Background. Living and working conditions of farmworkers have been difficult throughout United States agricultural history. Farmworkers experience low wages, unstable work availability, and numerous hazards. As they are immigrant, mobile, and often undocumented, they are usually missed in population-based surveys.

Methods. Data from the unique National Agricultural Workers Survey (NAWS) were analyzed to determine the prevalence of, and the employment and lifestyle characteristics associated with, use of U.S. health care, alcohol consumption, and dermatitis. The NAWS is a workplace-based multi-stage sample, representative of U.S. farmworkers. SAS survey procedures accounted for multi-stage sampling.

Results. Between 1999 and 2004 the NAWS interviewed 19,987 farmworkers. Sample sizes were 16,678, 9,906, 16,945 for analysis of health care, alcohol, and dermatitis, respectively. Fewer than half (43%) of farmworkers utilized health care. Men were more likely to drink (59%) and binge drink (23%) than women (14% and 4%, respectively). Dermatitis prevalence was significantly higher in women than men (12% versus 7%, respectively). Significant associations exist with economic variables (wages, assets); cultural integration variables (English speaking ability and immigration and mobility); and employment characteristics (employer, number of workers, years of U.S. farm work, and peach workers). Higher hourly wages were generally associated with better outcomes—higher odds of utilizing health care and lower odds of dermatitis in women—although in men the highest wages predicted higher odds of binge drinking. Among Hispanic men, speaking English “well” was associated with utilization of health care while intermediate English ability was associated with binge drinking. Male farmworkers employed by farm labor contractors had lower odds of utilizing health care but also lower odds of binge drinking.

Conclusions. The NAWS provides a unique data source addressing the health of farmworkers, a population not captured in surveys requiring workers have permanent addresses or stable employment. Farmworkers' risk of not receiving health care, binge drinking, and dermatitis are associated with employment and lifestyle factors. Outreach efforts should focus on the lowest income workers and those lacking English skills. The health impact of working for labor contractors should be explored further. Farmworkers who labor to feed Americans should not work at the expense of their own health.