2013 Paper Awards

Student award:
A Vehicle Rollover/Accident Prevention, Education, Training and Emergency Reporting System. Bo Liu and Ali Bulet Koc TP 2013-6.

Randomized Trial of a Hearing Conservation Intervention for Rural Students: Long-term Outcomes. 2011. Barbara Marlenga, PhD, James G. Linneman, BA, William Pickett, PhD, Douglas J. Wood, AuD, Steven R. Kirkhorn, MD, MPH, Steven K. Broste, MS, Mary Jo Knobloch, MPH, Richard L. Berg, MS. Pediatrics, V128(5): 1139-1146.


OBJECTIVES: We had the rare opportunity to conduct a cluster-randomized controlled trial to observe the long-term (16-year) effects of a well-designed hearing conservation intervention for rural high school students. This trial assessed whether the intervention resulted in (1) reduced prevalence of noise-induced hearing loss (NIHL) assessed clinically and/or (2) sustained use of hearing protection devices.

METHODS: In 1992–1996, 34 rural Wisconsin schools were recruited and 17 were assigned randomly to receive a comprehensive, 3-year, hearing conservation intervention. In 2009–2010, extensive efforts were made to find and contact all students who completed the original trial. Participants in the 16-year follow-up study completed an exposure history questionnaire and a clinical audiometric examination. Rates of NIHL and use of hearing protection were compared.

RESULTS: We recruited 392 participants from the original trial, 200 (53%) from the intervention group and 192 (51%) from the control group. Among participants with exposure to agricultural noise, the intervention group reported significantly greater use of hearing protection compared with the control group (25.9% vs 19.6%; P = .015). The intervention group also reported significantly greater use of hearing protection for shooting guns (56.2% vs 41.6%; P = .029), but the groups reported similar uses of protection in other contexts. There was no significant difference between groups with respect to objective measures of NIHL.

CONCLUSION: This novel trial provides objective evidence that a comprehensive educational intervention by itself may be of limited effectiveness in preventing NIHL in a young rural population.


Journal of Agromedicine
Volume 16, Issue 1, 2010
Special Issue:
Incidence and Cost of Nonfatal Farm Youth Injury, United States, 2001–2006
Full accessDOI:10.1080/1059924X.2011.534714
Eduard Zaloshnja PhDa*, Ted R. Miller PhDa & Barbara C. Lee PhDb
pages 6-18

Available online: 04 Jan 2011


The objective of this study was to estimate the annual incidence and cost of nonfatal farm youth injury in the United States for the period 2001–2006. The authors used 2001–2006 Childhood Agricultural Injury Survey data to estimate the annual incidence of farm youth nonfatal injury. To estimate the costs for injuries suffered by youth working/living on the farm, the number of injuries was multiplied by published unit costs by body part, nature of injury, and age group. The annual
number of nonfatal injuries to youth (ages 0–19) on farms in 2001–2006 was 26,570. The annual cost of nonfatal farm youth injuries was $1 billion (in 2005 dollars), with 26% of costs related to working on the farm and 47% on beef cattle farms. Around 9.3% of the cost was medical costs, 37.2% work and household productivity loss, and 53.5% quality of life loss.

Keywords: Farm youth, injury costs, injury incidence


Special Issue: Protecting Children in Agriculture

Developing the 2012 National Action Plan for Protecting Children in Agriculture. 2012. Barbara C. Lee PhD, Susan S. Gallagher MPH, Amy K. Liebman MPA, MA, Mary E. Miller RN, MN & Barbara Marlenga PhD.

Journal of Agromedicine, Volume 17, Issue 2, pages 88-93


In 1996 the US launched a National Childhood Agricultural Injury Prevention Initiative, guided by an action plan generated by a 42-member multidisciplinary committee. A major update to the plan was released following the 2001 Summit on Childhood Agricultural Injury Prevention. From the year 2010 through 2011 a comprehensive assessment of progress to date was conducted followed by the drafting, review and finalizing of a new action plan—“The 2012 Blueprint for Protecting Children in Agriculture.” This paper briefly describes the purpose and process for generating the new action plan then provides a listing of the 7 goals and 26 strategies within the plan. These goals and strategies account for trends in childhood agricultural injuries, changes in agricultural production and the demographics of its workforce, effectiveness of interventions, and the increasing use of social media, marketing and social networking. Primary funding for this project was provided by the National Institute for Occupational Safety and Health (NIOSH), which continues to serve as the lead federal agency for the national initiative.


