Incorporating Occupational Health Interventions in a Community-Based Participatory Preventive Health Program for Farm Families: A Qualitative Study

ABSTRACT

The purpose of this pilot study was to determine the willingness of the farm community to participate in a farm safety health initiative (expanding a community-based health program to include elements of the Certified Safe Farm program), as well as understand farmers' experiences with participation in the intervention. Focus groups and individual interviews were held to explore farmers' experience with the expanded health screening and on farm safety review. Results indicate that incorporation of the expanded intervention was well accepted amongst participants in this study.     

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).     

Farmer Assessment of the Certified Safe Farm Program

ABSTRACT

This article summarizes the qualitative findings from a study evaluating a novel agricultural health and safety program called Certified Safe Farm (CSF). Results are presented from focus groups held in 2002 and 2006 as well as mail-out surveys conducted in 2001 and 2002. Focus group participants and survey responders were farmers involved in CSF intervention studies. CSF aims to remove hazards through on-farm safety reviews, detect health concerns through clinical screenings, provide personalized occupational health and wellness education, and provide incentives for meeting farm safety targets. Farmers overwhelmingly felt that CSF was beneficial for their health and safety by improving their knowledge and behaviors. In both the focus groups and questionnaires, farmers felt that occupational health screening was the most important component of CSF, and on-farm safety review was the second most important component. Farmers also helped to identify areas in which CSF could be improved in the future. Major areas of suggested program improvement included increased involvement of entire farm families, increased enrollment of younger farmers, increased program incentives such as reduced insurance premiums, and increased ease of access to program providers (AgriSafe clinics), among other recommendations.     

Health Indicators of a Cohort of Midwest Farmers: Health Outcomes of Participants in the Certified Safe Farm Program

Occupational illness, injury, and fatality rates for those working in production agriculture are higher than in any other industry. A potential risk factor contributing to occupational injuries across all industries is acute or chronic co-morbidity (e.g., obesity, high blood pressure, high cholesterol), and related health issues that increase the risk for an occupational injury or illness. These chronic health conditions have been associated not only with increased risk for injuries, but also higher health-care costs, and greater absenteeism. Certified Safe Farm (CSF) is a comprehensive intervention program aimed to reduce occupational health and safety hazards and to promote general health among farmers. Prior publications have described CSF program efforts to reduce hazardous exposures, disabling injuries, organic dust toxic syndrome, occupational health-care costs, and to increase positive occupational health behaviors. This paper reports on the general health indicators of a cohort of 438 Iowa farm owner/operators enrolled in the CSF program. Overall, this study found that the farming population in Iowa has higher body mass index (BMI), but lower total cholesterol, low-density lipoprotein (LDL), and lower prevalence of hypertension compared to the general population. There was evidence that the combination of high blood pressure, cholesterol, and BMI were related to increased injury rates. Poor self-reported health status was also related to increased injuries but was not related to clinical health indicators. The CSF intervention led to improvements on health outcomes, particularly among those in the 35 to 49 age group. Little research has focused on the individual’s general health status as a predictor of risk of occupational injury. This study suggests the need for additional research and interventions integrating occupational safety and health prevention along with health promotion.     

Assessment of Personal Protective Equipment Use Among Farmers in Eastern North Carolina: A Cross-sectional Study

ABSTRACT

Agriculture consistently ranks among the top hazardous occupations, accounting for a significant number of injuries and fatalities in the workplace. Eastern North Carolina has a significant number of small, independent, family-run, owned, and operated farms. However, little is known about perception, behavior, training, accessibility, or purchasing personal protective equipment (PPE) for safety among farmers in the region. In this study, telephone interviews were conducted among participating farmers between March and June 2012 (N = 129). Univariate and bivariate analyses were conducted to examine associations between PPE behavior and workplace hazards, health-related concerns, and wearing and purchasing PPE. Findings indicated that personal behavior of wearing hearing protection devices (HPDs) and protection from the sun among farmers was low. However, a relatively high percentage of farmers reported wearing PPE when working with agricultural chemicals. Most farmers received training from agricultural extension offices. The findings indicate that, in general, farmers are well aware of the risks associated with occupational hazards and recognize concern for health and safety protection in the workplace. Transitioning these concerns into preventative action remains a challenge and priority for the agricultural health professional.     

