1.
Jacobs-­‐
NSF
1
A Biocultural Approach to Health Effects of Dairy Farming on a Rural Population
in the San Joaquin Valley
Kathryn Jacobs
ANTH 114: Senior Capstone
March 19, 2015

2.
Jacobs-­‐
NSF
2
A Biocultural Approach to Health Effects of Dairy Farming on a Rural Population
in the San Joaquin Valley
In this proposal I investigate the health disparities promoted by systems of
industrialized animal farming in the San Joaquin Valley of central California.
Specifically, I assess the living conditions of dairy farm laborers and the surrounding
community, focusing on the environmental health hazards that contribute to respiratory
diseases. This research will add to the body of work on structural inequalities within the
workplace, as well as the emerging field of environmental justice in the Anthropocene. In
this context environmental justice refers to the unequal distribution of resources and
exposure to hazardous environments experienced by many Americans in lower socio-
economic regions, resulting in chronic health problems and a lack of social mobility.
These issues stem from geologic changes in the human-created environment recently
titled the Anthropocene. The field of environmental justice within a biocultural
framework provides insight into the physical and psychological effects of power
inequalities from a human perspective. This study shows intellectual merit in that it will
produce an ethnographical context for interpreting the quantitative disparities shown
among a largely unidentified population. It will shed light on the true, human state of
health disparities and thus provide realistic implications for policy changes. Agriculture
lies at the heart of American identity, therefore these power structures are of particular
concern in our community.
Fresno County has infamously poor air quality, and roughly 20% of children in
this area have asthma rendering it the asthma capital of California1
. Dairy farming is the
primary industry in the area and has been charged with partial responsibility for the poor
air quality and consequential asthma rates. In order to gauge the validity of this statement
as well as the perceived vs. actual effect of poor respiratory health among locals I will
employ the anthropological practice of participant observation as well as semi-structured
interviews with workers and their families2
. The sites have been pre-selected by the
recent studies, from which I will draw conclusions about the exact relationships of the
sites, personal histories, and health outcomes based on determined environmental hazard.
I will use my qualitative findings to compare with previous studies3
on the quantitative
environmental statistics to look for a relationship between perceived health outcomes,
actual health outcomes, and level of occupational involvement at dairy sites. This study
projects broader impacts in that it will provide qualitative evidence for perceived and
actual health disparities among a marginalized yet rapidly increasing population. It also
suggests a need for future studies in different geographical locations to compare the
effect of various topographies on environmental impact, as well as changing impacts
between different types of animal farms.
1
Statistic
taken
from
kidsdata.org
21.3%
of
children
were
recorded
to
have
asthma
in
Fresno
county
during
2011-­‐2012
(http://www.kidsdata.org/topic/45/asthma/summary)
2
Methods
adapted
from
Holmes
(2006)
3
Sites
and
biological
data
adapted
from
Vogel
et
al
(2012)

3.
Jacobs-­‐
NSF
3
Statement of Research Problem
The colloquial phrase “factory farm” is used synonymously with the term
Concentrated Animal Feeding Operation (CAFO) to describe an industry with the sole
purpose of producing large amounts of inexpensive meat products. In this proposal I will
use the terms factory farm, industrial farm, and CAFO interchangeably to refer to the
mechanization and consolidation of animal growth, slaughter, and sale. These operations
are often critiqued for creating excess waste, polluting the environment, and destroying
the livelihood of honest, hard-working, American farmers (Lavin, 2009). The negative
connotations associated with these industries have only recently come to the forefront of
agricultural discourse through narratives of disenfranchised family farms and animal
rights activists. The prevalence of these terms in modern society reflects the shift in
American culture from widespread family farms to a few massive factories.
