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      PAPERS AFD PROCEEDINGS

               of the

SURGEON GENERAL'S CONFERENCE ON

AGRICULTURAL SAFETY AND HEALTH



               Edited by:

           Melvin L. Myers, M.P.A.

            Robert F. Herrick, Sc.D.

          Stephen A. Olenchock, Ph.D.

            John R. Myers, M.S.F.

             John E. Parker, M.D.

             David L. Hard, Ph.D.

             Katherine Wilson, M.P.H.

Public Law 101-517

April 30 - May 3, 1991
Des Moines, Iowa

Convened by

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
          Public Health Service
        Centers for Disease Control
National Institute for Occupational Safety and Health

September 1992


DISCLAIMER

Sponsorship of this Conference and these Papers and Proceedings by the National
Institute for Occupational Safety and Health (NIOSH) does not constitute
endorsement of the views expressed or recommendations for use of any commercial
product, commodity, or service mentioned. The opinions and conclusions expressed
in the papers and abstracts are those of the authors and not necessarily those of
NIOSH.

Recommendations are not to be considered as final statements of NIOSH policy or
of any agency or individual who was involved. They are intended to be used in
advancing the knowledge needed for improving worker safety and health.

This document is in the Public Domain and may be freely copied or reprinted. Copies of
         this and other NIOSH documents are available from:

    Publication Dissemination, DSDll
National Institute for Occupational Safety and Health
      4676 Columbia Parkway
       Cincinnati, Ohio 45226
       FAX (513) 533-8573

U.S. Department of Commerce
National Technical Information Services
   Springfield, VA 22161
NTIS PB 93-114890/$77.00 or A/O6

Superintendent of Documents
U.S. Government Printing Office
Washington, DC 20402
  GPO 017-033-00463-3

DHHS (NIOSH) PUBLICATION NUMBER 92-105

For information on other occupational safety and health problems, call:
               I-800-35NIOSH

ii


National Farm Safety Week, 1991

By the President of the United States of America

A Fro&math

The men and women who work in America's agrIcultura1 aector make a vital contribution to our Nation's
well-being. By providing conmunera with a variety of high-quality food and fiber at reasonable costs, they
help to keep our work force strong and healthy and, tn so doing. help to maintain the Nation's economic
productivity and competitiveness. Because we count on farmem and ranchers for 80 much, both as individuals
and aa a Nation, it is fIttIng that we observe National Farm Safety Week-a concerted public awareness
campaign aimed at promoting their health and safety.

Over the years much hae been done to Improve the safety of agricultural production. Advances in science and
technology and increased attention to avoiding safety rilrka have made farms and ranchen safer places to
work. Moreover, dedicated profeaeionale and volunteers have been working together to promote health and
safety In rural communities. These efforts are reflected by a welcome downturn in farm accident rates.
Unfortunately, however, while important strides have been made in reducing the risks of farming and
ranching, agricultural production remains one of our most hazardous lnduetrlee, with an accident death rate
that is more than four tImea the average of all induetriee. More must be done to reduce the toll of farm-related
accidents.

Most accidenta on the Nation'8 farme and ranches can be prevented by sensible meaauree that involve little
extra time, effort, or expense. For example, farmers and ranchers can reduce their risk of serious injury and
illness by following manufacturers' instructions on the use of chemicals and machinery and by utilizing
protective apparel and safety equipment when the job calls for it. Children should be kept away from
$ardous machinery, and all family members and employees should be trained in safety procedures and first
For generations. the men and women who work on our Nation's farme and ranches have endured long hours
of tough, physical labor. However, they have continually met the challenges of their vocation with determlna-
tion and pride--and with unparalleled success. During National Farm Safety Week, let us resolve to make
excellence in health and safety another one of America's great farming traditions.

NOW, THEREFORE I. GEORGE BUSH, President of the United States of America, by virtue of the authority
vested in me by the Constitution and laws of the United States. do hereby proclaim the week of September 15
through September 21. 19Ql, ae National Farm Safety Week. 1 urge all who live and work on our Nation's
farms and ranches to make the presematlon of personal health and safety an Integral part of their daily
activities. I also urge them to protect their children, not only by inetructlon In safety habits, but also by setting
an example of carefulness and by avoiding needless rmke. I also call upon organizations that serve
agricultural producers to strengthen their support for rural health and safety programs, and I encourage all
Americans to observe this week with appropriate activities as we express our appreciation for the many
contributions that men and women in agriculture make to our Nation.

IN WITNESS WHRREOF, I have hereunto set my hand this fifteenth day of April, in the year of our Lord
nineteen hundred and ninety-one. and of the Independence of the United States of America the two hundred
and fifteenth.

. . .
111


Surgeon General's Conference on Agricultural Safety and Health
FARM&E 2000 o A National Coalition tbr Local Action
Convened by the National institute for Occupational Safety and Health
April 30 - May 3, 1991, Des Moines, lowa

PREFACE

In 1990, the Congress established a national initiative in agricultural safety and health
under Public Law 101-517. The Congress directed that this initiative, when sustained over
a period of time, would result in a significant and measurable impact on . . . health effects
among rural Americans.

As part of that initiative, the Congress appropriated funds for the National Institute for
Occupational Safety and Health (NIOSH) to convene a Surgeon General's Conference
on Agricultural Safety and Health. This Conference was held in 1991 and was chaired
by Assistant Surgeon General J. Donald Millar, the Director of NIOSH. The purpose of
this Conference was to raise consciousness, build coalitions, disseminate information, and
encourage action to prevent injury and disease in agriculture. The Conference fulfilled
this purpose and established a vision for improving the total quality of health and safety
for agricultural workers and their families in America:

b Raise Consciousness. The Congress found that agricultural workers and their families
experienced excessive rates of injuries, many kinds of cancers and lung diseases, and
various health effects from exposures to agricultural chemicals. Their findings indicated
significant disparities in the quality of health among agricultural workers and their
families and a national need to improve the quality of their health. The Surgeon
General's Conference reinforced this need, and the evidence was broadened into
musculoskeletal problems, noise-induced hearing loss, dermatological conditions, stress,
and infectious diseases. Furthermore, participants at the Conference emphasized the
need to improve the health of agricultural workers and their families.

b Build Coalitions. The Surgeon General's Conference raised the consciousness of many
officials in the fields of agriculture, education, labor, and public health at the national,
state, and local levels. The need for a concerted effort was recognized by the par-
ticipants. Over 500 people participated from 41 states and the Commonwealth of Puerto
Rico as well as from other countries. As a result, a growing network of the participants
are reaching out among themselves and to others to offer and to receive help.

b Disseminate Information, The most visible manifestation of information dissemination
is these Proceedings and Papers: Surgeon General's Conference on Agricultural Safety and
Health of that Conference, which will be distributed to participants and key prevention
leaders at the national, state, and local levels across the nation.

b Encourage Action. The action that was overwhelmingly encouraged was to improve 1
health and safety of agricultural workers and their families. Moreover, the word,
PREVENTION, came through loud and clear--over and over-at the Conference. This
action, the improvement of agricultural safety and health through prevention, was
identified with three views: as an action for the 1990's, with national leadership, and
through people at the local level.

:he

Surgeon General's Conference on Agricultural Safety and Health - 1991

V


Preface

With the recognition of a need for improvement, the Congress, through its national
initiative at NIOSH, launched a program for improving the health and safety of agricul-
tural workers and their families. This program was comprised of:

b A Suwey. The Congress directed NIOSH to undertake a Farm Family Health and
Hazard Survey to develop more complete information on the circumstances of agricul-
tural injury and disease problems. Based upon this information, informed priority-setting
for prevention can be implemented and a baseline for measuring improvement can be
established.

b Research. To insure that preventive actions are taken based upon scientific findings,
including the etiology of the injuries and diseases, the Congress also directed NIOSH to
conduct research both intramurally and through university-based Centers for Agricultural
Health and Safety.

k Intewention. To actively promote and implement the research findings, the Congress
directed NIOSH to establish a national Agricultural Health Promotion System in
collaboration with county extension agents. The Congress also directed NIOSH to devise
an early detection strategy to reduce the number of cancer deaths among farmers
through Cancer Control Demonstration Projects for Farmers. In addition, funds were
provided for the training of professionals in agricultural safety and health.

b SuMZlance. To monitor results, the Congress directed NIOSH to establish an
Agricultural Health Nurse Program in which rural hospitals would provide ongoing
responsive (focused at intervention) surveillance to identify agriculture-related disease
and injury problems through the support of nurses at rural hospitals.

In 1991, the Secretary of Health and Human Services issued a report, Healthy People
2000, which included national goals and objectives for improving the health of
Americans. Three overarching goals emerged from this effort, each of which apply to
agricultural workers and their families. These goals are: increase the span of healthy life
for Americans, reduce health disparities among Americans, and achieve access to
preventive health services for all Americans. Emerging from the purpose established by
the Congress for a national initiative for agricultural safety and health from the goals of
Healthy People 2000, and from the Surgeon General's Conference on Agricultural Safety
and Health is a national vision for the 1990's for implementing the initiative:

To continuously and measurably improve the safety and health of every working man and
woman in American agriculture through the prevention of Leading Work-Related Diseases
and Injuries consistent with the goals and objectives of `Healthy People 2000.' O

(%c?$wc
Antonia C. Novello, M.D.
   Surgeon General

vi

Papers and Proceedings


Surgeon General's Conference on Agricultural Safety and Health
FARMSAFE 2000 . A National Coalition f?~ Local Action
Convened by the National institute tir Occupational Safety and Health
April 30 - May 3, 1991, Des Moines, Iowa

FOREWORD

The Surgeon General's Conference on Agricultural Safety and Health was convened by
the National Institute for Occupational Safety and Health (NIOSH) in 1991. NIOSH
was created in 1970 as a result of the passage of the Occupational Safety and Health
Act. NIOSH is the national public health organization responsible for the occupational
safety and health of all of the nation's workers. Moreover, NIOSH is a component of
the Centers for Disease Control (CDC), The Nation's Prevention Agency.

In 1990, the Congress expressed concern that agricultural workers and their families
experience a disproportionate share of injuries and diseases associated with numerous
chemical, biological, and physical hazards. For example, agricultural workers have the
second highest occupational fatality rate. They run a significantly higher risk of dying of
certain types of cancer than persons in other occupations. The Congress also observed
that inhalation of organic dusts from plant, soil, and animal sources, and from chemical
and other substances, results in occupational health risks to agricultural workers.

The Congress, recognizing that agricultural workers continue to suffer high levels of
injury and illness, directed NIOSH to lead a comprehensive national program and
undertake a series of initiatives in surveillance, research, and intervention to prevent
occupational injuries and diseases in agriculture. The Congress believed that NIOSH
was in a unique position to lead a comprehensive national effort to prevent injury and
disease in agriculture. The NIOSH initiative is intended to provide a balanced approach
to substantially reduce the incidence of fatal and nonfatal traumatic injury, chronic
injury, and occupational diseases among the 3.4 million agricultural workers in the
United States. NIOSH expanded its research program to address the safety and health
of workers in agriculture and awarded cooperative agreements to enhance the Institute's
existing program in the areas of surveillance, research, and intervention.

The Congress also directed that NIOSH convene a Surgeon General's Conference on
Agricultural Safety and Health. Held in 1991, its purpose was to raise consciousness,
build coalitions, disseminate information, and encourage action to prevent injury and
disease in rural areas. Several solutions for preventing diseases and injuries were
presented and discussed at this Conference. The following is a summary of the Con-
ference through the words of its participants, followed by a statement of the problem
that emerged from the Conference, and a vision for the future of agricultural safety and
health in America as well as a special mention of a particular, fully preventable agricul-
tural injury-"an occupational obscenity"-which was repeatedly emphasized at the
Conference.

CONFERENCE SUMMARY

The general design of the Conference was to, first in plenary session, address its purpose,
then provide direction through keynote speeches and questions, and pose some as-
sumptions about the future of both the agricultural workforce and workplace. The titles

Surgeon General's Conference on Agricultural Safety and Health - 1991                 vii


Foreword

of the sessions and titles in this document corresponding to this part of the Conference
are: The Potential for a National Coalition, Looking Ahead to the Next Century, Questions
to Guide the National Agenda, Medical Intervention Problems and Opportunities, and Issues
That Affect the National Agenda.

The Conference included five concurrent sessions dealing with the issues of surveillance,
research, and intervention. The proceedings from these sessions are addressed in this
document in the chapters entitled Surveillance-Agriculture-Related Diseases, Injuries, and
Hazards, Research-Chemical and Biological Hazards, Research-Mechanical and Physical
Hazards, Intervention-Worker Protection from Environmental Hazards, Intervention-Safe
Behaviors among Adults and Children. Within each of these sessions, presentations of
factual information were made, and discussions ensued from the perspectives of a range
of interested parties.

Returning to plenary sessions, the chair of each concurrent session reported the results
of deliberations in their session. In addition, a report was made on the issues raised at
another conference held concurrently on migrant and seasonal labor. These reports are
presented in the chapter entitled Elements of a National Agenda. The closing plenary
session provided an opportunity for concluding remarks from a variety of participants
who ranged from governmental to those representing farm organizations to a victim.
These remarks are documented herein in the chapter entitled Actions for the Future.

The Conference included a poster and video tape session with 102 posters presented.
The abstracts of the posters and titles of the video tapes are presented in the chapter
entitled Making Connections.

Six unifying principles emerged from the Conference as operational concepts for the
future. They are found in the words of 72 speakers at the Conference-these themes
offer a verbal tour through these Papers and Proceedings:

b CONTINUOUS IMPROVEMENT THROUGH PREVENTION. The Congress has directed
that a national initiative, of which this Conference was a part, be launched so that when
sustained over a period of time, would result in a significant and measurable impact on . . .
health effects among rural Americans. Augmenting this direction for continuous improve-
ment, the Surgeon General's Conference consistently and in multiple ways demonstrated
the need to prevent problems in order to improve the safety and health of agricultural
workers and their families.

Senator Tom Harkin of Iowa asserted, " . . . we need to make "Prevention First" our
motto for health care in the 90's." Dr. Thomas Dean of the National Rural Health
Association challenged the Conference, " . . . to go forth in these deliberations with a
sense of urgency and with an understanding that every day lives are lost because families
are being devastated and futures are being ruined because of our failure in the past to
build these coalitions."

. . .
VIII

Papers and Proceedings


Foreword

Speaking to a paradigm for prevention, Dr. William Popendorf from The University of
Iowa said, " . . . we face yet another challenge; how to translate them (parameters of
health effects) into "agricultural hygiene," the industrial hygiene paradigm of "anticipa-
tion, recognition, evaluation, and control learned in general industry . . . " Jeffrey
Human of the Office of Rural Health Policy encouraged the Conference to, ' . . .
confront conventional approaches and make new choices with limited funds, choices that
help solve rural health problems."

Willis Eken of the Minnesota Farmers' Union contended, " . . . that it is something of a
sham if the most effective tool for safer environmental protection regarding machinery is
a law suit." Joseph Kinney of the National Safe Workplace Institute urged the Con-
ference, " . . . to begin to get realistic about how you would like to see these issues ad-
dressed." Merlin Plagge of the Iowa Farm Bureau observed about OSHA standards that,
(1

. . . knowing they exist has encouraged farmers to work for safer farmsteads."

b RECOGNIZETHENEEDS OF THE POPULATIONAT RISK. Fundamentaltoprevention
is recognizing the needs of agricultural workers and their families, a population at
disproportionately high risk of work-related disease and injury.

Dr. Myron Johnsrud of the U.S. Extension Service asserted, "A national strategy could
rest on the belief that the most effective preventive efforts will emerge from a process
that emphasizes identifying and characterizing problem areas and populations at risk."
Relatedly, Dr. James Merchant of the Institute of Agricultural Medicine and Oc-
cupational Health at The University of Iowa reported, "Agricultural production is now
changing dynamically, resulting in a substantial increase in farmers with non-farm jobs,
greater involvement of women and seasonal workers, and involvement of children and
recreational farmers in agricultural operations."

Dr. Leslie Whitener of the Economic Research Service at the U.S. Department of
Agriculture defined this population: `The largest component (46 percent) of the
agricultural work force in 1987 was made up of the 3.6 million people who did unpaid
farmwork . . . .the hired component of the agricultural work force will continue to grow
in importance as hired workers increasingly replace family workers on farms and as the
number of large, labor-intensive commercial farms continues to increase."
Christopher Atchison of the Iowa Department of Public Health noted, "Because farming
has traditionally been a family business, that it is not just the professional farmer, it is
the farm family that is at risk for injury."

Cheryl Tevis from Succes@Z Faming Magazine observed, " . . . that about half of farm
women work outside the home." Todd Frazier from NIOSH expressed his viewpoint,
"Because I am from a public health background and have always been interested in the
population at risk, these demographics spell out to me a very serious challenge that we
are facing when we look at projects that address the problems of farm families in
generally rural areas."

Surgeon General's Conference on Agricuttural Safety and Health - 1991

ix


Foreword

Speaking of the migrant labor portion of the population, Roberta Ryder of the National
Migrant Resource Program asked, "Is it really acceptable that such a large poriion of our
population be relegated to the edge for the duration of their lives?" Dr. Russell Currier
from the Iowa Department of Public Health recognized two patterns of disease among
agricultural workers, "Migrant farm workers experiencing human-host illnesses, often
episodic and exacerbated by substandard living and employment conditions. All other
farm workers experiencing sporadic, isolated illness that is most frequently zoonotic,
vector-borne, or environmentally acquired in nature."

b SURVEILLANCE TO MEASURE IMPROVEMENTS. Part ofpreventionis the study of
trends so as to measure progress. Surveillance is the means of doing so. Through
surveillance, we can systematically and continually collect, analyze, and interpret data
related to health and safety and direct prevention programs so as to control and, when
possible, eliminate the occurrence of diseases and injuries.

With reference to John Donne's 16th century poem, Dr. William Halperin from NIOSH
spoke to the role of surveillance as a guide to preventive action, "Surveillance in modern
times is the equivalent of the tolling of the bells with the added commitment to inves-
tigation of the causation of morbidity and mortality and dissemination of data and
analysis with the goal of prevention." Dr. John May from the New York Center for
Agricultural Medicine and Health speaking to the use of sentinel events in surveillance
relayed that, " . . . intervention should affect other workers by either addressing the
hazardous exposure, by screening similarly exposed workers, or by insuring that at least
adequate protection is provided to similarly exposed workers."

About surveillance and priorities, Dr. Dennis Murphy from Penn State University
contended, "If we are going to let data guide us, we have to get to some specific
categories to have some guidance." Dr. Henry Anderson from the Wisconsin
Department of Health and Social Services reported, "We need to move away from the
broad view to some specific, high-priority activities."

Regarding the role of the "helping" professions, Rodney Gilmore from the North Dakota
State Department of Public Health related, "We learned that in order to keep a good
surveillance system going, you must keep direct and frequent contact with the medical
facilities and with the providers who are giving you the information." Dr. Eugene Freund
from NIOSH suggested, "Inasmuch as the nurses, through their interactions with
providers, can do case surveillance, they can help with the recognition of problems that
may not be identified in the community."

b RESEARCH TO FIND ROOT CAUSES. A principle that emerged at the Conference was
to base actions on facts. Research is a way of finding the facts, and through research, we
work to understand the causes of work-related diseases, injuries, and hazards; detect
their vulnerabilities to prevention; and discover, assess, and improve measures to reduce
them. Dr. Lorann Stallones from Colorado State University reported, "National policy
guidance is needed in order to provide focus for targeting proper areas of research and
to define the scope of research to be performed within priority areas."

x                                      Papers and Proceedings


Foreword

Regarding high technology, Dr. Ronald Eckoff of the Iowa Department of Public Health
introduced two speakers saying that they, " . . . will reveal changes in the agricultural
work place as it is affected by new and different crops and by biotechnology." Dr. Daniel
Kugler from the Office of Agricultural Materials at the U.S. Department of Agriculture
noted, " . . . that agriculture, indeed, is a very high-tech business." Dr. Jane Rissler from
the National Wildlife Federation challenged the Conference with, "I hope that this
presentation will provoke a wide-ranging consideration and evaluation of the potential
impacts of biotechnology on farm worker health." Regarding noise-induced hearing loss,
Dr. Matthew Marvel from the Oneonta Health Center observed that, "We also might
find some high-technology solutions like using sound cancellation."

The occupational problems faced by farmers were seen to be numerous, significant, and
preventable. Dr. Susanna Von Essen from the University of Nebraska summarized the
problems with lung diseases on the farm, `The presence of inflammation is a common
theme in these disorders." Other problems were addressed by Dr. Linda Rosenstock
from the University of Washington when she maintained that, "On the basis of this study
and the accumulating evidence in the medical literature, we feel that even episodes of
acute organophosphate poisoning can cause permanent neurologic dysfunction."
Dr. Aaron Blair from the National Cancer Institute observed, "A critical role for
suppression of immune responsiveness by pesticides has been demonstrated for infectious
disease and maybe for other diseases."

The injury problem was addressed by Dr. Sverker Hoghind from the Swedish Farmers
Safety and Preventive Health Association who explained that, "Machine design may be
related to hazards of two kinds. One is accidents causing acute injuries. The other is
chronic injuries or illnesses because of long-term, unfavorable effects on the body during
work operations." Murray Madsen from Deere and Company observed that, "Sometimes
equipment is in mint condition; other times it is not, or modified, or built from scratch in
a local shop." Dr. Thomas Bean from Ohio State University reported that, "In either
case, the majority of studies indicated that farm equipment was the single factor most
associated with on-farm injury." John Crowley from the Equipment Manufacturers
Institute urged that, "Behavioral research is needed to guide engineers on how equip-
ment can be designed for safer operation and maintenance."

Dr. Susan Gerberich from the University of Minnesota maintained that, "A major barrier
to progress in the prevention of agricultural injuries has not only been a lack of
knowledge about the magnitude of the problem but also a lack of knowledge about
specific causes or risk factors due to the lack of analytical studies." Penn Peters of the
U.S. Forest Service stated that, "A high-priorityresearch area is in the injuries that result
from a felled tree having hit another tree, which includes hangup fell, broken limbs or
tops, and butt rebound."

Regarding the hazards of overhead electrical lines, Robert McLymore from North
Carolina State University remarked, `That moment of carelessness may end up with that
piece of equipment getting in contact with that line. We know how electricity kills."
Governor Robert Ray, Chairman of the National Advisory Committee on Rural Health

Surgeon General's Conference on Agricultural Safety and Health - 1991                xi


Foreword

Policy, observed that, "the suicide rate for farmers is now 30 to 40 percent above the
national non-farm rate."

Dr. David Co&ran of the Occupational Safety and Health Administration recounted a
conversation' "She was telling me that the top occupational category suffering from
tendinitis in the state of Washington is farmworkers." Regarding greenhouse workers,
Dr. John Coumbis of the Agency for Toxic Substance and Disease Registry related that,
I'  . you find some of the reports of back pain in roughly a third of the work force, pain
id multiple joints in 19 percent, pain of the upper extremities in 11 percent of the
workers, lower extremities in 8 percent, and neck pain in 2 percent."

b RESPECT PEOPLE WHILE CONTROLLING THE PIROBLEMS. Another principle that
emerged overwhelmingly at the conference was respect for people, and also consistent
with our Conference theme of A National Coalition for Local Action, our intervention
must be based upon such respect.

Speaking to this theme through a video message, Secretary Louis Sullivan of Health and
Human Services stated, "The key to making those strategies effective--the critical, vital
factor that will determine our success in lowering the risks of agricultural work-is local
initiatives and efforts," Assistant Surgeon General William Roper declared, "As the
theme of this meeting, N&ionaZ Coalition for Local Action, clearly portends, the foun-
dation of our public health system' as it functions in agriculture and other sectors, must
be the local public health agency."

Dr. James Dosman from the University of Saskatchewan recommended, " . . . the estab-
lishment of health and safety committees at the local level, organized by target pop-
ulations, for the purpose of identifying issues, facilitating programming, and achieving
results." Referring to agricultural workers, Ellen Widess' Children's Advocacy Institute
contended, `Unless we also deal with those economic realities of their lives and their
limited choices, we will fail in our efforts to improve health and safety."

Regarding networking and community involvement' Dr. Dean Stueland from the
National Farm Medicine Center related, "We need to close the loop between what is
happening on the farm and what is happening in medicine so that people understand
each other." Wayne Sprick of the National Young Farmer Educational Association said,
`The FFA chapters and those younger people are looking for opportunities to conduct
community-service types of projects." Robert Graham with the National Vocational
Agriculture Teachers' Association commented, "We encourage students to sit down and
do a community review by interviewing resource people with organizations, such as the
community health organizations, the district representatives of OSHA and NIOSH, the
Farm Bureaus, and National Grange Affiliates." Valerie Wilk from the Farmworker
Justice Fund reported, "In a number of the workshops there were very concrete examples
of groups who had worked in coalition, either within their community or statewide, on
particular health and safety issues: workers' compensation or field sanitation."

xii

Papers and Proceedings


Foreword

Gene Graham with the W.K Kellogg Foundation challenged the Conference, " . . . (how
can we) develop meaningful opportunities for enfranchisement, access to the institutions
of society, and the much needed occupational safety and health interventions for migrant
and seasonal workers?" Craig Merrilees with the Consumer Pesticide Project contended,
"Health and safety improvements come only when people are organized and when they
are able to control their own destiny"' Thomas Seymour from the Occupational Safety
and Health Administration observed, "In the OSHA history of writing rules, regulations
and enforcement, we have found that the people who are interested in trying to correct
these problems need to be on board and in support of the process."

Regarding the issue of training, Cynthia Douglass from the Occupational Safety and
Health Administration conveyed, `The answer lies in education, training, and increasing
awareness of those hazards and how they can be reduced." Malanie Zavala from the
University of California-Davis pointed out that, " . . . a lot of these people come here
without an excellent education' and this is going to make a difference as to what they
can understand in terms of reading-not so much in terms of spoken language, I think'
but in terms of things that they are going to have to read."

On children and women, Marilyn Adams of Farm Safety for "Just Kids" proposed, "My
experience with the youth tells me that they are our best bridge to the farm family. If
you take this one step further and train farm women in tractor safety, chemical safety,
rescue, and the other aspects of farming along with the youth, Dad and Grandpa will not
have a chance after we start rocking the boat and making waves." Surgeon General
Antonia Novello declared, "As a woman' I totally agree with the philosophy of Marilyn
Adams' group, Farm Safety for "Just Rids"' who say that the one person on a farm who
can play the most pivotal role in educating farmers and farm children about the dangers
of working on a farm is the woman." Nineteen-year-old Mark Timm from the National
FFA Organization related, "Not only does America need its young, but young people
need your help, support, guidance, and leadership." Dr. Walter Armbruster of the Farm
Foundation observed, "We also know that reaching adults through youth is a very
effective channel for modifying adult behavior."

b UNDERSTAND 'THE SYSTEMYNORDERTO CONTROLTHEPROBLEMS. Ageneral
principle that emerged was to develop win-win situations by understanding the system,
recognizing people as part of the system' and intervening early in that system in its
design.

Dr. Rice Leach, Chief of Staff to the Surgeon General' in speaking to a `win-win'
strategy conveyed it succinctly, " . . . I submit that the purpose of this endeavor or our
mission is to prepare the next generation to live in harmony with nature." Judith
Heffeman of the University of Missouri-Columbia remarked, `There is a social
movement afoot that looks at environmental and food safety and a whole host of issues
that are . . . put together, and so pesticide usage and water quality-and you know the
litany-we have heard much of it here." Dr. Robert Pinger from Ball State University
reported, "Integrated Pest Management is the use of the safest and most appropriate

Surgeon General's Conference on Agricultural Safety and Health - 1991

. . .
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Foreword

combination of methods (physical, chemical, and biological) to control vector popu-
lations."

Dr. Kelley Donham from the University of Iowa reported, "One of the items that came
out of the group was a call for a sustainable human resource in agriculture. This was
based on an analogy to the sustainable agriculture movement from a natural resources
conservation perspective." Larry Belmont from the Idaho Panhandle Health District 1
stated, "Our next best alternative is to develop new solutions or new systems of service to
cover those areas."

Recognizing human behavior as an important part of the system, Dr. Robert Aherin
from the University of Illinois propounded, `This theory has proven that intention is
strongly correlated to one's behavior and behavioral intentions are formed by two basic
determinants, one personal in nature and the other reflecting social influence." Assistant
Surgeon General Michael McGinnis offered an avenue for prevention by noting that,
,I

  the prominent role of behavior in health threats is not novel or unique, some of the
lessons that can be gleaned from other public health areas may be germane to the kinds
of approaches that we seek to establish for agricultural health and safety." In contrast,
Dr. Pamela Elkind from Eastern Washington University contended, "This assumption,
simply stated, is that to make agriculture safe for the farm families and workers, it is
necessary to motivate them to protect themselves from health and safety hazards . . . I
shall attempt to demonstrate to you that these assumptions lack validity."

Regarding design, Dr. David Pratt of the New York Center for Agricultural Medicine
and Health reported, "Intervention strategies are most effective when they are applied
early in the process." Dr. Gary Erisman, a private farmer, declared, " . . . design is the
most critical stage for the prevention of hazards and hazardous products." Ray
Crammond, consulting engineer, said of design, "I think the biggest problem is people
who ignore the human input." Rollin Schnieder from the University of Nebraska stated,
"You have to realize that a lot of the equipment that we have in agriculture is not totally
designed." Professor Stephan Konz from Kansas State University maintained, "Designing
out the problem is the best approach because it is a permanent solution." Dr. Richard
Fenske from the University of Washington said, " . . . there are many opportunities, if we
are creative, to reduce the hazard before we ever have to worry about personal protec-
tive equipment." Dale Baker from J.I. Case Company challenged the Conference, "Is
anyone going to invest the time and effort to develop new designs unless there is, in fact,
a demand?"

THE PROBLEM: DISEASE AND INJURY

To help establish priorities for the field of occupational safety and health, NIOSH in
1983 developed a list of 10 Leading Work-Related Diseases and Injuries and proposed
national strategies to prevent each of them. NIOSH invited leading experts to improve

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and elaborate on these strategies at two national symposia held in 1985 and 1986.' The
initial list was based upon three criteria: the scope of the problem, the severity of the
problem in the individual case, and the vulnerability of the problem to prevention. More
recently, infectious diseases have also emerged as a significant problem in occupational
safety and health.'

The problem is disease and injury, our common enemy. We have seen how this enemy
attacks American agricultural workers and their families. Recognized at this Conference
were a number of The Leading Work-Related Diseases and Injuries:

1.

2.

3.


4.

5.

6.


7.

8.

9.

IO.

11.

Occupational Lung Diseases - farmers' lung, asthma, hog lung, silo fillers' disease, etc.

Musculoskeletal Injuries - milkers' knee, tractor drivers' syndrome, tendinitis, repetitive
motion trauma, etc.

Occupational Cancers - skin, bladder, and brain cancer, leukemia, etc.

Severe Occupational Traumatic Injuries - machine-related fatalities, electrocutions,
suffocations, suicides, amputations, eye injuries, etc.

Occupational Cardiovascular Diseases - heat stroke.

Disorders of Reproduction - miscarriages, infertility, etc.

Neurotoxic Disorders - dementia, neurologic dysfunction, etc.

Noise-Induced Hearing Loss

Dermatological Conditions - burns, lacerations, dermatitis, etc.

Psychological Disorders - depression, stress, etc.

Infectious Diseases - zoonosis, tuberculosis, etc.

A VISION FOR THE FUTURE

In 1990, the Congress directed NIOSH to lead a comprehensive national program to
prevent occupational injuries and diseases in agriculture. NIOSH gains its authority for
responding to this direction from the Occupational Safety and Health Act of 1970, which

  1 Proposed Natiottal Strategies for the Prevention of Leading Work-Related Diseases and Injuries.  Part
1 in 1986 and Part 2 in 1988, Published by the Association of Schools of Public Health under a Cooperative
Agreement with the National Institute for Occupational Safety and Health.

  2 For an example related to agricultural workers see: Centers for Disease Control. "Prevention and
Control of Tuberculosis in Migrant Farm Workers: Recommendations of the Advisory Council for the
Elimination of Tuberculosis," MLVIXI? 1992;41 (No. RR-lo).

Surgeon General's Conference on Agricultural Safety and Health - 1991                     xv


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established the national goal "to assure so far as possible every working man and woman
in the Nation safe and healthful working conditions and to preserve our human resour-
ces."

NIOSH is charged in the Act to undertake scientific activities that will enable the goal to
be won. In response to this charge, NIOSH identifies those populations at highest risk,
defines risk factors that guide our efforts to reduce those risks, and provides information
to whomever has the ability to act in preventing the problem.

The Surgeon General's Conference of 1991 has established a national commitment to the
continuous improvement of safety and health among agricultural workers and {heir
families. It is a "Total Quality" commitment! As a result of the Conference, the Surgeon
General has identified a VISION for a national program for agricultural safety and health
in America:

To continuously and measurably improve the safety and health of every working
man and woman in American agriculture through the prevention of Leading
Work-Related Diseases and Injuries consistent with the goals and objectives of
`Healthy People 2000. '

In 1991, the U.S. Public Health Service published a report, Healthy People 2000:
National Health Promotion and Disease Prevention Objectives. This document is a
statement of national opportunities. This report is not intended as a statement of
Federal standards and requirements, but as a product of a national effort that involved
over 10,000 people. The Surgeon General addressed three overarching goals from this
report in the Preface. These goals are buttressed by specific and substantive objectives,
which are aimed at guiding decisions about programs, resource allocations, and profes-
sional and personal commitments.

The objectives enumerated in Healthy People 2000 deal with Health Status, Risk Reduc-
tion, Services and Protection, and Surveillance. The Health Status Objectives address
the problem of disease and injury, the Risk Reduction Objectives address the control of
the causes of the disease and injury problem. The Services and Protection Objectives
relate to the processes that require improvement so that risk can be reduced. The
Surveillance Objectives address the process of diagnosing and reporting information
about health status, risk reduction, and services and protection so as to better guide and
focus our intervention to control disease and injury.

With the vision of the future in mind, FarmSafe 2000 is a program commitment to
Healthy People 2000. Consistent with this commitment, we have listed, as illustrative
examples, 11 Health Status Objectives for the year 2000 that correspond with the

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problem, the 10 Leading Work-Related Diseases and Injuries plus infectious diseases.3
Each objective represents a significant improvement in health status over an existing
baseline by the year 2000.

1.

2.

3.

4.

5.

6.

7.

8.

9.



10.



11.

Occupational Lung Diseases - Reduce asthma morbidity, as measured by a reduction in
asthma hospitalizations to no more than 160 per 100,000 people (11.1).

Musculoskeletal Injuries - Reduce cumulative trauma disorders to an incidence of no
more than 60 cases per 100,000 full-time workers (10.3).

Occupational Cancers - Reverse the rise in cancer deaths to achieve a rate of no more
than 130 per 100,000 people (16.1).

Severe Occupational Traumatic Injuries - Reduce work-related injuries resulting in-
medical treatment, lost time from work, or restricted work activity to no more than 6
cases per 100 full-time agricultural workers (10.2~).

Occupational Cardiovascular Diseases - Reduce stroke deaths to no more than 20 per
100,000 people (15.1).

Disorders of Reproduction - Reduce the prevalence of infertility to no more than 6.5
percent (5.3).

Neurotoxic Disorders - Reduce nonfatal poisoning to no more than 88 emergency
department treatments per 100,000 people (9.8).

Noise-Induced Hearing Loss - Reduce significant hearing impairment to a prevalence of
no more than 82 per 1,000 people (17.6).

Dermatological Conditions - Reduce occupational skin disorders or diseases to an
incidence of no more than 55 per 100,000 full-time workers (10.4).

Psychological Disorders - Reduce suicides to no more than 10.5 per 100,000 people
(6.1).

Infectious Diseases - Reduce tuberculosis to an incidence of no more than 3.5 cases
per 100,000 people (20.4).

Another Health Status Objective, which would be classified under Severe Occupational
Traumatic Injuries, is to reduce deaths from work-related injuries to no more than 4 per
100,000 full-time agricultural workers. There was an annual average of 6 deaths per
100,000 for the period, 1983 to 1987. The next issue that I will discuss relates directly to
this objective.

   3 Each Objective is parenthetically followed by an identifying number. This number uniquely
identifies each Objective within the document: U.S. Department of Health and Human Services, Public
Health Service. Healthy People 2000: National Health Promotion and Disease Prevention
Objectives.  1990; DHHS Publication No. (PHS) 91450212, Washington, DC: Government Printing Office.

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AN "OCCUPATIONAL OBSCENITY

One final issue that was raised at the Conference cannot go without special mention.
Amidst expressions of anguish and pleas for reason, there was an overwhelming interest
in a particular issue, namely the need to reduce the risk of fatalities related to tractor
roll-overs.

Deaths from tractor roll-overs are the leading cause of traumatic fatalities on the farm.
There is no acceptable excuse for the persistence of this problem as deaths from tractor
roll-overs are fully preventable. The problem justifies the term, "occupational obscenity."
Twenty-seven speakers at the Conference addressed this problem. Categorized by the six
principles that emerged as unifying concepts at the Conference, here is what they said:

b CONTINUOUS IMPROVEMENT THROUGH PREVENTION.

A good example of the need for such a model is the prevention of tractor roll-over deaths througlz
the application of roll-over protective structures (ROPS) on both new and older tractors.  The
epidemiological evidence for the very significant risk posed by tractors without ROPS is clear. . .
The data available from Sweden, which mandated such a program, makes it equally clear that
ROPS can prevent almost all tractor roll-over deaths. An important question for this conference
is whether an American intervention model can be developed that can produce a significant
reduction of tractor roll-over deaths and injuries.  A second question, with much broader
ramifications, is, "Yf we cannot develop a U.S. model for a proven intervention on the single most
important cause of agricultural mortality, how can we succeed in addressing less dramatic yet still
impotiant causes of agricultural d&eases and injuries?"                  - Dr. James A. Merchant
                       Director, Institute of Agricultural Medicine and Occupational Health
                                               The University of Iowa

IJZ Sweden in 1959 the law was put forward concerning safeq frames (ROPS) in new tractors.  It
was also decided that employed agricultural workers were not allowed to work in tractors lacking
such frames. Self-el?tployed farmers and family members for many years were excluded from this
law and could use old tractors without frames in farm work A new tractor, of course, had this
device. IJI 1983 the law was extended to include family farmers. It was later decided that even old
tractors had to have frames if they were to be used in agn'cultural work The effect on fatalities
due to tractor turn-over since the year of legtilation was striking. It is obvious that thti action from
the authorities, unpopular as it might have been, has had quite a significant effect in preventing
severe accidents.                                       - Dr. Sverker Hogliind
                       Director, Swedish Farmers Safety and Preventive Health Association
                                                       Stockholm, Sweden

b RECOGNIZE THENEEDS OFTHEPOPULATIONAT RISK.

Even though the land is so jlat, we still have a tendency to have tractor roll-overs in the eastern part
of the state . . . Tractor roll-overs are still a major source of fatalities in the state.   - Rodney Gilmore
                                        Injury Control Program Manager
                               North Dakota State Department of Public Health

Bob Aherin said something about ROPS that really interested me. He said to ident@ the farmers
with high risk exposure and to identify appropriate intervention strategies . . . As a farmer, this
makes much more sense to me than suggesting that all farmers should put ROPS on all tractors.

  . . .
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We need to start somewhere and give the farmer a realistic picture of the high-risk exposure with
all tractors with end loaders or whatever the highest rirk is . . . I heard Wes Buchele address the
issue of retrojits. By all means, guarding for the older equipment neea3 to be made accessible and
marketed It is my personal feeling that dealers should not resell equipment without all protective
shields. They have a responsibility to their customem to market the proper shielding for their own
products.

         - Marilyn Adams
President, Farm Safety for "Just Kids"

Farm children have been injured and killed for years. I was too young to remember a tragic tractor
roll-over accident that claimed the life of our neighbor's son, Years later I remember finding the
yellowed and brittle newspaper articles about it that my mother had saved On looking back, I
think that that accident may have bud a lot to do with the fact that my brothers were not expected
to function as hired hands at a young age. . . When askeg `!lf cost were not a consideration, would
you use roll-overprotection ?" 89percent said they woukl; 96percent would use safety shielding; and
50 percent would use day care. These figures may be slightly high. We all know it is good to have
good in ten tions.                                           - Cheryl Tevis
                                                       Senior Farm Issue Editor
                                            Successful Farming Magazine

We have had a great deal of discussion, in thk session, about ROPS. We have all seen the slide,
many times, of the success of ROPS in Sweden. In 1985, we had a commitment by the North
American tractor manufacturers to make ROPS standard on all tractors. With a few exceptions
of tractors that are being imported into thk country and those that are for orchard applications, all
tractors since that time are equipped with ROPS. By 1970, ROPS in this country became available
OJZ virtually all major manufacturers'product lines. There was no demand for them. Therefore,
we have a significant number of tractors in operation in the U.S. that were built in that interval
between 1970 and 1985 that are not equipped with ROPS. I would suggest, in gross temzs, that
there are about a million tractors that are equipped with ROPS or that have ROPS built into the
cab. About a million tractors that are out there could have a ROPS installed on them but do not.
Another million tractors that are in use were built prior to thir introduction of ROPS and here
installation of ROPS becomes a real technological fisue. Now we should look at those two issues
separately.

IJZ putting ROPS onto tractors that were built prior to 1970, there are some significant technical
issues. Will the tractor structure survive an impact with this ROPS attached? The structure was
not built for that kind of use. New frames could be designect, possibly, to accommodate the design
by sharing the load forward to the transmtision housing. There is now a need to develop that new
structure. There were many applications for those old tractors where implements were attached to
the same location that we would attach thti ROP structure. If you destroy that, you have destroyed
the utility of that tractor. There is also the tisue of the economics ofpum'ng those ROPS OJI old
tractors. If there is to be a program of that nature, it is going to have to start with the development
of some pubic policy change that will create that demand Is anyone going to invest the time and
effort to develop new designs unless there ti, in fact, a demand?

The issue for tractors built in the interval between 1970 and 1985 where a ROPS can be installed
becolnes an issue of how to create an environment where the public demands those ROPS. They
are available. A demand undoubtedly could bring down the cost that was mentioned earlier. Until
there is a demand, there will not be any initiative that will cause that to happen. It is the chicken
and the egg situation. If you could decrease the cost, maybe you could increase the demand  You

Surgeon General's Conference on Agricultural Safety and Health - 1991                xix


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cannot decrease the cost, however, until there is a demand We are now again looking at what is
a public policy issue of how you create that demand I would say to you that my brother is aware
of the &sues of ROPS and tractor overturns. But fatal tmctor overtumr are a rare event (a farmer
is far more likely to be killed in a car accident than a tractor overturn). Virtually all farmers are
aware of the issue of fatal tractor 0veWm.s in the same sense that farmers (and the general public)
are aware of the issue of cigarette smoking causing cancer.                     - L. Dale Baker
                                              Product Safety Engineer
                                               J.I. Case Company

b SURVEILLANCETOMEASUREIMPROVEMENTS.

For many conditions we are at different surveillance stages in this scheme. For one condition that
we have heard much about, that of famt fatalities due to tractor roll-over, we have identified the
problem, we large@ know the scope of the problem, and we know what needs to be done to target
interventions.                                        -Dr. Henry A, Anderson
                                    Chief, Section of Environmental Epidemiology
                                 Wisconsin Department of Health and Social Services

For example, in 1958, Sweden instituted a law that any new tractor that wasproduced had to have
roll-over protection.  In the years thereafter, surveillance data indicate a decline in roll-over
fatalities. In 1978 Sweden instituted another law that any tractor in use had to have roll-over
protection, and the problem was eradicated                     - Dr. William E. Halperin
                                                      Associate Director for Surveillance
                               Division of Surveillance, Hazard Evaluations, and Field Studies
                                  National Institute for Occupational Safety and Health

The Olmstead Agricultural Trauma Study provided the basis for the Regional Rural Injury Study,
currently being conducted in a five-state region: Minnesota, Wuconsin, North Dakota, South
Dakota, and Nebraska. Data collection covers a twelve-month period of time for over 4,000 rural
households, utilizing computer-assisted telephone interviews.  This effort will enable the
identification of injury rates for each state and the region as well as multiple analytic substudies,
including tractor-roll-avers and animal-human injuries. The project also includes application of
the results to the development of intervention strategies, to be achieved by convening nationally
recognized experts and the regional participants in the Agricultural Injury Intervention Strategy
Workshop.                                                - Dr. Susan Goodwin Gerberich
                                 Division of Environmental and Occupational Health
                        School of Public Health, University of Minnesota, Minneapolis, Minnesota

We will look at safety risk factors, injuries, ergonomics, roll-overs, power-take-offs, and secondary
occupations.                                                       -Todd M. Frazier
                                                   Chief, Surveillance Branch

Division of Surveillance, Hazard Evaluations, and Field Studies
    National Institute for Occupational Safety and Health

They (nurses) can ident@ that as a problem and trigger efforts to prevent it from happening again.
Since they will be located in their own regions, they will often be able to identifi all cases of a given
condition, tractor roll-overs or power take-off injuries.  They can ident@ the scope of those
problems, use that information to target intervention efforts, and after intervention efforts, evaluate
how effective they have been . . . The Extension service havepeople who know how to retrofit trac-
tors with roll-over protection, if that is something someone wants to do.       - Dr. Eugene Freund
                                           Medical Officer, Surveillance Branch

Division of Surveillance, Hazard Evaluations, and Field Studies
    National Institute for Occupational Safety and Health

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w RESEARCH TO FIND ROOT CAUSES.

Farm equipment accounted for 40 to 60percent of deaths and injuries in the majority of studies,
followed very closely by livestock injuries and jalk Numerous types of farm machinery have been
implicated in all sties. Since the majon@ offm machinery is associated with tractors, it stana
to reason that injuries "involving" tractors were the most common type of machinery-related trauma.
Tractor over-tunas, it appeared, were involved in the majority of agricultural fatalities. Many studies
indicated that youth and the elderly were most often associated as an at-risk population , . .  The
studies varieci, though, when you compared those using statistics porn government agencies that
were not gathering the appropriate and associated data with youth . . .

The opportunity presents itselj to include some homespun theory. This happens to be a theory of
mine: on family fam, older tractors and equipment are ofren reserved for general duty while
newer pieces of machinery are delegated to more production types of tasks. The general duty may
be more hazardous than the normal production tasks on farms. As a result, general duty fi often
done by the youth or the elder&, The typical fmer, the principal operator, is using the newer
machinery to plow and till the field, etc., while the older machinery may be relegated to cutting the
fence rows or ditch banks and stationary operations that may be more hazardous than doingfield-
related operations. As a result, when you combine the inexperience of youth and the diminished
capacity that comes with aging (because the elderly or youth usually do this general duty) with the
inherent danger of the equipment, you have an increasedpotential for trauma. . . Research on roll-
over protection on older tractors should continue.                        - Dr. Thomas L. Bean
                                Safety Leader, Ohio Cooperative Extension Service
                                                Ohio State University

Dr. Bean stressed the need to install ROPS on farm tractors . . , "R OPS is a proven intervention
strategy. Wlzy can we not implement it. 3" Is the problem the cost, the infrastructure, the regulation,
or the legal system?                                                  - Penn A. Peters
                                                   Project Leader
                                                               U.S. Forest Service

In the late 1950's and early 1960's, extensive research and development work was done by the
industry to establish the eficacy of ROPS designs for the kinds of tractor overturns that can occur
in normal farming and road transport. Manufacturers began supplying ROPS commercially in the
late 1960's. The experience in both the United States and Europe has proven ROPS to be an
effective sajev device.

There is a need for additional research on small tractors' ROPS. The standard `protective zone"
around the tractor operator, which controls the size of the ROPS envelope, was defined on the basis
of the ergonomic data that existed in the 1950's and 1960's. The zone remains essentially un-
changed today. The Equipment Manufacturers Institute (EMI) sponsored a literature review of the
different protective zones used for the design of several kinds of vehicles, including aircraft,
automobiles, racing cars, farm equipment, construction equipment, and mining equipment.  This
study, which was perjonned by Triodyne, Inc. of Skokie, Illinois, has been completed Publication
will be through both the Society of Automotive Engineers (SAE) and the American Society of
Agricultural Engineers (ASAE) before the end of 1991. The basic conclusion of the Triodyne study
was that it did not appear, from the kindr of systems that are in place, that sufficient research had
been done that could serve as the basis for making the protective zone of a ROPS, as specified by
current standards, for smaller for small tractors. Small tractors are often used in low overhead
clearance settingsin vineyards, orchards, storage buildings, and machine shed.

Surgeon General's Conference on Agricultural Safety and Health - 1991

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The higher the profile of a ROPS relative to an overhead object such as a tree branch, the greater
the likelihood that a farmer will not want to equip a tractor with ROPS or, if there is one on a
tractor, to keep it in place. Clearly, there is potential safety value in making the ROPS as compact
as possible without compromising protection in the event of a tip-over. As Murray Madsen
mentioned in his presentation, one approach to addressing this situation is to make ROPS that can
be raised or lowered They telescope or fold down for temporary use in the lowered position under
low clearance conditions. There are some companies that have such ROPS on the market tooday.
Industry's research capabilities concerning ROPS are limited to mechanical and structural aspects.
There is little more to be done there with the exception of the small tractor ROPS.

Accident data ident@ tractor roll-overs as the leading cause of machinery-related death on the
f arm.  Therefore, perhaps the most pressing challenge for behavioral researchers and health
professionals is to find an effective way to ensure, short of compulsory measures such as regulation,
that ROPS are installed and kept on tractors. EMI believes that behavioral research in this area
holds promise of effecting a substantial reduction in roll-over injury and fatality rates. The starting
point for such research, we submit, may be recognition that over one million of the approximately
3.6 million agricultural tractors in use today in the United States do have ROPS on them.  There
are over one million farmers who chose to equip their tractors with ROPS when they purchased
t?tem. The question should be asked how these farmers arrived at their decision to equip the
tractors with ROPS. Was it because of the Occupational Safety and Health Administration's
(OSHA) rule? Was it because manufacturers were able to package the ROPS in a cab that was
noise-insulated and isolated from vibration of the tractor. 3 It provided air conditioning, heating,
and stereo; i.e., it was made so attractive in other respects that the farmer was willing to pay for
the ROPS cab.

Or were there other factors? The key to getting ROPS on the over-2.5 million tractors that do not
now have them may indeed be found by examining the factors in the decisions of the approximately
one million farmers who did decide to equip their tractors with ROPS. The third essential criterion
is that a safety device must not by its presence, introduce different r&ks that would not exist without
it. Murray Madsen referred to a study that showed that some accidents occurred because of an
operator presence-type device.

I am reminded of a situation that exbted several years ago when OSPi%, with all good intent,
promulgated its ROPS rule for agriculture. As it turned out, there were some small tractors t?lat
had backhoes mounted to the three-point hitch, with a separate seat for the operator affud to the
backhoe frame behind the tractor.  Without the ROPS there was not any problem. It was
discovered that when a ROPS was installed on a tractor with the threepoint-hitch-mounted
backhoe, a crush point between the elevating backhoe boom and the rigid ROPS structure was
created A number of fatalities occurred because of that condition. The solution was to do away
with the three-point-hitch-mounted backhoe or redesign the ROPS or both. A combination of these
measures was implemented through various field reworkprograms to eliminate the hazard  When
tractor ROPS were being developed, manufacturers' test programs included actual roll-overs of
tractors with experimental ROPS designs at different attitudes and speeds.  There is a need in
many cases, to verify that a new safety feature will be acceptable to the farmer.    -John H. Crowley
                                              Director of Safety Programs
                                        Equipment Manufacturers Institute

It has been learned in recent times that amuude measures do not correspond with behavioral
criterions. The early attitudinal studies would evaluate a very general behavioral statement. An
example of this would be when evaluating the potential purchase of ROPS on a tractor a subject

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might be asked to evaluate a statement such as, "Roll-overprotective structures are . " A
more appropriate evaluative statement for predicting ROPS purchasing behavior would be to ask
farmers their attitude toward buying roll-overprotective structures.  The am'tude question would
look as follows: "My buying a roll-overprotective structure in the next two years for one of my non-
ROPS equipped tractors is      ," The attituaZna1 question must match the corresponding
behavioral criterion in terms of 1) action, 2) target, 3) context, and 4) time. In the previous
example the action was "my buying," the target was "ROPS for one of my (the subject) non-ROPS
equipped tractors, " the context was "general, n and time was "within the next two years. "

In summary, there may be a substantial difference between people's amtt.&es toward objects (in this
example, ROPS) and people's am*tudes toward behaviors associated with objects (in this example,
buying ROPS). To predict behavior, this distinction is crucial An example of an issue that might
benefit from Theory of Reasoned Action type of analysis would be the installing of ROPS on
tractors. Tractor roll-overs are a major factor in farm work- related deaths. It is well known that
if a tractor has a ROPS it almost eliminates the death potential in a tractor roll-over incident. But
only about 30 percent of the farm tractors in the United States have a ROPS. Thus, at issue is
what it would take to persuade farm tractor owners to install a ROPS on non-ROPS tractors.
There have been significant educational programs to promote the purchase of ROPS among farm
tractor owners. But there has been no signijicant increase in the retrofitting of ROPS on non-ROPS
equipped tractors. If an analysis was conducted among US farm tractor operators utilizing the
Theory of Reasoned Action, one could learn what intervention initiatives would be necessary to
effect a significant change in this behavior. For example, it could be learned how much if anything
farmers would be willing to spend for a ROPS, their general perception of the need for ROPS on
their tractors, tractor use problems that they may encounter with ROPS, and so on. This type of
information would provide focus for initiatives to deal with this issue rather than using the
traditional `Shotgun" approach of trying anything and seeing if it works.         - Dr. Robert Aherin
                                   Professor, Department of Agricultural Engineering
                                              University of Illinois

b RESPECT PEOPLE WHILE CONTROLLINGTHEPROBLEMS.

Again, economic realities make choices very dificult. Take for example, ROPS protection. Most
farmers know the dangers and would willingly retrofit their tractors, but there is economic reality.
                                                               - Ellen G. Widess

Director of Health and Safety Policy, Children's Advocacy Institute
                    Center for Public Interest Law

"I think I am going to invest in (it) whatever it costs," although I did hear myself saying to my
husband last night, "Honey, we have got to buy roll-over bars. " That is on the agenda. But we,
with other income, can probably do that; but I knowpeople who are borrowing money to put bread
on the table.                                                  -Judith Bortner Heffernan
                             Executive Director of Heartland Nehvork for Town and Rural Ministries
                                        University of Missouri-Columbia

I heard one presenter say that her family was going to buy the roll-over protective device for their
tractor. I encourage her to follow through on this commitment.                - Dr. Rice C. Leach
                                     Chief of Staff, Office of the Surgeon General

When we looked at the tractor roll-over problem with Marshfield, we decided that there was no
need for further research on the problem. What we decided we needed was a way to help farmers
who wanted to retrofit older tractors with roll bars or other roll-overprotective devices to find those

Surgeon General's Conference on Agricultural Safety and Health - 1991                     XXIII


Foreword

"ROPS," as tltey are called  So we asked Marshjield to develop and publish a catalog of all
American manufacturers of `ROPS, " all products they produce and what make of tractor, model
of tractor, and year of tractor they will build Then Marshfield sent the catalog to all extension
agents in tJze country, so it is available where it is needed Producing that catalog is not the best
step we could take as a society. As we have seen in the slide on the Swedish experience, tJze best
step we could take would be to require "ROPS." But as an Office, it was the best we could do,
                                                 -Jeffrey Human
                                        Director, Office of Rural Health Policy
                                                       U.S. Public Health Service

We have also seen ROPS development and the recent development of retractable or foldable ROPS
for tlzose essential applications where you must go into a buil&ng that is shorter - not as tall as
your tractor's ROPS. I would also say to those of you who wonder about ROPS that since 1985
virtually every tractor produced Aas been sold with a ROPS on it or right at the fingertips.  Since
1970, virtually every tractor could have a ROPS put on it, and some have since I960. Consider,
for example, Jzow to convince tlze owner of a 30-year-old tractor worth, at most, $1,000, to put a
$500 ROPS OJZ it. Tile University of Illinois, NIOSH, and the University of Iowa are doing researclt
to Jtelp find some of tlzose kinds of answers. A ROPS that provides protection and still meets tlze
needs of users under limbs, vines, and rafters holds promise. It is likely that this kind of roll-over
protection will produce more acceptable designs for the user. Perhaps it may not produce as much
protection as users have become accustomed to with larger or more conventional roll-overprotective
structures. Is tlzere an opportunity for validating acceptable ROPS for more compact tractors?
                                                - Murray Madsen
                                  Product Safety Engineer for Agricultural Equipment
                                                Deere and Company

TJtere are also recommendations aimed at reducing specific hazards, such as the danger of injury
or deatla in tractor roll-over or from moving machinery parts . . . OSHA also reviews existing
standards tlzat apply to agriculture, such as the ROPS standard  We look at wlzether tltese
standards should be modified to reflect changing conditions in the United States, in the world, and
in the industry. We need your Jzelp, tlzouglz, on reviewing and modibing these standards, if we are
to Jtave good, common-sense safety standards. In another area, a member of our staff leas been
comparing tlte new standard OJI ROPS for tractors and other vehicles, which was adopted by SAE,
to the existing OSHA standard We have received design and test data from American tractor
manufacturers and otlters. We have made a preliminary conclusion that the new SAE standard
is equal to or exceeds the current OSHA standard and therefore, is acceptable to the agency. A
final decision on this will be made slzortly. Hopefully, this will make it easier for American farm
equipment manufacturers to compete in the European market.             - Cynthia Douglass
                                      Deputy Assistant Secretary of Labor
                                 U.S. Occupational Safety and Health Administration

b UNDERSTAND"THE SYSTEM"IN ORDERTO CONTROLTHEPROBLEMS.

Look no furtlzer than tile agriculture-implement lobby here today, This lobby has blocked roll-over
protection in tJtis country for 30 years with bee-jerk, protective, self-interested arguments tlzat
continue to allow farmworkers to die in thk country, out of their narrow interest. That is wrong.
Tire reason that it Jzappened i.s not because we have not done enough scientific research to
document the problem.                                     - Craig Merrilees
                                       Director, Consumer Pesticide Project

xxiv

Papers and Proceedings


Foreword

ROPS for tractors and tractor seat-belt use couldprevent the majoriv of tractor-related deaths. Vir-
tually all new tractors sold in the United States have ROPS . . . Because of the relatively long life
of tractors, most agricultural tractors in use do not have ROPS in place.  Nearly half of the
approximately 400 tractor-related deaths that occur each year in this nation involve roll-overs. How
do we ensure that the older tractors and machines without these modem safety features get
retrojitted with modern safety features when feasible or get taken out of use? The issue of how
such updating and retrofitting is practical presents a significant challenge . . . Although more
research and more data are needed to direct intervention, we know certain health and safev
precautions work; ROPS work                             - Dr. Myron D. Johnsrud
                                              Administrator, Extension Setice
                                            U.S. Department of Agriculture

Perhaps the best example of passive controls is ROPS.                        - Dr. David S. Pratt
                            Director, New York Center for Agricultural Medicine and Health
                                                 Cooperstown, NY

There are some issues, the ROPS issue is the most typical one, that we can approach from a
national perspective.                                      - Dr. Dennis Murphy
                                            Professor, Penn State University

The committee divided itself into working groups to develop suggestions and recommendations in
the areas of training, and also in the need.s for standards like ROPS and machine guarding.  In
1972, the full committee recommended its first standard They recommended that we do a ROPS
rule for farm tractors.  The first agricultural standard that OSHA issued under its normal
rule-making was the ROPS standard We proposed that back in 1975, we finalized it in 197.5, and
it becar?re effective in October, 1976. It dealt with all farm tractors made after October, 1976; they
had to be equipped with the ROPS. The standard is based on the ASAE Standard, Jll-94.  The
complete text of that Standard was put into the OSHA standard

Even though tractors were required to have ROPS, we continue to see deaths of tractor operators
from roll-overs. We have seen seat belts cut off or cut out; seat belts were not used in several roll-
over deaths.  Obviously, we have not seen the results that the Swedes have achieved with tlteir
standardization efforts.  OSHA wants to see its standard evaluated  We want to see this standard
looked at very thoroughly to see why it is not working. What can we do to mod@ it, to make it
work, to become more effective ? We know that seat belts are considered by many farmers and
farmworkers as a hassle in hooking and unhooking, especially when you have to get off the tractor
a number of times. The new ASAE Standard J2l-9.4, is a revision of this effort.  We have said
publicly that the standard is acceptable in meeting our ROPS standard that we require here.  We
have done that administratively. The International Standards Organization (ISO) is also involved
in wn'ting standards for ROPS, and the IS0 Standards 5700 and 34-63 are additional new ROPS
standards. Our ROPS standard is not as stringent as theirs. In our opinion, if you have a ROPS
design that meets all the tests of the IS0 Standards, that will be acceptable in meeting the OSlZ4
Standard as well.                                      -Thomas H. Seymour
                              Fire Protection Engineer, Directorate of Safety Standards
                                U.S. Occupational Safety and Health Administration

Due to engineering advances in the last three decades, farm equipment manufacturers have incor-
porated more safety devices on their equipment. Integral rotary shield for power take-off shafts
and roll-over protective structures for tractors have been two major accomplishments in making
farm machinery more user-safe.  Since tractor roll-overs are involved in a large portion of
agricultural fatalities, elimination of this type of incident alone would cause the death rate on

Surgeon General's Conference on Agricultural Safety and Health - 1991                     xxv


Foreword

American farms to plunge. But farmers themselves murt make the commitment to run a safe
operation. When they see the dangers and learn the advantage, safety happens. In Nebraska, for
example, university safety experts have conducted 450 tractor roll-over demonstrations since 1970
to convince farmers of the dangers. About 23,000 young people were trained in tractor safety.
There have been two known fatalities in this group. The national average for a group that size
would be five deaths.                                       - Merlin Plagge
                                                President, Iowa Farm Bureau

In conclusion, I wish to thank CAPT Melvin L. Myers for his hard work in planning and
managing both the Surgeon General's Conference on Agricultural Safety and Health and
the production of these Papers and Proceedings. I also wish to thank the rapporteurs,
CAPT Robert F. Herrick, CAPT Stephen A. Olenchock, Mr. John R. Myers,
CDR John E. Parker, and Dr. David L. Hard, who assisted with the concurrent sessions
and the editing of the papers presented at those sessions.

