ASH-NET Conference, Baltimore 2003

  • Petrea, Robert (Chip)

Papers and Abstracts

Overview of Operational Structure and Potential Changes
Paul Gunderson, Ph.D. Emeritus, Marshfield Medical Research Foundation of Marshfield Clinic

History of Agriculture at Risk: A Report to the Nation
Kelley J. Donham, M.S., D.V.M., College of Public Health, University of Iowa, and Julia F. Storm, M.S.P.H., College of Agriculture and Life Sciences, North Carolina State University

Abstract --- A four-part action oriented process, called "Agricultural Occupational and Environmental Health: Policy Strategies for the Future" was initiated in Iowa in 1988. This three-year process involved a broad representation of members of the relevant scientific community and farm constituency in the United States. This consensus-based process brought about substantially greater recognition of agricultural health and safety as an important public health issue in the United States. As a result, greater resources were directed to address the issue. Among many accomplishments, the process achieved new funding for the National Institute of Occupational Safety and Health (NIOSH) to initiate an agricultural health and safety initiative. It was also influential in facilitating the development of other areas of agricultural health and safety work, such as the Kellogg agricultural health and safety initiative and the Agricultural Health Study. The most visible piece of the process, the proceedings document entitled Agriculture At Risk: A Report to the Nation, described the situation and outlined specific recommendations. This report title shall hereafter refer to the entire three-year process and the results.

The Agriculture at Risk process was initiated because of the magnitude of the problem, and the lack of resources available to address the problem. At the time, there was no policy on the issue, and there was little medical or public health involvement. Additionally, there was a need for an interdisciplinary effort joining medical, public health, Extension, and other professionals to identify and solve problems.

This paper reviews in detail the specific objectives and processes of Agriculture at Risk. The outcomes are reviewed, including the formation of the National Coalition for Agricultural Safety and Health, the NIOSH agricultural initiative, and the Surgeon General's Conference on agricultural safety and health.

The authors evaluate each recommendation outlined in Agriculture at Risk relative to the degree of accomplishment. Furthermore, the limitations of the process and accomplishments are reviewed, such as the exclusion of forestry and fisheries.

A summary and conclusions, including the authors' perspective on future directions for the first decade of the new millennium relative to changing agricultural demographics, the growth of industrial agriculture, and changing technologies is presented.

Women in Agriculture: Risks for Occupational Injury Within the Contexts of Role and Haddon's Injury Model
Carrie A. McCoy, Ph.D., M.S.P.H., R.N., C.E.N., Northern Kentucky University, and Ann K. Carruth, D.N.S., R.N., Southeastern Louisiana University, and Deborah B. Reed, Ph.D., M.S.P.H., R.N.C., University of Kentucky

Abstract --- This paper examines exposure to occupational injury producing events among women within the context of role and Haddon's Injury Model. According to the 1998 Statistical Abstract of the United States, 23% of farm operators and managers and 19% of farm workers were female. Until recently few studies have focused on occupational injury in farm women. Sociologists suggest that contributing factors may be the gendered division of labor on farms and the invisibility of farm women's work. This gendered division of labor is culturally mediated and influences the types of farm tasks performed and subsequent exposure to agents of injury. Role, commodity and economics all influence the number and types of farm tasks. Women on farms are exposed to a multitude of biologic, chemical, physical, and mechanical agents while performing farm tasks. Whether these exposures result in an injury outcome is dependent upon factors intrinsic to the individual (host), a catalyst that produces the outcome (agent), and external factors (environment). Research to date has focused on the injury event. There is a lack of studies examining both the pre-event phase, and the interaction between host, agent, and environment among women in agriculture.

Children and Agriculture: Health and Safety Update
Barbara C. Lee, Ph.D., National Farm Medicine Center, and Barbara L. Marlenga, Ph.D., National Farm Medicine Center

Abstract --- This past decade had witnessed considerable attention to the persistent problem of childhood agricultural diseases and injuries. While this topic was not specifically addressed in the 1987 Agriculture at Risk report, there have been multiple efforts at regional and national levels since that time. Most notable activities have been the development and implementation of the 1996 national action plan, funded primarily through federal funds - including federal agency coordination, injury surveillance, research, and intervention evaluations; development of the North American Guidelines for Children's Agricultural Tasks released in 1999; and the implementation of grass-roots farm safety for youth programs funded by agribusinesses and individual donors. While considerable efforts have addressed educational approaches, there are few comprehensive evaluations to confirm their efficacy. Momentum for using public policy approaches may be mounting but this approach remains controversial and would encounter considerable resistance. Childhood disease and injury prevention remains a complex issue because of the wide diversity of issues such as residency, tradition, parenting practices, status of child working versus bystander or visitor, child labor laws with multiple exemptions, and spectrum of adverse exposures. Future directions will be influenced by the changing role of children associated with the industrialization of agriculture and globalization of trade.

Older Farmers: Factors Affecting Their Health and Safety
Maria C. Hernandez-Peck, Ph.D., Center for Studies in Aging, School of Social Work and Human Services, Eastern Washington University

Abstract --- Agriculture has been recognized as one of the most hazardous occupations in the United States. In an industry where according to the 1997 Agricultural Census, an estimated 500,000 farm workers, 1/4 of all farm operators are 65 years of age or older, age becomes a serious factor when considering potential risk for injuries among this population. Because no mandatory retirement age exists for older farmers, many may continue to perform some tasks beyond their ability to safely accomplish their work.

Older farmers have been said to be a "special needs population that needs recognition and attention." To date, however, this particular group has been underrepresented within the research literature dealing with Farm Health and Safety. This White Paper seeks to highlight currently available research literature on older farmers. Areas to be addressed include, the work histories of older farmers, factors involved in their decisions to retire, lifetime experiences with farm accidents, existing chronic health conditions, and access to health care.

