The Girasoles (Sunflower) Research Program

‍Introduction and Specific AIMS

Led by Dean Linda A. McCauley in partnership with the Farmworkers Association of Florida, the Girasoles research team is a group of University and community based researchers who have worked together for more than a decade to address occupational and environmental health concerns, including heat exposure and heat-related illness (HRI), facing farmworkers in the United States. Our primary goal is to protect the health of vulnerable agricultural workers through creation of new knowledge that will inform policies and practices to ensure safe working environments.

Our current ongoing study (OHEaRD) seeks to:

Determine if renal biomarkers, AKI, and sustained decrease in renal function are associated with environmental and exertional heat exposure in heat-exposed agricultural workers over two years
Use non-targeted metabolomic analysis to explore physiologic pathways of AKI and sustained decrease in of renal function in agricultural workers
Determine if exposure to pesticides commonly used on Florida crops act independently or modify observed changes in renal function, and if these relationships are modified by factors such as smoking and pain medication use
Using an r2p approach, develop educational intervention toolkit for workers and other relevant stakeholders (e.g., health care providers and agricultural employers) aimed to promote hydration and healthy renal function

Study Team

Linda

McCauley

Phd, RN

Emory University

Multiple Principal Investigator
Dean and Professor
Nell Hodgson Woodruff School of Nursing

Jeff

Sands

Emory University

Multiple Principal Investigator
Juha P. Kokko Professor of Medicine
Emory School of Medicine

Vicki

Hertzerg

PhD

Emory University

Multiple Principal Investigator
Professor
Nell Hodgson Woodruff School of Nursing

Roxana

Chicas

PhD, RN

Emory University

Co-Investigator
Assistant Professor
Nell Hodgson Woodruff School of Nursing

Lisa

Elon

MS, MPH

Emory University

Co-Investigator
Senior Faculty Associate
Rollins School of Public Health

Donghai

Liang

PhD, MPH

Emory University

Co-Investigator
Assistant Professor
Rollins School of Public Health

Madelyn

Houser

PhD

‍Emory University

Co-Investigator

Assistant Professor

NiKola

Patrushev

Emory University

Laboratory Manager
Nell Hodgson Woodruff School of Nursing

Nathan

Mutic

MS, MAT, MEd

Emory University

Project Manager
Nell Hodgson Woodruff School of Nursing

Community Partners

Nezahualcoyotl

Xiuhtecutli

Farmworker Association of Florida (FWAF)

General Coordinator
Community Principle Investigator

Jeannie

Economos

Farmworker Association of Florida (FWAF)

Health and Safety Coordinator

Joan

Flocks

University of Florida

Joan Flocks, JD
Co-Investigator
Professor
University of Florida Levin College of Law

Current Trainees

Carin

Molchan

MS, BSN-RN, CCRP

Carin Molchan, is a first-year doctoral student at the Nell Hodgson Woodruff School of Nursing at Emory University. She recently joined the Girasoles research team, and is engaging in all aspects of the research process while completing her first two years of coursework.

“This work matters to me because I am passionate about sustainable and just food systems, from growing to consumer purchasing, and farmworkers are an essential component of that system. To understand the concerns of this community, and to have the opportunity to work collaboratively towards innovative solutions that address those issues, is a dream come true.”

When Carin is not working with the Girasoles team, she enjoys all the diversions that the great outdoors offers! Whether it's camping, hiking, climbing, or fishing, she prefers to be outside.

Adriana

Rangel

Adriana is a first year graduate student at Rollins School of Public Health, Emory University obtaining her MPH in Environmental Health and Epidemiology. Her role as a graduate student intern includes creating health education material in Spanish from previous manuscript publications to present to farmworker populations, as well as laboratory work.

“This work matters to me because environmental and occupational health hazards disproportionately impact marginalized populations, and I resonate with Girasoles goals of addressing these gaps through advocacy and promoting educational interventions in order to improve outcomes.”

When Adriana is not working with the Girasoles team, she enjoys watching movies, exploring the city, and trying new places to eat.

Roy

Chang

Roy is a second year undergraduate student at Emory studying Quantitative Sciences with a concentration in Economics and a double major in Human Health. He is currently a student researcher as a part of Emory’s Scholarly Inquiry and Research Experience (SIRE) program, investigating retention rates among the Girasoles sample population.

“This work matters to me as there are insufficient labor protection laws, especially for immigrants who are an extremely vulnerable and marginalized group. By being a part of the Girasoles group, I can have the chance to improve the working conditions of immigrants and help them not only survive, but thrive.”

When Roy is not working with the Girasoles team, he enjoys swimming, playing trombone and piano, and trying new foods.