I wish to thank Ms. Katherine Wilson who coordinated the poster and video tape session
md reviewed the abstracts from those posters for this publication. Many others who
ilelped to make this Conference a success are named in the acknowledgements of this
document.

But most of all, it was the work of the 540 participants at this Conference who made it a
success through honest engagement with the issues and interaction with others. Their
names are listed by their respective state near the end of this document. My thanks to
all for making this Conference a splendid success in our national movement to improve
the safety and health of agricultural workers and their fami1ies.U

J. Donald Millar, M.D., D.T.P.H. (Lond.)
     Assistant Surgeon General
      Director, National Institute
for Occupational Safety and Health

xxvi

Papers and Proceedings


Surgeon General's Conference on Agricultural Safety and Health
FARM&FE 2000 . A National Coalition for Local Action
Convened by the National Institute for Occupational Safety and Health
April 30 - May 3, 1991, Des Moines, Iowa

THE PLANNING COMMITTEE

Melvin L. Myers, M.P.A. - Chair
Office of the Director
NIOSH, CDC
1600 Clifton Rd, NE
Atlanta, GA 30333

Robert W. Mason, Ph.D.
Division of Standards
Development and Technology
Transfer, NIOSH, CDC
4676 Columbia Pkwy
Cincinnati, OH 45213

Stephen A. Olenchock, Ph.D.
Division of Respiratory Disease
Studies, NIOSH, CDC
944 Chestnut Ridge Rd
Morgantown, WV 26505

Katherine Wilson, M.P.H.
Division for Chronic Disease
Control and Community
Intervention, NCCDPHP, CDC
3005 Chamblee-Tucker Rd
Chamblee, GA 30341

Robert A. Wright
Office of Vital and Health
Statistics Systems, NCHS, CDC
6525 Belcrest Rd
Hyattsville, MD 20782

Lawrence J. Doemeny, Ph.D.
Division of Physical Sciences and
Engineering, NIOSH, CDC
5555 Ridge Ave
Cincinnati, OH 45226

Pantelis G. Rentos, Ph.D.
Division of Training and
Manpower Development
NIOSH, CDC
4676 Columbia Pkwy
Cincinnati, OH 45213

John R. Myers, M.S.F.
Division of Safety Research
NIOSH, CDC
944 Chestnut Ridge Rd
Morgantown, WV 26505

John J. Coumbis, M.D.
Oak Ridge Fellow, ATSDR
1600 Clifton Rd, NE
Atlanta, GA 30333

Stephen M. Ostroff, M.D.
Division of Bacterial and Mycotic
Diseases, NCID, CDC
1600 Clifton Rd, NE
Atlanta, GA 30333

Russell E. Savage, Ph.D
Division of Biomedical and
Behavioral Science, NIOSH, CDC
4676 Columbia Pkwy
Cincinnati, OH 45213

Robert F. Herrick, Sc.D.
Division of Surveillance, Hazard
Evaluation, and Field Studies
NIOSH, CDC
5555 Ridge Ave
Cincinnati, OH 45226

Paul Burlack
Division of Injury Control
NCEHIC, CDC
2858 Woodcock Blvd
Chamblee, GA 30341

William H. Gimson
Financial Management Office
OPS, CDC
255 E Paces Ferry Rd
Atlanta, GA 30305

Surgeon General's Conference on Agricultural Safety and Health - 1991

xxvii


The Planning Committee

- ADVISORS TO THE PLANNING COMMWEE -

John E. Parker, M.D.
Division of Safety Research
NIOSH, CDC
944 Chestnut Ridge Rd
Morgantown, WV 26505

Bradley K. Rein, P.E.
Extension Service, USDA
Rm 3346, South
14th and Industrial Ave, SW
Washington, DC 20250

Jeffrey H. Lancashire
Office of the Director
NIOSH, CDC
1600 Clifton Rd, NE
Atlanta, GA 30333

Ann M. Cronin
Office of the Director
NIOSH, CDC
1600 Clifton Rd, NE
Atlanta, GA 30333

David L Hard, Ph.D.
Division of Safety Research
NIOSH, CDC
944 Chestnut Ridge Rd
Morgantown, WV 26505

Cathy J. Wasem, RN, MN
Office of Rural Health Policy
Health Resources and Services
Administration
5600 Fishers Ln, Rm 14-22
Rockville, MD 20857

Vivian K. Morgan
Division of Standards
Development and Technology
Transfer, NIOSH, CDC
4676 Columbia Pkwy
Cincinnati, OH 45213

Stephen Mallinger
OSHA, US Department of Labor
Rm N3653
200 Constitution Ave, NW
Washington, DC 20210

Dushanka V. Kleinman, D.D.S.
Office of the Surgeon General
USPHS, Rm 71OG
200 Independence Ave, SW
Washington, DC 20201

Todd M. Frazier, Sc.M.
Division of Surveillance, Hazard
Evaluation, and Field Studies
NIOSH, CDC
5555 Ridge Ave
Cincinnati, OH 45226

   . . .
xxvlll

Papers and Proceedings


Surgeon General's Conference on Agricultural Safety and Health
FARM&FE 2000 . A National Coalition for Local Act/on
Convened by the National Institute for Occupational Safety and Health
April 30 - May 3, 1991, Des Moines, Iowa

ACKNOWLEDGEMENTS

Convening and holding the Surgeon General's Conference on Agricultural Safety and
Health was a team effort as was preparing these Papers and Proceedings. In addition to
the planning committee and their advisors, the presenters, the panel moderators and
rapporteurs, and panel members, we wish to thank the following staff to the Surgeon
General, NIOSH staff, and editorial advisors for their diligent work for this Conference
and for their help in the preparation of this document:

For their willing and timely assistance from the Office of the Surgeon General,
Dushanka V. Kleinman, D.D.S., who served as the principle liaison within the Office,
Rice C. Leach, M.D., who maintained an open door for resolving the most pressing
problems, and for assisting the Surgeon General, Elizabeth P. Schmidt, Theresa Hyatt,
and Margaret Garikes.

For their attention to detail and quality from NIOSH, Kimberly L. Barth for her diligent
work in assembling and preparing much of the information that proceeded the con-
ference and that is in this document including coordinating its changes;
Elizabeth H. Dryden who coordinated with commitment and diplomacy the staff and the
logistics of the conference with the contractor; Trevia K. Pereira for her early assistance
to the planning committee; Renee L. Ross for her willing help in formatting the abstracts
and appendixes of this document; Amy A. Huston, Julie A. Wasil, and Judy L. James for
their assistance in making the many editorial changes during the progress of this
document; Ann M. Cronin, Mary B. Griffin, Richie D. Dickerson, Kay Basile,
Terry L. Stewart, Terri L. Sims, Kami L. Townsend, and Lunette IS. Utter, who helped
with the logistics at the Conference; Janice M. Huy, Vivian K. Morgan, and
Charlene B. Maloney for their professionalism in preparing and showing the Conference
exhibit.

For their assistance as editorial advisors from NIOSH, Newell E. Tozzer,
Charlene B. Maloney, Shirley M. Carr, William E. Halperin, M.D., and
Richard A. Lemen, Ph.D. For their added assistance as editorial advisors,
Henry A. Anderson, M.D., Ph.D., Kelley J. Donham, D.V.M., Lorann Stallones, Ph.D.,
David S. Pratt, M.D., Walter J. Armbruster, Ph.D., Rice C. Leach, M.D.,
Cathy J. Wasem, RN, MN, and Valerie A. Wilk, M.S.

And for her superb work as the contractor for this conference, Rosita Bachmann and to
her associates.0

Surgeon General's Conference on Agricultural Safety and Health - 1991

xxix


Surgeon General's Conference on Agricultural Safety and Health
FARM&FE 2000 . A National Coalition for Local Action
Convened by the National institute for Occupational Safety and Health
April 30 - May 3, 1997, Des Moines, Iowa
               TABLE OF CONTENTS

iii National Farm Safety Week, 1991: A Proclamation
                  f3y the President of the United States of America

v Preface

vii Foreword

xxvii The Planning Committee

xxix Acknowledgements

xxxi Table of Contents

By Antonia C. Novel/o, M.D.

By J. Donald Millar, M.D.

1  Welcome from the Chair of the Conference       By J. Donald Millar, M.D.

2 Welcome to Des Moines                   By John P. Dorrian

3 Welcome to Iowa               By Christopher G. Atchison, M.P.A.

THE POTENTIAL FOR A NATIONAL COALITION
                         Moderator: Antonia C. Novel/o, M.D.
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7  Raising Safety and Health Consciousness among Farmers and Farmworkers
                             By Ellen G. Widess, J.D.

17  Building Coalitions for Preventing Injury and Disease in Agriculture
                            By Thomas M. Dean, M.D.

22  Disseminating Safety and Health Information through Education
                          By J. Michael McGinnis, M.D.

28  Encouraging Action in Preventing Injury and Disease in Agriculture
                           By Louis W. Sullivan, M.D.

30  Surgeon General Conferences: A Model for the Future
                           By Antonia C. Novello, M.D.

Surgeon General's Conference on Agricultural Safety and Health - 1991                xxxi


Table of Contents

LOOKING AHEAD TO THE NEXT CENTURY     Moderator: J. Donald Miliar, M.D.
                          .
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35  Remarks by the Chair of the Conference        By J. Donald Millar, M.D.

36 Healthy People 2000 and Agriculture

By Senator Tom Harkin

43 Building Infrastructures for Prevention

By William L. Roper, M.D.

48 Charge to the Conference

By Antonia C. Novel/o, M.D.

QUESTIONS TO GUIDE THE NATIONAL AGENDA         Moderator: Mark Timm
::::::::::::j::::::::::::::::::::::::::::::::::::::~::::::::::::::::::::::::::::::::::::::::::::::~:::.:.:.:.:.:.:.:.:.: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                                . . \.,.....,.....,...,.,
                      . . . . . .._...........i . . . . . . . i... .,:,:.~:.:.:.:.:.:.:.:.:~:.:.~~:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.~:~.:.:.:.:.:.:.:.:.:~:.:.:.:.:.:.:.:.:.:.~~~:.:.:.:~.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:~.~,:::::::::::~::::::::::::~:::~~:::::::~:::::~::::::::~::::::::::~::::~:::::~:::~~:::::::::~~ :,~,~,:.:,:.~,,.,.,,,.,.~,~.,,,~ ~
                                  . . . . . . . .  

55 Remarks by the National FFA President             By Mark Timm

59 The Role of Public Policy in Agricultural Safety and Health
                          By Joseph A. Kinney, M.P.A.

67 Surveillance for Agricultural Safety and Health

By William E. Halperin, M.D.

73  Research for Agricultural Safety and Health     l3y James A. Merchant, M.D.

86  Intervention for Agricultural Safety and Health    By Myron D. Johnsrud, Ph.D.

MEDICAL INTERVENTION PROBLEMS AND OPPORTUNITIES

    
:::::::::::::::::.:.: ..l........_......i `;;;:`:`: ..__...._,,,,.,.,.,,,,,....,,,.,,,,,.,.,..,......................................................................
 . . . . . . . . . . . . . . . . . . . . . . . . . . . ,: :.:,:. ~ .:.:.:.:.I:.:.):.:.:.:,:,:,:,:,

93 Rural Health Policy                   By Jeffrey Human, M.A.

97  Medical Intervention Problems and Opportunities in Rural Areas
                          By Governor Robert D. Ray

ISSUES THAT AFFECT THE NATIONAL AGENDA
                         Moderator: Ronald D. Eckoff, M.D.

IO5 Introductory Remarks                By Ronald D. Eckoff, M.D.

107 The Agricultural Workforce

By Leslie A. Whitener, Ph.D.

123 Attitudes and Risk Behavior in Agriculture

By Pamela D. E/kind, Ph.D.

129 Industrial Crops of the Future

By Daniel E. Kugler, Ph.D.

134 Biotechnology and Agriculture

By Jane Rissler, Ph.D.

xxxii

Surgeon General's Conference on Agricultural Safety and Health - 1991


Table of Contents

PROPOSALS FOR A NATIONAL AGENDA
::~.::::::::::::::::::::::::::::~~::~~~.~::~~~~~:::::::~::::::::::~:::~::::~.:::::~::::~~:~~::::::~~:~~.:.:.:.~:.:~.~~~.   . . .
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                                                                      .Q.. . . . . . . . ,. .......v....,.. .., . A . . . .

1. Surveillance - Agriculture-Related Diseases, Injuries, and Hazards

Moderator: Henry A. Anderson, M.D.      Rapporteur: Robert F. Herrick, Ph.D.
. . . . . . . . . . 
   _, ,, 
        _, .._...,.,.(.(,.(/...,._.,.,.,.,.,...,.,.,.,,,.,.,.,.,...,...............,.,.,.....,.,.............. . . . . . . . . . . . . . . _.........,..., . . . . . . . . . . . . . . . . . . . . . . . . ,............ .,.a . . . . . . . . . . . n., _.........,.. . . . . . . . ,........., ._/ ,.........,...,._ . . . . . . . . . . . .._...... .,.,... ,.,.,.,...........,._ .,.,... ..,...,.,........._.... . . . ..,._/........., .,. ,l..,.,.i_........ ,.,........., . . . . . . . . . . . . . . . . . . . . . .._.... . . . . . . . . . . . . . . . ..i... ..A., .,..

143 Surveillance: A Physician's Viewpoint           l3y John J. May, M.D.

151 Chemical Hazards                  By Linda Rosenstock, M.D.

157 Respiratory Diseases                By James A. Dosman, M.D.

161  Surveillance of Injuries in Agriculture     Sy Susan G. Gerberich, Ph.D., et. al.

179 Musculoskeletal Disorders and Hazards        By John J. Coumbis, M.D.

184 A Government Perspective I             By Todd M. Frazier, Sc.M.

189 A Government Perspective II            By Eugene Freund, Jr., M.D.

192 A Consumers' Perspective               f3y Craig Merrilees, B.A.

199 An Agricultural Safety Perspective          By Dennis J. Murphy, Ph.D.

2. Research - Chemical and Biological Hazards

Moderator: Kelley J. Donham, D.V. M.    Rapporteur: Stephen A. Olenchock, Ph.D.
     . . . . . . . . . . . . ..,...,.,.....,.,...,.......... . . . . . . . . . . . . . . . . . . . . . ,.... . . . . . . . . . ,.............,.,....                                                            
..,.....,....... . . . . . . .                     . . . . . . . . . . . . . . . . . . . . . . . .._............................................................................................................................ . . . . . . . . . . . .._.... . . . . . . . ../...............................................,.,...............,.,...............,.,...........,...........,.,.. /. . . . . . . . . . . . . . . . ...\...

204 Airborne Dusts                  By Susanna Von Essen, M.D.

216 Infectious Diseases                By Russell W. Currier, D.V.M.

229  An Overview of Potential Health Hazards among Farmers from Use of Pesticides
                              By Aaron Blair, Ph.D.

243 Gases, Liquids, Vapors, and Drugs         By William Popendorf, Ph.D.

255 The Migrant Workers' Perspective           By E. Roberta Ryder, B.A.

261 A Foundation's Perspective              By Gene F. Graham, M.S.

267 A Clinical Perspective

f3y Dean T. Stueland, M.D.

Surgeon General's Conference on Agricultural Safety and Health - 1991

xmlll


Table of Contents

3. Research - Mechanical and Physical Hazards

Moderator: Lorann Stallones, Ph.D.
..,.,., ..,...,.......,.....,...................,.........,.................. _.... .,....... . . . . . . . . . .,. . . . . . . . . . . . ,.......... 5. . . . . . . . . . . . . . . . . . i... .,._.,.C,C.,..I.,. ..,., ,A.. i...., .,. ,.,.i....... V..,. ,...i... . . . . . ..i.. ..i...., . . . . . . . . . . . . . . . . . . . . . . .  Rapporteur: John R. Myers, M.S.F.
                                                . . . . . . . . . ..v.. . . . . . . . . . . . . .../... . . . . . . . . . . . . . . . . . . . . . . . . . . . . _...... ..,.. .,.,... ..,~/.~,..........~....,~,~.~,.,~..,....~,..~.~,..~,~,.,~,.,....~..,..~,~,~.....~.~.~.......~,........., . . .._ .,.,. . . . . . . . . . . . . . . . . . ..

274 Farm Machinery and Vehicles             By Thomas L. Bean, Ph.D.

278 Musculoskeletal Hazards               By David Cochran, Ph.D.

285 Electrical Power                  By Robert L. McLymore, M.S.

293 Noise and Stress                   By Matthew Marvel, M.D.

2% Technology Transfer                  By Murray Madsen, P.E.

308 The Manufacturers' Perspective           By John H. Crowley, M.B.A.

317 A Forestry Perspective                 By Penn A. Peters, P. E.

321 A Regulatory Perspective              By Thomas H. Seymour, P.E.

4. Intervention - Agricultural Workers' Protection from Hazards

Moderator: David S. Pratt M.D.           Rapporteur: John E. Parker, M.D.
..i... . . .
   /.....,.......,.,../.....,.......,...........,.........,...,.......,...,...............,.......... . . . . . . . . I..   .,./,.......,.,.i,.,.......,.,...,.,.............,~,.,.,...........,.,.,.,.,.............,.,.,.,.,.,.,.....,.,.,.,.,.,.,.,...,.,.,.,.,.,.,...,.,.,.,.,...,...,.,.,.....,.,...,.............,.... . . . ..,....._.. ..,.....,.,.,.,.,...
                          ,.

327  Farming Methods and Systems Analysis         By Gary Erisman, Ph.D.

334  Ergonomics                      By Stephan Konz, Ph.D.

340  Personal Protective Equipment           By Richard A. Fenske, Ph.D.

351  Machine Design                   By Sverker Hogliind, M.D.

357  Vector Control                   f3y Robert R. finger, Ph.D.

365 A Consulting Engineer's Perspective         By Ray H. Crammond, P.E.

372  An Extension Specialist's Perspective        By Rot/in D. Schnieder, M.S.

378  An Agricultural Engineering Perspective          By L. Dale Baker, P.E.

XXXiV            Surgeon General's Conference on Agricultural Safety and Health - 1991


Table of Contents

5. Intervention - Safe Behaviors among Adults and Children

Moderator: Walter J. Armbruster, Ph.D.

Rapporteur: David L. Hard, Ph.D.
        . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..,., ..v,.,...,. . . . . . . . ..v............

383  Health Education

391  Vocational Agriculture

397 The Mass Media and Agriculture

405  Multilingual Training

412 County Health Education

419 A Rural Sociologist's Perspective

432 Young Farmers' Perspective

437  Farm Family Behavior Perspective

f3y Rodney Gilmore, B.S., B.A.

   f3y Robert Graham, M.S.

     By Cheryl Tevis, M.A.

    By Malanie Zavala, B.S.

   By Larry Belmont, M.P.H.

l3y Judith Bortner Heffernan, M.A.

       By Wayne Sprick

    By Robert Aherin, Ph.D.

ELEMENTS OF A NATIONAL AGENDA

Moderator: Richard A. Lemen, Ph.D.

::::::.:`:`":`:."`:`:`:`:`:`:`:`:':':':.::~:?.::::::::::::::::::::::~.::~::::::~:~:::::;~.~:;::::::::::::::::~:~.~:::::::::~~:~:.:.~:.:.:.:.:.: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\., .
                               . .                      .
                                . . . . . . . . . . ..`...`..."............................,~.~.,.,~,~.~,~. x.7 .`,;,..):.:,) :.,.f,,,,;,,,.,.i~.~.;r,.,. 2: ,:.:.: ,:.,., . . . . . .                      .,...,.,.. I .,...,./...
                                             . ,A., . . .                     
                                            .   . .,   A .,.. .A.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A. ,A.. A., :.>z>:.:.: .):,:.:, :,:.~.~>>:~,:~: :,:, > :.:.r,,,.,.,,,.,.~vi~,,
                                                          . . . .
                                                            . . 0. n . . . . . . ,.. A.. A.. A.. . . .,., . . . . . . .
445 Surveillance - Agriculture-Related Diseases, Injuries, and Hazards
                         By Henry A. Anderson, M.D.

448 Research - Chemical and Biological Hazards    By Keliey J. Donham, D.V. M.

453 Research - Physical and Mechanical Hazards    By Lorann Stallones, Ph.D.

457 Intervention - Agricultural Workers' Protection from Hazards
                           By David S. Pratt, M.D.

462 Intervention - Safe Behaviors among Adults and Children
                       By Walter J. Armbruster, Ph.D.

466 Report on Migrant and Seasonal Farmworkers      By Valerie A. Wilk, M.S.

surgeon General's Conference on Agricultural Safety and Health - 1991


Table of Contents

471 Outstanding FFA Poster               By Rice C. Leach, M.D.

472 OSHA Initiatives in Agricultural Safety and Health
479 Sustainable Agriculture and Safety
485 The Farm Bureau's Continuing Commitment

By Cynthia Douglass

By Willis R. Eken

By Merlin Plagge

489 A Victim's Perspective of the Conference          By Marilyn Adams

492 Conference Summary

By Rice C. Leach, M.D.

MAKING CONNECTIONS

Coordinator: Katherine Wilson, M.P.H.
                         . .
msPM?mY
  .                       . .   . *p.#.$$..#$#

498 Poster Abstracts

Co-coordinator: Ann M. Cronin

582 FFA Poster Abstracts

597 Video Presenters

620 International Participants

625 Metric System of Weights and Measures

627 The Surgeon General's Conferences on Occupational Health

By Anne Mather

629 Excerpts from Diseases of Workers          By Bernardino Ramazzini

                                                      . .
                        ,.,.....,.,...,....., . . . . ..~........,...,.,. ,.,.(,.,., ..,., .,.,.,.,. ..,.. .,.,.,. ,.,.. /v..,.,... ,.,., . . . ..A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..~..  . . .  .., ,A.,... ii, c. CA.,.

637 INDEX

Surgeon General's Conference on Agricultural Safety and Health - 1991



Surgeon General's Conference on Agricultural Safety and Health
F~.&AFF 2000 o A National Coalition for Local Action
Convened by the National Institute for Occupational Safety and Health
April 30 - May 3, 1991, Des Moines, Iowa

WELCOME FROM THE CHAIR OF THE CONFERENCE

        By J. Donald Millar, M.D.
Director, National Institute for Occupational Safety and Health
Assistant Surgeon General of the United States Public Health Service

I am very delighted and proud to welcome
you to this Surgeon General's Conference
on Agricultural Safety and Health. The
nickname is "FarmSafe 2000," and the
theme is "a national coalition for local
action."

Now all of this is by way of saying that
everybody here is interested in preventing
the unnecessary wastage of life, limb, and
health that is associated with the oldest
and noblest occupation-agriculture. Be-
yond that common interest, we are a very
diverse group.

I would wager that some of you never
heard, for instance, of NIOSH, the
National Institute for Occupational Safety
and Health, before this meeting. That is
not unexpected, because most of the pro-
fessional life of NIOSH has been devoted
to the problems of smokestack indus-
tries-manufacturing, mining, and other
occupations-but that is very rapidly chang-
ing in this rapidly changing world of ours.

We were created by the Occupational
Safety and Health Act of 1970, which
sought to "assure safe and healthful work-
ing conditions for every working man and
woman," So we are obliged at this point in
our national history to turn our attention
to all problems that create unsafe and
unhealthful working conditions for men
and women.

That Act created two organizations you
may have heard of OSHA and NIOSH;

both are quite different organizations; both
are in different parts of the Federal Gov-
ernment, and you will hear from leaders of
both during this week.

OSHA is located in the Department of
Labor and has responsibility, among other
things,-for promulgating and enforcing
occupational standards.

NIOSH is in the Public Health Service, the
Department of Health and Human
Services, and is expected to exercise scien-
tific leadership in this field. So we are
expected to produce and disseminate scien-
tific information that enables the preven-
tion of occupational diseases and injuries.

Among the things we do best is to convene
people, such as at this conference, to
bring people together so that they are able
to share with each other useful scientific
information, which can permit the practice
of prevention in every setting where it can
be done. So we were very eager when the
Surgeon General called on us to sponsor
this conference-the first of its kind in
agricultural safely and health that has ever
been convened.0

Dr. J. Donald Millar: And now it is my distinct
pleasure to introduce the convener of this Confer-
ence, the Surgeon General of the United States
Public Health Service. She is the first woman and
the first Puerto Rican to hold the position of Sur-
geon General. She is a dynamic and vivacious
leader in the war against death and disease. I
give you the fourteenth Surgeon General of the
United States, Dr. Antonia C. Novello:

Surgeon General's Conference on Agricultural Safety and Health - 1991

7


Sugeon Gmml's Confsmnce on Agrkulfuml SaMy and HeaM
FARMSAFE2OOO~ANaiionalCmlMn~rLocalAc~n
Conwned by the National lnadtuh kr Occupational Sahty and lkmUh
April 30 - h&y 3, 19Q1, Des Moines, law8

WELCOME TO DES MOINES, IOWA

By John P. Donian
Mayor, Cii of Des Moines

Dr. Anton& C. Novello: Thank you Dr. Mlllar. Ladles and Gentlemen-l welcome you to the Surgeon
General's Conference on Agricultural Safety and Health, the tenth Surgeon General's Conference on
Occupational Health, and the first one in 50 years. The last one was convened in 1941, but I will
speak further on that history later. I would now like to introduce Mr. Dorrlan, the mayor of Des
Moines, Iowa. It Is a great pleasure for me to be able to introduce him. He Is a lifelong resident of
Des MOin8S, and he has served in the city government since 1983. Fdlowing service as mayor pro
tern, he was elected mayor in 1957. We also know that he currently serves as the Executive Dlrector
of the Central Iowa Building Trades. Among his many public service activities, he currently ~8~8s on
the Governor's Commlttee of Partnership for Economic Progress. Ladles and Gentleman, I would like
to welcome Mr. Dorrian:

Thank you very much. On behalf of myself
and all the other members of the Des
Moines City Council, I want to welcome you
to the City of Des Moines, and a very spe-
cial welcome to Dr. Novello. Thank you for
that nice introduction.

We are extremely proud of our city, and we
hope that if it is your first visit to Des
Moines you will be pleasantly surprised. If
it has been awhile since you have been to
the City of Des Moines, then you have seen
some good changes take place.

We are the capital city of the State of Iowa,
and as the stewards of the capital city, we try
to prepare the city well for everyone's visit.
We have spent a lot of dollars on the Sky-
walk System, for example. The weather is
pretty good today, but there are days when
people really appreciate that Skywalk Sys-
tem. Several miles of it now exist, and it is
very expensive to erect, but there is a pur-
pose in mind.

Sometimes it snows in Iowa, and sometimes
it gets extremely warm with a little bit of
humidity. So we need our Skywalk System.
We have a lot of neat things that we hope

2

you are able to take in while you are here.
We even have a horse track running out
there; I do not know if any of you are famil-
iar with that or not, but for every dollar that
is bet out there my property taxes may not
go up-if you have it in your heart to support
the horse racing. I have not been out there
myself much, but we have a lot of other neat
things-the botanical center and the zoo, the
libraries, the Governor's Mansion and the
Capital Building.

We just have a lot of attractions. We like to
keep all these things going, and that is
where you can help, if you would have it in
your heart to do so. We hope that you will
find a place to spend a dollar or two while
you are here in our city. But really, we do
hope that you have a good conference. I
have to apologize because I have to leave.
We do hope that you have a good confer-
ence, and again a very special welcome to
you to the capital city of Des Moines, Iowa.
We are extremely proud to have all of you
with us.

We do hope that you have a good confer-
ence. Enjoy yourself and come back often.
Thank you.0

Papers and Proceedings


Thank you, Dr. Novello. Before I officially  I am pleased to welcome such a broach-
welcome you on behalf of Governor     based group of individuals to this confer-
Branstad to Iowa, I want to acknowledge   ence. Represented here today are individ-
the work that Dr. J. Donald Millar, who   uals from 40 states and several foreign
opened this conference and is the Assistant  countries, evidence that agricultural safety
Surgeon General and Chair of this confer-  and health is an issue that is not only na-
ence, put into organizing this great event.   tional but international in scope. Your
On behalf of the people of Iowa, we thank  attendance here demonstrates your com-
you for bringing this conference here.    mitment to agricultural safety and health.

Mayor Dorrian has already welcomed you
to Des Moines. On behalf of Governor
Terry Branstad and the Iowa Department
of Public Health, I want to welcome you to
Iowa and to the Surgeon General's
Conference on Agricultural Safety and
Health.

We, of course, believe it is quite ap-
propriate for this conference to be held in
Iowa, a leading agricultural state. Each
year Iowa farmers produce more than $9
billion in crops and livestock. Twenty-five
percent of America's pork and eight per-
cent of the nation's grain-fed beef are
raised in Iowa. Among the states, Iowa
ranks second in the value of agricultural
exports, and in 1988, Iowa ranked first in
the nation in the production of red meat.

Though everyone here today may know
that agriculture is one of the most hazar-
dous occupations there is, according to the
Year 2000 Health Status Objectives,
farmworkers suffered 14 injuries per
100,000 during the years 1983 through
1987. The national goal would be 6 in all
occupations. So, you can see agricultural
injuries are high even in the statistics that
we know.

The health objectives further state that
agricultural worker deaths may be under-
estimated because many farm work forces
have fewer than 11 workers and are, there-
fore, not identified by national data sys-
tems. The National Safety Council has
estimated a rate as high as 52.1 deaths per
100,000 agricultural workers.

Surgeon General's Conference on Agricultural Safety and Health
FARMSAFE 2000 o A National Coalition rbr Local Action
Convened by the National Institute for Occupational Safety and Health
April 30 - May 3, 1991, Des Moines, Iowa

WELCOME TO IOWA

  By Christopher G. Atchison
Director, Iowa Department of Public Health

Dr. Antonia C. Novello: Governor Branstad was unable to attend the conference today. So, I would
like to introduce Christopher G. Atchison, the Assistant Director of the Illinois Department of Public
Health, who is here to speak in his behalf.  Mr. Atchison has served as the Assistant Director of the
Illinois Department of Health since 1987. As Assistant Director, he has been responsible for program
development, legislative action and executive implementation of agency programs. He has also
served as a chair of the Governor's Interagency AIDS Task Force and was involved in the establish-
ment of the Center for Rural Health. In addition, as a member of the Illinois Public Health
Association, he recently worked on a task force to restructure public health in Illinois according to the
future of public health reported by the Institute of Medicine. Mr. Atchison has just been appointed as
director of the Iowa Department of Public Health and his welcome to us today marks his maiden
speech to this state. Please welcome Mr. Atchison:

Surgeon General's Conference on Agricultural Safety and Health - 1991

3


Opening Remarks

Until now, the hazards have been under-
counted and largely ignored and under-
funded, but that is changing as we can see
when we look at the stated purposes of
this conference-to raise consciousness,
build coalitions, disseminate information,
and encourage action to prevent injury and
disease related to agriculture-certainly all
very worthwhile goals.

Nationally, we are beginning to develop
surveillance systems that document the
kinds of injuries that are occurring and
where they are occurring--efforts that are
just beginning to develop interventions and
strategies, which will help prevent those
injuries and fatalities.

In Iowa, we recently finished the first year
of a surveillance program to collect infor-
mation about agricultural injuries and
fatalities, the Sentinel Project Researching
Agricultural Injury Notification Systems,
which we simplified to called SPRAINS.
SPRAINS is the only statewide surveil-
lance program currently in existence, and
we have been astounded by some of the
figures we have gathered.

We know that there are currently about
116,000 full- and part-time agricultural
workers in the state; and there were over
2,000 injuries and over 83 fatalities record-
ed in 1990. Eleven of these fatalities were
children under the age of 15. Of the total
fatalities, 51 percent were in the less-than-
20-year-old age group and the over-65 age
group.

In any other occupation, these people
would not be working. However, in
agriculture-related occupations, workers
span the ages from childhood to the senior
years; and apparently young workers and
seniors are most vulnerable to fatal inju-
ries.

We must note, because farming has tradi-
tionally been a family business, that it is
not just the professional farmer, it is the
farm family that is at risk for injury. Our
statistics show that 70 percent of all inju-
ries are suffered by farm family mem-
bers-spouses, children, grandpas and
grandmas helping out.

The major causes or vectors of injury fall
into three groups. Number one is machin-
ery. Number two is animal-related. Num-
ber three is falls and slips. Where do the
injuries occur? Everywhere from the barn
to the pasture. At least in Iowa, no clear
pattern has emerged.

Iowa is developing interventions and strat-
egies by building broadbased collaborative
efforts. Among the organizations involved
in these collaborative ventures are State
government, academia, farm organizations,
and community-based organizations.

The Governor has appointed a task force
to look at our health and safety objectives
for the year 2000. The purpose of this task
force is to adopt objectives and measures
that will guide the planning and allocation
of resources throughout the decade, result-
ing in:

1. Increasing the span of life in Iowa.

2. Reducing health disparities among
Iowans.

3. Achieving access to prevention services
for all Iowans by the year 2000.

Recently I had the pleasure of meeting
with Dr. Richard Remington, who chaired
the Institute of Medicine's commission on
the future of public health, and the
Governor has appointed him the chair of
our Year 2000 effort. Dr. Remington and

4

Papers and Proceedings


Welcome to Iowa, April 30, 1991

I hope to build this planning process into
the development of programs and projects
across all agencies and communities, which
are involved in the public health system in
Iowa.

We must note, because farming has tradi-
tionally been a family business, that it is
not just the professional farmer, it is the
farm family that is at risk for injury. I

Another major collaborative effort, the
Iowa Center for Agricultural Safety and
Health, ICASH, brings together key orga-
nizations concerned with agricultural
health and safety. ICASH is a partnership
of the University of Iowa, Iowa State
University, the Iowa Department of Public
Health, and the Iowa Department of
Agriculture and Land Stewardship. Its
mission is to coordinate the state's resourc-
es and to establish programs to improve
the health and safety of farm families,
farm workers, and the agricultural commu-
nity.

Some exciting projects ICASH has under-
taken include the following:

1. The expansion of the Iowa Agricultural
Health and Safety Service Project to a
statewide network of hospitals. This
project provides comprehensive occupa-
tional health and safety services.

2. The development of an illness and inju-
ry prevention program for livestock
confinement operators.

3. A health and safety program for school
classrooms and rural youth groups.

4. Sponsorship of a community-based
project to increase awareness of farm
machinery hazards.

5. The dissemination of information col-

lected by the statewide agricultural
injury surveillance program.

Another collaborative effort is Work Safe
Iowa. Work Safe Iowa has established an
occupational medicine and associate pro-
gram at the University of Iowa with the
goal of promoting occupational safety and
health through education and consultation.
The program was designed to assist com-
munity hospitals in implementing and
strengthening their occupational medicine
clinics and related outreach services. In
addition, the community hospitals serve as
a vehicle to integrate Work Safe Iowa
services into local communities.

The Iowa Center for Rural Health and its
advisory committee represent another
collaborative effort. The Center for Rural
Health, located within the Office of Health
Planning at the Iowa Department of Public
Health, acts as a focal point for the state's
efforts in preserving quality health care in
Iowa's rural areas. The Center and its
broadbased advisory committee strive to
identify health needs, build rural coalitions,
provide technical assistance to rural areas,
administer grants for rural projects, and
act as an advocate and information re-
source with respect to rural health issues.

The Occupational Health and Safety Nurs-
es Program at the Iowa Department of
Public Health is the tie between the state
and the communities. This program builds
on existing rural health programs and links
the Health Department to rural health
areas.

Surgeon General's Conference on Agricultural Safety and Health - 1991


Opening Remarks

Yet another community-based program is
the Farm Family Risk Assessment and
Education Program that is targeted at farm
youth. It includes a farm family "safety-
walkabout" training program where farni-
lies learn to recognize existing farm haz-
ards and receive assistance in changing the
farm workplace into a safe environment.

Finally, we know that if all prevention
interventions have failed, we must turn to
Emergency Medical Services (EMS). In
Iowa, EMS is a community-based program,
and 75 percent of the medical providers
are volunteers.

Medical treatment begins at the scene of
an injury or illness and can make the criti-
cal difference between life and death.
EMS has become an even more critical
issue to rural Iowa over the last decade, as
our population has aged and access to
health care has become a pressing concern.

In the movie &Zd of Dreams, Iowa was
memorialized when someone asked the
hero, "Is this heaven?" and the hero re-
sponds, "No, this is Iowa." You and I
know that Iowa is not heaven; it is close,
but it is not heaven, as our agricultural
injury and fatality numbers certainly prove.
That is why we must work toward making
Iowa and the nation a safe and healthy
place to live and work.

Remember, even in the movie Field of
Dreams, an injury to a farm family member
was almost a tragedy. Helping prevent
those injuries is our goal and our challenge
at this conference.

Once again, on behalf of Governor
Branstad and the people of Iowa, welcome
to Des Moines and to this conference and
to this opportunity to move preventable
injury programming out of the big cities
and into rural America.0

Papers and Proceedings


Surgeon General's Conference on Agricultural Sathty and Health
FARM&FE 2000 o A National Coalition for Local Action
Convened by the National Institute for Occupational Safety and Health
April 30 - May 3, 1997, Des Moines, Iowa

RAISING SAFE7Y AND HEALTH CONSCIOUSNESS
  AMONG FARMERS AND FARM WORKERS

        By Ellen G. Wiakw, J.D.
Director of Health and Safety Policy, Children's Advocacy Institute
         Center for Public Interest Law

Dr. Antonia C. Novello: Now, we know that in 1990 this conference was authorized .by Congress with
four purposes, which Mr. Atchison mentioned. The first topic is going to be addressed by Professor
Ellen Widess, and she will speak to us on the first topic, which is raising consciousness.  Professor
Widess brings a breadth of experience to our conference that ranges from managing pesticide
regulatory programs to protecting the safety and health of children. Professor Widess received a law
degree from the University of California at Berkeley in 1974. Ms. Widess then served on the faculty
post until 1978, when she became Chief of the California State Pesticide Regulatory Program within
the Division of Occupational Health. From 1984 to 1986, she managed the Workers' Compensation
Program for the University of California at Berkeley and later, from 1986 to 1988, managed a similar
program for the Texas Department of Agriculture. Also, while in Texas, from 1986 to 1988, Professor
, Widess directed the pesticide regulatory program for the Department of Agriculture. Last year, she
was an adjunct professor of the University of Texas School of Law where she taught, with specific
emphasis, on Toxic Torts and Occupational Health. Ellen Widess has come to us today from the
Children's Advocacy Institute in San Francisco, where she is Director of Health and Safety Policy.
She will speak at this moment on the topic, Raising Safety and Health Consciousness  Among
Farmers and Farm Workers. Professor Widess:

I am very, very pleased to be here. When
I was first asked to speak in the place of
our new Secretary of Labor, Lynn Martin,
I thought it was my fantasy come true.
After working for the OSHA Program, I
long had a fantasy of wanting to be the
Secretary of Labor.

Particularly after toiling, as Dr. Novello
has indicated to you, for many years in
these various lives trying to address the
problems of farmers and farm workers'
safety and health, I thought this would be
a fabulous chance to clear up the jurisdic-
tional confusion many of us have noted
and to determine who protects agricultural
workers, who should regulate pesticides
and with what standards, and who, in fact,
has responsibility for farm safety.

That fantasy lasted only a few moments.
Then I came to my senses. It dawned on

me that were I really the Secretary of
Labor, I would have to deliver.

I might, in fact, make a few friends, but no
doubt I would make more than an enemy
or two and be saddled with all the con-
straints of government. As one who has
been a regulator for many years, I am
delighted to come today to this conference
as an advocate, openly advocating, for the
interests of children, who are our future
generation.

I am reminded by the line from my old
boss, Jim Hightower, former Agricultural
Commissioner of Texas, "Ain't nothing in
the middle of the road but dotted lines and
dead armadillos." I hope today to be a
little bit provocative, because I think it is
time we got out of the middle of the road.
This conference is an extremely hopeful

Surgeon General's Conference on Agricultural Safety and Health - 1991


The Potential for a National Coalition

beginning of a more promising future in
this much-needed work.

As Dr. Novello has indicated, I have had a
checkered life. I would like to give you
some perspective from my work, both in
and out of regulatory life. I have worked
for OSHA in one life and then for an
agricultural department, retreating at vari-
ous periods to academia-scarred from the
regulatory battles-to come back and take
stock of what have we accomplished in this
regulatory arena.

What were our successes? What are more
viable options ?  What have been the vari-
ous creative solutions that we have de-
vised?

CONSCIOUSNESS-RAISING AMONG
FARMERS AND FARM WORKERS

I had the dubious honor of attempting to
regulate pesticides in Texas, which is to
most sane people pretty much a mission
impossible. This is to try to somehow
meet the needs of farmers while also pro-
tecting workers, consumers, and the envi-
ronment. That is a very tough bill.
I think we took a number of very creative
approaches to that mission, including pass-
ing the nation's only right-to-know law.

Though this law was billed as the
"farmworker right-to-know law," it clearly
provided critical information about pesti-
cides and their health effects to thousands
of farmers and farm families in Texas.
The children often were applying pesti-
cides where groundwater (and drinking
water supply) came from contaminated
well waters. They were affected by drift
just as farm workers were.

During those years, we also sought to
change consciousness, not only among

workers, but among the public who de-
manded blemish-free produce. We devel-
oped a model organic farming program,
which would not only reorient farmers to
reduce their chemical inputs, but also
change consumer consciousness and pro-
vide farmers with the technical assistance
they needed and the economic assistance.

I think that is one of the messages that I
want to convey today. .We have to deal
not only with the health and safety data we
have-we have plenty of data-but we also
have to deal in terms of raising conscious-
ness among the populations of both farm-
ers and farm workers. We have to realize
that we deal with certain economic imper-
atives, some realities in agriculture.

Unless we also deal with those economic
realities of their lives and their limited
choices, we will fail in our efforts to im-
prove health and safety. We have learned
this in the industrial world, and we should
apply that lesson as well in the agricultural
world.

Unless we also deal with those economic
realities of their lives and their limited
choices, we will fail in our efforts to im-
prove health and safety.  I

Also, in my time in Texas, we focused
(unusual for an agricultural department),
on building and supporting a rural health
program. As we sought to protect farm
workers, we realized that we had to deal
more basically with the overriding needs of
all rural Texans: farmers, farm families,
farm workers and their families, and their
overriding, haunting lack of rural medical
care in Texas.

8

Papers and Proceedings


It leads the nation tith the highest rate of  the rich San Joaquin agricultural valley.
hospital closings, no OB-GYNs in most   State epidemiologists were unable to corre-
rural counties to deliver babies, dwindling  late the cancers with specific pesticide use.
emergency room facilities for farm injuries,  So in a sense, it was a negative study.
and few physicians trained in agricultural   However, that study uncovered some other
medicine or pesticide-poisoning treatment.  realities, including the most horrifying
So, all our efforts to promote agricultural   statistics about malnutrition, lack of immu-
safety and health and provide crop sheets  nization, and lack of primary health care
and good training materials on pesticides   for farmworkers and rural poor, conditions
would have little chance of success in the   that characterize the Third World. We
frontiers of rural Texas.           tend not to believe these conditions exist
                      in rural America.
I was fortunate to work with a national
coalition, The National Coalition of     To best address how to raise health and
Agricultural Safety and Health (NCASH),  safety consciousness of farmers and
and the National Rural Health       farmworkers we must do several things:
Association, because in working for worker
and farmer protection, we realized that is   b First, we have to understand the unique
one part of a very looming and serious    nature of this work force and the common
national rural health problem.       grounds and the differences. My thesis is
                      that there is much more that these two
We realized that we must deal directly    worlds share in common than they differ
with the basic needs of farmer, farm work-  on. Basically they share powerlessness and
ers, and their families and redirect state   disenfranchisement in this country, eco-
policies to meet these needs. Our efforts  nomic and political powerlessness. That is
to promote agricultural health and safety   reflected in the lack of resources, research,
were part of a much larger political and   jurisdictional clarity, health and safety
economic problem of the powerlessness of  standards, training materials, and many
farmers and farmworkers in the country.   other things that other speakers will ad-
                  dress throughout this conference.
Now to my current role with the Children's
Advocacy Institute, which provides a voice  My thesis is that we need to build on that
for children's well-being in California and  common ground. If we do not get to the
the nation. I see this as a continuum.    essential root causes of that powerlessness
                   and turn that around and empower farm-
If we are not taking care of our children   ers, farm workers, and their communities,
and protecting future generations, we are a  we will ultimately fail in our efforts to
doomed society. And dealing with chil-   improve health and safety. I will discuss
dren is yet another face of rural poverty,   some of the areas in common in a mo-
disenfranchisement, and lack of access to    ment.
basic health care.            b Second, I think we need to look at the
An example is a recent epidemiological   lessons that hopefully we have learned
study by the California Department of    from the industrial workers' struggle for
Health Services of cancer clusters in    health and safety and examine what has
McFarland, a rural town in the heart of   worked and whether that can be translated

Raising Safety and Health Consciousness among Farmers and Farm Workers, April 30, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991                 9


The Potential for a National Coalition

to the agricultural work force. Obviously,
it is a different work force. We do not
have workers who work continually in steel
mills or petrochemical plants.

We have rather independent, entrepre-
neurial farmers who are not used to regu-
lation as are industrial employers. Howev-
er, there is a lot of commonality even in
that. I think the key issues there are the
collective action that has led to the im-
provement of health and safety for indus-
trial workers.

Just as our conference theme is "a nation-
al problem, local solutions," we need to
look at what is nationally needed and a
national minimum standard.

\

Improvements such as the asbestos stan-
dard or the cotton dust standard, or the
right-to-know law for industrial workers,
have not had to be fought out at every
shop floor in every factory. There has
been some national minimum standard of
care, of humanity, of morality.

Then, there has been the opportunity on
the shop floor for local initiatives for work-
ers by unions to do even better. Just as
our conference theme is "a national prob-
lem, local solutions," we need to look at
what is nationally needed and a national
minimum standard. We can not expect
farmers and farmworkers to be fighting
that out for themselves every day.

b Finally, we need to seek ways to empow-
er and ways that lead to local solutions.
We have learned that for industrial work-
ers as well. People have to have a stake in
their own health and safety. Solutions

70                                            PaDers and Proceedinas

have to fit local needs and use local talents
and resources.

In agricultural, even more than industrial
workforces, a uniform national standard or
prescription simply will not work. It will
not work for the populations we are deal-
ing with and the problems they face.

WORKABLE SOLUTIONS

I also want to encourage that we look for
simple solutions and be very realistic about
what has worked and what has not. A
good example is in the area of farmworker
protection.

There is a tendency to talk and move to-
ward increasingly more sophisticated per-
sonal protective equipment for farm-
workers to enable them to enter treated
fields. We already know a lot about prob-
lems in using this equipment. These are
problems such as heat stress, availability of
protective equipment, maintenance of it,
worker attitudes, and the general impossi-
bility of having that scheme work.

We also have seen another example of the
development of the field sanitation stan-
dard, which took about 17 years to pro-
vide, something as basic as toilets and
water in the field. When you see that it
has taken 17 years to get toilets in the
fields and then you imagine the most com-
plicated and sophisticated personal protec-
tive equipment and worrying about the
nightmare of enforcement, you really have
to think:

Is that the way we ought to be going?

Is there not another solution?

Can we not instead look for another
way to farm, a way to use less toxic


substances that may not require those    regulation. Farmworkers, on the other
kinds of protective measures that are    hand, are obviously a lot less educated
difficult to enforce and use?        about those risks. They frequently have
                   even fewer economic options and great
There, too, we have a lot of issues in com-  fear of exercising their right to protection
mon. We have the real cost to farmers,   on the job.
farmworkers, and their families for cheap
food in this country. Those costs are mea-  Those may be the differences, but should
sured in the mangled bodies and in the   they divide the two populations? I think
statistics that we have heard and will hear.  that there is much more that they share in
They are measured in the acute poison-    common. Both farmers and farmworkers
ings, which are grossly under-reported    form the hidden, invisible work force of
because workers are afraid of being de-    America.
ported or retaliated against, or have no
idea of their rights.            Agriculture has steadily become the most
                   dangerous. occupation. It comprises less
Moreover, we have no uniform national   than 3 percent of the work force, yet has
data base for reporting those illnesses and  over 14 percent of work-related deaths.
injuries. We have chronic risks that are   There is a staggering lifetime risk of occu-
yet to be measured, which are incalculable,  pational death for farmworkers; the nonfa-
whose long-term social costs, if we were to  tal injuries are equally depressing.
do a fair cost benefit analysis, would out-
weigh the benefits of using some of the   Yet there is depressing news, even with
most toxic pesticides.           non-reporting, of the degree of injury
                   among farmworkers. We have in a 1987
In any case, there is the basis of a common  Federal Government report, over 280,000
fight, and allies, and alliances. Even uriho-  handicapped migrant and seasonal
ly one alliances, unimagined strange bed-   farmworkers and 60,000 handicapped de-
fellows might come together on some of   pendents, with one-third of those estimated
these issues.                   to be work-related.

Let me elaborate a bit more on the issue   Children comprise a large percent of those
of the unique agricultural work force. We  injuries attributed to both farmers and
are told constantly that agriculture is dif-   farmworkers. And as Chris Atchison has
ferent from the industrial work force and   mentioned, an equally disturbing factor of
obviously that is true. There are, in fact,   the ill-health is the high injury rate suf-
real differences that are cultural, racial,   fered by our elderly. No, there is no re-
and often those of class between farmers   tirement in agriculture. No one can look
and farmworkers.             forward to early retirement.

Farmers, based on the farm studies that   It apparently is true that you cannot even
have been conducted in Iowa and New    look forward to a childhood in agriculture.
York, indicate high concern about health   Children are truly the invisible workers. In
and safety and even fairly sophisticated   my new incarnation, I am going to work
understanding about those risks. There is   hard on that because I think there is a
also a serious and healthy antipathy for   sense, not only among farmworkers and

Raising Safety and Health Consciousness among Farmers and Farm Workers, April 30, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991                77


The Potential for a National Coalition

farmers but in the morality of this country,
that we can not visit these same tragedies
on our children. Even if we, as adults, are
willing to take those risks or have no other
options, we can not do this to our children.
We want a better life for our future gener-
ations.

It certainly is true that both farmworkers
and farmers want better lives, but both
have few options. Child labor is not a
matter of choice; it is a question of eco-
nomic necessity both for farmworkers and
farm families.

Marilyn Adams, who will be speaking later,
eloquently captured this in a recent video,
Danger, ChiZdren at Risk, which highlighted
child labor in several different sectors
including children of farmworkers and
farmers. She said:

You would never hire a 10 or 12 year-old
to work on your farm, but you let your
own child work because you have to.
You can not afford to hire one.

Many farmworkers are also driven by eco-
nomic necessity, the piece-rate system that
characterizes much of corporate agricul-
ture in America. There are children in the
fields working side-by-side with their par-
ents. Though the health and safety stan-
dards do not adequately protect children,
they work in the fields to help families
make a living.

On the farmer's side, we know that agricul-
ture is the most dangerous work. Again,
economic realities make choices very diffi-
cult. Take for example, ROPS (roll-over
protective structures) protection. Most
farmers know the dangers and would will-
ingly retrofit their tractors, but there is
economic reality.

Farmers have to choose between continu-
ing survival and retrofitting or paying the
mortgage on the farm. Taking the little bit
of money that is left over these days in the
struggling farm economy to pay for safety
equipment to protect themselves and their
children is a difficult choice.

The point is that hazards do not recognize
the lines between farmers and
farmworkers. The safety and health haz-
ards cross over those lines. A good exam-
ple of that is the issue of parathion and
whether it should continue to be used.
The EPA has indicated that it may finally
act to discontinue parathion's use.

This is not a mystery pesticide. There is a
well-developed body of literature on para-
thion as the most documented cause of
worker death and the cause of a very high
percentage of children's deaths in children
six and under. Despite the known risks,
we have continued to use parathion for
over 25 years. Yet the hazards are not
only visited on farmworkers and their chil-
dren, but also on farmers and surrounding
communities.

In California, a recent study demonstrated
that parathion was deposited by fog in the
San Joaquin Valley. It drifted significant
distances away from the original site of
application; affected other farmers' crops;
and contaminated the soil, the drinking
water, and other rural communities. The
point is that parathion is not just a hazard
that affects farmworkers, but is also a
hazard to farmers and their families.

Finally, in terms of this work force that
faces such political and economic
powerlessness, we face a problem of our
trying to turn this around and raise con-
sciousness, Either we have people who are
unaware of the risks, and we have to edu-

12                                   Papers and Proceedings


cate them, or they know them but are    er to act on that information, on that
absolutely unable to do anything about    knowledge. For industrial workers, the
them because of economic reality.      fight for health and safety is best when
                     there is collective, unified action.
Again, we look at industrial workers' fights
for safety and health and we see a stark   Generally it comes from unionized work
contrast. Farming is unlike industry, where  forces that have some economic power, are
the costs of safety and health are eventual-  not afraid, and have independent means to
ly borne by the industry and factored into   have their own health and safety profes-
the cost of production.           sionals advocate for others beyond them-
                         selves. That collective force for industrial
We have not chosen, in this country, to    workers has been the key ingredient of
factor safety and health into the costs of   political and economic power to push gov-
preparing our food. The costs, essentially,  ernment and industry. Not that this has
are borne by farmers, farmworkers, and   been an easy fight, we have many exam-
their families.               ples where workers have had to be the
                          "canaries."
Further, we have farmers and farmworkers
who are fairly remote and isolated, spread  What about the fight for knowledge? That
out all over the country. They may be    may worry some of you, and maybe it
migrants or they may be non-citizens. All  should because the fight for knowledge
in all, we have no basis for real political   and the raising of consciousness definitely
constituency or clout. Neither farmers nor  means increasing demands. One option
farmworkers are validated citizens.     might be more regulation. I think we need
Though they feed the nation, they are    to look very carefully at what will work, is
generally left out hungry.          needed, and is most effective.

LESSONS LEARNED              The lesson that we have Iearned from
                    occupational safety and health in the in-
Now let us look at the lessons that we     dustrial world is that often the most effec-
have learned from our history of fighting   tive safety and health programs do not
for occupational safety and health in indus-  require or depend on complete regulation.
try-                   We maybe do not need police officers
                    everywhere in every work force. Given
As I mentioned, the first lesson to apply to  this economic climate, we simply do not
the agricultural work force is that we have  have the governmental resources, nor will
to give people a stake in improving their   we ever. We have to come up with some-
own safety and health. The first critical   thing that is effective and relevant.
step is to give people information because
information is obviously the basis for     What I am suggesting in terms of raising
awareness, for consciousness.        health and safety consciousness is to give
                   people the information and tools to allow
But even more important, information such  them to make their own decisions and to
as crop sheets, safety information sheets,   allow them to come up with their own
pamphlets, videos, training programs, etc.,  solutions. In industry that has meant sell-
will not do without giving people the pow-  ing certain minimum standards-for exam-

Raising Safety and Health Consciousness among Farmers and Farm Workers, April 30, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991                13


The Potential for a National Coalition

ple, machine guarding or carcinogen stan-
dards. Many workers have been able to
bargain or even more than that to affect
bottom line.

In agriculture that means setting of some
minimum safety and health standards that
could then allow the dissemination of in-
formation to unleash local wisdom, re-
sources, and initiatives. These kinds of
alliances might come up with new
ideas-for example, re-examining our pesti-
cide policy, our agricultural policy, or our
attitudes and policies about child labor.

I am excited about the new OSHA initia-
tive and the direction it is taking in terms
of giving people more information and
consultation, which is the first step. The
next step is the power to act on it.

A TALE OF TWO CITIES

I would like to close with a tale of two cit-
ies-two different cases that I would like to
present, which have to do with the mean-
ing and success of empowerment.

The first case involves a pesticide poison-
ing of a large crew in the Salinas Valley of
California in 1978. Now this was not a
case of the small farm that, I think, is de-
scribed most commonly in this conference.
This was a fairly typical corporate agricul-
tural operation that is common in Califor-
nia and in other states. This is a different
and very important agricultural model,
because no one is ultimately responsible
for worker protection.

In this case, there was an absentee land-
owner, a farm manager, a marketing coop-
erative who hired an irrigator, a pesticide
applicator, and finally, a crew leader to
bring in labor. No one talked to each

other, No one had any idea how the
whole thing fit together.

As a result, a large crew of workers, in-
cluding a matriarch, her father of 70, her
two children under 12, a sister in her first
trimester of pregnancy, and a host of other
workers, entered a field that had been
sprayed only 6 hours before with two of
the most toxic pesticides, Phosdrin and
Phosphamidon. There is a legal reentry of
48 hours.

These workers were in the fields, by mis-
take, through no one's conscious endanger-
ment or recklessness. An inevitable mis-
take happened because of the nature of
that kind of agriculture.

What happened. 3 The workers became
severely poisoned, but no one knew the
signs and symptoms of pesticide poisoning.
Even the crew leader was sick, but kept on
working. Because the workers were de-
pendent on what they could make per
bushel of cauliflower, they kept on work-
ing. This happened even though one
worker was unconscious, others were vom-
iting, and many were severely sick.

The aftermath of this case is important in
terms of a lesson that we can learn about
raising health and safety consciousness
among workers. The workers were severe-
ly poisoned and the recovery was much
longer than anyone expected. The pesti-
cide poisoning taught us a lesson, again by
workers being "canaries," of the effects of
organophosphate poisoning and the slow
regeneration of cholinesterase.

The children working in the fields had
most severe and persistent symptoms, and
even a year later were describing symp-
toms of sweating and nightmares from
their exposures.

14                                     Papers and Proceedings


One of the most important things that    train workers about the health risks and
saved these workers and made a real dif-
ference was that the workers were protect-  how to protect themselves, empowerment,
ed and kept out of further re-exposure to  and economic power in order to use that
pesticides. In this case, there was immedi-  knowledge-giving them the chance, for
ate assistance by rural legal assistance    example, to be out on workers' compensa-
                        tion in order to recover.
people who taught the workers about their
rights, who taught and empowered them to
take advantage of programs that are avail-  One regulatory change that shifted the
able to all other workers. These are pro-  balance was the posting of fields. There
grams such as workers' compensation and  was a realization that you can not always

unemployment insurance.         depend on perfect knowledge. In this case,
                       even the crew leader did not know the

These rights, incidentally, are not granted  fields had been sprayed and everyone
to all farmworkers in all states, but were   walked in equally ignorant. Mistakes hap-

extended in California. That made the     pen.

difference. Those workers did not have to
go back to work immediately, which would  Eleven years later, another large crew of

have exacerbated their health effects.    80 workers similarly walked into a field
                  long before the legal reentry period. They

The medical care has to be characterized  had never been trained in pesticide poison-
as some of the finest in this country. The  ing and were not fortunate enough to have
immediacy of care, knowledge about pesti-  fields posted.
cide poisoning and tracking of the workers
was impeccable. While a fortunate occur-  Ironically the applicator, in this case, was a

rence for those workers, this is, unfortu-   relative of the farm manager; he himself
                       was affected. The farmer also bore anoth-
nately, not a common one.        er serious loss, because his crops could not
And finally, the workers who were poi-    be sold. Unwilling to take the risk of
soned in this episode were trained about   having crops with over-residues, all of that
the effects of pesticide poisoning. The    produce was withdrawn,

next time they were in a field that had
been sprayed and they began to experience  So, there were losses, serious medical,
the symptoms of organic phosphate poison-  personal losses for the farm workers in
                       terms of their health. Economic losses
ing-pin-point pupils, nausea, dizziness, and
so forth-they left the fields.        were suffered by those farm workers be-
                  cause they too were working piece-rate.

They realized what was happening to them  When they had to stop because they were
and could stop it. They did not need an   poisoned, they lost their day's work.
OSHA or an agriculture inspector on the
fields. They were their own protectors.   The Tampa Register reported on a woman
                   who said she kept on working although she

Other lessons that we learned from that   knew it was dangerous because she had
case, that are important to translate more  bills to pay. That was simply a fact of life.
generically, were the obvious importance   She refused incidently to give her full
of good rural health care, the necessity to  name for fear of losing her job. This is,


Surgeon General's Conference on Agricultural Safety and Health - 1991                 75

Raising Safety and Health Consciousness among Farmers and Farm Workers, April 30, 1991


The Potential for a National Coalition

again, an economic reality of the life of
farm workers.