In addition, need for further research, not only on the subject of Farm Health and Safety, but on the topic of successfully aging in place within rural communities will be highlighted. The need to connect with already established community based service networks under Older Americans Act to enhance successful aging will be addressed.

Environmental Health - Overview of Air, Water, Soil
Barbara McCarthy, Ph.D., Colorado State University

Agricultural Health and Safety among Minority Populations
Giulia Earle-Richardson, M.P.H., Northeast Center, New York Center for Agricultural Medicine and Health

Abstract --- Describing the agricultural health and safety risks of a population that is defined primarily by what it is not is a daunting task. The term "minority" refers to all farm owners, employees and temporary laborers who are not Caucasian of Northern European descent. Available research to date provides little data on the health and safety risks to minorities in agriculture.

While concerns about differences in risk among minority populations are appropriate, it is important to acknowledge that for minorities, as with majority populations, occupational hazards are a function of what work is undertaken. Risk varies to the extent that distribution of tasks varies and to the extent that similar work is done in different ways. Research on risk to minorities should focus on sociologic and economic factors that explain these variations.

Analyses of national occupational fatality data by race and role on the farm have shown elevated rates of fatality among black farmers, and conflicting evidence with regard to other minorities. The challenge for researchers will be to characterize work tasks for these groups in more detail as well as other factors that might explain any observed risk differences.

The paper will identify key agricultural tasks done ethnic and racial minority groups and review existing research on majority / minority occupational risk in these areas. In addition, ongoing prevention activities to serve these sectors and groups will be described.

Amish and Other Old Order Anabaptists
William E. Field, Ed.D., Department of Agricultural and Biological Engineering, Purdue University, and Paul Jones, Breaking New Ground Resource Center, Purdue University

Abstract --- The Amish and other Old Order Anabaptists have been inseparably linked with agriculture since first coming to America in the 1700s. However, few efforts have been identified which analyze the issues involved with Old Order Anabaptist farm injuries or present best practices for addressing these problems. As part of an effort to develop culturally appropriate and effective injury prevention strategies for use within the Old Order Anabaptist community, this article identifies important cultural issues that should be considered in understanding and attempting to reduce farm injures in this population, summarizes statistics concerning farm related fatalities among Old Order Anabaptists, and discusses methods which have been effectively used to address farm injuries within these communities. As this population continues to double approximately every 22 years, the implications of farm-related safety and health issues among Old Order Anabaptists will become increasingly significant in relation to the larger agricultural community.

Neighbor Health and Large-scale Swine Production
Kendall M. Thu, Ph.D., Northern Illinois University

Abstract --- I describe the emergence of research examining linkages between large-scale swine operations and the health of neighbors. I specifically outline recent public research as they relate to research traditions examining interior occupational health issues among workers in confinement operations and exterior emission issues as odor nuisances. I then characterize and discuss recent research that assesses constellations of health symptoms reported at significantly higher rates among exposed neighbors. I also discuss public policy consequences of recent research that indicates neighbors are experiencing health problems as the results of exposure to large-scale swine operations.

The Respiratory Inflammatory Response to the Swine Confinement Building Environment
Susanna Von Essen, M.D., M.P.H., Department of Internal Medicine, Pulmonary and Critical Care Medicine Section, University of Nebraska Medical Center, and Debra Romberger, M.D., Department of Internal Medicine, Pulmonary and Critical Care Medicine Section, University of Nebraska Medical Center

Abstract --- Swine confinement facility workers often develop respiratory problems secondary to their work, including acute bronchitis, the asthma-like syndrome, exacerbation of asthma, chronic bronchitis and mucuous membrane irritation syndrome. Organic dust toxic syndrome is seen in these workers as well. Swine confinement barns are characterized by the presence of multiple factors that can cause respiratory tract and systemic inflammation symptoms, including dust, endotoxin and ammonia. Investigators have found evidence of inflammation characterized by increased numbers of neutrophils, macrophages and to a lesser degree, lymphocytes in both naïve subjects and swine confinement building workers. Interestingly, this inflammation is most pronounced in subjects with no prior exposure to this environment. This finding raises the question of whether or not tolerance to endotoxin or other substances in this environment is induced after repeated exposures. There is a great need for implementation of feasible interventions for reduction of the risk of having symptomatic respiratory disease as a result of working in a swine confinement facility.

Tractor Risk Abatement and Control
Melvin L. Myers, M.P.A., Consultant

Abstract --- The agricultural tractor was the principal source of fatal injury on American farms for the latter part of the 20th century, and they maintain that distinction today. Much has been learned about the toll of these fatalities and how to prevent them over the last ten years, yet public policy has generally been unsuccessful in reducing this toll. A policy conference entitled, Tractor Risk Abatement and Control, convened in 1997 to develop recommendations to reduce this death toll. Several stakeholders at the conference agreed on twenty-five action items, which if implemented would reduce the number of tractor-related deaths by more than 2,000 by the year 2015. These items relate to tractor overturns, runovers, and traffic collisions as well as youth operators. Priorities for action include increasing the number of retrofit designs of roll-over protection structures for old tractors, intervening in discussion groups on the internet regarding tractor safety, and establishing regulations to improve tractor safety on the public roads. In addition, economic incentive programs need to be established, as do social marketing programs that raise social norms for recognizing unsafe tractors and their operation.

