2014 Paper Awards

Modifiable risk factors for depressed mood among farmers. Onwuameze OE, Paradiso S, Peek-Asa C, Donham KJ, Rautiainen RH. Ann. Clin. Psychiatry 2013; 25(2): 83-90.
Affiliation: Southern Illinois University School of Medicine, Department of Psychiatry, Springfield, IL, USA.

BACKGROUND: Risk for depression among farmers is not fully understood. DSM-IV considers sadness or depressed mood a critical symptom of depression. The aim of this study was to examine risk factors for depressed mood among farmers using a longitudinal study design. METHODS: Participants were principal farm operators in the Iowa Certified Safe Farm study. We identified risk factors for depressed mood by calculating relative risks (RR) using the generalized estimating equations method.

RESULTS: In the multivariate model, pesticide exposure (RR = 1.26; 95% CI: 1.04 to 1.53), having an additional job off the farm (RR = 1.32; 95% CI: 1.08 to 1.62), stress (RR = 3.09; 95% CI: 2.55 to 3.75), and previous injury (RR = 1.41; 95% CI: 1.05 to 1.89) prospectively increased the risk of depressed mood. CONCLUSIONS: Consistent with earlier non-longitudinal studies, the results of this study suggest that reducing pesticide exposure, stress, and injury may reduce the risk of depression in the farm setting.

Distribution and characteristics of occupational injuries and diseases among farmers: A retrospective analysis of workers’ compensation claims. Karttunen JP, Rautiainen RH. Am. J. Ind. Med. 2013; 56(8): 856-869.

Affiliation: TTS-Work Efficiency Institute, Rajamaki, Finland.

BACKGROUND: Research indicates occupational injuries and diseases are not evenly distributed among workers. We investigated the distribution and characteristics of compensated occupational injuries and diseases requiring medical care in the Finnish farming population. METHODS: The study population consisted of 93,564 Finnish farmers, spouses, and salaried family members who were covered by the mandatory workers’ compensation insurance in 2002. This population had a total of 133,207 occupational injuries and 9,148 occupational diseases over a 26-year period (1982-2008).

RESULTS: Clustering of claims was observed. Nearly half (47.1%) of the population had no compensated claims while 52.9% had at least one; 50.9% of farmers had one or more injuries and 8.1% had one or more diseases. Ten percent of the population had half of injury cases, and 3% of the population had half of occupational disease cases. Claims frequently involved work tasks related to animal husbandry and repair and maintenance of farm machinery. Injury and disease characteristics (work activity, cause, ICD-10 code) differed between individuals with high and low personal claim rate. Injuries and diseases of the musculoskeletal system had a tendency to reoccur among those with high claim rate. These outcomes were often related to strenuous working motions and postures in labor-intensive animal husbandry.

CONCLUSIONS: Analyses of longitudinal insurance data contributes to better understanding of the long-term risk of occupational injury and disease among farmers. We suggest focusing on recurrent health outcomes and their causes among high risk populations could help design more effective interventions in agriculture and other industries.

All-terrain vehicle-related nonfatal injuries among young riders in the United States, 2001-2010. Shults RA, West BA, Rudd RA, Helmkamp JC. Pediatrics 2013; 132(2): 282-289.

Affiliation: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia; and.


OBJECTIVE: To estimate the numbers and rates of all-terrain vehicle (ATV)-related nonfatal injuries among riders aged ≤15 years treated in hospital emergency departments (EDs) in the United States during 2001-2010.

METHODS: National Electronic Injury Surveillance System-All Injury Program data for 2001-2010 were analyzed. Numbers and rates of injuries were examined by age group, gender, primary body part injured, diagnosis, and hospital admission status. RESULTS: During 2001-2010, an estimated 361 161 ATV riders aged ≤15 years were treated in EDs for ATV-related injuries. The injury rate peaked at 67 per 100 000 children in 2004 and then declined to 42 per 100 000 children by 2010. The annualized injury rate for boys was double that of girls (73 vs 37 per 100 000). Children aged 11 to 15 years accounted for two-thirds of all ED visits and hospitalizations. Fractures accounted for 28% of ED visits and 48% of hospitalizations.