The lesson is we have 11 years later an
inevitable risk, one that could have been
predicted-the same pesticide and same
lack of training. Most importantly, this
farmworker crew had been trained about
the signs and symptoms of pesticide poi-
soning. Thus they were aware and protect-
ed the next time they were forced to reen-
ter a treated field before the legal reentry
interval.

That leads me to the lesson that we
learned in passing the right-to-know law
for farmworkers and farmers. This law
was initially fought by farmers who felt it
was an unnecessary, burdensome regula-
tion that would have a serious economic
impact on agriculture with no measurable
benefit.

Many farmers came to believe the law and
training program had benefits for farmers
and their families as well. The reality is
that both farmworkers and farmers have a
right and a need to know about the effects
of pesticides. Those hazards are visited in
both worlds.

We found that by requiring that farmers
give workers crop sheets about the various
pesticides registered for different crops, we
nourished the beginning of an awareness,
in farmworkers, about the risks that they
had to take. There are choices they have
to make for themselves and their families.

More surprising and encouraging, it also
changed the consciousness of farmers.
When they saw a list of pesticides ranging
from the most toxic to least toxic pesticides
available to be used on a particular crop,
farmers realized they had choices.

The choices are not only to protect their
workers but to protect their families as
well. Their families were often applying
the pesticides and it was their ground wa-
ter. They were uniformly concerned about
protection of the water and the protection
of future generations.

I am still haunted by the images in the
video that I have mentioned, Danger: Kids
at Risk. It points out very clearly that
children, from both farmworker and farm
families, are at peril and that we have
really denied them a future. It is a huge
and, I think, an unacceptable sacrifice that
farmers and farmworkers have had to
make.

One of the speakers in this video ends with
a message that is very powerful. We need
it if we are to be successful in raising con-
sciousness of both these populations. It is
a message told by a teacher who works
with migrant children, but it applies equal-
ly to children of farm families. It is this:
You must tell the children,

You are important. You are American
citizens and entitled to something impor-
tant.

We must fight for the future of our chil-
dren; otherwise we will fail as parents, as
communities, and as a society.

I also listened to the "Farmers' Hotline,"
which was developed by the Texas Depart-
ment of Agriculture to help farmers and
their families on the brink of suicide, de-
pressed about economic conditions beyond
their control. It is time that we stopped
blaming the victims, farmers and
farmworkers, and stopped allowing them to
blame themselves. We must provide them
the means to protect themselves.0

76                                     Papers and Proceedings


Thank you. It certainly is an honor to be
invited to speak to this distinguished
group. However, when I was asked to
address the group regarding coalitions, I
wondered if I was really the one. That is
not, certainly, my area of expertise.

I am a country doctor who has been in a
small town in South Dakota for about 13
years. I am not a political organizer or an
expert in conflict resolution and certainly
not an expert in any of the various techni-
cal aspects of agricultural safety.

On the other hand, I do know something
about agricultural injuries. I grew up on a
farm and as I was looking back on some of
these experiences, I recalled at least four
times when I personally survived potential-
ly fatal agricultural injuries. Certainly it
brings home the significance of this issue.

I remember the time when, as a teenager,
we were cutting silage, and I was driving
down the road with a fully-loaded silage
wagon, as fast as the old "M" Farmhall

Surgeon General's Confenmce on AQtkultum/ Sahty and Health
F~WSAFE 2000 o A National Coalition fir Looal Action
Convened by the National lnsdtuta for Occupational Safety and Health
April 30 - May 3, 1991, Des Moines, Iowa

BUILDING COALITIONS FOR PREVENTING
INJURY AND DISEASE IN AGRICULTURE

   By Thomas Dean, M.D.
President, National Rural Health Association

Dr. Antonia C. Novello: Our next speaker is going to be Dr. Thomas Dean, and he has distinguished
himself in the field of rural health. He served in the U.S. Public Health Service as part of the National
Health Service Corps, from 1975 to 1983, and he received a commendation medal. Dr. Dean's years
with the Public Health Service were served as staff physician and later as a medical director of the
Frontier Medical Services in Hyden, Kentucky. In 1978, he returned to his home state of South
Dakota in Wessington Springs, to serve as medical director at Tri County Health Care. He has
remained there as medical director since leaving the public health service. He is active in many
professional activities in South Dakota, and he is on the Executive Committee, since 1987, of the
National Rural Health Association. He currently serves as its president. Let me introduce Dr. Thomas
Dean, to describe the second purpose of this conference, Bui@g Coalitions For Preventing
lnjuty and Decease in Agriculture. Dr. Dean:

would go. The tractor began to drift to
the right, and I turned to the left.

The tractor continued to go to the right
and pretty soon we were off the road and
ended up crossways in the ditch; I hit the
embankment so hard that it broke the
front end out from underneath the tractor.
A pin had fallen out of the steering col-
umn, and how I avoided rolling over, I
have no idea.

I remember another time when we were

going to a local horse show, and we had to
go out in the pasture to catch one of the
horses. My dad and I went out and caught
the horse, and I was walking home leading
the horse when all of a sudden something
spooked this young colt. He took off and,
without me being totally aware of what
was going on, pulled the coil of rope tight
around my hand.

Pretty soon I was down on my face sailing
through the grass behind this horse. For-
tunately it rained that morning and so it
was not too bad until the horse decided to

Surgeon General's Conference on Agricultural Safety and Health - 1991                 17


The Potential for a National Coalition

go between the fence and a tree; the two
were only about 18 inches apart. For
reasons that I do not completely under-
stand, just before the horse pulled me
between the fence and the tree he stopped.

At that point my father caught up, and
things were okay. It really does, I think,
bring home the fact that these are real
issues. I do not believe I was particularly
wild, and I do not think our farm was any
more dangerous than the average one. I
suspect anyone who has grown up in an
environment like that probably could re-
late similar sorts of experiences.

So, as I look back, trying to think what I
could contribute to this group, I would
hope that maybe I can bring some per-
spective, some understanding of farmers
and farm communities, some firsthand
experience as I have just mentioned about
the importance of the issue. Finally, I
think I can offer some experiences with a
coalition that has experienced some suc-
cess, namely the National Rural Health
Association (NRHA), which truly is a
coalition of some very disparate organiza-
tions and interests.

I think the success that our association has
had can be attributed in large part to the
fact that it is a coalition. Certainly all of
the people that we represent have their
own professional organizations who are
able to speak and, in many ways, active in
speaking for their interests. But NRHA
has enjoyed a considerable amount of
success simply because we were able to
bring together a group of people with very
diverse backgrounds and interests and
focus on a single issue. That, in turn, has
given credibility to the arguments and the
efforts that I think have really paid off and
have helped to produce some movement

for the betterment of health services in
rural areas.

Recently we have become affiliated with
the National Coalition for Agricultural
Safety and Health, NCASH, which several
speakers have already mentioned. I would
mention just a brief commercial.

There is a brochure, a little flyer, that will
be out at the front desk, which describes
NCASH and also tomorrow evening, at
6:00 in the Council Bluffs Room, there will
be a reception for anyone interested in
closer involvement with the National
Coalition for Agricultural Safety and
Health. If any of you are interested in
getting more information, Gary Kukulka
from the NRHA staff is here, as well as
David Pratt and Kelley Donham, who have
both been very involved in this effort.
They can certainly give you further details
about the activities of NCASH.

But, to get back to the issue of coalition
building, the question is, Why is it that we
are focused on coalitions? What is it
about the problems that we are facing
today, which brings us in this direction?

I certainly believe that it is a well-placed
emphasis, and I believe it is well-placed
because of the nature of the barriers that
we face. Certainly our barriers are not
lack of knowledge.

We, no doubt, can use more knowledge,
but we have a great deal of information
about the problems we face. It is not lack
of skills.

We have a great many skilled, dedicated
people who have been concerned about
these issues for some time. These skills
can be improved, but that is not the barri-
er that blocks us.

18                                   Papers and Proceedings


Even resources or lack of resources is not
the major barrier. We can always use    4. Certainly by far the most important

more resources but we have substantial     issue in any effective coalition is that we

resources, if we can mobilize them. I think   have effective and energetic leadership.
our biggest problem is the coordination,    That is why we are here today.
direction and implementation of the things
that we already know.          We certainly face a tremendous diversity
                  of challenges and a tremendous variety of
It is not what to do. Our question is really  different problems, but if we are going to

how to do it. That is how the issue and   make progress, we really need to have the
the significance of coalitions evolved.    leadership to bring about a vision of where
                   we want to get to. I think an analogy is
The dictionary defines a coalition as:    the process of assembling a jigsaw puzzle.
                   We have all the pieces, but unless we can

a temporary alliance of factions for some   come up with a vision, the big picture that
specific purpose.            is on the front of the box, it is not likely
                  that we are going to be very effective at
I think that clearly is the goal that we are  pulling together our activities.

trying to accomplish. I do not know that it
needs to be temporary, but we certainly   That is what this conference is designed to
need to bring together the disparate fac-   focus on and certainly the main thing that

tions that are involved in these issues.    we hope will come out of it. I believe the
                   Surgeon General and her staff at NIOSH
                       deserve tremendous credit and our thanks
Examining what brings about an effective
coalition, I think there are at least four   for putting this process in motion.
characteristics and probably others:     In trying to understand this situation a

1. There needs to be a unifying issue.    little more, I would like to spend a couple

Clearly we have that. I think the fact   of minutes looking at a somewhat analo-
that this size of group would come to-   gous situation that NRHA has been in-

gether testifies to the fact that this is a  volved in over the last several years. Dur-
                   ing that time, in our concern about main-
powerful issue.             taining health services in rural communi-

2. We need a desire to bring about change  ties, it has become increasingly apparent
                   that the preservation of rural health servic-
and, with that, a willingness to compro-
mise on some of our own personal    es and the development of the communi-

agendas in order to accomplish a larger  ties in which they exist go hand in hand.

goal.                Certainly if the community is not coordi-
                   nated and working, the health services will

3. We need to have some appreciation or  not be coordinated and working.

some feeling that, in fact, action and   One of the things that has come out of this
change are possible. Coalitions do not
hang together in stalemates, but if we   realization is several projects around the
have the sense that real change and    country that focus on improving health
improvement can come about, coalitions  services through community organization.

can be extremely effective.       The one that I would like to quote from is
                   referred to as the Community Health Ser-

Building Coalitions for Preventing Injury and Disease in Agriculture, April 30, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991                 19


The Potential for a National Coalition

vices Development model, which was a
project funded by the Kellogg Foundation,
and currently active in the State of
Washington.

The goal was to help communities whose
health services were deteriorating by focus-
ing on and organizing the strengths of the
community itself. They went into commu-
nities where, in many cases, the health
services were falling apart, and they have
come out with a number of fairly striking
successes, at least on the preliminary eval-
uation.

The particular report that I am going to
cite now was published as a working paper
from the WAMI Rural Research Pro-
ject-their working paper #ll. Anyway, in
reviewing their successes, they looked at
six elements, which were predictors of suc-
cess.

1. Clearly, the quality of local leadership.

2. The breadth of involvement of local
stakeholders. Certainly ownership of
this issue and local involvement are
critical if we are going to have any kind
of effective response.

3. Community commitment. Their conclu-
sion was that in many cases a situation
of helplessness and a culture of depen-
dence had evolved, which really effec-
tively neutralized any response to efforts
and unless that attitude could be over-
come, success was very unlikely.

4. Teamwork within the community.

5. Comprehensive, complete and honest
identification of problems within the
sys tern.

6. Availability of concurrent education in
order to provide the necessary skills to
respond.

I would say that the situation that we face
and that will be addressed in this confer-
ence is quite analogous to that. Certainly
all of those issues are relevant. Apprecia-
tion of their existence and their presence
will predict the success of any coalitions
that we evolve.

Self-reliance and self-determination are
bedrock values of rural people, but unfor-
tunately over time many of these have
atrophied as outside problems have led to
a sense of frustration and helplessness.
We need to convince rural people that this
energy can be rekindled, and we have to
show them that even in this complex world
they have a critical role and that what they
do really does make a difference.

I would challenge you to go forth in these
deliberations with a sense of urgency and
with an understanding that every day lives
are lost because families are being devas-
tated and futures are being ruined be-
cause of our failure in the past to build
these coalitions.

As we focus on the development of coali-
tions, I would say that we really need to
look in two different directions.

b We need to build the coalitions within
the professional community. We have a
diverse group of professionals that are
involved in these concerns-the safety pro-
fessionals, public health professionals, and
the medical community.

20

Papers and Proceedings


Building Coalitions for Preventing Injury and Disease in Agriculture, April 30, 1991

We have to put our professional egos aside
and certainly, speaking as a physician, I
know that there are many professional
egos involved. My profession clearly has
more than its share.

b Second, and probably more importantly,
we need to build the bridges between the
professional community and the people on
the farms. They need to understand that
there is real concern and that there is help
available and that what they have to con-
tribute is important.

I would certainly echo the concerns that
we must not depend on regulation. If
there is any group that hates regulation
more than doctors, it is farmers; and abso-
lutely the quickest way to wreck any pro-
gram, or at least to reduce cooperation
among the participants, would be to pro-
vide increased regulation.

In final analysis, I would say that the effec-
tiveness of anything we do will be deter-
mined by our own honest desire to im-
prove the lot of the people that we are
dealing with. It will depend extensively on
our ability to put aside our own egos and
professional pride to be sure that we can
work together and move toward the im-
provement that we are seeking.

Coalition building is not just the best way,
it really is the only way. I would challenge
you to go forth in these deliberations with
a sense of urgency and with an understand-
ing that every day lives are lost because
families are being devastated and futures
are being ruined because of our failure in
the past to build these coalitions.0

Surgeon General's Conference on Agricultural Safety and Health - 1991

27


Thank you very much, Dr. Novello. I
would like to begin by commending Sur-
geon General Novello for her leadership in
sponsoring this conference. She has often
said that she must be the Surgeon General
of all the people, and has certainly fol-
lowed that up by addressing issues that are
important to all Americans, and especially
to those Americans who have been disad-
vantaged. I think that this Surgeon
General's Conference on Agricultural
Safety and Health is indicative of that
leadership and both Surgeon General
Novello and Assistant Surgeon General
Millar deserve our thanks in that regard.

I would like to thank you for inviting me
to join you at this very important confer-
ence. Farming remains one of the most
hazardous occupations in our nation. The
annual death rate for farmworkers in
America is five times as high as the com-

Surgeon General's Conference on Agricultural Safety and Health
FARA.&WE 2000 . A National Coalition for Local Action
Convened by the National Institute for Occupational Safety end Health
April 30 - May 3, 7991, Des Moines, Iowa

DISSEMINATING SAFEW AND HEALTH
INFORMATION THROUGH EDUCATION

    By J. Michael McGinnk, M.D.
   Deputy Assistant Secretary for Health

Director, Office of Disease Prevention and Health Promotion
       Assistant Surgeon General

Dr. Antonia C. Novello: Now I would like to introduce Dr. J. Michael McGinnis. I am very pleased
that he is going to address this conference. Dr. McGinnis serves as Deputy Assistant Secretary for
Health, and holds the rank of Assistant Surgeon General. He has served as the Director of the Office
of Disease Prevention and Health Promotion since 1977. Dr. McGinnis is a Fellow of the American
College of Epidemiology and the American College of Preventive Medicine, and has held faculty
appointments at Duke University and George Washington University. His contributions include the
initiation and development of Healthy People: The Surgeon General's Report on Health
Promotion and Disease Prevention, Healthy People 2000: National Health Promotion and
Disease Prevention Objectives, and the Dietary Guidelines fqr Americans, which was jointly
issued by the U.S. Department of Health and Human Services and the US. Department of Agricul-
ture. In addition, he has collaborated with the National Institute for Occupational Safety and Health in
the mid-1980s on the project, The Future of Work and Health.  In 1988, he also developed The
Surgeon General's Report on Nutrition and Health.  It is with great honor that I introduce Dr.
McGinnis to speak on the third purpose of this conference, Disseminating  Safety and Health
information Through Education. Dr. McGinnis:

bined death rate for all other workers.
Every day nearly 500 agricultural workers
in America suffer disabling injuries, and
almost half of these injuries result in per-
manent impairment.

Since these troubling statistics are affected
by a number of factors, the health and
safety of agricultural workers is especially
vulnerable. One of the major problems
stems from the decentralized nature of the
workforce.

Because farmers live in rural areas and
have traditionally worked independently,
their health and safety needs have not
been adequately addressed. Furthermore,
because many farm work forces have fewer
than 11 workers, they are not identified by
national data systems and their burden of
suffering therefore may be underestimated.

22

Papers and Proceedings


A second factor is the issue of economic   In my comments today, I would like to
disincentives. Because there is no simple   echo many of the themes that were raised
way to spread the economic risk as large   by Ms. Widess and Dr. Dean by illustrating
corporations or other industries can do, the  some examples of how those themes can
costs of implementing many safety mea-   play out by virtue of successes from other
sures are passed directly on to farmers.   public health sectors in which public edu-
                   cation and behavior change have proved to
The final factor involves those health prob-  be a very important tools. I would like to
lems that adversely affect agricultural    share with you examples of the impact of
workers. Though trauma is the most      behavioral factors on a number of our
prominent health problem for        leading health problems.
farmworkers, respiratory diseases, other
sequelae of pesticide toxicity, certain can-   Several years ago, the Carter Center of
cers, dermatitis, noise-related hearing loss,  Emory University, in collaboration with the
and stress-related mental disorders are all  Centers for Disease Control, undertook a
problems that agricultural workers must   project called CZosing the Gap, which ex-
face. Though these health problems are   amined the burden of a variety of the
extremely diverse in the way they affect   leading killers in our society. It found that
individual farmers and their families, they  behavioral factors played a significant role
do have a major commonality.       in 55 percent of heart disease deaths, 60
                   percent of cancer deaths, and 70 percent
                          of motor vehicle deaths.
Fortunately, because the prominent role
of behavior in health threats is not novel   In fact, across all causes of death, and in
or unique, some of the lessons that can be   comparison to genetic factors, environmen-
gleaned from other public health areas   tal factors, and factors related to the lack
may be germane to the kinds of approach-   of access to appropriate treatment facili-
es that we seek to establish for agricultur-   ties, behavior contributed to almost
al health and safety.           one-half of all premature deaths from all
                    causes in our society. The leading causes
                    are by now well known to all of us, as a
                   result of the work of Surgeon General
Behavior plays a prominent role in both   Novello and her predecessors.
the onset and the management of many
occupational injuries and diseases. There-  Of the 2.1 million deaths each year in our
fore, motivating behavior change must be a  society, tobacco accounts for approximately
part of any approach to the solutions that  400,000 deaths each year. The impact of
we seek. Fortunately, because the promi-   factors related to the imbalance between
nent role of behavior in health threats is   diet and activity accounts for another
not novel or unique, some of the lessons   300,000 to 400,000 deaths.
that can be gleaned from other public
health areas may be germane to the kinds  Alcohol contributes to 100,000 deaths each
of approaches that we seek to establish for  year, including 20,000 deaths related to
agricultural health and safety.        alcohol's impact on motor vehicle opera-
                    tion. It is clear by these numbers that
                        behavioral choices have an enormous im-

Disseminating Safety and Health Information through Education, April 30, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991                23


The Potential for a National Coalition

pact on our society's health profile, includ-
ing the health profile of agricultural work-
ers in our country.

The good news is that we have made a
great deal of progress in the past several
decades. Tobacco use among males, for
example, has declined from 54 percent in
1964 (at the time the first Surgeon
General's report on tobacco and health
was released) down to approximately 30
percent today, almost half of what it was
when the campaign against tobacco was
initiated.

The changes with respect to diet are less
dramatic. Though the average percentage
of calories for dietary fat intake is still as
high as 36 percent, there has been a dra-
matic shift away from saturated fat con-
sumption, resulting in risk reduction for
heart disease.

Finally, we have also seen progress in the
area of alcohol. Cirrhosis rates are down,
and alcohol-related motor vehicle fatali-
ties have declined. There is greater aware-
ness of the problems related to alcohol,
and I suspect that the awareness will accel-
erate as a result of the special focus and
attention that Surgeon General Novello
has drawn to that issue.

These kinds of changes are not serendipi-
tous; they are the result of specific and
targeted campaigns. Some of these cam-
paigns have been local in nature and very
carefully controlled. I would like to share
with you two important examples of com-
munity mobilization to reduce behavioral
risks, which improved the health prospects
of those communities.

Both examples were carefully controlled
studies offering a scientific approach, and
both focused on cardiovascular disease

prevention through targeting multiple risks
simultaneously. These kinds of multiple
risk factor interventions can also be ap-
plied to improving the health of our agri-
cultural workers.

The Stanford Five-City Project addressed
coronary heart disease risks, such as smok-
ing, dietary habits, and blood pressure
control. The campaign used a comprehen-
sive mass media intervention strate-
gy-television, radio, and newspapers-in
combination with direct education provid-
ed in classes, community-level contests,
and school-based programs. As a result,
reduction in coronary heart disease risk in
the experimental cities was nearly 20 per-
cent greater than the secular trends of the
control cities.

The other example, the North Karelia
Study in Finland, used environmental
change (i.e., by increasing the availability
of low-fat foods and designing non-smok-
ing areas) in addition to mass media and
direct education. As a result, the overall
coronary heart disease mortality in the
target populations was reduced by almost
25 percent.

In addition to these carefully controlled
experiments of a community wide nature,
there have been some large-scale national
campaigns that have had a tremendous
impact on the entire nation. The Surgeon
General's campaign against tobacco, initi-
ated by Terry Luther, SG, in 1964, is per-
haps the most prominent example of a suc-
cessful national campaign.

Other examples include the initiation of
the National High Blood Pressure Educ-
ation Program in 1972 and the initiation in
the early 1980s of the National
Cholesterol Education Program, both by
our National Heart, Lung, and Blood

24

Papers and Proceedings


Institute. Programs growing out of grass-
roots efforts have also .had a tremendous
impact on behavioral change.

For example, Mothers Against Drunk
Driving (MADD) has provided important
impetus in efforts to reduce the terrible
tragedy of alcohol-related automobile

What have we learned from these efforts
that might be useful to the dissemination
of agricultural health and safety informa-
tion? First and foremost, we have learned
that the dissemination of information alone
is not enough. Knowledge is power, but
education alone will not accomplish the
task.

fatalities among our young people. Conse-
quently, we have seen some real gains in
overcoming the problems related to motor  In order to succeed, we need to change the

vehicles and alcohol.           entire environment, including the physical
                        environment as well as the social environ-
                        ment. The social environment contributes
Indeed, all of these efforts mobilized every
aspect of community life-schools, commu-  to shaping people's perspectives and there-
                          fore their risks.
nity organizations, voluntary organizations,
professional societies, and worksites-in a   We heard from Ms. Widess about the
coalition to address those problems. As
Don Millar would point out, occupationally  importance of the regulatory processes in
                   insuring that we have provided a safe envi-
based programs have also contributed

substantially to making the major inroads   ronment for farmworkers with respect to
                   pesticide use. We heard from Dr. Dean
that we have seen against high blood pres-
sure and tobacco smoking, as well as alco-  about the importance of safety standards
                   as well as public education efforts. Each
hol.                    of these are critical to success, and each
                   was used in the successful public education
As a result, coronary heart disease mor-
tality has declined by about 40 percent in   campaigns launched to reduce cardiovascu-
                   lar risk. For example, non-smoking areas
the last 15 years, stroke mortality has

declined by 55 percent, and auto fatality

mandated through clean air laws passed at
the local level have given tremendous

rates among children have declined by 22  impetus to our gains against tobacco.
percent in the last ten years alone. These
are striking examples of success stories:   The provision of lower-fat food changes,
success of public education efforts, with
their roots at the community level. Due to  not a regulatory measure, but a very im-

these accomplishments, overall childhood   portant environmentally oriented initiative
                   on the part of industry, has helped people

and adult mortality rates have decreased.
Specifically in 1980, the Surgeon General
targeted a 20 percent reduction in child-

to make changes that are important to
their daily lives. The engineering and
availability of better auto passenger re-

hood mortality and a 25 percent reduction  straints has allowed the improvements that
in adult mortality to be accomplished over  we have seen with respect to use of seat
the decade of the 1980's, by 1990. Both of  belts, in particular for our children, and
these goals have been met, and done so   has allowed the consequent improvements
largely through public education efforts.   in mortality in that regard.

                    It is clear that the approach must be bal-
                    anced between health protection on the

Disseminating Safety and Health Information through Education, April 30, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991                 25



The Potential for a National Coalition

one hand and health promotion on the
other. It is crucial to remember, however,
that health promotion can make a tremen-
dous difference. I would like to spend my
last few minutes, therefore, talking about
health promotion.

The health promotion sciences are not
tremendously well-developed, but we do
know that prior to behavior change, there
must be changes in knowledge, in attitudes,
and in beliefs. For changes in knowledge
and in attitudes to occur, we need messag-
es that are credible, that are reinforced
from a variety of perspectives, and that are
sustained over time. In other words, we
need to know the facts, we need to build
coalitions, and we need to stay with it.

Credibility of a campaign comes from
improving data sources, from deepening
the analysis of those data, and from involv-
ing leadership, such as your involvement
with the Surgeon General in this public
health effort on improving agricultural
safety and health.

I would like to give special emphasis to the
issue of data sources, because they are so
vital to insuring that the messages that we
give are credible. We heard from
Mr. Atchison earlier of the discrepancies
that exist in our current data sources.

When we know that some estimates de-
scribe 14 deaths per 100,000 agricultural
workers, whereas others indicate that there
may be as many as 50 deaths per 100,000
agricultural workers, it is evident that we
need to have better data on which to
shape our policies and programs. Improv-
ing data systems, especially for agricultural
workers, needs to be a priority for the
future.

We also clearly need to recruit allies to
help us disseminate the information. We
need to involve schools, employers, retail-
ers, and the media. We need to involve
farm equipment manufacturers and com-
munity leaders. The establishment of
solid, locally based coalitions is critical to
gains in agricultural safety and health, just
as they have been critical to the gains that
we have seen in other areas of public
health in recent decades.

Even knowledge, attitudes, and changes
therein, while necessary, may not be suffi-
cient to accomplish the kinds of gains that
we would like to see. People also need to
believe that these issues are directly and
personally relevant to themselves.

The message needs to be brought home.
Whether it is brought home to families
through children in school settings or
whether it is brought home to people
through interactions with health providers
taking a more careful history of individual
risk, it is clear that we need to find ways to
make these risks more relevant to the
individuals who are at greatest risk.

It is no accident that the biggest gains in
public health recently have been made in
areas where individual risks have been
defined in the form of a number (e.g.,
cholesterol level or a blood pressure read-
ing). It should be entirely possible to
develop a health hazard appraisal instru-
ment that can be used to better character-
ize the risk of individual farm settings, and
we need to work on new ideas.

In summary, know the facts, build coali-
tions, stay with it, and bring it home. It is
a tested formula. It has worked, and it can
work in agricultural safety and health.

26

Papers and Proceedings


Disseminating Safety and Health Information through Education, April 30, 1991

HeaZthy People 2000 is a statement of na-
tional goals and objectives for the year
2000, and I am delighted, Mr. Atchison,
that you have taken this on in a very sub-
stantial way here in Iowa. Richard
Remington is going to provide tremendous
leadership, and we will profit throughout
the nation in the kind of model that you
will be developing here in Iowa.

Healthy People 2000 envisions the year
2000 with nearly a third fewer farm inju-
ries and deaths than currently occur, but it
also envisions as a means to achieving
these goals, greater commitment on the
part of our health providers, schools,
manufacturers, and states to the problem
of agricultural safety and health.

It envisions greater national attention to
the issue. It envisions a situation in which
we can provide an example to the world
for improvements in agricultural safety and
health, just as we have provided an exam-
ple to the global community in improve-
ments against cardiovascular disease. I
believe that it is a vision that can be at-
tained in this Surgeon General's Confer-
ence on Agricultural Safety and Health as
an important step to forming the coalition
that can make it happen.0

Surgeon General's Conference on Agricultural Safety and Health - 1991

27


Surgeon General's Conference on Agricultural Safety and Health
FARM&FE 2000 o A National Coalition for Local Action
Convened by the National Institute for Occupational Safety and Health
&xi/ 30 - May 3, 1991, Des Moines, Iowa

ENCOURAGING ACTION IN PREVENTING
INJURY AND DISEASE IN AGRICULTURE
    - A Video Message -

  By Louis W; Sullivan, M.D.
Secretary of Health and Human Services

Dr. Antonia C. Novello: Dr. Louis Sullivan, our Secretary of Health, was going to come to this
meeting, but because of scheduling - you would not believe how many places we have to go when
we are in jobs like this, and he has to be in many more than anyone can ever dream of - he could

1 not make it; but, he sent a video message for you all, and I would like to show that for you:

Hello, I am Dr. Louis Sullivan, Secretary   tenfold can also be a. powerful, tragic
of Health and Human Services. Thank    threat to health and well-being.
you for inviting me to participate in your
conference-I regret that my schedule did   The seriousness of agricultural injury and
not allow me to attend.             disease demands national attention. Suc-
                   cessful improvements, however, will be

It is fitting to hold this conference in Des   rooted solidly in local initiatives. Your
Moines, For many years, Iowa has been at  theme-"A National Coalition for Local
the forefront of efforts to improve agricul-   Action"-establishes the ideal framework

tural safety.

This state has produced many national
leaders in rural health. In fact, Former
Iowa Governor Robert Ray is currently an
advisor to me as chair of the National
Advisory Committee on Rural Health.

The seriousness of agricultural injury and
disease demands national attention.

The advances in technology during the past
few decades have given today's agricultural
workers a tremendous advantage
unimagined by the workers of yesteryear.
But those advances have come at a price:
the technology that increases productivity

for addressing the problems of agricultural
occupational hazards.

Agricultural workers have one of the high-
est rates of occupational fatality in the
country. Although they represent only two
percent of the nation's work force, they
rank fourth highest in the number of work-
related traumatic fatalities.

The risks of agricultural work do not fall
equally across all types of work, nor among
the workers themselves. For example,
loggers have an especially high risk of
death with more than 200 deaths per
100,000 workers, a rate nearly 30 times the
general private- sector fatality rate.

28

Papers and Proceedings


Encouraging Action in Preventing Injury and Disease in Agriculture: A Video Message, April 30, 1991

There is also a clear disparity among pop-
ulation groups. Hispanic and black agri-
cultural workers face an occupational fatal-
ity rating 20 to 30 percent higher than
white populations. Other minorities are
more than twice as likely to die while
working at an agricultural job than in an-
other profession.

The key to making those strategies ef-
fective-the critical, vital factor that will
determine our success in lowering the
risks of agricultural work-is local initia-
tives and efforts.

However, the very definition of oc-
cupationaZ hazards means that it is possible
to reduce many of the risks involved. Our
first and strongest attack on occupational
hazards should be prevention. Improved
working conditions, use of safety devices,
and more extensive educational efforts will
lower job-related fatalities.

It is estimated that tractors are involved in
more than three-quarters of agriculture-
related deaths, most of which occur as a
result of tractor rollovers. Roll bars and
other preventive structures can be very
effective in limiting death and injury to
tractor operators, but often such safety
measures are not used.

To encourage farmers to use preventive
structures, the Marshfield Center, an
Health and Human Services (HHS)-funded
rural health research center in Marshfield,
Wisconsin, has published a guide to give
farmers information on where to find roll
bars and how to `use them to minimize the
risks of injury in rollovers.

Efforts to reduce job-related exposure to
chemicals should also be more effective. It
is estimated that 20,000 people suffer pes-
ticide poisoning each year. Often other
economical alternatives-such as crop rota-
tion and biological pest control-can signifi-
cantly reduce the risks of exposure.

The key to making those strategies effec-
tive-the critical, vital factor that will deter-
mine our success in lowering the risks of
agricultural work.-is local initiatives and
efforts.

This conference is already a milestone in
developing efforts to save lives and pre-
serve health. By thinking nationally and
acting locally, we can make agricultural
work in America. safer and healthier for
everyone.0

Surgeon General's Conference on Agricultural Safety and Health - 1991

29


Surgeon General's Conference on Agricukml Safety and Health
FAR&WE 2000 o A National Coalition for Local Action
Convened by the National institute for Occupational Safety and Health
April 30 - May 3, 7997, Des Moines, lowa

SURGEON GENERAL CONFERENCES:
  A MODEL FOR THE FUTURE

     By Antonia C. Novello, M.D.
Surgeon General of the United States Public Health Service

Thank you. As they said in the movie
"Field of Dreams," "We have built it, and
they have come." I would like to thank Dr.
Millar, Mel Myers, and the rest of NIOSH,
as well as the people of Iowa for helping
organize this event. I am honored to be
the first Surgeon General to hold a Con-
ference on Occupational Health in 50
years.

I imagine the last Conference was probably
set up much differently than this one. I
am sure it was much more of a "low key"
affair, without all the new communications
technology that has come along in the last
several years. Of course, the last Surgeon
General's Conference was not even video-
taped, so it is possible that back then the
Public Health Corps' Commissioned Offi-
cers could probably get away with not
wearing their uniforms, since no one would
find out!

At any rate, it is about time we had anoth-
er one of these Conferences. And it is my
hope that we do not have to wait another
50 years to have the next one, because I
am not real sure what my schedule will
look like at that time.

The last Conference was held in the year
1941, the same year the United States
entered World War II. Fifty years later,

30

we finally have the opportunity to hold
another Conference-just after we have
ended the Persian Gulf War. However, in
between those two wars, another war has
raged continuously for those of us in the
Public Health Service. The war against
disease and injury.

WHY THIS CONFERENCE IS
IMPORTANT TO ME

Ever since I became Surgeon General, it
has been written and said many times that
I will have a lot of difficulty trying to be
like Dr. Koop. That is OK, because I
would never be able to grow a beard like
him. It is also OK, because it is my desire
to set my owlt agenda as Surgeon General.

Although Dr. Koop was very successful in
redefining the role of Surgeon General by
bringing a lot of visib:ility to public health
priorities-priorities, which I will continue
to pursue-it is my prerogative to establish
new priorities as well. Today's Conference
on Agricultural Safety and Health marks a
perfect occasion for me to do that.

In addition to being frequently compared
with Dr. Koop, a lot has been made of the
fact that I am the first woman and Hispan-
ic to hold this position. I can not lie to
you-1 am both! However, as a woman and

Papers and Proceedings


Surgeon General Conferences: A Model for the Future, April 30, 1991

a Hispanic, there are aspects about this
conference, which are very important to
me.

As a woman-as well as a pediatrician-it
greatly concerns me that women and chil-
dren are so often the victims of farm inju-
ries and fatalities. These injuries and
fatalities occur because farming is fre-
quently a family occupation, where every-
one participates.

As a woman, I totally agree with the phi-
losophy of Marilyn Adams' group Farm
Safety for "Just Kids," who say that the one
person on a farm who can play the most
pivotal role in educating farmers and farm
children about the dangers of working on a
farm is the woman. She can most easily
influence her husband and her chil-
dren-either in a nice way, or if necessary,
in a not so nice way! In tomorrow's
"Charge to the Conference," I will more
strongly express my concerns about the
dangers to farm children.

These are my concerns as a woman. As a
Hispanic, I am well aware of the safety
and health problems of the migrant work-
er, many of whom are also Hispanic:

o Out of the 50 States in this country, 48
of them rely heavily on migrant workers
for help during he peak harvest seasons.

o These workers have very poor access to
health care facilities and infant mortali-
ty is very high, estimated to be 50 per
1000.

o Due to water shortages on many of
these desert-area farms, these workers
are often forced to drink irrigation
water, which may be contaminated with
farm chemicals or infectious agents.

o Crop dusting planes often swoop down
from the sky and spray toxic pesticides
onto fields where many of these migrant
workers are forced to sleep. Many
chemicals are known to cause problems
such as sterility and miscarriage.

o Finally, injuries and illnesses to these
workers are grossly under-reported to
safety and health officials, primarily due
to:

1. Language ba.rriers.

2. Fear of job--loss.

3. An overall lack of worker education.

I

7

As a woman, I totally agree with the
philosophy of Marilyn Adams' group
Farm Safety for "Just Kids," who say that
the one person on a farm who can play
the most pivotal role in educating farmers
and farm children about the dangers of
working on a farm is the woman.

We must take more initiative in educating
these workers. It is a situation we are
continuing to learn more about all the
time, as shown by Dr. Sullivan's comments
we just heard about Black farm workers
and their high risk of tuberculosis.

Surgeon General's Conference on Agricultural Safety and Health - 1991

37


The Potential for a National Coalition

Therefore, safety and health among mi-
grant workers, women, and children are all
issues that I care about, not only as your
Surgeon General, but as a woman and
Hispanic. This is why this Conference is
so important.

BACKGROUND ON THE SURGEON
GENERAL'SCONFERENCEON
OCCUPATIONAL HEALTH

I will now provide a little history on the
Surgeon General's Conference on Occupa-
tional Health. This is the 10th Conference
in U.S. history. The first conference was
held on May 20, 1925 by the Surgeon Gen-
eral of that period, Dr. Hugh S. Cumming,
who called a Conference to discuss the
problem of tetraethyl lead-a deadly occu-
pational poison. Attending that first Con-
ference were industrialists, chemists, labor
representatives, and physicians.

Surgeon General Cumming held another
Conference in 1926, in which the first
cooperative agreement on toxic substances
was reached. A third Conference, on the
health hazards of radium dial painting, was
held in 1928, and six more were held over
the course of the next 13 years (Other
Conferences dealt with: methanol; carbon
tetrachloride and similar volatile chlorinat-
ed liquid hydrocarbons; carbon tetrachlo-
ride fire extinguishers; aniline oil; carbon
disulfide; benzol; occupational cancer; and
chronic mercurial poisoning in the hatting
industry-better known as the "mad hatter"
syndrome).

CHARACTERISTICS OF
THIS CONFERENCE

Dr. Alice Hamilton, the famous industrial
hygiene pioneer and the first U.S. physi-
cian to devote her career to occupational
safety and health, was so encouraged by
these Conferences that she wrote:

it was to me both surprising and hearten-
ing to see men of such widely separated
backgrounds and interests... meet in a
spirit of reasonableness and genuine de-
sire to get at the real *facts and deal prac-
tical& with the problem.

That is true today, as well. I look around
the room and see people from many points
on the spectrum of society, and this is why
the theme of the Conference is called "A
National Coalition for Local Action."

Safety and health issues in agriculture must
be handled differently than safety and
health issues in other occupational fields.
Although people involved in the produc-
tion of food and fiber are the largest single
occupational group in the U.S., they are
also a very isolated group. Not only be-
cause they live in rural areas far away from
the noise and chaos of the urban environ-
ment, but also because they are isolated
when it comes to prot.ecting themselves.

There is no internal voice among the farm
community to represent them, and there is
no external voice to represent them either.
This is something the farm community has
in common with the children of the United
States; children have no voice among

32

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themselves to represent them, and no    Three people in particular deserve special
external group to speak for them either.   recognition for their involvement with
                      NCASH: Mr. Carrol Bolen, with Pioneer
Children, like farmers, are isolated.  This   H-Bred and the Executive Director of the
is why I chose to be a pediatrician.      Iowa 4-H Foundation, Ms. Lu Jean Cole,
                    the Director for Community Investment for
So, it is important that we address the    Pioneer H-Bred, and Mr. Tom Urban,
problems of the farming community begin-   Chairman and President of Pioneer Hi-
ning at the local level, although this is a   Bred International, Inc. Could Mr. Bolen,
national problem. This is certainly a     Ms. Cole, and Mr. Urban please stand and
unique approach to solving a public health  be recognized?
problem, and I am hopeful this is only the
beginning.                      CONCLUDING REMARKS

Actually, there is a precedent for this Con-  In Puerto Rico where I grew up, farming
ference. In September 1988, a Conference  was the dominant way of life for many
was held by a group, which ultimately be-   generations-as it was here in America.
came NCASH-the National Coalition for   Puerto Rico is much different now. A
Agricultural Safety and Health. That Con-  program known. as "Operation Bootstrap"
ference focused on four main objectives:    restructured and revitalized the Puerto
                    Rican economy, transforming it from an
Summarizing research and health and   agricultural economy to a manufacturing
safety programs.                economy.

Integrating the viewpoints of farmers   Although farming is no longer the major
and farm workers, the private sector,   way of life in Puerto Rico, there are still
and public institutions.         parts of Puerto Rico where farming still
                   exists, just as there are parts of the United
Identifying service needs and policy    States where fa.rming is still a major indus-
issues for the family farm.        try. Iowa is certainly one of those places.

Communicating the results to legisla-   Although the farming population has de-
tors, policy makers, federal/State agen-  creased over the years*, these are still the
cies, farm groups, farm families, and the  people who we rely on for our food. The
general public.              1989 Bureau of Labor Statistics reports
                   that the injury and illness rate in the agri-
That 1988 Conference is how the "National  culture, forestry, and fishing industry is
Coalition for Local Action" began. With-   estimated to be about 11 injuries and ill-
out their hard work, it is unlikely we could  nesses per 100 full-time workers, making it
have ever pulled this event off.       the third most hazardous industry in the
                   country. With the number of farms and

Surgeon General Conferences: A Model for the Future, April 30, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991                33


The Potential for a National Coalition

farm workers declining, this high injury
and illness rate is particularly alarming
because it poses a threat to the backbone
of food production in America.

The key to success for this "National
Coalition for Local Action" we are building
here is communication. There are many
different representatives involved in this
building process: farmers, physicians,
chemical company representatives, farm
machinery manufacturers, as well as repre-
sentatives from government and academic
institutions.

Naturally, there is going to be a great
many philosophical differences between
these groups. What we need to do is not
dwell negatively on the things we disagree
on, and instead focus positively on the
things we do agree on, and build from
there.

Only then, will this local action serve the
national purpose. This is our "Field of
Dreams." If we build it, they will come.0

*The number of farms in Iowa shrunk from 119,000 in 1980 to 105,000 in 1989 (according to the 1990 Statistical
Abstract of the United States). Accordingly, farm employment has also dwindled in the last decade. In 1980,
the farm employment population stood at approximately 3.7 million in the U.S. By 1988, that number decreased
to 2.9 million.

34                                  Papers and Proceedings


Surgeon General's Conference on Agricultural Satbty and Health
FARMSAFE 2000 o A National Coalition for Local Action
Convened by the National Institute for Occupational Safety and Health
April 30 - May 3, 7991, Des Moines, Iowa

REMARKS BY THE CHAIR OF THE CONFERENCE

       By J. Donald iWEar, M.D.
Director, National Institute for Occupational Safety and Health
        Assistant Surgeon General

The National Institute for Occupational   there begins a full 18 pages of names of
Safety and Health, part of the Centers for  people who have made this conference
Disease Control, and I am very, very de-   possible. At your leisure look through; as
lighted to welcome you again to this     you recognize these people during your
Surgeon General's Conference for Agricul-  time here just say thank you to them per-
tural Safety and Health. Is it not a great  sonally. There are lots of folks represent-
day in Iowa! It is beautiful out there. And  ed, from many walks of life; many from
just think how fortunate all the farmers of  NIOSH, many from outside of NIOSH. It
Iowa are that they get to spend the day    is to them that we owe the success of this
outside today. It is wonderful!         conference.

I want to thank you again for coming. Is
there anybody here from Amesworth or
thereabouts? My wife and I drove over
and we had a little automobile problem
there or about there, and the good folk at
the Amesworth Amoco Station were very
helpful to us. So I just wanted to say thank
you. Any of you from that area drop by
and tell them that here is one very grateful
Public Health Service officer who appreci-
ates their help.

It is really good to be here. You know,
this is the heartland, not only geographical-
ly, but in many ways philosophically, be-
cause here amidst the good people in the
center of our country who still pursue
farming as a primary occupation is the
reservoir of many traditional American
values-things that have made this country
the great nation that it is; all the more
reason why we should be here again, the
second day of the conference, focusing on
how to make their quality of life even bet-
ter and more productive.

There are two people there whose names
you will not see.  One is Dr. James
Merchant, from the University of Iowa,
who has demonstrated great national lead-
ership in this field and who, along with Dr.
Pratt, came to Atlanta one day and encour-
aged this meeting and many other things
related to agricultural safety and health.
We appreciate that leadership, and we are
glad to be responsive to it. The other is
one of our speakers this morning, Senator
Harkin, who provided legislative encour-
agement for us to convene in this session.

I would like you to, at this point, look in
your program, if you have it, at page 27;

So you will want to remember these people
with gratitude for having initiated-having
helped us all to initiate-this conference.
The three speakers that I am pleased to
introduce this morning all have roots in
traditional agricultural states-people who
have a good feel for the land. Whether or
not they, themselves, may have ever oper-
ated behind a plow or on a tractor or what-
ever, each of the,m brings to this a sense of
the appreciation of human worth that I
think is so important in public health.0

Surgeon General's Conference on Agricultural Safety and Health - 1991

35


Surgeon General's Conference on Agricultural SarXy and Health
FARMSWE 2000 o A National Coalition Ibr Local Action
Convened by the National Institute for Occupational Safety and Health
April 30 - May 3, 1991, Des Moines, Iowa

HEALTHY PEOPLE 2000 AND AGRICULTURE

  By Tom Harkin
U.S. Senator, State of Iowa

Dr. J. Donald Miiiar: I would like to introduce Senator Tom Harkin, a senator from the State of Iowa.
Last fail, in Iowa City, he and I shared a platform at the annual meeting there for occupational
medicine. Senator Harkin's father was a coal miner. His mother was an immigrant from Yugoslavia.
He worked his way through school here in Iowa and then served as a pilot in the U.S. Navy from
1962 to 1967. in 1970, he was appointed as a staff assistant to the U.S. House Select Committee on
U.S. Involvement in Southeast Asia. in 1972, he received his law degree from Catholic University in
Washington, D.C., and was elected a U.S. Congressman from Iowa in 1974. Through the years, he
has pursued what I think is a very fascinating practice, and that is a series of workdays on which he
works a full day side-by-side with an Iowan. Last fail he worked his 100th such day, and it was on an
Iowa farm. He was elected U.S. Senator in 1984 and again, as you know, was re-elected in 1990.
On both the House and Senate Agriculture Committees, he has been an outspoken advocate for
America's farm families. Since 1989 he has chaired the Senate Appropriations Subcommittee on
Labor, Human Services, and Education on which, again, he has advocated improved agricultural
safety and health. As his record shows, he has been able to effectively represent citizens from both
major parties while becoming known as a man who has the courage of his convictions. I present to
you Senator Harkin:

Thanks, Dr. Millar, for that generous intro-  toward preventing and curing disease with
duction. But I am not sure I deserve all   great leadership at CDC. You and those
that praise.                that work for you are making it possible
                    for us to meet the health care challenges
It kind of reminds me of what Mark Twain  facing this nation.
once said. He said,

You'll go to heaven for your charity,
unless you go somewhere else for your
exaggeration.

It is good to be home. I am proud to see
Iowa host such an important conference. I
see a lot of familiar faces out there today.

I would like to thank the Centers for Dis-
ease Control (CDC) for inviting me to
speak here this morning. I am honored to
share the stage with such world-class
health care leaders, like Dr. Millar, who is
fighting for the safety of working people all
over America; and Dr. Novello, the Sur-
geon General, who tells it like it is and
gets the job done.

I have been very impressed with your work
and your leadership, Dr. Novello. And of
course, Dr. Roper, who is leading the fight

Well, I will not s'peak to you too long this
morning. Here in Iowa, we do not waste
time with a lot of words. We say what we
mean, and get on with it.

I am here today because there is a crisis in
rural America: a real crisis. It goes be-
yond droughts and low commodity prices,
beyond floods and infestation. It strikes at
the heart of the American farmer.

It is a crisis about how we protect the
people who put food in our homes and
what we can do to help them. Quite

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frankly, our farmers are dying. Not just       o  Why cannot many farmers afford basic
here in Iowa, but everywhere, in farms and   health care and hospital expenses once
fields all over this country.          they are sick:?

We are here today to say American farm
families should not have the second high-
est fatality rates in the nation. That
170,000 disabling farm injuries each year is
a national tragedy. And that 300 children
killed on farms each year is a national
disgrace.

o  And why carmot we prevent it all from
happening in the first place?

It is not our place to ask why it took so
long for this discussion to start. That will
not solve anything.

Last year in Iowa alone, 83 people died on
farms, 16 of them children. Over 2,000
more were injured, including 439 children.

Dwelling on the. failed policies of the past
will not keep a young child out of a grain
elevator today. It will not teach farmers
planting beans or corn about the dangers
of pesticides.

What we learn here this week, what we
take back to our towns and hospitals and
community centers, may save thousands of
lives.

You know, it is funny that we call them
farmers. Just "farmers." Because they are
so much more than that. Sure, they farm.

Use what you learn here this week to fight
to make our farms safer places. And nev-
er stop searching for answers. The stakes
are too high to settle for anything less.

The work certainly will not end here at
this conference. But the discussion must
begin here. It is a discussion that needs to
start by asking the simple question, WYY?

They plant, and seed the harvest; they buy
combines, sell crops, fix broken tractors,
tend sick animals, and help bring life into
the world. They are meteorologists, soil
experts, businessmen and women, carpen-
ters, mechanics, and laborers. And they
perform a hundred separate tasks each day
in a hundred different locations.

o  Why are so many farmers and their
children losing their hands, their fing-
ers, and their lives performing routine
chores every day?

o  Why are farmers and their kids sick so
often, afflicted by acute illness?

Farmers are working longer days, with
more mechanization, bigger machines, and
more complex machines. Bigger farms
have collapsed planting seasons. Farmers
rush to get everything done. Their win-
dows for harvest are smaller. They work
harder and faster. Is it any wonder that
safety needs to be talked about?

o  Why do cancer, chronic lung disease,
arthritis, and hearing loss cripple so
many farm families?

There are those that look at this kind of
farm work and say:

o  Why cannot most farmers get a drink
of water after a long, hard day without
worrying about contamination?

We cannot do anything. Our money can
be better spent in other places. Studying
farm injuries and farm safety is a waste
of time.

Healthy People 2000 and Agriculture, May 1, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991

37


Looking Ahead to the Next Century

Well, tell that to Richard Zeman. Richard
is an Iowa farmer. He lives in Bode, Iowa
with his family. He has always lived in
Bode.

He was born and raised on the same farm
that he is on now. One September after-
noon 14 years ago, Richard was chopping
silage with one of those big choppers that
shoots the debris into a wagon behind it.

Richard's brother was following in the
wagon. Richard was going along, and
some weeds got caught in the chopper. He
stepped out of his tractor, leaving it still
running, circled around front, and stomped
down on the weeds to pull them out.

But something happened that Richard had
not planned. The chopper started to move
again. It took the weeds, and caught
Richard's pant leg with them. He strug-
gled to get free, but the machine pulled
him in. By the time his brother pulled him
out seven minutes later, Richard's right leg
was nearly severed from the knee down.

He survived. But here he was, 34 years
old, five kids, and forced to wear a fake
leg the rest of his life. Let me tell you, it
is pretty hard to farm with a false leg.

But Richard still farms today. Sure, he
moves slower. He cannot play the softball
and volleyball he used to, but he gets by
okay. That is, as long as the back spasms
for which he has had two operations do
not cause him too much pain, or his leg
stem does not blister too much.

Richard says that if there had been some
education then, or if he had heard a brief
word or two about safety, he would have
thought twice. He probably would not
have done what he did. And he would
have his leg. In fact, he would probably be

playing third base for the local softball
team.

How many Richard Zemans are there out
there? I know you are probably thinking,

Sure Harkin, we know that happened.
But that was a long time ago. Things
like that do not happen anymore.

Well, sure, and I say let me tell you anoth-
er story. Let me tell you about my friend
Marilyn Adams.

Marilyn is an Iowa farmer. She and her
husband, Darrell, have been farming the
same land in Earlham for many years.
Marilyn's son, Keith, loved the farm.

He always helped his dad in the fields and
around the barn. Of course, he also loved
going to church, and riding his bike, and
playing down at the pond. He had a pet
frog. And he planned on being a minister,
even at age 11.

Then one fall afternoon in 1986, Keith
went out to help his dad. While his father
was out working in the field, Keith worked
on the grain wagon closer to the house.

After a while, Keith's dad came back with
a load of grain.  He called Keith's name
but got no answer.  He looked around and
could not find his son a.nywhere. Eventu-
ally, something caught his eye. Mr. Adams
went closer to the grain wagon to look
around.

He found his ll-year-old boy suffocated at
the bottom of the wagon. To this day, the
Adamses do not know how Keith fell in.
The grain just sucked him to the bottom,
like a whirlpool.

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Marilyn Adams was distraught, as you
might imagine. A year went by, and while
still hurt, she realized not enough was
being done to promote safety to kids on
farms. In October, 1987, she formed Farm
Safety for "Just Kids," an education pro-
gram to teach kids about farm safety.

A month ago, I went on a farm safety tour
in Union, Iowa, at the Martin family farm,
Reginal and Melody. They have three
kids. There was something very special
about the tour.

Mr. Martin did not show me around. His
two boys did-Bryce and Paul, both less
than 10 years old. They had both been
through the "Just Kids" program and knew
all the dangerous places to stay away from.

So when people tell me that we cannot do
anything to make our farms safer places, I
say they are wrong. Too many of my
friends have been hurt for us to turn our
backs.

We can do more, and we must do more,
and as long as I am in Washington, that is
what I am going to fight for. And you can
count on it.

I am in kind of a unique position. Three
years ago, I took over as chairman of the
Senate subcommittee that funds health
programs in this country. Until then, there
had never been a focus on farm safety.

Well, we changed all that. In 1990, we got
$11.5 million for the Centers for Disease
Control to begin a farm health and safety
initiative program. We increased that
amount to $19.5 million in the 1991 bill,
and we hope to increase it more for next
year.

Healthy People 2000 and Agriculture, May 1, 1991

I am happy to say that $2.2 million has
gone to the University of Iowa, Iowa State
University, the Iowa State Department of
Health, and to a network of 14 Iowa hospi-
tals where they battle against farm disease
and disability every day.

The farm safety program is made up of
three parts. The first part focuses on iden-
tifying problems. The second part focuses
on research. And the third part focuses on
prevention and early intervention. We
have seen early intervention work outside
our farms and fields in other areas of soci-
ety-

We know, for instance, that a woman given
prenatal care while pregnant is 90 percent
likely to have a healthy baby. If we help
that poor kid with Head Start, WIG, and
school lunch programs, the child is more
likely to stay healthy, to stay in school, and
to go on to become a productive citizen.

That is why Marilyn Adams' program is
such a good idea. It reaches kids during
that stage when it is so easy for them to
learn. So they can recognize health haz-
ards and can teach others about them.

Early intervention and prevention works in
other places, too. Let me tell you about a
few projects.

At Mercy Hospital here in Des Moines, for
instance, we have started a cancer screen-
ing project for farmers, so cancer is detect-
ed early. Research has found that farmers
have higher rates of leukemia, Hodgkin's
disease, and lymphoma, as well as cancer
of the lip, skin, stomach, prostate, and
brain. We know that pesticide toxicity
causes many more problems.

You will hear a lot about cancer and
chronic disease over the next few days.

Surgeon General's Conference on Agricultural Safety and Health - 1991                39


Looking Ahead to the Next Century

We do not understand all the problems
and causes, but we have learned a lot.
Through projects like those at Mercy Hos-
pital, we can detect cancer early.

And through community outreach pro-
grams, we can educate farmers to the dan-
gers when we discover them-community
outreach programs like the Nurses in Ru-
ral Hospitals program, another project we
started in order to get public health nurses
into communities and rural hospitals and
Parent-Teacher Association (PTA) meet-
ings and everywhere that they will make a
difference.

These nurses go out and look for injuries
in farm communities. They are trained to
recognize trends in medical histories, and
to educate farm families to different risks.

The project just started. Currently, we
have these nurses in many states
throughout the country. And we will be
increasing that amount.

We have also got to continue our efforts to
provide farmers like Richard Zeman with
safety tips, so they think twice before doing
certain things. We know that taking
shields off equipment can be dangerous,
but many farmers do so because they inter-
fere with cleaning. We know that it is not
safe to go near moving parts on a machine,
but many take the risk to save time, or
they just miss the danger.

We know that kids should not go in a
grain bin when the elevator is running.
There are dangers on tractors and around
other machines. Heck, when I was a kid, I
used to ride on the fender of the tractor
all the time. We just did not know it was
dangerous.

Well, it is, and more people need to be
reminded that saving time may mean risk-
ing lives. Above all, we need to stop peo-
ple from thinking that farm injuries are
just "part of the job." That is kind of like a
traffic cop accepting a. traffic accident as
"part of the job," or a construction worker
accepting a fall from a tall building as
"part of the job."

There are things that can and must be
done to prevent illness, disease, and dis-
ability, and not only on our farms and in
our rural communities. Early intervention
and prevention must reach into all aspects
of American society in every city and town.

You know, we spend more than $700 bil-
lion on health care in this country-and we
are not getting our money's worth. We do
not need to spend more on health care.
We just need to spend it better.

Experts say that over half of that amount
is spent on preventable illnesses. Yet, of
the more than $700 billion, only a small
fraction is spent on prevention.

Well, my mother taught me the same thing
your mother taught you: an ounce of pre-
vention is worth a pound of cure. If that is
true, then what is a pound of prevention
worth? Everybody is talking about how to
patch and fix and mend people, and that is
important. But it is also important to talk
about how to prevent injury, disease, and
disability in the first place.

Well, my mother taught me the same
thing your mother taught you: an ounce
of prevention is worth a pound of cure. I

40

Papers and Proceedings


Imagine if Americans took care of their
cars like they take care of their bodies.
What would you say if I bought a new car,
drove it off the lot, never checked the oil,
never checked the water, never tuned it
up. Just drove.

And then, one day the engine seizes, I call
the mechanic, he tells me that I need a
new engine, so I say, okay, just put one in.
You would think I was a little crazy.

Fact is, most of us spend more to maintain
our cars than we do to maintain our bod-
ies. Most people put more effort into
watering their lawns to prevent browning
than they do into taking care of their
health to prevent costly and life-threaten-
ing illness later. Any farmer will tell you
that you fix the fence before the horse
escapes, not after.

Earlier this year, I introduced seven
bills-called "Prevention First" to focus our
attention on prevention and get rid of
some of the anomalies in our system. I
would like to talk about a few of these
anomalies on both sides of life.

o MAMMOGRAMS

- 1 in 9 will develop breast cancer in their
  lifetime.

- Of those, 1 in 4 will die.

- 500 alone will die in Iowa this year.

b Anomaly:

- Spend $15,000 for mastectomies.

- Spend up to $50,000 for chemotherapy.

- Too often a woman dies.

Healthy People 2000 and Agriculture, May 1, 1991

- But we will not spend $75 for
mammograms.

I HAD TWO SISTERS DIE.

o LOW BIRTHWEIGHT BABIES

- Spend $2,000 to care for them; gladly pay
it.

b Anomaly:

- But we will not spend less than $500 for
9 months for prenatal care.

. LEAD POISONING

- Thought problem was gone

b Anomaly:

- 28-month old Wisconsin boy died-
-calcium depleted.

- Will not spend $7 billion to treat prob-
lems.

o CENTERS FOR DISEASE CONTROL

- Need to commit more to research.

w Anomaly:

- Spent more on military research in last 27
months.

On our farms, in our factories, in our
schoolyards and boardrooms, we need to
make "Prevention First" our motto for
health care in the 90's.

On our farms, in our factories, in our
schoolyards and boardrooms, we need to
make "Prevention First" our motto for

Surgeon General's Conference on Agricultural Safety and Health - 1991

41


Looking Ahead to the Next Century

health care in the 90's. We will not solve
every problem in the first year.

For some problems, we may never find a
solution. But we can save a lot of lives
and a lot of money.

I am counting on you first, to learn, then
to educate. Take what you learn here
back to farmers and hospitals in every
community. Get the word out. Talk to
people.

Because when you come down to it, we are
the ones that will make a difference. And
we will stop this crisis before there are
more tragedies on our farms.

Above all, let us help protect the most
valuable product that comes off our farms:
our children. Let us teach them right so
their children do not experience any of the
problems we see today.

There is a lot of work to do. And we have
got to start now. I want to see America
where farmers do not have to accept injury
and illness and disease as "part of the job."

As long as I am privileged to work for you
in Washington, that is the kind of America
I will be fighting for. And you can count
on it!0

42

Papers and Proceedings


Senator Harkin, I am speaking for myself
and all of the Centers for Disease Control
(CDC) and especially the National Insti-
tute for Occupational Safety and Health
(NIOSH) in saying we are honored to be
in your home state for this important con-
ference. Iowa has already given a great
deal towards focusing national attention on
the health needs of farmers, farm workers,
and their families, and paving a way to
attend to these needs.