The innovation of industrial animal farming has created environmental issues for
local communities and the world at large. The term environmental justice describes
unequal access to resources between different populations based on their geographical
location, which are often determined by ethnicity and income level (Bolin, 2005). In the
United States, factory farms are disproportionately located in areas with high
concentrations of racial minorities and low-income families (Donham, 2007; Graham,
2010). Laborers working in this industry are directly faced with pollutants such as
ammonia, hydrogen sulfide, methane, total bacteria, fungi, endotoxins, and residues of
veterinary antibiotics (Mirabelli, 2006; Watanabe, 2008). The disproportionate amount of
air, water, and soil pollution contributes to a multitude of negative health effects among
local populations, including both physical and psychological afflictions (Mirabelli, 2006,
Thompson, 2001). There appears to be a correlation between immigrant status and
whether or not a person accesses healthcare, and fears of deportation often prevent
workers from seeking the care they require.
The power hierarchy within industrial farms is entrenched in the history and
development of industrial agriculture, ultimately resulting in a structure of violence
whereby migrant workers and local families are disproportionately impacted by various
health consequences. Air pollution is of particular concern because it causes chronic
respiratory diseases, and the odor is correlated with increased stress levels other
psychological ailments (Mirabelli, 2006). The term structural violence describes the
systematic exclusion of a group of people from accessing or satisfying their fundamental
human needs. I discuss structural violence as a framework in which health disparities are
understood as a consequence of structured social and environmental injustice, solidified
by economic deficiencies. Socio-economic status is a broad term combining both
monetary income and social capital, but I focus specifically on occupational roles of
industry laborers and the consequential physical and psychological effects on health.
As both a physician and medical anthropologist, Paul Farmer writes on the power
of structural violence and the need for social scientists to play an active role in effect
positive change in areas of economic disparity. Through employing a biocultural
approach to an environmentally driven health inequality, I hope to provide a relatable,
human perspective on the impact of poor air quality on this agricultural community. This
ethnography will indicate the tangible effects of dairy farm pollution on a rural lifestyle,
and the ways in which this health disparity is perceived throughout the community.

4.
Jacobs-­‐
NSF
4
Research Question and Hypotheses
How does the structure of labor in industrial animal farms affect the physical and
psychological health of its workers and the surrounding community?
I believe that I will find a significant correlation between the respiratory and
psychological health of residents and farm workers. I hypothesize that this correlation is
the result of poor air quality and that pollutant odors cause headaches and other
symptoms of poor health among residents, adding to the psychological stress. I will
attempt to assess the validity of my theory by addressing environmental, health, familial,
occupational, and communal stress indicators in my interview questionnaires. I also
believe that there will be a relationship between health outcomes and residential
proximity to a CAFO, suggesting that the further one lives from a factory correlates with
better respiratory and psychological health indicators. I will analyze this by interviewing
around the county and measuring the proximity of residences to CAFOs; I will also
measure various occupational settings and compare the interviews of these employees
with those of the farm laborers.
Project Significance and Literature Review
History of Factory Farming
The discourse over factory farming has developed in the United States since the
turn of the 20th
century. While its origins remain unknown, the term “factory farm” marks
the switch from traditional, family farms to a mechanized, stratified, and regulated
agriculture aimed towards maximizing production (Lavin, 2009). The main structural
forces driving the mechanization of animal farming were intensification, concentration,
and specialization (Stull, 2004; Bowler, 1985). The consolidation of animal farming into
four large companies, Tyson, ConAgra, Excel, and Smithfield, reflects the vertical
integration that ended the era of small-scale farmers who couldn’t compete with the low
production costs of large, specialized factories (Stull, 2004; Altieri, 2012). Many
researchers have found this transformation to have a harmful effect on factory workers as
well as animal product consumers. These effects range from the increasing spread of
zoonotic diseases, such as swine flu and mad cow, to the rapid evolution of antibiotic-
resistant bacteria, as well as the degradation of surrounding environments (Lessing, 2010;
Donham et. al. 2007; Nicole, 2013). Immigrants make up a disproportionate amount of
hired labor in this industry (50%)4
, yet their health has been largely unaccounted for on
both federal and community levels (Villarejo, 2003). The populations closest to the
factory systems feel the majority of negative health impacts impacts, which ultimately
creates a power inequality among the factory workers and the surrounding populations
(Holmes, 2006).
