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A5.1 Evaluation of a National Rural Youth Safety Initiative-Lee BC, Westaby JD, Berg RL, Kiu L

In 1997 the National FFA implemented its Partners for a Safer Community initiative, aimed at promoting agricultural safety and health among youth through education, community development and youth leadership at 4,000 FFA chapters across the U.S. With funding from NIOSH, a comprehensive evaluation was conducted to assess the program's impact on students' knowledge, attitudes, practices, and leadership skills, as well as development of community partnerships. Using a randomized controlled trial design, 110 FFA chapters in ten rural states were randomly assigned to a Standard intervention ( implemented nationwide), an Enhanced intervention (included Standard intervention plus mail/phone contacts, additional resources and financial incentive to motivate safety training interactions between FFA chapters and community nurses) or a Control group. Data from FFA Advisors and students were collected pre- and post intervention using a 70-item questionnaire with scales for self-esteem, safety knowledge, safety consciousness, risk taking, and leadership (all scales had internal consistency > .75). Self-generated identification codes matched students' and Advisors' responses in the beginning and end of an academic year. Data from Enhanced group community nurses were collected per telephone interviews.

Pre-intervention data were collected from 8,068 students (68% = male; 42% farm residents, 83% FFA members, 84% were 17 years or younger) and post-intervention data from 5,926 students. Of these, 3,081 were matched individuals. Using ANOVA and ANCOVA analytic procedures, data of matched individuals revealed minimal difference between experimental and control groups, thus, limited impact of the Partners...program. Even with a financial incentive for collaboration, 37% of community nurses (n=30) reported no contact, 57% reported spending five or fewer hours and only 5% nurses reported spending six to ten hours interacting with the FFA Chapter. Of ten factors affecting Partners... implementation, FFA Advisors reported "extremely busy with various school responsibilities" most strongly.


A5.2 Etiology and Consequences of Injuries Among Children in Farm Households: Regional Rural Injury Study-II-Gerberich SG, Gibson RW, French LR, Masten A, Renier C, Church TR, Luan X, Shutske J, Carr WP

While there is some evidence about the magnitude of agricultural-related fatality among children, there is limited information about morbidity and the risk factors for both morbidity and mortality. This effort addresses both etiology and consequences of agricultural injury in the five state region of Minnesota, Wisconsin, North Dakota, South Dakota, and Nebraska. Following a pilot study to test the methods and data collection instruments, lists of farm operations for each state maintained by the United States Department of Agriculture, were sampled randomly to select farms for participation in the project. The research design employs an eligible cohort of 4,000+ farm households, including children less than or equal to 19 years of age and involves unique methods for collecting data, simultaneously, for both risk factors and incidence/consequences of agricultural injuries.

A brief participation interview established eligibility for the study (i.e., actively involved in farming/ranching, as of January 01, 1999, and if the household included children); and to determine willingness to participate in the full study, involving two subsequent comprehensive interviews to collect data for two six month periods. A specially designed Computer Assisted Telephone Interview (CATI) instrument, administered by trained interviewers, included: 1) Household Log - basic demographic information; 2) Injury Log - injury occurrences (January 1-June 30 and July 1- December 31) and consequences; and 3) Exposure Section - exposures to potential risk factors on the farming/ranching operation for cases and randomly selected controls (3:1) <19 years of age.

In addition to descriptive analyses, logistic regression is used to model the dependence of injury on each exposure of interest and corresponding confounders. The ability to identify the risk factors, incidence rates, and consequences of injury is critical for providing sound scientific data for the development of focused intervention efforts.


A5.3 Farm Work Injuries to Children on Kentucky Beef Cattle Farms-Browning SR, Westneat SC, Szeluga R

Injury surveillance efforts in Kentucky have identified farming operations with beef cattle as associated with an increased injury risk to workers compared to other commodity farms. Examining the risk of farm-related injury among children, particularly on farms with beef cattle, is pertinent in Kentucky because its 71,000 family-owned farms use child labor to a greater degree than other states.

We report baseline results from a three-year longitudinal cohort study of children aged 5-18 years working on family farms in Kentucky. The primary intent of the study is to characterize the work tasks and exposures of these children-an estimated 41% of whom live on beef cattle farms-and to investigate a diverse set of potential risk factors for their work-related injuries. Parental or guardian proxies of a cohort of children (N= 450) are being interviewed every six months regarding the work exposures of the children and injury events which lead to a loss of time from farm work or school. Detailed data collection efforts regarding farm management practices on family farms are also being implemented.

Preliminary data indicate that adolescent males age 16-18 years had the highest rate of farm work injuries (9.2 injured children per 100 per year). Machinery, animals, contact with inanimate objects, and falls were the primary external causes of nonfatal farm work injuries among children age 5-18 years. Beef cattle farms with an annual farm income of more than $10,000 per year reported 70% of children age 10-18 work half or more days per year on the farm.

Our data suggest that rates of farm work injuries among adolescent males working on family farms may be higher than other states. At the meeting, further results related to the ongoing injury surveillance and assessment of children's agricultural work exposures will be presented.


A5.4 Case-Control and Case-Crossover Studies of Agriculture Related Injuries to Children and Adolescents-Alexander BH, Keifer MC, Rivara FP

Agriculture related injuries are a recognized occupational and paraoccupational health problem for children living and working in rural areas.

Case-control or case-cross over study designs are appropriate methods for studying the determinants of agriculture related injury in children and adolescents. However, several considerations must be made in the design and conduct of such studies to account for the nature of these injuries and the population understudy. Using examples from an on-going study of childhood injuries in Washington state, the problems of case ascertainment, control selection, and relevant exposure assessment are presented.

Case identification requires multiple information sources to locate cases in a region and adequately describe the injuries. Coding schemes are not reliable for identifying agricultural injuries so clinic and hospital records must be manually searched. The specificity of these records will vary considerably.

Controls must represent the agricultural exposure experience of the population that gave rise to the cases. This constraint poses several methodological and logistical problems when identifying the control population. The seasonal nature of agriculture makes the exposure window critical when assessing risk factors for injury. The exposure assessment must also account for variation in baseline environmental and behavioral risk factors across subsets of injured and non-injured children.

The use of a case-crossover study design eliminates the problem of valid selection of controls and is potentially useful for examining transient risk factors. However, the identification of appropriate hazard periods and assessing exposure within those periods is problematic.

The study of etiologic factors of agriculture related injury to children and adolescents is required to further develop effective prevention programs. The case-control and case-crossover study designs are appropriate if investigators are mindful of the potential limitations.

This work is supported by Grant Number 1R01/CCR516767-07 from the U.S. National Institute for Occupational Safety and Health.




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