Back in the fall of 1988, Des Moines host-
ed what turned out to be the seminal con-
ference on this topic, "Agricultural Occupa-
tional and Environmental Health: Policy
Strategies for the Future." It resulted in
the creation of the National Coalition for
Agricultural Safety and Health, and a
"Report to the Nation," which summarized
the findings and recommendations of the
conference. An Iowan, Jim Merchant of
the coalition, with several of his colleagues,

Surgeon General's Conference on Agricultural Safety and Health
FARMSAFE 2000 o A National Coalition for Local Action
Convened by the National Institute lor Occupational Sat&y and Health
April 30 - May 3, 1991, Des Moines, Iowa

BUILDING INFRASTRUCTURES FOR PREVENTION

By William L. Roper, M.D., M.P.H.
Director, Centers for Disease Control

Dr. J. Donald Millar: I am sure that nobody will appreciate that kind of attitude more than the next
speaker, my boss, Dr. William L. Roper, who is the Director for the Centers for Disease Control, which
is the nation's prevention agency. As Director of CDC since 1996, Dr. Roper has shown, again, true
national leadership in emphasizing that this country must have prevention in order to deal with many
aspects of the health care problem. Dr. Roper served in a variety of positions before coming to CDC
in 1990. He received his medical degree from the University of Alabama School of Medicine, in 1974,
and subsequently a Master of Public Health from that university in 1981. He completed a residency
in pediatrics at the University of Colorado Medical Center in 1977. He has served as a local health
officer, a county health officer in Alabama, and also later as assistant state health officer. During that
period, he also served in several faculty positions at the University of Alabama. From 1982 to 1983,
he was a White House Fellow in the White House Office of Policy Development, with responsibility for
health policy. He then served as special assistant to the President for health policy-that is the
President of the United States-until 1986, when he served as administrator of the Health Care
Financing Administration, the agency that is responsible for Medicare and Medicaid. From 1986 to
1989, Dr. Roper served as Deputy Assistant to the President for all domestic policy and as Director of
the White House Office of Policy Development. In the time that he has been Director of CDC, it has
been very clear to all of us there that Dr. Roper is a man who is moved by human misery and who
seeks always to act decisively to help. I am very happy to present Dr. William Roper:

presented this report to my predecessor at
CDC and now my boss, Jim Mason, in
December of that year.

The presentation and report were persua-
sive. A CDC work group, headed by Don
Millar, was quickly formed and plans for
action followed. For the enactment of
these plans we have to thank Iowa's Sena-
tor Harkin, who provided the political
leadership in Washington to fund CDC's
plans. So we gratefully recognize Iowa's
profound role in bringing us to this point,
and on into a better future, which we are
here this week t.o help create.

As you know, CDC is the nation's preven-
tion agency, so with the theme of my pre-
sentation today, "Building Infrastructures
for Prevention," I would also like to recog-
nize another Iowan important to public
health, Dr. Richard Remington. He
chaired an Institute of Medicine (IOM)

Surgeon General's Conference on Agricultural Safety and Health - 1991                43


Looking Ahead to the Next Century

committee to study The Future of Public
Health.

The findings and recommendations of his
committee, published in a 1988 IOM re-
port under the same title, represent a lucid
appraisal of the state of our public health
infrastructure and what is needed. I be-
lieve it will prove influential for all of us in
this field and hopefully it will receive some
attention outside the field as well.

However, the building of infrastructures
has undoubtedly had as great a role as
wars in history. The construction of first,
railways, and then highways, and the shore-
to-shore electrification and communica-
tions programs all have had revolutionary,
long-term effects. The greatness of this
country owes much to these achievements.

Likewise, the building of the current public
health infrastructure has had profound
impact. I define this infrastructure as the
system of individuals and institutions that,
when working effectively together, promote
and protect the health of the people.

This infrastructure is made up of people,
materials, strategies, and facilities. Among
a host of achievements, our public health
infrastructure has led to generally sanitary
conditions in our cities and towns, progress
in cleaning our air and water, the control
of a host of communicable diseases, and
an overall reduction in smoking.

What we are hearing these days, however,
is that our progress in public health has to
some extent lost its footing and missed a
few steps. Having addressed the most
public crises of yesteryear, we are finding
ourselves challenged by an enormous range
of scientifically and socially complicated
problems for which public outrage and
political will are far from automatic.

The public health concerns in agriculture
make a case in point. You will be hearing
many statistics of injury and disease over
the course of this conference. The public
health needs of those living and working
on farms have been largely neglected. It is
not surprising.

When the general public thinks of life on
the farm, it conjures up a wholesome,
perhaps hard but also idyllic picture of
self-sufficiency and freedom from urban
stressors and pollution.

The statistics, from CDC and others, have
only recently been collected. The govern-
ment policies and media attention are still
largely focused on the medical care side of
the equation; we are providing incentives
for health care practitioners to work in
rural areas, and reporting about the finan-
cial straits and closings of rural hospitals.
There has been little prevention activity or
interest.

Social factors concerning farm populations
and their constituency groups have been
equally important. The coalition's 1988
report cited the character of independence
among people of farm populations, their
sense of responsibility, and consequently a
lack of organization or unions to represent
farm families and workers. I understand
there has been growing concern among
farmers about toxins but I suspect injuries
have always been, and are still, considered
by many to be a condition of the way of
life.

I would add to this t.he admirable trait of
farmers to make the most of what they
have, such as old equipment, making it
last. Given also the financial rigors, it
follows that farm constituency groups have
pursued issues of economics and freedom

44                                  Papers and Proceedings


from restrictive regulations, rather than
health.

In the past, when leaders in public health
considered agriculture, they might have
reasoned that the EPA is responsible for
the safe use of agricultural chemicals and
the Agricultural Extension Service has
safety responsibility, and not pursued the
subject further.

-I

As the theme of this meeting, "National
Coalition for Local Action," clearly por-
tends, the foundation of our public
health system, as it functions in agricul-
ture and other sectors, must be the local
public health agency.

This brings me back to "building infrastruc-
tures." Dr. Remington's IOM committee
defined the mission of public health as
"fulfilling society's interest in assuring con-
ditions in which [all] people can be
healthy." There are various infrastructures
in agriculture that have a role in pursuing
this mission.

Not only are USDA, EPA, and DOL need-
ed, there is need for contributions from
the public education system, rural hospi-
tals, academic centers, agriculture-related
businesses, volunteers, and community-
based organizations such as Marilyn
Adams' Farm Safety for "Just Kids." AI1 of
the individuals and institutions that have or
could have involvement are needed, work-
ing effectively together towards our public
health mission.

But it is time now that the public health   The CDC-NACHO study also brought us
agency become centrally involved with all  an important understanding of the resourc-
of these partners. Surveillance, epidemiol-  es available to local health departments
ogy, environmental and industrial hygiene,  outside of metropolitan areas. The re-

Building Infrastructures for Prevention, May 1, 1991

safety engineering, these are public health
prevention disciplines. The responsibility
for leadership in assuring healthy condi-
tions of life for our citizens lies with us.

In this context, I am going to emphasize in
the rest of my remarks a view of our pub-
lic health system and how it will have to be
strengthened, or some important aspects of
how to build an infrastructure for preven-
tion. The hope is that, working with you
in the Agricultural Extension Service, the
FFA, and in other organizations active and
concerned in this area, we can build an
infrastructure able to assure that
agriculture's workers and families can be
healthy. Not that public health agen-
cies-federal, state, or local-are going to
"take over," but that we will together build
the system, the infrastructure, successfully
to meet the problems of farm safety and
health.

As the theme of this meeting, "National
Coalition for Local Action," clearly por-
tends, the foundation of our public health
system, as it functions in agriculture and
other sectors, must be the local public
health agency. Most of the opportunity to
enhance health occurs locally.

Yet, as CDC found in working with the
National Association of County Health
Officials (NACHO) to inventory local
health units, even state agencies are gener-
ally once removed from communities. In
our survey, we found that only 17 percent
of county health departments were actually
an arm of the state health department, and
41 percent reported themselves totally
independent.

Surgeon General's Conference on Agricultural Safety and Health - 1991

45


Looking Ahead to the Next Century

sources at the local health department are
insufficient.

About half of the jurisdictions with a popu-
lation of fewer than 50,000 have a local
health officer who is a physician. A small
majority of these jurisdictions have a full-
time health officer.

They may have a handful of employees,
most commonly including a clerical posi-
tion, a registered nurse, and an engineer or
sanitarian, in that order. The budgets of
these local health departments range from
tens of thousands to a few hundred thou-
sand dollars. Included in these budgets
are Medicaid reimbursements for personal
health care.

Here we begin to see the picture of a
local, rural health department where per-
haps a single public health nurse is trying
to meet a range of competing demands,
including personal health needs such as
immunizations, tuberculosis control, child
health, and sexually transmitted disease
control; environmental health demands
such as safe water supply and sewage; and
other functions such as food and milk
control.

What resources can this lone rural nurse,
with a clerical assistant, bring to bear on
occupational safety and health on the farm,
for example? According to the CDC-
NACHO study, four out of five local
health departments in jurisdictions with
populations of fewer than 50,000 report, in
effect, "none."

What is the answer then, if this foundation
of the public health system, the local
health department, may not be equipped
to expand its activity to address the prob-
lems of the 9O's-injury control, occupation-
al and environmental issues, chronic dis-

eases, smoking and nutrition, to name a
few? The answer is not only enhancing
resources quantitatively, but directing them
to the rising demands, and where there is
need or opportunity, capturing resources
and assistance existing outside of the
health department and even outside of
government (raising coalitions).
In a word, what is needed at all levels of
the public health system is "leadership."
Leadership will build infrastructures for
prevention. See agricultural safety and
health as a reason for strengthening this
nation's public health system.

We have various complementary means of
leadership by which to accomplish our end.
First among these is advocacy to ensure
that we have the resources and participa-
tion we need.

Without articulate commumcation of our
mission and the challenges that stand in its
way, public health will not achieve the
prominence required. Advocacy is an
opportunity for public health in agriculture
because of the insight and eloquence of
many of the participants here today. How-
ever, public health advocacy must be unre-
lenting and, I emphasize, must occur at all
levels.

In democracy, the most powerful advocacy
swells from the community up. Local
health departments should assume the
community leadership role-setting forth
the health agenda, building the necessary
networks and alliances, mobilizing support,
putting together public and private re-
sources for common health purposes. It is
the job of the rest of us in public health,
whether we be state or Federal or outside
of either, to encourage and empower these
conmumity agencies to take on their lead-
ership.

46

Papers and Proceedings


Building Infrastructures for Prevention, May 1, 1991

If infrastructure is comprised of people,
materials, strategies and facilities, the
highest priority among these must be the
people, the public health work force.
After advocacy, human resources are im-
portant-public health is primarily people,
not technology.

I would hope all of you here will join in
supporting public health education, par-
ticularly of students of health professions.
Taking the training of physicians for exam-
ple, 99 percent of the curriculum in our
medical schools today teaches curative
medicine, nat prevention.

In building infrastructures for prevention,
we ought to think of our children as the
most important infrastructure of all! We
will always be striving to make our com-
munities safer and more healthful. But
raising generations with enough awareness
to live healthy lives among the hazards
around us and the hazards of choice is
something we can and should achieve.

Building infrastructures requires advocacy,
training, education . . . three other aspects
in urgent need of attention are informa-
tion, funding, and management and policy
development. In bringing public health to
agriculture, we are beginning in the right
direction.

The information is needed at all levels,
from the community to the nation. We are
working with several states, including Iowa,
to obtain this information and make it
available. The use of our funds in this
program, and the management and policy
making involved, are directed to build
infrastructures for prevention.

Looking forward, where we demonstrate
success. This may sound very optirmstic.
The agricultural program CDC is leading
is relatively small and much of the work is
ahead of us. We have our first egg, and
we are already counting flocks of chickens.
However, we are expecting this program to
grQW.

We have this coalition we are building.
We have, and this is what I have been
trying to convey about building infrastruc-
tures for prevention, a great deal of oppor-
tunity before us. In whatever capacity we
find ourselves, we can exert leadership to
build a public he.alth system of public and
private means that serves our agricultural
work force and their families.

In their report, the Committee for the
Study of the Future of Public Health refer-
enced de Toqueville as identifying an
American political tendency to "organize
actions around specific issues." The point
being made was that issue-specific political
groundswells can build or fragment our
public health system. A general consensus
on the mission and organization of our
public health system is needed behind such
groundswells if we are going to build a
system to serve, for the long-term, a whole
country of healthy people.

We have ourselves here just such an issue
as De Toqueville was referring to in the
19th century. We have recognized that
there is "a problem out on the farm," and
we have begun to assemble our forces.
Let us use the opportunity we have created
to build a public health system that will
work.0

Surgeon General's Conference on Agricultural Safety and Health - 1991

47


Surgeon General's Conference on Agricultural Safety and Health
FARMSAFE 2000 9 A National Coalition for Local Action
Convened by the National Institute for Occupational Safety and Health
April 30 - May 3, 1997, Des Moines, Iowa

A CHARGE TO THE CONFERENCE

  By Antonia C. Novello, M.D., M.P.H.
Surgeon General of the U.S. Public Health Service

Dr. J. Donald Millar: Well, what you did not read in USA Today yesterday, you are about to see
through the miracle of video communications:

A Video Introduction: Good Science and Good Sense -That is the motto of Dr. Antonia
Novello, who in March 1990 became the first woman and the first Hispanic to become Surgeon
General of the United States Public Health Service. The road to success for Dr. Novello began in her
hometown of Fajardo, Puerto Rico, the center of a region long known for its production of sugar.
After receiving her B.S. and M.D. from the University of Puerto Rico, Dr. Novello moved on to the
University of Michigan in Ann Arbor, where she served her pediatric internship and residency. She
also completed her subspecialty training in pediatric nephrology at Michigan, and later at Georgetown
University, and then went on to earn a Masters in Public Health from the Johns Hopkins University.
After several years working in the private practice of pediatrics and nephrology, Dr. Novello entered
the Public Health Service with the National Institutes of Health, where she eventually became Deputy
Director of Child Health and Human Development. Dr. Novello has served on several major public
health committees and organizations over the years and has received a long list of prestigious
awards in the process. Since her historic appointment as Surgeon General, Dr. Novello has made
issues such as childhood immunization, pediatric AIDS, and childhood injuries among the top
priorities on her agenda as the nation's number one public health spokesperson. Dr. Antonia Novello
. . . the 14th Surgeon General of the United States:
                                 - Edited and narrated by Jeffrey H. Lancashire

Greetings. I am glad to be here with you
this morning as I welcome you to the Sur-
geon General's Conference on Agricultural
Safety and Health.

about them whenever and whenever possi-
ble.

It seems somehow fitting, then, that I have
just returned from addressing the Third
National Injury Control Conference in
Denver, at which a national agenda for
injury control was drafted, and from a
symposium on trauma in Texas, where four
states came together to work on the pre-
vention of bead, neck, and spine injuries.

As the Surgeon General of this country, I
represent all of the citizens of this Nation.
But as a pediatrician, I am especially con-
cerned about the health of our Nation's
children, for they are our most important
resource and they represent our future.

The theme of this conference-FarmSafe
2000, A National Coalition for Local Action
-is a serious topic. One that I know we
have all placed on the top of our agendas.

As Surgeon General, I never thought that
much would be focused on the subject of
injuries-but because they are one of the
leading causes of death in this country for
all age groups, I will continue to speak out

48

I am concerned about the health of our
Nation's children. The more I talk about
their health, the more I must tell you that
it is very important for parents to recog-
nize the dangers that their children face
with regard to injuries.

We know that politically, children have no
voice and therefore no power, yet they
comprise one-quarter of the U.S. popula-

Papers and Proceedings


tion today, or about 64 million. As citizens
of the Nation, we must assess, help, plan,
and then act-it is our duty to build a
stronger foundation for our young people
and for their parents. We must speak for
those who cannot speak for themselves-for
those who are not with us today-it is their
right to live full and rewarding lives, and it
is our responsibility to do all that we can
to make those lives the best they can be.
As I said:

Injuries are the leading cause of death
in children today, with non-fatal inju-
ries out numbering fatal injuries. An-
nually, injuries claim the lives of over
22,000 children between the ages of O-
19.

Each year, an estimated 600,000 child-
ren are hospitalized and almost 16
million more are seen in emergency
rooms for their injuries.

The toll of injuries on the young is
devastating; they suffer more deaths
from injuries from the first year of life
through the age of 19, than from all
diseases combined.

Injuries are also the leading cause of
disability, with more than 30,000 chil-
dren suffering permanent disabilities
each year.

While the effects of such disabilities on
children's development, daily living, and
future productivity are great, the financial,
emotional, and social effects on the family
are enormous. Sadly enough, the number
of reported injuries suffered by our chil-
dren has not really changed much over the
past twenty years.

If we, at least acknowledge that injuries
occur and can be prevented-then maybe

Charge ta the Conference, May 1, 1991

injuries as a public health problem in this
United States whether in farm country or
in some Eastern State neighborhoods will
receive the attention, focus, and resources
commensurate with their magnitude.

The picture is worse for parents who are
farmers where additional hazards are faced
by their children. For example:

Over 24,000 children are estimated to
be injured each year on farms; 5000 of
them suffering serious injuries.

One out of five of all deaths occurring
on farms are for children under the age
of 16.

A Cornell University study shows that
children on farms under 14 years old
were more than three time as likely to
be injured, when compared to others
working on the farm.

Similarly, a Mayo Clinic study found
that there were two ages where farm
children were most vulnerable to injury;
age four, because kids could go any-
where on their own, and were not
scared of anything-and the other dan-
gerous age was 14, when children-
especially boys-began to take on major
farming chores.

Sixty-five percent of farm boys drive
tractors before the age of 12. By law,
they are permitted to drive a tractor
down the highway. If the tractor flips
over or is struck by another car, and
the child is injured or killed-this is not
reported as a workplace accident.

The long-term emotional toll and inju-
ries are enormous: A 1984 Wisconsin
study placed the cost for a serious farm
injury at $140,000 and the total hospital

Surgeon General's Conference on Agricultural Safety and Health - 1991                 49


Looking Ahead to the Next Century

and rehabilitation costs for farm inju-
ries were estimated to be about $2.5
billion dollars.

All of us here today know that we have
many problems that we must deal with.
The realities we face vary form lives lost to
long-term disabilities. As we heard yester-
day:

50

Agriculture is among the Nation's most
hazardous occupations.

We know that death rates, hover a-
round 50 deaths per 100,000 workers,
while the annual death rate for all
other industries combined is only 11
deaths per 100,000.

We know that in 1986, 1600 agricul-
tural deaths occurred, including approx-
imately 300 children that were killed
while engaged in farm-related activities.

We know that about 170,000 disabling
farm injuries occur each year, and
about half of all that survive them are
permanently disabled.

We also know that farms and other
agricultural operations are predomi-
nantly small businesses.

We also know that agricultural work is
typically conducted in remote areas
away from emergency medical or spe-
cialized diagnostic services.

We know that agricultural equipment is
typically over 15 years old, still in wide
use and frequently does not include
safety technology that would protect
the operator.

You may say, why are injuries such a prob-
lem in this country. 3 Well, I believe sever-
al reasons apply here.

. First, the term "accidents" still connotes
randomness, unpredictability, and prevent-
ability. These connotations prevent institu-
tions, the public, and educators from ap-
proaching injury prevention in a scientific
manner.

Injuries need to be visualized as a problem
of public health-allowing for us to deal
with them the same way we approach
disease and subsequent disease prevention
wherever they may occur.

b Second, I believe there is a lack of inter-
est and knowledge of the field by the gen-
eral public, as well as by some law makers.
People in the rest of the United States
might not realize that injuries that happen
in farm country have an effect on the
country as a whole.

b And third, but not least, there is a gener-
al lack of morbidity and mortality data,
which hinders prevention efforts that
sometimes can be most effective.

Obviously, we need to come together to
work this problem through. It is not just a
problem that happens in farm country, it is
a problem that happens everywhere. We
as united citizens must. bring it to the fore-
front. For example:

o  The U.S. Department of Agriculture
reports that there are 13.1 million per-
sons in the United States that derive
some of their income from farming,
and an additional 6 million dependents.

These workers and their families ex-
perience a disproportionate share of inju-

Papers and Proceedings



Charge to the Conference, May 1, 1991

ries and diseases associated with numerous
chemical, biological, and physical hazards.

Occupational Lung Diseases

In 1988, agriculture had the sixth highest
work-related lung disease rate in this coun-
try. Types of lung diseases ranged from:
allergic, to asthma and acute responses to
toxic or irritating grain fumigants.

Musculoskeletal Disorders

Another disease entity that is prevalent is
degenerative musculoskeletal disorders.
They result form chronic exposure to farm
machinery vibrating, or to repetitive trau-
ma associated with farm work. The most
noticeable for these are reported as low
back pain, hip arthrosis, and degenerative
arthritis of the knee and upper extremities.

Migrant workers are typically involved in
work that involves frequent hand and wrist
movements, awkward working positions,
and a dependence on manual lifting, which
may be conducive to carpel tunnel syn-
drome and low back injuries.

Occupational Cancer

Regarding cancer, epidemiological studies
of farmers have uncovered consistent ex-
cesses of hematologic cancers, including
leukemia, Hodgkin's disease, non-
Hodgkin's lymphoma, and multiple myelo-
ma, as well as cancers of the lip, skin,
stomach, prostate, and brain.

Causative agricultural exposures have not
been conclusively identified, but agents of
concern include nitrates, pesticides, viruses,
antigenic stimulants, and various fuels, oils,
and solvents.

Excess cancers of the lip and skin are
linked to increased exposure to the sun's
ultraviolet radiation.

Severe Traumatic Injuries

Severe occupational traumatic injuries
usually occur suddenly on the job and are
either fatal or require immediate medical
care. These injuries affect, in substantial
numbers, children under the age of 16 and
the elderly 65 and older.

Machinery, especially farm tractors, are a
major cause of death to agricultural work-
ers. Others result from inadequate farm
building design and livestock handling.

Of the estimated 1,500 machinery-related
deaths annually among all occupations,
more than half involve farm equipment.

Cardiovascular Diseases

Another serious disease associated with
agriculture is heat stroke. Agricultural
workers are at the highest risk of devel-
oping this compared to all other workers,
including miners and construction workers.

One associated risk factor is the lack of
available drinking water, which affects at
least one-fifth of labor-intensive farmwork
nationwide.

Reproductive Disorders

Workplace exposures can adversely affect
the male and female reproductive systems,
and as a consequence interfere with fetal
development, and children's health. Pesti-
cides may cause reproductive failure in
either men or women, genetic damage, or
miscarriage.

Surgeon General's Conference on Agricultural Safety and Health - 1991

57


Looking Ahead to the Next Century

Moreover, the nature of agricultural work
and the physiological changes of pregnancy
put the pregnant farmworker at increased
risk of health problems for both herself
and her baby.

Neurotoxic Disorders

Neurotoxic disorders present problems for
the farmers as well. Approximately 10,000
people in this country suffer acute poison-
ing by organophosphate insecticides annu-
ally. These pesticides affect the nervous
system, and up to not, the long-term neu-
rologic consequences are known.

Noise-Induced Hearing Loss

Regarding noise, noise-induced hearing
loss is a well-documented result of expo-
sure to farm machinery noise, especially
tractor noise. Approximately 323,000 agri-
cultural workers are exposed to potentially
hazardous noise levels. Such hearing loss
has been found to affect a quarter of youn-
ger farmers and fully one-half of older
ones.

Significant numbers of those affected have
been found to develop a communication
handicap by age 30.

Dermatological Conditions

Epidemiological data indicate that derma-
tological conditions caused by ultraviolet
radiation, plant materials, soils, fertilizers,
pesticides, and agents causing zoonotic
infection are very common among United
States farm workers.

In 1984, these disorders comprised over
two-thirds of the occupational illnesses
among crop production workers.

Skin disorders in this group were over five
times more common than among all pri-
vate sector employees combined, and near-
ly three times that of manufacturing em-
ployees.

Psychological Disorders

Additionally, farmers, farm family mem-
bers, and other rural inhabitants are not
exempted from stress-related psychological
disorders, especially depression.

Some of these psychological disorders
appear to be related to isolation, economic
hardship, weather conditions, or labor
status.

Infectious Diseases

In addition, some infectious diseases,
which are agriculture-related, vary form
one part of the country to another. Some
others, such as those related to poor sani-
tation, like dysentery, hepatitis, typhoid
fever, and intestinal ailments, are common-
ly spread by using the same eating and
drinking utensils, drinking non-potable
water, and from fecal-oral contaminating
due to the lack of toilet and handwashing
facilities.

Others, like parasitic infections - estimat-
ed to be 20 times that of either the general
U.S. population or even other rural or
poor urban populations, are epidemic
among migrant farm workers.

Such is also the case for tuberculosis. For
migrant workers, this is an occupational
problem, and not an imported disease.
The disease is 3,000 times more prevalent
among black migrants than the general
population as a whole.

52

Papers and Proceedings


So now that I have disseminated the infor-
mation, and you are aware of the problem,
what do we do?

First, and most importantly, parents who
farm need to know what the dangers are.
Second, parents must then educate their
children about these dangers. Ignorance-
like knowledge can remain forever.

The country is ready and the time is ripe
to move the national agenda forward re-
garding injury control. The key to any
success we might realize, however, lies in
our ability to come together, first at the
local level, and then at the Federal level.

And this is why we are here today-to ex-
plore what is needed to facilitate and pro-
mote this common goal, and work together
in making it a reality.

In order to accomplish this, we need to
return to some of the basic aspects of
public health and management.

o  We must work to raise the conscious-
ness of the public and alert the commu-
nity leaders about critical issues.

.  We must also build coalitions-partner-
ships between health, education, envi-
ronment, labor, and agriculture cornmu-
  nities.

We must begin to disseminate the appro-
priate information, and we must as a con-
sequence of such information, encourage
action to prevent injuries.

Ultimately, my goal is to motivate all of
you to reduce agriculture-related diseases
and injuries, by prevention.

If we are to be successful in this endeavor,
we must tackle the problem head on.

Charge to the Conference, May 1, 1991

My wish is that this Conference will set a
milestone in saving lives and preserving
health. To accomplish this, Dr. Millar and
I hope to convene a follow-up conference
in the near future to develop a national
strategy for the prevention of agricultural-
related diseases and injuries.

But until then I must tell you that it is my
belief that in agricultural safety and health,
prevention begins and ends with the fami-
ly, and so, the family should be one of our
main targets as we fulfill the charge I have
given to this Conference.

The key to any success we might realize,
however, lies in our ability to come to-
gether, first at the local level, and then
at the Federal level.

There was a famous 19th century Puerto
Rican literary figure, Eugenio Maria de
Hostos, who considered the family to be
the cornerstone of society. He said:

. . . as members of a family, we are so
closely bound to it by gratitude that we
recognize its effects from the cradle to
the grave. If we are born, we owe it to
the family; if we grow up, it is through
the protection of the family; if we are
educated, it is the work of the family;
when we are with the family we work for
it, away from it we long for it; we are
happy in the family and for its sake; if
we are unfortunate, we regret it for the
sake of the family; ill, we fear death for
its sake, and in dying, we long for it.

With all this in mind, your deliberations
here will set the stage for the work that
needs to be done in this field. You have
the responsibility of building a firm foun-

Surgeon General's Conference on Agricultural Safety and Health - 1991               53


Looking Ahead to the Next Century

dation for our future actions in the coming
decade. Your networking and coalition
building will set the partnerships that need
to be maintained.

This may be the tenth Surgeon General's
conference on occupational safety and
health, but this is just the beginning of our
work together.

Appropriately enough, today, May lst, is
traditionally viewed in agriculture as a "day
of fertility." Hopefully, today will mark the
day for our National Coalition for Local
Action to grow stronger. I trust that will
be the case.

We know that changes do not come easy-
they take commitment, partnership, and
dedication.

It is apparent to me that this group is
serious about injuries, and their impact on
the lives of all our citizens.

It also seems to me that we know what to
do and how to do it. Now we, together,
must do it.

Only when this is done will this local ac-
tion serve the national purpose. Friends,
this is our "Field of Dreams." If we build
it, they will come. I know we can, I know
we will.

Thank you, and God Bless.0

54

Papers and Proceedings


OPENING REMARKS

of you can probably relate to what I am
talking about.

Good morning, and thank you for that
kind introduction, Dr. Millar.

But, I am from a rural community, and I
can stand up here, as many have, and

It is a pleasure to be here. I have a back-
ground similar to that of many people who
have taken this podium. Senator Harkin
stood up here and said he was from a
small town.

relate to you story after story of my experi-
ences with working with agriculture-the
experiences of discing a loo-acre field at
the age of 10, or planting at the age of 11,
or maybe even driving a grain truck with
7% tons of grain at the age of 14.

Well, I am also from a small town, the
town of Fillmore, Indiana, a rural commu-
nity. Sometimes when I am talking across
the country, in cities such as Los Angeles,
Oklahoma City, Iowa City, talking about a
small town, I say, "You know Fillmore is so
small that when you drive into Fillmore
there is no need for a turn signal because
everybody knows where you are going any-
way."

I will be honest with you: at that point in
my life I did not give it a second thought.

By the same token, most of you involved in
agriculture know that it is a way of life,
and it is a respected way of life. I feel that
the objectives being accomplished here and
the directions that we are heading are
definitely right.

I think it is one of the few places in the   Dr. Millar, you talked about my involve-
country that you can dial the wrong num-   ment in the FFA. The FFA is the nation's
ber and still talk for thirty minutes. Many  largest intercurricular student youth orga-

Surgeon Gefleral's Conference on Agticu/tural Sat&y and Health
FARMWE 2000 9 A National Coalition for Local Action
Convened by the National Institute for Occupational SaWy and Health
April 30 - May 3, 1991, Des Moines, Iowa

REMARKS BY THE NATIONAL FFA PRESIDENT

    By Mark Timm
President, National FFA Organization

Dr. J. Donald Millar: One of the great things about this conference to me is that there are so many
young people here. We are very, very pleased with that aspect, and oftentimes in public health
meetings there are not a lot of young people around.  It seems to me that we have not made
prevention and public health all that attractive to young people. But this is a field that compels the
imagination of youth as well as the rest of us. So it is a great pleasure for;me, at this point in the
conference, to introduce you to a young national leader, Mark Timm, who is the national president,
FFA. Mark is president for 1990-91. He is 19 years old, and he serves over 387,000 FFA members in
over 7,600 local chapters nationwide, including the District of Columbia, Puerto Rico, and the U.S.
Virgin Islands. These FFA members are preparing for careers in the science, business, and
technology of agriculture. Mr. Timm was State FFA president in Indiana last year and is a National
FFA scholarship recipient. He is currently on a one-year leave of absence from Purdue Univer-
sity-my wife and I drove through West Lafayette just two days ago-where he is studying sales and
marketing with sights on working for an agricultural company in the future. During his year as FFA
president, he will travel more than 200,000 miles, making hundreds of appearances on behalf of the
FFA. It is my very great pleasure to introduce Mark to you:

Surgeon General's Conference on Agricultural Safety and Health - 1991

55


Questions to Guide the National Agenda

nization-nearly 400,000 FFA members
nationwide. And serving as national presi-
dent is a tremendous honor. It is a great
opportunity, but it is even a greater re-
sponsibility, because, as the speakers have
stood up here and talked abbut the role of
youth in America there are not very many
opportunities for youth to speak out and
speak to adults.

I have been given the chance to represent
a large portion of the youth in America
and the youth in agriculture. It gives me
great delight to see the young people in
our organization out here. I do not know
if you have had the chance to notice, but
there is more than just my jacket running
around here. There are seven chapters
from all across this country.

Dr. Roper talked about leadership. Well,
our organization is based on agriculture.
That is the backbone of this organization.

But, equally important, our students are
interested in developing their leadership,
their personal, and their academic skills,
through agriculture. We are teaching them
not only to be stewards of the land but to
be the future leaders of our communities,
of our state, of our country, and eventually
even of our world.

I would like to share with you some of the
leadership that we are showing in the area
of safety. We have a National Chapter
Safety Award Program.

This year, at our National Conventidn, we
honored over 150 chapters for outstanding
accomplishments in the area of safety.
Thirty-six chapters received gold recogni-
tion, and out of those 36, seven were cho-
sen to attend this conference. Those seven
chapters are going to be putting on poster

56

displays tomorrow afternoon in the poster
display demonstration.

I want to share with you, just to highlight
some of the safety areas that we work on
or that we address as an organization,
because, you see, our primary goal as a
national safety award program is just like
the goal that your theme states. It is a
national coalition for local action.

This year, at our National Convention, we
honored over 150 chapters for outstanding
accomplishments in the area of safety.

It is a national award program centered at
the local level. What we do is assess the
needs of the community. The chapter
assesses the needs of the community, and
some of those needs that we address are
National Farm Safety Week; Farm Safety
for Just Kids, which you have heard about;
chemical safety for farmers; water quality
testing; and all-terrain vehicle (ATV) and
three-wheeler seminars.

Chapters even address areas such as boat-
ing safety; holiday awareness programs
such as the testing of candy on Halloween;
fire-prevention safety; home safety, farm
machinery operations, and hazardous grain
hauling; chain-saw safety; restricted use for
pesticides; CPR classes and substance
abuse awareness. So, we are touching
several areas in safety, focusing primarily
on agriculture, which is our backbone, but
also other areas of safety.

Not only do we have our National Safety
Award Program, but we also are infusing
safety into our curriculum-agricultural
education. We have initiated programs in
areas such as food safety and environmen-

Papers and Proceedings


tal safety. As a matter of fact, one of our
most recent programs was food safety-a   1. Surveillance-Agriculture-related Dis-
                     ease, Injuries, and Hazards.

$300,000 project that business has picked
up and is willing to sponsor, and we plan
to start developing the actual curriculum
this summer.

2. Research-Biological and Chemical
Hazards.

3. Research-Physical and Mechanical

We will be writing the curriculum and will    Hazards.
be spreading it across the country, with 400
workshops, trying to educate our teachers  4. Intervention-Agricultural Workers'
of agriculture education and the home       Protection from Hazards.
economic teachers about food safety, all
the way from the production of food to the  5. Intervention-Safe Behaviors among
processing of the food. So we are covering    Adults and Children.
a wide range, a wide spectrum, of food

safety. We will educate teachers on food
safety, then they will educate the people
that make it count, and that is the young

A presentation panel will deliver talks on a
variety of issues. Tomorrow, after a morn-
ing plenary session, a concurrent session

people in America.

will reconvene to hear discussion panels
comment on today's presentations. The

I would like to close on my statements    concurrent session will reconvene again
about the FFA and our role in safety by   after lunch tomorrow, to hear public com-
quoting what one of the chapters that are   ment and to address the points to be re-
represented here-the Stockton Chapter of  ported back to the full conference on Fri-
Missouri-said in their safety award appli-  day morning.
cation:

Health is not everything,
but you're dead without it.

[REMARKS AT THE CONCLUSION
OF THE SESSION]

[REMARKS AFTER THE
FIRST SPEAKER]

Before we conclude, I would like to thank
them for giving me the opportunity to
come here, and I would also like to say
that, as the population of the rural com-

The rest of this session will frame the work  munity declines, so does our membership
of the conference around three activities:   in the FFA, the organization that I repre-
surveillance, research, and intervention.    sent. However, our urban membership has
Each of the three following speakers will   drastically increased, so we are involving a
pose questions related to each of these    much more diverse group of young people
activities, which will be addressed by five   interested in agriculture.
concurrent sessions.

                   I get the chance, as I travel across the
One session will address surveillance; two  country, to represent youth in agriculture,
will address research; and two will address  and I want to share with you one quick
intervention. These five concurrent ses-
sions will convene this afternoon. The five  story before we conclude. That is, a spe-

sessions are:              cial place that I have found off the coast of

Questions to Guide the National Agenda, May 1, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991

57


Questions to Guide the National Agenda

Alaska. It is a special place called the
Diomede Islands.

Why it is so special is because the Intema-
tional Date Line is found to run right
down between the Diomede Islands. Not
only that, but one side of the islands is
owned by the Soviet Union and the other
side is owned by the United States.

Not only does America need its young,
but young people need your help, support,
guidance, and leadership.  I

So you can sit on one side of the island
and look across and it would be the 28th
of the month, and on the other side of the
island it would be the 29th. On a clear
day, when you look across these islands,
not only would you see another perspective
on life, since the Soviets value the posses-

sions they have and we as Americans value
freedom-but on a clear day you can even
see tomorrow.

If you really think about that-the ability to
see into the future-1 wish I had the ability
to see in the future right now because, let
me tell you, I see a tremendously bright
future in this industry of agriculture.

I am proud to say that I am a part of agri-
culture and proud to be here representing
this organization, representing youth in
agriculture. With that, I would like to
leave you with one final statement on
behalf of the youth, and that is that Ameri-
ca needs youth because youth represents
the future of the state of this country and
of the existence of everybody. Not only
does America need its young, but young
people need your help, support, guidance,
and leadership.0

58

Papers and Proceedings


Surgeon General's Conference on Agricultural Sakty and Health
FARM&FE 2000 . A National Coalition for Local Action
Convened by the National Institute for Occupational Satkty and Heatth
April 30 - May 3, 1991, Des Moines, Iowa

THE ROLE OF PUBLIC POLICY IN
AGRICULTURAL SAFE7Y AND HEALTH

     Joseph A. Enney, M.P.A.
Executive Director, National Safe Workplace Institute

Mr. Mark Timm: Our first speaker this morning is Mr. Joseph A. Kinney, Executive Director of the
National Safe Workplace Institute, located in Chicago. Mr. Kinney spent his youth and entire
professional career closely linked to agriculture. He grew up in Kansas working on farms and
ranches and was deeply involved in breeding Charlette cattle when he was a college student at
Illinois State University. Mr. Kinney holds a Purple Heart from service in Vietnam. He later spent five
years working on agriculture in the United States Senate, and an additional five years as staff director
for the committee on agriculture in the National Governor's Association. He spent a significant
amount of time living and working with farm families in several states, including Idaho, North Carolina,
Minnesota, Alaska, and California. He holds graduate degrees from the Maximal School of Citizen-
ship and Public Affairs, and from the University of Pennsylvania. In 1987, Mr. Kinney founded the
National Safe Workplace Institute, which is a not-for-profit organization devoted to making oc-
cupational safety and health a higher priority for the private and public sectors. Both Mr. Kinney's
background and his interest in safety uniquely qualifies him to speak on the topic, The Role of
Public Policy in Agricultural Safety and Health. Mr. Kinney:

Good morning. It is really a privilege for
me to be here today to address the Sur-
geon General's Conference and to discuss
the role of public policy in agricultural
safety and health.

As you have just heard, I have had two
careers. My first career was in agriculture.
In fact, about 10 years ago or so I had the
opportunity to address an agribusiness
audience in Dallas, and one of the old
ranchers in the audience got up and made
a little speech and at the end of it he said,
"And son, how long you been involved in
agriculture?" I said, "Sir, 30 years. Next
question, please." So, you know, I feel like
I've been around it a fair bit of my life,
since I was about 32 when I spoke in Dal-
las.

Throughout my life, I have developed a
deep appreciation for the role that our
farmers and ranchers play in the produc-
tion of the food and fiber of this country.
They clearly are our backbone. Without

them, we would have nothing. In fact, if
you look at our economies and compare
them with many of the economies in the
industrialized world, one of the real
strengths we have is our efficiency in food
and fiber production. It is because of
people like Mark. We all really owe them
a lot.

As Mark said, I spent a lot of time living
and learning from farmers and ranchers. I
have cured tobacco in Harnett County,
North Carolina. I used to be involved in
all aspects of grain and livestock produc-
tion in Illinois. Certainly I have baled my
share of hay in Kansas. I have tended
ranges in Wind River, in Wyoming.

My least favorite job was culling potatoes
in Idaho. But I took those jobs because
working in Washington, you tend to be sort
of isolated and insulated from reality, and
so when I would meet an interesting farm-
er I would ask him, "Well, can I come and

Surgeon General's Conference on Agricultural Safety and Health - 1991

59


Questions to Guide the National Agenda

work for you for a week and learn what
you do?" That is how I did it.

I actually was injured once. I had a very
severe laceration to my left leg and was
stitched by a "vet." When we design our
surveillance systems, it is clear that we
have got to include veterinarians because I
was stitched by a vet. I have got a lot of
ugly scars, but it is the ugliest. But it was
a very valuable experience because it
taught me that farmers like to rely on their
own community. I would be very surprised
if there is not some resistance to NIOSH.

b Certainly one of the things that I learned
in my years in Washington was that the
agricultural community is strongly resis-
tant to OSHA. I think that will have to
change. Clearly, farmers are a unique
group. Farmers tend to work until the job
is done. They do not know a g-to-5 day.
But it is also clear that agriculture defies
easy generalization.

Throughout my life, and I am 42 now,
there have been two consistent themes.
The first is that our farms and ranches
tend to grow in size, almost year by year.
The little house on the prairie, near where
I grew up in Kansas, now looks a lot more
like Dallas.

b The second theme is that we are spen-
ding a lot of money-a significant amount
of money-on supporting farm incomes
from the Federal treasury. I think that is
very important to understand, because I
know farmers-and we will talk a little bit
about this today-want to resist any kind of
intrusions by external forces. But what
farmers need to understand-and rural
people need to understand-is that there is
a significant public investment in what they
do and, therefore, there is a significant

Frankly, there would be more public in-
volvement if it were not for the farm lob-
by. Having met with many farm organiza-
tions, I can tell you that at least in the past
they have resisted involvement. I think
that is going to change. In fact, I think we
will begin to see more public involvement
in these issues in the near future. I mean
involvement beyond the sort of touchy-
feely things of education and beyond
research issues. There are any number of
areas that we could see develop.

public interest in their health and
well-being.

My interest in occupational safety and
health stemmed from the death of my
brother, Paul, from a scaffold collapse in
Colorado. Since I have been involved, I
have had a peripheral interest in agricul-
tural safety. At the Institute, we have
written about it. We have talked about it
a little bit. We are doing a rather compre-
hensive analysis of options for public invol-
vement on job safety. I will touch a little
bit on that today.

Frankly, there would be more public
involvement if it were not for the farm
lobby.    I

You have heard plenty about the size and
magnitude of this problem. You know, the
National Safety Council puts out data and,
based on this data, agriculture has had
persistently high levels of injury relative to
other regulated areas. I guess the lesson
we could learn from that is that the free
market and, perhaps, many educational
approaches are not working. We need to
look more aggressively to other approach-
es.

60

Papers and Proceedings


The Role of Public Policy in Agricultural Safety and Health, May 1, 1991

I would like to show you a couple of trans-
parencies that I put together here so we
can get a sense of who is involved and
what is involved. Farmers like to talk
about target prices. People in public
health like to talk about target groups.

When we look at this issue, we need to
understand that there is more involved
than the men and women who own and
operate farm enterprises. There are chil-
dren. There are farmworkers. There are
all different categories of people.

Sector
Agriculture
Mining Workers
Covered by OSHA

Dollars Spent
Per Worker
    $0.30
  $181.68
    $4.34

U.S. Department of Agriculture's Commitment to
Agricultural Safety and Health, FY 1991:
b Extension Service-distributed on
a formula basis with $19,000 to
  each state:              $970,000
c Competitive Grant Program:    $1 ,ooo,ooo
      Source: Prof. William Field, Purdue University.
                                         1

Ygure 1. Federal Dollars (Fiscal Year 1987) Spent
on Occupational Safety and Health.

Now, potentially there are all sorts of laws
that could be applied in this area-child
labor laws, criminal prosecutions for not
only fatalities and homicides, but batteries
and injuries. There is obviously the possi-
bility of citations. Right now there is a
rider on the appropriations bill that keeps
OSHA from inspecting injuries or fatalities
on farms. Of course, there is Workers'
Compensation, and, finally, there are injury
lawsuits.

To this point the public involvement has
largely been limited to research and educa-
tion migrant protection, and health servic-

es. Of course, there is the sanitation stan-
dard. But the involvement of both states
and the Federal Government has been
quite limited.

1. Surveillance            $5,745,816
. Farm Family Health and Hazard Survey.
. Occupational Health and Safety
Surveillance Through Health Departments.

2. Research             $6,217,817
b Applied Preventive Research.
w Education and Training Programs.

3. intervention            $6,676,367
. Cooperative Agreement Program for
Agricultural Health Promotion Systems.
b Demonstration Cancer Control Projects for
  Farmers.
                       Source: NIOSH.

Figure 2. National institute for Occupational Safety
and Health-Agricultural Safety and Health Program.

In fact, if we look at Figure 1, we can see
that these data are a little old; but, I am
told by the producer of it, Bill Field of
Purdue University, that the data really
have not changed that much. As you can
see, occupational safety and health expen-
ditures equal about thirty cents per farmer.
Perhaps that is what they think their lives
are worth, but we spend a substantial
amount of money, for miners, and a small
amount of money for regular industrial
workers.

The Agriculture Department's commitment
is now essentially limited to a $975,000
fund distributed equally to states. Perhaps
we are going to hear that the U.S. Depart-
ment of Agriculture (USDA) is also going
to spend a million dollars in competitive
grants that will be committed by the end of
this fiscal year.

Surgeon General's Conference on Agricultural Safety and Health - 1991                61


Questions to Guide the National Agenda

Figure 2 shows NIOSH programs that are
multi-year programs. It looks like a lot of
money. NIOSH spends $X3-$19 million
dollars. In reality, it is quite little.

In Figure 3 what we wanted to measure,
in terms of budgetary expenditures, is the
commitment that we have to occupational
safety and health in America. Total feder-
al workplace health spending involves the
budgets for NIOSH, for the Occupational
Safety and Health Administration (OSHA),
and for the Mine Safety and Health Ad-
ministration (MSHA).

In 1981, we spent one dollar out of each
$1,579 of the Federal budget for these
programs-not very much. By 1991, that
amount of money had dropped to just a
one dollar out of each $2,408.

I

`igure 3. Workplace Safety and Health Regulatory,

       Total       Amount   How Many Federal
    Workplace   Required to   Dollars Spent for
Fiscal    Health    Keep Pace Each Dollar Spent on
Year   Spending with Inflation'  Workplace Health'
Gil   $4,294     n/a    $1,579
1983   $4,165    $4,854    $1,941
1985   $4,356    $5,234    $2,172
1987   $4,524    $5,493     $2,219
1989   $4,807     $987    $2,212
1991'   $5,447    $6,512    $2,408
o Estimate.
' Inflation data based on calendar years; 7997 figure is an
estimate.
' Another way of expressing this statistic: Number of federal
dollars spent for every sing/e dollar spent on the combined
budgets of OSHA, MSHA, and NIOSH.
     Sources: Inflation Data-Bureau of Labor Statistics,
   Budget Figures-Cffice of Management and Budget.
    Compiled by the National Safe Workplace Institute.

Research, and Education Spending-Adjusted for
inflation and as a Share of Federal Budget, Selected
Years (in millions).

What this chart represents to me is a di-
minished and decreasing commitment to
workplace safety relative to other budget

priorities. There is no way around that.
We have also looked at this and you know,
we have looked at occupational health
versus EPA, we have looked at this versus
the National Institutes of Health and a lot
of other measurements. Clearly, our com-
mitment to occupational health in this
country-workplace health-is going down.

Now in Figure 4, we looked at workplace
health compared to the national defense.

        Total
Fiscal   Workplace    National
Year    Health*     Defense     &tiJ
1981     $429.4    $157,513     366.9
1983      416.5     209,903     504.0
1985      435.6     252,748     580.2
1987       452.4     281,999     623.3
1989      480.7     290,361      604.0
1991'.      544.7    298,910 o **   548.8
*includes combined budgets of the Occupational Safety and
Health Administration, Mine Safety and Health Administration,
and National Institute for Occupational Safety and Health.
`*Estimate
`**Pts-Desert Storm
      Source: Cffice of Management and Budget.
   Compiled by the National Safe Workplace Institute.

:igure 4. Comparison of Total Workplace Heait
Spending Versus National Defense Spending,
Selected YE!XS (in hundreds of millions of dollars).

In 1981, as you can see, we valued our
national defense 367 times more than we
valued the health and safety of workers in
America. That is what these data say to
me. By 1987, the ratio had grown to 623
times. In 1991, it dropped to 548 times.
But, of course, that was before Desert
Storm. No one seems to know what is
going to happen to the defense budget. I
think we are going to have to add some-
where in the neighborhood of $40 billion
plus. So, the 548 times figure will be much
closer to 600 and something.

62

Papers and Proceedings


In fact, if you look on Figure 5, at work-   extension friends and they were telling me
place health spending compared to farm   how poorly the USDA agriculture research
income stabilization, in 1981 we supported  budget has been doing. My friends, you
farm income 23 times more than we sup-   have been doing much better than NIOSH,
ported workplace health.          OSHA, and MSHA, as you can clearly see
                    in this Figure 6.
Please do not misunderstand what I am
saying, I have worked hard on the farm   What these figures suggest to me, at least
bills of 1973, 1977, and 1981, and I certain-  at a superficial level, is that there may be
ly know all the arguments for target prices  more room to do more things at USDA.
and price support loans and all the various
USDA programs.             Of course, that raises a significant question
        I think they are very   I hope will be worked out in the next year
valuable. These are income transfers to   or two. The question is how we might best
farmers. Clearly, the dollar amounts fluc-  coordinate and work together. I think
tuate up and down depending on what    there is room for both agencies to be in-
commodity prices are doing, but never-    volved in this area. In fact, I think they al-
theless it is interesting to compare price   ready are. The Extension Safety programs
supports and workplace health spending.   go back a hundred years-a long, long time.

        Total       Farm                   Total     Agriculture
Fiscal   Workplace     income           Fiscal   Workplace    Research &
yri%TJ    Health*    Stabilization   &l&l   yeaJ   Health'      Services    Ratio
1981     $429.4     $ 9,783      22.8    1981     $429.4      $1,540       3.6
1983       416.5      14,344      34.4    1983     $416.5      $1,578      3.8
1985      435.6      21,323      49.0    1985     $435.6      $1,813       4.2
1987      452.4      29,606      65.4    1987     $452.4     $1,864      4.1
1989      480.7      14,817      30.8    1989    $480.7     $1,964       4.1
1991 o *     544.7      9,761       17.9   1991 o *    $544.7     $2,404       4.4
&ludes combined budoets of the Occuoationai Safety and   *includes combined budgets of the Occupational Safety and
Health Administration, Mine Safety and Health Administration,   Health Administration, Mine Safety and Health Administration,
and National institute for Occupational Safety and Health.     and National Institute for Occupational Safety and Health.
-Estimate.                         "Estimate.
       Source: Office of Management and Budget.          Source: Office of Management and Budget.
    Compiled by the National Safe Workplace Institute.       Compiled by the National Safe Workplace institute.

Ygure 5. Comparison of Total Workplace Healt   :igure 6. Comparison of Total Workplace Health
Spending Versus Farm Income Stabilization Spen-  Spending Versus Agriculture Research and Services,
ding, Selected Years (in hundreds of millions of dollars).   Selected Y&V.S (in hundreds of millions of dollars).
Figure 6 compares total workplace health  The next figure, Figure 7, is what my four-
spending to agricultural research and ser-  year-old son would call a "big nasty."
vices of selected years, basically every    These are the kinds of public sanctions
other year from 1981 to 1991.       that can be taken against job-safety viola-
                            tors.
As you can see, the agricultural research
and services budget is growing at a faster   b First, if you look at the economic
rate than workplace health. I was having   literature, the most costly part of OSHA's
breakfast this morning with some of my    involvement with business is not in fines,

The Role of Public Policy in Agricultural Safety and Health, May 1, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991                63


Questions to Guide the National Agenda

but clearly in the inspection process.
There are many studies on that.

b Second, there are civil penalties, and
they were recently increased by a
substantial magnitude.

b Third, there are criminal penalties.
There is legislation in the Congress now to
increase the amount of time we can spend
in jail for knowingly and willfully tolerating
workplace conditions that result in the
death of a worker. The government has
recently put one person in jail, under the
OSHA Act. It was a South Dakota con-
tractor and the incident involved excava-
tion fatalities. I have no idea how many
people die in excavation fatalities on farms
and ranches, but I am sure it is a substan-
tial number.

b Fourth is Workers' Compensation premi-
um increases.

b Fifth is a seldom-used tool, un-
fortunately. Hopefully, it will be used
more in the future. It is simply an injunc-
tion to stop people from doing what they
are doing.

b Sixth is the loss of eligibility to partici-
pate in public programs. The most recent
example is that of a construction company
called S.A. Healey, a Chicago company
that had a bad safety record with many
violations.

So far, they have lost a $78 million con-
tract in Los Angeles on which they are the
low bidder in, because of their safety re-
cord. They lost a $37 million contract in
Milwaukee, where they were the low bid-
der, because of their safety record. They
are the low bidder in an approximately
$200 million contract in another New Eng-

64

land state where my organization is active-
ly trying to knock them out.

I. Potential target groups:
b Farmers.

b Farm Families (spouse, children).
b Farm Children engaged in farm work.
b Farm Workers, Permanent, Full-Time,
  Year-Round.

b Farm Workers, Permanent, Part-Time,
  Year-Round.

b Farm Workers, Seasonal,
  Part- or Full-Time.
t Migrants.

2. Applicable laws:
b Child labor laws.
b Federal criminal prosecution: homicide,
  willful violation.

> State homicide or battery prosecution.
b Citations for violations by the
Occupational Safety and Health
Administration or corresponding state
  agency.

b Workers' Compensation.
b Injury law suits.

- Compiled by the National Safe Workplace Institute.

?gure 7. Target Groups and Laws that Could Be
Used To Regulate Agriculture Safety and Health.

One of the possibilities that we could see,
frankly, in the agricultural area, is the
possibility of cross-compliance. One of the
models that we might look at in terms of
public intervention and farm safety would
be a farm safety audit.

If farmers did not pass their audits or
make corrections within a specified period
of time, they could lose eligibility for price
support programs, soil-conservation pro-
grams, farm loan programs, farmers' home
programs-whatever programs exist, and
there are plenty of them.

Papers and Proceedings


The Role of Public Policy in Agricultural Safety and Health, May 1, 1991

Another area where I think we will see
some intervention, very soon, of a criminal
nature is children on farm equipment.
Mark Timm talked about his involvement
as a youth.

I could tell the same stories. One is a
recent event; a 21-month-old was killed
while helping his father when he fell under
the wheel of a tractor that his six-year-old
sister was driving. According to Bill Field,
at Purdue, the fact that 300 kids die each
year on farms-kids below the age of 15-is
supported by a similar study at the Univer-
sity of Tennessee.

In recent years, we have documented
three-year-olds who were killed in Nebras-
ka and Texas who were actually classified
as industrial deaths. Let me say one thing.
This 300 number may be substantially
larger in proportion to population than the
numbers of 15-year-olds who are
killed-murdered-in big cities because of
drugs. If that does not make your blood
boil, I think you should go out and have
your temperature checked.

There is no way that anybody with half a
conscience, looking at these numbers and
looking at these stories, can sit and not say
that this is not potential child labor abuse.
We have been responding to increasing
inquiries from prosecutors in various cities
who have been looking into bringing child
labor abuse charges in farm accidents. It
has not happened, but I am certain that it
will happen in the next few years.

Sunday there was a story on CNN-maybe
many of you saw it-about a guy named
Dominguez in Miami who is going to jail
because his kid did not have a seat belt
fastened. In fact, the kid was sitting in his
mamma's lap, if I remember the story cor-
rectly. They had a crash, and the kid was

killed. So the father is being prosecuted.
Frankly, there is not a dime's worth of
difference, in my view, between the
Dominguez in Miami and the man in
Visalia, California.

The last area where I think there is going
to be some involvement, as shown in Fig-
ure 8, has always been a dynamic area.
There are only 12 states in the United
States where farmworkers are recognized
as workers under workers' compensation.

Coveraae    States
Same as other
Workers . . . . . Arizona, California, Colorado,
Connecticut, Hawaii, Louisiana, Massachusetts,
Montana, New Hampshire, New Jersey, Ohio,
and Oregon (12).
Voluntary . . . . Alabama, Arkansas, Idaho,
Indiana, Kansas, Kentucky, Mississippi,
Nebraska, Nevada, New Mexico,
North Dakota, Rhode Island, South Carolina,
and Tennessee (14).
Limited . . . . . Alaska, Delaware, Florida,
Georgia, Illinois, Iowa, Maine, Maryland,
Michigan, Minnesota, Missouri, New York,
North Carolina, Oklahoma, Pennsylvania,
South Dakota, Texas, Utah, Vermont, Virginia,
Washington, West Virginia, Wisconsin, and
Wyoming (24)

-Compiled by the National Safe Workplace Institute
with the Assistance of the Farmworker Justice Fund.

:igure 6.  Workers' Compensation Coverage c
Agricultural Workers.

Workers' compensation is a no-fault injury
program. When you create workers' com-
pensation programs, you can not sue your
employer for injury. Voluntary really
means no program. I am sure-1 do not
have any studies but I am sure-that the
vast majority of farmers in those states
have no workers' compensation insurance.
Are there any studies on this subject that
you know of?

Surgeon General's Conference on Agricultural Safety and Health - 1991

65


Questions to Guide the National Agenda

About how many farmers have workers'
compensation insurance in the states where
it is voluntary ? It would be a good study
to do. In these other states-24 states-it is
limited, like in Georgia. Farmers who
work for the Department of Corrections
are covered, but all other farmers are
excluded. There are all sorts of different
restrictions. We have all the data. We
have analyzed the laws. That is the story!

Let me say that what we are now
recommending to farmworkers who are
injured, especially in the states with volun-
tary programs where there is no compensa-
tion coverage, is to sue. Sue the living
"Bejesus" out of the farmer for whom you
work.

This is the only way that we are going to
get the attention of people in states where
workers compensation is limited and farm-
ers are not covered-sue. It is only
recourse the injured have.

What has happened historically? To use
the terms of economists, the economics of
these injuries have been externalized.
Who pays for injury in the case of the
farmworker or migrant?

I can tell you who pays for it. It is the
families. It is the local public charities. It
is the public hospitals. It is not the farmer.
And, of course, if the farmer can external

ize the cost and risk to other forces in
society, it is rational for that farmer to do
so.

I am not going to sit up here and just tell
you exactly what is going to happen when
and where. I do not know. But, believe
me, it is moving toward public interven-
tions. I hope what that says to each and
every one of you out here is that you need
to begin to get realistic about how you
would like to see these issues addressed.

Our country spends more per capita for
the education of the young than any other
nation, save Switzerland. We spend lots of
money to prepare young people for life.
Cities help educate farm kids.

There is also public investment in human
lives, and we need to do more to protect
those lives in agriculture. I am sorry if
some of you people feel, as my son proba-
bly would feel, that I have come and been
the "big nasty" here today, but I think that
it is time that we begin to look at this and
realize that we have got to do something
about farm safety.0

66

Papers and Proceedings


Public health surveillance is central to the
process of disease prevention. Surveillance
systems are vital tools in targeting the
resources of the public health system and
in evaluating program effectiveness.

The Institute of Medicine report The Fu-
ture @Public Health' found the core
functions of public health to be as-
sessment, policy development, and assur-
ance of the availability of services. Sur-
veillance is intrinsic to the assessment
function and essential for proper policy
development and assurance of service
availability.

An ongoing national dialogue is needed on
the role of public health education in trai-
ning future public health professionals;
graduates of schools of public health are
acknowledging the need for more books
and course materials designed to prepare
students for public health practice. State
and local public health agencies, in partic-
ular, have recognized this need as they
recruit and hire new professional staff.
There is growing recognition of the role of
surveillance conducted by agencies of

Surgeon General's Conference on Agricultural SaWy and Health
FARM&FE 2000 o A National Coalition for Local Action
Convened by the National institute for Occupational Safety and Health
April 30 - May 3, 7991, Des Moines, lowa

SURVEILLANCE FOR AGRICULTURAL SAFETY AND HEALTH

           William E. Halperin, M.D.

National Institute for Occupational Safety and Health

Mr. Mark Timm: Our next speaker is Dr. William Halperin. He is the Associate Director for Surveil-
lance, Division of Surveillance, Hazard Evaluation, and Technical Assistance, at NIOSH in Cincinnati.
Dr. Halperin received his Master's in Public Health and M.D. from Harvard. In 1975 he became an
Epidemic Intelligence Officer at the Centers for Disease Control. In 1979 he became the Chief of
Industrywide Studies Branch at NIOSH. Dr. Halperin has served on numerous professional and
expert committees. He currently serves on the Committee on Risk Assessment Methodology at the
National Research Council. Dr. Halperin has published over 100 scientific papers, editorials, and
letters to editors. His epidemiological investigations include herbicides, dioxin, and biotechnology.
He was a co-author on perhaps the most popular paper in occupational health in the last 10
years-the Sentinel Health Event A Framework for Occupational Health Surveillance and
Education.  That leads to Dr. William Halperin's topic today, Surveillance for Agricultural Safety
and Health. Dr. Halperin:

government as well as by industry and
labor to advance the mission of public
health-"to fulfill society's interest in assur-
ing conditions in which people can be
healthy."'

Although surveillance is an essential ele-
ment of the practice of public health, the
subject is rarely taught in schools of public
health or fully discussed in textbooks of
public health or of epidemiology. This gap
reflects the diverging cultures of public
health between schools of public health
and public health practitioners, a diver-
gence recently addressed in a report of the
Institute of Medicine, The Future of Public
Health.

