RCE Greater Atlanta - 2018

The Girasoles Project
Basic Information
Title of project : 
The Girasoles Project
Submitting RCE: 
RCE Greater Atlanta
Contributing organization(s) : 
Emory University Sustainability Initiatives
Nell Hodgson Woodruff School of Nursing
The Farmworker Association of Florida
La Isla Network
Focal point(s) and affiliation(s)
Valerie Mac, PhD, RN
Organizational Affiliation: 
Emory University
Linda McCauley PhD, RN, FAAN, AAOHN
Organizational Affiliation: 
Emory University
Nell Hodgson Woodruff School of Nursing
Organizational Affiliation: 
Emory University
Antonio Tovar-Aguilar, PhD
Organizational Affiliation: 
Farmworker Association of Florida
Joan Flocks, MA, JD
Organizational Affiliation: 
Levin School of Law, University of Florida & Southeastern Coastal Center for Agricultural Health and Safety (SCCAHS)
Jason Glazer, BS
Organizational Affiliation: 
La Isla Network
Format of project: 
(1) Manuscript, (2) Audiovisual: Poster & Short Film
Language of project: 
Date of submission:
Friday, July 13, 2018
This project is the scientific basis for the development of future policy development for a heat standard for heat illness prevention training and heat prevention workplace standards.
At what level is the policy operating?: 
Geographical & Education Information
United States
Atlanta, GA, and Multiple cities across Georgia and Florida (Farmworker Association of Florida, operating communities in Pierson, Apopka, Homestead, Fellsmere, and Immokalee
Address of focal point institution for project: 
Nell Hodgson Woodruff School of Nursing, 1520 Clifton Rd, Atlanta, GA 30322
Farmworker Association of Florida, 1264 Apopka Blvd, Apopka, FL 32703
Target Audience:
Socioeconomic and environmental characteristics of the area : 
The Farmworker Association of Florida (FWAF) began in 1983 and was incorporated in 1986. It is a statewide, grassroots membership organization of more than 10,000 agricultural worker families from predominantly Mexican, Haitian, African-American, Guatemalan, Honduran and Salvadoran communities. FWAF members work mainly in the fern, foliage, citrus, vegetable, sod, mushroom, and landscaping industries. With five FL offices, the organization works in 15 FL counties, including the target community for this project. Since the early 1990s, the FWAF has addressed pesticide exposure, field sanitation, and other agricultural worker health and safety issues by educating agricultural workers about occupational exposure protection measures.
Description of sustainable development challenge(s) in the area the project addresses: 
In the face of a changing climate, it will be the most vulnerable populations who are the most adversely affected. Unfortunately, it often the most vulnerable who have the least amount of control of their work environments, and there are mandatory guidelines in the U.S. for heat illness prevention training and workplace measures to protect workers from heat hazards. To advance sustainable development, interventions and policy is needed to ensure a healthy and productive agricultural workforce.
August, 2014
With nine out of the ten hottest years on record occurring within the last decade, excessive heat is increasingly becoming a global public health priority. Mounting scientific evidence has documented the adverse health impacts of climate change, gaining the attention of public health organizations around the globe. Average air temperatures are projected to increase by 0.1°C per decade during the next two decades. This is of critical importance because according to the World Health Organization, with every degree Centigrade increase, mortality rates related to heat rise by 2-5%. The increasing severity of heat waves will lead to excess heat-related morbidity and mortality for all populations, but vulnerable populations most adversely affected will include the elderly, the poor, and individuals who work outdoors including farmworkers, construction workers, military personnel, and firefighters. According to the Centers for Disease Control and Prevention, farmworkers have been identified as an occupational group that is more than 20 times at risk for heat-related deaths compared to other occupational group. Research that can document critical information on the heat-related hazards of agricultural work and can be used to develop trainings and engage employers is of the utmost importance for protecting workers in the face of climate change and promoting a healthy, productive, and sustainable workforce.
Our objectives include: (1) Describing the heat hazards and associated heat-related health problems faced by agricultural workers in Florida through surveys, workplace environmental monitoring, and physiologic biomonitoring of workers; (2) Translate research findings into worker-centered heat illness prevention trainings; and (3) Disseminate research findings to workers, employers, key stakeholders, and the public to mobilize efforts for the sustainability of a healthy and productive agricultural workforce in the face of rising temperatures.