Ioana

Albu

Ioana is a Junior in the Nell Hodgson Woodruff School of Nursing pursuing a Bachelor in Science of Nursing on the traditional BSN pathway. Her role includes researching the health factors that impact retention rates in agricultural workers participating in a longitudinal study. This research is conducted alongside Dr. Chicas, Dr. Elon and Roy Chang. “This work matters to me because healthcare is a human right and advocating to repair an existing gap in the healthcare sector can only be done once there is research to back it up.” When Ioana is not working with the Girasoles team, she enjoys exploring the diverse food Atlanta has to offer in her free time.

Former Lab Members

Abby

Mutic

PhD, MSN

Assistant Professor
Nell Hodgson Woodruff School of Nursing
A former doctoral student, Dr. Mutic currently directs the R4 Pediatric Environmental Health Specialty Unit at Emory University. Her research focuses on environmental exposures and pediatric asthma.

Jacqueline Mix

PhD, MPH

A former postdoctoral fellow, Dr. Mix is currently an ORISE Research Fellow in the Division of Cancer Prevention and Control studying HPV-related cancers.

Valerie

Mac

PhD, RN

A former doctoral student and postdoctoral fellow, Dr. Mac is currently an epidemic intelligence service officer for the Centers for Disease Control.

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Community Outreach & Resources

Videos

Facing the Sun gives voice to South Florida’s agricultural workers confronting heat related illnesses, and follows a team of researchers and community advocates working to protect their health. Researchers at Emory University partnered with the Farmworker Association of Florida to conduct collaborative research on heat related illness in Florida through The Girasoles Study. Produced in collaboration with La Isla Network, this film provides a first-hand view of the experiences of agricultural workers interwoven with the story of The Girasoles Study. Facing the Sun documents the problem of heat illness, the research addressing it in Florida, and the goal of working with employers to make workplaces safer through the development and implementation of sustainable interventions.

Summary: This video presentation summarizes the findings of a recently published manuscript by the Girasoles Research Team, “Risk Factors for Reaching Core Body Temperature Thresholds in Florida Agricultural Workers” (May 2021). The video aims to inform viewers on the various types of heat-related illness, how to minimize risk, and overall describes the research objectives and methodology for the study.
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Presentations

Actividad física y actividades laborales en la población de trabajadores agrícolas en Florida
Factores de Riesgo para alcanzar temperatura corporal central en trabajadores agrícolas de Florida (Doc)
Factores de Riesgo para alcanzar temperatura corporal central en trabajadores agrícolas de Florida (Video)
Estado de Hidratación, Función Renal, y Daño Renal en Trabajadores Agrícolas de Florida
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Press

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Publications

Chicas RC, Elon L, Houser MC, Mutic A, Gallegos EI, Smith DJ, Modly L, Xiuhtecutli N, Hertzberg VS, Flocks J. (2022) The Health Status of Hispanic Agricultural Workers in Georgia and Florida. Journal of Immigrant and Minority Health 10, 1-8.

Chicas R, Xiuhtecutli N, Houser M, Glastra S, Elon L, Sands JM, McCauley L, Hertzberg V. (2021) COVID-19 and Agricultural Workers: A Descriptive Study. Journal of Immigrant and Minority Health 24, 58-64. PMC8507360.

Houser MC, Mac V, Smith DJ, Chicas RC, Xiuhtecutli N, Flocks JD, Elon L, Tansey MG, Sands JM, McCauley L. (2021) Inflammation-related factors identified as biomarkers of dehydration and subsequent acute kidney injury in agricultural workers. Biological Research For Nursing 23, 676-688. PMC8726423.

Chicas R, Xiuhtecutli N, Dickman NE, Flocks J, Scammell MK, Steenland K, Hertzberg V, McCauley L. (2021) Cooling interventions among agricultural workers: qualitative field-based study. Hispanic Health Care International 19, 174-181. PMC8363586.

Mac V, Elon L, Mix J, Tovar-Aguilar A, Flocks J, Economos E, Hertzberg V, McCauley L. (2021) Risk factors for reaching core body temperature thresholds in Florida agricultural workers. Journal of Occupational and Environmental Medicine 63, 495-402.

Mac VV, Elon L, Smith DJ, Tovar‐Aguilar A, Economos E, Flocks J, Hertzberg V, McCauley L. (2021) A modified physiological strain index for workplace‐based assessment of heat strain experienced by agricultural workers. American Journal of Industrial Medicine 64, 258-265.

Chicas R, Xiuhtecutli N, Elon L, Scammell MK, Steenland K, Hertzberg V, McCauley L. (2021) Cooling interventions among agricultural workers: a pilot study. Workplace Health & Safety 69, 315-322. PMC8693251.