The essence of the motivation for public
health was captured by the 16th century
poet John Donne, who unfortunately came
to the wrong conclusion about surveillance.
Donne wrote:

No man is an island, entire of itself; every
man is a piece of the continent, a part of
the main. If a clod be washed away by
the sea, Europe is the less, as well as if a

Surgeon General's Conference on Agricultural Safety and Health - 1991                67


Questions to Guide the National Agenda

promontory were, as well as if a manor of
they friend's or of thine own were: any
man's death diminishes me, because I
am involved in mankind, and therefore
never send to know for whom the bell
tolls; it tolls for thee.

The public health sentiment is captured in
the following line:

Any man's death diminishes me,
because I am involved in mankind.

This is not a matter of epidemiology or the
technology of public health, but rather a
matter of the philosophy that motivates
public health action.

The antithesis of surveillance is captured
in the following line: "Therefore, never
send to know for whom the bell tolls." In
earlier times, church bells were rung when
people died. Currently we have a need for
similar information to connect us to the
burden of morbidity and mortality and to
call forth public health practitioners so
that deaths and morbid events can be in-
vestigated and recurrences prevented.

Surveillance in modern times is the equiva-
lent of the tolling of the bells with the
added commitment to investigation of the
causation of morbidity and mortality and
dissemination of data and analysis with the
goal of prevention. Surveillance, as de-
fined by Alexander Langmuir, the father of
modern public health surveillance, and the
founder of the Epidemic Intelligence
Service of the Centers for Disease Control,
"means the continued watchfulness over
the distribution and trends of incidence
through the systematic collection, consoli-
dation, and evaluation of morbidity and
mortality reports and other relevant data'13"
for the purposes of prevention of disease
or injury.

It is worth lingering over some of the key
words in this definition. "Continued watch-
fulness" implies that the surveillance pro-
cess continues over time, rather than being
a one-time survey or epidemiologic study.
Repeated surveys from which trends can
be discerned are consistent with surveil-
lance. "Collection, consolidation, and eval-
uation" should differentiate surveillance as
a process from the important, but different
enterprise of registering cases in a disease
register, such as a cancer registry, if this
registry does not include analysis of the
data and dissemination of the results.

"Other relevant data" allows for collection
of information on risk factors for disease,
health or safety hazards, etc., or preventive
interventions, such as immunization, rath-
er than limiting surveillance to collection
solely of data on disease. To differentiate
surveillance from other useful collection of
data, such as marketing surveys for a prod-
uct, "for the purposes of prevention of
injury and disease" should be added to Dr.
Langmuir's definition.

Surveillance should not be so definitively
defined that in-depth investigation of indi-
vidual or sentinel cases is excluded. A
"sentinel health event" represents a failure
of prevention, such as a maternal death or
an industrial injury.

THE ROLE OF SURVEILLANCE IN
PUBLIC HEALTH PRACTICE

The practice of public health can be de-
fined as the logical application of methods
of problem recognition, evaluation, and
intervention for the purpose of prevention
of disease and injury in populations. A
working definition of epidemiology should
reflect both the traditional broad notion
that epidemiology is "the study of the
distribution and determinants of disease

68                                   Papers and Proceedings


frequency in man,"6 which encompasses   In comparison to data purposefully collect-
interest in epidemic and endemic diseases,  ed for a research study, information from
as well the inclusion of the supplemental   death certificates on industry and occupa-
views of theoretical epidemiology.       tion and even cause of death will be col-
Theoretical or modern epidemiology     lected without quality control, by minimally
focuses much more on the use of very    trained observers, and will inevitably con-
sophisticated analytic methodology for    tain errors. However, surveillance data,
understanding the relationship of risk fac-
tor and disease, particularly of endemic   often collected for administrative purposes
                   and secondarily used for disease preven-
disease, rather than on the description of
epidemics.'               tion, is inexpensive and readily available.

                   Milham and colleagues found that farmers
                   had a substantial excess in the proportion
Surveillance in modern times is the equiv-    of deaths due to electrocutions. When the
alent of the tolling of the bells with the   deaths were investigated, they found that
added commitment to investigation of the   many were due to contacting electric utility
causation of morbidity and mortality and   lines with portable aluminum irrigation
dissemination of data and analysis with   pipe. While the association of
the goal of prevention.          electrocution and aluminum piping must
                    have been evident to the sphere of people
`i                    involved with each incident, the problem
                    was only brought to the attention of the
A useful model that specifies the role of
surveillance in the practice of public health  public health community by the analysis of
                         minimal information available from death
has been developed by Greenwald,* and   certificates, and the dissemination of
further elaborated by Layde,9 and modified  results for the purpose of prevention.
here to describe the role of surveillance in
the prevention of occupational injury and   Data from the Annual Survey of the Bu-
disease.                 reau of Labor Statistics" provide an exam-
                    ple of tracking an occupational health
o The first step in public health is the    problem as its incidence changes. The
recognition of a problem; a related goal is  Annual Survey collects data from a sample
tracking the trends of a problem as its    of logs of injuries and illnesses kept by
incidence increases.            employers.

Sam Milham provides an example from the  These data demonstrate an upturn in the
analysis of death certificates for industry   numbers of cases of repeated trauma. Sur-
and occupation.l' Usual industry and occu-  veillance has done its job by disseminating
pation is entered onto every death certifi-  information on this apparent epidemic to
cate; however, only in some states is it    those with a need to know for the purpose
coded in order to be machine readable.   of prevention. The related role of
From 1979 to 1987, about 2.9 million    epidemiologic research necessary to deter-
deaths were coded for industry and occu-   mine the reality and etiology of this ap-
pation in approximately 23 states.      parent epidemic should be evident.

Surveillance for Agricultural Safety and Health, May 1, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991                69


Questions to Guide the National Agenda

o The second step in the process of public
health is the definition of the scope of a
problem. Two examples reflect the value
of ongoing collection of data in this en-
deavor and the usefulness of periodic sur-
veys .

The first example concerns the surveillance
of lead poisoning. In 16 states,
laboratories report to the state health
department if samples submitted for blood
lead determination in adults are in excess
of a state standard. This information
provides a crude estimate for the burden
of occupational lead poisoning for the
United States, currently about 17,000
reports each year."

A second example of the role of surveil-
lance in providing an estimate of the scope
of a problem comes from survey informa-
tion periodically collected by the National
Center for Health Statistics, Centers for
Disease Contro1.13 From 1983 to 1987,
successive periodic surveys provided infor-
mation from approximately 2700 white,
male farmers.

Farmers report 2.7 cases of skin cancer per
hundred farmers. Nonfarmers report less
than one case of skin cancer per hundred
people.

Farmers have three-fold the amount of
skin cancer than do nonfarmers. Thus, the
periodic survey provides a crude estimate
of the scope of the excess of skin cancer in
farmers, in contrast to a research study
that would likely include confirmation of
each case, and which would estimate in
substantially greater detail the exposure of
the farmers, and would likely be designed
to provide information on etiology or per-
haps use of preventive measures.

o The third step in the public health
process is to conduct etiologic research to
determine the cause of a disease. This
step consists of an epidemiologic study, not
surveillance. For example, an
epidemiologic study might be conducted to
determine the differential exposure of
cases of eosinophilia-myalgia syndrome as
compared to controls without the disease.
It does not require the ongoing collection
of information about cases; rather, it re-
quires more detailed information about
cases occurring during the research period.

o Once an etiologic agent or exposure is
identified, the fourth step in the public
health process is the design of an inter-
vention that will prevent transmission of
the infectious agent, exposure to a
chemical hazard, etc. Examples of inter-
vention include immunization, withdrawal
of a food contaminant, provision of a ven-
tilation system, etc. This is not surveil-
lance.

o The fifth step involves a trial of the
proposed intervention system in an experi-
mental situation where a limited number
of important factors are carefully con-
trolled. This type of public health experi-
ment does not involve surveillance.

o Successful interventions in the controlled
laboratory environment sometimes do not
withstand the more rugged environment of
the field test, the sixth step in the practice
of public health. Surveillance can play a
role in selection of field sites for testing.

o The seventh step in the public health
process is targeting scarce preventive re-
sources in order to maximize their effec-
tiveness. A classic example comes from
the eradication of smallpox.`4 While the
burden of smallpox was reduced by mass
immunization, smallpox persisted because

70

Papers and Proceedings


Surveillance for Agricultural Safety and Health, May 1, 1991

there were sufficient unimmunized to sus-
tain transmission. A turning point in ef-
forts to eradicate smallpox came with the
use of intensive surveillance for cases and
the targeting of immunization to the con-
tacts of cases.

CONCLUSION

There are four goals for surveillance.
These include:

Similarly, greater success in cancer preven-
tion might be obtained if screening pro-
grams for breast cancer and cervical cancer
were targeted to high-risk populations.
Another example of the use of surveillance
for targeting also comes from the surveil-
lance of elevated blood lead based upon
laboratory reports. Multiple elevated re-
sults from a single worksite almost insure
that the work environment is in need of
ameli0ration.15

1. The identification of new occupational
health problems.

2. The estimation of the scope or mag-

nitude of the problem.

3. The delineation of the trend in in-
cidence of the illness, disease, or
hazard.

4. The targeting of opportunities for

prevention.

o The eighth step in the practice of public
health is the evaluation of the effectiveness
of the public health intervention. Tracking
the trends of disease is one mechanism for
evaluating the effectiveness of intervention.

Surveillance is a powerful tool in many
parts of the complex continuum of prac-
tices that constitutes the public-health
problem-solving process.

For example, in 1958, Sweden instituted a
law that any new tractor that was produced
had to have rollover protection.16  In the
years thereafter, surveillance data indicate
a decline in rollover fatalities. In 1978
Sweden instituted another law that any
tractor in use had to have rollover protec-
tion, and the problem was eradicated.

Epidemiologists have much to owe to the
modern father of surveillance and field
epidemiology, Alexander Langmuir, who in
his wisdom commented, "Good surveillance
does not necessarily ensure the making of
the right decisions, but it reduces the chan-
ces of wrong ones."3O

REFERENCES

1. Institute of Medicine, The Future of Public Health. National Academy Press, Washington, 1988.

2. Public Health Service, U.S. Department of Health and Human Services, Healthy People 2000. National
Health Promotion and Disease Prevention Objectives, Washington, D.C., 1991.

3. Langmuir A. The Surveillance of Communicable Diseases of National Importance. New EngIand Journal
of Medicine. 268:182-191.

4. Langmuir, A. William Farr: Founder of Modern Concepts of Surveillance. International Journal of
Epidemiology. 5: 13-18, 1976.

Surgeon General's Conference on Agricultural Safety and Health - 1991

71


Questions to Guide the National Agenda

5.

6.

7.

8.

9.

Rutstein, D., MulIan, R., Frazier, T., Halperin, W., Melius, J., Sestito, J.: The Sentinel Health Event
(Occupational): A Framework for Occupational Health Surveillance and Education, JAPHA 73:1054-
1062, 1983.

MacMahon Brian, Pugh Thomas. Epidemiology: Principles and Methodr. Little, Brown and Company,
Boston, 1970.

Miettinen OK Theoretical Epidemiology: Principles of Occurrence Reseanzh in Medicine. John Wiley and
Sons, New York, 1985.

Greenwald P, Cullen JW, McKenna JW. Cancer Prevention and Control: From Research through
Applications. JNCI 79:389-400, 1978.

Layde P. Beyond Surveillance: Methodologic Considerations in Analytic Studies of Agricultural Injuries.
American Journal of Industrial Medicine. X3:193-200, 1990.

10. Helgerson, SD., Milham, S. Farm Workers Electrocuted When Irrigation Pipes Contact Powerlines.
Public Health Reports. 1985 May-June; 100 (3):325-S.

11. Personal Communication. T. Frazier. NIOSH. Cincinnati, Ohio, 2/91.

12. Personal Communication. Paul Se&man. NIOSH. Cincinnati, Ohio, 2/91.

13. Brackbill, R., Behrens, V., Cameron, L. Prevalence of Conditions among Farmers 1983-1987. in press.

14. Foege, WH, Millar, JD, Lane, JM. Selective Epidemiologic Control in Smallpox Eradication. Am J
Epidemiol 1971 Ott; 94(4):311-5.

15. Seligman, P., Halperin, W.: Targeting of Workplace Inspections for Lead. American Journal of Industrial
Medicine 20:381-390, 1991.

16. Thelin, A. Epilogue: Agricultural Occupational and Environmental Health Policy Strategies for the
Future. AJIM 18~523-526, 1990.

72

Papers and Proceedings


Surgeon General's Conference on Agricultural SaWy and Health
FARMSAFE 2000 o A National Coalition for Local Action
Convened by the National Institute tbr Occupational Safety and Heatth
April 30 - May 3, 1991, Des Moines, Iowa

RESEARCH FOR AGRICULTURAL SAFETY AND HEALTH

James A. Merchant, M.D., Dr.P.H.
Professor, Preventive and Internal Medicine

Director, Institute of Agricultural Medicine and Occupational Health
         The University of Iowa

Mr. Mark Timm: Our next speaker is Dr. James A. Merchant, Director of Agricultural Medicine and
Occupational Health at the University of Iowa. Dr. Merchant received his B.S. from Iowa State
University, his M.D. from the University of Iowa, and his Doctor of Public Health in epidemiology from
the University of North Carolina. In 1988, he became an Epidemic Intelligence Officer at the Centers
for Disease Control with an assignment to the North Carolina Board of Health. After this assignment,
he served as Assistant Professor in Medicine at the University of North Carolina. In 1975, Dr. Mer-
chant became Director of the Division of Respiratory Disease Studies at NIOSH. In 1981, he became
and currently is Professor of Preventive and Internal Medicine at the University of Iowa.  Dr. Merchant
has published broadly in pulmonary medicine and epidemiology. His early work was in associating
cotton dust exposure with byssinosis. He has published broadly on different lung diseases, which
include problems with vegetable dusts and other organic dusts in agriculture, farmers' lung, and
asthma.' Dr. Merchant is active in professional organizations and in chairing and serving on expert
committees at both the national and the international levels. Allow me to introduce to you Dr. James
Merchant to speak on Research for Agricultural Safefy and Health. Dr. Merchant:

ABSTRACT

In identifying research priorities for agricultural health and safety, one must first define the
populations at risk. In agriculture, those at risk greatly exceed the number of farmers who
report sole or primary employment from agriculture. Agricultural production is now
changing dynamically, resulting in a substantial increase in farmers with non-farm jobs,
greater involvement of women and seasonal workers, and involvement of children and
recreational farmers in agricultural operations. All are exposed to some degree to multiple
farm hazards-farm machinery, livestock, chemicals, organic dusts, and a wide variety of
biological hazards. Priorities for research in agricultural safety and health include disease
and injury surveillance; epidemiological investigations of morbidity, mortality and risk factors;
studies of toxicological effects and mechanisms of disease; and the opportunity for
meaningful intervention for disease and injury prevention. Those engaged in this research
must also recognize the influence of poverty, limited access to health care, and limited in-
surance coverage among many living and working in rural areas. As the result of the
national initiative in agricultural and environmental health, federal, state and foundation
funding is now available to address these research priorities. The challenge is to maintain
and cultivate these research opportunities through targeted research designed to advance our
understanding and prevention of diseases and injuries among those with agricultural
exposures.

THE POPULATION AT RISK

ry employment in farming; 3.1 million
reported some farm income; there were

The population at risk to farming expo-    2.7 million hired to do farm labor; and
sures is not known with precision, In 1980,  there were an additional 6 million farm-
some 2 million Americans reported prima-  family members, some of whom did farm

Surgeon General's Conference on Agricultural Safety and Health - 1991                 73


Questions to Guide the National Agenda

work. But the number of full-time farmers
is being reduced as agriculture moves
dynamically to larger numbers of corporate
farming operations, with greater numbers
of part-time farmers and farmers with off-
farm jobs, and more farm wives employed
in both farm and off-farm jobs, while sig-
nificant farm work is contributed by chil-
dren under the age of 18.

A state-wide survey of Kentucky farms
found 26 percent of farm men had off-farm
jobs, 15 percent of farm women had off-
farm jobs, and 23 percent with both farm
men and women holding off-farm jobs.'
Women's role in agricultural production
has been largely ignored in the occupation-
al literature, yet the proportion of women
participating in the agricultural workforce
has risen steadily from 11 percent in 1940
to 46 percent in 1980.'

In the University of Iowa Farm Family
Survey of 1988 that included Iowa, Wash-
ington and New York states, 25-40 percent
of women (depending on the state) were
employed full-time in farming, and 45-55
percent were employed part-time in farm-
ing. Only 11-30 percent reported doing no
farm work.' In addition, 3549 percent of
the farm women surveyed were employed
in off-farm work. Thus, many farm men
face two work exposures (farm and off-
farm job) while many farm women face
three (farm, off-farm job, and home).

In addition to the occupational risks posed
by the off-farm jobs, there is a significant
additional risk of travel to and from the
off-farm job on rural road-ways, often
under poor driving conditions. As 64 per-
cent of the nation's 48,700 motor vehicle
deaths in 1988 occurred in rural areas,
travel to and from work poses an addition-
al occupational risk, which has often been

ignored in occupational health and safety
research.4

There is even less information on the num-
bers of children at risk to agricultural
operations. In the University of Iowa
Farm Family Survey, the proportion of
farms reporting children regularly doing
farm work ranged from 18 percent (New
York) to 23 percent (Iowa).3 It is recog-
nized, however, that the number of
children at risk to agricultural operations is
much larger, as they are often exposed to
farm machinery, buildings, and livestock
while not engaged in routine farm work.

Migrant farmers are the most fluid popula-
tion at risk in agriculture. The numbers at
risk are not adequately defined, but it is
known that migrant farmers assume some
of the highest risks from exposure to
agricultural chemicals, long hours, and
some exposure to agricultural machinery,
in addition to poor living conditions,
limited-if any-insurance or health care,
and often an additional risk of extensive
travel over the harvest season.

Migrant farmers are especially challenging
to study, as they are highly mobile, have
variable exposures, and are a difficult
population on which to obtain valid data
because of language and legal barriers.
Migrant farmers are, nevertheless, a very
high priority for research because of their
extensive exposures and other risks to
health.

An additional population at risk in agricul-
ture is the weekend or recreational farmer
who typically farms a few acres using older
farm machinery, often has some livestock,
and often uses the same farm chemicals as
full-time farmers. The number of weekend
farmers is not known, but is increasing as

74                                    Papers and Proceedings


urban areas encroach on adjacent farm     factors and the multiple risks they face
land.                    in agricultural work are.

Thus, the total population at risk to agri-   These questions will be high priorities for
cultural exposures is large, but the number  the NIOSH Farm Family Health and Haz-
is unclear-while the number of full-time
farm workers appears to be decreasing, the  ard Survey and should also be priorities for
                   others engaged in health and injury surveil-
total population at risk to agricultural    lance and epidemiological studies of agri-
operations may not be, given the diversity   cultural workers.
of multiple work roles of farm men, wom-
en, children, and migrant workers. Cur-    RESEARCH METHODS
rently, there is no uniformity in classifica-
tion of farm men, women, and children in  Research approaches to agricultural safety
regard to farm work and off-farm work.   and health may be divided into five broad
Clearly, development of such a classifica-   research methodologies:
tion would be useful for assessment of
agriculture - related diseases and injuries   1. Basic Research (Toxicology and Mecha-
among those living in rural America.      nisms).

Therefore, four research priorities are:    2. Disease and Injury Surveillance (Infor-
                    mation Systems).

1. To determine the distribution of farm
men, women, and children and the total  3. Epidemiological Studies.
population at risk in agriculture.

                        4. Demonstration and Education Research
2. To develop the best standard classifica-   (Intervention Studies).
tion of farm men, women, and children,
by on-farm and off-farm employment,    5. Health Services Research.
that will provide the most relevant clas-
sification for health surveillance and     Basic Research
epidemiological assessment.

Basic research is essential for adequate

3. To assess what additional occupational  development of prevention strategies for
morbidity and mortality is attributable   agricultural safety and health. While this
to off-farm work and to travel to and   is less true for injuries, there is still a great
from off-farm work, and what the inter-  need for basic research on the toxicology
active effects of these multiple risks on  and mechanisms by which various agricul-
disease and injury incidence are.     tural exposures cause adverse health ef-
                         fects.

4. To determine, especially among migrant
farm workers, what non-farming mor-   b One clear need for greater basic
bidity and mortality is attributable to   research is in the area of toxicological
living conditions, limited availability of  testing of agricultural chemicals, especially
health care delivery, and extended trav-
el and what the interactions of these   older pesticides that have not yet been
                   tested for acute and chronic toxicity. This

Research for Agricultural Safety and Health, May 1, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991                75



Questions to Guide the National Agenda

is a subset of a larger testing issue faced by
the National Toxicology Program.

o At a National Institute of Environmental
Health Sciences Conference on Agricultur-
al Chemical Utilization and Human
Health, the need for further chemical
testing to address organ function, perinatal
toxicity, immunotoxicity, and chronic and
delayed effects including cancer and de-
layed nervous system manifestations (and
testing of combinations of chemicals) was
strongly recommended.

b A second area where basic research
needs to play an important role is in the
emerging area of agricultural
biotechnology. Genetically engineered
microorganisms promise substantial
benefits for food production throughout
the world.

Potential benefits include new crop
varieties that will benefit the grower
through lower input costs and increased
productivity, the food processor through
production of higher-quality and consistent
products, and ultimately the consumer
through production of more appealing and
nutritious foods. Use of biotechnology in
agriculture has potentially significant
implications for agricultural safety and
health.

Two potentially lowered risks that may
accrue through use of agricultural biotech-
nology include:

1. Reduced use or replacement of
agricultural chemicals now known to be
harmful to human health.

2. Reduced field exposures to crop
production, especially to farm
machinery, which is known to be the
single greatest risk in farming.

Biotechnology is currently being regulated
by EPA through the Federal Insecticide,
Fungicide, and Rodenticide Act (FIFRA, 7
U.S.C. 136-136~) and regulation adopted in
1984 (49 Federal Register 40659), the
Toxic Substances Control Act (TSCA, 5
U.S.C. 2601-2929), and by the USDA
through provisions of the Plant Pest Act (7
U.S.C. lSOaa-jj) and regulations adopted in
June of 1987 (CFR Part 330).

o While regulation of this emerging tech-
nology provides some assurance that ap-
propriate testing will be done, from a pub-
lic health perspective it is essential that
necessary testing for adverse effects on
plants and animals be conducted in the
laboratory and in small field experiments.

Experience to date suggests that the use of
biotechnology in agriculture will not be
associated with unpredictable exposures
that cannot be addressed using appropriate
work practices.'

Disease and Injury Surveillance

The development of disease and injury
surveillance or information systems is a
very high priority for the advancement of
agricultural safety and health research. As
surveillance is covered by another speaker,
I will confine my comments to those infor-
mation systems especially important to
epidemiological research. These informa-
tion systems fall in two categories-those
dealing with health effects (injuries and
diseases) and those dealing with exposures
(cohorts with specific exposures or systems
defining exposures to which human or
animal populations may be linked).

o Information systems that are especially
useful in epidemiology are specific disease
and injury registries. Often existing cancer
registration data is available from state or

76

Papers and Proceedings


hospital data. Use of these information   and birth defect registries. Data on the
systems is an inexpensive and powerful
epidemiologic tool.            sale of certain farm chemicals provide
                   another type of exposure registry. Another

Through the State Health Registry of Iowa  type may be derived from widespread tes-
                    ting of drinking water for nitrates and
at the University of Iowa, we are now able  pesticides.
to register birth defect and cancer inci-
dence. An Alzheimer's Disease Registry
has also been developed for some counties,  While these exposure registries usually
                   provide evidence of exposure to certain

and a Rural Injury Surveillance System is
now under development.

agricultural chemicals, epidemiological
research requires much more detail in
terms of the types and amounts of specific

These health effect registries are especially  chemical use, the time-frames of use, the
useful as they allow systematic collection   type of application, and the use (and non-
of large numbers of specific types of birth  use) of protective equipment. These types
defects, cancers, or injuries that can then   of data must almost always be collected
be studied quantitatively through the use   retrospectively, but could be collected
of case control studies. This approach has  prospectively in a small cohort or in a
been used effectively in the assessment of  sample of a larger cohort.
risk factors for a variety of specific types of
cancer.                  Collection of representative exposure data
                         is also essential in cross-sectional studies of

The same approach is now being applied   injuries and health effects. These data are
to birth defects, which have an added ad-   necessary in order to derive exposure
vantage of having a much shorter latency   response relationships, which are essential
(hence more accessible and valid data). In  to the development of guidelines for re-
the case of injuries, there is no latency and  duction of exposures and the prevention of
the circumstances of injury are usually    diseases and injuries.
clear. This will allow the injury registry to
collect more data at the time of the event  o There are very few trained industrial
and thus reduce the time and cost of case  hygienists specializing in agriculture. The
control studies.                  need for these skills in the collection and
                    interpretation of environmental data is

Epidemiological Studies

critical to advance agricultural health and
safety research.

o A significant problem in assessment of
surveillance and epidemiological data is
the lack of adequate exposure data. The
development of exposure registries is,
therefore, especially attractive,

Demonstration and Education
Research

Closely related to epidemiological research
is the area of demonstration and education

For instance, large cohorts of pesticide
applicators who must be licensed to do
their work now provide an especially im-
portant opportunity for epidemiological
research through record linkage to cancer

research that utilizes intervention studies.
While epidemiological research may clear-
ly show an excess in a certain type of can-
cer, birth defect, respiratory disease or
specific type of injury, a valid model for

Research for Agricultural Safety and Health, May 1, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991

77


Questions to Guide the National Agenda

intervention may not be available or may
be difficult to implement.

The traditional intervention model in occu-
pational safety and health is that of regula-
tion, which has seen some significant suc-
cesses, such as the reduction of respiratory
disease through the regulation of coal
mine dust and cotton dust. Occupational
safety and health regulation has, however,
been greatly diminished over the past
decade, and agriculture has traditionally
not been a regulated industry.

If we cannot develop a U.S. model for a
proven intervention on the single most
important cause of agricultural mortality,
how can we succeed in addressing less
dramatic yet still important causes of
agricultural diseases and injuries?

As a result, more innovative intervention
methods for disease and injury prevention
are needed in agricultural safety and
health. A good example of the need for
such a model is the prevention of tractor
roll-over deaths through the application of
roll-over protective structures (ROPS) on
both new and older tractors.

The epidemiological evidence for the very
significant risk posed by tractors without
ROPS is clear. The data available from
Sweden, which mandated such a program,
makes it equally clear that ROPS can
prevent almost all tractor roll-over deaths.

o An important question for this confer-
ence is whether an American intervention
model can be developed that can produce
a significant reduction of tractor roll-over
deaths and injuries. A second question,
with much broader ramifications, is, "If we

78

cannot develop a U.S. model for a proven
intervention on the single most important
cause of agricultural mortality, how can we
succeed in addressing less dramatic yet still
important causes of agricultural diseases
and injuries?"

Health Services Research

An observation made by Dr. James A.
Dosman in his summary of the research
workshops prior to the conference, "Agri-
cultural Occupational and Environmental
Health: Policy Strategies for the Future,"
was the following:

It is striking that the organized scientific
documentation of specific health risks is
occurring at a time when changing rural
economic resources and family and rural
community infrastructures are leaving few
community resources to alter specific risk
patterns. Thus, the assessment and pre-
sentation of health and family-life deft-
ciencies must be viewed in a climate of
economic adjustment, rural population
decline, and loss of personal, financial,
and social control by individuals and
families. However, one must realize that
whereas all these changes are occurring
simultaneously, unacceptable injury,
death, and dysfunction are occurring on
the farms and in rural areas.  This co-
nundrum describes a widening gap in
diagnostic and preventive health services,
and in family support services, between
rural dwellers and city dwellers.."

While this paper is not intended to address
the very broad field of health services
research, this quotation points out that
there are significant differences between
rural populations and their urban counter-
parts, which must be taken into account in
conducting epidemiological research. In
nearly every parameter of health-disease

Papers and Proceedings


and injury incidence, availability of health  agricultural mortality over the past ten
care, and related social services       years has shown relatively little
-people living in rural areas have less    improvement and remains higher than that
favorable statistics than their urban coun-   of mining and construction.
terparts.' Especially vulnerable are
migrant agricultural workers who are at   NIOSH, through its National Traumatic
triple jeopardy-poor, rural and uninsured.  Occupational Fatalities (NTOF) database,
                  reports 20.7 deaths per 100,000 agricultural

o These social service and health-care    workers, versus 7.9 deaths per 100,000 for
delivery factors clearly influence the inci-  the general private - sector workforce.'
dence of rural injuries and diseases and   Results of epidemiological studies and
point up the importance of interaction and  newly developed surveillance systems sug-
collaboration between those engaged in   gest these national estimates may sig-
agricultural health and safety research with  nificantly underestimate both deaths and
rural sociologists and those engaged in    farm-related injuries.
rural health care delivery research.

AGRICULTURAL DISEASE AND
INJURY RESEARCH PRIORITIES

The Iowa Department of Public Health
farm injury surveillance program
(SPRAINS) reported 83 deaths for 1990
based on voluntary reports from health-

Injury Morbidity and Mortality

care providers." As this was the initial
year of reporting, it is thought that this

Available data on the risk of injury and   number is incomplete; yet this number of
traumatic death consistently reflect a high-  deaths is over 60 percent higher than
er injury risk to those living in rural com-  previous estimates of farm deaths in Iowa.
pared to urban areas, with a mortality rate  Epidemiological studies draw our attention
for unintentional injuries twice that of    to the importance of farm machinery in
urban areas.* This excess is attributable to  fatalities and severe injuries, to higher
several factors, including increased mor-   rates of injury among children and the
tality from motor and non-motor vehicle   aged, and to the substantial numbers of
deaths arising from higher speeds on    intentional deaths (suicides and homi-
poorer roads, less seat belt use, more use   cides)."
of high-risk utility vehicles, and poorer
access to trauma care. At particular risk   While it is clear that traumatic injuries and
to rural injury are farmers, their family   deaths are epidemic on American farms,
members, and hired and migrant laborers.   we still lack national and state-based
                   information systems (surveillance), a rea-

In addition to the several factors that place  sonable understanding of risk factors, and
rural residents at increased risk are added  an adequate characterization of hazards of
the occupational risks of farming. The    farming associated with injury morbidity
National Safety Council estimated deaths   and mortality. Therefore, three research
among farm residents to be 56.2 per    priorities in the area of traumatic injuries
100,000, 30.1 of which were motor-vehicle-   are:
related, 20.1 work-related (18.1 in farm
work), 8.0 home-related, and 4.0 public   1. Development of national and state-
non-motor vehicle deaths.4 The trend in    based information systems, which will

Research for Agricultural Safety and Health, May 1, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991                79


Questions to Guide the National Agenda

provide essential injury and injury mor-
tality incidence data by type of injury
(ICD-9 codes), cause of injury (E-
codes), place of injury and demographic
information on the injured party.

2. From surveillance data or large epide-
miological studies, case control studies
of specific farm injuries, which will
allow much better understanding of risk
factors associated with the injury.

3.

A much better environmental assess-
ment of farm machinery, farm buildings,
livestock operations, on and off-road
vehicles, agricultural chemical use and
storage, and available prevention mea-
sures. This assessment is essential to
epidemiological surveys and case-
control studies

Respiratory Health Effects

Farmers and other agricultural workers are
exposed to a number of respiratory haz-
ards, the most common of which is organic
dust. Additional exposures, which are
known to be important include several
agricultural chemicals, toxic gases from
livestock confinement facilities, toxic and
immunogenic constituents of microorgan-
isms, feed additives such as antibiotics, and
infestations of insects, which may produce
lung disease." l3

A common denominator in these exposures
is a significant exposure to organic dust,
which has been shown by many epidemio-
logical studies to result in acute symptoms
of airway inflammation, heightened airway
reactivity and asthma, and acute changes in
lung function. Pulmonary edema followed
by bronchiolitis obliterans and hypersensi-
tivity pneumonitis are relatively uncommon
but well-known pulmonary conditions aris-
ing from certain agricultural exposures.

In some agricultural populations with long
exposure to organic dust, fixed airway
obstruction has been observed. Despite
recent interest in this area, there are sig-
nificant research gaps including the follow-
ing:

1. There is little surveillance data and
incomplete epidemiological data on
respiratory diseases in several agricul-
tural populations. Disease patterns and
risk factors are still incompletely
understood in the animal confinement
and grain handling and processing in-
dustries, and from exposures to
agricultural chemicals such as anhydrous
ammonia.

2. `&here is a very great need for the de-
velopment of dose-response data for
agricultural exposures in order to allow
fuller development of prevention strate-
gies.

3. There is a need to more fully explore
certain environmental factors, such as
exposure to storage mites and the toxic
products of certain microorganisms, in
both the laboratory and through field
studies.

Cancer

Epidemiological studies reported a decade
ago initially raised questions about an
association between soft-tissue sarcoma
and lymphoma and exposure to acetic acid
herbicides and chlorophenols. Since then,
over 20 additional cohort and case-control
studies have addressed this issue. The
results of these studies are not consistent,
but excess deaths from non-Hodgkin's
lymphoma, multiple myeloma and leuke-
mia have shown more consistent positive
associations.

80

Papers and Proceedings


In addition, excesses of lung, stomach and  Assessment of adverse reproductive effects
prostate cancer have been observed in    has a significant methodological advantage
cohort studies of manufactures and appli-   over assessment of cancer incidence in that
cators.14 Other potential risk factors for
cancer incidence include viruses, and     the latency from the time of exposure to
                   the time of the reproductive effect is much
dietary and other factors as possible     shorter than that for cancer, which is gen-
contributors to cancer incidence among
agricultural workers." A number of     erally 20 or more years. The lack of birth

methodological issues pose difficulties in   defect information systems has greatly
                    hampered evaluation of birth defects in
interpreting these findings and indicate    association with environmental exposures.
priorities for research in this area:       Priorities for research in this area fall in
                              two areas:
1. There is a uniform need for better
environmental characterization of agri-   1. Additional systematic toxicological test-
cultural chemical exposures through the   ing of agricultural chemicals and com-
development of valid and inexpensive    monly used combinations of chemicals
environmental exposure protocols.      for adverse reproductive effects.
2. Use of exposure registries linked with   2. Further development of birth defect
cancer registries promises to provide     registries and linkage of these infor-
important additional data on cancer risk   mation systems with exposure registries,
among agricultural workers.         and through the development of case-
                     control studies with adequate exposure
3. Improved epidemiological methods to     data.
assess and validate previous agricultural
and other exposures are needed for    Neurological Health Effects
adequate analysis and evaluation of
cancer data.                 Recent reviews of the neurotoxic effects of
                    pesticide exposure have focused on chronic
Reproductive Health Effects       neuropsychological sequelae from expo-
                   sures to organophosphate pesticides.19'"
Concern about possible adverse       While the early (immediate and delayed)
reproductive health effects arises from     neurotoxic effects are well-described for
toxicological testing showing some agricul-  organophosphate intoxication, until
tural chemicals to be teratogenic, from    recently little attention had been given to
widespread use of some of these chemicals,  evaluation of possible chronic effects.
and from some case reports suggesting as-
sociations between certain adverse repro-   However, as the result of several case
ductive effects and agricultural expo-      studies and clusters of adverse behavioral
sures.16' " The reports on dibromochloro-   and neurological findings, the World
propane (DBCP) on male reproductive   Health Organization (WHO) and the
function have provided an important exam-
ple of the toxic effects of this pesticide, an  United Nations Development Programme
                   (UNDP) are coordinating a ten-country
exposure, which now continues in some
developing countries."           European, prospective epidemiological
                   study on the neurotoxic effects of low-level
                   exposure to organophosphorus pesticides.

Research for Agricultural Safety and Health, May 1, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991                81


Questions to Guide the National Agenda

This study includes both pesticide for-
mulators and agricultural workers. Ad-
ditional studies of three types are needed:

1. A replicate of the European study
through the use of recently developed
and standardized tests of neuro-
psychological function and extensive
characterization of exposures to organo-
phosphate pesticides;

2. Well-controlled follow-up studies of
workers who have documented cases of
acute organophosphate intoxication for
possible chronic neuropsychological
effects; and

3. Greater attention to neurotoxic effects
of agricultural chemicals through toxico-
logical testing.

Repetitive Trauma

Trauma research in agricultural
populations has focused almost entirely on
acute traumatic injury and death. Yet
repetitive trauma is known to be a much
more significant problem than acute trau-
ma in most industries.

There is reason to suspect that significant
repetitive trauma may occur as the result
of vibration and repetitive tasks in the use
of farm machinery and other farming oper-
ations. A recent case-control study of hip
joint arthrosis among Swedish farmers
found a relative risk for this condition
between 2.1 and 3.2, varying by length of
time in farming.2'

There is also reason to believe that long
hours of work on agricultural machinery
may induce significant muscle fatigue,
which may, in turn, contribute to the risk
to acute injury. Repetitive trauma has not
been systematically studied among farming

populations, but should be a research pri-
ority:

1. Surveys of farming populations to assess
acute injuries or other health effects
should also include assessment of repet-
itive trauma conditions, especially those
involving the back, hip and knee.

2. Collaboration between agricultural
engineers and biomechanical engineers
should focus on ergonomic factors that
may contribute to repetitive injuries and
how these factors may be mitigated.

Dermatitis

Dermatitis is a condition endemic in farm-
ing. Data from the Bureau of Labor
Statistics (BLS) indicate a five-fold greater
incidence of dermatitis among farm
workers compared to workers in general
industry. Because of the limitations in
BLS data for agricultural workers, these
findings may represent a significant
underestimation of dermatitis in this
working population. A recent survey of
California grape and tomato workers found
a high cumulative incidence of dermatitis,
suggesting that dermatitis is a frequent and
recurrent problem among these farm
workers."

1. There is a need for systematic dermato-
logical surveys of Earm workers with
attention given to criteria for classifica-
tion of dermatological conditions, to the
sensitivity and specificity of question-
naires, and to the correlation between
questionnaire and exam results.

2. There is a great need for environmental
evaluation and measurement of derma-
tological irritants and sensitizers.

82

Papers and Proceedings


3. Development and evaluation of inter-
vention programs to prevent dermatitis
among farm workers are further re-
search needs.

Noise-Induced Hearing Loss

agricultural industries and foundations, to
the interest and support of several state
and federal agencies, to the efforts of the
National Rural Health Association, to the
work of many university faculty who par-
ticipated in the conferences and briefings,
and to the commitment of many members

Several studies have now reuorted bilateral
high-frequency hearing loss io be quite    of the U.S. Congress and several state
                    legislatures.
prevalent among farmersp Of particular
concern is the frequency with which this   As a result, and for the first time, a
abnormality is observed among farmers    healthy dialogue has involved all parties to
under the age of 30. This strongly suggests  these important issues. Significant resourc-
that noise is the cause of this injury. In-   es are now available through federal ap-
deed, farm machinery and chain saws are   propriations and some state appropriations
known to generate noise levels above     to mount this national research and inter-
recommended limits. A further finding has  vention initiative. This research effort is
been that relatively few farmers use     just beginning. The challenge ahead is to
hearing protection. Therefore, research   maintain this momentum and build upon
priorities here include:           these gains.

1. Systematic industrial hygiene surveys to   CONCLUSIONS
characterize farming operations where
noise levels exceed recommended lev-   1. The high risk of disease and injury
els.                   arising from agricultural exposures has
                     now been recognized and has now been
2. Development and evaluation of inter-    placed on the national public health
vention programs to provide adequate    agenda.
hearing protection to those engaged in
these farming operations.        2. Adequate resources and incentives have
                     been provided to address the multiple
THE NATIONAL AGRICULTURAL AND    research priorities. These resources
ENVIRONMENTAL HEALTH INITIATIVE    must be maintained and cultivated.

Since the publication of Agn'cultire At    3. A healthy dialogue has promoted the
Risk: A Report to the Nation, which sum-    involvement of most parties. Greater
marized the recommendations arising from    efforts are needed to involve full
the national public policy conference, "Ag-   representation of children, women,
ricultural Occupational and Environmental   migrants, and the rural poor.
Health: Policy Strategies for the Future,"
and the dissemination activities of the    4. The challenge ahead is to prioritize,
NCASH, there is a new level of awareness   implement, and publish research fin-
of the magnitude and severity of disease    dings and translate this research into
and injury among American agricultural    meaningful prevention and health deliv-
workers. Significant credit for initiation of    ery programs.0
and support for this effort is due to several

Research for Agricultural Safety and Health, May 1, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991                83


Questions to Guide the Natlonal Agenda

REFERENCES

1. Coughenour CM and Swanson L. Work Statuses and Occupations of Men and Women in Farm Families
and the Structure of Farms, Rural Sociology. 48(1):23-43, 1983.

2. Fassinger PAD and Schwarzseller HK. The Work of Farm Women: A Midwestern Study, Research in
Rural Sociology and Development. (1):37-60, 1984.

3. Ungar RL. Farm Women at Risk: Work Roles and Agricultural Bposures. Thesis, Department of
Preventive Medicine and Environmental Health, The University of Iowa, 1990.

4. National Safety Council. Accident Facts, 1988 Edition. National Safety Council, Chicago, Ill, 1988.

5. Glass DJ. Agricultural Biotechnology: Occupational Health and Regulatory Issues in Occupational
Medicine: State of the Art Reviews. 6(2):301-309, 1991.

6. Dosman JA. Technical Workshop Report: Working Group I: Occupational Health and Safety Strategies
for Agriculture, American Journal of Industrial Medicine. 18:353-356, 1990.

7. Summer L. Limited Access: Health Care for the Rural Poor. Center on Budget and Policy Priorities,
Washington D.C., 1991.

8. Baker SP, O'Neill B. and Karpf R. The Injuly Fact Book. Lexington, Mass.: Lexington Books, 1984.

9. Myers JR. National Surveillance of Occupational Fatalities in Agriculture, American Journal of Industrial
Medicine. 18(2):163-168, 1990.

10. Currier R. Iowa Department of Public Health, Personal Communication, 1991.

11. Stallones L. Surveillance of Fatal and Non-Fatal Farm Injuries in Kentucky, American Journal of
Industrial Medicine. 18(2):223-234, 1990.

12. Merchant JA. Agricultural Respiratory Diseases, Seminars in Respiratory Medicine. Thieme, Inc., No.3,
7:211-224, New York, 1986.

13. Merchant JA. Agricultural Exposures of Organic Dusts. Occupational Medicine: State of the Art Reviews.
2(23) April-JuneXl9-425, 1987.

14. Blair A and Zahm SH. Herbicides and Cancer: A Review and Discussion of Methodologic Issues, Recent
Results in Cancer Research. 120~132-145, 1991.

15. Pearce N and Reif JS. Epidemiologic Studies of Cancer in Agricultural Workers, American Journal of
Industrial Medicine. 18(2):133-148, 1990.

16. Schwartz DA and LoGerfo JP. Limb Reduction Defects in the Agricultural Setting, American Journal of
Public Health. 781654-659, 1988.

17. Gordon JE and Shy CM. Agricultural Chemical Use and Congenital Cleft Lip and/or Palate, Archives
Environmental Health. 36(5):213-221, 1981.

18. Whorton D. Dibromochloropropane Health Effects, Chapter 48 in Environmental and Occupational
Medicine. WN Rom (Ed). Little, Brown and Company, Boston, 1983.

84

Papers and Proceedings


Research for Agricultural Safety and Health, May 1, 1991

19. Rosenstock L, Daniell W, Barnhart S., Schwartz D, and Demers PA. Chronic Neuropsychological
Sequelae of Occupational Exposure to Organophosphate Insecticides, American Journal of Industrial
Medicine. 18(2): 321-326, 1990.

20. Davies JE. Neurotoxic Concerns of Human Pesticide Exposures, American Journal of Industrial Medicine.
18(2):327-332, 1990.

21. Thelin A. Hip Joint Arthrosis: An Occupational Disorder Among Farmers, American Journal of
Industrial Medicine. 18(2):339-344, 1990.

22. Schenker MB and McCurdy SA. Occupational Health Among Migrant and Seasonal Farmworkers: The
Specific Case of Dermatitis, American Journal of Indusbial Medicine. 18(2):345-352, 1990.
23. May JJ, Marvel M, Regan M, MarveI LH, and Pratt DS. Noise-Induced Hearing Loss in Randomly
Selected New York Dairy Farmers, American Journal of Industrial Medicine. 18(2):333-338, 1990.

Surgeon General's Conference on Agricultural Safety and Health - 1991

85


Surgeon General's Confemnce on Agricultural Satkty and Health
FCWMSAFE 2000 . A National Coalition for Local Action
Convened by the National institute rbr Occupational Satrsty and Health
April 30 - May 3, 1991, Des Moines, iowa

INTERVENTION FOR AGRICULTURAL SAFETY AND HEALTH

           Myron D. Johnsn.@ Ph.D.
            Administrator, Extension Service'
          United States Department of Agriculture

Mr. Mark Timm: From Washington, D.C., our next speaker is Dr. Myron Johnsrud, Administrator of
the USDA Extension Service. Dr. Johnsrud holds a master's and doctor's degree in administration
from the University of Wisconsin and farmed for a number of years in North Dakota. He directed the
North Dakota State University Cooperative Extension Service for 12 years. He served as chairman of
the Great Plains Agricultural Council, and served on the Board of Directors of the Prairie Public
Television Corporation and on the Board of Trustees of the National 4-H Council. Since 1986, Dr.
Johnsrud has directed the US. Department of Agriculture's Extension Service. In thls position, he is
responsible for a $15 million program and $370 million of federal allocations to the land grant univer-
sities for cooperative extension service programs. He is responsible for a major program for
redirecting the Extension Service, in partnership with the Cooperative Extension Service, a national
network in the 50 states and territories, and more than 3,100 countries. The redirection focuses on
current and critical issues of the nation. Dr. Myron Johnsrud will speak to us this morning on the
critical issue of lnrervenrion for Agricultural Safety and Health. Dr. Johnsrud:

INTRODUCTION

are in protecting agricultural workers and

"The health of the people is real& the
foundation upon which all their happi-
ness and all their powers AS a state de-
pend ,"

Benjamin Disraeli, prime minister of Brit-
ain, made that statement in a speech over
100 years ago, and it is still right to the
point today. Safety, too, which we link
closely with health, has long been essential
to civilization. Salus populi suprema lex
("The people's safety is the highest law")
was a legal and political maxim of ancient
Rome.

The need for surveillance and research to
guide injury control efforts in agricultural
safety and health presents many challenges
that have been identified by the previous
speakers. However, we must ask ourselves
how society will judge our success in solv-
ing the problems of agricultural injuries. I
believe that society will judge our success
by how effective our intervention methods

86

helping create the change in their behavior
necessary for their success. Intervention
countermeasures will rely upon the
knowledge gained from research and sur-
veillance programs to implement effective
solutions to agricultural health and safety
problems.

What makes agricultural production one of
the most hazardous occupations in the
United States? As we attempt to prevent
and reduce the incidence of fatal and
serious accidents and chronic illness on our
farms and ranches, do we know what areas
to focus on for the most success?

How do we keep agricultural safety and
health from being overlooked when ad-
dressing other issues that confront agricul-
ture, such as the environment, animal wel-
fare, or energy? How wide is our
scope+loes it stop at the farm gate or
timber mill? Or, does it include many
segments of food, feed, and fiber
processing?

Papers and Proceedings


These are just a few of the questions con-  occupational injuries experienced by agri-
fronting us today in the important issue of
agricultural safety and health. This mom-  culture over the past 50 years is due to the
                   accomplishments of these professionals
ing I want first to present a brief history   working cooperatively through or-
and the current status of intervention ef-   ganizations such as the National Institute
forts. Second, I will pose questions to    for Farm Safety and the safety committees
guide the concurrent session on developing  and standards committees of the American
intervention strategies for various targeted  Society of Agricultural Engineers (ASAE).
audiences, approaches to intervention, and
the need for collaboration. Third, I will   We cannot ignore the fact, however, that
suggest some areas that I see as the pres-   the rate of decline in agricultural fatalities
sure points, injuries, and fatalities of high-  and injuries is much slower than that expe-
est priority and the places where we have   rienced by mining and construction, the
the best chance to intervene successfully.    other two most hazardous industries in this
                    nation. Except for this fact, we would not

CURRENT STATUS OF INTERVENTION  be here today. Because of it and the ef-
                    forts of such organizations as NCASH, the

Voluntary safety efforts have had much    Congress has recognized the need to com-
success. Agriculture has the most exten-   mit additional resources to research, sur-
sive community of voluntary safety profes-  veillance, education, and intervention pro-
sionals of any industry in the United      grams.
States. What was probably the first farm
safety effort began in 1933, when the Sixth  Most of the new programs are being ad-
Annual Rock River Valley Safety Confer-  ministered by NIOSH. In administering
ence meeting at Fort Atkinson, Wisconsin  these programs, NIOSH has recognized the
organized a farm safety section.       value of supporting existing programs. Au
                    example of this is NIOSH's intervention

In 1937 the National Safety Council held a  program Agricultural Safety and Health
meeting of an agricultural section. Its first  Promotion Systems, which is providing
farm conference took place in 1947. An   funding to enhance educational safety
organized professional effort to prevent   programs through the Cooperative Exten-
farm accidents began in the Cooperative   sion System in 15 states.
Extension system early in the 1940's with
appointment of a full-time Extension farm  Two new NIOSH programs crucial to de-
safety specialist by the University of Wis-   veloping intervention include establishing
consin.                     two new centers in Iowa and California for
                    agricultural research and education and

A coalition of farm safety professionals    supporting occupational health and safety
representing agricultural equipment     nurses in agricultural communities. These
manufacturers, the Farm Bureau, insurance  programs exemplify, too, the key questions
companies, and the Cooperative Extension  we must ask ourselves in developing
System chartered the National Institute for  strategies for intervention programs.
Farm Safety in 1961 to provide a forum for
the exchange of research results, surveil-   1. How do we implement promising and
lance data, and effective intervention met-    innovative new programs such as nur-
hods. Much of the success in reducing the   sing services in agricultural communities

Intervention for Agricultural Safety and Health, May 1, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991                87


Questions to Guide the National Agenda

so that they complement existing inter-
vention programs?

2. How do we foster programs that utilize
the existing infrastructure of or-
ganizations, such as the Cooperative
Extension System and the National
Safety Council, to enhance our ability to
make the most effective use of resourc-
es available for intervention programs?

What is the current status of safety
features on farm equipment? New farm
equipment being sold today has the latest
state-of-the-art safety technology. When
machines are used and maintained proper-
ly, injuries and deaths from machinery-
related accidents can drop dramatically.
ROPS for tractors and tractor seat-belt use
could prevent the majority of tractor-relat-
ed deaths. Virtually all new tractors sold
in the United States have ROPS.

Because of the relatively long life of trac-
tors, most agricultural tractors in use do
not have ROPS in place. Nearly half of
the approximately 400 tractor-related
deaths that occur each year in this nation
involve rollovers. How do we ensure that
the older tractors and machines without
these modern safety features get retrofitted
with modern safety features when feasible
or get taken out of use? The issue of how
such updating and retrofitting is practical
presents a significant challenge.

I encourage us not to focus solely on trac-
tor fatalities, though they have become a
focus of considerable media attention.
They account for only a small percentage
of nonfatal injuries on farms, compared
with traumatic injuries from other causes
and chronic occupational illnesses. Engi-
neering and safety standards have long
been the primary method of injury control.

Many manufacturers of agricultural equip-
ment rely heavily upon the voluntary stan-
dards of ASAE in equipment design when
no mandated standards exist. The devel-
opment and issuance of technical standards
by ASAE has contributed strongly to inter-
vention for many years.

New standards and updates related to
safety are constantly needed. What inter-
vention programs do we need to ensure
that the vast array of small manufacturers
of farm equipment are aware of and
comply with both mandatory and voluntary
standards?

Unlike the situation in many other in-
dustries, the autonomy of the agricultural
workplace can render many safety stan-
dards useless as safety features are discard-
ed or overridden. How will this problem
be overcome?

DEVELOPING INTERVENTION
STRATEGIES

Characteristics of Target Audiences

How wide a net do we cast for our targets?
Do we include forestry and logging? Food,
feed, and fiber processing? Textile mills?
Workers at fast-food chains? Food safety
in general, which means all of us who eat?

As a first level of how wide we cast our
net, let us focus on the 3.32 million per-
sons who work on the nation's farms and
ranches. Nearly half of these people are
self-employed farm operators. The bal-
ance are unpaid workers (family), agricul-
tural service employees, and workers hired
directly by farm operators.

What methods would work best for
reaching farmers ? A recent study in New
York State found that farmers and farm-

88

Papers and Proceedings


workers, while acknowledging the need for
health and safety, did not have time to    may be possible if children do not ride on
                             tractors.

attend meetings.

Radio, general farm magazines, and con-     Studies of  the cognitive
versations with others are prime informa-                   physical
tion sources. The Cooperative Extension    limitations of children at various stages up
Service received a very high rating as a     through 15 years of age indicate that they
source of health and safety information.    are being put at risk through farm ac-
                     tivities that they are asked to perform.

A sizable share of the farm population is
children. Accidents are the primary cause
of death among children less than 15 years  I have yet to see a farm safety awareness
old in the United States as a whole and in  or education program that did not stress
farming. About 23,000 farm children are   the danger of extra riders on tractors. This
injured on farms each year. Why are these  poses some important questions that need
injuries occurring?             to be applied to all agricultural safety and
                   health problems.

Partly, it is the generally risky nature of
the farm environment and the fact that it   Why are our safety warnings going un-
is both home and office for farmers and   heeded? Are we reaching and involving
for their spouses and children. Often, the  our targeted audiences sufficiently to
economic realities of farming create a    develop effective education and awareness
dependence on children for labor. Fre-   programs that change behavior? What will
quently, either there is no adequate child   be the most effective combination of en-
care for them off the farm or it is too    gineering controls, awareness, education,
costly for farm families. These problems   regulation, and enforcement to find
exist for both the farm-operator family and  solutions to each problem?
the migrant-labor family.

                   Studies of the cognitive physical limitations
In a recent national survey, farmers     of children at various stages up through 15
reported that they allowed their young    years of age indicate that they are being
children (aged 6-9 years) to ride on a trac-  put at risk through farm activities that they
tor, and as many as 29 percent of 7-9 year-  are asked to perform. Their parents do
olds were driving the tractor. Between    not understand that risk potential. How
ages 7 and 15, farm children were per-    do we direct our educational efforts at
forming a wide range of farm operations   these target populations? Helping farmers
with tractors.               understand the developmental limitations
                   of their children could significantly reduce

When asked about risks of such behavior,   child accidents and deaths on farms.
farm parents surveyed saw a low accident-
risk level for their children when they were  Another target population is the estimated
riding on a tractor the parent was operat-  3 million migrant and seasonal farmwork-
ing or when the children were operating   ers from many different ethnic groups.
the tractor. As great as a 40 percent     Children are about one-third of this popu-
reduction in the farm fatalities to children   lation.

Intervention for Agricultural Safety and Health, May 1, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991

89


Questions to Guide the National Agenda

No comprehensive baseline health data
exist for them. Some of their health
problems and hazards are well
documented. Others require much more
investigation and research. Their need for
a wide variety of education and social
services is enormous. What are the unique
demographic, cultural, and language prob-
lems that must be overcome to provide
effective intervention programs for this
targeted audience?

The average age of U.S. farm operators is
52, with 21 percent of farm operators 65 or
older. Farm workers aged 65 and over
have two to three times the injury rate of
other age groups. Older workers are more
vulnerable to injury due to decreases in
sensory capabilities (hearing, vision, smell).

They also may be suffering from several
chronic occupational illnesses that have
high incidence rates among farmers. This
target audience offers unique challenges
for effective intervention programs that
reduce their risk of traumatic injury and
prevent increasing the severity of existing
health problems.

What intervention programs are needed by
audiences who have experienced an injury?
Approximately 600,000 farmers have a
disability that impedes their ability to per-
form essential farming tasks. This group is
also at high risk to further injury.

Expanding upon several pilot programs,
USDA's Extension Service, in cooperation
with the National Easter Seal Society and
other nonprofit disability organizations,
recently launched an innovative program
to help farmers with disabilities continue
farming.

such services as identification and referral
of farmers with disabilities, on-the-farm
technical assistance for modification of the
workplace, and, agriculture-based educa-
tion to prevent further injury and disability.
Accident victims can be a powerful influ-
ence in creating behavioral change. How
can we more effectively involve these in-
dividuals and the grassroots organizations
they have created, such as Farm Safety for
Just Kids?

Should we target groups that are not em-
ployed in agriculture or live on farms but
may become victims of farm injuries?
What are the risks to individuals that visit
or provide services to farms?

Approximately 40 percent of the fatalities
that occur in confined-space agricultural
accidents are attempted rescuers of farm
accident victims. The Cooperative Exten-
sion System has trained more than 17,000
professionals in farm accident extrication
procedure and nonprofessionals in first-on-
the-scene emergency response procedures.
These programs are crucial to reducing the
risk of injury to the rescuer, reducing the
severity of the injury to the victim, and
emphasizing the value of injury prevention.

Approaches to Intervention

Various approaches to intervention have
been applied to agriculture. What do we
know about the effectiveness of injury
control strategies in the agricultural
workplace? What new method emanating
from the public health approach and hu-
man factors engineering will be required to
solve these problems. 3 How do we educate
to achieve behavioral changes toward bet-
ter agricultural safety and health? Many
educational programs are in place.

Extension agents, disability experts, rural
professionals, and volunteers will offer

90

Papers and Proceedings


We have our own, ranging from training of  national strategy could rest on the belief
persons who will be using restricted-use   that the most effective preventive efforts
pesticides to courses that instruct youth   will emerge from a process that emphasiz-
(14-15 years old) in operating tractors safe-  es identifying and characterizing problem
ly. Of the more than 23,000 Nebraska    areas and populations at risk.
youth that have completed the tractor

certification training program conducted by  The collaborative efforts of engineers,
the Universitv of Nebraska Cooperative
Extension Se&ice, only two havg died in   ergonomists, safety professionals, industrial
                  hygienists, and experts in biomechanics and
tractor-related accidents.            the behavioral sciences are needed to
                   address the most compelling problem areas
                  by studying what makes up workplace
A national strategy could rest on the   systems and the process, tasks, and tools
belief that the most effective preventive   involved. They must identify potential
efforts will emerge from a process that   causal mechanisms, opportunities for inter-
emphasizes identifying and characterizing   vention, and possible prevention strategies.
problem areas and populations at risk.

How will automatic ("passive") protection
be used more in agriculture? Passive pro-

How do we educate people to change    tection is generally more effective than
                   "active" measures requiring effort by each
accident-causing or otherwise risQ       worker.
behavior? Simple identification of a public
problem such as agricultural safety and
health is not enough to allow the design   Engineering controls are available for
and development of successful remedial   many known hazards but have not been
                  systematically applied and evaluated.
programs.                "Passive" measures of prevention could
Building meaningful people-involvement   involve worker protective-system ventures
                  into the realm of intelligent microenviron-
into problem identification, program     ments that feature sensors, microproces-
development, and program delivery is
essential. Failure to involve the real    sors, adaptive protective mechanisms, and

stakeholders (the farmers and       display and imaging technology to protect,
                    inform, and warn workers for hazardous
farmworkers) dooms even the most out-    conditions at their onset.
standing programs to failure. The era of
unshared decisionmaking is generally be-   How do we ensure that the safety and
hind us.                health of the agricultural worker is not
                       sacrificed for the sake of other issues? In
Need for Collaboration         considering common issues, such as selec-
                  tive harvesting versus clearcutting in the
What is required. 3 The attention, effort,   forests, we need to be aware that selective
and cooperation of individuals and organi-
zations at every level of society, from this  harvesting may be better for the environ-

conference to our offices at home. Should  ment but that it places the logger at a

there be a national coalition to plan and to  greater risk of injury than occurs in clearc-
coordinate intervention programs? A    utting using modern equipment. Can we
                  engineer machines that allow selective

Intervention for Agricultural Safety and Health, May 1, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991                91


Questions to Guide the National Agenda

harvesting and that protect the workers
using them?

We must apply a systems approach that
identifies the multiple benefits and
feasibility of intervention methods. For
example, closed-container mixing systems
for pesticides not only protect the applica-
tor from exposure to pesticides, but can
also prevent ground water contamination
and reduce the possibility of mixing errors.
Communication of multiple benefits can be
an effective means of creating a change in
behavior.

FUTURE FOCUS

Let us look at success stories in agricul-
tural safety and health. What data do we
have on them? We know they exist. Prob-
ably one of the greatest shortcomings of
existing educational farm-safety programs
is the lack of scientific evaluations of their
effectiveness. We must conduct more
comprehensive evaluations. We need
more than simple, generalized descriptors-
beyond age and sex of the victim, the time
of year of accident, and its severity-for us
to develop innovative engineering or
educational countermeasures.

Although more research and more data
are needed to direct intervention, we know
certain health and safety precautions work;
ROPS work. Educational programs by the
Extension System and others in health,
hygiene, and pesticide use all have their
successes in reaching our target audiences.