Health Consequences of Industrialized Farming
Americans have been wary of labor injustices within the meat packing industry
since Upton Sinclair published The Jungle in 1906 (Stull and Broadway, 2004). The
4
Statistic
from
Alderete
et
al.
(2000)
specific
to
California,
numbers
are
likely
to
have
increased
in
the
last
15
years.

5.
Jacobs-­‐
NSF
5
adverse health effects of industrial CAFOs are studied by many current researchers
(Hollenbeck, 2013; Gibbs et al, 2012; Lessing, 2010; Karesh and Cook, 2005) and
continue to appear in popular discourse through books such as Jonathan Safran Foer’s
Eating Animals (2009). In terms of public health, three main areas of concern exist due to
the rise of factory farms: (1) resistance to anti-biotic and spread of infectious diseases
(Lessing, 2010; Hollenbeck 2013; Stanford et. al., 2012), (2) increase in non-
communicable disease by environmental contamination of air, water, and soil (Gibbs et
al, 2012; Graham and Nachman, 2010; Nicole, 2013), and (3) working conditions of
laborers causing chronic physical and psychological ailments (Holmes, 2013). My
research will focus on the latter concerns, as they exclusively reflect the direct affliction
of local communities, as opposed to consumers5
.
Biological Impacts
The density of animal populations in CAFOs increases the risk of intraspecies
pathogenic transmission, but also of interspecies enzootic pathogen transmission
(Hollenbeck, 2013). The nature of the human-animal link (Karesh and Cook, 2005) has
become critical to current epidemiological assessments of disease incidence and
prevalence, as well as medical understandings of proper practices and treatments. With a
larger supply of potential hosts, the rate of transmission and evolution of pathogens has
increased dramatically (Hollenbeck, 2013). Influenza provides an example of a
communicable, zoonotic disease whose prevalence has increased due to the conditions of
industrialized farms. The virus is able to spread and mutate at increasingly rapid rates due
to the ease of transmission from host to host in overcrowded areas, coupled with the fact
that these viruses have much shorter lifespan and turnover rate than the animal that they
inhabit (Lessing, 2010).
Another biological impact is the development of antimicrobrial resistant strains of
E. coli and other bacteria through the mass treatment of livestock with antibiotics. Similar
to the evolution of the influenza virus, when common bacteria are killed off on a large
scale and only the bacteria with natural resistance to the antibiotic survive, the result is
the development of resistant bacteria that can infect both the livestock and their consumer
(Stanford, 2012). This has particularly negative impacts when the waste pond of the
livestock (commonly described as a lagoon) leaks into natural rivers and contaminates
both the water supply and surrounding soil (Graham, 2010). This creates an
environmental hazard by spreading infectious diseases, which too often has been shown
to disproportionately affect low-income communities and racial minorities (Mirabelli,
2006). My project aims to study non-communicable diseases, and while this biological
hazard is important to note as a background to environmental racism6
, it affects
consumers across the nation in addition to the local residents I wish to target. The
purpose of this study is to assess the environmental impact of non-infectious diseases on
workers and the local population, which is why I will now focus on the air quality and the
5
While
the
issues
of
biological
security
affect
those
dealing
with
waste
differently
from
consumers,
I
focus
on
the
direct
pollutant
in
air
quality
which
has
been
shown
to
be
a
6
Environmental
racism:
a
contentious
issue
discussing
whether
or
not
racial
discrimination
acts
as
a
determining
factor
in
environmental
inequalities
(Bolin,
2005).
Since
there
is
evidence
supporting
the
disproportionately
high
amount
of
toxic
industries
and
waste
sites
in
minority
and
low-­‐income
communities,
I
believe
that
environmental
racism
is
a
valid
phenomenon.

6.
Jacobs-­‐
NSF
6
relationship between particulate matter and bioaerosol on respiratory diseases and
psychological health.