Factors Associated with the Prevalence of Non-ROPS Tractors on Farms in the U.S.
Citation: Journal of Agricultural Safety and Health. 16(4): 267-280. @2010
Authors: J. R. Myers


Rollover protective structures (ROPS) are an effective engineering control known to prevent tractor overturn deaths, the leading cause of occupational fatalities for farmers and farm workers in the U.S. However, the use of ROPS is known to vary greatly from farm to farm. A national sample of 11,458 farm operators from the 2004 Occupational Injury Surveillance of Production Agriculture (OISPA) survey was used to assess the association between the prevalence of ROPS and ten farm operator and farm demographic variables using logistic regression.

The variable were: operator’s age, operator’s sex, operator’s education, farm sales, full- or part-time farming, acreage, type of operation, number of hired workers, number of injuries, and region. All ten variables were found to have significant associations with the prevalence of non-ROPS tractors on farms in the univariate logistic regressions. For the multivariate model, all variables except for the sex of the farm operator remained significant. Farms with less than three adult injuries, no hired workers, less than 300 acres in size, a Midwest location, and a primary farm type of tobacco, fruit and nuts, dairy, or poultry and eggs all had adjusted odds ratios of 2 or greater. Increasing the prevalence of ROPS-equipped tractors is essential for reducing the leading cause of death on farms, tractor overturns. Economic factors play a major role in the prevalence and distribution of non-ROPS tractors on farms. The identified associations can be used to effectively target areas of the U.S. for ROPS promotion activities.


Journal of Agromedicine

Volume 14, Issue 2, 2009
Special Issue: Sixth International Symposium: Public Health and the Agricultural–Rural Ecosystem

Epidemiology, Surveillance, and Prevention of Farm Tractor Overturn Fatalities
Full accessDOI:10.1080/10599240902805991
Henry P. Cole EdD, Robert H. McKnight MPHScD & Teresa A. Donovan MPH
pages 164-171
Available online: 12 May 2009


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 <$10,000 a year, total equipment valued at <$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.

KEYWORDS: Demographics, economics, farm, fatalities, tractor-overturn


Evaluation of a Farm Safety Day Program: Participants and Non-Participants Over a One-Year Follow-Up Period

Citation: Journal of Agricultural Safety and Health. 15(3): 255-271. @2009
Authors: D. M. McCallum, M. B. Conaway, S. J. Reynolds


Safety education Farm safety day programs are attended each year by thousands of children in rural communities. This evaluation of a national farm safety day program assessed changes in knowledge and reported behaviors among safety day participants, aged 8 to 13 years, and a comparison group of children who did not attend a safety day. The outcome evaluation involved a quasi-experimental design with participants and non-participants, measured with a pre-test, three-month telephone follow-up, and one-year telephone follow-up survey. The study included 621 children from a sample of 28 safety days administered throughout North America and 413 non-participants recruited from the same or nearby communities. The survey instruments measured participants knowledge of safety hazards, knowledge of appropriate safety behaviors, and current practices with regard to safety behaviors. While both participants and non-participants showed improved safety knowledge and safe behavior scores over time, there were significantly greater increases in knowledge and behaviors for the safety day participants than for the non-participants. Improvements occurred for all age levels and were sustained through the one-year follow-up assessment. This study contributes to the body of evidence that such safety programs can have a long-term effect on the knowledge and safe practices of children who attend them.



FS4JK Farm Safety Day Camps: Who Learns the Most?
Citation: Journal of Agricultural Safety and Health.
15(1): 5-17. @2009
Authors: D. B. Reed, D. T. Claunch, M. K. Rayens


Farm Safety 4 Just Kids uses daylong community-based farm safety day camps as a primary method to instruct children about the hazards in farm environments. This article describes children’s knowledge about farm safety before and after a day camp experience and assesses differences in knowledge gain by farm residency status and by gender as a result of their attendance at the camps.

Data collection focused on three high-risk farm exposures: tractors, powered equipment, and large animals. A 32-item pre- and post-camp survey developed by the research team measured children’s knowledge scores in these three focal areas. The sample consisted of 1,233 children, ranging from 8 to 12 years of age. Mixed models were used to test for changes in knowledge over time and for differences by gender and by farm/nonfarm status of the child. The results were encouraging: both farm and nonfarm children increased their knowledge about farm injury risk. Overall, girls demonstrated greater knowledge than boys on both the pre- and post-tests. Based on these findings, farm safety day camps appear to improve the knowledge of children about the injury risks associated with the farm environment. Refinements to the camp structure may foster greater knowledge gain of children attending the camps. While education of children about farm safety is not the sole answer to decreasing injury, it is a key component that should not be discounted.


