Farmworker Community Research Articles

Addressing Latinx cancer care equity program for long-term united skills building (ALCANCE-PLUS): Updated results from an ongoing implementation.

151 Background: Addressing Latinx Cancer Care Equity - Program for Long-term United Skills Building (ALCANCE-PLUS) is an ongoing community-academic partnership between the Stanford University School of Medicine Partnerships to Advance Care and Pacific Cancer Care (PCC). The partnership began in 2019 and is comprised of several community-identified multi-level interventions to improve cancer health equity in an undeserved, rural migrant farm-working community. The intervention components are delivered by trained community health workers to low-income and racial and ethnic minoritized patients receiving active cancer treatment and include: 1) precision medicine education using literacy- and language-concordant educational tools; 2) food insecurity screening and intervention with plans to cross-train > 150 CHW's across the county to expand cancer screening and care delivery in the county. Here, we describe the characteristics of participants and the program's impact to date on metrics identified by the community. Methods: ALCANCE-PLUS eligibility includes: all patients with cancer actively receiving cancer-directed treatment at PCC who are ≥ 18 years old and speak English or Spanish. Community identified metrics of success include: % treatment adherence (completion), no-show rate, days from diagnosis to treatment, and % who received clinical trials education as compared to baseline (prior to program start). We used descriptive statistics and chi-squared tests to compare metrics of participants in the program to baseline. Results: At baseline, 62% of low-income and racial and ethnic minoritized patients in the county completed treatment, 35% had no-shows to clinic or infusion appointments with an average of 82.7 days from diagnosis to treatment and only 15% received clinical trial education. From July 2022 to May 2024, a total of 164 patients participated in the program. Mean ages were 60.88 ± 14.55, 68 (41.5%) identified as male, 104 (63.4%) as Hispanic or Latino, 2 (1.2%) African American or Black, 12 (7.3%) Asian American, 2 (1.2%) Native Hawaiian or Other Pacific Islanders, and 60 (36.6%) White. Insurance types included 63 (25.6%) patients with Medicaid, 56 (22.6) with Medicare, 13 (5.2%) with both, 72 (29%) with private insurance, and 7 (2.8%) with other insurance or uninsured. As of January 2024, treatment adherence was 100% for the 157 program participants, the average time from diagnosis to treatment dropped from 82.7 days county-wide pre-program to 30 days among enrolled participants, all participants received clinical trial education, and 38 (24.2%) were actively participating in a clinical trial. Conclusions: Community-academic partnerships to co-design and implement approaches to overcome community-identified needs for marginalized populations are essential to achieve cancer health equity.

Environmental Health Assessment by Local Environmental Justice Experts for Evidence-based Decision-making in an Agricultural Community of Northern California.

Environmental justice research driven by academics and policymakers often overlooks the valuable insights and leadership of the communities most impacted by environmental hazards. When institution-led research approaches are employed, inadequate community ownership and limited institutional accountability hinder the effectiveness of environmental public health interventions. In contrast, a community-owned and -managed approach to environmental justice research can guide community members in developing evidence-based interventions. This paper outlines a community-led environmental health assessment survey (sample= 100) and resulting community actions over six years (2017 to 2023) in a Northern California farmworker community with a perceived high prevalence of cancer and exposure to environmental hazards in households, neighborhoods, and job sites. Local resident experts in Knights Landing, CA, documented community risk factors and exposures in collaboration with interdisciplinary undergraduate and graduate student-researchers. The survey instrument focused on environmental hazards identified by local resident experts including vehicular and agricultural pollution, occupational pesticide contact, and sun exposure. Survey findings highlighted the need for targeted interventions to reduce environmental health risks, such as academic outreach programs, county investments in public services, and community-led mutual aid initiatives. Despite academic reservations about our non-random sampling method and data collection by local resident experts, our project sparked substantial actions and investments with minimal personnel and financial resources. Local leaders working with student-researchers developed more effective environmental public health interventions through a community-owned and -managed approach that went beyond the efforts of local regulatory and research institutions.