Environmental Justice and Migrant Health
The demographics of an area often correlate with the population’s access to clean
air, water, and soil. Animal factory farms have been known to release harmful bioaersols
that transfer pathologic microbes, causing allergic and irritant responses, respiratory
problems, hypersensitive reactions, and infectious disease among local communities
(Gibbs, 2012). These pollutants are particularly harmful to children, who have a smaller
body mass, the elderly, who have weaker immune systems, and the immunocompromised
who are already infected with diseases that make them dangerously susceptible to other
conditions. Communities in close proximity to swine CAFOs in North Carolina have
received particular attention due to the high concentration of these farms and their
notorious reputation for poor waste management (Nicole, 2013). A study of North
Carolina middle school students found that the average livestock odor rating was “faint”
or “moderate”, but that race and socioeconomic status (SES) were significant
determinants of proximity to CAFO as well as odor exposure (Mirabelli, 2006). This
suggests that people belonging to these social categories would be more likely to suffer
the negative health outcomes associated with breathing contaminated air.
One of the most at-risk populations for health consequences of CAFO-caused
environmental inequities is that of the factory workers. The term farm worker can be
broken down into three different subtypes: farm operators, unpaid family members of
farm operators, and hired farm workers (Villarejo, 2003). This study focuses on the hired
farm workers, who are primarily migrant workers7
. The psychological health of migrant
farm is important to consider because this population is burdened with not only the shame
of being considered an “illegal alien”, but also faced with the ultimatum of forfeiting
healthcare or risking deportation (Grzywacz, 2014; Holmes, 2006)). In California,
Mexican immigrants are particularly marginalized in terms of environmental justice
because they fill the niche of seasonal workers and are easily contracted to the
geographical regions plagued with factory farm contaminants (Bolin, 2005; Villarejo,
2003). The psychological burden of existing in a society with little social capital or power
to change one’s societal role creates a stressful environment (Grzywacz, 2014). When
coupled with an array systematic health disparity, from chronic pain and disease to acute
infection and illness, the stress of factory work can push one to a breaking point. Even
with the aid of federal Migrant Health Program funding, it is estimated that these services
only reach 13% of the target population (Holmes, 2006).
Broader Impact
This study has a broader impact in that it deconstructs the nature of health hazards
of a typically unidentified population within the context of environmental justice and
social hierarchy. It also provides future implications for studies comparing different sites,
especially sites other dairy farms with various types of CAFOs. While my focus lies
primarily on health and economic means, I acknowledge that there remain many other
determinants of violence, such as gender and ethnicity, which provide an undercurrent
7
Approximately
half
of
hired
farm
workers
are
undocumented
however
no
concrete
data
exists
on
this
population
making
it
difficult
to
quantify
exact
proportions.
Estimates
taken
from
Villarejo
2003.

7.
Jacobs-­‐
NSF
7
throughout this analysis. Through employing a holistic approach I will unpack the cycle
of violence at each level of marginalization.
Intellectual Merit
I support Paul Farmer’s emerging discipline of militant anthropology, however in
terms of intellectual merit there remains a need for ethnographers to fill in the qualitative
details absent from quantitative analyses. Ethnographies have emerged as important
indicators of health disparities (Hansen et al, 2013) and the role of social science in the
medical field has evolved from that of the passive storyteller to a catalyst for social action
by providing a larger context for these multi-level, complex problems. Through
employing a biocultural approach to an environmentally driven health inequality, I hope
to provide a relatable, human perspective on the impact of poor air quality on this
agricultural community. This ethnography will indicate the tangible effects of dairy farm
pollution on a rural lifestyle, and the ways in which this health disparity is perceived
throughout the community.
Research Design
Research Site and Population
Dairy farms make up the majority of CAFOs in California, contributing 21% of
the U.S. dairy supply8
(Watanabe, 2008; California Department of Food and Agriculture,
2007). Existing research links industrial dairy farms to air pollutants9
, and since the goal
of this study is to gauge the effect of air pollution on rural lifestyles an area with a high
prevalence of dairy farms is ideal. Fresno County is the 6th
most polluted county in the
country in terms of ozone, and the 4th
most polluted county for fine particulate matter10
.