Farming and Ranching with a Disability
Therese Willkomm, Ph.D., National AgrAbility Project, University of Wisconsin-Madison, Cooperative Extension

Abstract --- Nationwide, approximately 500,000 farmers, ranchers and other agricultural workers have physical disabilities that interfere with their ability to perform essential farm tasks due to injuries, illnesses or other health related conditions. For many individuals disability jeopardizes their rural and agricultural futures. In the 1990 Farm Bill, Congress authorized the establishment of AgrAbility to provide education and assistance to individuals affected by disabilities and who are employed in agriculture. Since 1991, AgrAbility Projects in 24 states have assisted more than 10,000 farmers nationwide in continuing this rural way of life. The program engages extension educators, disability experts, rural professionals and volunteers in offering an array of services including: on-site technical assistance on worksite modifications to accommodate for the disability; education to prevent further injury and disability; training to extension educators and rural professionals to upgrade their skills in assisting farmers with disabilities and developing and coordinating peer counseling networks. The incidence of disability on the farm continues to increase. Changes in agriculture present on-going unique challenges to farmers and ranchers affected by disability. Innovative strategies are needed to achieve success and to support the choice to continue in agricultural production. Newer assistive technologies will promote prevention or reduction of secondary injuries.

Influences of Disabling Conditions on the Nature and Frequency of Farm/ranch-related Injuries
William E. Field, Ed.D., Department of Agricultural and Biological Engineering, Purdue University, Aaron Yoder, M.S., Agricultural Safety and Health Program, Department of Agricultural and Biological Engineering, Purdue University, and Douglas Kingman, M.S., Agricultural Safety and Health Program, Department of Agricultural and Biological Engineering, Purdue University

Abstract --- Agricultural production remains one of the most hazardous occupations in the United States (Accident Facts 2000). Studies done approximately 20 years ago found that approximately 65% of reported farm-related injuries were severe enough to cause temporary disability, almost 2% resulted in permanent disability (Hanford,, 1982), and about 17% of farm operators had disabilities that prevented them from completing essential farm work-related tasks (Tormoehlen, 1982). More recent studies (Whitman, 1995) suggest that the incidence of disabilities have not changed substantially and as the mean age of farm operators has continued to increase, the incidence of disabling conditions due to age-related diseases such as arthritis, heart disease, impaired vision and loss of hearing, may have increased. The impact of disabling conditions on the frequency and nature of farm workplace injuries is not well understood and little has been published on the topic. There are, however, a significant number of farm operators and workers who may be exposed to increased risk of injury, including secondary injury, due to physical or mental limitations that impair judgment, behavior, physical mobility, response time, hearing, sight, touch and other human capacities. The focus of this paper will be to address the known characteristics of those working in agricultural production who are at risk due to physical or mental limitations, how these limitations translate into increased risk of injury, suggestions for intervention strategies that could reduce the risk and recommended areas for future research.

Agricultural Mental Health
Michael R. Rosmann, Ph.D., Sharing Help Awareness United Network

Abstract --- Not only is farming dangerous in terms of occupation-related physical injuries, illnesses and fatalities, but farming also is associated with high risk for serious mental health disorders. The suicide rate of farmers and farm workers is well above average during normal economic conditions, and rises to between two and three times the national average during economically stressful times. Yet the mental health of farmers, farm workers and their families is one of the most neglected areas of scientific endeavor and service provision. There is a paucity of mental health professionals in rural areas and even fewer who are culturally competent to serve farmers and ranchers.

To address these knowledge and service gaps, research and service programs are needed to reduce barriers to effective mental health and substance abuse treatment for farmers and ranchers. Specifically, Sharing Help Awareness United Network, in collaboration with the National Association for Rural Mental Health, has begun assimilating scientific knowledge into a textbook and curriculum to train mental health professionals to serve the agricultural population. Outreach workers, who are farm men and women, and telehealth are being utilized. Agricultural mental health concepts also are being integrated into the training of nurses and physicians at the University of Iowa's Agricultural Occupational Health Training program.

This paper summarizes progress in agricultural mental health and proposes a nationwide mental health support program for all persons engaged in agricultural production.

Environmental Health - Emerging Biological Hazards
Rich Fenske, Ph.D., University of Washington

Facing the Challenges of Agricultural Technology and its Impact on Health
Teresa Niedda, M.A., The Farmworker Health and Safety Institute, and Joan Flocks, J.D., University of Florida

Abstract --- It is often stated that the current state of agricultural health and safety is not adequately resolved. Yet, as food production shifts from small farms to agribusinesses and our food system becomes increasingly consolidated, a whole new set of potential health hazards is emerging. Corporations are focusing on large-scale production, mechanization, monoculture operations and biotechnology as a means to provide an abundant and low cost food supply while increasing their bottom line. Yet, there is little discussion of the potential health and safety effects caused by this trend on both those who work in the industries and those who consume the products. Higher crop yields and rapid farm animal growth can lead to a greater dependence on pesticides and antibiotics. Genetically altered crops may produce new forms of allergens and toxins. The use of industrial sludge as fertilizer and the proposed use of low level contaminated soil from nuclear power plants on our nation's farmlands may have severe, unforeseen dangers. Alternative solutions need to be explored in order to preserve the health and safety of all.

Migrant and Seasonal Adolescent Farmworkers: New Challenges
Martha S. Vela Acosta, M.D., M.S., Ph.D., National Farm Medicine Center

Abstract --- Migrant and seasonal farmworkers perform essential labor in producing food, contributing to the farm economy. This workforce persists as an under-served and understudied population facing numerous conditions that increases their risks of developing work related injuries and illnesses. Efforts to date have primarily focused on adult farmworkers, yet many adolescents are employed in agriculture. The total adolescent workforce (12 to 17 years old) in agriculture continues to be uncertain. The National Agricultural Worker's Survey (NAWS) data estimates that about 128,000 14 to 17 year old farmworkers were working in crop production each year (1993-1996). Demographics of adolescent farmworkers based in NAWS data accounted 7% of migrant workforce in crop agriculture.