Variations in associations of health risk behaviors among ethnic minority early adolescents

PurposeTo investigate patterns of vulnerability and protection factors associated with risk behaviors and the co-occurrence of risk behaviors in minority ethnicity early adolescents.MethodsAnalysis of data from the Research with East London Adolescents Community Health Survey (RELACHS), a school-based study of a representative sample of 2789 adolescents age 11–14 in 2001 (sample 73% non-Caucasian, 21% born outside the United Kingdom). Questionnaire data were obtained on sociodemographic variables, ethnicity, smoking, drinking, drug use, psychological well-being, physical health, and social support from family and peers. Models of associations for each behavior and co-occurrence of risk behaviors (defined as engaging in ≥ 2 behaviors) were developed by hierarchical stepwise logistic regression.ResultsTwo hundred ninety-two (10.9%) reported 1 risk behavior, 84 (3.1%) reported 2, and 25 (0.9%) reported 3 behaviors. In multivariate models, psychological morbidity was associated with higher risk of all behaviors and co-occurrence, while higher family support was associated with lower risk in all models. Non-Caucasian ethnicity was associated with lower risk of regular smoking and co-occurrence but not drinking or drugs. Birth outside the United Kingdom was associated with lower risk for individual behaviors but not co-occurrence. Religion and religious observance were associated with lower risk of smoking and drinking but not drug use or co-occurrence. Peer connectedness was associated with drug use, but with increased risk. Socioeconomic status was associated only with smoking.ConclusionsPatterns of associations of personal, family, and environmental factors appear to differ between smoking, drinking, lifetime drug use, and the co-occurrence of these behaviors. Hypotheses regarding common factors related to health risk behaviors may be misleading in ethnic minorities and immigrants. Co-occurrence may represent a distinct behavioral domain of risk that is partly culturally determined.     

Personal protective equipment (PPE) use and its relation to accidents among construction workers

Background:The construction industry is characterized by a high prevalence of accidents and injuries. Inadequate risk management measures, including failure to use or incorrect use of personal protective equipment (PPE) may significantly increase the risk of accidents.Objectives:The main objectives of the current study were to measure the prevalence of PPE use and accidents and their associated factors among construction workers.Methods:A cross-sectional field study with an analytic component was carried out on 384 workers from different sites in Port-Said, Egypt, using an interview administered questionnaire. The questionnaire included sociodemographic and occupational data, practice of PPE use and accident analysis.Results:About 60% of workers use PPE during work. Main reasons for non-use are discomfort, lack of knowledge on how to use it and poor fit. Occupational accidents in the last 12 months were reported by 64.3% of workers. The main accident types were: being hit by falling objects, falls from height, and tool related accidents. Safety training was the significant independent predictor of PPE use (AOR=2.0). However, age, marital status, smoking, safety training, and PPE use were also significant independent predictors of accidents (AOR=2.4, 3.1, 0.5, 0.5, and 0.2; respectively).Discussion:Among construction workers, PPE utilization is low with significant relation to safety training while occupational accidents are common and significantly related to safety training and PPE use. Therefore, safety training should be provided, and PPE use should be enforced at construction sites.Key words: Accidents, construction, PPE, safety     

我国布鲁氏菌病重点地区高风险职业人群个人防护用品使用及影响因素分析

目的 了解我国布鲁氏菌病（布病）高风险职业人群个人防护行为现状,为评估我国布病防治计划实施效果提供科学依据。方法 选择山西省和新疆维吾尔自治区的4个县,采用横断面调查方法,于2019年12月至2020年7月对布病高风险职业人群开展问卷调查。结果 共调查高风险职业人群2 384人,个人防护用品规范使用率为20.13%（480/2 384）,手套、口罩、胶鞋和工作服4种主要个人防护用品的使用率分别为38.26%（912/2 384）、31.80%（758/2 384）、32.01%（763/2 384）和30.87%（736/2 384）。不同年龄、职业、文化程度、地区的人群不同防护用品的使用率和规范使用率的差异有统计学意义（均P<0.001）,≥60岁、女性、农民、文化程度较低的人群各种防护用品的使用率和规范使用率均较低。多因素分析结果显示,职业和地区是布病个人防护用品规范使用的影响因素,牧民和兽医的个人防护用品规范使用率更高;阳高县和霍城县的高风险职业人群的个人防护用品规范使用率明显高于左云县和浑源县。结论 我国布病重点地区高风险职业人群4种主要个人防护用品使用率均不高,规范使用率低,不同地区差异很大,与防治计划目标差距较大,亟需向高风险职业人群发放防护用品,并开展易于接受的个人防护使用的宣教活动,加强各地经验交流和沟通。     

