The impact of agricultural injury on farm owners and workers in Alabama and Mississippi

BACKGROUND: Few studies have assessed the consequences of agricultural injury and none have done so comparing Caucasian and African-American farm owners and workers. METHODS: 1244 farmers were enrolled and prospectively observed between 1994-1996 for farming-related injuries. Injured farmers provided information on the consequences of injuries. RESULTS: One-hundred and thirty-one subjects reported a total of 140 injuries. The majority of injuries were classified as minor or moderate and required medical attention. African-American farm workers tended to have more severe injuries. Nearly all injured subjects experienced acute residual effects (e.g., pain when moving), while persistent effects occurred in about half of the injured subjects, the latter being more common among African-American workers. Lost work was a frequent nonmedical effect of the injury. African-American workers tended to be more likely to lose work and/or be hurt financially. CONCLUSIONS: The impact of agricultural injury is nontrivial, particularly for African-American farm workers. The provision of better medical care facilities for African-American farm workers may be a positive approach for reducing the impact of agricultural injuries in this population.     

History of agricultural injury among farmers in Alabama and Mississippi: prevalence, characteristics, and associated factors

BACKGROUND: There have been no studies of the prevalence, characteristics, and factors associated with the history of prior farm injury among active farmers. No studies have had adequate numbers of black farmers to evaluate farm owner/farm worker and black/white similarities and differences. METHODS: Our sample is based upon surveys administered to 1,310 active male farmers in nine rural counties in Alabama (5) and Mississippi (4). The farmers are white owner/operators (53.6%), black owner/operators (26.6%), and black workers (19.8%). RESULTS: Overall, 23.4% of the farmers had a prior injury. Prior injury was more frequent among white owner/operators (29.1%), compared with black workers (18.9%), and black owner/operators (15.2%). In multiple logistic regression analyses, post-high school education and tiredness when farming were independently associated with prior injury in black owner/operators. In white owner/operators, age > or = 60 years, post-high school education, full-time farming, tractor use, more pieces of machinery, hurry when farming, and alcohol consumption were associated with prior injury. In black workers, only being very careful was associated with prior injury. CONCLUSIONS: The results suggest that prevention efforts focusing on alcohol consumption, fatigue, and hurry when farming might reduce injuries; however, only a follow-up study of this sample can determine whether these associations reflect causal factors, recall, or selection bias.     

Increased risk of asthma among Finnish construction workers

AIM: To determine the risk of asthma among 7891 Finnish construction workers in the Pirkanmaa Region of southern Finland. METHOD: Retrospective cohort study of hospital records of the Tampere University Hospital. A population of Pirkanmaa paper mill workers (n=2686) and the Pirkanmaa working age population (n=252,500) served as reference populations. RESULTS: There were 147 new cases of asthma among the construction workers in 1991-1995. The annual rate was 37 per 10,000 workers and the odds ratio was 2.1 [95% confidence interval (CI)=1.2-3.6] for the women and 1.8 (95% CI=1.5-2.2) for the men when compared with the general working age population. In general, the risk of asthma among the paper mill workers did not differ from the risk of asthma among the general working age population. The construction workers had an increased risk for asthma, although the number of reported cases of occupational asthma was lower for the construction workers than for the paper mill workers or for the working population. CONCLUSION: Construction work, especially dusty tasks, was associated with an elevated risk of asthma. Thus the effect of exposure to irritant agents may have a role in the development of asthma among construction workers. For the most part, these cases of asthma do not meet the criteria for occupational asthma because the specified causal agent can not be defined. The aetiologic agents and mechanisms of asthma in construction work should be clarified for preventive measures.     