Journal of Agromedicine

Volume 15, Issue 2, 2010
Special Issue:
Obstructive Sleep Apnea Indicators and Injury in Older Farmers
Full access DOI:10.1080/10599241003636020
Karen Heaton PhDCENFNP-BC, Andres Azuero PhD & Deborah Reed PhD pages 148-156
Available online: 19 Apr 2010


The purpose of this study was to explore the relationship between sleep apnea indicators and injury in older farmers from Kentucky and South Carolina. Participants reported at least 1 day of farm work during the preceding year (n = 756) and received income from farming. The primary outcome variable was occurrence of injuries because of farm work in the past year. Main explanatory variables of interest included snoring, gasping, snorting, or cessation of breathing while asleep; trouble sleeping; consumption of sleep medications; trouble staying awake during daytime; and sleep quality. Simple logistic regressions established bivariate associations between explanatory and outcome variables. Explanatory variables significantly associated with the outcome in the bivariate analyses were used to fit a multivariable logistic regression model.

The results show that just over 10% of participants experienced a farm injury in the past year. Significant bivariate associations were detected between the occurrence of injuries and number of days of farm work (odds ratio [OR] = 1.003, p = .0002); number of hours of farm work during the last week (OR = 1.017, p = .0047); male gender (OR = 2.48, p = .0007); arthritis or rheumatism conditions (OR = 1.981, p = .004); stopped breathing while sleeping (OR = 2.338, p = .0027); and problems staying awake during the past month (OR = 2.561, p = .001). In the final multivariable model, “stopping breathing while asleep” (p ≤ .05) and “problems staying awake last month” (p ≤ .01) were retained. These results show that sleep problems were associated with injury in this sample of older farmers. Future studies are necessary to screen and diagnose older farmers with obstructive sleep apnea (OSA) to empirically determine the effect of this sleep disorder on injury.

KEYWORDS: Aging, farm, injury, sleep


Establishing the Need for an Engineering Standard for Agricultural Hitch Pins.
2012. G. R. Deboy, W. M. Knapp, W. E. Field, G. W. Krutz, C. L. Corum. Journal of Agricultural Safety and Health. 18(2): 141-154.


Documented incidents have occurred in which failure or unintentional disengagement of agricultural hitch pins has contributed to property damage and personal injury. An examination of current hitch pin use on a convenience sample of farm operations in Indiana revealed a variety of non-standard, worn and damaged, and inappropriately sized hitch pins in use. Informal interviews with the farm operators confirmed that hitch pin misuse, failure, or disengagement is a relatively widespread problem that remains largely unaddressed. On-site observations also suggested a low use of hitch pin retaining devices or safety chains. A review of prior research revealed that little attention has been given to this problem, and currently no documentation allows for an estimate of the frequency or severity of losses associated with hitch pin misuse, failure, or disengagement. No specific engineering standards were found that directly applied to the design, appropriate selection, or loading capacity of agricultural hitch pins. Major suppliers of replacement hitch pins currently provide little or no information on matching hitch pin size to intended applications, and most replacement hitch pins examined were of foreign origin, with the overwhelming majority imported from China or India. These replacement hitch pins provided no specifications other than diameter, length, and, in some cases, labeling that indicated that the pins had been “heat treated.” Testing of a sample of 11 commercially available replacement hitch pins found variation along the length of the pin shaft and between individual pins in surface hardness, a potential predictor of pin failure. Examination of 17 commercially available replacement pins also revealed a variety of identifiers used to describe pin composition and fabrication methods, e.g., “heat treated.” None of the pins examined provided any specifications on loading capacity. It was therefore concluded that there is a need to develop an agricultural hitch pin engineering standard that would reflect current agricultural
applications and practices and that would be promoted to both original equipment manufacturers and manufacturers and suppliers of replacement hitch pins. The standard should address the design of composite pins, heat treating, surface hardening, loading capacity and labeling of such, incorporation of unintentional disengagement prevention devices, indicators of the need for replacement due to wear, and safety information that should be included in operator instructions.

ASABE is the most appropriate organization to develop such a standard. It was also concluded that agricultural safety and health programs and professionals need to raise the awareness of farmers concerning the appropriate selection and use of agricultural hitch pins, including the need to replace non-standard pins with pins less likely to fail or disengage during use, the need to replace hitch pins with indications of potential failure, and the importance of using appropriate safety chains, especially during transport of equipment behind tractors and trucks on public roads.


