Injury, Musculoskeletal Symptoms, and Stress as a Function of Aging in Agricultural Operators in the Central United States

BACKGROUND

Studies show conflicting evidence on the association of age and occupational injury in agriculture, and few studies have addressed the effect of age on work-related chronic conditions or preventive practices among farmers.

METHODS

We examined the probability of injury, work-related stress, musculoskeletal symptoms (MSS), and preventive practices for MSS as a function of aging using surveillance data of 7,711 farm and ranch operators in the central United States.

FINDINGS

Segmented regression analyses of men (85% of sample) indicated that the probability of all four outcomes increased up to a certain age and then decreased; the changepoints in years of age being 59.6 for injury, 55.4 for work-related stress, 59.6 for MSS, and 67.9 for MSS preventive practices. Female operators had an increasing trend for stress up to age 29.7, while they showed no changepoints across their age spectrum in the proportion of injury, MSS, and prevention techniques.

CONCLUSION/APPLICATION TO PRACTICE

These findings emphasize the need for preventive efforts particularly among younger and middle-aged farmers and ranchers, and the need to modify work duties to match work abilities at older ages.

Agricultural Injuries: Risk Factors and Severity by Affected Body Part among US (Midwest) Farmers

OBJECTIVES

Statistics from the United States Bureau of Labor Statistics indicate that agriculture consistently ranks as the most hazardous industry in the US. To identify specific targets for prevention, we investigated injury risk factor profiles separately for each injured body site. We also characterized the severity of agricultural injuries by injured body site using the type of medical care and lost work time due to injury.

METHODS

We used the Central States Center for Agricultural Safety and Health (CS-CASH) surveillance data for 2018 to perform descriptive statistics and regression modeling.

RESULTS

We found that 12% (513/4351) of the participants experienced one or more injuries in the previous 12 months. Compared to female operators, male operators had 3.53 (95% CI: 1.17-10.68) times higher odds of back injury. Operators in livestock production had 2.77 times (95% CI:1.12-6.82), 2.28 times (95% CI:1.25-4.14), and 1.69 times (95% CI:1.10-2.59) higher odds of injury to the chest/trunk, finger, and leg/knee/hip, respectively, compared to operators in crop or mixed production. After adjusting for age and gender, operators who worked full time (vs. part-time) on the farm/ranch had 2.11 times (95% CI:1.03-4.34) higher odds of back injury. Arm/shoulder and leg/knee/hip injuries were more frequent in older age groups.

CONCLUSIONS

Prevention measures should be tailored considering specifically livestock producers with emphasis on trainings on proper livestock handling, such as being gentle, establishing routine, keeping distance, and avoiding sudden and loud noise when handling animals. Applying these techniques avoid startling the animals and reduce the risk of injuries.

Factors Associated with Musculoskeletal Discomfort in Farmers and Ranchers in the U.S. Central States

Agricultural work involves ergonomic and psychosocial strain, which contribute to musculoskeletal conditions. The aim of this study was to assess if specific ergonomic, psychosocial, and preventive factors are linked to musculoskeletal pain or discomfort symptoms (MSS) in farmers and ranchers. We analyzed data from the Central States Center for Agricultural Safety and Health survey that was conducted in 2018 in a seven-state region of the central United States. MSS were assessed with questions from the Standardized Nordic Questionnaire. The survey included questions on demographic, ergonomic, psychosocial and preventive factors. Farm production variables were added from the Farm Market iD database. We analyzed the data using Generalized Estimating Equations. The overall prevalence of MSS for all body sites combined was 59% among 4,354 farmers and ranchers who responded (19% response rate). After controlling for age, sex, and operator status, three factors (high stress level, sleep deprivation, and exhaustion/fatigue) showed the strongest associations with MSS in any body site, with adjusted odds ratios (OR) ranging from 4.8 to 5.6. Forceful exertions, repetitive tasks, awkward postures, frequent manual labor, and vibration were also significantly associated with MSS, with adjusted ORs ranging from 1.8 to 3.3. Recommended preventive techniques were not protective for MSS. New effective strategies are needed to reduce the high burden of musculoskeletal outcomes among farmers and agricultural workers.

Work exposures and mental and musculoskeletal symptoms in organic farming

This study focussed on harmful exposures and mental and musculoskeletal symptoms in organic and conventional farming using interview data of Finnish farmers over the winter of 2014-2015. The data consisted of 2,169 full-time farmers, out of whom 231 (11%) practiced organic farming and 1,938 (89%) conventional farming. Exposure to poisonous and irritating substances was less frequent while exposures to vibration and mould ('smell of root cellar') were more frequent on organic farms. Mental and musculoskeletal symptoms were slightly more common among organic farmers, but the associations were not statistically significant in regression modelling. Risk factors for mental symptoms included animal production, hired labour, female gender, constant hurry, working alone, economic uncertainty, and inadequate recovery from workdays. Risk factors for musculoskeletal symptoms included older age, female gender, constant hurry, economic uncertainty, difficult working postures, heavy lifting and carrying, and inadequate recovery. Workload and recovery, managing the transition period and better follow-up of the occupational well-being were identified as concerns among organic farmers. Practitioner summary: Converting from conventional to organic farming has become increasingly common. Farmer interviews indicated that exposure to poisonous and irritating substances was less frequent while exposures to vibration and mould were more frequent on organic farms. Mental and musculoskeletal symptoms and risk factors were similar in both types of farming.

Prevalence and Risk Factors for Pulmonary Conditions among Farmers and Ranchers in the Central United States

This study was conducted to evaluate the prevalence and risk factors for work-related respiratory conditions (asthma, farmer's lung, sinusitis, rhinitis, and environmental allergies, diagnosed by a physician) among farm and ranch operators in the central US. A survey was conducted by the Central States Center for Agricultural Safety and Health (CS-CASH) in 2018, focusing on work-related injuries, illnesses, exposures, and preventive measures in a seven-state region (Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and South Dakota). Farms and ranches (n = 16,818) with an email address and annual sales exceeding $5,000 were randomly selected for the survey. Agricultural production and weather data were merged with survey responses. The relationship between exposures and respiratory conditions was analyzed using generalized estimating equations. We received responses from 3,268 agricultural operations (19% response rate) containing information on 4,064 individual operators. The life-time prevalence of (any) respiratory conditions among farm/ranch operators was 18%. Risk factors for respiratory conditions included exposures to grain/hay/feed dust (OR 2.41), animal confinement dust (OR 1.57), field/road dust (OR 2.11), manure/silage gasses (OR 1.66), anhydrous ammonia (OR 1.51), fuels/solvents/paints (OR 1.92), older age group >70 vs. <43 (OR 1.40), female gender (OR 1.82), and being primary vs. third operator (OR 1.61). Farmers and ranchers have a high prevalence of respiratory conditions associated with dust and gas exposures at work. More effective protective measures are needed using the hierarchy of controls, including improved use of respiratory protection.

