Occupational Research Agenda for Northwest Farming

DISEASE & INJURY

THE MAJORITY OF TOPICS raised during telephone interviews and at the Farm Summit fell into the category of Disease and Injury, with certain issues emerging as the most commonly mentioned research priorities.

Both Farm Summit and telephone respondents mentioned problems that fit into the subtopic, Musculoskeletal Disorders. Issues included back injuries, and stresses and strains with lifting and repetitive motion as possible causes. Asthma and pulmonary problems were concerns under the subcategory Respiratory Disease. Telephone interview respondents listed potential causes of Respiratory Disease as exposure to dust, silica, diesel exhaust, and matter from field burning. Both groups of respondents identified Skin Disease as an important subtopic for further research. Included among their concerns were dermatitis, exposure to poison oak, and insufficient protection against the sun. Traumatic Injuries encompassed the most frequently mentioned concern of telephone respondents and Farm Summit participants. The injuries identified were falls, slips, trips, and cuts. Causes included tractor rollovers, improper operation of machinery, livestock, and ladders.

MUSCULOSKELETAL DISORDERS



Work-related musculoskeletal disorders of the upper extremities and the low back are common and costly. Workers’ compensation costs undoubtedly underestimate the actual magnitude of these disorders. The causes for such disorders are complex. Existing scientific evidence identifies some work activities and awkward postures as significant contributors to the problem. The prevalence of back injuries among agricultural workers appears high in the region. Tasks that require lifting or repetitive motion are of particular concern in Northwest farming. Interventions should be based on current scientific knowledge, but new research efforts are needed to characterize exposure, understand basic pathophysiologic mechanisms, and assure that these work-related disorders are successfully prevented and treated.

[NIOSH NORA: Lower Back Disorders, Musculoskeletal Disorders of the Upper Extremities]

IMPORTANCE

Low back disorders are among the most serious and costly types of musculoskeletal disorders in the workplace. It is estimated that claims associated with back pain cost more than twice the average compensable claim. Yet in many industries, including farming, workers are asked to carry out assignments that require high-risk activities. A similar pattern is seen for musculoskeletal disorders of the upper extremities, where the cumulative effects of repeated trauma are particularly important. Many of these disorders can be prevented through proper design of the work environment, redesign of tools, and appropriate worker training.

In Northwest farming, occupational activities that may contribute to these disorders include heavy lifting, carrying, forward bending, kneeling, and excessively fast-paced work. National health surveys conducted in the 1980s documented that farm workers have a higher prevalence of arthritis than do white collar, blue collar, service, or all workers combined. Also, musculoskeletal conditions are the most commonly reported ailments among farmers and farm managers. According to the Oregon Characteristics of Work Injuries and Illnesses for 1997, the most frequent types of injuries and illnesses among agriculture, forestry, and fishing workers are sprains and strains (36.2%).10 The highest rate of disabling claims by occupation in Oregon in 1996 for agricultural workers were for sprains, strains, and tears. Claims for these injuries were almost four times the amount of claims for other injuries, such as dislocation, fracture, amputation, cuts, bruises, and burns, among others.¹¹

Farm Summit and telephone interview participants identified lifting, repetitive motion, and shouldering the weight of bags during picking tasks as problems in this region.

RESEARCH OPPORTUNITIES

• Improve tool design with an emphasis on the relationship between anthropomorphy and work and variations among gender and age groups
• Review agricultural ergonomic research conducted in other countries
• Examine successful agriculture design solutions (e.g., Easter Seals, Hood River ladder redesign project, Oregon OSHA worksite)
• Develop injury prevention methods, including greater mechanization of harvesting methods and job rotation
• Understand the primary causes of sprains and strains
• Evaluate existing interventions
• Identify alternatives to high-risk work practices
• Improve training in safer work practices
• Involve workers in identifying work practices that could lead to musculoskeletal disorders

ADDITIONAL INFORMATION

Andersson GBJ, Fine LJ, Silverstein BA. Musculoskeletal disorders. In: Occupational Health (Levy B, Wegma D, eds). Boston: Little, Brown and Co., 1995. pp. 455-489.

Silverstein B, Kalat J. Work-Related Disorders of the Back and Upper Extremity in Washington State, 1989–1996. Technical Report 40-1-1997. Olympia, WA: Department of Labor and Industries, 1998.

RESPIRATORY DISEASE



Occupationally related airway diseases, including asthma and chronic obstructive pulmonary disease (COPD), are of concern in Northwest farming, and are of major public health importance. Nearly 30% of COPD and adult asthma nationwide may be attributable to occupational exposures. Research is needed to: clarify prevalence, risk factors, and exposure-disease relationships; refine techniques for monitoring worker health and the job environment; and develop effective and practical means for preventing work-related airway diseases in at-risk workers.