Environmentally determined respiratory diseases disproportionately affect children, the
elderly, and those with existing diseases. Between 2001 and 2005 the prevalence of
asthma increased from 14% to 17%, and is even higher (21.3%)11
among children under
the age of 18 (Kresge, 2007).
Local media sources identify Fresno as the “asthma capital” of California, and
this region had been the focus of recent studies on quantitative environmental air quality
(Anderson, 2007). Due to the unusually high prevalence of asthma in this location, it
makes a good candidate for studies on the relationship between human respiratory
diseases and psychological disorders and air quality. In order to accurately compare my
qualitative results with existing quantitative data, I will perform this study in coordination
with Vogel et al. (2012) at five previously outlined dairy farms12
. Each farm uses freestall
barns, housing at least 2,000 cows total, and uses flush lanes into open pits, which
releases pollutants into soil, air, and water (Mirabelli, 2006).
8
Statistic
for
2007,
which
has
most
likely
increased
in
the
past
8
years.
9
Particulate
matter
and
bioaerosol
exposure
are
linked
to
respiratory
infection
(Gibbs,
2007;
Vogel,
2012)
10
Report
by
California
Institute
for
Rural
Studies
on
Fresno
Air
Quality
(Kresge,
2007).
11
Asthma
diagnoses
in
California
via
Kidsdata.org
12
Based
on
methods
for
quantitative
measurements
of
particulate
matter
at
sites
outlined
by
Vogel
et
al.
in
2012.
Farms
listed
in
Appendix.

8.
Jacobs-­‐
NSF
8
In Fresno County, roughly half (51.6%) percent of the population describes
themselves as Hispanic or Latino, which is significantly higher than the California state
average (38.4%) (U.S. Census, 2013). The vast majority are immigrants (70%), nearly all
of which (90%)13
claim Mexican heritage (Alderete, 2000). I plan to address Fresno
residents who seek health care at one of the twelve federally qualified health centers14
, as
well as dairy farm workers who are members of the United Farm Workers Foundation in
Fresno. Once I build adequate rapport with the individuals I meet in the clinics, I will use
this ethos to gain referrals with residents who do not seek help at the clinics. I hope to
attain a large and equal sample size of farm workers and regular residents to accurately
compare the respiratory and psychological health outcomes associated with directly
working on the farm to those of local residents working outside of the industry.
Personal Interviews
In order to gather information on the perceived effect of air quality on individuals,
I will perform and tape-record semi-structured, in-depth interviews with dairy farmers
attending community clinics that specifically serve migrant farm workers. I will also
interview family members, farm worker union members, and regular residents based off
of referrals from the clinics and worker foundation with whom I am currently in
collaboration. These interviews will be based on the same 23-item stress scale as previous
psychological surveys15
, while also adding health and environmental indicators to the
existing three tier system of work, family, and community stressors (Appendix; Snipes,
2007; Alderete, 2000). This semi-structured interview will allow me to analyze
qualitative data through quantitative, statistical means16
. I will re-interview the same
subjects every three months and gauge if their answers are different at the beginning and
end of my study. I will also aim to get 10 life histories, one from each factory site worker
and one from a local in each surrounding area that works at a different occupation. I will
provide the option of interviewing in either English or Spanish, based on the participant’s
preference.
Participant Observation
This method of study requires long-term immersion in the designated society to
understand the effect of air quality as felt by the local population. While there are 5
different farm locations, they are all within the same county and reflect similar population
demographics. I will geo-locate a position relatively close to the center of the farms to
reside in, but will continue to perform interviews on the periphery of the county to
compare the effects of air pollutants on stress and respiratory illness relative to CAFO
proximity. I will spend the majority of my time building rapport with the population in
the center of the CAFO concentration because I hypothesize that they will present with
the most negative health outcomes associated with farming. I will spend multiple days in
13
Alderete
et
al.
published
in
2000
and
the
proportion
of
foreign-­‐born
migrant
laborers
has
most
likely
increased
in
the
last
15
years.