Prenatal Maternal Occupation and Child Epigenetic Age Acceleration in an Agricultural Region

Research on fetal epigenetic programming suggests that the intrauterine environment can have long-term effects on offspring disease susceptibility. To examine the association between prenatal maternal occupation and child epigenetic age acceleration (EAA) among a farmworker community. This cohort study included participants in the Center for the Health Assessment of Mothers and Children of Salinas, a prospective, Latino, prebirth cohort. Pregnant women were recruited from October 1, 1999, to October 1, 2000, from 6 community clinics in California's Salinas Valley agricultural region. Participants were 18 years or older, English or Spanish speaking, Medicaid eligible, and at 20 weeks' gestation or earlier at enrollment. Mother-child pairs who had blood DNA methylation measured at the ages of 7, 9, and 14 years were included. Data were analyzed from July 2021 to November 2023. Prenatal maternal occupation was ascertained through study interviews conducted during prenatal visits and shortly after delivery. Child EAA at 7, 9, and 14 years of age was estimated using DNA methylation-based epigenetic age biomarkers. Three EAA measures were calculated: the Horvath EAA, skin and blood EAA, and intrinsic EAA. Linear mixed-effects models were used to estimate longitudinal associations of prenatal maternal occupation and child EAA, adjusting for confounders and prenatal organophosphate pesticide exposure. Analyses included 290 mother-child pairs (mean [SD] maternal age at delivery, 26.5 [5.2] years; 152 [52.4%] female infants); 254 mothers (87.6%) were born in Mexico, 33 (11.4%) in the US, and 3 (1.0%) in other countries; and 179 families (61.7%) were below the federal poverty line during pregnancy. Mothers reported engaging in several types of work during pregnancy, including agricultural fieldwork (90 [31.0%]), other agricultural work (40 [13.8%]), nonagricultural work (53 [18.3%]), or no work (107 [36.9%]). Children whose mothers worked in agricultural fields during pregnancy had a mean of 0.66 (95% CI, 0.17-1.15) years of greater Horvath EAA, 0.62 (95% CI, 0.31-0.94) years of greater skin and blood EAA, and 0.45 (95% CI, 0.07-0.83) years of greater intrinsic EAA compared with children whose mothers did not work during pregnancy. In this cohort study, prenatal maternal agricultural fieldwork was associated with accelerated childhood epigenetic aging independent of organophosphate pesticide exposure. Future research on which factors related to agricultural fieldwork accelerate aging in the next generation can inform targeted prevention programs and policies that protect children's health.

Relational self and farmworker law reform: the case of Indonesia

This article celebrates and explores Keebet Benda-Beckmann’s important work on the centrality of “relationality” in legal pluralism, in Indonesia in particular, and more generally in the non-Western world. We aim to extend Benda-Beckmann’s argument on the centrality of relationality and legal pluralism into our analysis of an urgent project of Indonesian law reform: farmworker protection. We make an interpretive claim on the status of “relational self” as an organizing idea in the Indonesian legal consciousness. To build that interpretive claim, we provide qualitative context drawn from our field research in two farmworker communities in rural West Java, Indonesia. With the situation of Indonesian farmworkers as its case study, this paper presents how relational self-construal can be a starting point for the introduction of a greater access to justice. To build its argument, the paper first identifies relational self as the Indonesian farmworkers’ central notion of self. Ultimately, the paper develops a model of law reform proposal that takes relational self as its overarching supposition.

A qualitative community health assessment of HIV prevention awareness in a semi-rural Latinx seasonal farm working community in South Florida

This article explores HIV awareness and prevention in a Latinx seasonal farmworker community of south Miami-Dade County in the USA. The study took place as part of a larger community assessment that aimed to determine community needs and resources related to substance abuse, violence and HIV in the Latinx seasonal farmworker communities of south Miami-Dade County, with a particular focus on fathers’ and their male sons’ relationships. The study collected data on HIV knowledge and prevention, healthcare-seeking behaviours, cultural norms, and communication barriers about HIV prevention between fathers and sons. Data were collected through in-depth interviews with community leaders, two focus groups with social and health services providers, and four focus groups involving fathers and their adolescent sons. A deductive approach to data analysis was undertaken. Five major themes were identified: (1) HIVrelated knowledge and perception; (2) HIV prevention strategies; (3) barriers and needs for tailored preventive health and care services in the community; (4) stress over sex-related communication; and (5) the dominance of traditional masculine gender norms in the household and the community.

Advancing equity in cancer care through community-academic partnerships: Results from the addressing Latinx cancer care equity—Program for long-term united skills building (ALCANCE-PLUS).