[NIOSH NORA: Asthma and Chronic Obstructive Pulmonary Disease]

IMPORTANCE

Over the past two decades, the prevalence and mortality rates for asthma have been increasing in the United States. In Washington state, asthma deaths increased from 1980 to 1989.¹² Consistent with national trends, asthma is also a significant problem in Oregon.¹³ One quarter to one-third of these cases are probably linked to occupational risk factors. Asthma and bronchitis have been carefully studied in only a few agricultural occupations, such as animal confinement workers. Grain farmers have been found to be at increased risk for bronchospastic disease. Some pesticides have been linked to asthma, as have molds and airborne organic dusts from plant decomposition and microbial sources. Recent studies in California suggest that symptoms of respiratory illness are associated with duration of farm work and certain hand-labor tasks.

Farm Summit participants and those interviewed expressed general concern about respiratory diseases among farmers, farm workers, and the surrounding communities. Pulmonary problems, work-related asthma, and allergies were cited as priority farming health hazards in the region. Participants suggested that exposure to silica, dust, diesel exhaust, and particulates and chemicals resulting from field burning were important causes of respiratory disease among the region’s agricultural workers and communities.

RESEARCH OPPORTUNITIES

• Investigate the health effects and mechanisms of respiratory disease
• Characterize the prevalence of asthma in farming communities
• Evaluate the effects of dust and pesticides on asthma
• Determine the risk factors for asthma with preventive measures as the end goal

ADDITIONAL INFORMATION

Gamsky TE, Schenker MB, McCurdy SA, Samuels SJ. Smoking, respiratory symptoms, and pulmonary function among a population of Hispanic farmworkers. Chest 101:1361–1368 (1992).

May J, Schenker MB. Agriculture. In: Occupational and Environmental Respiratory Disease. (Haber P, Schenker MB, Balmes JR, eds). St. Louis: Mosby, 1996. pp. 617–636.

Schenker MB, Ferguson T, Gamsky T. Respiratory risks associated with agriculture. In: Occupational State of the Art Reviews: Health Hazards of Farming, Vol 6 (Cordes DH, Rea DF, eds). Philadelphia: Hanley & Belfus, Inc., 1991; 415–429.

SKIN DISEASE



Contact with plants, animals, and some agricultural chemicals can produce allergic and irritant dermatitis (contact dermatitis). Contact dermatitis is the most important cause of occupational skin diseases nationally, and accounts for 15–20% of all reported occupational diseases. Research is needed to better identify the prevalence and causes of this condition, and to improve exposure assessment and diagnostic methods.

[NIOSH NORA: Allergic and Irritant Dermatitis]

IMPORTANCE

Occupational skin disorders are the most commonly reported types of occupational illnesses not resulting from acute or cumulative trauma, with an estimated 64,200 cases recorded in the 1995 Bureau of Labor Statistics Annual Survey of Occupational Injuries and Illness. Agriculture consistently demonstrates the highest rate of occupational dermatitis among the major industrial sectors. In Washington state, the high rates of skin disorders in the agricultural industry prompted further investigation by the Washington State Department of Labor and Industries Safety and Health Assessment and Research for Prevention team. The overall rate for the industrial category Agriculture, Forestry, and Fishing is two claims per 1,000 FTE years. The highest rate of skin disorders seen within agriculture is in the fruits and tree nuts industry with a rate of 2.7 claims per 1,000 FTE years. The majority of workers filing claims had the occupational title of Farm Worker.¹⁴

Skin-related hazards in farming are numerous, and include plant materials, ultraviolet radiation, and chemicals—such as fertilizers and pesticides. Frequent skin contact with moisture, chemicals, friction, or dirt— all of which are common in farming—have each been previously associated with an increased risk of hand eczema and contact dermatitis.

Farm Summit and telephone interview participants identified skin disease, specifically dermatitis, as a significant health and safety hazard in the region’s farming industry. Causes of skin disease included exposure to the sun and poison oak. One respondent noted that it was common for farm workers with skin disease to be diagnosed as having a rash, and provided with topical steroids. This diagnosis and treatment approach did not lead to prevention, as the cause of the rash, either allergic, contact, plant irritation, pesticide, or fertilizer exposure, was not determined.

RESEARCH OPPORTUNITIES

• Improve information dissemination about protective clothing
• Design better protective clothing
• Develop more effective topical lotions to prevent poison oak exposure
• Develop surveillance systems to track the prevalence of diseases such as skin cancer and dermatitis
• Develop a more accurate definition of dermatitis and its etiologies as it relates to agriculture
• Design engineering innovations to reduce the level of skin exposure
• Conduct an epidemiologic study to determine the extent of skin diseases in the region’s farm labor community
• Investigate ways to manage environmental factors that affect the prevalence of skin diseases, for example, weed control and placement of hygiene stations

TRAINING OPPORTUNITIES

• Develop methods and curriculum to better educate medical personnel regarding occupational skin disease specific to agricultural workers
• Improve medical protocols for the treatment of agricultural-related skin disease
• Train workers in the prevention of skin diseases, for example, the benefits of using hygiene stations located at the work site
• Educate farmers and farm workers in plant recognition

ADDITIONAL INFORMATION

Arndt KA, Bigby M, Coopman SA. Skin disorders. In: Occupational Health and Recognizing and Preventing Work-Related Disease. (Levy BS, Wegman DH, eds). Boston: Little, Brown, and Co., 1995. pp. 491-506.

