Robert H. McKnight

Agricultural injuries among older Kentucky farmers : The Farm Family Health and Hazard Surveillance Study

This population-based study reports the cumulative incidence of agricultural injuries during a 1-year period in a sample of 998 farmers aged 55 years and older living in Kentucky. A total of 98 farm-related injuries were reported among 88 older farmers for a crude injury rate of 9.03 injured farmers per 100 farmers (95% confidence interval (CI) = 7.03-11.03) over a 1-year period. The leading external causes of farm injury were falls (24.9%), machinery (22.5%), wood-cutting (14.6%), and animal-related events (14.3%). Farmers working on farms with beef cattle (alone) (odds ratio = 1.90; 95% CI = 1.02-3.55) or farms with beef cattle and tobacco (odds ratio = 2.15; 95% CI = 1.00-4.59) had a statistically significant increased risk for a farm-related injury. Farmers reporting a prior injury that limited their ability to farm were at increased risk for a farm-related injury. Approaches to using farm injury surveillance data for injury control programs in the state are discussed.

Green tobacco sickness in children and adolescents.

Tobacco (Nicotiana tabacum) is cultivated in more than 100 countries, and in 2004, some 5.73 million metric tons dry weight of tobacco were grown worldwide. The top five tobacco producers forecast for 2004 are China (2.01 million metric tons; 35.1%), Brazil (757 thousand metric tons; 13.2%), India (598 thousand metric tons; 10.4%), United States (358 thousand metric tons; 6.2%), and Malawi (138 thousand metric tons; 2.4%). Together, these five countries account for two-thirds of worldwide tobacco production. Tobacco farming presents several hazards to those who cultivate and harvest the plant. Although some of these hazards, such as pesticide exposure and musculoskeletal trauma, are faced by workers in other types of agricultural production, tobacco production presents some unique hazards, most notably acute nicotine poisoning, a condition also known as green tobacco sickness (GTS). GTS is an occupational poisoning that can affect workers who cultivate and harvest tobacco. It occurs when workers absorb nicotine through the skin as they come into contact with leaves of the mature tobacco plant. GTS is characterized largely by nausea, vomiting, headache, muscle weakness, and dizziness. Historically, children have played a role in agricultural production in the United States, and they continue to do so today. This includes tobacco farming. The North American Guidelines for Childrens Agricultural Tasks, a set of injury prevention guidelines prepared by the National Childrens Center for Rural and Agricultural Health and Safety, lists GTS as one of several hazards children face when working on tobacco farms. Children 17 years of age and younger who work on U.S. tobacco farms come from three main groups: members of farm families, migrant youth laborers (primarily Latinos), and other hired local children. All three groups are at risk for GTS. Beyond the U.S., tobacco production using child labor is an emerging topic of concern in developing nations. An international movement, advocated by the Eliminating Child Labor in Tobacco Foundation, is underway to restrict child labor in tobacco production. GTS is a unique occupational poisoning associated with tobacco farming. We suspect that many public health practitioners, clinicians, advocates, and researchers are unaware of GTS among children and adolescents. In this article, we provide an overview of GTS among young people who work in tobacco, summarize reports documenting pediatric GTS cases, explain GTS etiology, and present three case studies of pediatric GTS in Kentucky. In addition, we discuss the need for expanded surveillance and prevention of GTS, both in the United States and globally.

The Process of Chore Teaching: Implications for Farm Youth Injury

&NA; This study explored parental views regarding suitable chores for farm youth, the process used in chore teaching, and the relationship between what parents teach about safety and the youths application of knowledge gained from teaching. Twenty‐three parents and 40 children participated in focus groups. Chore teaching consisted of parental appraisal of child readiness, child interest, safety rules, chore initiation, chore phasing, and chore modification. Parents allowed children to perform high‐risk chores when economically pushed or the available labor supply was inadequate. For safety behavior to be taught and role modeled by parents, the economic consequences of injury must be stressed.