The Social Marketing of Safety Behaviors: A Quasi–Randomized Controlled Trial of Tractor Retrofitting Incentives. 2011.
Julie A. Sorensen, Paul L. Jenkins, Maria Emmelin, Hans Stenlund, Lars Weinehall, Giulia B. Earle-Richardson, and John J. May.
American Journal of Public Health: April 2011, Vol. 101, No. 4, pp. 678-684.
doi: 10.2105/AJPH.2010.200162


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, post-intervention 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.


Limitations in fields of vision for simulated young farm tractor operators.
2010. J. H. Chang; F. A. Fathallah; W. Pickett; B. J. Miller; B. Marlenga. Ergonomics; V53(6): 758-766.


Farm tractors account for the majority of deaths and injuries among youths working on North American farms. A vehicle operator’s field of vision is an important operational aspect for safe driving. However, very little is known about visual limitations of young tractor operators compared to adult operators. The main purpose of this study was to quantify limitations in fields of vision of children with different anthropometry. The study was based on assessment of 42 farm tractors in popular use in the USA. The results showed that youth operators typically had diminished fields of vision compared to the average adult operator. The degree of visual limitation is greatest for objects at close distances and when objects are straight in front of the operator/tractor. This has serious implications in terms of risks for runovers, rollovers and collisions. Study findings may help illuminate the development of policies and guidelines in tractor-related jobs for children.


Ability of youth operators to reach farm tractor controls.
F.A. Fathallah, J.H. Chang, W. Pickett and B. Marlenga. Ergonomics; V52(6): 685-694


Farm tractor work is commonly assigned to young people on North American farms, where tractors account for the majority of deaths and major portions of non-fatal trauma to working youths. However, little is known about the potential mismatch between the anthropometric and physical characteristics of children and tractor characteristics. The purpose of this study was to evaluate the ability of children of varying ages and percentiles to reach major controls on 45 tractors in common use in the US. The main study finding was that many tractor controls, especially those that are hand-operated, may not be effectively reached by the majority of youth operators aged 12 to 16 years.

The study raises further serious questions about the ability of children to safely operate tractors in common use on US farms and calls for reconsideration of age guidelines for the assignment of children to tractor work on farms. This study provides novel ergonomic evidence about the ability of children to reach controls inside agricultural tractor cabins. The approach could be applied in similar situations where youths may operate other vehicles or machines. Study findings support the establishment and refinement of policies and guidelines related to youth tractor operation.

Keywords: agriculture; children; safety; reach; photogrammetry


Forces required to operate controls on farm tractors: Implications for young operators.
F.A. Fathallaha*, J.H. Changa, R.L. Bergb, W. Pickett and B. Marlenga. Ergonomics; V51(7): 1096-1108.


Farm tractors account for the majority of fatal injuries to adolescents working in agriculture and therefore remain a leading occupational priority. The question of whether these injuries occur because adolescents are assigned tractor jobs beyond their physical capabilities has not been answered. The purpose of this study was to estimate the activation forces required to operate controls on 40 tractors in common use in the US and compare them with existing estimates of physical strength for children of varying ages and with recommended ergonomic force limits for repeatedly engaging controls. Activation forces for steering, brakes and clutch were measured on each tractor. The main study finding was that the activation forces required to operate tractors typically exceeded the physical abilities of most children aged 13 to 17 years. This raises serious questions about the ability of children to safely operate tractors in common use on US farms. This study provides an ergonomic approach for evaluating the potential mismatch between young people’s strength capabilities and forces required in operating farm tractors. This approach could be
used in similar situations where adolescents may operate vehicles (e.g. all-terrain vehicles), machinery or other mechanical devices requiring activation of levers and controls. Study findings potentially inform the establishment of occupational policies surrounding tractor operation by young people.

Keywords: agriculture; children; safety; strength


Journal of Agromedicine
pages 251-260
Volume 16, Issue 4, 2011

Special Issue:
Depressive Symptoms and Sleepiness Among Latino Farmworkers in Eastern North Carolina
Full accessDOI:10.1080/1059924X.2011.605722
Joseph G. Grzywacz PhDab*, Arjun B. Chatterjee MDcb, Sara A. Quandt PhDdb, Jennifer
W. Talton MSe, Haiying Chen PhDeb, Maria Weir MAa & Thomas A. Arcury PhDab