Occupational stress among farm and ranch operators in the midwestern United States

BACKGROUND

This study used surveillance data from 2018 and 2020 to test the stability of work-related strain symptoms (high stress, sleep deprivation, exhaustion) with demographic factors, work characteristics, and musculoskeletal symptoms among farm and ranch operators in seven midwestern states of the United States.

METHODS

Cross-sectional surveys were conducted among farm and ranch operators in 2018 (n = 4423) and 2020 (n = 3492). Operators were asked whether, in the past 12 months, they experienced extended work periods that resulted in high stress levels, sleep deprivation, exhaustion/fatigue, or other work-related strain symptoms. Covariates included personal and demographic factors, work characteristics, number of injuries, work-related health conditions, and exposures on the operation. Summary statistics were tabulated for explanatory and outcome variables. The classification (decision) tree approach was used to assess what variables would best separate operators with and without reported strain symptoms, based on a set of explanatory variables. Regularized regression was used to generate effect estimates between the work strain variables and explanatory variables.

RESULTS

High stress level, sleep deprivation, and exhaustion were reported more frequently in 2018 than 2020. The classification tree reproduced the 2018 model using 2020 data with approximately 80% accuracy. The mean number of reported MSD symptoms increased slightly from 1.23 in 2018 to 1.41 in 2020. Older age, more time spent in farm work, higher gross farm income (GFI), and MSD symptoms in six body regions (ankles/feet, knees, lower back, neck, shoulders, wrists/hands) were associated with all three work strain symptoms.

CONCLUSIONS

Musculoskeletal pain and discomfort was a strong predictor for stress, sleep deprivation, and exhaustion among farmers and ranchers. This finding indicates that reducing MSD pain and discomfort is beneficial for both physical and mental health.

Assessing Nonresponse Bias in Farm Injury Surveillance Data

HIGHLIGHTS

Despite a response rate of about 18%, there was scant evidence of nonresponse bias. Farm and ranch characteristics of operations responding to a mailed survey were similar to those not responding. Responders were significantly more likely to be married but only slightly older and more educated than nonresponders. Earlier survey responders reported more injuries and greater severity when injured compared to later responders.

ABSTRACT

Nonresponse bias in a survey can result in misleading estimates of agricultural injuries and can misdirect prevention efforts aimed at reducing the burden of injuries on farmers. Responders (n = 2,977) and nonresponders (n = 13,849) were compared based on demographics and agricultural production characteristics to identify underrepresented subgroups. Injury characteristics were compared between early (n = 1,667) and late (n = 1,309) responders. Methods accounted for correlated data, sample size inflation of p-values, and assessment of meaningful differences. Few differences were identified between responders and nonresponders. Responders differed from nonresponders by state of residence, and responders were more likely to be married. Other characteristics (age, gender, education, farm size, crops grown, animals raised) were similar across groups. Early responders reported more injuries and more often sought medical care for an injury than late responders. The differences identified between responders and nonresponders were minimal and not likely to create bias. Differential reporting of injury and injury severity between early and late responders is worthy of further investigation.

Occupational Injuries among Latino/a Immigrant Cattle Feedyard Workers in the Central States Region of the United States

Agriculture is a dangerous industry with high rates of occupational injuries. Immigrants comprise the majority of the hired agricultural workforce in the United States, and these workers may be at a higher risk for job-related injuries. This study addressed the frequency, characteristics, and risk factors of occupational injuries among Latino immigrant cattle feedyard workers. Data were collected through structured interviews with Latino immigrant cattle feedyard workers in Kansas and Nebraska (n = 243; 90.9% male). Descriptive statistics and logistic regression were used to identify risk factors for injury. Nearly three-fourths of participants (71.2%) reported having experienced one or more injuries in the past while working on a cattle feedyard. The most frequent types of reported injuries, including those not requiring medical care, were bruises/contusions (40%), cuts/lacerations (21%), and sprains/strains (12%). These injuries were mainly caused by animals/livestock (33%), chemicals (23%), falls (12%), and tools (9%). Significant risk factors for injury included male gender (OR 5.9), being over age 35 (OR 2.6), working on a large or an extra-large feedyard (OR 5.4), having 11 or more employees on the feedyard (OR 3.6), and working more than eight hours a day (OR 4.7). Having received safety training was also associated with greater risk of injury in a univariable model (OR 2.6). Cattle feedyard workers are at high risk for injury and require more effective preventive measures.

Experiences and Challenges of Foreign Agricultural Workers in Finland

Highlights

Abstract. Foreign workers have become an important part of the workforce on horticulture and livestock farms in Finland. The aim of this study was to investigate the experiences of foreign workers regarding their working and living conditions. We conducted semi-structured theme interviews during two time periods: in 2008-2009 (n = 40 workers on eight farms) and again in 2018-2019 (n = 9 workers on four farms). We found variations in expectations and goals among workers when they take a job abroad. Compelling factors in the origin country included unemployment, low wages, and low standards of living, and enticing factors in the destination country included social relationships and expectations of better income. Personal networks had a strong role in the recruiting processes. Work on farms is physically demanding, and being a foreign worker affects social life in many ways, such as being separated from family and facing pressures from the home community to arrange jobs for others. New communication technologies have improved possibilities to stay in contact. Employers could contribute to better working and living conditions for foreign workers by improving work organization, ergonomics at work, orientation of new workers, and continued training of supervisors. Worker orientation and training should be carefully planned, taking into consideration the limited language skills, work competence requirements, and possibilities for career advancement of the workers. Keywords: Descriptive study, Foreign farm workers, Horticulture, Occupational safety.