The National Children's Center for Rural and Agricultural Health and Safety has a new consensus development initiative, generating recommendations for working conditions of adolescent farmworkers. This research process involves critical input from agricultural employers and encourages open dialogue from groups with diverse perspectives, such as migrant advocates, farmworkers, agricultural employers and researchers. A complete report with recommendations is expected by Spring 2001. Future issues for adolescent farmworkers require to address their housing, transportation, recreation and sociological needs.

Health and Safety Issues among Non-migrant Adult Farm Workers
Lorann Stallones, M.P.H, Ph.D., Colorado Injury Control Research Center, Department of Environmental Health, Colorado State University

Abstract --- The purpose of this paper is to discuss health and safety issues for adult farm workers in the United States who are not migrant workers. The agricultural work force is diverse, with farm operators representing approximately 35% of the total population in 1987. Some farm operators also hire themselves out for wages to other farmers. In 1987, unpaid agricultural workers included 2.9 million people, comprising the largest percentage of the agricultural work force (37%). Hired workers, not including migrant and undocumented foreign workers, comprised 28% of the agricultural workforce (2.2 million people). With the shift toward larger farms, hired labor use has become concentrated on larger farms in California, Texas, Florida, Washington, Wisconsin, North Carolina, and Pennsylvania accounting for almost half of hired labor expenditures. Unpaid and domestic hired farm workers are predominantly young males. Unpaid workers had relatively high educational attainment, while paid workers had lower educational status. Farm work for hired workers is sporadic, frequently unstable, and of short duration, with only one-fifth of the workers being year-round employees. Hired workers are involved in a wide range of activities including sugarcane, strip and baling tobacco, herding sheep, combine operation, milking, shearing Christmas trees, stocking catfish ponds, and farm management. Although this population contributes significantly to agricultural production, they have rarely been considered in research related to agricultural safety and health. Most studies provide information on farmers and some work has specifically addressed migrant workers, but there are relatively few studies that provide data separately for this portion of the agricultural workforce.

Ergonomics and Musculoskeletal Injuries in Agriculture
Larry Chapman, Ph.D., Department of Biological Systems Engineering, University of Wisconsin, and Jim Meyers, Ph.D.. Center for Occupational and Environmental Health, University of California at Berkeley

Abstract --- Farmers and farm workers face risks of work-related musculoskeletal injury and disease ranking among the highest in the nation. While the problem is little recognized within or without agriculture there is growing evidence that these potentially permanently disabling injuries can be readily prevented with attention to modified tools and practices. Improving prevention will reduce severe costs to both farmers and farmworkers and can result in improved productivity and a better place to work.

Analyses of 1988 NHIS data reported that one year period prevalence rate of back pain among individuals working in agriculture was about one and one-half times higher than the average for all US industries, and that farming was the occupation most often associated with disability in females and the second most often in males. Studies on agricultural workers in California report rates of MSD incidence ranking among the nation's highest risk industries and 100 times greater than rates suggested as industrial targets by NIOSH.

At the same time, these potentially permanently disabling injuries are readily preventable using ergonomics approaches. Examples of demonstrated preventive interventions from multiple crops and commodities are reported and a suggested approach to improving on-farm prevention of these injuries is presented.

Human Health Effects of Agriculture: Physical Diseases and Illnesses
Steven R. Kirkhorn, M.D., M.P.H., F.A.C.O.E.M., Occupational Health Resources, Immanuel St. Joseph's-Mayo Health System, Faculty-University of Minnesota Rural Family Practice Residency-Waseca, MN, Clinical Associate Professor, University of Minnesota Family Practice and Community Medicine, and Marc Schenker, M.D., M.P.H., F.A.C.P., UC Center of Agricultural Health and Safety at Davis, University of California at Davis School of Medicine

Abstract --- Agriculture has experienced both major bio-technological advances and economic and socio-cultural disruptions since the publication of the white paper "Agriculture at Risk" in 1988. At that time it was recognized that there were acute needs in the prevention of musculoskeletal syndromes and injuries, agricultural respiratory disease, noise-induced hearing loss, stress-induced mental disorders, contact dermatitis, and pesticide-related illnesses. There were also concerns regarding the excesses of cancers noted in epidemiological studies of farmers. In the ensuing twelve years, there continues to be inadequate application of methods to prevent respiratory disease and fatal incidents on the farm site and agricultural workplace. Considerable concern remains regarding the long-term effects of chronic pesticide exposure, including lymphomas and birth defects, without significant progress made in the isolation of the causative agents.

In this paper, we will discuss the progress made in the identification of new respiratory disease risks and illnesses, the rationale for promoting better monitoring of respiratory exposures, and for setting lower permissible exposure levels for airborne organic dusts and gases. Additional discussion will include emerging agricultural-related infectious diseases, pesticide-related illnesses, and ergonomic issues. The focus will be upon the current state of knowledge in these areas and recommendations for further research and application methods.

Traumatic Injuries in Agriculture
David L. Hard, Ph.D., NIOSH/DSR/AFEB, John R. Myers, NIOSH/DSR/SFIB, and Susan G. Gerberich, School of Public Health/EOH/RIPRC, University of Minnesota

Abstract --- Traumatic injury in agriculture has been identified as a major cause of mortality and morbidity among farm workers and others exposed in this environment. In 1988, there was consensus on the need for a national surveillance system that captured both agricultural mortality and morbidity. Additionally, surveillance systems were needed to identify exposure data and risk factors for workers in agriculture. While no single national surveillance system presently exists for the collection of data on all agricultural injuries, strides have been made in addressing specific concerns and recommendations. In 1992, BLS instituted the Census of Fatal Occupational Injuries and revised the Annual Survey for non-fatal injuries, resulting in a more accurate picture of the scope and magnitude of agricultural injuries on larger farms. NIOSH conducted a national survey, the Traumatic Injury Surveillance of Farmers project, between 1994 and 1996 to obtain national agricultural nonfatal injury estimates. In addition, grants have been funded to explore regional surveillance efforts, such as RRIS-II. In recent years, national and regional injury surveillance efforts, that include nonfatal events, have focused on targeted agricultural populations such as youth. These efforts serve as potential models for future efforts.

