John J. May

Occupational hearing loss

Hearing loss is a significant and unfortunately common occupational malady. Over the past several decades both the Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health (NIOSH) have initiated efforts to better understand and to limit the occurrence of occupational hearing loss, particularly as it relates to excessive noise exposure. This paper briefly addresses the pathophysiology of noise-induced hearing loss and then describes the occupational and non-occupational factors which influence a workers risk of hearing loss. The primary foci of this discussion are the clinical evaluation, diagnosis, and management of occupational hearing loss. Issues of prevention, OSHA-mandated hearing conservation efforts and compensation are reviewed.

Hearing Conservation for Farmers: Source Apportionment of Occupational and Environmental Factors Contributing to Hearing Loss

Those who work on farms continue to have a strikingly high prevalence of hearing loss, despite efforts to promote hearing conservation in agriculture. To develop improved hearing conservation programs, we performed a source apportionment analysis for hearing loss in a large, multiphasic health survey, the New York Farm Family Health and Hazard Survey. We used information from audiometric, otoscopic, and tympanometric examinations; detailed general health and farm exposure interviews; and a second interview that focused on additional potential determinants of hearing loss. Hearing loss on audiometry was significantly associated with increased age, male gender, education through high school or less, lifetime years of hunting with guns, lifetime years of use of a grain dryer, and a history of spraying crops during the previous year. Hearing conservation programs for farmers should thus be directed toward reduction in noise exposure, both from occupational and non-occupational sources. Additional study is needed to evaluate the association seen between crop spraying and hearing loss.

An analysis of self-reported joint pain among New York farmers.

Data from the telephone interview portion of the New York State Farm Family Health and Hazard Surveillance Project were used to study the prevalence and predictors of joint pain in a cohort of farmers and farm residents. The participants were owner/operators, workers, and residents from a representative sample of farms from 12 New York counties. A total of 1706 participants completed a telephone interview on musculoskeletal conditions. Joint trouble was defined as self-reported aches, pain, or discomfort in the past year in each of five different joint areas. The 12-month prevalence of joint trouble was: lower back 41%, neck/shoulders 35%, knees 29%, hands/wrists 28%, and hips 15%. Using logistic regression modeling, significant risk factors for joint trouble were identified (p < 0.05). Older age and being female increased the risk of aches, pain, or discomfort in most joints. Being the owner/operator increased the risk of neck/shoulder and lower back trouble, and being a worker increased the risk of neck/shoulder trouble. Doing tractor work was associated with trouble in all five joint areas, and milking was associated with knee trouble. These findings indicate that personal risk factors and the intensity and nature of the farm work contribute to joint trouble. Ergonomic improvements to tractors and milking facilities should be a high priority.

Safety awareness among New York farmers.

BACKGROUND This study was conducted to assess the health status and safety practices among year-round adult farm workers and residents and included a telephone interview survey of 1,727 persons from 552 farms. METHODS Logistic regression was used to analyze four safety questions. RESULTS Among 541 farm owner/operators significant predictors of making substitutions in the use of chemicals and major changes to equipment include younger age, more persons assisting on the farm, and higher gross sales. Having training is associated with having more than a high school education. Among all participants the perception that personal protective equipment are useful is associated with being younger, male, an owner/operator or worker, and having at least a high school education. CONCLUSIONS These findings suggest that older and less educated farmers should be targeted for health and safety programs.

Occupational injury and treatment patterns of migrant and seasonal farmworkers.

ABSTRACT Migrant and seasonal farmworkers are thought to be at increased risk for occupational injury and illness. Past surveillance efforts that employed medical chart review may not be representative of all farmworkers, since the proportion of farmworkers using migrant health centers (MHCs) and area hospital emergency rooms (ERs) was unknown. The purpose of the current study was to determine the proportion of workers using MHCs versus other sources of occupational health care, and to use these data to correct previous occupational injury and illness rate estimates. Researchers conducted a survey of migrant and seasonal farmworkers in two sites: the Finger Lakes Region of New York and the apple, broccoli, and blueberry regions of Maine. Researchers also conducted MHC and ER medical chart reviews in these regions for comparison purposes. Proportions of occupational morbidity by treatment location were calculated from the survey, and a correction factor was computed to adjust chart review morbidity estimates for Maine and New York State. Among 1103 subjects, 56 work-related injuries were reported: 30 (53.6%) were treated at a MHC, 8 (14.3%) at an ER, 9 (16.1%) at some other location (e.g., home, relative, chiropractor), and 9 (16.1%) were untreated. Mechanisms of injuries treated at MHCs versus all other sources did not differ significantly. The survey-based multiplier (1.87) was applied to previous statewide MHC chart review injury counts from Maine and New York. The corrected injury rates were 7.9 per 100 full-time equivalents (FTE) per year in Maine, and 11.7 per 100 FTE in New York. A chart-review based surveillance system, combined with a correction factor, may provide an effective method of estimating occupational illness and injury rates in this population.

Improving agricultural injury surveillance: a comparison of incidence and type of injury event among three data sources.