Available online: 29 Sep 2011


Depression and sleepiness are both risk factors for occupational accidents and unintentional injury. Relatively little is known about the experiences of these risk factors in the immigrant Latino farmworker population. This analysis uses prospective panel data from a sample of Latino farmworkers in eastern North Carolina that were collected at monthly intervals during the 2008 agricultural season to (1) describe depressive symptoms and daytime sleepiness among immigrant Latino
farmworkers across the agricultural season; (2) delineate associations of depressive
symptoms with sleepiness across time; and (3) determine whether depressive symptoms precede sleepiness, or if sleepiness precedes depressive symptoms. Results indicated that 45% of farmworkers experienced elevated depressive symptoms across the season, whereas 20% experienced elevated sleepiness. Elevated depressive symptoms were more common among farmworkers living in barracks, and less common among those living in trailers. Sleepiness was more common among women than men. There was no evidence that depressive symptoms contributed to sleepiness, or that sleepiness contributed to depressive symptoms. The pattern of results suggests that a substantial proportion of Latino farmworkers experience levels of depressive symptoms or sleepiness that places them at risk for occupational accident or unintentional injury. The results also suggest that depressive symptoms and sleepiness do not cause each other; rather, the association of depressive symptoms with sleepiness hints at the possibility of a common physiologic mechanism such as circadian disruption.

Keywords: Depression, farmworkers, immigrants, sleepiness


A Cross-Sectional Exploration of Excessive Daytime Sleepiness, Depression, and
Musculoskeletal Pain among Migrant Farmworkers.
Joanne C. Sandberg PhDa, Joseph G. Grzywacz PhD, Jennifer W. Talton MS, Sara A. Quandt PhD, Haiying Chen PhD, Arjun B. Chatterjee MD & Thomas A. Arcury PhD.

Journal of Agromedicine,
Volume 17, Issue 1, pages 70-80.


In this study the authors estimated the prevalence of elevated daytime sleepiness, depressive symptoms, and musculoskeletal pain among Latino migrant farmworkers, and examined the relationship among these symptoms. Data are from a cross-sectional survey of migrant farmworkers (N = 300) conducted in eastern North Carolina in 2009. Eleven percent of Latino farmworkers reported elevated levels of daytime sleepiness, 28% reported elevated levels of depressive symptoms, and 5% reported moderate to severe musculoskeletal pain on a daily or weekly basis. Depressive symptoms and daytime sleepiness were positively associated. Depression and daytime sleepiness may increase risk of injury; further research regarding sleep issues is warranted.


Journal of Agromedicine
pages 19-29

Volume 16, Issue 1, 2010
Special Issue:
Results From Inspections of Farmer-Installed Rollover Protective Structures
Full accessDOI:10.1080/1059924X.2011.532762

Julie A. Sorensen PhD, Tony McKenzie Jr. PhD, Mark Purschwitz PhD, Todd Fiske JD, Paul L. Jenkins PhD, Patrick O’Hara LMSW & John J. May MD

Available online: 04 Jan 2011


This study sought to assess the feasibility of self-installing rollover protective structures (ROPS) and to identify any patterns of self-installation deficiencies in a sample of New York ROPS Retrofit Rebate Program participants. Inspection engineers looked for/at damage, rust, holes, deteriorated welding, location of attachment, axle housing, the presence of original plates/bolts, and adequate seatbelt installation. Results indicated that only 31% of farmers received correct parts and also installed these parts properly. Ten percent of self-installed tractors had installation problems so severe they were referred to a dealer for correction. Issues with seatbelts, torque, and unmarked or defective bolts in ROPS kits were also detected.

Keywords: Fatalities, injury, intervention, machinery inspections, rollover protective structures, ROPS, ROPS installation, tractors


Respirator Use Among US Farm Operators:
Evidence from the 2006 Farm and Ranch Safety Survey.
Girija Syamlal MBBS, Patricia L. Schleiff MS, Jacek M. Mazurek MD, Brent Doney MS & Mark Greskevitch BS.

Journal of Agromedicine,
Volume 18, Issue 1,pages 27-38.


The objective of this study was to estimate the national prevalence of respirator use among primary farm operators in the United States. The authors analyzed the 2006 Farm and Ranch Safety Survey data collected for 12,278 actively farming primary farm operators. Weighted prevalence and adjusted prevalence ratios (PRs) of respirator use were calculated by farm operator characteristics, farm characteristics, and selected exposures/hazards. Of the estimated 2.1 million farm operators, 37.2% used a respirator on their farm. Respirator use prevalence was significantly higher among operators aged 16–34 years than those aged ≥65 years (46.9% vs. 30.0%; PR = 1.6); male than female operators (39.0% vs. 24.4%; PR = 1.6); operators managing crop farms than operators managing livestock farms (40.9% vs. 33.7%; PR = 1.2); and operators managing farms with value of sales ≥$100,000 than operators managing farms with value of sales ≤$9999 (57.4% vs. 31.4%; PR = 1.8). Of the operators who used a respirator, 69.9% used while working in a dusty environment, 22.6% used while applying/handling pesticides, and 30.4% used while doing other farm-related activities. These results show that an estimated one third of operators used respirators in 2006, and respirator use is most frequent among operators working in a dusty environment. Additional research identifying specific exposures for which respirators or dust masks are used, barriers to respirator or dust mask use, motivators for wearing respirators, and opportunities to increase the use of respiratory protection among farm operators, particularly on smaller farms, is needed.