Coalitions: Building Partnerships to Promote Agricultural Health and Safety
Teri Palermo, R.N., National Institute for Occupational Safety and Health, Janet Ehlers, National Institute for Occupational Safety and Health, and Susan Jones, R.N., Ph.D., Western Kentucky University

Abstract --- The Agriculture at Risk Report identifies the need for the development of coalitions, but with little additional detail. Throughout the 1990s, a variety of partnerships and community-based organizations with the primary mission to promote agricultural safety and health have been formed. These groups are altruistic, creative, energetic, and provide a critical perspective to the effort of improving the safety and health of the agricultural workforce at the local, regional, and national levels. These coalitions have been created as a result of philanthropic support, public funding, grass-roots interest, and personal experiences with agricultural injuries and fatalities. They are playing important roles in collaborating with researchers and in reaching the individual agricultural communities. They have been instrumental in conducting needs assessments and critical to the development and implementation of successful surveillance and interventions. Outreach and dissemination of research findings and other safety and health information to target audiences are a strength of these diverse groups. This paper will focus on community- based coalitions, providing an overview of the types, foci, activities, and results or impact of these groups during the 1990s and the challenges in maintaining and sustaining the coalitions. We will conclude by projecting the role of coalitions for the future.

Building a Just and Humane Food System through Collaborative Efforts
Richard Mandelbaum, El Comité de Apoyo a los Trabajadores Agricolas, (CATA / Farmworker Support Committee)

Abstract --- The current food system within the United States is based on the industrial model. Large scale operations are favored over small scale producers. The family farmer is unable to compete with an agribusiness supported by various direct and hidden subsidies, including an abundant and cheap labor supply. The underlying factors behind the poor health and safety record within the agricultural sector come more clearly into focus when viewed within this broader political and economic context.

There is a growing consciousness of the need to create alternative models that recognize the ties that bind small farmers, farmworkers, and the public at large. Such a model would be based upon a vision of the food system in which those who work the land, as well as those who depend on the food produced there, are provided a life of dignity and quality.

This model could embrace the growing consumer movement linking people directly to products generated under specific ecologically sustainable and socially just conditions. The most successful example of this type of program within U.S. agriculture has been that of organic certification. Such programs can and should be expanded to include social criteria benefiting both farmers and farmworkers, and would include (although not be limited to) significant improvements in health and safety.

Incentive Based Intervention Programs in Agriculture
Risto H. Rautiainen, M.S., Great Plains Center for Agricultural Health, The University of Iowa

Abstract --- The "three E's": engineering, education, and enforcement, have been traditional approaches in occupational health and safety promotion. These approaches have limitations in agriculture and there have been efforts to develop new financial incentive based programs. Incentives have included reduced insurance premiums, grants for purchasing Rollover Protective Structures (ROPS) and safety devises, and other discounts and benefits.

Following are examples of some incentive programs. The Ontario Farm Management, Safety and Repair Program in 1987-88 provided grants for farm safety improvements. CAD $7.2 million was used for safety improvements; maximum of $2,500 per farm, and 80% of the improvement costs were funded. The demand was much greater than the available funds (27,827 applicants). No evaluation was conducted regarding injuries, and the program was discontinued. The Swedish Working Life Fund provided grants in 1990-95 to about 2,000 farm employers for safety improvements totaling SEK 175 million ($23 million USD). A study of participating diary/beef farmers reported a 22% decrease in injury rate, 29% decrease in musculoskeletal disorders, and 16% decrease in working time. In Washington State, the Farm Bureau administered a Retro Program, which required that the members pass a safety inspection. In 1984-89 this program returned over $3 million in saved workers compensation costs to the member participants. New York Agricultural Hazard Abatement and Training (AHAT) Project among dairy farmers included hazard corrections and training sessions. Farmers received up to 14% rebates of their 1996 workers compensation premiums. 27% decrease in claims was observed, and there were significant changes in attitudes and beliefs. The Ohio Tailgate Safety Training Program included two $40 gift certificates for each participant for purchases of personal protective equipment (PPE). Initial results showed that 27% of the certificates were redeemed. Rollover Protective Structure (ROPS) grant campaign was conducted by Virginia Farm Bureau in 1995-97. A $150 rebate was offered for ROPS installation. The program was advertised among 140,000 Farm Bureau members. The number of retrofits was 5 in 1995, 11 in 1996, and 33 in 1997. Manufacturers and dealers have promoted "ROPS at cost" incentive programs for many years, however the success of these programs has not been documented. In New York, a study was conducted which showed that most farmers were not willing to retrofit ROPS on older tractors, unless the incentive was at least 75% of the total cost of the retrofit. The Finnish farmer's occupational health service program includes a farm visit, health examination and education. Since 1999, members receive a 20% discount in worker compensation premiums. This benefit significantly increased participation in the occupational health service program. A similar program in Norway enabled the participating farmers to receive discounts in insurance premiums. The Iowa Certified Safe Farm program includes a preventive health screening, an on-farm safety review with a passing score of 85%, and personal education. The program is currently pilot tested and members are anticipated to receive discounts in health insurance and farm supply purchases.

