Minneapolis, MN: University of Minnesota, PhD Dissertation, 2006 Feb; :1-376
Children living on agricultural operations have elevated risks of injury. Prior research has shown this risk to be correlated within families; children whose parents had sustained prior agricultural injuries were more likely to be injured than children whose parents had not. The current study explores potential causal explanations for intrafamilial risk of injury by examining associations between children's behaviors, environmental exposures, and injury. Data from the Regional Rural Injury Study-II, a population-based nested case-control study conducted in 1999 and 2001, were used to examine the hypothesized causal pathways. Computer-assisted telephone interviews aided collection of demographic, behavior, exposure, and injury data from agricultural households, for six-month recall periods. A total of 1,941 children, ages six to <20 years, were identified. This included 379 injury events (cases) and 1,562 randomly-selected controls. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using logistic regression, controlling for potential confounders by means of directed acyclic graphs. Results indicated that children's behaviors are potential risk factors for agricultural injury: elevated risks were identified for children with high levels of depressive symptoms (OR=2.0, CI=1.0--4.0) and aggression (OR=1.7, CI=0.9--3.0), and low levels of self-regulation (OR=0.4, CI=0.2--0.8) and careful/cautious behavior (OR=1.9, CI=1.2--3.1). This effect appears to be, at least partially, mediated through differential exposure to high-risk environments. For example, children with high, versus medium/low, levels of depressive symptoms were more likely to work with dairy cattle (OR=2.7, CI=1.3--5.5), while those with high aggression were more likely to ride on tractors (OR=1.7, CI=1.0--2.9) and operate large machinery (OR=1.7, CI=0.9--3.1). Intrafamilial injury did not appear to be mediated by high-risk behaviors and environmental exposures. Controlling for both, children whose parents reported past agricultural injuries had tripled risk, compared to those with neither parent injured (OR=3.1, CI=2.2--4.6). These results suggest that children's risk of injury is partially driven by their behaviors, which influence their high-risk environmental exposures. However, a more complex pathway, beyond that of the measured behaviors and exposures, is involved in observed intra-familial risks. These findings are important steps toward improved understanding of the causal pathways leading to children's injuries.
Age-factors; Age-groups; Agricultural-processes; Agricultural-workers; Agriculture; Analytical-processes; Behavior; Biological-effects; Children; Environmental-exposure; Environmental-factors; Environmental-hazards; Epidemiology; Exposure-assessment; Exposure-levels; Exposure-methods; Families; Farmers; Health-surveys; Herbicides; Injury-prevention; Mathematical-models; Medical-surveys; Occupational-exposure; Occupational-hazards; Occupational-safety-programs; Pesticides-and-agricultural-chemicals; Quantitative-analysis; Questionnaires; Risk-analysis; Risk-factors; Safety-education; Safety-measures; Safety-practices; Standards; Statistical-analysis; Surveillance-programs; Work-environment; Worker-health; Workers; Work-operations; Work-organization; Work-practices