Adoption of Rollover Protective Structures (ROPS) on U.S. Farm Tractors by State: 1993-1995, 2001, and 2004

Published by the American Society of Agricultural and Biological Engineers,
St. Joseph,

Citation: Journal of Agricultural Safety and Health.
17(2): 157-172.
Authors: D. L. Hard, J. R. Myers


This research compares state-level rollover protective structure (ROPS) prevalence rates from the early and mid-1990s to those observed in the years 2001 and 2004. In addition, state-level ROPS prevalence rates are compared to state-level tractor overturn fatality rates. Tractor data for 1993-1995 and for 2001 and 2004 for all tractors and ROPS-equipped tractors in use on U.S. farms were derived from surveys conducted for NIOSH by the USDA-NASS. Changes in ROPS prevalence rates at the state level between the two time periods were assessed using a two-sample paired t-test with unequal sample sizes. Poisson regression was used to assess the association between ROPS prevalence rates and tractor overturn fatality rates at the state level. Overall, 49 of the 50 states had an observed increase in the percentage of farm tractors equipped with ROPS from 1993-1995 to 2001 and 2004. This increase was statistically significant for 34 states. Large shifts in ROPS prevalence were found within individual states and in clusters of states. These include a major increase in the southeastern U.S. and some western states. However, a core of states in the northeast (many of them in or near the Appalachian Mountains) through the upper midwest remain in the bottom quartile for ROPS prevalence. For the years 1992 through 2004, the highest fatality rates were observed in many of the same states that were identified previously as having persistently low ROPS prevalence rates. There is a clear relationship between low state-level ROPS prevalence rates and high state-specific tractor overturn fatality rates. While progress has been made in increasing the percentage of ROPS-equipped farm tractors, it is projected that ROPS prevalence rates will not reach a protective level nationally until after 2015. Regionally, the northeast and midwest will not reach protective levels of ROPS-equipped tractors until after 2020. Based on the adoption rates observed, tractor overturn rates will likely continue to be a more localized, but significant, public health issue for several states beyond the year 2020. The results of this study show the geographic areas of the U.S. where the greatest need exists, and where a greater emphasis should be placed on ROPS promotion activities. However, addressing this public health issue on a large scale will require resources and an organized commitment, which have historically been lacking.


Determinants of agricultural injury: a novel application of population health theory. 2010.

William Pickett, Louise M Hagel, Andrew G Day, Lesley Day, Xiaoqun Sun, Robert J Brison, Barbara L Marlenga, Matthew King, Trever Crowe, Punam Pahwa, Niels Koehncke, James Dosman.
Inj Prev;16:376-382.


Objectives: (1) To apply novel population health theory to the modelling of injury experiences in one particular research context. (2) To enhance understanding of the conditions and practices that lead to farm injury.

Design: Prospective, cohort study conducted over 2 years (2007–09).

Setting: 50 rural municipalities in the Province of Saskatchewan, Canada. Subjects: 5038 participants from 2169 Saskatchewan farms, contributing 10 092 person-years of follow-up.

Main measures:

Individual exposure: self-reported times involved in farm work.
Contextual factors: scaled measures describe socioeconomic, physical, and cultural farm environments.
Outcome: time to first self-reported farm injury. Results: 450 farm injuries were reported for 370 individuals on 338 farms over 2 years of follow-up. Times involved in farm work were strongly and consistently related to time to first injury event, with strong monotonic increases in risk observed between none, part-time, and full-time work hour categories. Relationships between farm work hours and time to first injury were not modified by the contextual factors. Respondents reporting high versus low levels of physical farm hazards at baseline experienced increased risks for farm injury on follow-up (HR 1.54; 95% CI 1.16 to 1.47).

Conclusions: Based on study findings, firm conclusions cannot be drawn about the application of population health theory to the study of farm injury aetiology. Injury prevention efforts should continue to focus on: (1) sound occupational health and safety practices associated with long work hours; (2) physical risks and hazards on farms.