Assessment of personal protective equipment use among Midwestern farmers

BACKGROUND: Personal protective equipment (PPE) is readily available and widely recommended, yet usage among agricultural workers is largely unknown. METHODS: A mail survey of 2,483 farmers in six Midwestern states with telephone follow-up addressed PPE usage related to sun exposure, noise abatement, chain saw usage, welding and metal work, handling of large animals in and out of confinement facilities, feed handling, manure storage facilities, and mixing and applying chemicals. Summary statistics of survey responses were compiled. RESULTS: With the exception of welding masks, PPE usage was low. Farmers were satisfied with availability of PPE through local hardware and farm cooperatives, but the decision to use PPE was personal and influenced little by outside parties. CONCLUSION: PPE usage rates by farmers on Midwestern farms need to be increased. The desire of the individual farmer to reduce risk of personal injury or exposure should be targeted. The most effective venue will be local agricultural extension services.     

The Influence of Childhood Physical Abuse on Adult Health Status in Sexual Minority Women: The Mediating Role of Smoking

BackgroundAmong women in the general population, childhood physical abuse (CPA) is associated with poor adult health status and engagement in health risk behaviors. Sexual minority women (SMW) are at elevated risk of CPA, have higher rates of smoking, and may be at higher risk for poorer general health. In this study, we examined the influences of CPA on health status in a diverse sample of SMW. We hypothesized that SMW with a history of CPA would report poorer health than those without such histories and that early onset of smoking—an important health risk behavior—would mediate the relationship between CPA and current health status.MethodsStructural equation modeling was used to evaluate the influence of CPA on early health risk behavior (i.e., age of smoking onset) and current perceived health status in a community based sample of 368 SMW.ResultsMore than one fifth of the sample (21.5%) reported a history of CPA. One fourth of the sample was current smokers; the average age of smoking onset was 19 to 20 years old. The mean level of self-rated health status was between “fair” and “good.” When relationships were simultaneously estimated, the effect of CPA on health status was mediated by two sequential smoking factors: CPA was associated with earlier age of smoking onset, and age of smoking onset was associated with current smoker status. Being a current smoker had a negative effect on perceived health status.Implications for Practice and/or PolicyThese results suggest that tobacco use is an important pathway by which CPA influences current health status. Prevention and early intervention initiatives should focus on the reduction of CPA among SMW to eliminate the long-term health consequences of adverse childhood events among SMW.     

Occupational safety measures and morbidity among welders in Vellore,Southern India

Background: Welders in the unorganized occupational sector in the economically developing world are exposed to respiratory, skin, eye, ear, and neurological problems exacerbated by non-usage of personal protective equipment (PPE).

Objective: To study the frequency of health problems and the usage of PPE among welders in unorganized welding units in Vellore, India.

Methods: A cross-sectional survey was conducted among 150 welders to determine the frequency of skin, ear, eye, and respiratory morbidity and the usage of PPE. A group of 150 non-welders were chosen for comparison.

Results: Significant differences in the frequency of skin burns, redness, hyper pigmentation, itching, eye injuries, and sensorineural deafness were observed among the welders and non-welders (P < 0.001). Hypertension was noted in 12.6% of the welders as compared to 0.7% among the non-welders. None of the welders used appropriate PPE. For welders, low educational attainment was associated with an increased risk of eye injury (P < 0.05, OR = 0.29). There was also a significant difference between sensorineural deafness and a welder having less than 10 years of welding work experience (P < 0.001, OR = 18.18) which could probably be accounted for by the healthy worker effect.

Conclusion: Welders in this sample experienced a significant skin, eye, and ear morbidity accentuated by the non-usage of PPE. All worked without formal training and were unaware of the safe working guidelines that exist, but are not implemented for the welders in India.     

