Evaluating the Operational Feasibility of Repeated Field-Based Cholinesterase Monitoring Among Farmworkers: A Preliminary Study

Farmworkers experience disproportionate risks of pesticide exposure, yet only two U.S. states, California and Washington, currently mandate routine cholinesterase biomonitoring programs for agricultural workers. Although regulatory and resource limitations influence implementation of worker protection programs, operational barriers also complicate repeated biomonitoring among highly mobile and underserved farmworker populations. The objective of this preliminary study was to evaluate the operational feasibility of recruiting, retaining, and repeatedly monitoring farmworkers using a novel, rapid, portable cholinesterase analysis device under routine agricultural field conditions. Guided by an evidence-based feasibility framework, a multidisciplinary team administered surveys and collected blood samples from 25 farmworkers in rural North Carolina at three time points during a single agricultural season. Participation and visit completion rates were high, although worker mobility, changing job assignments, environmental conditions, and temperature-sensitive samples created logistical challenges. Experienced bilingual promotoras de salud played a critical role in coordination, communication, scheduling, and retention. Findings provide preliminary evidence that repeated field-based cholinesterase biomonitoring protocols are feasible and acceptable when supported by community-based outreach organizations with Spanish speaking health workers, structured logistics, and culturally responsive engagement strategies. Evaluation of the analytical performance is beyond the scope of this report, however, these results provide practical insights for strengthening occupational health surveillance and future implementation studies designed to protect agricultural workers.