Incentive based programs show varying success. The available data indicates that safety improvements such as ROPS and PPE require high levels of incentives before farmers become interested. Programs with more significant amounts of support have been popular, however, it is not clearly demonstrated whether they are effective in reducing injuries. The insurers have shown interest in offering incentives. These programs show promising results and suggest that more efforts should be placed in designing programs, which can effectively reduce injuries and insurance costs and benefit both insurers and farmers.

Community Intervention Strategies: Insurance/other Rebate Initiatives
Donald L. Griffin, CPCU, ARe, ARM, AU, National Association of Independent Insurers

Mortality and Morbidity in Agriculture in the United States
Risto H. Rautiainen, M.S., The University of Iowa, and Stephen J. Reynolds, Ph.D., CIH, The University of Iowa

Abstract --- The fatal injury rate in agriculture has been essentially the same for the past decades. According to the Bureau of Labor Statistics (BLS), Census of Fatal Occupational Injuries (CFOI), 807 persons died in 1999 in the agriculture industry, which includes forestry and fishing. The injury rate was 24 fatalities per 100,000 workers. This is five times higher than the rate in other industries on the average, and only mining has a higher fatality rate than agriculture. Tractor remains the primary cause of farm fatalities. National Safety Council (NSC) estimates that there were 255 tractor related fatalities in 1997, the rate being 6.5 deaths per 100,000 tractors. Approximately 60% of tractors in the United States lack Rollover Protective Structures (ROPS), and tractor overturn with non-ROPS tractors is the most frequent type of fatal farm injury. Some data shows that progress may have been made regionally to reduce fatality rates. Research also suggests that childhood fatalities reduced from 300 annually in 1978-83 to 104 annually in 1990-93. The rate reduction during this time period was 39%. Children are specifically at risk for runovers when bystanders or extra riders on tractors and farm equipment. The farming population is older than most other working populations. The elderly farmers are at risk for fatal injuries, especially from tractor overturns.

BLS reported 7.0 non-fatal injuries and 3.3 lost workday injuries per 100 full time workers in agriculture in 1999. This includes data only from those farms with 11 or more employees. NSC reported 140,000 disabling injuries in agriculture in 1998, the rate being 4 disabling injuries per 100 workers. NIOSH estimated that there were 121,936 lost-time injuries in 1994; 4.7 lost-time injuries per 100 full time workers. Some surveys have reported significantly higher injury rates in agriculture. Variation exists in these estimates due to different data collection methods and definitions for agriculture and injury.

According to BLS, morbidity from work related illness was 43/10,000 workers in agriculture. This data is limited to farms with 11 or more employees. NIOSH has reported 51 fatalities in 1996 from hypersensitivity pneumonitis, some of which may be agricultural work related. Research suggests that livestock farmers experience high rates of lung disease (up to 30%). NIOSH has reported that farmers experience lower rates of cancer (Proportional Mortality Ratio (PMR)=0.89) than other industries in 1984-95. Especially lung cancer rates (0.81) were lower in agriculture. Specific cancers including skin (1.22), non-Hodgkins lymphoma (1.01), and leukemia (1.05) were elevated in agriculture. Farmers also suffer from higher levels of suicide (1.11), and underlying stress and depression.

The reported rates for occupational injury and illness in agriculture are likely lower than the actual rates as the farmers in general have no workers compensation or surveillance, which would consistently identify and report work related incidents. Lack of comprehensive and accurate reporting limits the possibilities to draw conclusions regarding rates and trends. However, the available data suggest that agriculture remains one of the most hazardous occupations in the United States and has not experienced similar progress as other occupations.

Effectiveness of Farm Safety Interventions
Risto H. Rautiainen, M.S., The Great Plains Center for Agricultural Health, University of Iowa, and Lisa A. DeRoo, M.P.H., School of Public Health and Community Medicine, University of Washington

Abstract --- A systematic review was conducted to examine the effectiveness of farm injury prevention interventions. Electronic databases, journals, proceedings, and technical papers were reviewed, and experts in the field were interviewed to identify relevant information sources. Educational and multifaceted interventions were included and engineering and regulatory interventions were excluded. All study designs were accepted, including those without comparison groups and those with absent or inadequate evaluation methods.

We selected 25 studies for the review. Following are examples of the findings. Harper (1998) found that a community program in South Carolina distributing materials to local leaders and educators had no significant effect on attitudes or knowledge. Rodriguez (1997) evaluated an informational campaign in Iowa using messages through radio, newspapers, and safety publications. Phone surveys showed moderate but statistically significant increases in awareness, concern and behavior indicators. Hawk (1995) found significant differences in behaviors after a Farm Safety Walkabout in Iowa. Reed (1994) evaluated a farm safety fair in a rural church setting, and found that over 50% of participating families incorporated safety changes on their farms. Buchan (1993) evaluated farm safety day camps in Colorado and found knowledge acquisition increases from 45 -100% and behavioral changes from 31- 84.5% among participants. Wilkinson (1993) reported that tractor certification program participants in Wisconsin had a 15% increase in exposure to non-ROPS tractors, a slight increase in carrying extra riders, and a 9% increase in tractor safety inspections. Pekkarinen (1992) evaluated an educational program for reindeer herders in Finland and found a 43% decrease in injury rate. Jansson (1988) evaluated a safety training program for farmer-loggers in Sweden consisting of 15 one-day courses and demonstrations. 71% reported a change in working methods; use of protective leg guards increased from 65% to 90%; and use of protective boots changed from 65% to 85%. Abend (1998) reported that NY Agricultural Hazard Abatement and Training program consisting of hazard corrections, training, and insurance incentives, showed a 27% decrease in workers compensation claims. Carstensen (1998) evaluated an intervention in Denmark including a farm inspection, and a one-day safety course. Injuries reduced from 33.4 to 20.1/100,000 hours. Husman (1990) evaluated a national model for farmer's occupational health services in Finland. Improvements were found in knowledge and use of personal protective equipment, but not in working conditions or work practices.

