Research

The Middle East and North Africa (MENA) region, especially its LMIC countries, faces a myriad of environmental and occupational health (EOH) challenges in a context of dynamic political changes, multiple concurrent humanitarian crises, weak regulations, and limited investment in EOH research and research capacity building. The American University of Beirut (AUB) in Lebanon is partnering with Yale University, in collaboration with the University of Iowa in the US, to establish a Global Environmental and Occupational Health Research and Training Hub for the MENA region (GEOHealth MENA), with the goal to build and strengthen EOH research capacity at academic/research institutions and relevant NGOs in the region.

The focus of the current project will be agricultural health and safety with an emphasis on exposure to pesticide among refugee populations. The MENA region hosts more than 50% of the world’s total population of internally displaced persons and refugees. The GEOHealth-MENA research project will:

• Evaluate the pathways of pesticide exposure among Syrian refugee agricultural workers
• Assess the exposure of these workers to heat stress
• Investigate the association of such exposure with neurobehavioral outcomes
• Explore the role of social factors in this association

Findings will inform policy and practice guidelines that can improve the health of all agricultural workers. The multidisciplinary research team at AUB will build on a strong track record of studying refugee and migrant populations and translating evidence into policy. Yale and the University of Iowa will provide support to the AUB team in exposure assessment and the assessment of neurobehavioral performance.

The GEOHealth-MENA research project (U01 award) aims to assess the exposure of male and female Syrian refugee agricultural workers to pesticides in greenhouses and its impact on their neurobehavioral performance accounting for social stressors and heat stress.

The aim is to recruit 300 agricultural and non-agricultural workers aged 18-55 years old and living in the Beqaa region of Lebanon. Agricultural workers will be selected from farms with greenhouses, while non-agricultural workers will be selected from different workplaces outside the agriculture sector.

The specific aims of the GEOHealth-MENA research project are:

Aim 1: Build an exposure-based cohort of 300 Syrian refugee agricultural and non-agricultural workers (18-55 years old; 50% women) and quantify their exposure to pesticides (pathways and extent).

Aim 2: Characterize the social stressors to which the cohort is exposed.

Aim 3: Assess heat stress and heat-related physiological indicators and health symptoms among the recruited workers.

Aim 4: Using the two time-points (summers 2024, 2025), measure the association between exposure to pesticides, heat stress, and neurobehavioral performance, accounting for social stressors.

Data for the proposed research will be collected over two days in each data collection wave:

1. Field data collection:
   Farmers and workplace owners will be contacted, recruited, and consented for their workers to participate in the study. Participants will be recruited at their workplaces (farm or industry), informed of the study, and consented on their participation. Each participant (agricultural and non-agricultural worker) will wear over the full duration of the work shift an environmental passive sampler (FreshAir Wristband) to measure exposure to pesticides, a heat stress personal monitor (Kestrel D2 drop to measure temperature and humidity), and an armband monitor for heart rate monitor. Workers’ body temperature will be assessed using an ear thermometer. Agricultural workers will also provide two urine samples, before the start of work shift (pre-work shift sample) and at the end of the shift (post-work shift sample) which will be analyzed for selected pesticide metabolites. Participants will be observed over the work shift (up to 5 hours) and at the end of the work shift, they will be interviewed using questionnaires addressing heat related symptoms and illnesses, and climate change. We will also assess environmental exposure to heat stress by measuring temperature, humidity, and other parameters using the Questemp-44 Wet Bulb Globe Temperature (WBGT) in the workplaces, and in farms (inside and outside the greenhouse).
   Urine and environmental samples will be processed, frozen, and shipped for analysis at the laboratories of University at Buffalo and Yale University, respectively.
2. Assessment of neurobehavioral performance and social stressors:
   The participants will be transported to AUB’s AREC Center in the Beqaa within few days of the field observation for a second set of data collection. At AREC, participants will be assessed physically (height, weight, blood pressure, and heart rate), tested on a battery of computerized and non-computerized neurobehavioral tests, and interviewed to assess their social and economic status, occupational history, habits (smoking, nutrition), health conditions, livelihood conditions, social stressors and mental health. They will also be interviewed on their knowledge, attitudes, and practices (KAP) towards pesticides and heat. All participants will provide one urine sample at AREC.

The participants recruited for Wave I in summer 2024 will be invited for Wave II of data collection in summer 2025 following exactly the same procedures for data collection.

Pilot study (summer 2023):

A pilot study was conducted in summer 2023 (August-October) on a smaller number of participants (20 agricultural workers and 20 non-agricultural workers) to test the planned study procedures and protocols. Findings from the pilot study informed changes to the data collection tools and the study protocol of wave I in summer 2024.

Wave I data collection (summer 2024):

Wave I data collection kicked-off on July 29, 2024 and was halted on September 23, 2024 due to the war on Lebanon. A total of 128 agricultural and non-agricultural workers were recruited into the study (104 agricultural workers and 24 non-agricultural workers). Of those, 90 agricultural workers and 17 non-agricultural workers completed the full components of the study (with full data on day 1 and day 2).

Recruitment was initially prioritized for the agricultural workers to align with the summer greenhouse season, which was anticipated to conclude by the end of October. As data collection was halted, the final sample included more agricultural workers compared with non-agricultural workers.

Data from wave I is currently being cleaned and analyzed, and the results will inform the next steps and the planning for wave II in summer 2025.