Where do we need to go? We need to
focus on injuries that often result in death
or severe disability because of their impact
on the family and the economic and social
costs to society. We need to find workable
solutions to tractor fatalities and to reduce
and eliminate them, if possible.

Tractor-related injuries are about one-third
to one-half of all fatal farm injuries. This
figure has changed little in 20 years. We
also know that the youth and the aged
were involved in a significant portion of
total tractor injuries. We need to reach
these target groups more effectively.

Injuries that occur with high frequency and
may be easily prevented should receive
high priority, even if less severe in nature.
For occupational illnesses, we can increase
educational efforts in the use of common
methods of worker protection from haz-
ards and in the use of protective equip-
ment and clothing. Some types of clothing
and equipment, for example, can reduce
exposure to many harmful agents. We
need feasible engineering controls to re-
duce vibrations, noise exposure, air con-
taminants, and other harmful agents. We
need to stop the decay of basic health
services available in rural areas and to
reverse this trend.

I have raised many questions for your
consideration both now and after you re-
turn home. Your presence here today is
testimony to the momentum building to
address this issue.

I think that we can find the answers to
solving these problems through the collab-
orative efforts of all of you. We can act
on measures that we know work now and
search for more effective intervention
countermeasures. Safety and health are
the right of every person involved in agri-
culture. I wish us success in solving our
agricultural health and safety problems.0

92

Papers and Proceedings


Surgeon General's Confemnce on Agriculturel SaMy and Hem
FAIWSAFE 2000 o A National Coalition kw Lout/ A&on
Convened by the National Inst/tufe for Occupational Safety and Health
April 30 - May 3, 1991, Des Moines, Iowa

RURAL HEALTH POLICY

  By Jefiey Human, M.A.
Director, Office of Rural Health Policy
  U.S. Public Health Service

Surgeon General's Conference on Agricultural Safety and Health - 1991                93

Has this not been a terrific conference so
far? We have outstanding attendance.
We have had one excellent speaker after
another. The commitment to improve
agricultural safety and health has also been
striking in these presentations.

Groups like the National Coalition for
Agricultural Safety and Health and the
Farm Foundation have been working extra
hours to form consensus on the national
agenda we need to develop. This is a time
of hope.

One of the most interesting things about
several of the presentations so far was the
emphasis on the movie Field of Dreams,
and its use as a metaphor of hope. I asked
a city dweller last evening what movies
urbanites relate to these days. ~ "Well," he
said, "I'd include Deathwish, T i, Mean
     t
Streets, and Escape from New ork." I
think there is more hope in the country.

This morning's Des Moines Re ' ter ran a
nice story on Dr. Novello's sp ," ech, which I
thought was a high point of thb meeting.
What an anachronism to call her the "Sur-
geon General."

Her message makes it clear that she is
both the "Pediatrician Generat" and the
"Family Medicine General." And that is
what we need in rural health. ~ Yesterday,
everybody had a different ra $ `ng for agri-
culture as a dangerous occup ion. It was
first, second, third, and fourth'within an
hour.

Chris Atchison, and this morning, Dr. Bill
Halperin seemed to me to have the best
idea. Let us set up and run farm health
and safety surveillance systems in all states
as they do in Iowa. Let us keep track of
injuries and deaths and let us export this
record-keeping to the other states, so we
can keep track on a national basis and so
that we can intervene for prevention. We
also need to educate the nation's public on
the nature and extent of the dangers of
farm work to get the assistance we need.

It is very fitting that this meeting should be
in Des Moines. It was in this city, in 1984,
that the Des Moines Register won the Pulit-
zer Prize for a series of articles entitled "A
Harvest of Harm." Those articles argued,
persuasively, that agriculture has become
our most dangerous occupation.

It was in Des Moines and Iowa City, in
1988, that Jim Merchant and Kelley
Donham held a conference on agricultural
health and safety; the conference led to
the publication of Agricultzue at Risk: A
Report to the Nation, a report that has
brought the issues we are talking about
today to the nation and to the Congress.

The 1988 conference also led to the Ixma-
tion of the National Coalition for Ag. icul-
tural Safety and Health-a coalition that is
continuing to keep these issues in the fore-
front of national efforts to improve rural
health; a coalition that has now integrated
its work with the National Rural FIealth
Association; a coalition whose work at


Medical Intervention Problems and Opportunities

raising consciousness made this meeting
possible.

Iowa's leaders have been very influential in
other rural health endeavors. In the mid-
1980's, the administrators of small rural
hospitals detailed the problems they were
experiencing to the Congress. Don Dunn
and Art Spies (who is with us today) of the
Iowa Hospital Association, were among
the chief spokespersons of the movement.

The Iowa Congressional Delegation has
been as united as any in the country in
rural health advocacy. Senators Harkin
and Grassley helped build a Senate Rural
Health Caucus of 65 of the 100 members
of the Senate, and they have delivered
better-funded programs and new programs
through the Senate Appropriations Com-
mittee, on which they serve. Former Iowa
Congressman Tom Tauka was the first co-
chairman of the House Rural Health Care
Coalition, which now has 165 of the 435
members of the House, including all of
Iowa's Congressmen.

There is one other Iowa leader we should
speak of, but he is our next speaker. I will
get to him soon.

I am supposed to say something about the
Office of Rural Health Policy, which I
direct. We act as a voice of the rural
constituency in the Department of Health
and Human Services and coordinate its
rural activities. So I come to meetings like
this as much to listen as to speak..

Our primary responsibility is policy, but we
also run some programs. For example, this
year we will be making around 38 grants to
states to help them establish or enlarge
state Offices of Rural Health. These offic-
es work like our federal offices but at the
state level.

I think they can be very effective in repre-
senting rural constituencies in the state
capitals, in working with communities and
their health providers to solve local prob-
lems, and in working with the farm com-
munity on health and safety issues.

This year, we will be making anywhere
from 60 to 200 grants for local innovative
health services programs or programs that
support health professionals through edu-
cation, telecommunications, or similar
means. We expect several agricultural
health and safety proposals.

We fund seven rural health research cen-
ters nationwide. All of them have some
involvement in agricultural health and
safety and one center-the Marshfield Med-
ical Foundation-has agricultural health
and safety as its principal emphasis.

We heard about one of their projects yes-
terday from Secretary Sullivan. It illus-
trates the practical applied research I ask
for from each center.

When we looked at the tractor-rollover
problem with Marshfield, we decided that
there was no need for further research on
the problem. What we decided we needed
was a way to help farmers who wanted to
retrofit older tractors with roll bars or
other rollover protective devices to find
those "ROPS," as they are called.

So we asked Marshfield to develop and
publish a catalog of all American manufac-
turers of "ROPS," all products they pro-
duce and what make of tractor, model of
tractor, and year of tractor they will build.
Then Marshfield sent the catalog to all
extension agents in the country, so it is
available where it is needed.

94

Papers and Proceedings


Producing that catalog is not the best step
we could take as a society. As we have
seen in the slide on the Swedish experi-
ence, the best step we could take would be
to require "ROPS." But as an Office, it
was the best we could do.

We fund a national information center on
rural health. It is a part of the U.S. De-
partment of Agriculture and is within their
National Agriculture Library. So if you
want some rural health information, call l-
800-633-7701.

The nice thing is that you can also get
agricultural information or rural economic
development at this same number. Add
$24.95 and postage, and we will include all
the hits of Boxcar WiZZie. That is l-800-
633-7701. Offer is not valid in Mexico or
Canada.

My own office is also a sort of information
clearinghouse. In my presentations, I try
to share ideas on the things that are hap-
pening in the states and communities and
in Washington that affect rural health.

Thus, I talk around the country about the
problems of rural health and about the
potential solutions. For example, I tell
state officials that they should train more
nurses because we have a national rural
nurse shortage. If they ask where to get
the money, I suggest they cut back on
training so many lawyers at taxpayer ex-
pense.

If we are short of nurses, we are short of
essential health services for our people. If
we grow short of lawyers, however, what
are we short of? Essential lawsuits?

Certainly with a few less lawyers we might
have fewer malpractice suits. Seriously, let
us confront conventional approaches and

Rural Health Pblicy, May 1, 1991

make new choices with limited funds,
choices that help solve rural health prob-
lems.

I tell people in other states about the
package of programs offered to local sub-
scribers by the University of Iowa's Insti-
tute of Agricultural Medicine and Agricul-
tural Health. I do not have time to tell
you the specifics today, but I will mention
three features of the program, which is
based on a Swedish model.

1. It is hospital based and contributes to
the viability of rural hospitals. That is
important because 10 percent of all of
America's rural hospitals closed their
doors during the 1980's.

2. The program includes continuing medi-
cal education for physicians. A 1979
survey showed that 70 percent of all
medical schools offered no instruction
in agricultural medicine. The other 30
percent offered an average of four
hours of instruction during four years
of medical school. The young physician
new to an agricultural community may
be baffled by pulmonary and cardiac
conditions caused by agricultural dusts
  or chemicals. Ellen Widess' stories
yesterday play out over and over again,
and many times with worse endings
when we do not prepare our physicians
properly.

3. The program trains farm families to be
responsible for their own health and
safety. For example, they are shown
  how to make animal confinement hous-
es safe for themselves and the animals.
For more information, see Jim Mer-
chant or Kelley Donham or David
Pratt, who know more about these and
other similar programs than I do.

Surgeon General's Conference on Agricultural Safety and Health - 1991                95


Medical Intervention Problems and Opportunities

I want to tell you about one last program.
It is called "Stress Country Style," and it is
in Illinois. A network of health workers
throughout the state are available to help
farm families. Farmers call an 800 num-
ber, and help comes to them. There is no
stigma because the encounter is private at
the farm. Counseling is offered. Referral
to mental health or debt consolidation or
one of 100 other programs is offered.
Oklahoma and Iowa have similar pro-
grams.

Seriously, let us confront conventional
approaches and make new choices with
limited funds, choices that help solve
rural health problems.  I

We need more innovative stress reduction
programs like these. In Ontario between
1979 and 1982, 95 of the 273 farm deaths
were suicides, and the farm suicide rate
has been documented to be high in this

country as well. Mental health must be an
important part of our national strategy.

Incidentally, we need to place a special
emphasis on teenagers when we look at
mental health in the farm community. A
survey by the University of Minnesota's
Extension Service and the Medical School
indicated that 5 of every 100 rural adoles-
cents surveyed has attempted suicide with-
in the past month.

Nationally, the figure was 2 of 1,000. This
was in the early 1980's during the height of
the farm crisis, but other studies have
shown pervasive high levels of depression
among rural adolescents.

I should also mention that our office pro-
vides staffing for the National Advisory
Committee on Rural Health. I have left
some brochures about our office at the
registration desk. If there are none left,
call l-800-633-7701, and they will have us
send you one.0

96

Papers and Proceedings


Surgeon General's Conference on Agricuttud Safety and Health
FARMSAFE 2000 o A National Coalition for Local Action
Convened by the National Institute tit' Occupational W&y and Health
April 30 - May 3, 1991, Des Moines, Iowa

MEDICAL INTERVENTION PROBLEMS AND OPPORTUNITIES
            IN RURAL AREAS

By Governor Robert D. Ray

Chairman, National Advisory Committee on Rural Health Policy

Mr. Jeffrey Human: My last assigned task is to introduce our next speaker. My honest impression is
that Bob Ray is a real enigma. This is a guy who was elected to five terms as Governor of Iowa, and
then found a life after politics on his own. He did not lose an electior+he quit. There was no
scandal. He just left the political life. He wanted to try something new. This is almost unprecedent-
ed in American politics. Then Bob went out and got jobs on his own and made a mark. He ran a
successful insurance company, and now he is president of Blue Cross and Blue Shield of Iowa, with
a million subscribers. He is not some absentee figurehead president either. A top official of Blue
Cross nationwide tells me he has personally turned the program around in this state. Secretary
Sullivan tcld us yesterday that Bob Ray is one of his advisors. Well, he should be, because Bob is
chairman of the National Advisory Committee on Rural Health. That committee has provided
Secretary Sullivan and the Congress with a series of challenging recommendations on rural health
that have led to changes. For example, the Outreach program I told you about is partially a result of
a recommendation of the committee. There is a great revival of interest in national health reform.
There are many competing proposals. One of the best and most influential, based on universal
insurance coverage, is from the National Leadership Commission on Health Care. The Commission's
members read like a Who's Who in American health policy. The chairman is, of course, Bob Ray.
Bob Ray also was a U.S. Delegate to the United Nations and former chairman of the Indochinese
Refugee Panel, providing leadership in efforts to resettle Vietnamese and Cambodian refugees. Bob
is a graduate of Drake University's Law School, and he has a lot of honorary degrees and distinc-
tions. Those of us who work with him and for him with the National Advisory Committee on Rural
Health have discovered more important things about Bob. We have found him to be intelligent,
funny, caring, realistic, charming, articulate, and an excellent leader. He is one of the best listeners I
have ever met. He knows more about health care than most of us. It is a pleasure to introduce one
of America's great leaders, Robert D. Ray:

Jeff, thank you. Thank you very much. I
just learned a great deal about Jeff Hu-
man. I have always admired him and his
talent and his ability and I have watched
him in Washington, knowing that he is not
just a bureaucrat. He is a person with
tremendous compassion and understanding
of people, their needs, and their problems.

Jeff, what I did not know about you is how
flexible you can be.  You have talked to us
about education; you have talked to us
about tractors; you have talked to us about
Federal programs; you have talked to us
about Boxcar WiZZie; and you have talked
to us about me. I am here to tell you that

I am sure thankful I do not practice law
anymore.

I am not sure I should have been invited
to speak to you today at all because I am
not sure of my own commitments. There
is probably no one who is working harder
or who believes more that we should hold
down health care costs than I.

Earlier this year, I was in an automobile
accident and was taken to the emergency
room. I was laying there flat on the slab
and looking up, and two white spotlights
were shining down on me. It was very,
very warm and very comfortable.

Surgeon General's Conference on Agricultural Safety and Health - 1991

97


Medical Intervention Problems and Opportunities

I felt pretty good about that, but then I
looked kind of from one side to the other,
and I saw these green things running
around. There were doctors standing here
and there. Once in awhile one would lean
over and look at me, and I would look at
him. The funny thing about it is that never
one time did I look up and say, "How
much is it going to cost, Doctor?"

And so there are conflicts within all of us.
We want the best health care system possi-
ble. We do not always want to pay for it.
We believe that there are ways in which
we can cut and save-but not on the service
that we get.

So, it is very difficult when we talk about
what is needed and what is doable. If at
first blush you think it is just overwhelming
and impossible, you would quit.

Then when you realize that things do hap-
pen-maybe slowly, but they do happen.
There is always change going around.
Maybe the change will inure to a system
that we want to change. That is the reason
it has been exciting to me to work with
Jeff Human and the people in Washington
and DHHS.

Some of the business people and the major
leaders of this country are trying to do
something about health care. We have
long learned that you can not do some-
thing about cost alone because if you con-
trol cost, you reduce access.

You cannot do something about quality of
care alone, even though that, by itself,
might reduce health care costs 30 or 40
percent, because it costs money to do cer-
t ain things.

You cannot just provide more access for
everybody without affecting costs and qual-

ity. So we have to deal with all of those
aspects of health care and the health care
delivery system together.

I think that it is awfully easy for us in the
rural areas to be neglected because we do
not have the votes they have in the big
states: California, how many congressmen
do they now have? New York?

It has been very impressive, what has hap-
pened in Congress over the last several
years. Jeff already mentioned how many
members belong to the House Coalition on
Rural Health. So, a lot of good things
have happened, and our advisory commit-
tee, I think, has had some influence, some
impact, and I am pleased to be associated
with them.

I am pleased that the Surgeon General
decided that we should have this confer-
ence and that our senators endorsed it,
and Tom Harkin helped to get it here in
the State of Iowa. There is no better place
we could have a conference on rural
health than right here in the State of Iowa.
I think we ought to have one of these
every 50 years.

An awful lot has happened to change the
landscape of American health care during
this past 50 years. Advances in technology
and the proliferation of medical specialties
allow us to live longer and healthier lives.
That is good. But unfortunately, farm
families, farm workers, and rural farming
communities do not share equally in all of
this achievement with our neighbors in
urban areas.

This conference is very timely, and I am
pleased that it is here in the State of Iowa.
And I want to thank the Surgeon General
for being here.

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Papers and Proceedings


Medical Intervention Problems and Opportunities in Rural Areas, May 1, 1991

There are so many people that I would
like to acknowledge on the federal level,
on the state level, and on the regional
level-our Senators, Congressmen, Dr.
Donham and Dr. Merchant, and the list
goes on and on. I am going to save
you-spare you-the time that it will take
do that.

to

Let it suffice to say, I truly appreciate what
you are doing because this is important-
not just to those people who live on farms,
but even those who live in small towns; it
is important to every one of us. I will get
back to that.

The diverse groups of people like yourself
who focus specifically on rural health at
this conference give us a unique chance to
build and strengthen active, vital, rural
health networks. It offers the opportunity
to develop links between the researchers
and the health professionals, between
health professionals and extension agents,
between extension agents and surveillance
experts, and between surveillance experts
and researchers. The list goes on and on;
you get the picture.

We just finished a rather tasty meal. You
have probably had better; you have un-
doubtedly had worse, but by most stan-
dards, let me tell you, there are people in
this world who have never, ever had a
meal that good. Let me give you some
food for thought.

Just stop and pause and reflect for a mo-
ment with me about who produced that
food. I am not talking about the culinary
part, the chefs part, but about the people
who provided the labor and the risk and
the sacrifice that we enjoyed at noon: we
are spoiled. We in this country try to
decrease the calories that we eat, while the
rest of the world measures growth and

progress by the increase in calories their
people eat.

Our farmers only get a very small fraction
of what we spend for food. They get 4
cents for the wheat that goes into a loaf of
bread, which costs roughly a dollar and a
quarter. They get 5 cents for the corn that
goes into a 7-ounce box of corn flakes,
which sells for a dollar and a quarter.

We in this country spend a smaller percent
of personal income on food than any other
civilized country. You people pay, on the
average, 11.9 percent of your personal
income for food. It was 18 percent in
1959. It has been reduced.

Yet, in other countries, like the European
countries, they are paying around 17 per-
cent; Japan, 19 percent; the Soviet Union,
28 percent; India, 54 percent; China, 48
percent. We have a bargain.

Look at what is happening in the Soviet
Union. During our lifetime we have grown
up knowing about two superpowers-one
the United States of America and the
other the Soviet Union.

Today the Soviet people stand in lines for
hours. You see them on television. You
can watch them-waiting for a little piece
of bread that they cannot even afford.

Add to that the fact that the suicide rate
for farmers is now 30 to 40 percent
above the national non-farm rate.

L

We are fortunate, yet we take it all for
granted. Our farmers produced the food
that the chef prepared for us today, but
they did it accepting some risk: the possi-

Surgeon General's Conference on Agricultural Safety and Health - 1991

99


Medical Intervention Problems and Opportunities

bility of an untimely death or serious injury
or acute or chronic illness-all of
that-while they were growing the food and
raising it.

RURAL STATISTICS

Earlier at this conference, if I understand
correctly, you heard some alarming statis-
tics. Let me briefly reiterate what I think
some of them were.

Although farmers and farmworkers com-
prise only 3 percent of the work force, they
suffered 14 percent of work-related deaths,
according to National Safety Council fig-
ures. Agriculture, as you heard just a
moment ago, precedes mining now as the
most hazardous occupation.

Unlike mining, where the death rates have
been decreasing, agriculture mortality rates
have remained consistently high during this
past decade. The fatality rate in farm
work is five times the average for all U.S.
industry-five times.

Researchers have discovered that midwest-
ern farmers have a higher-than-normal
chance of dying of leukemia. The cause is
uncertain. Some experts fear an unusual
incidence of leukemia is linked to the use
of modern pesticides in raising corn.

A serious new hazard known as "hog lung"
is also one of the by-products of the mod-
ern system of raising hogs in confinement.
In a half-dozen or more of our cities, water
supplies contain greater than acceptable
amounts of pesticides and other synthetic
organic chemicals.

Millions of rural poor people are risking
health problems because of substantially
substandard diets. That problem is attrib-
uted to the pride of rural poor who are

unwilling to accept food stamps and other
assistance. These numbers do not even
take into account all the children who die
each year in farm-related activities.

In addition to deaths, there are 130,000 to
170,000 disabling farm injuries every year.
These injuries entail an enormous hospital
rehabilitation cost, and nearly half of all
survivors of serious farm trauma are per-
manently impaired. Add to that the fact
that the suicide rate for farmers is now 30
to 40 percent above the national non-farm
rate.

Jeff just gave you some other information
about that fact. He mentioned that I had
served as a representative to the United
Nations. When I was there, I found myself
frequently talking to those of other coun-
tries, and especially Africans, who no lon-
ger could produce enough food for their
own people.

They had joined a crowd of socialized
countries, and soon learned that they just
could not produce food like they used to.
They liked talking to me because they
knew that I came from the State of Iowa,
one of the best farm states in the country,
in the world.

We spent hours talking about how our
farmers could produce food better than
anybody in the world. I believe that we
could help them. We used to talk about
how we might do that.

One day I was telling them about how
wonderful our farmers were and how well
they could produce food. Then, the very
next day, I picked up the New York Times
and there on the front page was a dateline
story from Spencer, Iowa; and this is a
quote, "More suicides on Iowa farms." I
just hoped that my friends I talked to the

700                                  Papers and Proceedings



day before did not read that. But it was
and it is a fact of life. It is a shocking fact  related mortality. Some of these figures

of life.                 reflect the corn prices of the 1980's. You
                  probably are not surprised to hear that the
                        number of farm foreclosures reached

I have just given you a few statistics that I  650,000 between 1981 and 1987.
think indicate the importance of your get-
ting together today for this conference.    You may not know that rural America also
Let me turn our attention to the big issue
of rural health care and rural health care   lost over 500,000 manufacturing jobs at the

delivery.                same time. It is estimated that for every
                    seven farms that have been lost, one rural
                        business has closed.

RURAL POVERTY

                   The rural population increased in the
Many of you are undoubtedly familiar with  1970's. The 1980's saw a dramatic shift.
the agricultural, occupational, and environ-  Growth was stagnant at best and some
mental health conference that was held
here in Des Moines a couple of years ago.  midwestem communities lost population,
                   Iowa being one of them. All of you know
That conference report was called Agricul-  we are going to lose a Congressman. We
ture at Risk.               do not want to lose that Congressman; we
                          have no choice.

It described the need for occupational
health and safety services. It discussed the  These economic and demographic trends
challenges facing the rural health care    together with changes in the delivery and
system, challenges like failing rural hospi-  financing of health care have taken a huge
tals, pay disparities between urban and    toll on the rural health care systems, espe-
rural physicians, difficulties in retaining   cially the rural hospitals. Ten percent of
both rural health providers and patients,   all U.S. rural hospitals closed during the
and the need for a strong emergency medi-  1980's, and it was estimated that about 25
cal services system. Although the public's  percent of those still serving patients were
image of rural America is one of pictur-    in serious trouble.
esque countrysides and healthy lifestyles,
this image belies the reality of life in much  With greater rural poverty has also come a
of rural America. These are hard times   rise in uncompensated care provided at
for many rural communities, the result of  rural hospitals. Under Medicare's perspec-
both economic and demographic trends.   tive payment system, rural hospitals, since
                   1983, have been paid at a lower rate than

For example, the rural poverty rate in-    urban hospitals, as much as 25 percent
creased steadily during the 1980's and for  lower. This has been devastating to many
the first time is now higher than the urban  rural hospitals because Medicare patients
rate. Rural residents are much more likely  represent an exceptionally high percentage
than urban residents to have no health    of their patients.
insurance coverage at all-public or private,

Rural residents are plagued by chronic
disease, higher rates of infant mortality,
and dramatically higher rates of injury-

One of the first recommendations that the
National Advisory Committee on Rural
Health made to Secretary Sullivan was to
establish a single national standardized

Medical Intervention Problems and Opportunities in Rural Areas, May 1, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991               707


Medical Intervention Problems and Opportunities

payment for Medicare hospital reimburse-
ments. I am pleased to be able to say that
Secretary Sullivan has been successful in
seeking a higher annual update for rural
hospitals. The Congress has now legislated
a phase-out of the rural-urban differential
in Medicare payments.

In 1989, the Federal Government imple-
mented the Rural Hospital Transition
Grant Program to address rural hospital
vitality. Under this program about 180
new grants were made to rural hospitals
each year for the past two years. Hospitals
can receive up to $50,000 a year to help
them with strategic planning and imple-
mentation of programs to help them with
that change in rural health care needs and
practices.

Iowa has fared very well under this pro-
gram. Twenty-three of these grants were
awarded to Iowa hospitals in 1990. That
totals $819,000 and represents 10 percent
of all the federal funds awarded.

The second program that the Federal Gov-
ernment is implementing right now is the
EACH/PEACH Program. EACH means
Essential Access to Community Hospitals.
PEACH means Primary Care Hospitals.
The Congress authorized this program in
1989 to provide financial incentives for
rural hospitals to downsize and to focus on
providing primary care and limited inpa-
tient services and emergency care.

The program also encourages these prima-
ry care hospitals to form networks an-
chored by larger full-service, essential-
access community hospitals. Seven states
will receive funding this year to develop
networks in primary care in essential-ac-
cess community hospitals.

RURAL HEALTH PERSONNEL

Another rural health issue receiving a lot
of attention is the shortage of rural health
personnel. To maintain a rural health
system, we have to have physicians, nurses,
emergency medical service helpers, and
other health personnel.

Rural counties have only one-third as
many physicians per capita as the nation at
large. In these counties, 20 percent of
physicians are over the age of 65 and,
obviously, are going to retire very soon.
Communities also have problems recruiting
and retaining physicians. Right now 165
Iowa communities are looking for doctors.
Rural communities particularly find it
difficult to recruit and retain registered
nurses, physical therapists, occupational
therapists, x-ray technologists, and other
health professionals critical to health care
systems.

Some recent federal efforts may help ad-
dress a few of these problems. The Na-
tional Health Service Corps was re-autho-
rized last year. Its funding was increased.
This program places physicians, nurse
practitioners and physician assistants in the
underserved areas. In recent years, about
70 percent of the placements have been in
rural areas.

A Medicare bonus was implemented two
years ago for physicians practicing in rural
underserved areas. The bonus was in-
creased just recently to 10 percent.

That represents just a very small incentive,
but given the substantially lower rate that
many rural physicians receive as compared
to urban physicians, it is at least a step in
the right direction. Both of these provi-

102                                 Papers and Proceedings


sions, I might add, were recommended by   1980's caused incredible stress for rural
the National Advisory Committee for    individuals and families, but the accompa-
Rural Health.             nying drop in land values and tax bases
                  made it increasingly difficult for rural com-
Congress has also mandated a new Medi-   munities to finance mental health services.
care physician payment system. Under this
payment system, primary care physicians   As we look at ways to strengthen our rural
are going to be reimbursed at higher levels  health care system, we have to make sure
than they currently receive, and that ought  that mental health services are a part of
to help.                that system. Mental health personnel are
                   also trained for rural practice. Iowa State
At the same time, we should not overlook  University, for example, has recently been
the issue of rural emergency medical ser-   awarded a $4.5 million grant to establish a
vices. In Iowa there are more than 400   center for family research in rural mental
ambulance services and approximately     health.
10,000 trained personnel. Seventy percent
of these people are unpaid volunteers, and  Right now Iowa has about $24 million in
most all of them are in the rural areas.   rural health related federal grants, employ-
The difficulties of recruiting and retaining  ing a variety of programs.
these dedicated individuals who have other
jobs, spend long hours in training, and    Mercy Hospital here in Des Moines, for
donate their time free to an important   example, has received $750,000 for a can-
health service are, I think, rather obvious.  cer screening and control program for farm
                       families in 35 Iowa counties.
Rural volunteer ambulance services also
struggle to purchase equipment. An ambu-  CONCLUSION
lance, fully stocked, is going to cost
$70,000 and rarely is there money from   Well, what is the sum and substance of it
government to pay for that.        all? I think, notwithstanding the problems
                    and all the difficulties, we can be some-

So they have their chili suppers and their  what encouraged by the recent progress in
chicken barbecues just to raise the money  both rural health and in agricultural health
for an ambulance, That, actually, is where  and safety. Make no doubt about it, we
most of the money comes from. It seems  have a long, long way to go.
kind of strange to think that the emergency
services upon which we depend so heavily,  Public policy items all have their life span
particularly in rural areas-services that   on the national agenda. The challenge
treat farm injuries, heart attacks, highway  that we face is to keep rural health and
traffic accidents-are actually provided by  agricultural health and safety issues on that
volunteers.              agenda long enough so that we can make
                  and see a very substantial difference.

RURAL MENTAL HEALTH

                 If we can do that, we are going to see that
Now, the third and last rural health issue I  the time and the effort and the money
want to mention is rural mental health. As  were all well spent to ensure a future for
I said a moment ago, the farm crisis of the  our rural areas. This conference is unique

Surgeon General's Conference on Agricultural Safety and Health - 1991               703

Medical Intervention Problems and Opportunities in Rural Areas, May 1, 1991


Medical Intervention Problems and Opportunities

because of the range of the players that it
has brought together.

I would suggest that we have a second
conference; in fact, I already did before
the Surgeon General left. I think I am not
speaking out of school-she said she agrees.
We really ought to have one.

I think it would be nice if we had it before
50 years, because I would like to come
back. I would like to see what we have
done between now and next year or the
next year or whatever time that conference
is set for.

The last Surgeon General's Occupational
Health Conference resulted in something
maybe very important, the elimination of
mercurial poisoning in the hatting industry.
We do not have much hatting industry
anymore. In contrast, this conference has
the potential to lead to dramatic decreases
in agricultural deaths as well as advances
in preventing and treating agriculturally
related diseases and injuries.

To wrap it up, I would like to just share a
quotation from the newsletter of the Cen-
ter of Rural Affairs, Walthill, Nebraska. It
puts what you are doing here in a broader
context of rural development and, in a
sense, summarizes what I think this confer-
ence is about. I am going to quote:

"Good rural development conserves the
best in people; the resources they live
from, the values that nourish them, and
the institutions that sustain them. We
need not try to prevent change but to
shape it in ways that conserve our
future."

I would add to that, the health and future
of our rural farmers, farmworkers, and the
farm community. If we succeed at doing
that, every one of us will benefit. I appre-
ciate so much you being here, because that
is what you are here for, to do exactly
what that quote says. Thank you very
much.0

104

Papers and Proceedings


Thank you. I want to add my welcome to
Iowa to the welcomes you have already
heard from others in Iowa. I should give
you a little warning. Some people have
come to Iowa and said what a nice state it
is, what a pretty state it is.

My warning is, I came here in the
Commission Corps of the Public Health
Service 26 years ago, on a two-year as-
signment with no intention of staying, and
I am still here. So, we do not want you to
leave the conference early, but if you do
not want to get trapped into staying here,
maybe as soon as the conference is over,
you will want to get out of the state.

Chris Atchison talked the day before
yesterday about some of the things that are
going on in the Iowa Department of Public
Health in relation to agricultural safety
and health. So I will not repeat those
things. But I would mention that when
you go to the poster sessions this after-
noon, if my counting is somewhere near
correct, there are 101 posters there.

Five are from the Iowa Department of
Public Health about our activities. There

1Surgeon General's Confennce on Agricultural Salty and Health
F~,v.!%IFE 2000 o A National Coalition ior Local Action
Convened by the National institute kr Occupational Safety and Health
April 30 - May 3, 1991, Des Moines, Iowa

INTRODUCTORY REMARKS

    By Ronald D. Eckz$ M.D.
Director, Division of Family and Community Health
   Iowa Department of Public Health

Dr. Richard A. Lemen: To lead this panel this morning is Dr. Ronald Eckoff, a physician who is
currently the Director of the Division of Family and Community Health with the Iowa Department of
Public Health. Dr. Eckoff is a native of Michigan, having trained in both undergraduate and medical
school at the University of Michigan. He holds a Master in Public Health degree from Harvard
University. He has been active within the Iowa State Health Department, and I was looking at his
resume and noticed that somewhat4ike locusts, I suppose-every 20 years he has been asked to be
the Acting Director or Acting Commissioner of the Iowa Department of Public Health. He has a very
good background in public health, and he will be leading the discussion today. I would like, at this
time, to present to you Dr. Ronald Eckoff of the Iowa State Department of Public Health. Dr. Eckoff:

are another 22 or 23 from other agencies
and organizations in Iowa: Iowa State
University, the University of Iowa, the
Lung Association, the Easter Seal Society,
county extension, and others. So I would
certainly encourage you to view those
sessions this afternoon.

As I have listened to other people and as I
have talked to people here, I have come to
the conclusion that everybody at this con-
ference either is currently engaged in far-
ming, grew up on a farm, spent a lot of
time visiting their grandparents' farm when
they were kids, or at least liked to visit
farms or go to the petting zoo section of
the zoo.

I did grow up on a farm, but I am here to
tell you that I did not do any of those
dangerous things that some of the other
speakers have talked about. I did not
drive a combine at a young age, or a grain
truck, or anything like that.

Of course the fact that I grew up on a fruit
farm in Michigan, and we raised apples
and pears and that sort of thing, not corn
and soybeans, might have had something

Surgeon General's Conference on Agricultural Safety and Health - 1991                105


Issues That Affect the National Agenda

to do with that. I will not mention to you
the kinds of things that I might have done
that were dangerous.

This morning's session we shift gears just a
little bit and talk about some issues that
affect agricultural health and safety. We
have been talking more specifically about
some of the dangers and the activities, and
now we are going to talk about issues that
affect agricultural safety and health.

Our first two speakers will address the
agricultural work force and the behavior of
its members. Then the second two
speakers will reveal changes in the agricul-
tural work place as it is affected by new
and different crops and by biotechnology.
Biotechnology is certainly a word we hear
used a great deal these days.0

106

Papers and Proceedings


Surgeon General's ConWence on Agricuttura/ Safety and Health
,QRMSAFE 2000 o A National Coalition Ibr Local Action
Convened by the National institute Ibr Occupational SaWy and Health
April 30 - May 3, 1991, Des Moines, Iowa

THE AGRICULTURAL WORK FORCE:
   PATTERNS AND TRENDS

By Leslie A. Whitener, Ph.D.
Economic Research Service
U.S. Department of Agriculture

Dr. Ronald D. Eckoff: Dr. Leslie Whitener is a sociologist and Head of the Agricultural Labor Section,
Economic Research Service, U.S. Department of Agriculture. Dr. Whitener holds M.A. and Ph.D.
degrees in Sociology from The American University in Washington, DC., with specializations in the
sociology of work and advanced statistics. She has over 15 years of experience in farm labor
research and has authored or co-authored more than 50 papers, monographs, book chapters, and
journal articles relating to the agricultural and rural labor force. Specific studies have focused on the
problems and needs of migrant farmworkers, the effects of Food Stamp and Federal employment
programs on hired farmworkers, and labor market conditions facing farmers who seek off-farm jobs.
Dr. Whitener's presentation focuses on patterns and trends in the U.S. agricultural work force and
their implications for farm safety issues. Dr. Whitener:

INTRODUCTION             to have one of the highest "accident" rates

Major changes have occurred in American
agriculture during the last 40 years, which
have affected the way we think about
farms and the nation's farmworkers.
Farms have become fewer and larger and
agricultural production has become
increasingly concentrated on the bigger
farms.

The greater availability of machinery,
chemicals, water, improved seed and live-
stock, and public financing have led to a
greater substitution of capital for labor.
As a result, the number of agricultural
workers has declined by over 70 percent
since 1950 and the activities and working
conditions of US. farm workers have
changed dramatically.

Some of these changes have raised serious
questions about the health and safety of
agricultural workers. Agriculture continues

of any major industry group-a fact you will
undoubtedly hear repeated throughout this
conference. According to the Bureau of
Labor Statistics, for example, the incidence
rate of workplace injuries and illnesses for
agricultural production workers (12.2 in-
juries per 100 full-time workers in 1989) is
exceeded only by construction and some
manufacturing industries.*l

Other data sources show even higher injury
and illness rates for agriculture. My com-
ments today will help to provide a context
for understanding some of the farm safety
and health issues raised in this conference.
To that end, my presentation focuses on
the changing structure of American farms
and on the demographic and employment
characteristics of the people who work on
those farms.

I will concentrate on three major points
that have important implications for cur-

*The incidence rates for agricultural production workers do not include workers on farms with less than 11
employees.

Surgeon General's Conference on Agricultural Safety and Health - 1991

107


Issues That Affect the National Agenda

B

0

Increased up to 45 percent
Declined up to 16.7 percent

m Declined between 16.7 and 52.8 percent

Source:  1987 ~OIU~U of Agriculture

Figure 1. Change in Farm Numbers, 1982-87. Two-thirds of the Nation's counties lost farms;

the heaviest losses were in the eastern half of the Nation.

rent and future agricultural safety and
health issues.

b First, U.S. agriculture has changed
dramatically over time; farming and the
nature of farmwork are very different
today than they were in the 1950's.

b Second, the agricultural work force is a
diverse group of workers who perform a
wide variety of activities on the farm. This
diversity complicates generalizations about
farm safety problems and solutions.

b Third, all is not what it seems, and many
of our long-held tenets about farming and

708

farmworkers are no longer relevant or
have been based on stereotypic images
that were never true. These new ideas and
patterns suggest caution when projecting
farm labor trends to the future.

CHANGES IN FARM STRUCTURE

Perhaps the most notable change in
agriculture over the last four decades has
been the decrease in the number of farms.
Farm numbers declined by over 3 million
between 1950 and 1987, falling to about
2.1 million farms in 1987.2 Yet, these
declines have not occurred consistently
across the country (Figure 1).

Papers and Proceedings


The Agricultural Workforce, May 2, 1991

Between 1982 and 1987, for example, the
largest declines in farm numbers occurred
along the South Atlantic coast and the
Mississippi Delta. During this period, the
slow-growing economy of the rural South
encouraged many poor, part-time farmers
to leave farming for higher-paying non-
farm jobs. Many small farms were con-
solidated into larger operations.

The Corn Belt, Lake States, and most of
the Northeast also showed declines in farm
numbers but at slower rates of loss. While
the farm recession of the early 1980's un-
doubtedly affected major farm production
states, the effects appear to be less serious
than expected.

During 1982-87, the period immediately
following the farm recession, much more
change occurred in regions not usually
associated with major agricultural produc-
tion. Figure 1 shows little shading in the
midwest, and there is little indication of
severe decline in these states.' The reces-
sion apparently resulted more in financial
restructuring than in farm loss in these
areas.

In contrast to these patterns of decline,
farm numbers increased in many parts of
the United States, particularly in the
Western States and in southern Florida.
The increase in farms may be a reflection
of rapid population and employment
growth in these areas during the mid-to
late 1980's. Farm increases, particularly in
the West, were also due to division of
farms into smaller units as partnerships
dissolved or as older operators retired and
divided their farms among heirs.

Farm numbers will continue to decline in
the 1990's, but at a slower rate than was
experienced during much of the post-
World War II period. By the year 2000,
the number is expected to drop by about 6
percent-substantially below the 11 percent
decline seen during the 1980's.

Thousands of Farms           Acres
6000 1       I 600
  \     Average Size

o] , , , , F,,mNymbyrs, lo
1950                1987
          Year

      Source: Census of Agruculture, selected years.
Figure 2. Change in Farm Numbers and Size,
1950-87.

As the number of farms decreased,
average farrn size increased, forming what
some have called the "Iron Cross of
Agriculture" (Figure 2).5 Farm size
averaged 216 acres in 1950 but increased
FgSo;le' twice that, size (462 acres) by
    . ** There will be more large farms at
the turn of the century than there are
today, and by the year 2000 the largest 1
percent of farms is expected to account for
half of all farm production.6

As the number of fams decreased,
average fm size increased, forming what
some have called the %-on Cross of
Agriculture. "

** Note that the rates of increase in farm size have consistently declined since the 1950's, and the trend toward
larger farm size may be stabilizing?

Surgeon General's Conference on Agricultural Safety and Health - 1991                709


Issues That Affect the National Agenda

The current trend toward fewer and larger
farms is due to many factors, including
technological development, economies of
scale, tax laws, price instability, differences
in operators' managerial ability, capital
requirements, credit availability, foreign
trade arrangements, and Government
programs and regulations.'

PATTERNS OF LABOR USE ON
U.S. FARMS

What do these structural changes mean for
labor use on U.S. farms? Changing farm
structure has transformed labor re-
quirements on U.S. farms. Capital
substitutions of machinery, chemicals,
water, and fertilizer for labor resulted in a
substantial drop in the need for the num-
ber of workers in agriculture. In 1989, the
number of hours of labor required in
agriculture was about one-third of its 1950
level.'

Feed, seed, and livestock purchases
increased over 80 percent since 1950. The
use of agricultural chemicals, including
fertilizer, lime, and pesticides, increased by
over 500 percent. During the same period,
farm output and worker productivity
increased dramatically. In 1950, the
average farmworker supplied farm
products for about 16 people; by 1989, the
number had risen to 98 people.'

As a result, the agricultural work force,
including both family and hired workers,
declined by over 70 percent between 1950
and 1989 (Figure 3). Farm operators and
their unpaid family members continue to
provide the major portion of labor in
agriculture.

percent of annual average employment; by
1989, the proportion had increased to 35
percent.

Millions of Workers
8-

7-

6-

5 -

4 '-

3-

2-    ,---- ---\ .k--
l-      Hired ---------__

o-

   1945   1955 1965   1975   1985
           Year
           Source: USDA, NASS Farm Survey.
Figure 3. Farm Employment Trends, 1945-90.

The amount and type of labor used on
farms is related to the size of the farm
operation, the commodities produced, and
the geographic location of farms.9 Less
than half (about 954,000) of the nation's 2
million farms employed hired or contract
workers in 1987.'

Small part-time farms, particularly those
involved in grain or livestock production,
are more likely to rely on family labor.
Larger farms, especially those producing
fruits and vegetables, tend to have labor
needs in excess of the capacities of the
families who farm them. A closer
examination of farms by three size
categories provides a useful perspective on
patterns of farm labor use (Figure 4).

Small Part-Time Farms

However, hired workers have gradually    Almost two-thirds of the nation's farms are
replaced some family workers on farms.   small, part-time operations with annual
In 1950, hired workers comprised about 23  product sales of less than $25,000. For

110                                  Papers and Proceedings


most of these farmers, farming is a secon-
dary occupation, and off-farm income has
become increasingly important to their
economic survival.

Large i
Commercial

Mid-Sized Commercial (21%)
       Source: 1987 Census of Agriculture.

Figure 4. Farm Size Based on Cash Value of
Sales, 1987.

These farms are generally small, owner-
operated farms, largely dependent on
family members for labor supply. Over
two-thirds did not use any hired or
contract labor in 1987, and the remainder
averaged less than $5,000 in labor expenses
per farm.9 Most are involved in grain and
livestock production and are dispropor-
tionately located in the southern half of
the United States. Between 1982 and
1987, these small part-time farms ac-
counted for half of the national loss in
farms.

Mid-Size Commercial Farms

About one-fifth of U.S. farms are mid-size
commercial farms with annual product

The Agricultural Workforce, May 2, 1991

sales of $25,000-99,999. Mid-size commer-
cial farms are largely producers of cash
grains, cotton, and cattle-agricultural
products, which do not require large
amounts of hired labor per farm. The
1982-87 loss in the number of farms was
heavily concentrated among mid-size com-
mercial farms.

This group suffered the largest rate of
decline all the farm size categories, losing
12.5 percent of its farms. Operators of
mid-size farms are under considerable
financial pressure to either enlarge their
farming operations to a more viable com-
mercial size or to scale back to a smaller
part-time size of operation. Consolidation
of mid-size farms into larger units has
been a major source of the growth of large
commercial farms over the two past
decades.

Large Commercial Farms

Large commercial farms, those with annual
sales over $100,000, have grown in number
over time and comprised about 14 percent
of all U.S. farms in 1987. Agricultural
production and hired farm labor use are
becoming increasingly concentrated on
these larger farms.

The largest 2 percent of commercial farms
(with cash sales of $500,000 and over)
accounted for over half (54 percent) of the
total expenditures for hired labor in 1987.
These farms tend to specialize in
vegetables, melons, fruits, tree nuts, and
specialty crops. The production and har-
vest of these crops has not been widely
mechanized and continues to require large
amounts of hired labor during critical
periods.

These large farms are concentrated
geographically. California, Texas, and

Surgeon General's Conference on Agricultural Safety and Health - 1991

III


Issues That Affect the National Agenda

Florida, together with four other states
(Washington, Wisconsin, North Carolina,
and Pennsylvania) accounted for almost
half of all hired labor expenditures in
1987. Hired farmworkers will become
increasingly important to agricultural
production as these labor-intensive farms
continue to grow in number.

Patterns of change by farm sales class
suggest continued movement toward a
bifurcated or dual structure of agriculture.
One group represents a small number of
large, capital and labor-intensive commer-
cial farms that produce a growing share of
the nation's food and fiber.

         Source: Agricultural Work Force Survey.
Figure 5.  Components of the Agricultural
Work Force, 1987.

The second component represents a large
number of small, owner-operated farms
that are largely dependent on off-farm
income and use few hired workers. Al-
though comprising the majority of farms,
these small part-time farms account for
only a small portion of total production,

and many exist primarily as a means of
preserving a rural lifestyle for operators
and their families.'

THE AGRICULTURAL WORK FORCE:
A PORTRAIT OF DIVERSITY

Who are the nation's farmworkers? Data
from the U.S. Department of Agriculture's
(USDA) Agricultural Work Force Survey
indicate that almost 7.7 million persons 14
years of age and older were employed on
U.S. farms as farm operators, hired
farmworkers, and unpaid farmworkers in
1987." Over 1 million persons performed
more than one of these three activities.
For example, some farmers operated their
own farm but also hired themselves out for
wages to other farmers.

To avoid double-counting individuals in
more than one category, individuals were
grouped by their major farmwork oc-
cupation, the activity in which they spent
the most time during the year. By this
definition, there were approximately 2.7
million farm operators (35 percent), nearly
2.2 million hired farmworkers (28 percent),
and almost 2.9 million unpaid farmworkers
(37 percent) (Figure 5).

These data help to define an agricultural
work force that is subject to potential risk
from farm accidents, illnesses, and injuries
because they work on farms. However,
several groups are excluded from this
population at potential risk, including
children working on farms. The Fair
Labor Standards Act allows children to
legally work on farms under certain con-
ditions.* * *

The Agricultural Work Force Survey did
not collect information on the number of
children under 14 who worked on the
nation's farms. We do know, however,

772                                   Papers and Proceedings


that about 1.2 million children under 14
years of age resided in farm operator
households; it is likely that many of these
children helped out with farm chores.

Another 800,000 children lived in
households headed by hired farmworkers;
some may have worked along with their
parents." There is no direct evidence from
the survey to suggest how many of these
children actually worked on farms.

The Agricultural Work Force Survey also
did not count two other groups of hired
farmworkers-foreign workers who legally
enter the United States to do temporary
farmwork and undocumented foreign
workers who enter this country illegally to
do hired farmwork.

These hired workers were probably not
included in the survey data because they
returned home before data collection in
December or because they tended to avoid
contact with Federal enumerators. These
two groups are discussed in more detail
later in this paper.

A look at the numbers and characteristics
of the different components of the agricul-
tural work force reveals the considerable
diversity among these workers and points
up the difficulties of generalizing farm
occupations.

The Agricultural Workforce, May 2, 1991

Farm Operators

About 2.8 million people operated a farm
that they owned, rented, or leased at some
time during 1987, according to USDA's
Agricultural Work Force Survey.`" Two or
more persons (such as a husband and wife
or partners) could operate one farm, and
both would be included as farm operators
under this definition.

Most of the farm operators were white (97
percent), male (77 percent) and middle-
aged (median age of 47 years). Farm
operators on average had relatively high
levels of formal education. Eight out of
ten operators had completed high school
and three out of ten had some college
education.

Farm operators averaged 235 days oper-
ating a farm in 1987. About 58 percent
worked 250 days or more operating a farm,
while only 11 percent worked fewer than
25 days. In addition, almost half did some
non-farm work during the year and non-
farm work provided an important source of
income. Those who did non-farni work
averaged 213 days of work in non-farm
activities with average annual non-farm
earnings of $15,882.

Unpaid Workers

Unpaid farmworkers are those who do any
amount of farmwork without receiving cash

***The Fair Labor Standards Act limits the employment of minors in agriculture according to age and
occupational activity. Children 14-15 years old may work on farms outside school hours in non-hazardous
occupations in agriculture. Children aged 12-13 years may work outside school hours in any nonhazardous farm
job with written parental consent or on the same farm where their parents are employed. Children lo-11 years
of age may work outside school hours in any nonhazardous farm job, with written parental consent only on farms
where none of the employees are legally entitled to the Federal minimum wage; a special waiver may be obtained
from the U.S. Department of Labor. Children of farm owners or operators may be employed by their parents
at any time and in any occupation on a farm owned or operated by their parents."

Surgeon General's Conference on Agricultural Safety and Health - 1991                113


Issues That Affect the National Agenda

wages or salary, or receive only a token
cash allowance, or do farmwork for room
and board or payment-in-kind. The largest
component (46 percent) of the agricultural
work force in 1987 was made up of the 3.6
million people who did unpaid farmwork.

The majority of these workers were white
(95 percent), male (66 percent), and young
(median age of 31 years). They had
relatively high levels of education; 77 per-
cent had completed high school and 37
percent had some college."

The largest component (46 percent) of
the agricultural work force in 1987 was
made up of the 3.6 million people who
did unpaid farmwork.  I

Most of these unpaid workers did not
reside in farm operator households.
However, the 34 percent of unpaid workers
who did live in farm operator households
generally worked more days at their farm
activities. They averaged 101 days of un-
paid farmwork compared to only 30 days
for those not living in farm operator
households.

Almost 70 percent of unpaid farmworkers
did some non-farm work during the year.
They averaged 211 days of non-farm work
and 40 days of unpaid farmwork and
earned an average of $13,900 from non-
farm work during the year.

Hired Workers

The nation's hired farmworkers originate
from three different sources of labor:
domestic workers (including those hired
directly and those employed through crew
leaders or farm labor contractors), foreign

nationals brought into the country under
the H-2A Program, and undocumented
foreign workers.

1. Domestic Hired Farmworkers

The number of hired farmworkers has
decreased by almost 40 percent, falling
from a high of 4.2 million workers in 1950
to about 2.5 million in 1987." Most of
these losses occurred in the 1950's and
1960's, largely as a result of the adoption
of new production and marketing tech-
nology on farms, including labor-reducing
machines and higher-yielding crops and
livestock.

During the 1970's, however, hired worker
displacement slowed considerably as large-
scale mechanization and technological
innovations with large labor displacement
potential leveled off. Between 1970 and
1987, the number of hired farmworkers
stabilized at 2.5 to 2.6 million annually,
after years of continuous decline."

On average, hired farmworkers are young
and male, with relatively low levels of
education. More than 40 percent of hired
workers 25 years of age and over had not
completed high school compared with only
15 percent of the U.S. labor force 25 years
and over. The educational disadvantage
was even more pronounced for minorities.

Because of the seasonal nature of agri-
culture, hired farmwork is frequently
unstable, sporadic, and of short duration.
In 1987, the average hired farmworker
spent 112 days doing farmwork. However,
there was considerable variation in days
worked. More than half (55 percent)
worked fewer than 75 days during the year.
Only one-fifth were year-round workers
who worked more than 250 days during the
year (Figure 6).

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Percent                  - Herd sheep in Idaho.

   c25    25-74   75-149  150-249  250+
       Days Worked
       Source: 1987 Agricultural Work Force Survey.
Figure 6.  Hired Farmworkers by Days of
Farmwork, 1987.

Hired farmworkers were paid an average
of $4.87 per hour for farmwork in 1987.
This low wage and the seasonal
employment combined to make hired
farmworker earnings among the lowest of
all occupational groups in the United
States. Hired farmworkers earned an
average of $6,663 from both farm and non-
farm jobs in 1987, accounting for only 41
percent of the $16,2501' earned by the
average nonagricultural private sector
workers.

However, the nation's hired farmworkers
are a diverse labor force, and a picture of
the average farmworker can be misleading.
Popular image depicts hired farmworkers
as a large, undifferentiated group of low-
income workers with little education and
few skills, who harvest the nation's fruits
and vegetables mostly in California and
Florida. Yet hired farmwork comprises a
wide range of activities performed all over
the United States.12 For example, hired
farmworkers:

- Cut sugarcane in Florida.
- Strip and bale tobacco in Kentucky.

The Agricultural Workforce, May 2, 1991

- Operate a combine in Kansas.
- Milk cows in Vermont.
- Shear Christmas trees in Michigan.
- Stock catfish ponds in Florida.
- Serve as farm managers in Oregon.

Hired farmworkers not only perform
widely different activities, but they work
for a variety of reasons. Hired farm-
workers include household heads, who do
hired farmwork on a regular or year-round
basis and whose families depend on their
farm earnings for economic support, as
well as non-farm workers who do seasonal
farmwork to supplement their non-farm
earnings.

Also included is a large group of students,
housekeepers, and others not in the labor
force most of the year, but who do a few
days or weeks of farmwork during the year.
Some of these workers are earning extra
spending money while others contribute
necessary earnings to the family income.16

2. Migrant Farmworkers

Migrant farmworkers provide a necessary
supplement to local labor when demand
exceeds the supply of farmworkers living in
a local areas. After almost 50 years of
Congressional hearings, countless Federal
task forces, poignant documentaries and
books, and national media coverage of the
socioeconomic problems of migrant farm-
workers, we still wrestle not only with the
question of how to help these workers, but
also how to count them.

Data collection is complicated by the wide
variation in definitions and measurement
procedures used by Federal agencies and
others concerned with migrants, as well as
with difficulties in counting a transient
population. As a result, population counts

Surgeon General's Conference on Agricultural Safety and Health - 1991

115


Issues That Affect the National Agenda

range widely from a low of around 200,000
reported by USDA in the mid-1980's to as
many as 1.6 million migrants and their
dependents reported."

Little statistical information is available on
the travel patterns or routes followed by
migrants as they harvest the Nation's
crops. Common perception suggests the
existence of three major migrant streams,
one each on the east and west coasts, and
one in mid-continent. However, the
uniformity of migrant travel patterns has
not been well-documented leading one
farm labor expert to observe that:

The maps of migratory streams-Atlantic,
Pacific, and Mid-continent-which in the
past were so prominent and still are to
be seen now and again, embodied more
jlows of imagination than of people."

Figure 7 illustrates the commonly per-
ceived image of three major migrant
streams. Figure 8 shows the more likely
patterns. In 1977, David Lillisand et al.
conducted a survey for the Legal Services
Corporation across the
county to determine the
state of origin, last state of
employment, and next state
of destination for migrants
in various states."

While the data do show
three broad patterns of
migratory travel consistent
with the common image,
they also indicate con-
siderable deviation from
three major streams. The
study concluded that if pat-
terns of migrant travel
existed at all, they were
much more complex than

the commonly perceived image of three streams.

3. Foreign Workers

Foreign workers leave their home
countries to work in U.S. agriculture
because there are more jobs and higher
wages here. Lack of education, work ex-
perience, or language fluency do not
hinder foreign workers as much in agricul-
ture as in many other types of jobs. As a
result, many U.S. farm employers have
come to rely on foreign workers as a ready
source of labor.

b Temporary Foreign Workers. Some
foreign nationals are legally admitted to
the United States to do hired farmwork
under the H-2A Temporary Foreign
Worker Certification Program. This
program, administered by the U.S.
Department of Labor, permits foreign
workers to enter the United States to do

farmwork when there are not enough
available qualified domestic workers to
the work and when the employment of

do

Figure 7. Travel Patterns of Domestic

   From
Puerto Rico

Seasonal Migratory Agricultural Workers.
         - Source: Migrant Health Program, U.S. Public Health Service.

176                                   Papers and Proceedings


The Agricultural Workforce, May 2, 1991

foreign workers will not adversely affect
the wages or working conditions of similar-
ly employed U.S. farmworkers.

About 26,000 farm jobs were certified for
foreign workers under the H-2A program
in 1989. Due to their small numbers,
H-2A workers have little effect on the
national farm labor market. However,
they do account for a significant portion of
the labor force in some production areas,
particularly Florida sugarcane, and eastern
and northeastern apples.

Concern over the large number of un-
authorized workers coming to the United
States led to the passage of the
Immigration Reform and Control Act
(IRCA) of 1986. The Act was designed to
reduce the flow of undocumented workers
by imposing fines and jail terms on
employers who hired them.

At the same time, IRCA offered legal U.S.
residence status to qualifying un-
documented workers who had resided

b Undocumented Foreign
Workers. Illegal aliens
have a much greater effect
on the U.S. farm labor
market because of their
large numbers than do
legally admitted foreign
workers. There is little
reliable statistical infor-
mation on the numbers
and characteristics of these
workers. Deriving a
reliable count is
problematic because of the                                                   c
migratory nature of this
illegal work force and      Figure 8. Farm Labor Migration Patterns."

because many of these    - Source: Lillisand et al. in a study prepared in 1977 for the Legal Services Corporation.

workers will not participate

in surveys for fear of revealing their illegal  continuously in the United States since
status.                 before January 1, 1982. Over 1.7 million
                   persons were approved for resident status.
Experienced observers of the farm labor
market during the mid-1980's believed that  Many of these people are experienced
undocumented workers accounted for    farmworkers and may choose to continue
about lo-15 percent of all hired farm-    to work in agriculture. IRCA also es-
workers, with higher proportions in the    tablished a Special Agricultural Worker
labor-intensive fruit and vegetable sector.20  (SAW) program for producers of
Farm labor experts now believe this figure  perishable commodities.
to be much higher.            This program allows undocumented

workers who previously worked in seasonal
agricultural services to apply for legal

Surgeon General's Conference on Agricultural Safety and Health - 1991                777


Issues That Affect the National Agenda

resident status. About 1.3 million persons
applied, and a high approval rate is ex-
pected.

IRCA could have important implications
for the supply, demand, working con-
ditions, and wage structure of both illegal
and U.S. hired agricultural workers in the
future. The absence of reliable statistical
information on illegal aliens creates dif-
ficulties for estimating the effect of im-
migration reform on agriculture.

. ..the hired component of the agricultural
work force will continue to grow in impor-
tance as hired workers increasingly
replace family workers on farms and as
the number of large, labor-intensive com-
mercial farms continues to increase.

However, it is likely that many of the
farms affected by immigration reform will
be those that hire large numbers of
seasonal farmworkers. Vegetable, melon,
fruit and tree nut, and horticultural
specialty farms are generally the least
mechanized and require a large number of
workers for short periods of time. These
farms are generally concentrated on the
Pacific Coast, in the Southwest, the Nor-
theast, in Florida, and around the Great
Lakes.`, 21

OUTLOOK FOR THE FUTURE

Patterns of farm labor use have changed
dramatically over the past four decades
and definite employment trends emerged
in the seventies and eighties. What do
these trends suggest for farm labor re-
quirements in the future?

It is likely that the trend toward fewer and
larger farms will continue in the near
future, although the rate of change is ex-
pected to be slower than during the 1970's
and 1980's. Also, the hired component of
the agricultural work force will continue to
grow in importance as hired workers
increasingly replace family workers on
farms and as the number of large, labor-
intensive commercial farms continues to
increase.

If current trends in farm inputs persist, we
will see increased use of agricultural pes-
ticides, fertilizers, and pesticides.
Mechanization of the harvest of some
fruits and vegetables is possible in the near
future, but labor reductions are not likely
to be as great as those of the 1950's or
1960's.

For tree fruits and nuts, extensive replan-
ting of trees is often required for machine
harvesting, and costs for replanting and
lost productive years are often difficult to
justify. For some fruits and vegetables,
such as strawberries and asparagus, the
technology needed to machine harvest
efficiently with minimal product damage
has not yet been developed.16

The 1990 Food, Agriculture, Conser-
vation, and Trade Act of 1990 directs the
Secretary of Commerce to include ques-
tions relating to agricultural
accidents and farm safety in the 1992
Census of Agriculture.

Several factors will help determine pat-
terns of farm labor use in the future,
including technology development, inter-
national trade, farm programs, immigration
policy, and relative prices of major farm

178

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The Agricultural Workforce, May 2, 1991

inputs. Recently enacted immigration
reform legislation has not yet been em-
pirically evaluated and could have impor-
tant effects on farm labor supply, demand,
and wages.

Also, negotiations are currently underway
between Mexico and the United States
concerning removal of trade barriers bet-
ween the two countries. A Mexican free
trade agreement has the potential to affect
movement of jobs and workers across the
border.

SUMMARY AND IMPLICATIONS

My comments today point to three major
conclusions:

b First, changes in the structure of farming
have dramatically affected the numbers,
activities, and working conditions of the
agricultural labor force.

Farming and the nature of farms are very
different today. The trend toward fewer
and larger farms has reduced the number
of family workers but increased the
average farm's hired labor requirement.

Operators and hired workers must have a
varietv of skills to nerform farm tasks.
ranging from hea equipment operator to
chemical applicator.2 Length and intensity
of farm work days exhibit high variation, -
and the number of hours worked per day is
often dictated by weather conditions.