77 Background: Addressing Latinx CANcer Care Equity - Program for Long-term United Skills Building (ALCANCE-PLUS) is an ongoing community-academic partnership between the Stanford University School of Medicine Partnerships to Advance Care and Pacific Cancer Care (PCC). The partnership began in 2019 and is comprised of several community-identified multi-level interventions to improve cancer health equity in an undeserved, rural migrant farm-working community. The intervention components are delivered by trained community health workers to low-income and racial and ethnic minoritized patients receiving active cancer treatment and include: 1) precision medicine education using literacy- and language-concordant educational tools; 2) food insecurity screening and intervention with plans to cross-train >150 CHW's across the county to expand cancer screening and care delivery in the county. Here, we describe the characteristics of participants and the program's impact to date on metrics identified by the community. Methods: ALCANCE-PLUS eligibility includes: all patients with cancer actively receiving cancer-directed treatment at PCC who are ≥ 18 years old and speak English or Spanish. Community identified metrics of success include: % treatment adherence (completion), no-show rate, days from diagnosis to treatment, and % who received clinical trials education as compared to baseline (prior to program start). We used descriptive statistics and chi-squared tests to compare metrics of participants in the program to baseline. Results: At baseline, 62% of low-income and racial and ethnic minoritized patients in the county completed treatment, 35% had no-shows to clinic or infusion appointments with an average of 82.7 days from diagnosis to treatment and only 15% received clinical trial education. As of program start in July 2022, a total of 143 patients participated in the program. Mean ages were 58.6 ± 14.53, 77 (57%) identified as male, 91 (63%) as Hispanic or Latino, 1 (0.7%) African American or Black, 11 (8%) Asian American, 1 (0.7%) Native Hawaiian or Other Pacific Islanders, and 48 (36%) White with 108 (75%) insured by Medicaid or Medicare or uninsured. As of June 26, 2023, there were statistically significant improvements in treatment completion (p<0.001) with 140 (98%) completed treatment; reductions in no show with only 3 (2%) participants with a no-show for their clinical or infusion appointments, average time from diagnosis to treatment was halved to 42.5 days (p<0.001) and all participants received clinical trial education (p<0.001) with 48 (34%) actively participating in a clinical trial. Conclusions: Community-academic partnerships to co-design and implement approaches to overcome community-identified needs for marginalized populations are essential to achieve cancer health equity.

Comparing Longitudinal Measures of Cholinesterase as Biomarkers for Insecticide Exposure Among Latinx Children in Rural Farmworker and Urban Nonfarmworker Communities in North Carolina.

In a 2-group prospective design, this study compared seasonal cholinesterase levels of Latinx children in rural farmworker families and comparable urban children to assess the impact of environmental exposure to cholinesterase-inhibiting insecticides. Quarterly blood samples and passive dosimeter wristbands were collected over 2 years in 8-year-old children (74 rural, 62 urban). Laboratory analysis assessed total cholinesterase, acetylcholinesterase, and butyrylcholinesterase from blood samples, and insecticides from wristbands. In spring and summer, total cholinesterase and acetylcholinesterase levels were depressed in rural children compared with winter and fall. Butyrylcholinesterase was depressed in rural children in fall compared with spring and summer. Adjustment for insecticide exposure did not affect these associations. Environmental exposures to cholinesterase-inhibiting insecticides have measurable biochemical effects on blood cholinesterases in rural children from farmworker families.

Planning Collaborative Practices for Archiving Farmworker Communities’ Histories

This article summarizes the project "Planning Collaborative Practices for Archiving Farmworker Communities’ Histories." It also describes the challenges faced in launching the project and the initial activities.

Developing Infographics to Present Research Findings from CBPR to Latinx Farmworker Community Members.

Community-based participatory research (CBPR) facilitates vulnerable communities and scientists collaborating to address pertinent health issues. For Latinx farmworkers, the employment of children and their resulting morbidity and mortality in the hazardous farm environment is a concern. Communicating child farmworker research results to farmworkers and service providers must take into account their language, literacy, and educational characteristics. We describe the collaborative development and dissemination of research findings on child farmworkers by a CBPR partnership with the Latinx farmworker community. Key points for communication with infographics were abstracted from peer-reviewed research papers. An iterative process sought community partners' input as the research partners developed the infographics. We developed infographics on heat-related illness, education, and musculoskeletal impacts of child labor, guided by published criteria for effective infographics. Efforts to disseminate finished infographics needed greater rigor. Infographics provide a means to communicate CBPR findings to community members.

Pesticide Exposure among Latinx Children in Rural Farmworker and Urban Non-Farmworker Communities: Associations with Locality and Season.