Use of protective equipment among California farmers

BACKGROUND: Agriculture is a hazardous industry associated with many occupational injuries and illnesses. We describe California farmers' self-reported exposure to five agricultural hazards and their use of protective equipment. METHODS: A telephone survey of 1,947 California farmers recorded information on occupational exposure, health outcomes and use of protective equipment to lessen risk from exposure to dust, sun, noise, pesticides and tractors. RESULTS: Over 93% of respondents reported using personal protection around pesticides; however, fewer than 1/3 used consistent protection against other hazards. Younger age and male sex were associated with better use of protection from dust, noise, pesticide and tractors, but negatively associated with sun protection. There was no consistent relationship of protective behaviors with cigarette smoking, living on the farm, marital status, or time in non-administrative farmwork. Risk perception was strongly associated with behavior; farmers concerned about specific health problems were much more likely to use protective equipment. CONCLUSIONS: Some farmer characteristics are associated with more safe behaviors, but efforts to encourage protective behaviors on farms should be broadly based in view of a lack of a single risk-taking profile among California farmers.     

Prevalencia y factores asociados al consumo de tabaco en alumnos de enseñanza secundaria de Cataluña

ObjectiveThe aim of this study was to analyze those factors associated with cigarette smoking in adolescent school children, in order to plan future school interventions for promoting good health strategies developed by the schools and Primary Health Care professionals.DesignCross-sectional study with a two-stage cluster sampling.SettingThe study included 97 schools, and was carried out in 2005-06 in Catalonia (Spain).Participants14-16 year-old secondary school children.Main measuresThe survey was based on a self-administered paper-based questionnaire that collected sociodemographic variables, academic level, health status, family variables, sexual relations, addictive substances, mood state, and variables related to opinions on cigarette smoking The association between these variables and smoker/non-smoker variable was analyzed, as well as factors that could increase the probability of becoming a smoker using multilevel models.ResultsA total of 9340 completed questionnaires, including 4653 from males, were received from the pupils, with a mean age of 15.2 years. The results showed that 71.1% of pupils were non-smokers, 75% of whom were males and 67.3% of females. The following factors increased the probability of becoming a smoker (OR and 95%CI): being a female 0.60 (0.53-0.68), being in the 4^th year 1.27 (1.12-1.43), low academic performance 3.38 (2.74-4.17), self-reported regular/poor health status 2.81 (2.21-3.58), smoking parents 1.68 (1.45-1.95), alcohol consumption 5.05 (4.35-5.86), having 3 or more problems of mood state 1.22 (1.05-1.41), living without parents 1.59 (1.07-2.38), agreeing with tobacco industry advertising 1.64 (1.45-1.85) and believing that tobacco acts as a relaxant 3.57 (3.23-4.17).ConclusionsAlthough the majority of pupils were non-smokers, smoking was more prevalent among females. The factors associated with cigarette smoking in the adolescents included sociodemographic, sociocultural, and personal environmental factors, as well as their opinions on the habit.     

Staffing and Protective Equipment Access Mitigated COVID-19 Penetration and Spread in US Nursing Homes During the Third Surge

ObjectivesDuring the last quarter of 2020—despite improved distribution of personal protective equipment (PPE) and knowledge of COVID-19 management—nursing homes experienced the greatest increases in cases and deaths since the pandemic's beginning. We sought to update COVID-19 estimates of cases, hospitalization, and mortality and to evaluate the association of potentially modifiable facility-level infection control factors on odds and magnitude of COVID-19 cases, hospitalizations, and deaths in nursing homes during the third surge of the pandemic.DesignCross-sectional analysis.Setting and ParticipantsFacility-level data from 13,156 US nursing home facilities.MethodsTwo series of multivariable logistic regression and generalized linear models to examine the association of infection control factors (personal protective equipment and staffing) on incidence and magnitude, respectively, of confirmed COVID-19 cases, hospitalizations, and deaths in nursing home residents reported in the last quarter of 2020.ResultsNursing homes experienced steep increases in COVID-19 cases, hospitalizations, and deaths during the final quarter of 2020. Four-fifths (80.51%; n = 10,592) of facilities reported at least 1 COVID-19 case, 49.44% (n = 6504) reported at least 1 hospitalization, and 49.76% (n = 6546) reported at least 1 death during this third surge. N95 mask shortages were associated with increased odds of at least 1 COVID-19 case [odds ratio (OR) 1.21, 95% confidence interval (CI) 1.05-1.40] and hospitalization (1.26, 95% CI 1.13-1.40), as well as larger numbers of hospitalizations (1.11, 95% CI 1.02-1.20). Nursing aide shortages were associated with lower odds of at least 1 COVID-19 death (1.23, 95% CI 1.12-1.34) and higher hospitalizations (1.09, 95% CI 1.01-1.17). The number of nursing hours per resident per day was largely insignificant across all outcomes. Of note, smaller (<50-bed) and midsized (50- to 150-bed) facilities had lower odds yet higher magnitude of all COVID outcomes. Bed occupancy rates >75% increased odds of experiencing a COVID-19 case (1.48, 95% CI 1.35-1.62) or death (1.25, 95% CI 1.17-1.34).Conclusions and ImplicationsAdequate staffing and PPE—along with reduced occupancy and smaller facilities—mitigate incidence and magnitude of COVID-19 cases and sequelae. Addressing shortcomings in these factors is critical to the prevention of infections and adverse health consequences of a next surge among vulnerable nursing home residents.     

