for workplaces without the collection of new data. Because many concerns about workplace cancers are related to exposures, it is critically important that exposure assessments are thorough, transparent, and addressed as part of the response.