A. Ryan

Child bystanding: A risk factor for injury and identifying its' determinants on midwestern agricultural operations

BACKGROUND Agriculture is considered among the most dangerous occupations and has consistently ranked among the top three. Production processes, associated with this occupation, place at risk not only workers but also others who live on the operations. We evaluated the incidence and determinants of associated bystander injuries in the Regional Rural Injury Study-II (RRIS-II). METHODS The RRIS-II followed 32,601 people ( approximately 85% of eligible) from rural communities in the Midwest for 1999 and 2001, using six-month recall periods, and identified their injury events. Demographic, injury, and exposure data were collected through comprehensive and case-control computer-assisted telephone interviews. Multivariate logistic regression analyses were used to estimate the risk of child bystanding and agricultural injury, while controlling for potentially confounding variables. RESULTS Nearly 60% of all 425-child injury cases (<20 years) responded to sometimes/frequently bystanding in six out of seven different agricultural environments (e.g., workshops, animal areas, etc.) Multivariate regression analyses, with odds ratios and 95% confidence intervals, showed increased odds of injury for bystanding near used (1.5; 1.1, 1.9) or stored (1.4; 1.1, 1.8) machinery, and near fields and barnyards (1.4; 1.0, 1.9). Further, multivariate analyses revealed increased odds of bystanding for parental beliefs, such as: child age (1.4; 1.0, 2.0) near stored equipment. Parental levels of strictness were also evaluated and showed decreased odds of bystanding when the parents were not strict about the childs wearing a seatbelt near used equipment (0.5; 0.3, 1.0). Households with only one child had decreased odds of bystanding for five of the exposures while there was an increased odds of bystanding near animals for households with five or more children. CONCLUSIONS Although parents cannot child-proof their operations, it is important for them to understand the apparent odds of and risks associated with bystanding. Children can have injury odds similar to adults in this environment; therefore, it is necessary to examine parental factors that may be associated with childrens likelihood of bystanding in high-risk work environments.

Bystander injury evaluation of children from Midwestern agricultural operations

BACKGROUND With more than a million youth living on agricultural operations, it is important for parents to understand the consequences of bystander injuries that children experience in these environments. We identified the childhood injuries for bystander status and compared the severity of these injuries to the working children in the Regional Rural Injury Study-II (RRIS-II). METHODS RRIS-II followed 16,546 children ( approximately 85% of eligible) from rural communities in the Midwest for two six-month recall periods in 1999 and 2001. Demographic, injury, and exposure data were collected through comprehensive computer-assisted telephone interviews. Child injuries were cataloged using narrative scenarios into four categories: (a) directly work-related; (b) indirectly work-related; (c) non-working accomplice; and (d) non-working attendant; the latter three all being bystander categories. Poisson regression modeling was used to calculate rates of bystander injuries. Frequencies were used for comparison of severity measures. RESULTS Among the 463 child injuries (aged <20yrs), 102 were bystander injuries. Of the bystander-related injuries, 14 were identified as indirectly work-related (working bystanders), 27 as non-working accomplice (passengers/tag-alongs), and 60 as non-working attendant (playing on the operation). The overall rate of bystander injuries was 6.4 per 1,000 people, 95% CI (5.0, 8.1). Males, compared with females, had more than twice the injury rate (8.7; 95% CI 6.4-11.8, and 3.9; 95% CI 2.7-5.7, per 1,000 people, respectively). Bystanders in this population had more severe injuries with 4% having life-threatening circumstances; of these, 4% of the accomplices and 2% of the attendants subsequently died. CONCLUSIONS Children who live or work on agricultural operations are vulnerable to many hazards. Therefore, this study examined child injuries and found a clear difference in the consequences of these injuries between working-related and bystanding-related injuries. IMPACT ON INDUSTRY Unlike occupations such as construction and mining, where laws and organizations have been created for the protection of bystanders, agricultural bystanders have remained unprotected and have had to face the consequent injury and death outcomes. As public health professionals considering these risks, it is necessary that we work to develop more intervention studies and continue to propose suggestive guidelines for child safety in these environments so as to challenge family traditions and possibly spark public policies that will give further protection to this population.

Work-related assault against educators with a history of violence victimisation

Work-related violence is consistently ranked among the leading causes of occupational death in the USA. In addition, approximately 2 million non-fatal work-related assaults are reported annually. A case-control study design was used to investigate risks of work-related physical assault (PA) associated with a history of violent victimisation among educators. A total of 6469 state-licensed educators (Kindergarten Grade 12) worked in the previous 12 months and were eligible to participate. Exposure data were collected from cases (reporting a PA event in previous 12 months, n=290) for the month before PA, and from controls (no work-related PA in previous 12 months; n=867) for a randomly selected working month. Potential confounders were identified for multivariable logistic regression from directed acyclic graphs; re-weighting adjusted for potential biases. OR and 95% CI identified increased risks for educators with any prior history of work-related (17.3, 11.4 to 26.3) or non-work-related PA (2.0, 1.2 to 3.5). In addition, PA risk in the previous 12 months increased with the number of previous victimisations. Using zero prior work-related PA as a reference, risks increased for those with number of prior events: 1–3 (15.0, 9.7 to 23.1); 4–10 (21.5, 10.5 to 44.2); and more than 10 (43.7, 17.1 to 111.3). Risk also increased for those with non-work-related PA prior events: 1–3 (1.8, 1.0 to 3.1) and 4 or more (7.8, 1.7 to 36.7). In addition, risks also increased for educators with histories of non-physical violence (threats, sexual harassment, verbal abuse, bullying) – both work- and non work-related. The results present a compelling case for targeted interventions and further research.

Short- and long-term consequences of agricultural injuries among children/youth and impact on agricultural operations: a case-control study

Occupational and residential environments overlap on agricultural operations, placing children/youths as well as adults at risk. This study was conducted to determine the short- and long-term physical, psychosocial and economic consequences of injuries occurring among children/youths living in operation households and the associated burden on the overall operations in Minnesota, Wisconsin, North Dakota, South Dakota and Nebraska Midwestern states characteristic of major types of United States agricultural production. From a random selection of 32 000 agricultural operations, generated from the states operations by the United States Department of Agriculture, 1474 eligible agricultural households participated. Baseline and follow-up data on physical and mental health, agricultural and other injury disability and economic status, were collected by trained interviewers using computerised assisted telephone interview data collection instruments; two 6-month injury data collection periods followed baseline collection. Among all household members, a total of 584 injuries were incurred with 250 related to their own agricultural operation. Respective child/youth case and control households, identified for these two 6-month periods were: (1) 100 cases (122 injuries), 366 controls; (2) 115 cases (138 injuries), 414 controls. Follow-up evaluation data were collected annually for each set, for the subsequent 2 years. Analyses focus on short-/long-term consequences, by examining changes between baseline, and follow-up data, comparing case and control households. Confounders are selected for multiple logistic regression analyses using directed acyclic graphs; reweighting adjusts for response and eligibility biases. Results of this effort address a serious deficiency in knowledge about the burden of agricultural and other injury consequences.