Sleep patterns and risk of injury among adolescent farm residents

BACKGROUND: Sleep patterns have been associated with decreased alertness among adolescents and to a limited extent, increased risk of injuries. The purpose of this study is to describe the relationship between sleep patterns and injury occurrence among adolescents aged 13 to 18 years living on farms in Colorado. METHODS: A cross-sectional survey of randomly selected Colorado farm residents aged 13 to 18 years was conducted between August 2003 and April 2004. A total of 262 youth completed the study. Information was obtained on injuries within the preceding year, sleep patterns, sleep hours, daytime sleepiness, and a number of social and demographic variables. Univariate analyses were done to describe relationships of study variables with injuries. Multivariate modeling was done to assess sleep patterns that were associated with injuries controlling for other variables. RESULTS: Sleep patterns associated with increased risk of injuries (p<0.05) included oversleeping and having been late for class; falling asleep in afternoon classes; ever being up past 3 am; sleeping less than an average of 9.25 hours per night on weekends, and on school nights and weekends combined; and sleeping less than an average of 8.5 hours on weekends, and on school nights and weekends combined. CONCLUSIONS: Sleep patterns were significantly associated with occurrence of injuries.     

Tuberculosis risk among migrant farm workers on the Delmarva peninsula.

A survey was conducted to ascertain the risk of tuberculosis (TB) among migrant farm workers on the Delmarva peninsula. Relevant histories were obtained from 842 migrants; a total of 709 skin tests were completed, and 239 sputum specimens were examined for acid-fast bacilli (AFB) and culture. No cases of infectious tuberculosis were ascertained by history or AFB examination. One sputum culture was positive for M. tuberculosis and 13 were positive for various species of nontuberculous mycobacteria. Thirty-seven per cent of migrants tested had significant skin test reactions of 10 mm or more. Reaction rates for men were 41 per cent and for women 25 per cent. Age specific rates ranged from 14 per cent in children aged 5-14 to 54 per cent for ages 45-54. Rates for the principal national/ethnic groups were Haitians 55 per cent, Mexicans 36 per cent, US Blacks 29 per cent and US-born Latinos 20 per cent. Based on these results and other information currently available, it is recommended that current Centers for Disease Control (CDC) recommendations for TB prophylaxis continue to be applied for migrant workers, but that mass screening by skin testing in camp populations not be emphasized. Other recommendations focus on: case finding of active disease, improving continuity and follow-up, increasing coordination among involved agencies, and actively supporting improved economic and living conditions for migrant farm workers.     

PMR study of mortality among Alabama workers and farmers

Computerized records of all Alabama deaths occurring to persons 16 years of age and over for the 5-year period 1984-1988 were obtained from the Alabama Department of Public Health. Using proportionate mortality ratio (PMR) methodology and death certificate occupation, cause-specific mortality patterns were examined for all Alabama decedents (N = 182,178), for all Alabama workers (N = 125,369), and for the occupational group of “farm operators and managers” (N = 11,691). In comparison with the U.S. general population, little difference was found between cause-specific PMR results for the total Alabama population and those for all workers, suggesting the absence of a generalized “healthy worker effect.” In comparison with the U.S. population, PMR results for farmers suggested lowered mortality from all malignant neoplasms and all heart disease, and elevated mortality from all external causes of death. In comparison with the Alabama population, PMR results for farmers continued to suggest lowered mortality from all malignant neoplasms, specifically for cancers of the respiratory, digestive and lymphopoietic systems. However, significantly elevated PMRs for external causes of death appeared only among nonwhite female farmers. Further investigation of these deaths suggested that this finding was more likely attributable to an increased risk of housefire deaths associated with rural lifestyle than with occupational factors.     

Tuberculosis among Pennsylvania migrant farm workers

The purpose of this study was to determine the tuberculin positivity rates and the incidence of sexually transmitted diseases (STDs) among a population of seasonal, nonmigrating farm workers. Participants were tested for tuberculosis (TB) sensitivity, syphilis, gonorrhea, and chlamydia. Patients were afforded follow-up even if they returned home to Mexico during the course of their treatment. We found that the TB rate (15%) and the incidence of STDs to be significantly lower than in other studies of migrant populations. We hypothesize that exposure to urban commercial sex workers who frequent many migrant camps may be involved in the transmission of TB. Further research is needed to determine the incidence of TB among commercial sex workers and the extent to which transmission occurs between these two populations. We also describe our follow-up program and recommend a closer adherence to the Centers for Disease Control and Prevention guidelines with respect to adequate health education and disease prevention.     