Chicas R, Xiuhtecutli N, Dickman NE, Scammell ML, Steenland K, Hertzberg VS, McCauley L. (2020) Cooling intervention studies among outdoor occupational groups: A review of the literature. American Journal of Industrial Medicine 63, 988-1007. PMC7745167.

Mix JM, Elon L, Thein Mac VV, Flocks J, Economos J, Tovar‐Aguilar AJ, Hertzberg VS, McCauley LA. (2019) Physical activity and work activities in Florida agricultural workers. American Journal of Industrial Medicine 62, 1058-1067.

Chicas R, Mix J, Mac V, Flocks J, Dickman NE, Hertzberg V, McCauley L. (2019) Chronic kidney disease among workers: A review of the literature. Workplace Health & Safety, 2165079919843308.

Mac VVT, Hertzberg V, McCauley LA. (2019) Examining agricultural workplace micro and macroclimate data using decision tree analysis to determine heat illness risk. Journal of Occupational and Environmental Medicine 61, 107-114. PMC6367045.

Mac VVT, Tovar-Aguilar JA, Elon L, Hertzberg V, Economos E, McCauley LA. (2019) Elevated core temperature in Florida fernery workers: results of a pilot study. Workplace Health and Safety 67, 470-480.

Mix J, Elon L, Mac V, Flocks J, Economos E, Tovar-Aguilar AJ, Hertzberg VS, McCauley LA. (2018) Hydration status, kidney function, and kidney injury in Florida agricultural workers. Journal of Occupational and Environmental Medicine 60, e253-e260.

Flocks J, Tovar JA, Economos E, Mac VVT, Mutic A, Peterman K, McCauley L. (2018) Lessons learned from data collection as health screening in underserved farmworker communities. Progress in Community Health Partnerships: Research, Education, and Action 12, 93-100.

Mac V, McCauley L. (2017) Farmworker vulnerability to heat hazards: a conceptual framework. Journal of Nursing Scholarship 49, 617-624. PMC5656499.

Mac VV, Tovar-Aguilar JA, Flocks J, Economos E, Hertzberg VS, McCauley LA. (2017) Heat exposure in central Florida fernery workers: results of a feasibility study. Journal of Agromedicine 22, 89-99. PMC5682629.

Hertzberg V, Mac V, Elon L, Mutic N, Mutic A, Peterman K, Tovar-Aguilar J, Economos E, Flocks J, McCauley L. (2017) Novel analytic methods needed for real-time continuous core body temperature data. Western Journal of Nursing Research 39, 95-111. PMC5797591.

Mac V, McCauley L. (2017) Farmworker vulnerability to heat hazards: a conceptual framework. Journal of Nursing Scholarship 49.

Mutic AD, Baker BJ, McCauley LA. (2017) Deleterious Effects From Occupational Exposure to Ethylene Thiourea in Pregnant Women. Workplace Health & Safety, 2165079916687312.

Mutic A, Mix J, Peterman K, Elon L, Economos E, Flocks J, Tovar-Aguilar JA, McCauley L. (2017) Classification of heat-related illness symptoms among Florida farmworkers. Journal of Nursing Scholarship 50. PMCID in process.

Runkle J, Flocks J, Economos J, Dunlop AL. (2016) A systematic review of Mancozeb as a reproductive and developmental hazard. Environment International.

Runkle J, Flocks J, Economos J, Tovar-Aguilar J, McCauley L. (2014) Occupational risks and pregnancy and infant health outcomes in Florida farmworkers. International Journal of Environmental Research and Public Health 11, 7820. PMC4143835.

Flocks J, Vi Thien Mac V, Runkle J, Tovar-Aguilar JA, Economos J, McCauley LA. (2013) Female farmworkers' perceptions of heat-related illness and pregnancy health. Journal of Agromedicine 18, 350-8. PMC5682625.

Kelley MA, Flocks JD, Economos J, McCauley LA. (2013) Female farmworkers' health during pregnancy: health care providers' perspectives. Workplace Health & Safety 61, 308-313.

Runkle J, Tovar-Aguilar JA, Economos E, Flocks J, Williams B, Muniz JF, Semple M, McCauley L. (2013) Pesticide risk perception and biomarkers of exposure in Florida female farmworkers. Journal of Occupational and Environmental Medicine 55, 1286-92.

Flocks J, Kelley M, Economos J, McCauley L. (2012) Female farmworkers' perceptions of pesticide exposure and pregnancy health. Journal of Immigrant & Minority Health 14, 626-32.

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