Agricultural Injuries among Farmers and Ranchers in the Central United States during 2011-2015

The high risk of occupational fatalities in agriculture is well documented, but information on non-fatal injuries is lacking due to challenges in injury surveillance. This surveillance study explored the frequency, characteristics, and risk factors for non-fatal injuries among farmers and ranchers in the central United States. The Central States Center for Agricultural Safety and Health (CS-CASH), in collaboration with the USDA National Agricultural Statistics Service (NASS), conducted annual surveys (n = 34,777 sent) during 2011-2015 covering a seven-state region (Iowa, Kansas, Minnesota, Missouri, North Dakota, Nebraska, and South Dakota). The average response rate was 32% in the five consecutive annual surveys. The average injury incidence rate was 7.0 injuries/100 operators per year. Most injuries (89%) occurred during agricultural work. The most frequent sources of injury were livestock (22%), machinery (13%), and hand tools (12%). Risk factors for injury included: male gender, younger age (vs. 65+ years), farming as the primary occupation, greater work time, greater land area, ranch (vs. farm), organic farming, internet access, and production of several types of crops and animals. Most injuries (56%) required a doctor visit, and 12% required hospitalization. The average medical costs were $1,936 out of pocket and $8,043 paid by insurance. The combined average costs for most serious injuries were $7,858. Most injuries (66%) resulted in some lost time from agricultural work, and 13% were serious, resulting in more than 30 days of lost work time. The non-fatal injury rate for self-employed farmers and ranchers was higher than that of hired agricultural workers reported by the Bureau of Labor Statistics. This result reaffirms farming/ranching as a dangerous occupation and emphasizes the need for efforts to prevent agricultural injuries, especially those associated with identified injury sources and risk factors.

Determinants of Good Work Ability among Organic and Conventional Farmers in Finland

Based on earlier studies, farmers have poorer work ability compared to workers in most other occupations. The aim of this study was to explore if organic production has a positive effect on producers' work ability while controlling for demographic and production characteristics. This study used telephone interview data collected by the Finnish Institute of Occupational Health in 2014-2015. The material consisted of 2,164 farmers: 231 in organic production and 1,933 in conventional production. Work ability was measured with a single question regarding the farmers' current work ability compared with their lifetime best on a scale of 0 to 10, with 0 meaning unable to work. The data were analyzed using multivariable logistic regression. Organic production had a negative effect on work ability, while larger farm size, experiencing economic uncertainty rarely/never/occasionally (vs. often), age under 55 years, having occupational health coverage, and experiencing low amounts of physical strain or mental strain had positive effects in a multivariable model. While this study could not consider potential biases from the farmers' existing health status at the time of switching to organic production and other sources, it is clear that greater attention needs to be paid to improving worker health, safety, and wellness in organic farming.

Gender Division of Farm Work and Occupational Injuries

Several studies have shown that males are at greater risk of agricultural injuries than females. We investigated if gender division of farm work helps explain this risk difference in the self-employed Finnish farming population. We used insurance claims data and postal survey data charting the relative division of farm work between male and female farmers. Over the five-year study period (2009 to 2013), the average number of farmers was 75,893 (67% males and 33% females). A total of 22,648 occupational injuries (77% males and 23% females) were compensated during that time. Males had significantly higher rates of any, minor, serious, and recurrent injuries compared to females. Altogether, 319 usable responses were received in the postal survey (13% response rate). Both farm work time and occupational injuries differed by gender. Crop production, construction, forestry, and machinery contracting work were male-dominated, whereas females took the main responsibility for domestic and caretaking work. On livestock farms, animal husbandry was divided quite evenly between males and females (56% and 44% contributions, respectively). Animal husbandry-related injuries were distributed similarly (58% males and 42% females), but all other types of injuries occurred mostly to males. These results suggest that the risk of injuries is also nearly equal, given equal work time. Therefore, gender is an indicator of different work exposures in farming, rather than a risk factor for injury. Better understanding of the division of work and the corresponding risk of injuries can help in the design of interventions for males and females in agriculture. Keywords: Agriculture, Claim, Exposure, Farmer, Gender, Insurance, Occupational injury, Work.

Predictors for occupational injuries and diseases among commercial fishers in Finland 1996-2015

Fishing is a hazardous occupation worldwide. Commercial fishers in Finland are an aging and diminishing population with a high injury rate. Insurance claims data for self-employed Finnish commercial fishers during the years 1996 through 2015 (n = 1951) were analysed to assess predictors for occupational injuries and diseases. Out of the available variables, fishery location, career length, and participation in the voluntary occupational health service programme were not significant predictors. Male gender (OR 2.02; 95% CI 1.37-2.99), Finnish mother tongue vs. Swedish (OR 1.98, 95% CI 1.53-2.55), and higher income levels from fishing (four income categories, OR range: 1.71-3.53) were associated with higher odds for a compensated occupational injury or disease claim among commercial fishers in the final multivariate model. The identified risk groups could be targeted for interventions, and the content of the occupational health service programme should be developed to gain protective effect.

Occupational injuries and diseases among commercial fishers in Finland 1996-2015

BACKGROUND

Commercial fishing is recognised as one of the most hazardous professions worldwide. In Finland, commercial fishing has some special characteristics, including fishing on ice during frozen waters, and pluriactivity of the fisher family to gain additional income. The goal of this study was to describe injury characteristics among commercial fishers in Finland during the years 1996-2015. With this information, we wish to promote creation of effective safety campaigns and interventions.

MATERIALS AND METHODS

The data for this study was acquired from The Farmers' Social Insurance Institution, who handles the mandatory pension and occupational injury insurance of Finnish commercial fishers. Descriptive statistics was used to categorise and analyse the data that comprised the anonymized insurance history of 1954 insured fishers and reports on 1135 compensated injuries, 11 fatalities, and 53 occupational disease cases.

RESULTS

The results show, that the injury rate of Finnish commercial fishers is high. Forty per cent of the fishing-related injuries occur aboard or when entering or leaving the vessel, while 37% happened ashore, and 11% on sea or lake ice. The most common type of incident is preceded by a slip, trip, or sway followed by a fall to lower level. The injuries result in a median disability length of 21 days. An elevated risk for Finnish (vs. Swedish) speaking, as well as for male fishers was found. The occupational diseases of the studied population were for the most part results of manual, repetitive and/or physically straining work due to e.g. hauling in fishing equipment. Due to small numbers and lack of case data, it is not possible to make any further analysis of the 11 fatalities, which were all drownings.

CONCLUSIONS

Based on our findings, injury prevention should be targeted, besides preventing fatalities because of drowning, at mitigating the risks for slips, trips, and falls both aboard and ashore.

Occupational Health and Safety of Finnish Dairy Farmers Using Automatic Milking Systems

INTRODUCTION

Conventional pipeline and parlor milking expose dairy farmers and workers to adverse health outcomes. In recent years, automatic milking systems (AMS) have gained much popularity in Finland, but the changes in working conditions when changing to AMS are not well known. The aim of this study was to investigate the occupational health and safety risks in using AMS, compared to conventional milking systems (CMS).