The use of agricultural chemicals on the
farm has increased dramatically since the
1950's, and technological developments
have placed a wide variety of complex
machinery on U.S. farms. The changing
nature of agricultural work has led to
increased concern about the health and
safety of agricultural workers.

. Second, the agricultural work force is
comprised of diverse workers with dif-
ferent demographic characteristics, skills,
and experience, who work on a variety of
farms in a multiplicity of farm activities
throughout the country. Components of
the agricultural work force include farm
operators, unpaid workers, domestic hired
farmworkers, legal and illegal foreign
workers, migrants, and children. This
diversity complicates generalizations about
farm safety problems and solutions.

F Third, many of our long-held beliefs
about farming and farmworkers are no
longer relevant or have been based on
stereotypic images that were never true:

1.







2.








3.







4.








5.

Despite long-term declining trends in
farm numbers, some areas of the
country, particularly the West, are ex-
periencing increases in the number of
farms.

The majority of U.S. farmers are part-
time farmers and have a principal oc-
cupation other than farming. For
whatever reason, farming is a second
job, and many work only a few days in
farm activities.

Employment of hired farm workers is
highly concentrated on the large com-
mercial farms, and 2 percent of the
biggest farms accounted for over half of
all labor expenditures.

While the number of hired farmworkers
has declined over the last 40 years,
most of the decrease was in the early
1950's and 1960's. During the 1970's
and 1980's, the number of workers
stabilized.

While many hired farmworkers are
involved in the harvest of fruits and

Surgeon General's Conference on Agricultural Safety and Health - 1991                179


Issues That Affect the National Agenda

vegetables, farmworkers also do such
diverse activities as shearing sheep,
pruning Christmas trees, stocking cat-
fish ponds, and baling tobacco.

These findings suggest that we should not
become complacent about long-term pat-
terns and trends in farm employment.
However, continued monitoring of farm
labor conditions is dependent on adequate
data collection on all components of the
agricultural work force.

While we collect comprehensive infor-
mation on agricultural production levels,
value of sales, and costs of production,
little data are available on the characteris-
tics, wages, and working conditions of
agricultural workers. More detailed farm
labor information at the local level is
needed to help assess the impact of farm
labor policies and programs, including
those related to agricultural safety and
health, on the employment and working
conditions of the nation's farmworkers.

Passage of the most recent Farm Bill may
help to improve our data collection efforts
in this area. The 1990 Food, Agriculture,
Conservation, and Trade Act of 1990
directs the Secretary of Commerce to
include questions relating to agricultural
accidents and farm safety in the 1992 Cen-
sus of Agriculture.  The Bureau of the
Census is currently pre-testing a series of
questions to collect these data in the next
Census.

At the same time, the Farm Bill also
authorizes the Secretary of Agriculture to
make grants for the establishment of farm
safety education programs for farmworkers,
timber harvesters, and farm families.
These grants, coordinated with state offices
of rural health and the U.S. Department of
Health and Human Services, are to
provide information on such topics as the
reduction of occupational injury and death
rates, exposure to farm chemicals, occupa-
tional rehabilitation of farmers with
physical disabilities, and farm accident
rescue procedures.

The changing nature of agricultural work
has led to increased concern about the
health and safety of agricultural workers.

While funding for these grants has not yet
been appropriated, the mechanism is in
place to improve our farm safety
educational efforts. These two legislative
components of the 1990 Farm Act recog-
nize growing National concern over
agricultural safety and health issues and
provide the potential to improve our data
collection and expand our educational
efforts to help reduce accidents, illnesses,
and deaths on the nation's farms.0

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The Agricultural Work-force, May 2, 1991

REFERENCES

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

U.S. Department of Labor. Survey of Occupational Injuries and Illnesses, 1989. Summary 91-1.
Washington, D.C.: Bureau of Labor Statistics. January, 1991.

U.S. Department of Commerce, Bureau of the Census. 1987 Census of Agriculture. Volume 1,
Geographic Area Series, United States Summary and State Data, 1989.

Brooks, Nora L., Judith Z. KaIbacher, and DOM A. Reimund. Farm Structural Trends in the 1980's. AIB
No. 605. Washington, D.C.: U.S. Department of Agriculture, Economic Research Service, 1990.

Carlin, Thomas A. and DOM A. Reimund. Changes in Farm Structure. Paper presented at the Annual
Agricultural Outlook Conference, Washington, D.C., 1990.

Friedland, William H. The Labor Force in U.S. Agriculture, in Lawrence Busch and William B. Lacy,
Food Security in the United States. Boulder, Co.: Westview Press, 1984, pp 143-181.

Smith, Matthew G., Clark Edwards, and Neal Peterson. How Many Farms? Projecting U.S. Farm
Numbers and Sizes, Rural Development Perspectives. Vol. 3, Issue 3. June, 1987.

Schertz, Lyle P., et al. Another Revolution in U.S. Farming. 7 AER No. 441. Washington, D.C.: U.S.
Department of Agriculture, Economic Research Service, 1979.

U.S. Department of Agriculture. Production and Efficiency Statistics, 1989. Washington, D.C.: Economic
Research Service, 1991.

Oliveira, Victor J. Hired and Contract Labor in U.S. Agriculture, 1987: A Regional Assessment of
Structure. Washington, D.C.: U.S. Department of Agriculture, Economic Research Service, forthcoming
1991.

Runyan, Jack L. A Summary of FederaI Laws and Regulations Affecting Agricultural Employers. AIB No.
550. Washington D.C.: U.S. Department of Agriculture, Economic Research Service, 1989.
Ohveira, Victor J. The Agricultural Work Force of 1987. AER No. 609. Washington, D.C.: U.S.
Department of Agriculture, Economic Research Service, 1989.

Oliveira, Victor J. and E. Jane Cox. Characteristics of Agricultural Work Force Households, 1987. AIB
No. 612. Washington, DC.: U.S. Department of Agriculture, Economic Research Service, 1990.

U.S. Department of Agriculture. The Agricultural Work Force Survey of 1987. Economic Research
Service, 1987.

Oliveira, Victor J. Trends in the Hired Farm Work Force, 1945-87. AIB No. 561. Washington, D.C.: U.S.
Department of Agriculture, Economic Research Service, 1989.

U.S. Department of Labor. Employment and Earnings. Washington, D.C.: Bureau of Labor Statistics.
January, 1987.
Whitener, Leslie A. and Rafrq Mtmir. Hired Farm Labor, pp 102-112 in Barse, Joseph R. (ed.), Sever1
Farm Input Industries. Agricultural Economic Report No. 635. Washington, D.C.: U.S. Department of
Agriculture, Economic Research Service. Washington, DC, 1990.

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Issues That Affect the National Agenda

17. Whitener, Leslie A. Migrant Farmworkers: Characteristics and Trends, in Out of Sighi, Out of Mind:
An Update on Migrant Farmworker Issues in Today's Agricultural Labor Market. National Governors'
Association, 1985.

18. Holt, James, et al. Toward the Definition and Measurement of Farm Employment, in Proceedings of
Workshop on Agricultural and RuraI Data. Jointly sponsored by the American Agricultural Economics
Association and the U.S. Department of Agriculture, 1977.

19. Lillesand, David, Linda Kravitz, and Joan McClellan. An Estimate of the Number of Migrant and Seasonal
Farmworkers in the United States and the Commonwealth of Puerto Rico. Washington, D.C.: Legal
Services Corporation, 1977.

20. Coltrane, Robert. Immigration Reform and Agricultural Labor. AER No. 510. Washington, D.C.: U.S.
Department of Agriculture, Economic Research Service, 1984.

21. Duffield, James, Mitchell J. Morehart, and Robert Coltrane. Labor *end&es Help Determine Farms
Affected by Immigration Reform. AIB No. 557. Washington, D.C.: U.S. Department of Agriculture,
Economic Research Service, 1989.

22. Daberkow, Stan G. and Conrad F. Fritsch. Agricultural Workplace Safety? A Perspective on Research
Needs, American Journal of Agricultural Economics. 61 (4), 1979, pp 824-835.

722

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Surgeon General's Confemnce on Agrfcultural SaWy and Health
FARMSAFE 2000 o A National Coalition Rx Local Action
Convened by the National institute Ibr Occupational Safety and Health
April 30 -May 3, 1991, Des Moines, Iowa

ATTITUDES AND RISK BEHAVIOR

By Pamekz D. Elki& Ph.D.
Professor, Department of Sociology
Eastern Washington University

Dr. Ronald D. Eckoff: Our next presentation will be by Dr. Pamela Elkind on attitudes and risk
behavior. Dr. Elkind has a bachelor's degree in sociology from Boston University, a master's degree
in sociology from Boston University, and a Ph.D. in sociology from Northeastern University with joint
course work at Tufts University. Her special areas of work have been environment and energy, social
impact assessment, medical sociology, rural communities, and research methods. Dr. Elkind has
held a variety of research and consulting positions and for the past ten years has been at Eastern
Washington University in the Department of Sociology where she is a professor of medical sociology,
environmental sociology, and a research specialist. Dr. Elkind will be presenting this morning in
relation to Attitudes and Risk Behavior.  Dr. Elkind:

Thank you. Good morning. I have been
asked to speak to you today about
behavioral attitudes related to hazardous
farm activities. To speak to this subject,
three questions should be asked.

b Firstly, why consider agricultural at-
titudes?

b Secondly, what are the relevant at-
titudes?

. Thirdly, how are these attitudes related
to farm health and safety practices?

These are the questions we will consider
today.

AGRICULTURAL ATTITUDES

The first question I shall address is, Why
consider agricultural attitudes? As in this
extraordinary conference, farm health and
safety is receiving attention in the early
90's. Coalitions of concerned citizens and
organizations are becoming common.
OSHA is developing regulations. NIOSH
is funding large projects. Kellogg is
initiating special innovation projects.

Popular magazines are covering the risks
of agriculture. Programs and projects that
deal with the safety of farm populations
are being conceptualized.

Within the framework of the various
projects, there appears to be an important
assumption. This assumption, simply
stated, is that to make agriculture safe for
the farm families and workers, it is neces-
sary to motivate them to protect themsel-
ves from health and safety hazards.

The assumption further suggests that the
way to accomplish this is to educate them
about the dangers and possible negative
outcomes of hazards. It is assumed that
armed with the statistics and the
knowledge of the means of protection, the
agriculturalist will change behaviors, ul-
timately diminishing injuries and casualties.
I shall attempt to demonstrate to you that
these assumptions lack validity.

Principal persons in 206 farm families were
interviewed in the State of Washington, in
1988 and 1989. The data were gathered as
one of four subgroups in an analysis of
farm hazards sponsored by the University

Surgeon General's Conference on Agricultural Safety and Health - 1991               123


Issues That Affect the National Agenda

of Iowa, Institute of Agricultural Health
and Occupational Medicine. Many of you
have referred to this as the NCASH study.

1

This assumption, simply stated, is that to
make agriculture  safe for the farm
families and workers, it is necessary to
motivate them to protect themselves from
health and safety hazards...1 shall attempt
to demonstrate to you that these as-
sumptions lack validity.

There is a good deal of similarity between
the four states, data sets, but today we will
speak of Washington State. Respondents
were asked to compare farming to other
occupations in terms of occupational
hazards, including health effects and in-
juries. In our Washington State sample, 80
percent of those questioned believed that
farming is at least as dangerous as other
occupations, and there is no significant
correlation between perceptions of farm
safety and gender, occupational longevity,
age, education, or outside occupational
status. This leads us to conclude that
there is a generalized agreement across all
categories in the farm population that
agriculture is hazardous.

However, the knowledge that farming is
dangerous does not necessarily affect the
attitudes of the respondents (Figure 1).
When asked if they were more concerned
about farm safety and health than econ-
omic issues, as, for example, farm product
prices, only 21 percent were more con-
cerned about health and safety.

Furthermore, when later in the interview
we asked if the health hazards in farming
are great enough for them to discourage
their children from farming, only 6 percent

124

of the sample replied yes (Figure 2). In
fact, those who felt farming was most
dangerous were more likely not to dis-
courage their children from farming.

            Number of
            Resoonses   Percent
Yes              43       20.9
No              140       45.5
Equally Concerned     53       25.7

Figure 1. More Concerned About Health and Safety
Than Farm Product Prices.

There is the greatest likelihood that a farm
family knows agriculture is dangerous in
terms of health and injury, yet parents
believe it is an appropriate occupation for
their children and are more concerned
over the economics of agriculture than
anything else.

Figure 2. The Health Hazards in Farming Are Great
Enough That You Could Discourage Your Children
from Farming.

In an interview, it is difficult to evaluate
behavior, since only reported behavior is
measured. Yet, some elements may be
scrutinized. Respondents were asked
about the precautions they take when
dealing with agri-chemicals, tractors,
machinery, or with grains, feed, and bed-
ding material.

They were asked to choose from among
lists of choices, which range from staying

Papers and Proceedings


downwind and washing one's hands to
wearing protective devices and using
machine or vehicle safety equipment.
Though many of the safety approaches
would appear to take little effort, 18 per-
cent did none of these.

Conversely, 82 percent of the sample take
some safety precaution, and there is no
significant difference in their behavior with
respect to the degree they consider agricul-
ture hazardous. Some families practice a
good deal of safety. About 40 percent of
the sample reported that they regularly
practice 5 percent to 10 percent of the
safety precautions. Again, there was no
significant difference between these
behaviors when correlated with diverse
perceptions of farm hazards.

This analysis suggests to us that:

b First, based on the sample of
Washington State farm families surveyed,
there is a good deal of knowledge about
farm hazards in the population. Farmers
perceive agriculture as dangerous.

b Second, we might conclude that the
attitudes about the importance of those
hazards with respect one's own life differ
from the knowledge of the hazards. In
fact, when weighed against the family's
economic well-being or a child's future in
agriculture, the hazards are overlooked.

b Third, behaviors of taking precautions
tend to be unrelated to the knowledge of
hazards. Farmers who regularly take many
safety precautions do not say that farming
is any more or any less dangerous than
those who do nothing to protect their
families and workers.

Thus, I will argue, based on the
Washington State sample, that knowledge

Attitudes and Risk Behavior, May 2, 1991

about farm-based safety and health
hazards is unrelated to deep-seated values
and attitudes about what is important in
farm life, and it is ultimately unrelated to
the behaviors found in farm families with
respect to safety practices. I will further
argue that if knowledge is, in fact, not
related to the reported attitudes and
behaviors, one cannot conclude that
change in the knowledge about safety will
yield change in safety precautionary
behavior. There are, I might add, some
number of intervening variables within the
attitudinal structures of farm families that
require understanding in order to discover
in what way behavioral changes might take
place to increase farm safety practices.

RELEVANT ATTITUDES

Next, we should discuss what the relevant
attitudes are that we might consider.
Research since the 1930's has
demonstrated a consistent value orien-
tation pervasive in rural farm regions. The
value set is known as agrarianism. It ap-
pears to partially emanate from Thomas
Jefferson's anti-Federalist thinking as ap-
propriated from Aristotle, Locke, and
Montesquieu.

The pattern is derived from farmers' back-
grounds in the class struggles of the 18th
century European estate system.

o  Agrarianism suggests that rural life is
natural and healthy rather than ar-
tificial or evil.

o  The ownership of land makes the
farmer self-reliant and independent.

o  Agriculture is nationally important.


o  Thus, farming is a virtuous occupation.

Surgeon General's Conference on Agricultural Safety and Health - 1991                125



Issues That Affect the National Agenda

The sense of equality and independence in
agriculture points to a positive benefit of
democracy, and farmers tend to be fierce
defenders of democracy.

Sociologists defined rural life, early in the
century, as having an habitual character
and an even flow. Life rested upon deeply
felt and emotional relationships rooted in
the steady rhythms of uninterrupted habit.

The intimate relations between persons
were based upon their individuality and
wholeness. The traditional lifestyle was
comprised of friendship groups, neighbor-
liness, and blood relations.

The attitudes of persons involved in 20th
century agricultural production result
from a lifestyle structured around conflic-
ting values; traditional agrarian and con-
temporary market values clash.

The social values and ideas had their
points of reference within these social
groups and organizations. Farm-based
economic independence and social equality
foster the sharing of problems and ac-
tivities by collectives engaged in land-based
living over time.

However, the deepest problems of modern
life derive from the claim of the individual
to preserve the autonomy and individuality
of existence in the face of overwhelming
social forces, of historical heritage, of exis-
tence, of external culture, and of the tech-
nique and technology of life. Farmers ex-
perience these problems more than other
groups. Agrarian values stress autonomy
and individuality, but agriculture neces-
sitates a great deal of interaction within

the economic and political institutions of
the society.

Agriculture is a scientific endeavor re-
quiring a great deal of educational back-
ground reinforced by practical experience.
It involves a knowledge base in agronomy,
economic projection, and fiscal
management training, personnel
management training, and a solid
knowledge of both the marketplace and
government regulatory policy.

Farming today, at every level, is involved
with local, state and federal governments
in, for example, subsidies, tax adjustments,
and regulations of both crop output and
farm practices. Technological develop-
ment necessitates a constantly changing
body of regulation in agriculture.

The agricultural lifestyles, attitudes, and
behaviors today are the outcome of the
opposing forces of traditional agrarianism
against the economic realities of a highly
technical, rapidly changing society. The
attitudes of persons involved in 20th cen-
tury agricultural production result from a
lifestyle structured around conflicting
values; traditional agrarian and contem-
porary market values clash. The result is a
shared pattern of living and thinking,
which differs from both the old farm ways
and the highly urbanized, post-industrial
society.

SAFETY AND HEALTH PRACTICE

Finally, let us consider how these attitudes
are related to farm health and safety prac-
tices. There is a paucity of research on the
question, but I shall use a few of the avail-
able studies to suggest some answers.

According to Warwick, everything we know
about accidents leads us to the conclusion

726

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that faulty habits and attitudes are the
prime accident producers.'

Murphy, hypothesizing that those farmers
who hold different attitudes about health
and safety from other farmers would have
different accident records, looked at the
diversity of attitudes and accidents in
Pennsylvania.' Using a semantic differen-
tial procedure contrasting attitudes in
about 500 farmers, he found no significant
difference between the attitudes of persons
working where accidents had occurred in
the previous five years, and those of ac-
cident-free farmers. In fact, no differences
in safety attitudes or occurrences were
found between farmers, when they were
grouped by such demographic and struc-
tural variables as farm size, number of
workers, type of farm, level of education,
or hours worked on the farm.

He concludes that other factors are likely
to be more related to farm accidents than
safety attitudes. His suggestion is that the
pressures exerted by society and the low
value actually placed upon safety in the
decision process is likely to cause more
risk behavior and, ultimately, accidents.

Napier, et al., conducted an extension-
based analysis of farm risks in the state of
Ohio.3 Their statistically based research
also indicated that there were no sig-
nificant demographic or structural
variables that would account for the ac-
cident rate differentials on farms in Ohio.
Further, they considered a farmer's ac-
cident background and decided that social
learning or experience with hazards does
not make a significant difference in ac-
cident rates, since people may or may not
repeat their mistakes.

Farm family attitudes may be related to
economic well-being, as the Washington

Attitudes and Risk Behavior, May 2, 1991

study suggests. They may revolve around
the problems of agricultural productivity
and the various costs surrounding preven-
tive measures; however, the attitudes and
ultimately behaviors could also be con-
nected to a range of risk-taking personality
characteristics and coping mechanisms.

They are also likely to be related to an
occupational culture. An excellent
example of occupational culture could be
considered that of mine workers. Yount
found very definite work culture charac-
teristics in risk behavior associated with
mine workers.4

The manner in which they treated hazards,
the interaction with respect to fear, and
discourse while in social settings all
demonstrated risk-taking and hazard--
coping mechanisms shared by the work
culture. These characteristics and attitudes
are influenced by the environment of their
daily work, and they influence their
everyday behaviors. Similar feelings and
findings are likely to be found in
farmworkers.

Other elements such as ethnic or gender
culture may also be related to attitudes.
For example, a NIOSH/OSHA safety
training story comes to mind. An Hispanic
male working with hazardous materials was
ordered to wear protective clothing: shoes,
mask, and gloves. He wore all of these
items except the gloves.

When ordered continuously to wear the
gloves for his own protection, he finally
responded that yellow gloves remind him
of his mother washing dishes. As a strong
male, he could not force himself to wear
the gloves. When black gloves replaced
the yellow ones, the problem was solved.
In the case of this worker, there were
personality characteristics associated with

Surgeon General's Conference on Agricultural Safety and Health - 1991                727


Issues That Affect the National Agenda

the cultural statement of masculinity that
were outstanding. These stories are per-
vasive in the occupational safety domain.

What characteristics and attitudes are at
play when engineers monitoring construc-
tion sites or hazardous waste sites and
educated not to enter sealed tunnels
beyond four feet continuously take flash-
lights and go into these areas? They have
read the statistics, and they are
well-educated persons. If asked, they
respond that they have been doing it for
years, or it is the only way to get the job
done, or they shrug and laugh, according
to one OSHA-trained supervisor.

Do each of you use seat belts? I am sure
you have read the studies. And how many
of you smoke cigarettes despite warnings?

Much as Murphy, Napier, et al., Aherin
and others--many others-are suggesting, in
order to reduce farm hazards, it will be
necessary to undertake a good deal more
investigation into the forces behind the for-
mation of attitudinal behavior and far
communities.U~

The various dimensions of risk-taking
behavior and their attitudinal components
tend to be at the very heart of this
problem. Only through a thorough
comprehension of these behavioral
dynamics will policy-makers and change
agents design successful interventions,
which are likely to alter risk-taking in
order to reduce farm injuries and health
hazards.0

REFERENCES

1.



2.



3.



4.




5.

Warwick, W. Safety Education: Man, His Machines and His Environment. New Jersey: Prentice Hall,
1975.

Murphy, Dennis. Farm Safety Attitudes and Accident Involvement, Accident Analysis and Prevention.
Vol. 13, No. 4:331-337. London: Permagon Press, 1981.

Napier, T. L, W.R. Goe, and R.R. Pugh. Incidence and predictive factors associated with farm accidents
in Ohio. Ohio Extension Service document, 1987.

Yount, Kristen R. Work-emergent behaviors and traits: the segregation of energy workers in boom-
towns. Differential Impacts of Rural Resource Development, Pamela D. Elkind (ed.) Boulder: Westview
Press, 1986, pp 119-144.

Aherin, Robert A. Understanding and Predicting the Safety Behavior of Farmers, Paper presented at
the American Society of Agricultural Engineers Conference, Chicago, 1985.

128                                   Papers and Proceedings


Surgeon General's Conference on Agticultural Sakty and Health
FARM&FE 2000 o A National Coalition for Local Action
Convened by the National Institute for Occupational Safety and Health
April 30 - May 3, 1991, Des Moines, Iowa

INDUSTRIAL CROPS OF THE FUTURE

  By Daniel E. Bugler, Ph.D.
Director, Office of Agricultural Materials
U.S. Department of Agriculture

Dr. Ronald D. Eckoff: We shift gears a little bit again now. instead of talking so much about the
workers, we're going to talk about some other things that are happening that relate. Our next
presentation will be by Dr. Daniel Kugier, regarding industrial crops of the future. Dr. Kugler has a
Ph.D. in Agricultural Economics from Michigan State University and works for the United States
Department of Agriculture. He led economic and policy studies for soil and water conservation
programs with special emphasis on the economic impacts of variable cost sharing and soil depletion
on the adoption of conservation practices. In 1986, he joined the Cooperative State Research
Service in Washington, D.C., to start up and manage the Department's Kenaf Development Program,
a program designed to remove barriers preventing the commercialization of this non-wood fiber plant
for manufacture of newsprint. in 1989, he was appointed director for the Office of Agricultural
Materials, where he oversees research, development and commercialization of a number of crops,
which provide new raw materials and chemical feedstocks to industry. Dr. Kugler will speak, this
morning, on the topic, industrial Crops of the Future.  Dr. Kugler:

First, I want to thank the organizers for
the opportunity to come here to Iowa and  I thought that the best way to illustrate this

address this important conference in the   area would be to provide you seven

area of issues, which affect the national   examples of industrial crops of the future.

agenda. It is always important to keep in-  They have a variety of potentials. Some of
                    them are commercializable now; some next

formed of changes that will affect the

agricultural industry, which is so important  week; some of them may require the
                   remainder of this decade before they can

to our country.              come to the marketplace.

Specifically, I want to offer to you a      You will find that a number of them are
glimpse of an area of agriculture that many  surprisingly common. Others, as I have
of you know nothing about or, at most,
may not think about on a day-to-day basis.  mentioned before, you may have never
                         seen or heard of before.

It is an area that we refer to as industrial
crops or agricultural materials-these being  ASPEN, SOUTHERN PINE
crops or materials, which provide
non-food, non-feed materials to industry
for use in processing and product manufac-  The first crop is the very beautiful aspen
ture and marketing. These materials     tree. Many of you may be familiar with it.
                      This tree is an excellent source of wood
generally do not enter the food chain
either for human consumption or as     fibers and is harvested mainly from the
                        northern United States and from forest
animal feeds, although there are some    plantations in Canada.
notable exceptions in pharmaceuticals and
in the area of some by-product meals that
are used for animal feeds.         The fiber from this tree is very well suited
                    for the manufacture of dry-formed compos-
                   ites. Aspen, in a dry, refined form-very

Surgeon General's Conference on Agricultural Safety and Health - 1991                129


Issues That Affect the National Agenda

coarsely refined- resembles shredded
wheat.

When you take it and blend it with syn-
thetic fibers such as glass or polyester and
add thermal-setting resins, you can create
an air-laid, non-woven mat. This par-
ticular kind of mat can then be put into a
heated compression mold to make a
variety of shapes of various angles and
depths that can be used in a wide variety
of products with which you are very
familiar.

Common applications include interior car
door panels, dashboards, and the head
liner that is over the top of you when you
sit in your automobile. So, the next time
you're rolling down the window in your
car, underneath that vinyl or leather panel
there may be an aspen tree.

CORN, WHEAT, RICE, OR POTATO
STARCH

The second example is pretty familiar to
you folks here in Iowa. Corn is very abun-
dant and well known as a food source in
our diets. However, there is more to do
with corn than to just eat it.

Corn is a principal source of starch, which
is being extensively explored by
government, universities, and industry to
make degradable thermoplastics or starch
polymers. Here in the United States alone
we manufacture, on an annual basis, some
60 billion pounds of plastics from
petrochemical sources.

There are technologies available right now
that can put up to 40 percent starch-and it
can be from wheat, potato or other sour-
ces-into various kinds of plastic film such
as grocery bags and trash can liners.
There are other technologies that are in

development that will put 85 percent to 95
percent starch into these kinds of plastic
materials and use it to make a variety of
molded products.

There is one effort that we believe is very
significant-the Department of Agriculture
and Department of Defense have joined
hands with several universities and a major
private company to produce degradable
starch products, which will satisfy the
Marine Plastic Pollution and Research
Control Act of 1987. That particular act of
Congress requires the Navy to cease the
disposing of plastics at sea by the end of
1992, unless they are fully degradable in
the marine environment. This is a very,
very busy project. It is a very challenging
and, we believe, achievable opportunity.

INDUSTRIAL RAPESEED AND
CRAMBE

For the next industrial material, you will
see a very beautiful slide of a crop in the
state of Idaho. It is industrial rape seed.
Many of you may know a cousin of this
crop, called canola. The canola variety
vegetable oil is sold in your supermarket
under the Puritan label, from Proctor and
Gamble.

The industrial variety of rape seed,
however, retains a high content of erucic
acid, and that erucic acid can be used to
manufacture a number of functional fluids,
plastics, and nylons. I have several
examples of things we are doing with high
erucic acid rape seed.

We have been working with some com-
panies and universities to produce an
automatic transmission fluid supplement,
which is made from the derivatives of rape
seed oil. Tests have shown at this point,
when compared to standard factory-fill

130                                   Papers and Proceedings


fluids, that with this particular kind of
supplement, wear is reduced 50 percent,
oxidative breakdown is reduced 24 percent,
and that pentane insolubles are reduced
some 60 percent.

In another product, we are producing cut-
ting fluids from rape seed oil. The cutting
fluids show longer use. They show ex-
tended tool life. In addition to that, there
are no halogenated fluids produced, which
require hazardous waste disposal.

One other very significant product, which
has been made from crambe oil, another
crop source of erucic acid, is nylon 1313.
Crambe, indeed, is a crop of the future
and nylon 1313 is a product of the future
because it is very lightweight, has very low
water absorption characteristics and shows
exceptional dimensional stability. We
expect in the near future that nylon 1313
will be used in a variety of aircraft and
marine applications.

GUAYULE

My fourth example is another very interes-
ting crop. Guayule is native to the south-
western United States and northern
Mexico.

It is a perennial shrub that reaches
maturity at about three to five years of
age. We extract natural rubber and resins
and a variety of other chemical feedstocks
from the plant's steno, branches, and roots.

The advanced varieties of this particular
plant have about 10 percent high molec-
ular weight rubber, which is very similar to
and comparable in performance with the
Hevea rubber, which we import mainly
from Malaysia, Thailand, and Indonesia.
We are currently 100 percent import
dependent for our nation's rubber supply,

Industrial Crops of the Future, May 2, 1991

and it costs us a billion dollars a year in
export dollars.

Right now we are manufacturing tires
made from guayule natural rubber, which
will go on the Navy's F18 and A4 aircraft
at a Goodyear plant in Virginia. We are
also manufacturing light truck tires, which
will be used for testing by the Army at a
Firestone facility in Illinois. These are
very important strides forward in
developing a domestic rubber industry.

In addition to the natural rubber in this
particular plant, there are some very
interesting resins. The most notable one
can be used to produce a strippable
coating for preservation of machine parts
and mothballing aircraft. We are currently
seeking work with the Air Force to test out
this particular coating.

KENAF

The fifth example is another industrial
crop that many of you may know if you
have an ornamental hibiscus plant in your
yard at home. This is a hibiscus grown for
its industrial fibers, called kenaf. It is an
annual plant of tropical and semitropical
origin, native to east central Africa.

In the cotton belt of the United States, this
crop will grow 12 to 20 feet tall and
produce six to ten tons of dry matter per
acre. The fibers of this particular plant
are very interesting. There are two fibers
in the plant: a bark and an inside core.
They make a very natural mixture for
manufacture of newsprint.

The outer fibers are long and tough and
strong. The inner fibers are short and flat
and make good filler and surfaces. When
you take the entire plant and thermo-
mechanically pulp it, you make a very high

Surgeon General's Conference on Agricultural Safety and Health - 1991               737


Issues That Affect the National Agenda

quality pulp that makes a very high quality
newsprint, which has been accepted by the
newsprint industry as a real commodity.

Currently in the state of Texas, there are
plans to build a $50 million newsprint mill
based on kenaf. We hope to see those
plans activated this year and to see news-
print in production by the end of 1992 or
early 1993.

In addition to newsprint, there are a
variety of other products made from kenaf
fibers, which show premier. These are
composites, packaging, poultry litter, high-
grade specialty papers, absorbants and soil
amendments.

PACIFIC YEW TREE

The next example of an industrial crop is
the Taxus plant, an ornamental yew used
as a landscaping shrub all over the country.
Bark of the Pacific yew tree and needles
and twigs of ornamental Taxus shrubs yield
a complex natural chemical called taxol.

According to the National Cancer Institute,
taxol is the most important anticancer drug
in 15 years and is in the last stage of can-
cer. The Department of Agriculture has
organized an effort to establish immediate,
medium and long-term supplies of the tree
bark and shrub clippings for extraction of
the drug. Agriculture will help provide the
renewable raw material for this life-saving
drug.

SOY BEAN

The last example, like corn, is another very
familiar agricultural plant. But also like
corn, there is more to do with soybeans
than eat or feed it.

Printer's ink using soybean oil has been
under development since the early 1980's
and inks with 30 percent soybean oil are in
use. Notably, The Gazette in Cedar
Rapids, Iowa, under the leadership of Joe
Hladky, Publisher and Chair of the
American Newspaper Publishers As-
sociation Technical Committee for Inks, is
the pioneer in daily commercial use.

In March 1991, the Department of Agricul-
ture announced a 100 percent soybean oil
ink that is completely compatible with
newspaper presses. This formulation
removes all the petroleum from the ink
and shows low rub-off, lower cost, and
more environmentally soundness in terms
of degradation and recycling of old
newsprint. If all newspaper ink were made
with soybean oil, it would require 40 mil-
lion bushels.

RENEWABLE MATERIALS

We are talking about renewable materials
from agriculture, and I stress the word
"materials." We are looking to make
polymers, functional fluids, composites,
structural materials, natural fiber products,
and pharmaceuticals-all of which are
extremely important to the health of our
business and industry in this country.

Why do we do this ? There is a variety of
reasons. There are some very obvious
balance-of-trade implications here, where
we can reduce the imports of certain com-
modities, in particular petroleum and rub-
ber. There are opportunities to turn
around and export things that we currently
import.

There are very obvious areas in which we
can improve the competitiveness of our
country by utilizing the excess productive
capacities of our farmland to produce new

732

Papers and Proceedings


crops or to use some of the crops that we
are currently producing in excess. All of
this, of course, is designed to spur rural
economic development, increase our
domestic production and add value to our
agricultural materials at home, send them
to the international market place.

In addition to that, we are trying to alter the
image, to some extent, of agriculture, and to
let this country and the world know that
agriculture, indeed, is a very high-tech
business.

In the area of leadership, one of the things
we would like to be able to do in this
country is to be a leader in technology
development. One thing we have done an
excellent job on in this country, for years
and years, is research.

We are the pre-eminent research country
in the world, but the honest truth is, we
have not done a very good job of taking
those research results and moving them
into the marketplace by doing value-added
work. Many other countries come here,
take our research discoveries and inven-
tions home with them, make the products
and then deliver them back to us. There is
no need for that. We can do much of that
here in our own country.

Industrial Crops of the Future, May 2, 1991

How are we going at this? The Office of
Agricultural Materials is a very small of-
fice. We are working very closely with
industry, very closely with academia, and
very closely with state and federal gov-
ernment to do something that Washington
calls `precompetitive generic technology
development." We are trying to enable
commercialization, that is, to bridge the
gap that currently exists between the
research bench and the marketplace.

In addition to that, we are trying to alter
the image, to some extent, of agriculture,
and to let this country and the world know
that agriculture, indeed, is a very high-tech
business. We are every bit as sophisticated
as and have scientific talent on a par with
those that are conducting research on
supercomputers, high-performance
ceramics, etc.

To close, let us look at this slide that
shows the official seal of the United States
Department of Agriculture. It has an
animal-drawn plow in the front and some
shocks of corn in the back. Focus your
attention at the statement at the very bot-
tom, where it says:

Agriculture is the foundation
of business and commerce.

Industrial crops and many other crops can
be and are strengthening and enhancing
that foundation.0

Surgeon General's Conference on Agricultural Safety and Health - 1991

733


Surgeon General's Conference on Agricultural SatWy and Health
FARM&FE 2000 o A National Coalition tir Local Action
Convened by the National Institute kw Occupational Sidety and Health
April 30 - May 3, 1991, Des Moines, Iowa

BIOTECHNOLOGY AND AGRICULTURE

By Jane Rider, Ph.D.
Biotechnology Specialist
National Wildlife Federation

Dr. Ronald D. Eckoff: Our final presenter this morning is Dr. Jane Rissler, who will be speaking about
biotechnology and agriculture. Dr. Rissler received her Ph.D. degree in plant pathology from Cornell
University and conducted postdoctoral research in fungal physiology at the Boyce-Thompson
institute for Plant Research. She has taught and conducted research in the university setting for a
number of years. Since 1983, Dr. Rissler has been engaged in biotechnology science and regulatory
policy work. From 1983 to 1988, she was at the Environmental Protection Agency where she was
involved in the formulation and implementation of biotechnology policies. She served as a science
advisor for and a project manager of the Pile Technology Project that operated under the Toxic
Substances Control Act and was a special assistant in biotechnology to the EPA Assistant
Administrator for Pesticides and Toxic Substances. In those position, she helped to develop EPA
biotechnology regulatory policy and coordinated EPA's activities in the development of the Federal
regulatory framework for biotechnology. She currently is a biotechnology specialist with The
National Wildlife Federation. As part of her work in the National Wildlife Federation's National
Biotechnology Policy Center, she has recently authored or co-authored several documents:
Biotechnology's Bitter Harvest, Herbicide Tolerant Crops and the Threat to Sustainable
Agriculture, Natural Resources and Environment,  Biotechnology and Pest Control: Quick
Fix Versus Sustainable Agriculture published in the Global Pesticide Monitor. She is the
co-editor of the Gene Orchange a National Wildlife Federation Newsletter that provides a public
voice on genetic engineering. This morning, Dr. Rissier will discuss Biotechnology and Agricul-
ture. Dr. Rissier:

INTRODUCTION

I was asked to come here today to talk
with you about potential farm worker
health issues raised by the use of biotech-
nology products in agriculture. In fulfilling
that request, I will briefly explain the tech-
nology, where it is likely to be heading in
the next decade, and some concerns for
worker safety that may arise from the tech-
nology. I appreciate the opportunity to
provoke discussion of biotechnology and
agricultural worker health issues and hope
that worker safety experts will consider
and evaluate these issues as the technology
is developing and before its widespread
use.

Before I begin, however, I would like to
tell you of my biases that are relevant to

734

this talk. I represent a major environmen-
tal group, the National Wildlife
Federation, the country's largest conser-
vation, education, and environmental ad-
vocacy organization, with over 5.8 million
members and supporters and 50 affiliated
state groups.

Four years ago the Federation established
the National Biotechnology Center, to try
to prevent the environmental and human
health consequences associated with other
technologies, such as the synthetic
chemical, fossil fuel, and nuclear tech-
nologies. The Center's objectives are to
minimize the risks of this new technology
and to ensure that the public has a role in
the regulation and development of the
technology.

Papers and Proceedings


I am here, not as a proponent of agricul-
tural biotechnology, but as a skeptic-a
skeptic who fears that the technology poses
significant risk and uncertainty. Further-
more, from a vantage point of studying the
industry for nearly eight years, I seriously
question whether biotechnology should or
can assume a major role in answering the
environmental, human health, and produc-
tivity problems facing U.S. agriculture.

WHAT IS BIOTECHNOLOGY?

Broadly speaking, biotechnology refers to
the use of living organisms as products or
processes for humanity. People have used
organisms for food and drink (e.g., yogurt,
bread, wine, cheese) for millennia. From
early agriculturalists to 20th century plant
and animal breeders, humans have
manipulated living organisms to improve
food and fiber production.

1

I am here, not as a proponent of agricul-
tural biotechnology, but as a skeptic-a
skeptic who fears that the technology
poses significant risk and uncertainty.

Advances in molecular biology in the last
three decades allow human beings to
manipulate organisms in dramatically dif-
ferent ways than are possible with
traditional breeding methods. Many of
these methods have been developed out of
basic research in the 1960's and 1970's and
have been adapted in the last 15-20 years
to produce commercial products.

These methods, along with the products
and processes developed using them,
constitute modern biotechnology. The
terms are not used precisely or consis-
tently. Sometimes the term biotechnology

Biotechnology and Agriculture, May 2, 1991

is used to characterize a small subset of
techniques, that is, genetic engineering,
gene splicing, or recombinant DNA techni-
ques. Other times it is used in varying
degrees to include other techniques.

A Powerful Technqlogy

This is a powerful technology-a technology
in its infancy. As an illustration, I use the
words from a promotional piece from
Monsanto, a company that made a huge
investment in biotechnology:

A new science destined to take
[hulmankind into technology as a scien-
tific milestone comparable to the
realization of atomic energy or the
development of semiconductors and
powe#ul computers. '

The power of the genetic en-
gineering-gene splicing-techniques comes
from the capacity to combine genes from a
wide array of organisms: mouse genes in
tobacco plants, human genes in bacteria,
or chicken genes in potatoes. Traditional
breeding techniques are dramatically more
limited in the range of possible gene com-
binations. Only closely related organisms
can be interbred by traditional means. By
combining genes from widely disparate or-
ganisms, genetic engineers will create a
variety of genetically novel organisms im-
possible by traditional means.

Expected Products

Using genetic engineering techniques, cell
and tissue cultures, and other modern
techniques, the industry promises transfor-
mations in the way food and fiber are
produced and processed in this country.
Among the products already on the market
and that we can expect to see in the near

Surgeon General's Conference on Agricultural Safety and Health - 1991                135


Issues That Affect the National Agenda

future or within a decade or two are the
following:

1.









2.

3.









4.

Genetically engineered food (grain,
fruit, vegetables, oil) and fiber
crops-for example, genes from insects,
chickens, mice, fish, bacteria, viruses,
and unrelated plants have already been
splices into crops; these crops have
been field tested in the last two years.

Food and food supplements from
genetically engineered microor-
ganisms-cheese, yogurt, alcoholic
beverages-for examples, a cheese en-
zyme produced by bacteria containing a
cow gene is already in wide commercial
use and tryptophan, a food supplement
derived from genetically engineered
bacteria, was on the market; it was
removed because nearly 30 people died
and hundreds more became ill with
eosinophilia myalgia syndrome as a
result of consuming the product;
whether the genetic engineering
contributed to the toxicity is not yet
known2

Genetically engineered food
animals-cows, pigs, chickens, fish-carp
with a trout growth hormone gene are
being tested in ponds in Alabama; pigs
and cows containing human genes have
been produced.

Genetically engineered hormones, an-
tibiotics, vaccines-among the products
thus far developed, bovine growth hor-
mone, derived from genetically en-
gineered microorganisms, is being used
to enhance milk production; a recom-
binant vaccine against pseudorabies is
already on the market; a recombinant
rabies vaccine is being tested in wild
animals in Virginia and Pennsylvania.

136                                  Papers and Proceedings

5. Genetically engineered microorganisms
to control plant diseases and enhance
crop growth--several recombinant
microbes have already been field
tested.

6. New uses of crops and animals to

produce commercially valuable
chemicals-cows producing drugs in
milk; tobacco plants producing anti-
cancer proteins.

While this list is incomplete,' it gives an
idea of the power of a technology still in
its infancy.

BIOTECHNOLOGY COMPANIES

The following are companies that are
farthest along-as measured by their
progress in field testing genetically en-
gineered plants and microorganisms-in
developing novel organisms for use in
agriculture:

. Monsanto          . Ciba-Geigy
= DuPont                . Sandoz
. Calgene             = BioTechnica
a Upjohn           . Pioneer HiBred
. Crop Genetics International
. Northrup King       * Rohm and Haas
* Agrigenetics Advanced Sciences
. Agracetus          * Canners Seed
. Amoco Technology
. Boyce Thompson Institute
. Wistar Institute     H Rogers NK Seed
= Dekalb Plant Genetics      = Frito-Lay
* Campbell Institute for Research and
Technology.

WHAT FARM WORKER HEALTH
ISSUES ARE RAISED BY
AGRICULTURAL BIOTECHNOLOGY?

Based on industry predictions about the
nature and pace of agricultural biotech-
nology, it is obvious that farm workers will


Biotechnology and Agriculture, May 2, 1991

be exposed to genetically engineered or-
ganisms: micro-organisms, viruses, plants,
animals.

1

I hope that this presentation will provoke
a  wide-ranging  consideration  and
evaluation of the potential impacts of
biotechnology on farm worker health.

Keeping in mind that this is a new tech-
nology, one based on a highly artificial
manipulation of living things, one that
poses significant unknowns and uncertain-
ties, it is time to begin discussing the
agricultural worker-health ramifications of
biotechnology. The organizers of this
conference, is placing this talk on its agen-
da, recognized this need. I hope that this
presentation will provoke a wide-ranging
consideration and evaluation of the poten-
tial impacts of biotechnology on farm
worker health.

The experiences that we have to draw on
to initiate this discussion come from
genetic engineering research laboratories,
the pharmaceutical industry where
genetically engineered organisms have
been used for some time, and industries
and agriculture based on traditionally
developed microorganisms, plants, and
animals.

A complete discussion of risP would re-
quire consideration of both hazards and
exposure. This talk is limited to an at-
tempt to identify potential farm worker
health hazards that may develop from a
large commercial agricultural biotech-
nology industry. I have not attempted to
describe exposure beyond general
statements indicating that more farm
workers are likely to be exposed to

increased numbers of living or-
ganisms-both genetically engineered and
conventionally bred ones-and their
products.

The list of potential hazards I offer may be
incomplete; I welcome suggestions. Some
are more speculative than others. As the
hazards are evaluated by experts, some will
be judged as more problematic than
others. Some concerns are the same that
one would expect with non-engineered

organisms.

POTENTIAL BIOLOGICAL

Opportunistic Pathogens6

HAZARDS

Several factors point to the potential for
increased problems for genetically en-
gineered organisms that are opportunistic
human pathogens. Developers may en-
gineer microorganisms whose opportunism
is unknown. Scientists may unknowingly
engineer an opportunistic pathogen for one
of two reasons.

b First, they are working with organisms
about which little, including opportunism,
is known. Splicing genes into an organism
requires little or no information about the
organism's ecological or pathogenicity
traits.

b Second, engineers may have some infor-
mation on the organism's ecological
characteristics but, because of isolation
between scientific disciplines, the scientists
may not know that the same organism has
been classified as opportunistic (or even
frank pathogens) by human health experts.'
The organism may, in fact, have different
taxonomic designations in two different
disciplines.

Surgeon General's Conference on Agricultural Safety and Health - 1991

137


Issues That Affect the National Agenda

1.

2.

Farmers and farm workers, as a
population engaged in one of the
nation's two most hazardous jobs (the
other is mining), may often be unheal-
thy and highly stressed as a result of
their occupation"-and more susceptible
than the population at large to oppor-
tunistic infection.

In addition to their occupational stress,
the farm worker population is likely to
show an increase in the number of
immunosuppressed or compromised
persons as a result of the epidemic of
acquired immune deficiency syndrome
(AIDS) and related diseases. Persons
with suppressed or compromised im-
mune systems are generally more sus-
ceptible to infection by opportunistic
pathogens.

One example of an opportunistic pathogen
that already is the subject of biotechnology
research and development is the vaccinia
virus-the virus originally used to immunize
the human population against smallpox.
The vaccinia virus has long been known to
cause, though rarely, disease and death,
including encephalitis,' in im-
munocompromised/suppressed persons.
Recently, three persons infected with
AIDS reportedly died after being inocu-
lated with a vaccinia viru~.`~

Work is underway to genetically engineer
vaccinia virus to make vaccines against a
number of animal diseases, including
rabies and rinderpest. To create these
vaccines, one or a few genes is taken from
the rabies or rinderpest virus and spliced
into the vaccinia virus. The genetically en-
gineered vaccinia virus then is used to
inoculate animals to prevent rabies or
rinderpest from developing.

FRANK PATHOGENS"

Generally, we expect that companies will
not use and regulators will not permit the
use of genetically engineered human
pathogens in agriculture. However, a
problem arises because of the potential for
splicing genes into poorly characterized or-
ganisms, some of which may be human
pathogens. As noted above, scientists may
engineer organisms about which they know
little in terms of ecological or
pathogenicity traits.

Another question that may arise is whether
genetic engineering could transform a non-
pathogen into an opportunistic or frank
pathogen. Because pathogenicity is
generally a complex trait controlled by
many genes, it is not likely that splicing in
one or a few genes could create a
pathogen. On the other hand, there are
instances where engineering an organism
that is closely related to a pathogen, i.e.,
already possesses most of the characteris-
tics of a pathogen, might change that or-
ganism into a pathogen.12

ENDOTOXINS3

Greater use of gram-negative bacteria
(e.g., pseudomonads and rhizobia) in
biotechnology applications may increase
the incidence of respiratory problems
among farm workers. Some scientists have
hypothesized that the endotoxin portion of
the gram-negative cell wall may be respon-
sible for the respiratory disorders as-
sociated with a number of agricultural
industries: grain and silage handling, pork
and poultry production in confined
facilities, composting, and poultry proces-
sing.`"

738

Papers and Proceedings


ALLERGENS"

Allergens, which incite a hypersensitive
reaction, include substances produced by
plants, animals, and microbes. If biotech-
nology achieves even a portion of the suc-
cess promised by its proponents, there will
be an increase in the agricultural use of
living and novel organisms-and their
products.

Consequently, we may see an increased
incidence of hypersensitivity-due to
greater exposures to living organisms, in
general, and due specifically perhaps to
changes caused by genetic engineering.
Genetic engineering may introduce new
allergens, for example, by producing ex-
pected secondary metabolites in microor-
ganisms. Foreign genes in crops may
produce new allergens in the plants and
their pollen.

ANTIBIOTIC RESISTANCE

Many novel organisms are genetically en-
gineered to resist one or more antibiotics.
This is a trait added, not to improve the
organism, but to confirm that gene splicing
has been successful. Splicing in antibiotic
resistance is part of standard genetic en-
gineering methodology. The worker health
issue that arises is the extent to which the
unintentional ingestion of antibiotic-
resistant microbes could result in the sub-
sequent transfer of antibiotic resistance to
gut microflora and eventually to
pathogens.16

Transfer of antibiotic resistance to path-
ogens could make them resistant to
therapeutic control by the drugs to which
they are resistant. Thus far, most drug
resistances used in genetic engineering in
this country are antibiotics not widely used
clinically.

Biotechnology and Agriculture, May 2, 1991

UNEXPECTED/UNKNOWN HAZARDS

This is a category of hazards whose
definition will only be known in retrospect.
Generally, what I am proposing is that
there may be unexpected and as yet
unknown hazards associated with this high-
ly artificial technology-perhaps a new
illness or an old one unexpectedly as-
sociated with genetically engineered or-
ganisms.

Already genetic engineering has produced
unexpected effects. Three examples are:

1.








2.









3.

Naked DNA from human cancer cells
can unexpectedly trigger tumors when
the DNA is applied to abraded skin. It
was previously thought that DNA had
to be transported into target cells by a
carrier."

Human or bovine growth hormone
genes spliced into pigs gave the ex-
pected result-leaner pigs. However,
the genetically engineered pigs also
displayed unexpected deleterious ef-
fects: arthritis, gastric ulcers, weak
muscles, and lethargy.l*

Experiments with petunias, genetically
engineered to alter pigment production
in flowers, showed "results . . .
completely different form those the
scientists expected."" Not only was the
actual frequency of nonpigmented
flowers ten times greater than expected,
but the flower pigmentation responses
to environmental conditions were total-
ly unexpected.

POTENTIAL CHEMICAL HAZARDS

One of first agricultural biotechnology
products to reach the market will be crops
engineered to resist herbicides, that is,

Surgeon General's Conference on Agricultural Safety and Health - 1991                139


Issues That Affect the Natlonal Agenda

crops created so farmers can apply more of
certain herbicides to obtain weed control
and not harm plants. Some of the her-
bicides for which plants are being en-
gineered for resistance are 2, 4-D,
bromoxynil, glufosinate, glyphosate, and
sulfonylurea. Increased use of certain
herbicides, particularly those like 2, 4-D
and bromoxynil, which are known or
suspected to be human health hazards,
poses risks to workers who apply them or
are otherwise exposed."

On the other hand, a potential improve-
ment in farm worker safety may come
from genetic engineering for pest resis-
tance, such as splicing insect toxin genes
into plants. Pest-resistant crops may
provide at least a short-term decrease in
the use of dangerous insecticides and fun-
gicides.

WHAT SHOULD BE DONE TO ENSURE
WORKER SAFETY IN AGRICULTURAL
BIOTECHNOLOGY?

Four actions will go a long way toward
enduring the safety of farm workers ex-
posed to agricultural biotechnology
products.

1. Evaluate risks. Public and occupational
health experts should begin to evaluate
the risks that a growing agricultural
biotechnology industry poses to farmers
and farm workers.

2. Use only no- or low-risk organisms,
ones that are well-characterized and
thoroughly evaluated, for potential
human health hazards. Only these
should be approved for agricultural use.

3. Reduce exposure to biotechnology
products. Standard approaches, such as
worker protection equipment,
procedure, and training, should be
adopted to reduce worker exposure to
biotechnology products.

4. Initiate and maintain medical surveil-
lance. The case for surveillance is best
made in a report from a Centers for
Disease Control/National Institute for
Occupational Safety and Health
(CDC/NIOSH) Ad Hoc working group
on medical surveillance for industrial
applications of biotechnology?'

Uncertainty provides the strongest ar-
gument for maintaining medical surveil-
lance over workers engaged in industrial
applications of biotechnology. As is the
case for any newly developed technology,
there is a lack of information concerning
the nature or severity of any acute or
chronic health hazards, which might be
associated with the industrial applications
of this technology. The CDC/NIOSH
working group is of the opinion that medi-
cal surveillance of biotechnology workers
constitutes prudent medical practice. Such
surveillance should be aimed at the early
detection of sentinel disease events.

The detection of any occupational illness
caused by recombinant organisms or their
products will have important biological and
public health consequences and should be
actively sought.0

140

Papers and Proceedings


Biotechnology and Agriculture, May 2, 1991

REFERENCES AND NOTES

1.

2.

3.

4.

5.

6.

7.



a.




9.

"Out Front in Biotech," Monsanto Magazine, Fall 1986.

"L-Tryptophan Puzzle Takes New Twist," Science, August 31, 1990, page 988.

See The Gene Exchange, Volumes 1 and 2, National Wildlife Federation, Washington, DC, 1990-
1991, for additional information on many of these organisms and products.

In the 1970's the major risk associated with the new genetic engineering technologies was the
potential for disease among laboratory researchers and the public. Conferences were held and
experiments were conducted to evaluate the human health risks (see for example, Risk Assessment of
recombinant DNA Experimentation with Escherichia coli K12, Proceedings from a Workshop at
Falmouth, MA, published in The Journal of Infectious Diseases, Volume 137, Number 5, May 1978).
Since that time, in the absence of epidemics attributable to recombinant DNA, the fears have largely
dissipated. However, as far as we know, there have been no extensive, systematic studies monitoring
the health of recombinant DNA researchers-recent disturbing report may cause a reconsideration of
the safety of some aspects of genetic engineering research. See, for examples, "Some DNA Lab
Work Raises Cancer Risks," BioWorZd Today, October 12, 1990, page 1; "Cancer Deaths Probed at
Pasteur Institute," Science, June 27, 1986, page 1597.

To understand the complexities and limitations in fully describing the human health risks of some
biotechnology products, see "The Toxicology of Genetically Engineered Microorganisms" by L.S. Katz
and J.K. Marquis, pages 51-63 in Risk Assessment in Genetic Engineering, M. Levin and H. Strauss,
eds., McGraw-Hill, New York, 1990.

Pathogens that do not cause disease in healthy individuals but may do so in certain unhealthy or
stressed persons.

"Plant-associated bacteria as human pathogens: disciplinal insularity, ambilateral harmfulness, and
epistemological primacy" by M.P. Starr, Annals of Internal Medicine 90: 708-710, 1979.

See, for example, Agriculture at Risk: A Report to the Nation by the National Coalition for Agricul-
tural Safety and Health, Institute of Agricultural Medicine and Occupational Health, Iowa City, IA,
1989.

"Vaccine Technology: Developmental Strategies," Bio/Technology, Volume 5, page 1038-1040,
October 1987; "Smallpox, Vaccinia, and Cowpox" by A.R. Rao, pages 1672-1686 in Medical
Microbiology and Infectious Diseases, edited by A.I. Braunde. W.B. Saunders, Philadelphia, 1981.

10. "Deaths of 3 Patients Not Included in Report About AIDS Experiment," New York Times, April 14,
  1991.

11. Outright pathogens; pathogens that cause disease in healthy persons.

12. See "Phenotypic Properties of Source Microorganisms and Their Genetically Modified Derivatives,"
pages 99-112 in National Research Council, Field Testing Genetically Modijied Organisms:
Frameworkfor Decisions, National Academy Press, Washington, DC, 1989, for a discussion of the
potential effects of genetic engineering on pathogenicity.

l3. Components of the cell walls of gram-negative bacteria.

Surgeon General's Conference on Agricultural Safety and Health - 1991                141


Issues That Affect the National Agenda

14. See discussion and references in "Inhaled Endotoxin and Decreased Spirometric Values" by R.M.
Casteban, SAA. Olenchock, K.B. Kinsley, and J.L. Hankinson, The New Engknd Journal of Medicine
317: 6054510, 1987.

15. Substances which induce hypersensitivity/allergy. Hypersensitivity in humans is a specific and
deleterious reaction to a substance that does not, in similar amounts, affect other persons.

16. See, for example, "Emergence of Antibiotic-Resistant Bacteria in the Intestinal Flora of Farm
Inhabitants," by S.B. Levy, Journal of Infectious Diseases 137: 688690, 1978.

17. "Some DNA Lab Work Raises Cancer Risks," BioWorld Today, October l2, 1990, page 1.

18. "Gene-Watchers' Feast Served Up in Toronto: Putting Foreign Genes into Domestic Animals,
Science October 7, 1988, pages 32-33.

19. "Jumping Genes Confound German Scientists" by D. MacKenzie, Nau Scientist, December 15, 1990,
page 18. See also "The German Experience Gained with Field Testing of Genetically Modified
Plants" by P. Lange, pages 161-164 in Biological Monitoring of Genetically Engineered Plants and
Microbes, Proceedings of an International Symposium, Kiawah Island, 1990.

20. Biotechnology's Bitter Harvest: Herbicide-Tolerant Crops and the Threat to Sustainable AgricuIture by
R. Goldburg, J. Rissler, H. Shand, and C. Hassebrook, 1990, Biotechnology Working Group,
Washington, DC.

21. "Medical Surveillance of Biotechnology Workers: Report of the CDC/NIOSH Ad Hoc Working
Group on Medical Surveihance for Industrial Applications of Biotechnology' by P.J. Landrigan, M.L.
Cohen, W. Dowdel, L.J. Elliott, and W.E. HaIperin, Recombinant DNA Technical Bulletin 5133-138,
  1982.

142

Papers and Proceedings


Surgeon General's Cont&ence on Agricuttural Salty and Health
FARMSAFE 2000 o A National Coalition lor Local Action
Convened by the National Institute ti~or Occupational Safety and Health
April 30 - May 3, 1991, Des Moines, Iowa

SURVEILLANCE: A PHYSICIAN'S VIEWPOINT

      &y John J. May, M.D.
Director, Bassett Farm Safety and Health Project
New York Center for Agricultural Medicine and Health

The title of my talk today is A Physician's
Viewpoint, which is a nice title. For a
while I thought maybe I would just talk
about the Chicago Cubs. Then a couple of
weeks ago, I thought perhaps I would ex-
pound about the Internal Revenue Service
for a while. Actually, what I will try to do
today is present a physician's point of
view-a practicing physician's point of
view-regarding our role in the surveillance
of agricultural health and safety problems.

I will try to build upon Dr. Halperin's very
excellent discussion of surveillance this
morning, focusing in particular on the
potential contribution of the rural physi-
cian. Next, I will review some of the likely
obstacles or roadblocks that, at least in my
mind, might prevent effective physician
surveillance. Finally, I will try to suggest
some ways of using existing resources to
enhance physician surveillance.

I will try to define a couple of terms. The
first term is surveillance, which refers to
the collection, collation, analysis, and dis-
semination of data for purposes of pro-
gram planning, implementation, and evalu-
ation.

For my purposes, when I talk about physi-
cians, I am referring not only to medical
doctors and doctors of osteopathy but also
to registered nurses, to nurse practitioners,
to physician's assistants, to anyone who is
involved in the delivery of primary care in
a rural setting.

By "health department," I am referring to
any body that processes the information
that is reported to it and who collects and
analyzes surveillance data.

By "farmer," I am referring to a broad
group: anybody who does physical work in
agriculture.

How is it that the physician gets involved
in this scheme of surveillance, which was
so nicely outlined earlier this morning?
Well, of the methods that were described
earlier, you will recall that some are based
upon examination of large, existing, data
bases, looking for evidence of trends in
morbidity and mortality. Some are based
upon recognition of excess hazard, possibly
using some of the data that has been col-
lected over the years by NIOSH or by
OSHA.

SENTINEL HEALTH EVENTS

Dr. Halperin also mentioned the
recognition of individual cases or sentinel
health events. This is where, in my view,
the practicing physician can contribute to
surveillance. The sentinel events are oc-
currences that have been determined to be
of public health significance. Dr. Halperin
described many of the other characteristics
of the ideal sentinel event.

The recognition of a sentinel event is im-
portant, both for the individual case and
for others experiencing similar risk. An
appropriate response to a sentinel event

Surgeon General's Conference on Agricultural Safety and Health - 1991                743


Surveillance - Agriculture-Related Diseases, Injuries and Hazards

may involve an intervention aimed at the
index case, which, hopefully, can reverse
the problem or at least prevent further
morbidity.

. ..the intervention should affect other
workers by either addressing the hazar-
dous exposure, by screening similarly
exposed workers, or by insuring that at
least adequate protection is provided to
similarly exposed workers.

Additionally, the intervention should affect
other workers by either addressing the
hazardous exposure, by screening similarly
exposed workers, or by insuring that at
least adequate protection is provided to
similarly exposed workers. These events
can be detected in several ways.

Screening programs

Screening of specific worker populations
can occur in various settings. A lot of this
is done by employers both under duress
from OSHA and on their own. It can be
done through an occupational health clinic.
If such screening uncovers evidence of
occupational disease in a worker, this
event should trigger a careful analysis and
possibly an intervention.