Suicides among Farmers in Three Southeastern States, 1990-1998

Several studies have documented higher rates of suicide among farmers in comparison to other occupational groups, both in the U.S. and internationally. The purpose of this study is to describe the epidemiology of farmer suicides in three southeastern states (Kentucky, North Carolina, and South Carolina) during the nine-year period 1990-1998. Electronic death certificate data were obtained from the National Center for Health Statistics. Over the nine-year period, there were 590 deaths related to suicide (E-codes: 950-959) among farmers (occupation codes: 473, 474, 475, 477, and 479) in the states of Kentucky, North Carolina, and South Carolina. The results of this study confirm the increased rate of suicide mortality among white male farmers in comparison to the total white male population in these three southern states. The increased rate of suicide was significantly elevated among farmers age 25-34 years (RR: 2.07; 95% CI: 1.61-2.67) and among those age 75-84 (RR: 2.04; 95% CI: 1.70-2.45) and age 85 years and older (RR: 2.67; 95% CI: 2.02-3.54) in comparison to the total white male population.The use of a firearm was the primary mechanism of death for the majority (86%) of the cases. Farmer suicide mortality rates in the southeastern U.S. are higher than in Midwestern states. The elevated rate of white male farmer suicides in North Carolina over this time period (35% higher age-adjusted suicide rate in comparison to South Carolina) suggests a need for further investigation to assess the individual, social, and economic factors that may explain this elevated rate. Interventions for the prevention of suicide need to be directed to older male farmers who consistently have higher suicide rates than similar males in other occupations.

Spatial and temporal clustering of an occupational poisoning: the example of green tobacco sickness.

Nicotine poisonings in tobacco farm workers (Green Tobacco Sickness, GTS) reported to the Kentucky Regional Poison Center during 1991 were assessed for spatial, temporal and space-time clustering. Among 62 index cases, 10 had worked with others who also reported GTS that day. Analysis of index cases, using Best and Rayners V(2), showed significant cyclic clustering by hour of day the report was received (p = 9 x 10(-9)); chi-square revealed significant spatial clustering by agricultural district (p = 0.0002). Space-time clustering was detected using the E-M-M statistic (p = 0.008); however, the space-by-time interaction of Raos chi-square goodness-of-fit statistic did not detect space-time clustering (p = 0.32).

Intervening to Improve Health Indicators Among Australian Farm Families

ABSTRACT The Sustainable Farm Families project (http://www.sustainablefarmfamilies.org.au/) was a 3-year demonstration and education project designed to influence farmer behavior with respect to family health and well-being among cropping and grazing farmers in Victoria, New South Wales, and South Australia, Australia. The project was conducted by the Western District Health Service, Hamilton, Australia, in partnership with farmers; Farm Management 500 (peer discussion group); the Victorian Farmers Federation; Royal Melbourne Institute of Technology; and Land Connect. During the 3 years of the project, 128 farmers—men (70) and women (58)—were enrolled. The project utilized a combination of small group workshops, individualized health action plans, and health education opportunities to encourage farm safety and health behavior changes and to elicit sustained improvements in the following health indicators: body mass index (BMI), total cholesterol, fasting blood glucose, and blood pressure. Mean changes in these health indicators were analyzed using repeated measures analysis of variance (ANOVA) and McNemars test compared the proportion of individuals with elevated indicators. Among participants with elevated values at baseline, the following average reductions were observed: BMI 0.44 kg/m2 (p = .0034), total cholesterol 48.7 mg/dl (p < .0001), blood glucose 10.1 mg/dl (p = .0016), systolic blood pressure 12.5 mm Hg (p < .0001), and diastolic blood pressure 5.0 mm Hg (p = .0007). The proportion of participants with elevated total cholesterol at baseline decreased after 24 months (p < .001). Such findings suggest that proactive intervention by farmer associations, rural health services, and government agencies may be an effective vehicle for promoting voluntary farm safety and health behavior change while empowering farm families to achieve measurable reductions in important health risk factors.

Epidemiology, Surveillance, and Prevention of Farm Tractor Overturn Fatalities

ABSTRACT Census of Fatal Occupational Injuries data identify six states within or near the Appalachian mountain range that have the highest rates of agricultural tractor overturn deaths within the United States. Demographic and economic data that characterize farms in these six states were compiled from U.S. Department of Agriculture (USDA) 2002 Census of Agriculture files. Regional geological and geographic data were examined to identify topographic features within the six states. In combination, these data suggest that a majority of farms in these states are small acreage livestock operations, located on terrain with steep slopes, with annual value of sales <

Farm tractor safety in Kentucky, 1995

10,000 a year, total equipment valued at <

Familial Clusters of Green Tobacco Sickness

20,000, with low prevalence of tractors with rollover protective structures (ROPS), and operators who work at off-farm jobs >200 days per year. Variations in these variables across the six states are examined as compared to the pooled values for all six states, and as compared to the pooled values for all U.S. farms. Surveillance methods for identifying, targeting, and implementing ROPS-promotion efforts within these states are described.