Activities and/or practices employed: 
We utilized community-based research, community engagement through promotors, and physiologic biomonitoring to carry out this research. We then developed heat illness prevention trainings from our research findings that are being carried out by farmworker advocates and community health workers. Finally, we created a short film (an interactive website coming August 2018, along with a longer video) with a media partner to disseminate our research findings. We are continuing to engage key stakeholders through presentations, meetings at worksites/with employers, and written dissemination of results.
Size of academic audience: 
>250 agricultural worker participants, >100 learners at scientific and community presentations, and >100 agricultural workers who have completed the heat illness prevention training developed from these research findings.
Participants were monitored for up to three workdays using a comprehensive biomonitoring protocol. Participants exceeded the recommended core body temperature (Tc) limit of 38.0ºC on over 3/4 of the observed workdays for a median duration of 76 minutes. Tc ≥ 38.0ºC was associated with time spent in vigorous activity, body fat percentage, post-work shift dehydration, and heat index. In the analysis of a subsample of workers (192 workers), approximately 53% of the workers were dehydrated pre-shift and 81% post-shift; 33% of participants had acute kidney injury (AKI) on at least one workday. The odds of AKI increased 47% for each 5-degree C (8F) increase in heat index. A high proportion of Florida agricultural workers exceeded recommended Tc limits and there was a strikingly high prevalence of dehydration and acute kidney injury in Florida agricultural workers. These results provide evidence for the necessity of interventions to address heat hazards in agricultural workers.
Lessons learned: 
We have found that partnerships between academic, community, employer, and media communities is paramount for projects that support global sustainability efforts. The engagement of a media partner has allowed us to examine new avenues for disseminating our research findings. The use of research findings to create evidence-based trainings for workers provides a product to participants who might have participated in the research, but also helps to maintain communication with communities that opened their doors to researchers. Future opportunities include the engagement of more employers and agricultural extension agents through the provision of on-site heat illness trainings for employers and workers.
Key messages: 
Agricultural workers are at risk of health effects related to working in the heat. There is evidence of body core temperatures above the recommended limits, dehydration, and acute kidney injury in vulnerable worker populations. To promote a sustainable future with a healthy and productive agricultural workforce, effective interventions are needed.
Relationship to other RCE activities: 
The American South is an area that has long struggled with racial tensions and equity challenges, but which has a rich history of advancing progress for social justice. Facing more current environmental challenges around climate change and water scarcity, the region is also developing a reputation as a leader in resilience building and sustainable development. Environmental justice programming and dissemination of research findings to communities is key to regional plans for our RCE. We will be leveraging these research findings and evidence-based training programs that have been developed through this work for vulnerable communities through policies to expand these training programs and partner with employers to ensure a health and productive agricultural workforce.
This work was supported by the National Institute for Nursing Research under Grant 1F31NR014611-01 and under Grant T32NR012715 (PI: S. Dunbar) for trainee V. Mac; the National Institute for Occupational Health under Grant 2T42OH008438-10 (PI: T. Bernard) via a pilot award for V. Mac and R. Chicas; The American Association of Occupational Health Nurses Foundation Liberty Mutual Scholarship; and a subaward from the Southeastern Center for Agricultural Health and Safety (OH011230-02S1)


File Name Caption for picture Photo Credit
Image icon sara.jpg (2.24 MB) An Emory student, practicing pipetting for biologic sample collection V. Mac
Image icon radio.jpg (1.92 MB) Videographer from La Isla Network capturing a promotor recording a community radio study participant recruitment announcement on Radio Poder, a community radio station in Homestead, Florida V. Mac
Image icon training.jpg (1.67 MB) A PISCA Heat illness prevention training in Immokalee, FL generated from the findings of The Girasoles Study V. Mac
UN Sustainable Development Goals (SDGs)
(https://sustainabledevelopment.un.org/sdgs) and other themes of Education for Sustainable Development (ESD)
SDG 2 - End hunger, achieve food security and improved nutrition, and promote sustainable agriculture 
SDG 3 - Ensure healthy lives and promote wellbeing for all at all ages 
SDG 8 - Promote sustained, inclusive and sustainable economic growth, full and productive employment, and decent work for all 
SDG 9 - Build resilient infrastructure, promote inclusive and sustainable industrialisation, and foster innovation 
SDG 11 - Make cities and human settlements inclusive, safe, resilient and sustainable 
SDG 12 - Ensure sustainable consumption and production patterns 
SDG 13 - Take urgent action to combat climate change and its impacts 
SDG 16 - Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels 
Curriculum Development 
Global Action Programme (GAP) on Education for Sustainable Development – Priority Action Areas
Priority Action Area 1 - Advancing policy 
Priority Action Area 3 - Building capacities of educators and trainers