CONCLUSIONS: The reasons for the decline in ATV-related injuries among young riders are not well understood but might be related to the economic recession of the mid-2000s and decreased sales of new ATVs. Although many states have regulations governing children’s use of ATVs, their effectiveness in reducing injuries is unclear. Broader use of known effective safety measures, including prohibiting children aged ≤15 years from riding adult-sized ATVs, always wearing a helmet while riding, not riding on paved roads, and not riding as or carrying a passenger could
additionally reduce ATV-related injuries among children. Last, more research to better understand ATV crash dynamics might lead to safer designs for ATVs.

Neurodevelopmental effects in children associated with exposure to organophosphate pesticides: A systematic review. Muñoz-Quezada MT, Lucero BA, Barr DB, Steenland K, Levy K, Ryan PB, Iglesias V, Alvarado S, Concha C, Rojas E, Vega C. Neurotoxicology 2013; ePub(ePub): ePub.

Affiliation: Faculty of Health Sciences, Catholic University of Maule, Avda. San Miguel 3605, Talca, Región del Maule, Chile. Electronic address: mtmunozq@gmail.com.


Many studies have investigated the neurodevelopmental effects of prenatal and early childhood exposures to organophosphate (OP) pesticides among children, but they have not been collectively evaluated. The aim of the present article is to synthesize reported evidence over the last decade on OP exposure and neurodevelopmental effects in children. The Data Sources were PubMed, Web of Science, EBSCO, SciVerse Scopus, SpringerLink, SciELO and DOAJ. The eligibility criteria considered were studies assessing exposure to OP pesticides and neurodevelopmental effects in children from birth to 18 years of age, published between 2002 and 2012 in English or Spanish. Twenty-seven articles met the eligibility criteria. Studies were rated for evidential consideration as high, intermediate, or low based upon the study design, number of participants, exposure measurement, and neurodevelopmental measures. All but one of the 27 studies evaluated showed some negative effects of pesticides on neurobehavioral development. A positive dose-response relationship between OP exposure and neurodevelopmental outcomes was found in all but one of the 12 studies that assessed dose-response. In the ten longitudinal studies that assessed prenatal exposure to OPs, cognitive deficits (related to working memory) were found in children at age 7 years, behavioral deficits (related to attention) seen mainly in
toddlers, and motor deficits (abnormal reflexes) seen mainly in neonates. No meta-analysis was possible due to different measurements of exposure assessment and outcomes. Eleven studies (all longitudinal) were rated high, 14 studies were rated intermediate, and two studies were rated low. Evidence of neurological deficits associated with exposure to OP pesticides in children is growing. The studies reviewed collectively support the hypothesis that exposure to OP pesticides induces neurotoxic effects. Further research is needed to understand effects associated with exposure in critical windows of development.

An estimate of the U.S. government’s undercount of nonfatal occupational injuries and illnesses in agriculture. Leigh JP, Du J, McCurdy SA. Ann. Epidemiol. 2014; ePub(ePub): ePub.

Affiliation: Department of Public Health Sciences, University of California, Davis School of Medicine, Davis, CA.


BACKGROUND: Debate surrounds the accuracy of U.S. government’s estimates of job-related injuries and illnesses in agriculture. Whereas studies have attempted to estimate the undercount for all industries combined, none have specifically addressed agriculture. METHODS: Data were drawn from the U.S. government’s premier sources for workplace injuries and illnesses and employment: the Bureau of Labor Statistics databanks for the Survey of Occupational Injuries and Illnesses (SOII), the Quarterly Census of Employment and Wages, and the Current Population Survey. Estimates were constructed using transparent assumptions; for example, that the rate (cases-per-employee) of injuries and illnesses on small farms was the same as on large farms (an assumption we altered in sensitivity analysis). RESULTS: We estimated 74,932 injuries and illnesses for crop farms and 68,504 for animal farms, totaling 143,436 cases in 2011. We estimated that SOII missed 73.7% of crop farm cases and 81.9% of animal farm cases for an average of 77.6% for all agriculture. Sensitivity analyses suggested that the percent missed ranged from 61.5% to 88.3% for all agriculture.

CONCLUSIONS: We estimate considerable undercounting of nonfatal injuries and illnesses in agriculture and believe the undercounting is larger than any other industry.

Reasons include: SOII’s explicit exclusion of employees on small farms and of farmers and family members and Quarterly Census of Employment and Wages’s undercounts of employment. Undercounting limits our ability to identify and address occupational health problems in agriculture, affecting both workers and society.