Agricultural injuries among a population-based sample of farm operators in Alabama

A population-based study of the occurrence of agricultural injuries during the previous year was conducted in a simple random sample of 1,000 farm operators in Alabama in 1991. The participation rate was 86.2%. The cumulative 1-year incidence was 9.9% (95% CI = 7.7–12.1), based on the number of injuries, and 7.8% (95% CI = 5.8–9.8), based on the number of farmers injured. Limbs were the body parts most frequently injured: fingers (10.7%), hands or wrists (10.7%), and legs (8.9%). The leading external causes were machinery (28.6%), falls (23.2%), and animals (12.5%). There was a higher injury frequency at the end of the week, with a Saturday peak. Seasonal pattern of injury displayed a bimodal curve, one peak in spring, and a higher peak in early fall in September. The most risky farm types were forestry and dairy. The factors predictive of increased injury risk in multiple logistic regression included younger age, farm ownership, greater percent of working time spent on farming, more alcohol consumed, and prior residual injury. The results provide some indications for formulating agricultural injury control programs and for future research. © 1994 Wiley-Liss, Inc.     

Prostate cancer risk in California farm workers

Previous studies have evaluated prostate cancer in farm-working populations and most, although not all, have found an elevated risk of this cancer in farmers and farm workers. Specific occupational risk factors have not been identified. A nested case-control study of prostate cancer was conducted within a large cohort of a predominantly Hispanic labor union in California, the United Farm Workers of America. By conducting an electronic record linkage between a roster of the union members and the California Cancer Registry for the years 1988 through 1999, newly diagnosed cases of prostate cancer were identified within the union. Age-matched controls were randomly selected from the remainder of the cancer-free cohort. Risk for prostate cancer was examined by examining the type of crops and commodities cultivated by the farm workers as well as by the date of first union activity and duration of union affiliation. In addition, the risk of prostate cancer was evaluated in association with use of several pesticides recorded by the California Department of Pesticide Regulation. Between 1988 and 1999, 222 newly diagnosed prostate cancer cases were identified for analysis and 1110 age-matched controls were selected. The risk of prostate cancer was not associated with patterns of employment in any crop/commodity. Increasing duration of union affiliation was associated with decreasing prostate cancer risk. Although risk was not associated with total pounds of pesticides applied in the years and counties where farm workers were employed, risk was increased with specific chemicals, including simazine, lindane, and heptachlor, and suggestive increases were observed with dichlorvos and methyl bromide. We concluded that Hispanic farm workers with relatively high levels of exposure to organochlorine pesticides (lindane and hepatachlor), organophosphate pesticides (dichlorvos), fumigants (methyl bromide), or triazine herbicides (simazine) experienced elevated risk of prostate cancer compared to workers with lower levels of exposure.     

Cancer risk among female agricultural workers: a multi-center case-control study.

BACKGROUND: Cancer risk among women engaged in farming has been poorly investigated. This group of female workers is of particular interest, however, since they may experience exposure to several potential agricultural hazards. METHODS: A hospital-based case-control study was conducted in five Italian rural areas to examine the association between cancer and farming among women. The areas selected were located in three different regions (i.e., Piedmont, Tuscany, and Emilia-Romagna). The following cancer sites were selected for the study: stomach, colon, rectum, lung, skin melanoma, skin non-melanoma, breast, cervix and corpus uteri, ovary, bladder, kidney. Cases of non-Hodgkin's lymphoma were also included. Altogether, 1,044 newly diagnosed cases aged 20-75 years were ascertained from hospital records from March 1990 to September 1992, and for 945 of them detailed information was collected by a standard questionnaire. The analyses of data were performed comparing each case series to a reference group drawn from among the other sites. Unconditional logistic regression models were used in the statistical analyses. RESULTS: Statistically significant increased risks in association with farming were estimated for skin melanoma (OR 2.7, 95% CI 1.2-5.8) and bladder cancer (OR 2.7, 95% CI 1.2-6.1). Lung cancer was also found increased but not at a statistically significant level (OR 1.7, 95% CI 0.7-4.4). An OR lower than unity was observed for postmenopausal breast cancer (OR 0.4, 95% CI 0.3-0.7). CONCLUSIONS: The present study suggests that women in farming might experience increased risk of cancers, not usually found in excess among male farmers, as well as a protective effect for postmenopausal breast cancer. The role of different patterns of exposure or gender specific responses should be considered in further studies.     