BACKGROUND Agriculture ranks as one of the most hazardous industries in the nation. Ongoing injury surveillance is key to identifying and preventing major sources of injury. OBJECTIVE The objective of this study was to compare the total number and types of injuries identified from community reporting versus two newly available medical data systems. These new systems are important because they are less time consuming and expensive to maintain. METHOD Farm injury case records from 2007 were collected for 10 NY counties from the following sources: ambulance reports, hospital data, and community surveillance data. RESULTS For the 107 ambulance report cases, horses (35%), tractors (15%), and livestock (10%) were the three leading injury sources. For the 261 hospital cases, the leading sources were hand tools (24%), farmstead machinery (23%), and buildings/structures/surfaces (22%). Tractor injuries (37%) were the most common source of injuries identified by the 44 community surveillance cases. Struck by object was the most frequent injury event type for hospital and surveillance data (34%, 30%). Falls were the highest category for ambulance reports (36%) and were also common for hospital data (29%). Nine of the 11 fatal cases were found through community surveillance. CONCLUSION Ambulance reports and hospital data contribute a large number of additional farm injury cases to existing surveillance data. From these cases, horse injuries, falls, and hand tool injuries appear to play a larger role in farm injuries. Future research should explore how to best use these electronic resources for agricultural injury surveillance.

Tractors and rollover protection in the United States.

ABSTRACT There are approximately 4.2 million tractors on farms and ranches across the United States. The average age of tractors is over 25 years and some of the oldest models are the most popular. Older tractors are less safe than newer tractors, and many older tractors are operated by individuals with increased risk of being injured or killed on a tractor. A key tractor safety device, a rollover protective structure (ROPS), is missing from most tractors manufactured before 1985. Data from the US Department of Labors Census of Fatal Occupational Injuries (CFOI) suggest that the production agriculture sector accounts for approximately 70.3% of the 3299 work deaths in the Agriculture, Forestry, and Fishing industry between 2003 and 2007. Nearly 900 of these incidents involve farm tractors and of these, approximately 43% were from tractor overturns. Efforts to reduce both the number of tractor overturn fatalities and injuries have been underway for years. These efforts primarily encompass worker education/training programs and activities, ROPS design and engineering applications, and research on more effective ways of encouraging tractor owners to retrofit their older tractors with ROPS. This paper reviews various approaches available to reduce the fatalities, serious injuries, and economic burden associated with tractor overturns. Past and current efforts to promote ROPS in the United States and in other countries, current safe tractor operations education and training programs, and ROPS-related safety engineering projects are discussed. Recommendations for advancing safe tractor operation and the number of tractors protected by ROPS are given. This review was prepared for the Agricultural Safety and Health Council of America/National Institute for Occupational Safety and Health conference, “Be Safe, Be Profitable: Protecting Workers in Agriculture,” January 2010.

The Social Marketing of Safety Behaviors: A Quasi–Randomized Controlled Trial of Tractor Retrofitting Incentives

OBJECTIVES We assessed the effect of social marketing incentives on dispositions toward retrofitting and retrofitting behavior among farmers whose tractors lacked rollover protective structures. METHODS From 2006 to 2007, we conducted a quasi-randomized controlled trial with 391 farm owners in New York and Pennsylvania surveyed before and after exposure to 1 of 3 tractor retrofitting incentive combinations. These combinations were offered in 3 trial regions; region 1 received rebates; region 2 received rebates, messages, and promotion and was considered the social marketing region; and region 3 received messages and promotion. A fourth region served as a control. RESULTS The social marketing region generated the greatest increases in readiness to retrofit, intentions to retrofit, and message recall. In addition, postintervention stage of change, intentions, attitudes, subjective norms, and perceived behavioral control levels were higher among farmers who had retrofitted tractors. CONCLUSIONS Our results showed that a social marketing approach (financial incentives, tailored messages, and promotion) had the greatest influence on message recall, readiness to retrofit tractors, and intentions to retrofit tractors and that behavioral measures were fairly good predictors of tractor retrofitting behaviors.

Noise and chemical induced hearing loss: special considerations for farm youth.

Abstract Farm youth face multiple risks for injury and illness in agriculture. Reviewed here is evidence from current literature illustrating the noise and chemical exposure hearing risks that farm youth potentially face. Sources of noise (e.g., machinery) and potentially toxic chemical exposures (e.g., solvents and pesticides) common in the farm environment are reviewed, illustrating the need for heightened research attention to a problem that may affect up to 2 million children in the United States alone and that requires both public and occupational health solutions. As existing studies have not sufficiently explored potential ototoxic effects of these exposures on children and adolescents, recommendations are outlined for research characterizing both chemical and noise exposures to farm youth and their combined effects on hearing.

Encouraging the installation of rollover protective structures in New York State: the design of a social marketing intervention

Aims: Increasing the percentage of rollover protective structure (ROPS) equipped tractors has been the focus of many agricultural safety campaigns. Traditionally efforts have attempted to persuade farmers through education or community awareness interventions. These efforts have lead to marginal change. In response, a social marketing approach was tested as a means for increasing interest in ROPS retrofitting in New York. Methods: An initial phone survey was conducted with a random sample of New York farmers to identify a potential target population. Following target selection, in-depth interviews were conducted to isolate barriers and motivators to retrofitting. This information was used to develop message prototypes which were tested in small focus group discussions. Selected and revised messages, as well as various other incentives developed in response to feedback from interviews, were then tested in a prospective, quasi-randomized controlled trial. Results: Small crop and livestock farms were selected as the intervention target since they represent 86% of New York farms with none or only one ROPS protected tractor. Barriers to retrofitting which were identified in interviews were: 1) constant exposures normalize risk, 2) risk is modeled by significant others and 3) safety in general and retrofitting in particular requires too much time and money. The piloting of ROPS incentives led to a marked increase in ROPS sales in New York. Conclusions: Social Marketing provides a promising framework for the design of agricultural injury prevention programs. The potential implications for other health initiatives seeking to promote behaviour change are also discussed.