• remaining counties in large metro area
• best health & health practices

• usually rural, usually on provider for seveal counties
• usually higher proprotion of racial minorities

seasonal; worked within past 2 years; has a temporary abode

• 3-5 million in US
• life expectancy 49
• many return to country of origin after growing season ends
• 85% minority, many are American citizens
• typically: 6 months farm work, 8 wks nonfarm work, 8 wks travelling, 10 weeks unemployed (often go home) per year

• 1962
• provides support for clinics
• grants to community-based & state orgs
• 670,000 received services in 2002
• reaches only 20% of migrant population

• also enters home & food
• risk of mild psychological & behavior deficits
• severe poisoning can cause death

<20,000 resident communities, or <99 per square mile

• 50% diagnosed with 1+ chronic conditions
• average one less physician visit per year than urban
• health status varies greatly
• 26% rural families below poverty line
• 40% rural children live in poverty
• 25% of Americans live in rural area
• larger proportion of whites
• more young & old

• poorer health
• highest death rates for children & young adults
• highest death rates from accidents
• highest suicide rates
• fewest dental visits
• highest teenager smoking rates
• AIDS increasing more quickly here (heterosexual sex, most cases)
• gay men not open & more likely to engage in unprotected sex

• signficantly better health
• suburban women least likely to be obese
• most likely to have insurance

• acute: headache, dizziness, confusion, irritability, twitching, weakness, respiratory problems, NVD, stomach cramps
• chronic: cancer, Parkinson's like symptoms, infertility, liver namage, neuro problems
• nurse should develop a pesticide history

• more diverse clinical experiences, exposures
• broader scope of practice
• sparse resources
• slower pace
• lack of anonymity
• prestigious status in community

Community Health Primary Health Care

• partnership model to address some of the deficits/disparities between rural  & other
• steps

• Define & characterize community
• ID health problems
• Develop/modify HC services
• Monitor & eval program process & client outcomes

• usually wait for crisis to seek help
• epidemic of young male suicides in some communities

• 1996 Welfare Reform legislation changed availability of federal services; immigrants treated differently depending if they came before or after this
• many legal & illegal immigrants are ineligible for food stamps, social security income, etc

• dental
• TB (often drug resistant; little continuity of care)
• HIV
• depression, anxiety, phobias

• employers with 11 or more farm workers must provide drinking water, hand washing facilities, & toilets
• compliance is poor
• farming/ranching often do not fall under OSHA guidelines because they are small enterprises (usually no worker's comp, either)

• often appear normal & healthy
• but often have malnutrition (vit A, iron), dental caries, inadequate immunizations, colds & stomach bugs
• 2.5 times more likely to repeat a grade than child that does not move
• Migrant Head Start helps (6 mo - 5 yrs)
• 55% graduate high school

• 14 years is minimum for farm work
• 16 years for other industries
• 12-13 if parents consent or parent works on same farm
• <12 can work on a farm with fewer than 7 full-time workers
• federal law does not protect children from overwork; may work very early or very late

• prefer polite nonconfrontational relationships
• may nod to indicate understanding but really don't
• expect chit-chat for first few minutes
• expect nurse to not be rushed and to be a good listener
• humor & touching appreciated
• health decisions often by females
• health may be seen as gift from God; illness a punishment
• consider themselves healthy if they can work
• most common folk remedies: chamomile, peppermint, cactus, epazote