This study uses repeated measures to document the pesticide exposure of rural and urban Latinx children (age eight at baseline), and to compare these children in terms of the frequency and concentration of their exposure to a large set of pesticides, accounting for season. We used silicone wristbands worn for one week up to ten times at quarterly intervals from 2018 to 2022 to assess pesticide exposure in children from rural farmworker (n = 75) and urban non-farmworker (n = 61) families. We determined the detection and concentrations (ng/g) of 72 pesticides and pesticide degradation products in the wristbands using gas chromatography electron capture detection and gas chromatography mass spectrometry. The most frequently detected pesticide classes were organochlorines, pyrethroids, and organophosphates. Controlling for season, organochlorine or phenylpyrazole detections were less likely for rural children than for urban children. Detections of organochlorines, pyrethroids, or organophosphates were lower in spring and summer versus winter. Controlling for season, urban children had greater concentrations of organochlorines, while rural children had greater concentrations of pyrethroids and Chlorpyrifos. Pesticide concentrations were lower in winter and spring compared with summer and fall. These results further document that pesticides are ubiquitous in the living environment for children in vulnerable, immigrant communities.

Critical Environmental Justice and Pandemic Events: Florida Farm Work during COVID-19

Extant research has well established that exposure to infectious disease can be a significant problem for vulnerable populations that have been deemed “essential” during widespread health crises. We contribute to this growing body of literature by delineating the utility of the critical environmental justice (CEJ) framework for investigating infectious disease in the context of at-risk groups such as farmworker communities. Specifically, we highlight how the four pillars of CEJ are applicable to potential or real exposure to pathogens in farmworkers' living and working spaces, and how responses and support for these essential workers can be shaped by intersectional factors, the “expendability” of farmworkers, and broader state and corporate structural influences. We draw from a case study of Florida farmworker outreach professionals to center the perceptions and experiences of individuals working directly with farmworker communities during the COVID-19 pandemic. We conclude with a discussion of how our research contributes to the broader understanding of CEJ in the context of widespread health threats, as well as an overview of lessons learned for regulatory and health agencies.

Review: Feminista Frequencies: Community Building through Radio in the Yakima Valley, by Monica De La Torre

Review: <i>Feminista Frequencies: Community Building through Radio in the Yakima Valley</i>, by Monica De La Torre

Parent Perception of School Meals in the San Joaquin Valley during COVID-19: A Photovoice Project.

School-based nutrition programs are crucial to reducing food insecurity. The COVID-19 pandemic adversely impacted students' school meal participation. This study seeks to understand parent views of school meals during COVID-19 to inform efforts to improve participation in school meal programs. Photovoice methodology was used to explore parental perception of school meals in San Joaquin Valley, California, a region of predominately Latino farmworker communities. Parents in seven school districts photographed school meals for a one-week period during the pandemic and then participated in focus group discussions and small group interviews. Focus group discussions and small group interviews were transcribed, and data were analyzed using a team-based, theme-analysis approach. Three primary domains emerged: benefits of school meal distribution, meal quality and appeal, and perceived healthfulness. Parents perceived school meals as beneficial to addressing food insecurity. However, they noted that meals were unappealing, high in added sugar, and unhealthy, which led to discarded meals and decreased participation in the school meal program. The transition to grab-and-go style meals was an effective strategy for providing food to families during pandemic school closures, and school meals remain an important resource for families experiencing food insecurity. However, negative parental perceptions of the appeal and nutritional content of school meals may have decreased school meal participation and increased food waste that could persist beyond the pandemic.

CDC-Supported National Network of Farmworker-Serving Organizations to Mitigate COVID-19.

The Centers for Disease Control and Prevention has partnered with the National Center for Farmworker Health to respond to the impact of COVID-19 on US farmworker communities. Immigrant farmworkers are often isolated from public health infrastructure. This partnership built the capacity of a national network of organizations to connect farmworkers to COVID-19 education and vaccinations in 20 states through training and resource sharing. The partnership funded 194 network member staff, trained 1130 individuals, and supported COVID-19 outreach to more than 600 000 farmworkers. (Am J Public Health. 2023;113(2):166-169. https://doi.org/10.2105/AJPH.2022.307159).

The Immokalee Community Health Coalition: Operationalizing Trust.

The COVID-19 pandemic disproportionately affected migrant farmworker communities in the United States in case rates and deaths. In rural Immokalee, Florida, human rights, health care, and social support organizations with different strengths joined together to form a coalition that provided health information, tests, vaccines, and social supports. This report offers practical advice on how similar coalitions can overcome barriers to care, improve outcomes, and overall increase trust in the health system.

The Intersection of Workplace and Environmental Exposure on Health in Latinx Farm Working Communities in Rural Inland Southern California.