Most of the studies reported some improvements in knowledge, attitudes, and/or behaviors after intervention. Only three studies measured actual injury outcomes. For most of the studies, the validity and interpretation of the evaluation results are questionable due to limitations in design such as the lack of comparison groups and reliance on self-reported outcomes. There is some indication that multifaceted and incentive based programs are more effective than one-time event type programs or media campaigns although the evidence is not consistent. The review showed both successful and unsuccessful examples of different types of programs. This may indicate that the various aspects of program delivery are critical for successful intervention.

Engineering and Technology - Buildings and Structures
Dick Steffen, Ph.D., Southern Illinois University

Federal Laws and Regulations Affecting Farm Safety
Jack L. Runyan, Ph.D., Food and Rural Economics Division, Economic Research Service, U.S. Department of Agriculture

Abstract --- Farm operators, their family members, and hired workers are exposed agents that can cause fatal, permanent, long-term, and short-term injuries and illnesses. They sometimes work under conditions that may reduce their awareness of the dangers of operating equipment and handling livestock. The Federal government has enacted legislation and promulgated regulations that protect most nonfarm workers, but provide only limited protection for hired farmworkers and almost no protection for farm operators and their family members.

The child labor provision of the Fair Labor Standards Act does not allow anyone under 16 years of age to be employed in any agricultural occupation declared hazardous by the Secretary of Labor. This provision does not apply to children of farm owners or operators.

The Occupational Safety and Health Act requires employees to furnish each employee employment and a workplace free from recognized hazards causing or likely to cause death or serious harm. However, immediate family members of the farm employer and farms employing less than 11 workers are exempt from coverage.

The Worker Protection Standard (WPS) applies to all operators of farms, forests, nurseries, and in greenhouses used in the production of agricultural plants (food, feed, and fiber plants, trees, turf grass, flowers, shrubs, ornamentals, and seedlings); operators who hire or contract for services of workers; and those who apply pesticides to agricultural plants and crop advisors on any farm, forest, nursery, or greenhouse. There are no small farm or minimum number of farm employee exemptions in the WPS. Operators and their immediate family are exempt from some of the provisions.

The Certification of Pesticide Applicators Standard (CAS) requires an individual applying restricted-use pesticides to be certified by a certifying agency as competent and thus authorized to use or supervise the use of restricted-use pesticides. Like in the case for the WPS, operators and their immediate family are exempt from some of the provisions.

Although operators and family members are exempt form most Federal safety laws and regulations, they should be aware of the prohibited practices and suggested improved ones. Raising the awareness of these people is one challenge for practitioners of farm safety.

Farm Population, Migration and its Implications on Health and Safety: an Anthropological Approach
Carlos Buitrago, Ph.D., University of Puerto Rico

Abstract --- The paper focuses on the analysis of ethnographic data provided by last stage of a three year research project on migrant "farmworkers" carried on in México and in agroindustries located in eastern United States. It focuses on complex, somewhat dispersed, fragmented, alleatory and contingent migratory processes.There are also transnational networks related to and that mediate these population movements along migration "constructed pathways" that are constantly created, transformed, discarded, modified. It states, therefore that there is a lack of regular patterns in the multiple contexts where the migrants operate, within the arbitrary and highly controlled and exploitative contexts of flexible (despotic) agroindustialism. A reconceptualization of the characterization of "migrant farmworker" as a segment of a a multiple laboral identity is related to the lack of patterns and to these multiple and contingent contexts. It examines specific instances, contexts and practices that impinge upon the nature and character of these migrants flows and displacements, such as the varied and fragmented workplaces and its dynamics, related locations, like living quarters, transportation and communication contexts. The main orientation is to show the future implications that these processes, contexts and practices may have on farmworkers' health and safety and to develop specific recommendations for research.

Occupational Safety and Health among California Farm Workers: Results of a Statewide Survey
David Lighthall, Ph.D., California Institute for Rural Studies

Abstract --- This paper summarizes key occupational issues facing farm workers in California. It also discusses major barriers to improvements in occupational safety in the state and their implications for national policy. The California Institute for Rural Studies conducted a statewide health and safety survey of California farm workers during the 1999 cropping season. With support from The California Endowment, the California Agricultural Worker Health Survey (CAWHS) interviewed 971 farm workers in seven communities distributed across all six agricultural regions of the state. Respondents provided a comprehensive range of data in respect to occupational safety and health. This included: (1) a detailed work history of the past 12 months, (2) a record of a workplace safety training received and protective measures employed, (3) causes and treatments of any major injuries received in the past 12 months of farm work, and (4) field sanitation conditions encountered in their current job. The paper summarizes key findings of the study, including a focus on crop/task combinations that emerged as most risk prone as well as inadequacies in WPS training. The paper also addresses differentials in training and injuries based on whether workers were employed directly by growers or by farm labor contractors.

Agricultural Occupational Health Services and Delivery: Alternative Strategies to Deliver/distance Learning
Carol J. Lehtola, Ph.D., The University of Florida, and Tom Karsky, M.S., University of Idaho

Abstract --- It was recognized and noted in the 1988 Agriculture at Risk: A Report to the Nation that educational initiatives are necessary for improving the health and safety of the agricultural work force. It was stated (p. 34) that "suggestions for improving agricultural safety and health will fare best if they are supported by an aware and concerned general public." The report included recommendations to assure that the varied educational needs would be achieved.