Prevention of agricultural injuries: an evaluation of an education-based intervention. 2008.

L M Hagel, W Pickett, P Pahwa1, L Day, R J Brison, B Marlenga, T Crowe, P Snodgrass, K Ulmer, J A Dosman.
Inj Prev; 14:290-295.


Objective: To evaluate the effectiveness of an agricultural health and safety program in reducing risks of injury.

Design: Cross-sectional survey.
Setting: 50 rural municipalities in the Province of
Saskatchewan, Canada.
Intervention: The Agricultural Health and Safety Network (AHSN), a mainly educational program that administered 112 farm safety interventions over 19 years.

Subjects: 5292 farm people associated with 2392 Saskatchewan farms. Farms and associated farm people were categorized into three groups according to years of participation in the AHSN.

Main measures: Impact: self-reported prevalence of: (1) farm safety practices; (2) physical farm hazards.

Outcome: (1) self-reported agricultural injuries.

Results: After adjustment for group imbalances and clustering at the rural municipality level, the prevalence of all impact and outcome measures was not significantly different on farms grouped according to years of AHSN participation. To illustrate, the adjusted relative risk of reporting no rollover protection on tractors among farms with none (0 years) versus high (>8 years) levels of AHSN participation was 0.95 (95% CI 0.69 to 1.30). The adjusted relative risk for agricultural injuries (all types) reported for the year before the survey was 0.99 (95% CI 0.74 to 1.32).

Conclusions: Educational interventions delivered via the AHSN program were not associated with observable differences in farm safety practices, physical farm hazards, or farm-related injury outcomes. There is a need for the agricultural sector to extend the scope of its injury prevention initiatives to include the full public health model of education, engineering, and regulation.


Encouraging Farmers to Retrofit Tractors: A Qualitative Analysis of Risk Perceptions Among a Group of High-Risk Farmers in New York.
J. A. Sorensen, J. J. May, K. Paap, M. A. Purschwitz, M. Emmelin.
Journal of Agricultural Safety and Health.
14(1): 105-117.


Tractor rollovers continue to be one of the most frequent causes of agricultural fatalities. Despite knowledge of rollovers and the efficacy of rollover protective structures (ROPS), few New York farmers have considered installing ROPS on their unprotected tractors. Qualitative interviews conducted with an “at-risk” segment of the New York farming community indicate that there are a number of barriers to safety in general and to retrofitting, in particular. The following themes and categories emerged in relation to safety and risk taking: constant exposures to risk with positive outcomes normalizes risk; the modeling of risk by significant others positions risk as part of a farming identity; and the pressure to reduce costs, save time, and accept risk frames risk-taking as the cost-effective option (especially in regard to retrofitting, which farmers believe is both expensive and time-consuming). Recommendations for researchers planning retrofitting interventions would be to focus safety messages on the risk to significant others or on the financial impact of rollovers, and to provide financial incentives and assistance to farmers
considering retrofitting.


Changing the Child Labor Laws for Agriculture: Impact on Injury.
Barbara Marlenga, Richard L. Berg, James G. Linneman, Robert J. Brison, and William Pickett.
American Journal of Public Health:
February 2007, Vol. 97, No. 2, pp. 276-282.
doi: 10.2105/AJPH.2005.078923


Objective: The child labor laws are intended to protect young workers from the most dangerous jobs. However, children who work on their parents’ farms are exempt from these laws. We evaluated the potential for preventing the occurrence of farm injuries among children by changing the US Federal Child Labor Laws, Hazardous Occupations Orders for Agriculture.

Methods: A retrospective case series of 1193 farm injuries among children from the United States and Canada was assembled. The Hazardous Occupations Orders were systematically applied to each case. Injury preventability was estimated.

Results: A total of 286 (24%) cases of injury involved immediate family members engaged in farm work. Among these children, 33% of those aged younger than 16 years and 36% of those aged 16 or 17 years were performing work prohibited under the Hazardous Occupations Orders.

Conclusions: Removing the family farm exemption from the Hazardous Occupations Orders and raising the age restriction for performing hazardous agricultural work from 16 to 18 years would be efficacious in preventing the most serious injuries experienced by young family farm workers. Potential reductions in injury would meet Healthy People 2010 goals for reducing traumatic injury in the agricultural sector.


Evaluation of a policy to reduce youth tractor crashes on public roads.
B Marlenga, B C Doty, R L Berg, J G Linneman.
Inj Prev 2006;12:46-51.


Objective: Evaluate the effectiveness of a United States state law, Wisconsin Act 455, in reducing highway tractor crashes involving youth operators.