METHODS

An anonymous online survey was sent to each Finnish dairy farm with an AMS in 2014. Only those dairy farmers with prior work experience in CMS were included in the final analysis consisting of frequency distributions and descriptive statistics.

RESULTS

We received 228 usable responses (131 male and 97 female; 25.2% response rate). The majority of the participants found that AMS had brought flexibility to the organization of farm work, and it had increased leisure time, quality of life, productivity of dairy work, and the attractiveness of dairy farming among the younger generation. In addition, AMS reduced the perceived physical strain on the musculoskeletal system as well as the risk of occupational injuries and diseases, compared to CMS. However, working in close proximity to the cattle, particularly training of heifers to use the AMS, was regarded as a high-risk work task. In addition, the daily cleaning of the AMS and manual handling of rejected milk were regarded as physically demanding. The majority of the participants stated that mental stress caused by the monotonous, repetitive, paced, and hurried work had declined after changing to AMS. However, many indicated increased mental stress because of the demanding management of the AMS. Nightly alarms caused by the AMS, lack of adequately skilled hired labor or farm relief workers, and the 24/7 standby for the AMS were issues that also caused mental stress.

CONCLUSION

Based on this study, AMS may have significant potential in the prevention of adverse health outcomes in milking of dairy cows. In addition, AMS may improve the productivity of dairy work and sustainability of dairy production. However, certain characteristics of the AMS require further attention with regard to occupational health and safety risks.

Pesticide use practices in rural Armenia

Pesticide use can have adverse effects on both human health and the environment. Inappropriate use of pesticides increases the health risk to those who work with or live around pesticides. Educational programs for agricultural workers on the proper use of pesticides and personal protective equipment coupled with pesticide regulations are important tools to reduce the associated health risks. The authors conducted a survey (N = 2336) on pesticide use practices in the Ararat Valley of Armenia in 2000-2006. This study was a cross-sectional design. A multistage sampling method was implemented in the selection of the study population. The authors developed a questionnaire containing 173 questions to evaluate demographic characteristics, health conditions, and details of pesticides use practices. The intensity of pesticide use was high; 82.8% of respondents used them. More than 150 brand names of pesticides were in use. Unregistered, obsolete, expired, and banned compounds were found in active use. Poor compliance with the basic rules of pesticide safety was found throughout the study population, with 21.3% using gloves and only 11% using respirators. The agricultural workers' knowledge of the toxic properties of these pesticides as well as basic hygienic norms was very low. In some instances, the number of agrichemical applications to crops, particularly cucumbers and melons, reached 40 applications during the growing season. Better protection and training of pesticide users in Armenia is needed.

Characteristics of and risk factors for compensated occupational injury and disease claims in dairy farmers: a case-control study

Research indicates that dairy farmers have an elevated risk of work-related adverse health outcomes. This case-control study evaluated the characteristics of and risk factors for compensated occupational injury and disease claims among Finnish dairy farmers. The cases consisted of 19 farm couples in which both spouses had a history of multiple claims. There were 283 claims in total, a rate of 26.6 claims per 100 person-years. The controls consisted of 12 couples in which neither spouse had compensated or rejected claims during their work history as insured farmers. A combined mail/telephone survey charted potential risk factors for compensated claims. These claims frequently involved work tasks and causes related to animal husbandry. Cattle were the most common cause for injuries in general and for serious injuries in particular. Gender differences in farm work and claims were observed. Using logistic regression analyses, we identified personal and work-related risk factors including long work history, small-scale dairy farm operation, and conventional stanchion barn for dairy cattle. Outdated working conditions, while not statistically significant, were positively associated with claims as well. Declined current work ability and musculoskeletal or respiratory conditions were significantly associated with claims where each of these outcomes may contribute to the other. Identified factors could be used to select subgroups of dairy farmers with either elevated or reduced risk of claims. Prevention of adverse health outcomes could be most effective when targeted to farmers at highest risk of occupational injury and disease.

Distribution and characteristics of occupational injuries and diseases among farmers: a retrospective analysis of workers' compensation claims

BACKGROUND

Research indicates occupational injuries and diseases are not evenly distributed among workers. We investigated the distribution and characteristics of compensated occupational injuries and diseases requiring medical care in the Finnish farming population.

METHODS

The study population consisted of 93,564 Finnish farmers, spouses, and salaried family members who were covered by the mandatory workers' compensation insurance in 2002. This population had a total of 133,207 occupational injuries and 9,148 occupational diseases over a 26-year period (1982-2008).

RESULTS

Clustering of claims was observed. Nearly half (47.1%) of the population had no compensated claims while 52.9% had at least one; 50.9% of farmers had one or more injuries and 8.1% had one or more diseases. Ten percent of the population had half of injury cases, and 3% of the population had half of occupational disease cases. Claims frequently involved work tasks related to animal husbandry and repair and maintenance of farm machinery. Injury and disease characteristics (work activity, cause, ICD-10 code) differed between individuals with high and low personal claim rate. Injuries and diseases of the musculoskeletal system had a tendency to reoccur among those with high claim rate. These outcomes were often related to strenuous working motions and postures in labor-intensive animal husbandry.

CONCLUSIONS

Analyses of longitudinal insurance data contributes to better understanding of the long-term risk of occupational injury and disease among farmers. We suggest focusing on recurrent health outcomes and their causes among high risk populations could help design more effective interventions in agriculture and other industries.

Modifiable risk factors for depressed mood among farmers

BACKGROUND

Risk for depression among farmers is not fully understood. DSM-IV considers sadness or depressed mood a critical symptom of depression. The aim of this study was to examine risk factors for depressed mood among farmers using a longitudinal study design.

METHODS

Participants were principal farm operators in the Iowa Certified Safe Farm study. We identified risk factors for depressed mood by calculating relative risks (RR) using the generalized estimating equations method.

RESULTS

In the multivariate model, pesticide exposure (RR = 1.26; 95% CI: 1.04 to 1.53), having an additional job off the farm (RR = 1.32; 95% CI: 1.08 to 1.62), stress (RR = 3.09; 95% CI: 2.55 to 3.75), and previous injury (RR = 1.41; 95% CI: 1.05 to 1.89) prospectively increased the risk of depressed mood.

CONCLUSIONS

Consistent with earlier non-longitudinal studies, the results of this study suggest that reducing pesticide exposure, stress, and injury may reduce the risk of depression in the farm setting.