In order to accomplish this, it was recognized that alternative (i.e., different from the traditional in-the-classroom lectures) delivery methods needed to be developed. In 1990 an agricultural safety class was offered to off-campus students at Iowa State University via videotape. The successful offering of this class, led to further developments in offering safety classes via distance education methods and technologies. Classes were designed for agricultural safety and health professionals, agribusiness owners and employees, and farmers and farm families.

Further developments have led to safety classes being taught via web based instruction.

This paper will address issues, ideas, and initiatives for teaching agricultural safety and health via alternative strategies. Examples will also be provided of successful activities that have been developed to enhance teaching agricultural safety and health.

The Impact of Biotechnology and Information Technology on Agricultural Worker Safety and Health
John M. Shutske, Ph.D., Biosystems and Agricultural Engineering Department, University of Minnesota

Abstract --- In recent years, biotechnology and information technology applications have been rapidly adopted in production agriculture. These technologies are symbiotic. The profitable use of biotechnology depends largely on farmers and agricultural workers having timely and accurate information related to the food production and processing supply chain. Biotechnology applications include the use of genetically modified organisms (GMO) containing genetic material from other organisms, giving the plant or animal a desirable trait (such as herbicide resistance). Information technology applications include the Internet, precision agriculture, and wireless communication networks that allow producers to obtain and use context-specific information to make crucial decisions. Both technology categories are likely to have significant impact on the safety and health of those working in agriculture. Production of GMO crops and animals has the potential to change worker exposures related to pesticide usage, confined space entry, and handling of products from modified crops and animals. With expanding use of information technology, knowledge providers have the opportunity to supply needed information at a time and in a place most useful and valued by users. While this presents exciting opportunities, there will be incredible competition from other information providers. Capturing the attention of the user with appropriate and timely agricultural safety and health information, including information related to new and evolving exposures will become increasingly challenging in this rapidly changing environment.

Medical Education for Agricultural Health and Safety
John R. Wheat, M.D., M.P.H., University of Alabama, Kelley J. Donham, D.V.M., University of Iowa, W. M. Simpson, Medical University of South Carolina, Natalie Roy, M.P.H., Innovative Public Health Strategies, and Steve Kirkhorn, M.D., University of Minnesota Rural Family Practice Residency

Abstract --- Medical education for agricultural health and safety is evolving to intersect primary care, rural community health, and occupational and environmental medicine (EOM). Hazards of agriculture concentrate in rural areas among diverse primary care and community health concerns. Family physicians who respond to this diversity can maintain rural practices and establish credibility necessary for acceptance as partners in programs for agricultural community health. Rural family physicians with expertise in community health and EOM can be the front line of agricultural medicine.

Several educational efforts are relevant to producing these physicians: 1) rural medicine, 2) rural public health, 3) Family Medicine, and 4) OEM, including agricultural medicine. Agromedicine education to prepare physicians to partner with agricultural scientists and cooperative extension agents should also be considered. Each of these efforts requires faculty with special expertise and resources. Few institutions are prepared currently to merge and coordinate these programs into a coherent rural and agricultural medicine program.

We recommend that a medical school in each distinctive agricultural region construct a model for developing these agricultural medicine physicians and seek partners and resources to operationalize the model. One example is the Alabama rural medicine pipeline model. A vocal rural and agricultural constituency may be required for success.

Rural Emergency Response - the Safety and Health Safety Net
Gary Erisman Ph.D., CSP, EMT-B, Illinois State University

Abstract --- The Highway Safety Act of 1966 requires states to have highway safety programs that conform to uniform standards set by the U.S. Department of Transportation. One of the 18 program standards contained in this Act deals with the availability of emergency medical services.

Data from three wars-W.W.II, Korea, and Vietnam strongly supports the following assertion: speed of medical intervention and transport to the hospital emergency room is the key to increasing survival rates from traumatic injury. Unfortunately, the importance of available emergency services in rural areas appears to be an area largely overlooked in the 1989 edition of Agriculture at Risk: A Report to the Nation.

To a large degree, the identity of a community revolves around the services it makes available. Emergency service availability has a direct impact on the quality of life of a community. Rural fire fighters, rescue personnel, police, emergency medical personnel, hospital staffs and auxiliary organizations - mostly volunteers - exist to support and nurture those in need.

This paper examines rural response capability with particular emphasis on emergency medical services. Results of current research on problems within the system are summarized and suggestions for addressing these problems are provided.

Training of Agricultural Safety and Health Specialists - Academic Preparation and In service of Agriculture Safety and Health Specialists/engineers
Guided Discussion Led by Gary Erisman, Ph.D., Illinois State University

Cognitive-Behavioral Approaches to Community Safety Education
Henry P. Cole, Ph.D., University of Kentucky

Abstract --- Surveillance to determine whom in a community is at risk for illness or injury is basic but not sufficient to implementing a community education intervention. Behavioristic principles can identify the antecedent environmental conditions and the reinforcers that maintain dangerous attitudes and behaviors among community members. A behavioral analysis helps the researcher to understand the logic of risky behavior from the community members' perspective, and to not condemn the behavior as stupid. Cognitive principles can be used to translate surveillance data about risky behaviors and their consequences into simple messages that are easily understood through actions, images, and stories. In doing so, abstract epidemiology principles for prescribing safety practices become concrete, personally relevant, and empowering. Replacing habitual risky behaviors with safe practices requires changes in both knowledge and attitudes. While simply showing or telling someone what they need to know can transmit knowledge, such direct instruction is ineffective for changing attitudes. Attitudes are changed primarily through interactions with human models and by compelling stories we hear, tell, and live. Partnerships of researchers and the at risk members of the target community can best accomplish the surveillance process, the behavioral analysis, and the translation of surveillance data to meaningful community education.

Engineering and Technology - Machinery
Lloyd Redding, Equipment Manufacturers Institute Representative

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