Workplace and environmental exposures pose health risks for racial/ethnic minorities in rural agricultural communities, placing them at a disadvantage in accessing needed health care. Over three fourths (76%) of the 2.4 million farmworkers in the United States are immigrants, mostly from Mexico. However, little is known of the community health concerns and barriers to care of Latinx farmworkers in inland southern California. This qualitative study used a community-based participatory research approach, conducting nine in-home meetings to obtain meaningful community input on health concerns and barriers to access healthcare services among rural residents of the Eastern Coachella Valley, who are also located near the desert-bound Salton Sea of inland southern California. All interviews were audio-recorded and analyzed via listening to the audio recordings and summarizing data in templates and matrices. Participants discussed health concerns related to agricultural labor, including heat-related illness, musculoskeletal ailments and injuries, skin disorders, respiratory illness, and trauma. Participants raised concerns about environmental exposures related to agriculture and the nearby Salton Sea, a highly saline lakebed, and proposed solutions to improve the health of their communities. The findings from this study suggest farmworkers are aware of the health risks posed by living and working in rural farmlands but lack resources and information to act upon and advocate for improved public health.

ReUnidos: Farmworker Skin Cancer Health Navigation Program.

113 Background: Farmworkers are at increased risk for skin cancer because of occupational exposure to sun and pesticides. In 2017/2018, Farmworker Justice conducted the Unidos community mobilization project to raise skin-cancer awareness and promote skin-cancer care access in farmworker communities. Unmet needs were identified in follow-up care coordination for patients who screened positive for a suspicious skin lesion. We undertook this ReUnidos study to document the incidence of skin cancer in the farmworker community and to evaluate the benefits of a health-navigator program to facilitate follow-up care. Methods: Participants (primarily Latinx) are screened in the community setting by volunteer dermatologists. Those who screen positive for suspected skin cancer are invited to participate in the study. They are assigned a trained navigator who addresses the importance of evaluating the lesion, the details of the diagnostic process, and any questions the subjects have. The navigators also help arrange travel, scheduling of appointments, interpretation services, and any other supports needed during the care journey. Data are collected on the number of biopsies performed, diagnoses, time from screening to diagnosis, skin cancer staging, time to treatment, as well as satisfaction with and perceived effectiveness of the navigator program. Outcome measures are extracted from chart review and final semi-structured interviews of both subjects and navigators. The project seeks to screen 1,000 community members. Approximately 2% are expected to screen positive for a suspicious lesion and require follow-up care. Results: To date, 16 health navigators have been trained and 6 screening events have been conducted in Northern San Diego County by Vista Community Clinic. A total of 126 adult participants have been screened, with 47% identifying as farmworkers. One participant screened positive for a potential skin cancer and has consented to the study. Conclusions: Community-based screenings linked to health-navigation programs may be effective tools to increase access to skin-cancer care among farmworkers. A telemedicine screening model is also being investigated for a second site in upstate New York to expand rural skin screening access. This model may also be useful in care coordination for other malignancies in farmworker communities such as lung cancer and lymphoma, which have also been linked to occupational pesticide exposure.[Table: see text]

COVID-19 Pandemic Response in a Migrant Farmworker Community: Excess Mortality, Testing Access and Contact Tracing in Immokalee, Florida.

Background:Migrant and seasonal farmworkers face enormous barriers to health and have been a particularly vulnerable population during the COVID-19 pandemic, but their pandemic experiences and potential inequities have not been well studied.Objectives:We aimed to assess the impact of COVID-19 in Immokalee, Florida, a community with a significant population of migrant and seasonal farmworkers. We evaluated for differences in pandemic experience by language, a known barrier to healthcare, to inform and strengthen future public health efforts.Methods:First, to estimate the burden of COVID in the area, we conducted a descriptive analysis of data on COVID-19 deaths for Collier County from May-August 2020. We then surveyed a cross-sectional, randomized representative sample of 318 adults living in Immokalee from March-November 2020 to assess socio-demographics, workplace conditions, sources of information, ability to follow guidelines, and experiences with testing and contact tracing programs. Results were compared across language groups.Findings:Average excess mortality in Collier County was 108%. The majority surveyed in Immokalee had socio-demographic factors associated with higher COVID risk. Non-English speakers had higher workplace risk due to less ability to work from home. Haitian Creole speakers were less likely to be tested, though all participants were willing to get symptomatic testing and quarantine. Those participants who tested positive or had COVID-19 exposures had low engagement with the contact tracing program, and Spanish-speakers reported lower quality of contact tracing than English speakers.Conclusions:The community of Immokalee, FL is a vulnerable population that suffered disproportionate deaths from COVID-19. This study reveals language inequities in COVID testing and contact tracing that should be targeted in future pandemic response in Immokalee and other migrant farmworker communities.