Factors Influencing Poisoning Symptoms: A Case Study of Vegetable Farmers Exposed to Mixed Insecticides in Prek Balatchheng Village,Cambodia

This study aimed to identify factors influencing poisoning symptoms among 153 mixed insecticide–exposed vegetable farmers in one Cambodian village, where 153 factory workers were selected as a comparative nonexposed group. The research instruments were questionnaires and reactive-paper test kits. The majority of vegetable farmers were male, with approximately 87% of the total participants with an average age of 34 years. The personal hygiene scores of most vegetable farmers (108; 70.8%) were moderate, and knowledge scores were at poor level (131; 85.6%). Abnormally low cholinesterase (ChE) levels were detected among 119 (77.8%) farmers. Multiple logistic regression analysis was used to identify factors associated with possible poisoning symptoms. This study found that mixing an average of four to six types of insecticides (odds ratio [OR] = 4.6; P = .03) and abnormal ChE level (OR = 4.09; P = .004) was associated with central nervous system (CNS) symptoms. Age group >45 years (OR = 2.8; P = .04) and type of vegetable “other” (OR = 2.73; P = .02) were associated with gastrointestinal symptoms. Type of insecticide, organophosphates (OPs) and carbamates (CMs) (OR = 3.2; P = .04), was associated with respiratory symptoms. It is recommended that farmers should reduce insecticide spraying times, increase their use of personal protective equipment (PPE), and undergo training on insecticide use. These combined measures should improve the insecticide-related health status of vegetable farmers in this area.     

山东省小学生吸烟行为与健康素养的相关性分析

目的 探讨4~6年级小学生吸烟行为与健康素养的相关性。方法 采用多阶段分层整群抽样方法,以问卷形式调查2017年山东省4~6年级小学生健康素养水平及烟草使用情况,收集调查对象一般人口学资料、健康素养水平、吸烟情况,采用二分类logistic回归分析烟草使用与健康素养的相关性。结果 共发放9 240份调查问卷,合格问卷9 210份,调查对象应答率为99.7%。4~6年级小学生现在吸烟率为2.6%,男生现在吸烟率（3.1%）高于女生（2.0%）;总体健康素养水平为60.8%,其中男生为56.7%,女生为64.9%。吸烟者健康素养水平为14.4%,非吸烟者为62.0%。logistic回归分析显示,影响吸烟的自变量有年级、父亲文化程度、经济发展水平、自我评价学习成绩和健康素养水平（P<0.01）。控制了混杂因素影响后,不具有健康素养水平小学生吸烟率是具有健康素养水平的8.62倍（1/0.116）。结论 山东省4~6年级小学生吸烟行为与健康素养水平存在相关性。     

贫困农村地区高血压患病率及相关危险因素的调查报告

探讨了贫困农村地区高血压患病率及易患因素。初步调查结果表明，高血压患病率明显高于全国其他农村地区，是高血压发病高发区。汉族男性患病率高于回族男性，主要与回族男性因宗教信仰限制吸烟、饮酒而导致吸烟率、饮酒率低有关；同时，也与回族村民高盐饮食率低有关。高血压与超重及肥胖、吸烟、饮酒、口味偏成、常吃腌菜及腌肉等因素密切相关。笔者认为。本次调查的突出见解是：当地村民普遍常年吃腌成菜和腌肉(汉族)是导致高血压患病率高的最重要的原因，是今后开展高血压健康促进工作时．对村民不良生活习惯实施干预工作的重中之重。