Design: Policy outcome evaluation involving review of a retrospective case series.

Setting: Youth highway tractor crashes from Wisconsin for the years 1994–2003 that resulted in a fatality, injury, and/or property damage.

Subjects: One hundred and forty six tractor crash cases involving operators younger than 16 years.

Methods: Describe and model the tractor crash patterns before and after enactment of the law, and examine the relation between the contributing circumstances identified in the crash reports and the content covered in the mandated tractor certification course.

Results: There was neither a significant change in the number of youth tractor crashes after the law was passed, nor any reduction in the proportion of crashes where the youth operator was designated at fault. The tractor certification course did not cover the major factors contributing to youth tractor crashes on public roads.

Conclusions: No significant effect of the law was detected and crash rates at the end of the study period were similar to those before Wisconsin Act 455. The authors’ findings should not be construed to suggest that public policy, in general, is an ineffective strategy for the prevention of pediatric agricultural injuries.
Negotiating a balance in public policy debates will be a challenge, but it is clear that future policy initiatives need to identify and implement the right policy for the right problem.


Fatal agricultural injuries in preschool children: risks, injury patterns and strategies for prevention.
Robert J. Brison, William Pickett, Richard L. Berg, James Linneman, Jamie Zentner, and Barbara Marlenga.
2006 June 6; 174(12): 1723–1726.
doi: 10.1503/cmaj.050857


Background: Agricultural injuries are an important health concern for pediatric populations and particularly for children of pre school age. This study was conducted to estimate rates and determine patterns of fatal agricultural injury among young children exposed to agricultural hazards and to identify strategies to prevent such injuries.

Methods: A national case series was assembled retrospectively for the years 1990–2001. We identified children aged 1–6 years who were fatally injured during the course of agricultural work or through contact with a hazard of an agricultural worksite. Using a standardized survey instrument, we collected data from provincial coroners’ and medical examiners’ case files. Fatal agricultural injury rates (calculated with denominator data from the Canada Census of Agriculture) were
compared with national all-cause, unintentional fatal injury rates in the general population of Canadian children during the same period (calculated with denominator data from the Canada Census of Population).

Results: The annual rate of fatal agricultural injury was substantially higher than that of all-cause, unintentional fatal injury among Canadian children aged 1–6 years (14.9 v. 8.7 per 100 000 person- years, respectively). Differences in risk were attributed to elevated fatal agricultural injury rates among boys. Most injuries occurred in the agricultural worksite, largely (84/115 [73%]) the result of 3 mechanisms: being run over by agricultural machinery as a bystander (29%) or as an extra rider who fell from the machine (22%), or asphyxia due to drowning (23%). Major crush injuries (of the head, chest and abdomen) and asphyxia from drowning were the most frequent mechanisms of injury.

Interpretation: Preschool-aged children exposed to agricultural worksites are at high risk of fatal injuries. Prevention strategies should focus on restricting children’s access to these worksites. Physicians and allied health care professionals who care for rural families could take on a proactive role in communicating the nature and magnitude of these risks.


A Spatial Cluster Analysis of Tractor Overturns in Kentucky from 1960 to 2002.
Daniel M. Saman, Henry P. Cole, Agricola Odoi, Melvin L. Myers, Daniel I. Carey, Susan C. Westneat.
PLoS ONE 7(1): e30532.

This is an open access journal and can be accessed here:


Background: Agricultural tractor overturns without rollover protective structures are the leading cause of farm fatalities in the United States. To our knowledge, no studies have incorporated the spatial scan statistic in identifying high-risk areas for tractor overturns. The aim of this study was to determine whether tractor overturns cluster in certain parts of Kentucky and identify factors associated with tractor overturns. Methods: A spatial statistical analysis using Kulldorff’s spatial scan statistic was performed to identify county clusters at greatest risk for tractor overturns. A regression analysis was then performed to identify factors associated with tractor overturns.

Results: The spatial analysis revealed a cluster of higher than expected tractor overturns in four counties in northern Kentucky (RR = 2.55) and 10 counties in eastern Kentucky (RR = 1.97). Higher rates of tractor overturns were associated with steeper average percent slope of pasture land by county (p = 0.0002) and a greater percent of total tractors with less than 40 horsepower by county (p<0.0001). Conclusions: This study reveals that geographic hotspots of tractor overturns exist in Kentucky and identifies factors associated with overturns. This study provides policymakers a guide to targeted county-level interventions (e.g., roll-over protective structures promotion interventions) with the intention of reducing tractor overturns in the highest risk counties in Kentucky.