Barriers and enabling factors for safety improvements on farms in Finland

Systematic reviews of agricultural safety and health interventions have shown little evidence of effectiveness. In this study, we used a self-documentation and collaborative interpretation method (cultural probes, n = 9) as well as farm interviews (n = 11) to identify factors affecting the adoption and implementation of safety information. The three main barrier groups found were (1) personal characteristics of the farmer, (2) limited resources to make safety improvements, and (3) the slow incremental evolution of the physical farm environment where old, hazardous environments remain along with new, safer improvements. The enabling factors included good examples or alarming (and thus activating) examples from peers, ease of implementation of the promoted safety measures, and enforcement of regulations. The findings suggest that a user-centered approach could facilitate the development of more effective safety and health interventions. A conceptual model of the safety intervention context created in this study can be used as a framework to examine specific barriers and enabling factors in planning and implementing safety and health interventions.

Youths operating all-terrain vehicles--implications for safety education

All-terrain vehicle (ATV) use has increased in recent years. ATV injuries and deaths have also increased, particularly among youth. The authors administered a survey at a National FFA convention to identify safety-related behaviors, injuries, and effects of ATV safety training. There were 624 participants aged 12 to 20 with a median age of 16; 56% were male and 69% lived on a farm. The median age for first riding an ATV was 9. ATV size recommendations were rarely observed; nearly all ATVs operated by youth less than 16 years of age were over 90 cc. Safety-related behaviors were reported as follows: always wearing a helmet (24%), never taking passengers (12%), never riding as a passenger (16%), and never riding on paved road (19%). A small percentage (22%) had participated in ATV safety training; 41% were willing, but 46% said such training was not available. ATV training was positively associated with always wearing a helmet (odds ratio [OR]: 1.72, 95% confidence interval [CI]: 1.12-2.63), never taking passengers (OR: 2.31, 95% CI: 1.36-3.91), never riding as a passenger (OR: 3.02, 95% CI: 1.90-4.79), and never riding on paved road (OR: 1.57, 95% CI: 0.99-2.50). However, training was also associated with an increase in injuries (OR: 1.96, 95% CI: 1.31-2.94), although this effect was not found in multivariable models. It was not known if the injuries occurred before or after the training and no exposure time data were available. Gender differences were found in behaviors and injury rates (males 37%, females 20%). The results suggest ATV safety training improved behaviors. Gender differences in operation, behaviors, and injuries should be considered in training.

Risk factors for serious injury in Finnish agriculture

BACKGROUND

Previous studies indicate 20% of injuries represent 80% of injury costs in agriculture. To help prevent the most costly injuries, we aimed to identify characteristics and risk factors associated with serious injuries.

METHODS

We analyzed insurance records of 93,550 self-employed Finnish farmers. We ranked injury causes by claim cost and used multiple logistic regressions to identify risk factors for (any) injury and serious injury (injuries exceeding claim costs of 2000 euros).

RESULTS

A total of 5,507 compensated injuries occurred in 2002 (rate 5.9/100 person-years), and 1,167 or 21% of them (rate 1.25/100 person-years) were serious. The causes/sources resulting in highest average claim costs were motor vehicles; stairs, scaffoldings, and ladders; trailers and wagons; floors, walkways, and steps; other structures and obstacles; augers, mills, and grain handling equipment; horses; combines and harvesting equipment; tractor steps; and uneven and slippery terrain. Older age, male gender, higher income level, greater field size, residing on the farm, Finnish language (vs. Swedish), occupational health service (OHS) membership, and animal production were risk factors for injury. The risk factors for serious injury were similar; however, the effects of age, income level, and the raising of horses were more prominent. Language, residence, ownership status, and OHS membership were not risk factors for serious injury.

CONCLUSIONS

Cost-effective prevention efforts should address the following risk factors: older age, male gender, larger income and operation size, livestock production (particularly dairy, swine, and horses), motor vehicle incidents, falls from elevation, and slips, trips and falls.

Pesticide handling and exposures among cotton farmers in the gambia

OBJECTIVES

There are substantial health hazards to farmers and the environment associated with pesticide use in developing countries. Based on observations by the authors and previous reports, most previous studies in Africa are descriptive in nature. The aim of this study was to investigate how cotton farmers are exposed to pesticides in The Gambia and quantify their pesticide exposures and provide information for the formulation of a policy on pesticide safety for the country.

METHODS

A representative sample of 20 cotton farmers in the Central and Upper River Divisions (CRD and URD) of The Gambia were surveyed by questionnaires. Dermal pesticide exposures among a subset of 10 farmer/pesticide applicators were assessed by dermal patch samples, observation, and postapplication questionnaires.

RESULTS

The study revealed that a toxic organochlorine insecticide, Callisulfan (endosulfan), is frequently sprayed on cotton plants by the farmers. The farmers wore no protective equipment and were inadequately dressed for work with this pesticide. Laboratory analysis of the mixed formulation showed a wide range in the concentration of the pesticide solution among the farmer/pesticide applicators and dermal patch samples showed very high residues of endosulfan analytes on their body surfaces.

CONCLUSIONS

A low level of awareness of pesticide toxicity prevails amonsg cotton farmers in The Gambia. There is a less than adequate control of pesticides and other hazardous agrichemicals in the country.

Slip, trip and fall injuries in potato, sugar beet and open field vegetable production in Finland

STF injuries are common in agriculture. The purposes of this study were to assess the magnitude of STF injuries, to identify contributing factors and to propose preventive actions to reduce injuries in potato, sugar beet and open field vegetable production in Finland. The material consisted of 1648 injury claim records and 22 interviews. The analysis showed 45% (n = 740) of the non-fatal injuries were STFs or jumps. Phrase analysis of injury descriptions provided further insight into the characteristics of STF injuries. The current findings suggest interventions should focus on making access paths (e.g. stairs, ladders, platforms) safer, minimising the need for mounting and dismounting equipment, decreasing manual material handling, improving contamination control and housekeeping in working areas and improving the safety of traffic areas and farmyards.

Interventions for preventing injuries in the agricultural industry

BACKGROUND

Agriculture is more hazardous than most other industries. Many strategies have been introduced to reduce injuries in the field, yet the effectiveness of different interventions on occupational injuries still remains unclear.

OBJECTIVES

This review aims to determine the effectiveness of interventions to prevent occupational injuries among workers in the agricultural industry compared to no interventions or to alternative interventions.

SEARCH STRATEGY

Cochrane Central Register of Controlled Trials, Cochrane Injuries Group's specialised register, MEDLINE, EMBASE, PsychINFO, OSH-ROM (including NIOSHTIC and HSELINE) databases were searched up to June 2006. Reference lists of selected articles, relevant reviews and additional topic related databases and web sites were also searched. The searches were not restricted by language or publication status.