14
Clinics
outlined
in
Diringer’s
Report
(2008).
See
Appendix.
15
Building
from
Snipes
et
al.
(2007).
See
Appendix.
16
I
will
conduct
parametric
statistical
analysis
through
SPSS
programming
once
answers
are
categorized
and
assigned
numerical
values.

9.
Jacobs-­‐
NSF
9
the factories17
recording working conditions and observable health characteristics18
. I will
spend equal amounts of time shadowing factory workers, working in factories, and
shadowing physicians19
. This portion of my study will not begin until I am fully
acclimated20
and relatively accepted by the local population. I will record events and
conversations with detailed field notes and pictures.
Data Analysis
With proper funding, I plan to hire a bilingual research assistant to help promote a
safe and fluid environment during our interviews and analysis. During this yearlong
research period I will assemble raw data through recording tapes/digital voice recorder, a
camera, and a laptop. I will use these instruments to record all interviews, life histories,
observations, field notes, photographs, and other extraneous materials. I will code
questionnaire answers by their level of concern, using the 23-item21
stress scale
developed by Snipes et al. (2007). I will then use the statistical analysis program SPSS to
compare the various conditions and assign the proper codes to each categorical and
numerical variable. I will then perform spatial analysis using geographic information
systems (GIS) to plot the descriptive and parametric health indicators with the biological
and environmental determinant data calculated by Vogel et al.22
at the University of
California, Davis.
Statement of Competency
I am proficient in Spanish and plan to higher a bilingual assistant to help me near
fluency and enhance my ethos within the community. I will have a Bachelor of Science in
Anthropology and Public Health Science from Santa Clara University with minors in
Biology and French at the time of this study. While I have only conducted biological
anthropology research thus far, I believe that using a biocultural framework of analysis is
well within my abilities. I have taken classes on biostatistics and geographic information
systems, and am well versed in statistical programming as well as spatial analysis. I am
also currently in contact with each of the twelve health centers I plan to attend, and
understand the clinical protocol due to my public health background. I have spoken with
the leader of the United Farm Workers Foundation in Fresno as well and am set to attend
the bi-weekly informational session about deferred action and naturalization in the first
week of April23
. I have discussed my methods closely with Christopher Vogel24
and
17
Similar
to
Seth
Holmes
in
Fresh
Fruit,
Broken
Bodies,
(2013)
I
anticipate
that
my
experience,
as
a
Caucasian
female,
in
these
factories
will
still
be
inherently
distinguished
from
the
workers
because
at
the
end
of
the
study
I
will
return
home,
whereas
this
is
a
reality
from
which
they
have
low
prospects
for
escape.
18
Observable
health
consequences,
coughing,
wheezing,
sore
throat,
croaky
voice,
etc.
See
Appendix.
19
With
permission
of
the
physician
and
patient,
I
do
not
anticipate
this
will
be
a
large
portion
of
my
study.
20
Anticipated
3
months
of
immersion
before
I
can
gain
access
to
workers
everyday
life
and
sit
in
on
patient
visits.
21
See
Appendix.
22
Pending
communication
but
based
on
data
from
Vogel
et
al.
(2012).
23
Email:
slugo@ufwfoundation.org
and
phone:
(559)
496-­‐0700.
Fresno
office
serves
the
San
Joaquin
Valley
including
the
counties
of
Fresno,
Madera,
Merced,
and
Tulare.

10.
Jacobs-­‐
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10
gained access to the sites used in his research on particulate matter and bioaerosols in
Fresno (Vogel et al, 2012). I am currently in the process of getting in touch with Seth
Holmes to learn more in depth about his methods for An Ethnographic Study of the Social
Context of Migrant Health in the United States (2006).