Increased risk of hepatitis E in sewage workers from India

Considering feco-oral transmission of hepatitis E virus (HEV), the risk of the infection was assessed among sewage workers. On the basis of the close contact with sewage, the participants (n = 147) were divided into sewage workers (n = 92) and others (n = 55); none used personal protective equipment (eg, coveralls, boots, gloves) Age-matched individuals from lower socioeconomic status and without any exposure to sewage were used as controls. IgG-anti-HEV positivity in enzyme-linked immunosorbent assay was significantly higher (P < 0.01) among staff members (83/147, 56.5%) than the controls (19%). A significant rise in anti-HEV positivity (P < 0.05) was recorded in sewage workers working for >5 years. Multivariate regression analysis identified contact with sewage as the independent variable associated with anti-HEV positivity. Strict adherence to good working practices must take top priority for protection of these workers from sewage pathogens.     

Increased risk for hepatitis A among female day nursery workers in Belgium

To assess the risk for hepatitis A virus (HAV) infection inan occupational group potentially at risk for faeco-oral contactwith very young children, a prevalence study of total anti-HAVantibodies (lgG/lgM) was conducted among 591 female employeesin day nurseries in Flanders, Belgium, and in a reference groupof 560 healthy female blood donors, matched for age. Analysiswas also performed on formally exposed persons (n=413) versusblood donors (n=560). The overall prevalence of HAV markerswas 48.4% (95% Cl: 44.2–52.5) in exposed day nursery personnel,compared with 42.9% (95% Cl: 38.7–47.0) in blood donors.The age-specific prevalence rates showed a steeper rise fromthe age of 30 years among the exposed employees than among theblood donors, with significantly higher prevalences between35 and 44 years of age. The discrepancies levelled off above60 years of age. Standardization for parenthood using logisticregression did not affect the odds ratio. These results arein line with recent findings of a higher prevalence of HAV markersamong groups of workers professionally exposed to small children.Appropriate measures for the protection of these groups shouldbe taken.     

Agricultural injury in California migrant Hispanic farm workers

BACKGROUND: Agriculture is among the most hazardous industries in the United States. METHODS: A longitudinal study of injury among migrant Hispanic farm workers residing in six Northern California Migrant Family Housing Centers (MHCs) during the 1997 harvest season was conducted. Participants completed an initial interviewer-administered work-and-health questionnaire at the beginning of the harvest season addressing the preceding year; there were three periodic follow-up surveys. RESULTS: There were 1,201 adult farm workers (participation 85.2%) who completed the initial questionnaire. Of these, 837 (69.7%) completed the final follow-up survey. There were 86 agricultural injuries (incidence 9.3/100 full-time equivalent employees (FTEs), 95% CI 7.5-11.5/100 FTE). Increased risk for agricultural injury occurred among women paid piece-rate (RR 4.9, 95% CI 1.8-12.8). Sprains and strains were most common (31%), followed by lacerations (12%). CONCLUSIONS: Agricultural injury experience in this cohort is comparable to that of agricultural workers in other U.S. settings. Increased risk among women paid piece-rate suggests further study and potential policy changes regarding payment regimens. Heterogeneity of injury in this population presents a major prevention challenge. In view of high frequency of strain and sprain injuries, ergonomic interventions deserve further study.     