SELECTION CRITERIA

Randomised controlled trials, cluster-randomised controlled trials, prospective cohort studies with a concurrent control group, and interrupted time series studies assessing any type of intervention aiming to prevent fatal or non-fatal injuries among workers in agriculture.

DATA COLLECTION AND ANALYSIS

Two reviewers conducted data extraction and study quality assessment independently. Rate ratios of randomised controlled trials were calculated and the effect sizes were combined in a meta-analysis. Interrupted time series studies were reanalysed and each of them studied for having an immediate and a progressive effect.

MAIN RESULTS

Five randomised controlled trials (RCTs) with 11,565 participants and three interrupted time series studies (ITSs) with 26.3 data points on average met the criteria. For educational interventions aiming at reducing injury rates among adults the pooled rate ratio after recalculation from effect sizes in three RCTs was 1.02 (95% CI 0.87 to 1.20). For educational interventions aiming at children the pooled rate ratio for injury rates in two RCTs was 1.27 (95% CI 0.51 to 3.16). One ITS that evaluated the effect of an intervention that included financial incentives decreased the injury level immediately after the intervention with an effect size of -2.68 (95% CI -3.80 to -1.56) but did not have a significant effect on the injury trend over time with an effect size of -0.22 (95% CI -0.47 to 0.03). One ITS study that evaluated the effect of legislation to ban Endosulfan pesticide on fatal pesticide poisonings increased the level of poisonings immediately after the introduction with an effect size of 2.20 (95% CI 0.97 to 3.43) but led to decrease in the trend of poisonings over time with an effect size of -2.15 (95% CI -2.64 to -1.66). One ITS study documented four different regulations aiming to increase the use of rollover protective structures (ROPS) on tractors and their effect on injuries and fatal injuries. The introduction of two different pieces of legislation requiring ROPS on new tractors sold after a certain date was associated with a decrease of fatal injuries over the long term (effect size -0.93 95% CI -1.02 to -0.03) but they were also associated with an increase of injuries in general (fatal and non-fatal injuries combined). Introduction of legislation requiring ROPS on all tractors, old tractors included, was not associated with a decrease but with an increase of injuries and fatal injuries over the long term.

AUTHORS' CONCLUSIONS

The selected studies provided no evidence that educational interventions are effective in decreasing injury rates among agricultural workers. Financial incentives could reduce injury rates. Legislation to ban pesticides could be effective. Legislation expanding the use of safety devices (ROPS) on new tractors was associated with a decrease in fatal injuries.

Interventions for preventing injuries in the agricultural industry

BACKGROUND

Agriculture is more hazardous than most other industries. Many strategies have been introduced to reduce injuries in the field, yet the effectiveness of different interventions on occupational injuries still remains unclear.

OBJECTIVES

This review aims to determine the effectiveness of interventions to prevent occupational injuries among workers in the agricultural industry compared to no interventions or to alternative interventions.

SEARCH STRATEGY

Cochrane Central Register of Controlled Trials, Cochrane Injuries Group's specialised register, MEDLINE, EMBASE, PsychINFO, OSH-ROM (including NIOSHTIC and HSELINE) databases were searched up to June 2006. Reference lists of selected articles, relevant reviews and additional topic related databases and web sites were also searched. The searches were not restricted by language or publication status.

SELECTION CRITERIA

Randomised controlled trials, cluster-randomised controlled trials, prospective cohort studies with a concurrent control group, and interrupted time series studies assessing any type of intervention aiming to prevent fatal or non-fatal injuries among workers in agriculture.

DATA COLLECTION AND ANALYSIS

Two reviewers conducted data extraction and study quality assessment independently. Rate ratios of randomised controlled trials were calculated and the effect sizes were combined in a meta-analysis. Interrupted time series studies were reanalysed and each of them studied for having an immediate and a progressive effect.

MAIN RESULTS

Five randomised controlled trials (RCTs) with 11,565 participants and three interrupted time series studies (ITSs) with 26.3 data points on average met the criteria. For educational interventions aiming at reducing injury rates among adults the pooled rate ratio after recalculation from effect sizes in three RCTs was 1.02 (95% CI 0.87 to 1.20). For educational interventions aiming at children the pooled rate ratio for injury rates in two RCTs was 1.27 (95% CI 0.51 to 3.16). One ITS that evaluated the effect of an intervention that included financial incentives decreased the injury level immediately after the intervention with an effect size of -2.68 (95% CI -3.80 to -1.56) but did not have a significant effect on the injury trend over time with an effect size of -0.22 (95% CI -0.47 to 0.03). One ITS study that evaluated the effect of legislation to ban Endosulfan pesticide on fatal pesticide poisonings increased the level of poisonings immediately after the introduction with an effect size of 2.20 (95% CI 0.97 to 3.43) but led to decrease in the trend of poisonings over time with an effect size of -2.15 (95% CI -2.64 to -1.66). One ITS study documented four different regulations aiming to increase the use of rollover protective structures (ROPS) on tractors and their effect on injuries and fatal injuries. The introduction of two different pieces of legislation requiring ROPS on new tractors sold after a certain date was associated with a decrease of fatal injuries over the long term (effect size -0.93 95% CI -1.02 to -0.03) but they were also associated with an increase of injuries in general (fatal and non-fatal injuries combined). Introduction of legislation requiring ROPS on all tractors, old tractors included, was not associated with a decrease but with an increase of injuries and fatal injuries over the long term.

AUTHORS' CONCLUSIONS

The selected studies provided no evidence that educational interventions are effective in decreasing injury rates among agricultural workers. Financial incentives could reduce injury rates. Legislation to ban pesticides could be effective. Legislation expanding the use of safety devices (ROPS) on new tractors was associated with a decrease in fatal injuries.

Injury and Illness Costs in the Certified Safe Farm Study

CONTEXT

The Certified Safe Farm (CSF) intervention program aims to reduce occupational injuries and illnesses, and promote wellness to reduce health care and related costs to farmers, insurers, and other stakeholders.

PURPOSE

To evaluate the cost effectiveness of CSF.

METHODS

Farms (316) located in a 9-county area of northwestern Iowa were recruited and randomized into intervention and control cohorts. Intervention farms received occupational health screenings, health and wellness screening, education, on-farm safety reviews, and performance incentives. For both cohorts, quarterly calls over 3 years were used to collect self-reported occupational injury and illness information, including costs to the farmers and their insurers.