Research Schedule
I will begin my immersion in the spring of 2015, relocating into the community as
of April 1st
. Interviewing will commence after one (1) month of immersion, around May
1st
, and continue until March of 2016 for a total of eleven (11) months of ethnographic
field research.
• April 1, 2015 -Depart San Jose, CA and arrive in
Fresno, CA
• April 2-30, 2015 -Acclimate to community
and gain access to clinics and farms
• May 1, 2015- March 31, 2016 -With the help of a bilingual
Research assistant, I will conduct
ethnographic research on the
workers and local residents of
five (5) factory farms in Fresno
County.
• April 1, 2016 -Return from Fresno to San Jose
and commence data analysis
24
Department
of
Environmental
Toxicology
at
UC
Davis
and
experienced
worker
in
Fresno
Dairy
Farms.
Co-­‐author
of
Vogel
et
al.
(2012).

11.
Jacobs-­‐
NSF
11
Works Cited
Alderete, Ethel, DrPH, William A. Vega, PhD, Bohdan Kolody, PhD, and Sergio Aguilar-
Gaxiola, MD PhD. "Lifetime Prevalence of and Risk Factors for Psychiatric Disorders
among Mexican Migrant Farmworkers in California." American Journal of Public Health
90.4 (2000): 608-14. Web.
Altieri, Miguel A., and C. I. Nicholls. "Agroecology Scaling Up for Food Sovereignty and
Resiliency." Sustainable Agriculture Reviews 11 (2012): 1-29. Web.
Anderson, Barbara. “Fresno is State’s Asthma Capital” Fresno Bee (2007)
http://www.fresnobee.com/2007/12/12/v-printerfriendly/263218/fresno-is-states-asthma-
capital.html
"Asthma Summary" Kidsdata.org. Lucile Packard Foundation for Children's Health, Web.
http://www.kidsdata.org/topic/45/asthma/summary
Bolin, Bob, Sara Grineski, and Timothy Collins. "The Geography of Despair: Environmental
Racism and The Making of South Phoenix, Arizona, USA." Research in Human Ecology
12.2 (2005): 156-68.
Bowler, Ian R. Agriculture under the common agricultural policy: a geography. Manchester
University Press, 1985.
Diringer, Joel, JD MPH. Making a Difference: The Federally Qualified Health Centers in
Fresno County. Rep: Diringer & Associates, 2008. Print.
Donham, Kelley J., Steven Wing, David Osterberg, Jan L. Flora, Carol Hodne, Kendall M. Thu,
and Peter S. Thorne. "Community Health and Socioeconomic Issues Surrounding
Concentrated Animal Feeding Operations." Environmental Health Perspectives 115.2
(2006): 317-20. Web.
"Fresno County QuickFacts from the US Census Bureau.” United States Census Bureau. Web.
2013.
Gibbs, Shawn G., PhD, William W. Hurd, MD, Christopher F. Green, PhD, Angelina Gandara,
BS, and Patrick M. Tarwater, PhD. "Respiratory and Reproductive Health in Women
Near Confined Animal Feeding Operations in the American Southwest." Texas Public
Health Journal 64.2 (2012): 4-11. Web.
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Appendix
Table 1: Accessible Fresno dairy farms cited by Vogel et al. (2012) and to be used for qualitative analysis.
Dairy Site No. of Cows (total)
#51 2,620
#54 3,200
#56 4,950
#57 9,550
#60 2,400
Table 2: Federally Qualified Health Centers in Fresno County as outlined by Joel Diringer, JD, MPH
(2008).