Reding DJ, Rauska ML, Lappe KA, Fischer W. Cancer education interventions for rural populations. Cancer Practice 2:353–358 (1994).

Rosenman KD, Gardiner J, Swanson GM, Mullan P, Zhu Z. Use of skin-cancer prevention strategies among farmers and their spouses. Am J of Prev Med 11: 342– 347 (1995).

Sama S, Bushley A, Cohen M, Cotey M, Park B, Kaufman J. Work-related skin disorders in Washington state, 1993–1997. Olympia, WA: Department of Labor and Industries, 1998.

TRAUMATIC INJURIES



Injury takes a huge toll in many US workplaces, including farms. Multiple factors contribute to traumatic injuries, such as the characteristics of the workforce, job design, work organization, economics, and other social factors. Fatalities and traumatic injuries resulting from human contact with machinery, livestock, equipment, and electricity are common in farming. Overexertion, stress, fatigue, lack of training, and operator attitude can all serve as precursors for incidents. Research should focus on leading causes and high-risk groups. Development of effective interventions may require collaboration among different academic disciplines and cooperation among many organizations.

[NIOSH NORA: Traumatic Injuries]

IMPORTANCE

More than 77,000 US workers died as a result of work-related injuries from 1980 through 1992. This represents a rate of 16 fatal injuries each day. Agriculture, mining, construction, and transportation are the four industries with the highest occupational fatality rates. A major cause of death within agriculture is machine related incidents. Nonfatal injuries are also common in agriculture and, in many instances, result in lost work time and expensive medical treatment. Washington state recorded more than 10,000 compensable claims from 1991–1994, or an average of more than 2,500 claims per year. The total cost of work-related injuries and fatalities for all industries is estimated to be greater than $121 billion annually. Costs associated with agriculture are a significant contributor to this total.

In 1997, fractures, multiple injuries and cuts, lacerations, and punctures represented three of the four most frequently accepted disabling claim categories reported in Oregon. According to Oregon’s Workers’ Compensation Claim Characteristics for 1996, 23% of claims for those working in agriculture, forestry, and fishing resulted from falls and 22% occurred when objects struck workers. A large number of the claims were for lacerations (10%) and contusions (6%); and because of the above-average percentage of falls, there were numerous fractures (11% of the Division’s claims).¹⁵

Between 1979 and 1997, in Idaho, the most frequent cause for fatalities among agricultural workers was due to machinery. Tractors were the most frequently reported cause of all fatalities (47%), followed by general machinery (12%) and trucks (10%). Overturns resulted in the highest number of deaths among tractor fatalities (44%). Tractors were also a leading cause of fatal incidents among children under 18. Additional causes of fatalities during these years were contact with livestock, primarily horses, and irrigation.¹⁶

Traumatic injuries in the region’s farming industry were the most frequently identified hazards in the telephone interviews, and represented a top priority for all of the constituency groups at the Farm Summit. Types of injuries included cuts, scrapes, slips, and falls. The majority of respondents stated that the leading cause was improper operation of machinery, most often tractors. Other traumatic incidents among the region’s farm owners, operators, and workers were attributed to livestock, ladders, and electricity. Stress and fatigue were also noted as potential predispositions of farming-related injuries.

RESEARCH OPPORTUNITIES

• Identify the specific cause of traumatic injury on the farm
• Determine the severity of the injury by types of work
• Correlate incidents and operator stress levels
• Interview victims and determine the circumstances that lead up to their injury, then identify common causes
• Evaluate injury prevention training and retrofitting compliance

ADDITIONAL INFORMATION

Merchant JA, Kross BC, Donham KJ, Pratt DS. Agriculture at Risk: A Report to the Nation. Marshfield, WI: Marshfield Clinic, 1989.

Myers JR. Injuries among Farm Workers in the United States, 1993. DHHS 97–115. Cincinnati, OH: NIOSH, 1997.

National Safety Council. Accident Facts, 1998 Edition. Itasca, IL: National Safety Council, 1998.

National Safety Council National Education Center for Agricultural Safety homepage: http://www.necasag.org/

Tractor Risk Abatement and Control: The Policy Conference (Final Report, 10–12 September 1997). Iowa City, IO, University of Iowa.

University of Idaho Cooperative Extension System. Ag Safety and Health homepage: http://uidaho.edu/bac/agsafety/

US NIOSH. Fatal Injuries to Workers in the US, 1980–89: A Decade of Surveillance. DHHS 93-1085. Washington, DC: National Institute for Occupational Safety and Health, 1993.

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