FINDINGS

Annual occupational injury and illness costs per farmer paid by insurers were 45% lower in the intervention cohort ($183) than in the control cohort ($332). Although out-of-pocket expenses were similar for both cohorts, combined costs of insurance and out-of-pocket expenses were 27% lower in the intervention cohort ($374/year per farmer) compared to the control cohort ($512/year per farmer). Within the cohort of intervention farmers, annual occupational injury and illness cost savings were directly associated with on-farm safety review scores. Reported health care costs were $237 per farmer in the safest farms (those farms scoring in the highest tertile) versus $485 per farmer in the least safe farms (lowest tertile).

CONCLUSIONS

Results suggest that farmers receiving the intervention had lower health care costs for occupational injuries and illnesses than control farmers. These cost savings more than cover the cost of providing CSF services (about $100 per farm per year).

Sleep quantity and quality as a predictor of injuries in a rural population

This study aimed to assess the association of sleep disturbance and injuries in a rural population of Iowa. Study participants were 1345 adults who were enrolled in the KCRHS. Sleep problems were assessed based on self-reports at the beginning of the study. Injury information was collected by telephone interviews an average of every 6 months from August 1999 to June 2004. Sleeping for less than 7.5 hours increased the risk for injuries by 61% (rate ratio, 1.61; 95% confidence interval, 1.21-2.15) compared with sleeping for 7.5 to 8.5 hours (reference). Snoring frequency/severity and daytime fatigue/sleepiness were not significant in predicting the risk for injuries. Alcohol consumption of 1 to 2 or more drinks per day increased the risk for injuries among those who had sleep problems. Having adequate hours of sleep is important in preventing injuries. Avoiding alcohol consumption would be especially helpful in reducing injuries among people with sleep disturbance.

Cost of Compensated Injuries and Occupational Diseases in Agriculture in Finland

Although agriculture is one of the most hazardous industries, the costs of agricultural injuries and illnesses are not well known. This study aimed to determine the cost burden from compensated injuries and occupational diseases in Finnish agriculture using workers compensation records. The incidence rates in 1996 were 7.4/100 for injuries and 0.61/100 for occupational diseases. Men had a higher risk of injury (RR = 1.89; 95% CI: 1.81-1.97), but a lower risk of an occupational disease (RR = 0.68; 95% CI: 0.60-0.78), compared to women. The total cost burden was 75 (Euros) per person in 1983, increasing to 215 in 1999. The total insurance cost in 1996 was 23.5 million consisting of medical care (16%), per diem (lost time compensation within one year from the incident) (37%), pension (lost time compensation after one year from the incident) (23%), survivors pension (3%), impairment allowance (7%), rehabilitation (6%), and other costs (9%). The total cost was 0.7% of the national gross farm income and 2.2% of the net farm income. The mean cost of 1996 cases was 1340 for injuries and 6636 for occupational diseases. Injuries represented 92% of the claims and 71% of the total costs. Occupational diseases represented 8% of the claims and 29% of the costs. Twenty percent of the most severe claims represented 79.5% of the total insurance costs. Injuries and occupational diseases result in significant costs in agriculture. Lost time was the largest cost item. Overall, injuries were more costly than occupational diseases. This study indicates that the 20%-80% rule applies to agricultural injury and illness costs, and from the cost standpoint, it is important to focus prevention efforts on the most severe incidents.

A Comparison of Self-Reported Hearing and Pure Tone Threshold Average in the Iowa Farm Family Health and Hazard Survey

BACKGROUND

Self-reported hearing measures are useful for surveying hearing loss in a population because they are short, and easy to administer by either questionnaire or telephone. This study aims to assess the performance of several self-reported hearing measures to identify hearing loss in a group of Iowa farmers.

METHODS

The study subjects were 98 male farmers who participated in the Iowa Farm Family Health and Hazard Survey. We tested three self-reported hearing measures; the hearing screening questions, the Rating Scale for Each Ear (RSEE), and the Health, Education and Welfare-Expanded Hearing Ability Scale (HEW-EHAS), which were originally developed and implemented in the National Health Interview Survey. The sensitivity and specificity of the self-reported hearing measures were assessed by comparing them with pure tone threshold averages. These sensitivity and specificity measures were compared between younger and older age groups.

RESULTS

The sensitivities of the screening questions, RSEE, and HEW-EHAS were 73.0%, 66.7%, and 53.3%, respectively. The specificities of the self-reported hearing measures were similar, which ranged from 81.4% to 84.8%. The sensitivities of the self-reported hearing measures were higher in the younger age group while the specificities were higher in the older age group.

CONCLUSIONS

The results of this study support the use of simple screening questions in identifying hearing loss among farmers.

Hearing loss as a risk factor for agricultural injuries

BACKGROUND

Previous studies suggested that hearing impairment based on self-report might increase the risk of agricultural injuries. However, self-reported hearing measures may be subject to inaccuracy and subjective perception. We assessed the association of agricultural injuries with hearing loss and other hearing characteristics using measured hearing.

METHODS

Study subjects were 150 farmers who participated in the Iowa Certified Safe Farm study. Injury information was collected by telephone interviews at 2-5 month intervals from September 1999 to October 2002. Hearing levels were measured annually using the pure tone audiometry from 1998 to 2002. Adjusted rate ratios of injuries were calculated using the multivariate Poisson regression model.

RESULTS

Hearing loss in the better ear (RR = 1.62), hearing asymmetry (RR = 1.67), and fair/poor self-reported hearing (RR = 1.96) were significantly associated with the risk of agricultural injuries. It is notable that self-reported hearing might be a stronger predictor of injuries than pure tone audiometry (PTA). Exposure to noise elevated the risk of injuries in those farmers with hearing loss or hearing asymmetry. The occasional use of hearing protection was significantly associated with agricultural injuries.

CONCLUSIONS

This study adds substantial evidence that hearing loss acts as a risk for agricultural injuries. Prevention of hearing loss and noise exposure may be important in reducing the burden of agricultural injuries.

Effects of premium discount on workers' compensation claims in agriculture in Finland

BACKGROUND

The objective of this study was to measure changes in injury claim rates after a premium discount program was implemented in the Finnish farmers' workers' compensation insurance. We focused on measures that could indicate whether the changes occurred in the true underlying injury rate, or only in claims reporting.

METHODS

Monthly injury claim rates were constructed at seven disability duration levels from January 1990 to December 2003. We conducted interrupted time series analyses to measure changes in the injury claim rates after the premium discount was implemented on July 1, 1997. Three additional policy change indicators were included in the analyses.