No. Clinic Name Address
1 Bullard and Fresno Health Center
6011 N. Fresno Street, Suite 115
Fresno, CA 93710
2 Divisadero Health Center
2021 Divisadero Street
Fresno, CA 93701
3 Divisadero Women’s Health Center
145 Clark Street
Fresno, CA 93701
4 Divisadero Health Care for the Homeless
2029 Divisadero Street
Fresno, CA 93701
5 Easton Health Center
5784 S. Elm Avenue
Fresno, CA 93706
6 Elm Health Center
2790 S. Elm Avenue
Fresno, CA 93706
7 Elm Children’s Center
2798 S. Elm Avenue
Fresno, CA 93706
8 Garland Health Center
3727 N. First Street, Suite 106
Fresno, CA 93726
9 Orange & Butler Health Center
1350 S. Orange Avenue
Fresno, CA 93702
10 Regional Medical Center
2505 Divisadero Street
Fresno, CA 93721
11 West Fresno Health Center
302 Fresno Street, Suite 102
Fresno, CA 93706
12 West Fresno Dental Center
302 Fresno Street, Suite 204
Fresno, CA 93706
Focus Group Questions used in Snipes et al. (2007)- Potential for adaptation on site
1. What is stress?
2. Are there other names for the word “stress”?
3. What are some different forms of stress?
4. What types of things cause you to experience stress?
a. Family?
b. Community?

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c. Health?
d. Work?
e. Environment?
5. How do you know when you are experiencing stress?
a. How does it feel when you experience this?
6. What types of things can a person do to prevent or reduce their stress?
a. Family?
b. Community?
c. Health?
d. Work?
e. Environment?
7. Are there sources of stress that cannot be prevented or reduced?
a. Family?
b. Community?
c. Health?
d. Work?
e. Environment?
Stress Scale for Mexican Farm Workers - Borrowed from Snipes et al. (2007)
Escala del Estrés para Trabajadores del Campo Mexicanos
1. ¿En el último mes, se ha sentido estresado porque no tiene bastante dinero para pagar los
gastos?
1. Ni siquiera (nunca)
2. Si, un poco (casi nunca)
3. Si, algunas veces (de ves en cuando)
4. Si, muchas veces (mas de lo usual)
5. Si, la mayoría del tiempo (casi siempre)*
2. ¿En el último mes, se ha sentido estresado por la falta de trabajo?
3. ¿En el último mes, se ha sentido estresado por la injusticia en el trabajo?
4. ¿En el último mes, se ha sentido estresado por daños dolorosos en el trabajo?
5. ¿En el último mes, se ha sentido estresado porque tiene que trabajar demasiado?
6. ¿En el último mes, ha tenido sentimientos de desesperación por enfermedades en su familia?
7. ¿En el último mes, ha tenido sentimientos de desesperación por la falta de dinero para pagar los
gastos médicos?
8. ¿En el último mes, ha tenido sentimientos de desesperación porque miembros de su familia
tienen problemas que usted no puede resolver?
9. ¿En el último mes, se ha sentido estresado por problemas de dejar~a~sus hijos cuando va a
trabajar?
10. ¿En el último mes, ha tenido sentimientos de desesperación porque miembros de su familia
viven lejos?
11. ¿En el último mes, se ha sentido estresado por problemas con sus hijos?
12. ¿En el último mes, se ha sentido estresado por la falta de comunicación en su hogar?
13. ¿En el último mes, se ha sentido estresado por un problema de alcoholismo en su hogar?
14. ¿En el último mes, se ha sentido estresado por el uso de drogas en su hogar?
15. ¿En el último mes, se ha sentido estresado por abuso domestico en su hogar?
16. ¿En el último mes, se ha sentido estresado por el crimen en su comunidad?
17. ¿En el último mes, se ha sentido estresado por la discriminación en su comunidad?
18. ¿En el último mes, se ha sentido estresado porque no habla inglés?
19. ¿En el último mes, se ha sentido estresado porque no hay comunicación con la juventud en su
comunidad?
20. ¿En el último mes, se ha sentido estresado porque hay discriminación en sus escuelas?
21. ¿En el último mes, es difícil hacer cosas por la falta de energía?
22. ¿En el último mes, ha perdido sueno por causa del estrés?
23. ¿En el último mes, se ha sentido deprimido por causa del estrés?
*1-5: Para cada pregunta