The Arizona Prevention Research Center partnerships in Arizona to promote COVID-19 vaccine health equity.

BackgroundVaccine hesitancy in the face of the COVID-19 pandemic is a complex issue that undermines our national ability to reduce the burden of the disease and control the pandemic. The COVID-19 pandemic revealed widening health disparities and disproportionate adverse health outcomes in terms of transmission, hospitalizations, morbidity and mortality among Arizona's Latinx rural, underserved, farmworker, disabled and elderly populations. In March 2021, ~8.1% of those vaccinated were Latinx, though Latinxs make up 32% of Arizona's population. The Arizona Vaccine Confidence Network (AzVCN) proposed to leverage the expertise of the Arizona Prevention Research Center (AzPRC) and the resources of the Mel and Enid Zuckerman College of Public Health (MEZCOPH) Mobile Health Unit (MHU) to identify, implement and evaluate a MHU intervention to increase uptake of COVID-19 vaccines.MethodsThe AzVCN focused efforts on Latinx, rural, un/underinsured and farmworker communities in the four Arizona border counties that are at greater risk of COVID-19 morbidity and mortality and may have limited access to vaccination and other essential health services. The AzVCN used listening sessions to create a feedback loop with key stakeholders and critical health care workers to validate barriers/enablers and identify solutions to increase vaccination uptake emerging from the network. The AzVCN also implemented a community-based intervention using community health workers (CHWs) based in a MHU to increase knowledge of the COVID-19 vaccines, reduce vaccination hesitancy and increase vaccination uptake among Latinx rural, un/underinsured and farmworker populations in Southern Arizona.ResultsAzVCN outcomes include: identification of enablers and barriers of COVID-19 vaccination in the priority populations; identification of strategies and solutions to address vaccine hesitancy and increase vaccine uptake among priority population; and evidence that the proposed solutions being tested through the AzVCN contribute to increased vaccine uptake among the priority populations.ConclusionThrough these efforts the AzPRC contributed to the CDC's Vaccinate with Confidence Strategy by collaborating with CHWs and other key stakeholders to engage directly with communities in identifying and addressing structural and misinformation barriers to vaccine uptake.

Perceptions of the Coronavirus and COVID-19 testing and vaccination in Latinx and Indigenous Mexican immigrant communities in the Eastern Coachella Valley

BackgroundA novel coronavirus, SARS-CoV-2 (known as COVID-19), spread rapidly around the world, affecting all and creating an ongoing global pandemic. Across the United States, Latinx and Indigenous populations have been disproportionately affected by COVID-19 cases and death rates. An examination of the perceptions and beliefs about the spread of the virus, COVID-19 testing, and vaccination amongst racial-ethnic minority groups, specifically Latinx and Indigenous Latin American immigrant communities, is needed to alleviate the widespread disparity in new cases and deaths.MethodsThis study was carried out from August 2020 to January 2021 and used community-based participatory research to engage community partners and build the capacity of community health workers (i.e., promotores de salud) and pre-medical and medical students in conducting qualitative research. The objective of the study was to examine the structural and social determinants of health on perceptions of the coronavirus, its spread, and decisions around COVID-19 testing and vaccination. Data collection included ethnography involving observations in public settings and focus groups with members of Latinx and Indigenous Mexican farm-working communities in the Eastern Coachella Valley, located in the Inland Southern California desert region. A total of seven focus groups, six in Spanish and one in Purépecha, with a total of 55 participants were conducted. Topics covered include perceptions of the coronavirus and its spread, as well as COVID-19 testing and vaccination.ResultsUsing theme identification techniques, the findings identify structural and social factors that underly perceptions held by Latinx and Indigenous Mexican immigrants about the virus and COVID-19, which, in turn, shape attitudes and behaviors related to COVID-19 testing and vaccination. Common themes that emerged across focus groups include misinformation, lack of trust in institutions, and insecurity around employment and residency.ConclusionsThis immigrant population is structurally vulnerable to historical and present-day inequalities that put them at increased risk of COVID-19 exposure, morbidity, and mortality. Study findings indicate a significant need for interventions that decrease structural vulnerabilities by addressing issues of (dis)trust in government and public health among this population.