RESULTS

The overall injury claim rate decreased 10.2%. Decreases occurred at four severity levels (measured by compensated disability days): 0 days (16.3%), 1-6 days (14.1%), 7-13 days (19.5%), and 14-29 days (8.4%). No changes were observed at higher severity levels. Minor injuries had a seasonal pattern with higher rates in summer months while severe injuries did not have a seasonal pattern.

CONCLUSIONS

The premium discount decreased the overall claim rate. Decreases were observed in all categories up to 29 disability days. This pattern suggests that under-reporting contributes to the decrease but may not be the only factor. The value of the premium discount is lower than the value of a lost-time claim, so there was no financial reason to under-report lost-time injuries. Under-reporting would be expected to be greatest in the 0 day category, but that was not the case. These observations suggest that in addition to under-reporting, the premium discount may also have some preventive effect.

Vegetable Oil Sprinkling as a Dust Reduction Method in Swine Confinement

The aim of this project was evaluate the effectiveness of an oil sprinkling system as a dust-reduction method for swine production facilities. This article presents the results of the second-year experiment of a multi-year study. The first-year experiment demonstrated that a 5% oil-water emulsion automatically applied at the rate of 3 and 5 g/pig/day achieved a 23% to 34% reduction in total dust. The modifications for the second year experiment included: (1) increasing oil application rate to 7 and 8 g/pig/day, (2) replacing sprinkler heads to achieve a smaller droplet size and a more direct spray pattern on pen-floor surfaces, and (3) more closely matching the treatment and control rooms by stage in the pig production cycle. Four swine finishing rooms were used for this study; two were treatment rooms (soybean oil at 7 g/pig/day, and canola oil 8 g/pig/day) and two were control rooms. The treatment rooms had a low-pressure oil-sprinkling system, which sprinkled 5% oil-to-water mixture 12 times per day, 12 s each time. Concentrations of several environmental contaminants were measured. The average total dust concentration in the control rooms was 1.39 mg/m3. The average total dust concentration in the treatment rooms was 0.65 mg/m3. The treatment reduced dust by an average of 52%, (p = 0.0001). There was no difference in the degree of dust control between soybean oil and canola oil. The respirable dust concentrations were very low in all rooms, and there were no significant differences between rooms in ammonia, carbon dioxide, temperature, or humidity.

Injuries in the Iowa Certified Safe Farm Study

The aims of this article are to assess injury characteristics and risk factors in the Iowa Certified Safe Farm (CSF) program and to evaluate the effectiveness of CSF for reducing injuries. This intervention program includes a health screening, on-farm safety review, education, and monetary incentives. Cohorts of farmers in an intervention group (n = 152) and control group (n = 164) in northwestern Iowa were followed for a three-year period. During the follow-up, there were 318 injuries (42/100 person-years), of which 112 (15/100 person-years) required professional medical care. The monetary cost of injuries was $51,764 ($68 per farm per year). There were no differences in the self-reported injury rates and costs between the intervention and control groups. Raising livestock, poor general health, and exposures to dust and gas, noise, chemicals and pesticides, and lifting were among risk factors for injury. Most injuries in this study were related to animals, falls from elevation, slips/trips/falls, being struck by or struck against objects, lifting, and overexertion. Machinery was less prominent than generally reported in the literature. Hurry, fatigue, or stress were mentioned as the primary contributing factor in most injuries. These findings illustrate the need for new interventions to address a multitude of hazards in the farm work environment as well as management and organization of farm work.

Mortality and morbidity in agriculture in the United States

This article summarizes the trends in agricultural injuries and illnesses in the past decade, as well as the needs for surveillance in the future. Agriculture is one of the most hazardous industries in the U.S. The fatality rate in agriculture remained high (about 22/100,000 workers) through the 1990s. and tractors remained the leading source of death, causing approximately 300 fatalities each year. Non-fatal injuries and illnesses decreased in the employed agricultural worker population. There are no adequate injury and illness data for self-employed farmers and family members to show trends over time. The reported injury rates have been 0.5 to 16.6/100 workers, based on the source of information. Many studies have shown high rates of respiratory and musculoskeletal symptoms, hearing loss, and skin disorders in agriculture. The overall cancer rate is lower; however, certain cancers are elevated in farmers. Surveillance information has not improved significantly in the past decade; however, many studies have provided more insight into the prevalence, incidence, and risk factors for injury and illness. Further efforts are needed to better define the populations at risk, including farmers and ranchers, family members, workers, migrant and seasonal workers, and others exposed to farm hazards. Fatalities are well documented, and it is important to continue existing surveillance in the future. Surveillance systems should be developed to collect information on agriculture-related non-fatal injuries and illnesses.

A systematic review of farm safety interventions

OBJECTIVE

The main objective of this study was to systematically review the existing evidence for the effectiveness of farm injury prevention interventions.

SEARCH STRATEGY

We used a systematic approach to search the following electronic databases: MEDLINE, EMBASE, ERIC, PsycInfo, Sociofile, NTIS, Agricola, Expanded Academic Index, Dissertation Abstracts, and Occupational Safety and Health (NIOSHTIC). Proceedings and technical papers of the National Institute for Farm Safety were reviewed. We also checked the references of potentially eligible studies and consulted with experts in the field to identify other relevant information sources.

SELECTION CRITERIA

Papers had to involve a farm safety intervention to be included in the review. To best characterize the current state of farm safety research, all study designs were accepted, including those without comparison groups and those with absent or inadequate evaluation methods.

RESULTS

We identified 25 studies for the review. Eleven of the studies involved farm safety education programs, five consisted of multifaceted interventions that included environmental revisions, a farm visit, or both; nine papers described farm safety interventions but did not report results from an evaluation. Farm safety education interventions included safety fairs, day camps; certification programs; workshops; and courses for farm families, youth, and agricultural workers. Multifaceted interventions were targeted to farm operators and generally involved farm safety audits, followed by environmental or equipment changes and/or safety education. Program evaluations assessed changes in safety attitudes, knowledge, and/or behaviors and generally involved pre- and post-test methodology. Only three studies examined changes in the incidence of farm injuries. Of the studies evaluated, most reported positive changes following the interventions. However, limitations in the design of evaluations make the results of many of the studies difficult to interpret.

CONCLUSIONS

There is a need for more rigorous evaluations of farm safety intervention programs. Suggested study design improvements include randomization of study subjects when appropriate, use of control groups and the objective measurement of outcomes such as behavior change and injury incidence.