Perceived cancer risk and risk attributions among African-American residents of a low-income,predominantly African-American neighborhood

Objective. In some national surveys, African-Americans have had lower scores on perceived cancer risk items than whites. Our goals were to confirm low perceptions of cancer risk in an African-American community sample and explore participants' attributions for their perceived cancer risk.

Design. Data were from three cross-sectional surveys. We report levels of perceived absolute and comparative cancer risk in a community sample of African-Americans (N = 88), and African-Americans (Ns = 655, 428) and whites (Ns = 5262, 1679) from two nationally representative Health Information National Trends Surveys (HINTS). We analyzed the content of spontaneously-provided explanations for perceived risk from the community sample.

Results. Perceived absolute and comparative cancer risk were lower in the community and national samples of African-Americans than in the national sample of whites. Participants' spontaneous attributions for low or lower than average risk included not having family history or behavioral risk factors, classes of attributions noted elsewhere in the literature. However, participants also explained that they wanted to avoid wishing cancer on themselves (positive affirmations) and hoped their risk was low (wishful thinking), responses rarely reported for majority-white samples.

Conclusions. Results provide further evidence that cancer risk perceptions are lower among African-Americans than whites. Some participant explanations for low perceived risk (wishful thinking, affirmations) are inconsistent with behavioral scientists' assumptions about perceived risk questions. Results reveal a need to expand cancer risk attribution typologies to increase applicability to diverse populations, and may indicate that perceived cancer risk questions have lower validity in African-American populations.     

Tuberculin reactivity among California Hispanic migrant farm workers

We conducted a cross-sectional study of tuberculin reactivity among residents of two northern California migrant-farm-worker housing centers. Participants completed a brief health questionnaire and were offered tuberculin skin testing with radiologic and medical follow-up. Four hundred and sixty-nine persons (estimated participation rate: 70%) completed questionnaires. All but one were Hispanic. Two hundred and ninety-six (63%) participants completed tuberculin skin testing and 49 (16.6%) showed reactivity (≥10 mm induration at 48–72 hours). Increased prevalence was seen for the 15–39-year age group (vs. persons younger than 15: OR 2.59; 95% CI 0.79–8.47), former smokers (vs. never smokers: OR 3.11; 95 %CI 1.20–8.09), and persons born outside the U.S. (OR 2.09; 95% CI 0.66–6.61). Prophylaxis with isoniazid was recommended for 23 persons; nine (39%) completed therapy. No cases of active tuberculosis were found. Prevalence of tuberculin reactivity in this population is lower than reported among Hispanic farm workers in the eastern and midwestern U.S. Higher prevalence may obtain among California farm workers not included in the study population, including homeless, single, and highly mobile persons. Public-health efforts in this population should focus on ever-smokers, young adults, and persons born outside the U.S. Am. J. Ind. Med. 32:600–605, 1997. © 1997 Wiley-Liss, Inc.     

Occupational mortality patterns among British Columbia farm workers

To examine mortality risks for farm laborers proportional mortality ratios (PMRs) were calculated for 2,328 British Columbia farm workers who died at age 20 years or over during the period 1950 through 1978. Significantly fewer deaths than expected from degenerative heart disease (PMR = 91, p less than .01) and from all cancers combined (PMR = 78, p less than .001) were observed. Deaths from bronchitis and emphysema (PMR = 70, p less than .05) were also fewer than anticipated. Elevated risks of death were found for accidents (PMR = 129, p less than .001), for homicide (PMR = 242, p less than .01), and for pneumonia (PMR = 146, p less than .001).     

Pesticide-related symptoms among farm workers in rural Honduras

A survey of 96 families in a rural region of Honduras, conducted in 1998, showed that 80 of these predominantly (95 or 96) farming families used pesticides in their work or at home. Paraquat was used most often, and safety measures were very rarely taken in its use. Seventy-seven families stored pesticide containers in their homes, often within the reach of children. Every worker who used paraquat had at least one symptom potentially related to its use, and the prevalences of childhood disorders in the region are abnormally high compared with national averages.