Reporting programs

Alternatively, sentinel cases may be picked
up in reporting programs, which may re-
quire reports from physicians or, in some
cases, laboratories. Examples of this might
include patients who turn up with clinical
evidence of occupational asthma, or situa-
tions in which blood samples are deter-
mined to have elevated lead levels. In
most states, such situations are reported to
the department of health. Often this is a

144

legal requirement for the practitioner.
The value of this kind of case identifica-
tion was demonstrated very nicely in a
number of Dr. Halperin's examples earlier
today.

PROBLEMS IN PHYSICIAN
REPORTING OF OCCUPATIONAL
SENTINEL EVENTS

For the next few moments, I would like to
review some of the potential problems
associated with the surveillance of sentinel
events, both in theory and in terms of
applying it to the agricultural setting.

It is widely acknowledged that this type of
surveillance leads to the detection of only
a significant minority of cases. This is
most clearly seen in the infectious disease
experience.

Here is a study from Vermont that looks
at the typical or passive mode of reporting
and compares it to an active approach in
which physicians were contacted on a
weekly basis. You can see that with the
customary model, the passive model, only
about half as many cases of hepatitis, mea-
sles, rubella, and Salmonella were reported
when compared to the more active ap-
proach.

If we look at occupational health, the news
is not really any better. One example is
physician-generated reports of occupational
disease in Maryland from 1981 through
1983.

There were 17 clinics in the Baltimore
area that were doing a substantial amount
of occupational health as part of their
practice. There were 16 board-certified
occupational physicians in Maryland, and
there were at least 143 worksite clinics in
operation in the state.

Papers and Proceedings


Surveillance: A Physician's Viewpoint, May 1, 1991

In 1982, 279 cases in total were reported.
Twenty-three percent of these were report-
ed by one physician, and 62 percent were
reported by another physician. So, 85
percent of all the case reports in Maryland
in 1982 came from two physicians.

Obviously, there are some potential prob-
lems with the reporting of sentinel events
in that the afferent limb of the reflex here
is certainly not flawless.

There is another set of problems relating
to the other side, the efferent part of the
reflex. The public health body, which is
the recipient of these notifications, must
have the personnel, the interest, and the
funding to provide an appropriate analysis
and response to these notifications. But
look at what we know about the effective-
ness of this interaction.

This is from a 1985 survey of the health
departments of 50 states as well as the
health department of New York City and
Washington, D.C. You can see that about
60 percent of the departments mandated
physician reporting of selected occupation-
al illnesses.

Lead poisoning was the most commonly
required reportable condition, yet only five
of these health departments had developed
criteria for evaluating reports of lead
poisoning. Eighteen departments indicated
routine or periodic efforts to obtain ad-
ditional details on reported cases. Only 10
departments used the case report, so only
about one-third of those who mandated
reporting used the case reporting in any of
their interventional activities, only seven
departments had ever published a sum-
mary of information from case reports, and
no department reported having evaluated
its surveillance program to determine the
rate of reporting.

So, it is clear that the surveillance of occu-
pational sentinel events is a complex activi-
ty. It is not currently being done optimally
by any of the participants.

PROBLEMS IN PHYSICIAN
REPORTING OF AGRICULTURAL
SENTINEL EVENTS:

Physical and Farmer Interaction

Now, let us look at some of the potential
challenges involved in applying this model
to agricultural health and safety. The
physician and farmer interaction is not
always a many-splendored thing. First of
all, some farmers feel that they do not
have the funding or the time required to
see their physicians on a regular basis.

A second issue is the farmer's perception
of the physician's expertise regarding agri-
cultural health problems. If I tried to
assure an audience of farmers that their
physician could consistently recognize
occupational hazards and could always
advise them reliably on the proper treat-
ment and prevention, my statements might
be received by the farmers with an ele-
ment of skepticism.

Physician Recognition of Sentinel
Events

This leads us into the second aspect of the
issue of reporting, and that has to do with
physicians. My observations over the last
10 years are that physicians, in general,
tend to have relatively limited sophistica-
tion with regard to agricultural medicine.
There are a variety of occupational prob-
lems, which have been outlined by
Dr. Novello and a number of other
speakers, that can affect farmers.

Surgeon General's Conference on Agricultural Safety and Health - 1991

145


Surveillance - Agriculture-Related Diseases, Injuries and Hazards

Some of these are clearly job-related, and
others are probably job-related. Many
physicians would have difficulty diagnosing
some of these conditions and would sel-
dom relate others to the farmer's oc-
cupation.

Physician Reporting of Sentinel Events

If we assume that the farmer does come to
see the physician and that the physician
correctly diagnoses the problem, does it
get reported ? This relates to the physici-
an's awareness of the responsibility to re-
port as well as their interest in doing the
reporting.

I cannot show you any data on the level of
this interest. As a practicing physician, I
can assure you that when things get
relatively busy, the interest in reporting is
limited.

Public Health Response to Sentinel
Events

Now, a final challenge in the physician
reporting of agricultural sentinel events, in
my mind, has to do with the need for a
mutually productive interaction between
the reporting physician and the health
department. Reliable reporting will con-
tinue only if it is clearly beneficial to either
the physician or to his patient.

Yet these departments have limited resour-
ces. Even if there is sufficient interest at
the health department level, it is unlikely
that most health departments have the
expertise in agricultural medicine to mount
an effective response to this kind of infor-
mation.

For the past 10 minutes I have outlined a
series of problems and roadblocks involved
in this issue that make it seem that the
likelihood of effective physician surveil-

746

lance is somewhere between slim and
none. I believe, however, this is an effec-
tive activity that can be made to work, and
there are resources available that can be
applied to the task.

RESOURCES

The National Coalition for Agricultural
Safety and Health (NCASH) was formed,
following the meeting in Des Moines and
Iowa City. This group has successfully
worked to secure funding to begin some of
the efforts that we are seeing today.

NIOSH certainly had contributed to this
field prior to the beginning of the NCASH
endeavor. Since then, it has received fund-
ing needed to begin a more organized
attack on these problems. Now, through
NIOSH, there is a wealth of experience
with occupational problems, although not
specifically with agricultural problems.

The recently designated NIOSH centers
should be able to provide consultation and
educational support that is specifically
aimed at agricultural issues. As you know,
these are located in Iowa and California.

Another NIOSH-initiated program is the
Rural Nurse Sentinel Program, which I
suspect Dr. Freund will expand upon to-
morrow. Briefly, this is a program that
proposes to locate specially trained occu-
pational nurses in rural regions where they
will interact with rural physicians and oth-
ers to form a network for surveillance pur-
poses.

In addition to NIOSH-funded programs,
there are a handful of other groups around
the country that have a particular interest
and expertise in agricultural medicine. In
New York we have been working in this
field for about 10 years. We were preced-
ed in this by the group from Marshfield,

Papers and Proceedings


Wisconsin. In other places in the country,
there certainly are a number of interested
individuals who have considerable experi-
ence working with farmers and farrnwork-
ers.

Certainly, a number of the land-grant uni-
versities have developed expertise in engi-
neering and safety issues, and, in some
cases, this has expanded into the area of
health and health education. An example
of this would be Bill Field at Purdue,
whose interest in rehabilitation of injured
farmers has resulted in his acquiring a
knowledge of rehabilitation medicine that
makes most of us physicians envious.

Some occupational medicine groups have
become increasingly interested in this field
and clearly have become resources. Our
previous speaker and her program in
Seattle are certainly an example of this. In
general, however, I think that agricultural
problems are not an area of expertise or
even of particular interest for many oc-
cupational physicians.

POSSIBLE SOLUTIONS

Let me see if I can spend a few minutes
proposing ways in which some of these
resources might be used to help us get
around the various obstacles that I de-
scribed a few minutes ago.

Physician and Farmer Interactions

The physician and farmer interaction is a
difficult problem, and it certainly needs to
be addressed. Currently physicians are not
viewed as being particularly knowledgeable
with regard to agricultural problems, nor
are they affordable or convenient to the
farmers.

Surveillance: A Physician's Viewpoint, May 1, 1991

Some of these issues can be improved,
certainly with aggressive efforts at con-
tinuing medical education. As you heard
at lunchtime? here in Iowa interested
physicians w&in a community may some-
times enter a program in which they re-
ceive intensive training in agricultural
health problems at the center. Such in-
dividuals then become local resources.

Educational efforts by physicians can go a
long way towards building bridges between
farmers and physicians. Jim Hartye has
developed an innovative approach at his
clinic in North Carolina.

Periodic health screening events are
scheduled for the farm community. When
these people come in for free spirometry
or free blood pressure checks or free
cholesterol checks, these are coupled with
discussions of safety practices, protective
equipment, etc.

Mary Lee Hill, from our group, will pres-
ent a poster later this week demonstrating
the effectiveness of a similar program. A
proposal for this type of approach was
recently discussed by the American
Academy of Family Practice.

The experience that we have had in New
York is that educational programs are a
very effective way to reach out to the farm
community. For this reason, we never
decline an invitation to speak to a farm
group, whether it be large or small. We
have an educational booth that spends a
lot of time on the road going to various
farm shows and programs. We design the
programs that accompany this booth to be
interactive in some way.

Frequently, there is some sort of a
come-on with free hearing testing or free
respiratory testing. The main point is to

Surgeon General's Conference on Agricultural Safety and Health - 1991                147


Surveillance - Agriculture-Related Diseases, Injuries and Hazards

obtain a teachable moment with this group
and spend some time educating.

These kinds of contacts with farmers and
their families have enabled us to learn a
lot. It also, at the same time, has strength-
ened our relations with the agricultural
community in New York and has enabled
us to gain some recognition with the com-
munity as having some experience and
expertise in agricultural health problems.

Now the local practitioner is unlikely to
have the time, interest, or expertise to
approach farmer education in this way.
However, if one were supported in this
effort with teaching materials, with exam-
ples of acceptable protective equipment, as
well as a basic understanding of this mate-
rial, these efforts might prove not only
possible but actually productive, not only
in terms of educating but in terms of alter-
ing the relationship that currently exists
between physicians and farmers.

In the waiting room of a rural clinic in
Sweden that is run by a physician, with a
particular interest in agricultural medicine,
prominently displayed are various types of
protective equipment as well as instruc-
tions. He provided fairly sophisticated
discussions of ergonomics for his patients.
I think these kinds of effort go a long way
to building bridges with the farm com-
munity.

Physician Recognition of
Sentinel Events

The problems in physician recognition
relate to the level of sophistication that the
physician has regarding occupational and
specifically agricultural health problems.
The potentially large number of events,
many not clinically certain or absolutely
related to work, clearly poses a problem
for these physicians. Here again, aggres-

148

sive, continuing medical education is part
of the answer.

In addition, I think the number of report-
able events must be limited to a few.
These should be defined for epidemiologic
rather than clinical purposes. For exam-
ple, if we agree that farmer's lung is an
appropriate target for surveillance, we
would not require that a case demonstrate
repeated recurrences, antibody positivity,
and a predominance of lymphocytes in the
bronchoalveolar lavage fluid.

Rather, we would want to hear about any
febrile reactions with myalgias or cough
that occur following dusty work. The
determination of whether this is farmer's
lung, or organic dust toxicity, or simply
pneumonia would be made later on by a
different part of that reflex loop. A form
that we use in the Occupational Health
Network in New York allows for a sub-
stantial amount of uncertainty regarding
the clinical diagnosis.

Nevertheless, these people get on the re-
cords and it is possible at a later date to
sort out how certain we were and how
good the evidence was that this was a bona
fide case. So I think that although physi-
cians have a need to be quite certain,
epidemiologists are more comfortable with
less certainty. Physicians have to be edu-
cated to this difference, if they are going to
report these cases.

Physician Reporting of Sentinel Events

Physician interest in reporting agricultural
or any illness is going to be affected by the
level of antipathy felt towards the local
health department. In my home state of
New York, this is considerable, and the
easiest way to infuriate a New York physi-
cian is to send him a letter that says, "Dear
Provider, The New York State Department

Papers and Proceedings


of Health now requires that you do the
following." There is no way to enforce
these kinds of laws, and so I do not think
it is a productive way to approach the
physicians.

Interest in reporting is further moderated
by the amount of time and effort needed
to do so as well as by the natural reluc-,
tance to get wrapped up in what is some-
times a quagmire of workmen's compensa-
tion. If the health department hopes to
receive reports, the system must be readily
accessible, user friendly, and perceived as
beneficial either to the physician or to her
patient. A system like the Poison Control
Center Network, which provides consulta-
tion and support to the physician, will at-
tract a lot more interest than simply
another annoying letter from the health
department.

Active surveillance has repeatedly been
shown to be more effective and well-
received by physicians.

Once again, I will use an example from the
infectious disease literature. This is a
study from Rochester, New York.

They divided the physicians into three
groups. Some received a weekly phone
call, some received a weekly post card, and
most just performed passive surveillance as
is typical.

Not surprisingly, there was substantially
more response in the telephone group than
in the post card group. There was better
response in the post card group than in the
passive group. So the message is that
active surveillance is better, and I think
NIOSH, recognizing this, has initiated the
nurse surveillance program, which I men-
tioned earlier.

Surveillance: A Physician's Viewpoint, May 1, 1991

Public Health Response to Sentinel
Events

Now, the final series of roadblocks, as I
see them, are at the level of the health
department. We have already seen that
health departments often have poor, if any,
response to the cases of commonly report-
ed occupational illness. The response to
agricultural illness is likely to be worse,
since it's unlikely that the department will
have any experience, much less expertise,
in the area.

It is not likely that agricultural problems
will be able to compete in a busy, urban-
based, overworked, and underfunded
health department. What is the solution to
this particular set of problems?

I would propose that the health
department ought not to be directly in-
volved in the feedback part of this loop.
Ideally, this would best be done by a
group, which is interested in and
knowledgeable about agricultural
problems-a group that could offer the
"poison control center"-type of approach
with support and consultation for the refer-
ring physician. Ideally, industrial hygiene
and agricultural engineering consultation
would be offered to the physician's patient.

Who can provide these kinds of services
for the health department? In some cases,
it might be a medical school. In general,
however, I think most medical centers'
lukewarm approach to occupational health,
abysmal records in rural health, and lack
of appreciation of agricultural medicine
make it likely that we should look else-
where for help.

The resource, which I would favor, is the
existing NIOSH program for Centers for
Agricultural Research, Education, Disease

Surgeon General's Conference on Agricultural Safety and Health - 1991

149


Surveillance - Agriculture-Related Diseases, Injuries and Hazards

and Injury Prevention. Expansion of this
program on a regional basis throughout
the country would enable education of
physicians so frequently mentioned in the
last few minutes. These centers would
interact to support the nurse sentinels,
provide user friendly feedback and support
to practicing physicians, and help bridge
the gap between the farm community and
the medical establishment.

In summary, I believe that the practicing
rural physician can definitely make a valu-
able contribution to the detection of occu-
pational sentinel events in farmers. There
are particular problems, or potential

problems, that are related to the ability of
health departments to coordinate respons-
es to these reports, related to the compe-
tence of physicians in agricultural medi-
cine, and related to the farmers' percep-
tion of the physician relative to the farm
workplace.

I believe that there are potential solutions
to these problems and that many of these
might best be approached by the use of
regional centers for agricultural health and
safety, which could provide education,
consultation, and support services to prac-
ticing physicians and farmers.0

750

Papers and Proceedings



Surgeon General's Conference on Agricultural Safety and Health
FARMSME 2000 . A National Coalition for Local Action
Convened by the National Institute for Occupational Sakty and Health
April 30 - May 3, 1991, Des Moines, Iowa

CHEMICAL HAZARDS

By Lina!u Rosenstock, M.D.
Director of Occupational Medicine
  University of Washington

Dr. Henry A. Anderson: So, let me introduce Dr. Linda Rosenstock who is Director of Occupational
Medicine at the University of Washington. She has done considerable research and has been very
active dealing with chemicals-actually all occupatlonal exposures--and today is going to specifically
address chemical exposures as they occur in the agricultural setting. Dr. Rosenstock:

There are two things that I would like to
highlight during this discussion about pesti-
cide health effects. The first is to consider
how surveillance can be used to prompt
further investigation and research, particu-
larly looking at the interface between sur-
veillance and research.

The second is to use this opportunity to
talk specifically about a class of pesti-
cides-the organophosphate pesti-
cides-because of their significant acute
toxicity and because of their potential for
chronic toxicity.

As we try to break new ground and broad-
en our concern for farmers and farmwork-
ers to include community effects of expo-
sures, we will need to investigate the whole
spectrum of the dose-response curve. I
will provide evidence of long-term neuro-
logic consequences of the highest levels of
exposures, which are those that follow
serious acute poisoning.

I want to raise for consideration the poten-
tial for long-term, chronic neurologic ef-
fects from lower levels of exposures to
pesticides in the unpoisoned worker. This
could happen by directly applying or han-
dling the pesticides and even, perhaps, in
the indirect exposures seen in the com-
munity setting.

SURVEILLANCE

My colleagues and I at the University of
Washington first became involved in pesti-
cide health-effects research in clinical
evaluation of patients. Our primary goal
at the Occupational Medicine Clinic is to
attempt to define a patient's medical con-
dition and then to try to determine wheth-
er or not it is work-related.

One such patient was a farmworker who
had spent all of his adult life in farm labor
He was living east of the mountains near
some of our largest apple orchards. He
was referred because of concerns by his
physician, who had known him well for a
number of years. Following an episode
two years before we saw him, he devel-
oped a number of new, now chronic,
health problems.

At the time we saw him, the patient com-
plained of persistent headache, memory
loss, confusion, and generalized fatigue.
These symptoms followed soon after a
significant pesticide poisoning two years
earlier.

He had been involved in a full day of
working behind a chemical sprayer, sus-
taining significant skin absorption of an
organophosphate pesticide, and was over-

Surgeon General's Conference on Agricultural Safety and Health - 1991                757


Surveillance - Agriculture-Related Diseases, Injuries and Hazards

come and soon hospitalized with what was
a moderately severe pesticide poisoning.
He never successfully returned to work
after that episode.

He tried to go to work one week later and
just could not. It was at this time that his
family and his physician documented a sig-
nificant change in his general mental
status.

The patient had one previous significant
pesticide poisoning five years before this
latter episode, from which he recovered
well except for some continuing complaints
of new, mild headaches.

On physical examination, we found evi-
dence of disorientations and problems with
memory. Clinically, he looked similar to
elderly patients who present with dement-
ing disorders such as Alzheimer's disease.
Full neuropsychological tests documented
in a more objective fashion significant
abnormalities in a wide array of neurologic
functions consistent with an organic brain
syndrome or chronic encephalopathy.

On the basis of this information, we con-
firmed that he had a significant dementia-
type illness. Important questions still re-
mained. What caused this illness? Was it
related to work?

There were certainly several features that
made us think it was not traditional
Alzheimer's disease. Not only was he a bit
young to present this level of abnormality
from the disease, but it had come on rath-
er suddenly. Clearly, the temporal relation
to the pesticide poisoning was remarkable.

With that in mind, we decided to turn to
the medical literature for assistance. Over
the last few decades, there have been
many suggestions of the potential for chro-
nic neurologic problems to follow acute

752

poisonings. Little formal epidemiologic
research has been done.

ORGANOPHOSPHATE PESTICIDES

Our lack of knowledge is perhaps surpris-
ing given the extent of pesticide exposures
and intoxications. Current estimates from
the World Health Organization (WHO)
are that around the world there are about
three million severe pesticide poisonings a
year.

Organophosphate pesticides are the
leading cause of intoxications in most ar-
eas. Only about one-third of the poison-
ings are occupational. Two-thirds of these
are accidental, including suicide.

It is estimated that the annual poisoning
fatality rate on a global basis is about
220,000. People who get occupationally
poisoned, as expected, have a lower fatali-
ty-to-case ratio than those who sustain
intentional and unintentional nonoccupa-
tional poisoning.

It is estimated that 99 percent of fatal
poisonings occur in the developing world.
It has also been estimated that about 5,000
to 10,000 serious poisonings occur each
year in the United States.

Much is known about the early effects that
will follow acute organophosphate pesti-
cide intoxication. In addition to the acute
syndrome there are a few others, which
may follow by days or perhaps weeks.

The question, though, that I would like to
address and give you some information
about is whether or not high-level, acute,
single doses of organophosphate exposure
can lead to chronic central nervous system
neurologic deficits.

Papers and Proceedings


Chemical Hazards, May 1, 1991

In order to look at this question, we had   and reasonably well-validated pesticide
an opportunity to perform a study in Leon,  registry has been in place there for about 4
Nicaragua. Leon is the center of an agri-   years.
cultural region in Nicaragua. A very active

Table I. Neuropsychological Performance of Poisoned and Comparison Charts.

TEST

Mean Test Score (SD)'     Estimate of
Poisoned Not Poisoned   Difference of
n = 36    n = 36   Means (95% Cl)'

LANGUAGE
       WAIS-R Vocabulary      25.2 (12.1)
ATTENTION
Verbal   WAIS-R Digit Span"'      4.6 (2.1)
Visual    Digit Vigilance (seconds)     305 (135)
MEMORY
Verbal   RN Auditory Verbal Learning' 7.9 (2.9)
Visual    Benton Visual Retention Test++ 4.6 (2.4)
VISUO-MOTOR
Speed   Digital Symbol"       19.2 (12.5)
Sequencing Trail A (seconds)        81 .O (33.0)
Problem
Solving  Block Design         7.7 (7.3)
MOTOR
Steadiness Pursuit Aiming II"      75.9 (33.6)
Reaction  Simple Reaction Time
         (milliseconds)' +         340 (Ill)
Dexterity  Santa Ana Dexterity Test
         (dominant hand)' +        31.7 (6.5)
Speed   Finger Tapping (dominant hand) 46.3 5.9
AFFECT/SYMPTOMS
      Brief Symptom Inventory3   20.6 (10.7)
        Questionnaire 16       7.2 (4.0)

28.7 (9.4)

6.3 (3.2)   1.7
256 (91)  60.3

8.8 (2.7)
6.1 (2.2)

25.4 (11.9)   6.1
63.3 (26.7)  20.6

14.7 (9.2)   6.9

94.4 (29.9)   18.4

308 (50)    32

35.6 (7.0)   4.2
47.3 (6.4)   1.1

18.8 (9.8)   1.8
4.7 (3.8)   2.5

3.4    (-1 .I ,8.0)

0.9
1.5

;0.6,2.9)*
(18.9,101.9)*

(-0.2,2-O)
(0.6,2.5)*

(1.6,10.6)*
(7.7,33.5)*

(3.7,10.2)*

(7.3,29.6)*

(-2.0,66)

(1.3, 7.0)*
(-1.9,4.0)

(-2.9,6.5)
(1.0,4.1)*

"

= Test results represent raw scores (numbers of incorrect responses) unless other units are specified.
+

= Positive value for Estimate of Means (and 95% Cl) indicates worse performance by poisoned cohort
  relative to comparison cohort. Estimate is based on paired t-test. Estimate may differ from value
  obtained by subtracting sample means in instances where full paired data were not available.
`+ = Component of WHO Neuropsychological Core Test Battery (11).
4 = ~~0.01 by paired t-test.
' Digit Span (total recalled: forward and backward).                SD = standard deviation
2 Rey Auditory Verbal Learning (number correct after distraction, Trial VI).     Cl = confidence interval
3 Brief Symptom Inventory (Positive Symptom Total).
          -Adapted from Rosenstock L et al. Chronic Nervous Effects of Acute Organophosphate Intoxication,
                                                 The Lancet. 338: 223-227, 199 1.

Surgeon General's Conference on Agricultural Safety and Health - 1991

753


Surveillance - Agriculture-Related Diseases, Injuries and Hazards

For example, in one region over a several-
month period in 1987, there were close to
300 reported cases. Most were occupation-
al cases of poisoning and two-thirds of
these were hospitalized.

Some conditions of pesticide use in
Nicaragua are worth noting by a look at
some photographs. A common reason for
occupational poisonings is malfunction of
backpack sprayers. These are made of
plastic and there often are not replacement
parts available. Skin absorption is has-
tened in the hot climate. A breakdown of
equipment in league with skin absorption
can lead rapidly to serious overexposures.

Another photo shows a warning label on a
container; the label that gives a warning is
in English. This is not very helpful in a
Spanish-speaking country where only about
half the population in the rural area is
even literate.

I will now review briefly how we undertook
the study and what our main results have
been. We were able to identify 36 men
who had been hospitalized in the main
hospital in this region with moderate to
severe organophosphate pesticide poison-
ing. We studied them, on average, about
two years after the poisoning episode.

A community comparison group was com-
posed by matching to each poisoned indi-
vidual someone of the same age and sex
who was either a close friend or a sibling
and who worked in the same community.
By doing this kind of design, which is a
retrospective, cohort, matched-pair design,
we had a comparison group that was signif-
icantly exposed to pesticides. What was
different was that this group had never
been medically treated for a poisoning.

Neuropsychological functioning was as-
sessed by a test battery, which evaluated a

754

wide array of neurological functions includ-
ing motor testing, visual perception and
processing, testing of memory and lan-
guage abilities, and affect.

Table I shows the characteristics of these
populations. There was good matching of
otn community (never poisoned) and our
poisoned group.

Table II. Characteristics of Poisoned and
Comparison Cohorts.

Not

            Poisoned Poisoned
          (N = 36)  (N = 36)
Mean age in years
(2S.D.)      27.6 (29.5) 27.8 (k9.3)
Number with no
formal education   17 (47%)  12 (34%)
Number who consumed
any ethanol in
past month     13 (36%)  16 (44%)
Number with heavy
ethanol consumption
past month*     5 (14%)   6 (17%)
* Defined as drinking more than 70 bolt/es of
beer or 70 one-ha/f bottles (500 cc) of rum in
past month.

      - Adapted from Rosenstock L et al.
Chronic Nervous Efiects of Acute Organophosphate
   Intoxication, The Lancet. 338: 223-227, 1991.

They are almost identical in age. About
70 percent of the comparison cohort has
also worked with pesticides. A large num-
ber also gave complaints that were consis-
tent with pesticide poisoning, but they had
not been hospitalized for these episodes.

The poisoned group performed worse than
the non-poisoned comparison group for all
outcomes studied (Table 11).

Papers and Proceedings


Chemical Hazards, May 1, 1991

In one set of tests, which is a World
Health Organization (WHO) standardized,
neuropsychological battery, the poisoned
group had statistically significant worse
performance on five out of six subtests.
We also did some additional tests. The
same pattern holds.

On the basis of this study and the ac-
cumulating evidence in the medical
literature, we feel that even episodes of
acute organophosphate poisoning can
cause permanent neurologic dysfunction.

We cannot in this study tease out as much
precision as we would like to compare the
contribution of cumulative pesticide expo-
sure to the overall effect. Any analysis we
did, looking at why the poisoned group did
worse, suggested that it was the actual

QUESTIONS

episode of acute poisoning that contributed
as the main factor to these differences in
performance rather than other measures of
pesticide exposure. On the basis of this
study and the accumulating evidence in the
medical literature, we feel that even epi-
sodes of acute organophosphate poisoning
can cause permanent neurologic dysfunc-
tion.

Although we concluded that it was likely
that the patient first presented in this dis-
cussion had sustained a work-related or-
ganic brain syndrome, much remains un-
known about organophosphates and chron-
ic neurologic sequelae. Further study is
needed to try to replicate our findings and
explore the effects of specific chemicals
within the organophosphate group, the role
of other factors interacting with these
chemicals, and the clinical significance of
the observed neuropsychologic disturb-
ances.tl

Dr. James A. Dosman: Linda, thanks a lot. I really enjoyed your talk. As scientists we never pay attention
to one case, but, as you know, clinical observation is the first step in epidemiology. About two years ago a
man came to me who said that he was perfectly healthy until one afternoon when he was spraying with
(inaudible); it is a carbamate.

When he went out in the morning, the wind was still. Then the wind came up and it blew over him. When
he got in at noon he felt so weak that he could not get to the house. Eventually he did. He lay there for
two or three days; he seemed to recover. Since that time, he has been unable to do anything. He has felt
depressed. He cannot make decisions. He cannot be effective. I would like to ask you, do you think, on the
basis of the work that you have carried out, that this kind of mental reaction is possible following one
overdose?

Dr. Linda Rosenstock: I think it is a good question. Using the word "possible" makes it a little easier to
answer. If I were asked, again using this legal standard, if there is a greater than 50 percent likelihood, I
would have more trouble saying yes.

I think the case reports in the medical literature suggest that there may be significant anxiety and depression
following exposures. The question is how much exposure and what the mechanism is. Unfortunately, I think
the conventional wisdom has been to say people just get traumatized and we are looking only at a psycholog-
ical reaction. They are anxious and it has nothing to do with the effects, directly, of the chemicals.

Surgeon General's Conference on Agricultural Safety and Health - 1991

755


Surveillance - Agriculture-Related Diseases, Injuries and Hazards

In our study, we were actually surprised. We expected to find differences in psychiatric performance. In
other words, there is increased anxiety and depression in the previously poisoned group, which I went over
quickly.

In our study, we found no such differences. That made it easier for us to say everything else was real. If we
found differences, then a lot of critics would say, "Well, you are or@ measuringproblems with memory because
people are depressed; if you are depressed you do not concentrate as well because you are distracted." It made
it easier for us to defend our results.

But I still think, despite our negative findings in that regard, that the medical literature suggests that results
like this can happen. I think they are worthy of further investigation. It is too easy to write off all of these
people who have these complaints and say that they, all of a sudden, got a little crazy when they were not
crazy before.

Dr. Henry Anderson: I think we all want to keep in mind that we are going to be hearing examples. What
we are challenged with is, what data systems or what surveillance currently exists that can assist in the
identification of the cases so that it can interface with follow-up research? We have one of the key chemical
exposures. I think we are all aware that there are multiple chemical exposures that go on in the agricultural
setting. One of the key ones is the organophosphate poisoning. We think in terms of the continuum that
Bill presented. We have laboratory testing to measure effect. Whether it is an adverse effect is still being
argued. We have exposure assessment techniques. We have disease outcomes ranging from fatality to acute
poisonings. The challenge is, "How can surveillance assist in a better understanding of the other parameters
that relate to these types of exposures?"

756

Papers and Proceedings


Surgeon General's Conference on Agricultural Safety and Health
FARMSAFE 2000 o A National &m/it/on ti.w Local Actjon
Convened by the National institute for Occupational Salty and Heatth
April 30 - May 3, 1991, Des Moines, Iowa

RESPIRATORY DISEASES

By James A. Dosman, M.D.
Director, Center or Agricultural Medicine
  University of Saskatchewan

SUMMARY

The structuring of health surveillance pro-
grams for widely dispersed agricultural
populations is difficult because of the mul-
tiplicity of exposures and health effects.
There is also the difficulty with reaching
and communicating with widely dispersed
populations.

In order to accomplish this objective, a co-
operative approach between government,
industry, the community, and individuals is
necessary. In order to achieve successful
"rural family life enhancement," a high
degree of local ownership and leadership
in the program is essential.

The problems of structuring health surveil-
lance programs for widely dispersed popu-
lations that do not fit traditional labor-
management structures for industry are
numerous. Nonetheless, the significant
issues relating to health and well-
being-involving high rates of death, dis-
ability, and accidents; respiratory difficul-
ties as the result of dust, microbe, and
chemical exposure; possible enhanced can-
cer risks as a result of environmental ex-
posures; hearing loss as a result of unquan-
tified and uncontrolled noise levels; skin
problems as a result of exposure to dusts,
chemicals, microbes, and other substances;
and stress and psychiatric problems as a
result of isolation, economic difficulties,
and inter-generational family problems-all
demand a coordinated occupational health
program.

On the organizational level, structuring
such programs is difficult as farmers and
other agricultural workers are widely dis-
persed, do not belong to single organiza-
tions or companies, and are thus difficult
to reach for health surveillance, early iden-
tification, and an educational-preventive
perspective.

THE TOOLS OF HEALTH
SURVEILLANCE

In this model, no one organization may be
responsible for, or effectively deal with,
occupational health and well-being ques-
tions. In order to achieve success, cooper-
ation is required between government,
industry, the community, and individuals.
This paper describes certain approaches at
each of these four levels.

1

. ..we recommend the establishment of
health and safety committees at the local
level, organized by target populations, for
the purpose  of identifying issues,
facilitating programming, and achieving
results.

GOVERNMENT

Governmental agencies can exercise con-
siderable influence on health surveillance
by moral leadership, regulatory approach-
es, and information retrieval and distribu-
tion. In Canada, for example, Labour

Surgeon General's Conference on Agricultural Safety and Health - 1991                157


Surveillance - Agriculture-Related Diseases, Injuries and Hazards

Canada, a regulatory agency for workers
that is involved in the cereal grain indus-
try, requires that dust levels be maintained
at no greater than 10 mg/m3 time-weighted
over an &hour day, and that workers be
given the opportunity for questionnaire
assessment and pulmonary function testing
every 3 years. As part of this program,
Labour Canada requires receipt of dust
level and medical information.

The latter requirement has contributed to
compliance and interest in the program on
the part of industry and labor. It has
provided scientific information that is
being utilized to estimate longitudinal
effects of grain dust exposures on human
health. Thus, the regulatory process ap-
pears to be accomplishing a number of
goals:

1. Reduction and regulation of environ-
mental dust levels.

2. Compliance of industry and workers in
providing for, and being involved in, a
periodic human health assessment pro-
gram.

3. The utilization of information from this
program in scientific research, that in

Table I. Number or Dust Samples Obtained in
Elevator Facilities.

turn may assist in
level regulations.

re-evaluating dust

In some ways, this program may be consid-
ered a model of the manner by which
government may stimulate action at several
levels.

INDUSTRY

Where concentrations of agricultural work-
ers exist, as in the grain transport and
storage industry, industry may play a lead-
ing role in promoting good health amongst
its workers. Utilizing the Canadian grain
industry as an example, compliance among
companies in initiating dust removal equip-
ment in grain facilities has been relatively
good. Table I indicates that out of a total
of 2,048 dust samples obtained in grain
facilities in Canada in the early 1980's,
only 19.8 percent of the samples obtained
by Labour Canada, and 17.2 percent of the
samples obtained by the companies them-
selves, exceeded the recommended maxi-
mum dust exposure limit of 10 mg/m'.

An additional dimension to the provision
of health surveillance services for these
workers is taking place in Canada in the
Province of Saskatchewan. In this prov-
ince, all grain companies have gone be-

Canadian Grain

       ~5 mg/m3  >5 mg/m3  > 10 mg/m3
          n   %      -2L      -2L
Labour Canada*  341  64.8 -ik 35.2 %i   19.8
Companies'*   1008  66.2  514  33.8 261   17.2
Samples Collected:                      o 1980-1984, n = 526
                                    H 1978-1986, n = 1.552
                             Total = 2,078
- Reprinted from: McDufie HH, Pahwa P, Dosman Jk Respiratory Health Status
           of 3,098 Canadian Grain Workers Studied Longitudinally,
            American Journal Industrial Hygiene. (in press) 1991.

yon6 the legal requirements
of Labour Canada and are
providing sufficient resources
for a more comprehensive
approach to health surveil-
lance that goes beyond the
minimum respiratory re-
quirements of the regulatory
agency.

158

Such additional services
include, in addition to
respiratory testing, one-to-
one nurse counselling invol-
ving lifestyle management

Papers and Proceedings


(smoking and other issues), use of personal
protective devices, back care, stress, and a
variety of other occupational health ques-
tions. In our experience, the workers have
responded positively to this initiative.

COMMUNITY

The provision of health surveillance to
widely dispersed farmers and their families
must, by necessity, involve the community.
In Saskatchewan, in the model being uti-
lized, a widely dispersed approach is taken
to occupational safety and health through
the Agricultural Health and Safety Net-
work of the University of Saskatchewan.

In this approach, individual rural
municipalities, the local unit of self-govern-
ment, enroll their resident farm families in
the Agricultural Health and Safety Net-
work for the promotion of better health
and farming practice. Since its commence-
ment three years ago, 10 percent of the
rural municipalities in the province have
enrolled their farm families in this net-
work, comprising about 7,000 persons.
Once enrolled in the network, individual
farm families receive preventive materials
on various topics relating to good healthy
farm practice annually.

In addition, health surveillance services,
such as respiratory testing and seminars on
safe dust management, the use of personal
protective devices, and other issues, are
provided. Recently, as part of this pro-
gram, seminars on safe chemical
management have been offered, and a
hearing conservation survey took place in
one municipality.

This program is financed by individual
subscriptions from the municipalities, amo-
unting to l/lOth of one mill of taxation per
year. The relation between the Center for

Respiratory Diseases, May 1, 1991

Agricultural Medicine, which promotes the
program, and individual farm families is
through elected rural Municipal Councils.
While it is too early to determine the ef-
fectiveness of this approach to health sur-
veillance, it appears to offer potential.

THE INDIVIDUAL

The most successful approach to good
work, health, and lifestyle practice is
through an educated and motivated indi-
vidual. Farm families are scattered widely
geographically. With farm work practices
being ingrained over many years, the pro-
cess of education remains the most impor-
tant and useful means of making gains.

The basis of the approach through the
Agricultural Health and Safety Network is
to achieve an educated and motivated
individual. Yearly provision of materials,
the provision of stickers for farm imple-
ments identifying individuals as members
of the Agricultural Health and Safety Net-
work, and tailored educational sessions are
important in this process. In addition,
information and material developed within
the geographic area in question that is
useful to, and identified with, the type of
farm practice, social issues,' and family life
of the region, are important.

RURAL FAMILY LIFE ENHANCEMENT

The goal of health surveillance in the agri-
cultural industry should be a broadly based
approach to a multiplicity of issues that go
beyond the workplace per se arid result in
an enhanced quality of life for persons who
live in rural areas, the majority of whom
are involved in agriculture and its related
industries. In order to accomplish these
goals, a combined, coordinated approach
between government, industry, community
organizations, and individuals is essential.

Surgeon General's Conference on Agricultural Safety and Health - 1991                159


Surveillance - Agriculture-Related Diseases, Injuries and Hazards

Underlying this cooperative approach is   lishment of health and safety committees
the necessity of local ownership of and    at the local level, organized by target pop-
leadership for programs that are undertak-  ulations, for the purpose of identifying
en. Specifically, we recommend the estab-  issues, facilitating programming, and
                    achieving resu1ts.O

160

Papers and Proceedings


Surgeon General's Conference on Agticultwal Safety and Health
FARMSAFE 2000 o A National Coalition kr Local Action
Convened by the National Institute For Occupational &My and Health
April 30 - May 3, 1991, Des Moines, Iowa

SURVElLLANCE OF INJURIES IN AGRICULTURE

      By Susan Goodwin Gerberich, Ph.D.
    Division of Environmental and Occupational Health,
School of Public Health, University of Minnesota, Minneapolis, Minnesota

               Robert W: Gibson, PhD.
           Division of Environmental and Occupational Health,
    School of Public Health, University of Minnesota, Minneapolis, Minnesota, and
Department of Behavioral Sciences, School of Medicine, University of Minnesota, Duluth, Minnesota

Paul D. Gundemon, Ph.D.

National Farm Medicine Center, Marshfield Medical Pesearch Foundation, Marshfield, Wisoconsin

      L. Joseph Melton III, M.D., M.P.H.
       Department of Medical Statistics and
Epidemiology, Mayo Clinic/Mayo Medical School, Rochester, Minnesota

      L. Ronald French, Ph.D.
Chronic Disease and Environmental Epidemiology Section
Minnesota Department of Health, Minneapo!is, Minnesota

Colleen M. Renier, B.S.

Department of Behavioral Sciences, School of Medicine, University of Minnesota, Duluth, Minnesota

John A. True, MS.

Department of Agricultural Engineering, University of Minnesota, Minneapolis, Minnesota

W Peter Cam, M.P.H.

Division of Environmental and Occupational Health, School of Public Health
      University of Minnesota, Minneapolis, Minnesota

ABSTRACT

There has been no comprehensive data system to identify the magnitude of the injury problem
in the rural farming community or the potential risk factors that may be associated with this
problem. Serious discrepancies among the existing data sources, pertinent to occupational
morbidity and mortality, limit identification of the true magnitude of the problem. Based on a
recent National Academy of Sciences report, it has been documented that fatal as well as non-
fatal occupationally related injuries have been greatly undercounted. In part, these discrepancies
in mortality and morbidity data are due to variations in definitions, the worker populations
included, methods of case ascertainment, and the data sources utilized.

Fatality rates identified for agriculture have ranked among the highest for many years. However,
given the overall discrepancies among the data systems and the reporting limitations for
agriculture, these would appear to be extremely conservative estimates. A major barrier to
progress in the prevention of agricultural injuries has not only been a lack of knowledge about
the magnitude of the problem but also a lack of knowledge about specific causes or risk factors

Surgeon General's Conference on Agricultural Safety and Health - 1991                767


Surveillance - Agriculture-Related Diseases, Injuries and Hazards

due to the lack of analytical studies. This paper includes an historical perspective of surveillance
and its importance to the problem of injuries in the agricultural community. Special emphasis is
placed upon the data sources and methodological approaches that have been used in agricultural
surveillance, including advantages and limitations.

Among the agricultural injury surveillance efforts that will be discussed are two major
population-based efforts, conducted by a multi-disciplinary team, using a methodology that can
also serve as a model for long-term surveillance efforts at the state, regional and national levels.
These efforts are the Ohnsted Agricultural Trauma Study (OATS) and the Regional Rural
Injury Study (RRIS):

1. The overall purpose of OATS was to identify the magnitude and characteristics of the injury
problem among all farms in Olmsted County, Minnesota, using a telephone interview
methodology, validated through medical records. Data pertinent to the household members,
characteristics of the farm operation, and injury events (farming and non-farming related;
intentional and unintentional) were collected. In concert with this effort, a case-control study
to facilitate identification of risk factors, an inter- and intra-rater reliability study of E-coding,
and a follow-up pilot investigation of machinery-related injury events were also conducted.
Specific findings, including injury rates, characteristics of the injuries and injury events, and
risk factors, are presented with regard to implications for surveillance.

2. OATS provided the basis for the Regional Rural Injury Study (RRIS), currently being
conducted in a five-state region: Minnesota, Wisconsin, North Dakota, South Dakota, and
Nebraska. Data collection covers a twelve-month period of time for over 4000 rural
households, utilizing computer-assisted telephone interviews (CATI). This effort will enable
the identification of injury rates for each state and the region as well as multiple analytic
substudies, including tractor-rollovers and animal-human injuries. The project also includes
application of the results to the development of intervention strategies, to be achieved by
convening nationally recognized experts and the regional participants in the Agricultural
Injury Intervention Stratepy Workshop.

INTRODUCTION

There has been no comprehensive data
system to identify the magnitude of the
injury problem in the rural farming com-
munity or the potential risk factors that
may be associated with this problem that
can enable progress in the prevention of
agricultural injuries. Serious discrepancies
among existing data sources limit identifi-
cation of the true magnitude of occupa-
tional morbidity and mortality. For exam-
ple, the fatality rates identified for agricul-
ture have ranked among the highest for
many years, but a recent National Acade-
my of Sciences report,' documented that
fatal as well as non-fatal occupationally-

related injuries have been greatly under-
counted.

Another major barrier to progress in the
prevention of agricultural injuries has been
a deficiency in knowledge about specific
causes or risk factors due to the lack of
analytical studies. This paper includes an
historical perspective of surveillance and
its importance to the problem of injuries in
the agricultural community. Special em-
phasis is placed upon the data sources and
methodological approaches that have been
used in agricultural surveillance, including
advantages and limitations.

162

Papers and Proceedings


SURVEILLANCE: AN HISTORICAL
PERSPECTIVE

Surveillance is a French word originally
meaning, "keeping a close watch over an
individual or group of individuals in order
to detect any subversive tendencies."2 Cur-
rent dictionary definitions, e.g., "vigilant
supervision, " "spylike watching," or "watch
or observation kept over a person,
especially one under suspicion or a
prisoner,`" continue this negative con-
notation. This historical perspective
provides a basis for the negative percep-
tion of "surveillance" in the general
population that can seriously affect data
collection efforts.

Surveillance of disease evolved in the 17th
century when fear of plague epidemics
resulted in efforts to document the impact
of morbidity and mortality. Subsequently,
surveillance efforts have been utilized to
monitor acute disease outbreaks and to
ascertain potential relationships between
working environments and certain health
conditions in Europe.2 However, it was
not until the 19th century that surveillance
had evolved as a "means of collection and
interpretation of data related to environ-
mental and health monitoring processes for
the definition of appropriate action, for
prevention and health care."2

A surveillance effort comparable to those
that were developed in Europe and fo-
cused on disease entities did not emerge in
the United States until 1900; full national
mortality coverage was not attained until
1933.

INJURY SURVEILLANCE

Of great importance is the fact that, al-
though injuries have been identified as a
persistent problem over time, there have

Surveillance of Injuries in Agriculture, May 1, 1991

been no adequate comprehensive surveil-
lance systems established.' In particular,
occupational injuries, which constitute an
important part of the injury problem in the
United States, have not received attention
commensurate with the magnitude of the
problem. Agriculturally related injuries
have received even less attention since
about 95 percent of all farming operations,
by virtue of their size, do not fall under
the jurisdiction of the Occupational Safety
and Health Administration's, or other
agencies' recording and reporting require-
ments." '

Occupational Injury Surveillance

Serious discrepancies among the existing
data sources pertinent to occupational
morbidity and mortality limit identification
of the true magnitude of the problem. In
1989, the National Safety Council esti-
mated that there were 10,400 occupa-
tionally related fatalities.' The Bureau of
Labor Statistics: (BLS) reported 3,300 for
the same year.' A third source of occupa-
tional fatality data is the National Trau-
matic Occupational Fatality (NTOF) data
base at NIOSH, based on death certificates
specifically coded with the "injury-at-work'
designation. Through this source, it was
estimated that approximately 7,000 work-
related fatalities occurred each year during
the period between 1980 and 1985.

Similar discrepancies are identified for
non-fatal occupational injuries. In 1989,
the National Safety Council estimated that
there were 1.7 million disabling injuries.
During the same year, the Bureau of
Labor Statistics estimated that ap-
proximately 6.2 million work-related inju-
ries occurred, with 2.9 million of those
involving lost work days? Another source
of data is based on a sample of ap-
proximately 66 emergency rooms from the

Surgeon General's Conference on Agricultural Safety and Health - 1991               763


Sweillance - Agriculture-Related Dlseases, Injuries and Hazards

United States Consumer Products Safety
Commission's (CPSC) National Electronic
Injury Surveillance System (NEISS). From
an unpublished NIOSH report based on
these data, it was estimated that over 3.8
million occupational injuries of varying
severity and outcome are treated every
year in all U.S. emergency departments.
In part, these discrepancies in morbidity as
well as mortality data are due to variations
in definitions, the worker populations that
have been included, different methods of
case ascertainment, and the various data
sources that have been utilized."

and interpretation, epidemiologic surveil-
lance (Figure 1) enables the identification
of the magnitude of the morbidity and
mortality problem, injury epidemics, new
injury problems, and potential risk factors.

CQEVENTIW AND CWTWL
JTRATBZYIPRXIW
   ItAA4ENTATIOH

PLAta4Iffi

INTEWRETATION

Agricultural Injury Surveillance

Fatality rates identified for agriculture
have ranked among the highest across all
occupations for many years. Based on
National Safety Council data for 1989,
agriculture accounted for a rate of 40
deaths per 100,000 workers, compared with
9 deaths per 100,000 workers for all occu-
pations. National morbidity rates in agri-
culture have been elusive due to the lack
of adequate population-based data for
non-fatal events.

Figure 1. Surveillance of Injuries in Agriculture.

However, the data suggest a major prob-
lem among farm residents.s'"-15 In 1989, an
estimated 120,000 disabling injuries oc-
curred in agricultural work, with 70,000 of
these involving farm residents.' Given the
discrepancies among the various data sys-
tems and the reporting limitations for
agriculture, the estimates identified would
appear to be extremely conservative.

Of particular importance is that it can
provide a scientific basis for analytic re-
search to identify specific risk factors that
are critical to the development of interven-
tion strategies for the prevention and con-
trol of agricultural injuries. The integrity
of a surveillance system is reliant upon
regular evaluation and modification, as ap-
propriate, with specific attention to validity
and reliability measures. Finally, the sur-
veillance system provides for ongoing eval-
uation of specific prevention and control
activities so that alterations can be imple-
mented, if necessary, along the way.

ELEMENTS OF SURVEILLANCE

A major barrier to progress in the preven-
tion of agricultural injuries has been not
only a lack of knowledge about the magni-
tude of the problem but also a deficiency
in knowledge about the specific causes or
risk factors due to the lack of analytical
studies.`s*`6 Through ongoing, systematic
data collection, with consequent analysis

Meaningful injury surveillance requires
data that will allow the calculation of pop-
ulation-based morbidity and mortality
rates. This requires complete numerator
and denominator data for the population
from which the data are drawn.

164                                    Papers and Proceedings


Surveillance of Injuries in Agriculture, May 1, 1991

A serious deficiency in many of the surveil-
lance efforts that have been initiated is the
inabili
data. Y to identify adequate denominator
    4 1 ) 17-19 Not only is it essential to iden-
tify the total numbers of people at risk but
also the various demographic characteris-
tics of that population (e.g., age, gender,
education, socioeconomic status, length
and types of exposures, experience, and
behavioral characteristics).

Of further importance is the collection of
exposure data that address the farming
operation, including the sizes and types of
operations, the animals involved, and the
machinery, equipment, and chemicals that
are in use. Basic to the numerator is a
clearly established definition of injury that
may be very broad or may focus on specif-
ic types and severity of injuries, sources
and locations of injuries that occur to the
entire population or, perhaps, to certain
subpopulations, and whether the injuries
are intentional or unintentional.`9

These elements are all integral to an injury
definition. Utilization of an active versus
passive system of reporting will enhance
the likelihood of identifying complete nu-
merator data."* u Of further importance is
consideration of the specific time period
for which the data are to be collected, the
relevant data analysis to be conducted, and
dissemination and utilization of the
results."' 22

Based on recommendations published from
a National Academy of Sciences Commit-
tee,4' p there are essential data elements
for injury surveillance (Table I). These
include time of the event; place of occur-
rence; demographic characteristics of the
injured person; characteristics of the injury,
including the body part affected, type and
severity; the agent causing the event, as
well as the source and mechanism of the
event, and the circumstances surrounding
the injury event; medical care provided;

Table I. Essential Data Elements for injury Surveillance.

INJURY CASE ELEMENTS
. TIME OF EVENT
. PLACE OF OCCURRENCE
o DEMOGRAPHIC CHARACTERISTICS OF THE INJURED PERSON (e.g., age, gender,

education, socioeconomic status, occupation)
o CHARACTERISTIC OF THE INJURY (including body location affected, type of injury, severity)
o ' AGENT CAUSING THE EVENT (e.g., mechanical, chemical, electrical energy)
o * SOURCE OF THE EVENT (e.g., machinery, tractor, gun, animal)
o * MECHANISM OF THE EVENT (e.g., fall, struck by/against)
9' CIRCUMSTANCESSURROUNDINGTHEINJURY EVENT (actively involved, equipmentfailure,

weather, surface, or other environmental conditions)
o MEDICAL/HEALTH CARE PROVIDED TO THE INJURED PERSON
o HEALTH OUTCOME OF THE EVENT (e.g., complete recovery, persistent disability involving limitation
of activities)

o Necessary to facilitate International Classification of Diseases (ICD) External Cause Coding (E-coding).

Adapted from Ing, 198.5; Committee on Trauma Research, Commission on Life Sciences, Natural Research Council and
the National Institute of Medicine, 198.5.

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Surveillance - Agriculture-Related Diseases, Injuries and Hazards

and overall health outcome. Inclusion of
appropriately coded severity levels is par-
ticularly important in determining the
overall magnitude.a*25

A major barrier to progress in the
prevention of agricultural injuries has not
only been a lack of knowledge about the
magnitude of the problem but also a lack
of knowledge about specific causes or risk
factors due to the lack of analytical
studies.

Identification of the agent, source and
mechanism of the injury event, together
with the circumstances surrounding the
event, is crucial to External Cause Coding,
or E-coding, using the International Classi-
fication of Diseases (ICD) codes and
modifications specific to agricultural inju-
ries.", 26 The use of E-codes provides the
critical link between the source and the
nature of an injury, which enables targeting
for more comprehensive analytic studies to
identify specific risk factors and, subse-
quently, to develop relevant prevention
and control programs; it also facilitates
comparisons across data sets. The fact
that intervention at the source of the injury
event has been the most successful in the
prevention and control of injuries high-
lights this element as integral.%

The items that have been identified pro-
vide only the very basic elements of a
surveillance system. More comprehensive
systems can be implemented with the rec-
ognition that as more items are included,
the system becomes more expensive and it
is more difficult to ensure consistency and
quality of the data.19

766

SURVEILLANCE OF AGRICULTURALLY
RELATED INJURIES

Advantages and Limitations of
Surveillance Efforts

A v&e@ of efforts in the surveillance of
agriculturally related injuries have been
undertaken to ascertain the magnitude of
the problem, with varying degrees of suc-
cess. The data sources for these efforts
are presented in Table II (at the end of
this paper), with elaboration on the ad-
vantages and limitations of each of these
sources. For example, death certificates,
which are utilized in agricultural fatality
surveillance, are easily accessible. Yet
there are many limitations, including the
persistent lack of attention by those who
complete these certificates to indicating
that the event occurred at work. As a
single source for surveillance, fatalities
account for an extremely small proportion
of the total problem.15

The Occupational Safety and Health Ad-
ministration (OSHA) is extremely limited
as a data source, given that about 95 per-
cent of farms are not covered by this sys-
tem; Federal appropriations do not enable
enforcement of OSHA regulations among
farms employing ten people or less. For a
variety of reasons, there has also been
underreporting of both morbidity and mor-
tality data through the BLS.' Workers'
Compensation data also are limited by
virtue of a small proportion of farmers
covered by this system.

Another very large national system, the
Fatal Accident Reporting System (FARS),
which is operated by the National Highway
Traffic Safety Administration (NHTSA),
enables identification of non-truck farm
vehicle fatalities that occur on roadways.z7
However, it is not possible to identify the

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specific type of vehicles involved through
this system.

Newspaper clipping services have been
used by several investigatorsS*12 in various
efforts and, while this source has serious
limitations, it can facilitate recognition of
emerging as well as persistent injury
problems. To a limited degree, it can also
detect fatal events that are not readily
accessed through death certificate data.

While hospital records may enable iden-
tification of specific diagnoses and treat-
ments, there are also many limitations in
using these records for surveillance. These
include the problem of confidentiality, as
well as inadequate information on the cir-
cumstances surrounding the event and the
long-term consequences, together with a
bias toward the more severe injuries." Of
particular importance is the fact that only
a small proportion of injuries related to
farm operations result in hospitalizations
and, with extremely rare exceptions, the
hospital record sources are not population-
basedls.

The records from emergency departments,
outpatient facilities, and from primary care
practitioners have even greater limitations,
including accessibility, unless they are
linked into a major data base.  Operation
of such data bases is extremely difficult
and, consequently, very rare. The
denominator is a major problem for these
data sources, as well. While there are a
few success stories, linking multiple data
sources is extremely complex and not
recommended.19

Data from a combination of some of the
above sources have also been used with
varying success.`9*2830 In Minnesota, a
feasibility effort in establishing injury sur-
veillance was initiated to link multiple

Surveillance of Injuries in Agriculture, May 1, 1991

existing data sets, ranging from hospital-
based data to agency-based data, including
highway crash events.19 Many limitations
were identified. These included:

1. Issues of confidentiality, which
prevented access to personal identifiers
in some cases, preventing detection of
duplication of cases.

2. Quality and quantity of data elements,
affected by varying injury definitions,
data elements included, methodologies
and a combination of active and passive
reporting.

3. The inability to calculate rates other

than for mortality, which accounted for
only 0.3 percent of the total injury
problem.

Finally, there is the potential for ongoing
surveillance using in-person and telephone-
based interviews or mailed questionnaires,
each with advantages and limitations. In
general, the quality of data do not vary
greatly between in-person and telephone
interviews, given the same interview con-
tent.31 However, the in-person interview is
much more expensive. While mailed ques-
tionnaires can provide ease of contact, the
quantity and quality of information and the
potential for lower response rates can be a
problem.

POPULATION-BASED SURVEILLANCE
OF AGRICULTURAL INJURIES IN THE
UPPER MIDWEST

Olmsted Agricultural Trauma Study
(OATS): Given the limitations that have
been identified and that there has been no
comprehensive data system to identify the
true magnitude of the injury problem in
the agricultural community or the variables
that might be associated with this problem,

Surgeon General's Conference on Agricultural Safety and Health - 1991                767


Surveillance - Agriculture-Related Diseases, Injuries and Hazards

a major project was undertaken in Minne-
sota in 1986 by a multidisciplinary team of
investigators. The purpose of this
population-based effort, known as the
OATS,15 was to determine the magnitude
of the injury problem, using a methodology
that could serve as the basis for long-term
surveillance efforts at the state, regional,
and national levels.

OATS, which served as the basis for the
current regional five-state effort, was
implemented in Olmsted County, Min-
nesota due to the ability to validate
telephone interview-based injury data using
the Mayo Clinic's comprehensive Roches-
ter Epidemiology Project.`SV32 This interna-
tionally recognized unique data base con-
tains health care records for virtually all
residents in the county.

Definition of Terms

Two basic issues our research team dealt
with, initially, were the elusive definition of
a farm and the definition of an injury. The
definition of a farm was based on the
USDA's Master Sampling Frame; their
definition is "an operation with annual
sales of $1,000 or more of agricultural
products."

An injury event was defined as one, which
restricted normal activities for at least four
hours, involved a loss of consciousness, loss
of awareness, or amnesia for any length of
time, or required professional health care,
or any combination of these three.

This included both farming and non-farm-
ing activity-related injuries classified either
as intentional or unintentional. The injury
definition was based on experience in
previous research endeavors and is com-
patible with definitions used by the
NCHS."

168

Data Sources

The sources of data included both tele-
phone interviews and medical record re-
view. Demographic and exposure data
were collected from both male and female
heads of household by trained telephone
interviewers, using specially designed, pre-
tested data collection instruments. The
female head of household was the pre-
ferred respondent for demographic infor-
mation on the family and whether or not
any family members, workers, or visitors
had been injured during the designated
one-year time frame.

The male head of household was the pre-
ferred respondent for the farming opera-
tion exposure information. Injured persons
were interviewed, directly, to obtain infor-
mation concerning the injury events, with
the exception of children under the age of
18, in which case the female head of
household was asked to respond pertaining
to their injuries.

The injury data collected included type,
severity, source, mechanism, and contribut-
ing factors. Injury events reported through
the telephone interviews were validated by
review of the health care records in the
Mayo Clinic medical records linkage sys-
tem."' 32

Selected Results and Discussion

Among the total eligible farms in the cou-
nty (n= 892), there was an overall partici-
pation rate of 82 percent, with 75 percent
completing all components of the inter-
view. The distribution of the farm house-
hold members by age and gender revealed
nearly identical mean ages for males and
females (34.7 and 34.6, respectively).

Examples of the exposure data that were
collected included the types of farming

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operations, which enabled calculation of
specific injury rates. For example, the
rates for farming and non-farming activity-
related injury events per 100 farms per
year were 16.0 and 21.6, respectively.
Similarly, the injury event rates per 100
farm residents for farming and non-far-
ming related activities were 4.6 and 6.2,
respectively.

The fact that non-farming injury rates
exceeded the farming-related rates is of
particular interest. Consideration of the
total injury picture is essential to address
the overall impact of injuries on the farm-
ing operation and potential intervention
strategies that might ultimately be imple-
mented.

The age- and gender-specific rates provid-
ed further information. It is important to
note that the conclusions drawn from any
such data can vary with the use of different
denominators. For non-farmwork related
injuries, among males (whose overall rate
was 6.3 injury events/100 persons), those
less than. 14 years of age (8.8/100) and 14-
24 years of age (11.9/100) had the highest
rates; among females (whose overall rate
was 5.1 injury events/100 persons), the
highest rates occurred in those age groups
less than 14 years (5.2/100), 14-24 years
(7.0/100), and 25-44 years (5.6/100).

In contrast, when considering the
farmwork-related injury events per 100
farm residents, the older age groups
emerged as being primarily involved.
Among males (whose overall rate was
6.5/100), the hi hest rates were shown in
the 25-44 (12.3 100) and 45-64 (7.6/100)
   f
year age groups; among females (whose
overall rate was 1.5/100), the highest rate
was in the 45-64 year age group (2.6/100).

Surveillance of Injuries in Agriculture, May 1, 1991

In order to target groups for potential
intervention efforts, it is also critical to
consider the total exposure time with re-
gard to farming-related injuries. Given
this information, a very different pattern
was demonstrated, whereby the children
and younger adults were shown to be at
greatest risk.

Among the males, the highest injury rate
per 100,000 hours worked per year was in
the age group involving those less than 14
years of age (8.3); the next highest rate
was among those 25-44 years of age (4.7).
Among females, the highest rate was found
in the 15-24 year age group (6.0), followed
by the 45-64 year age group (2.8).

To identify potential risk factors, the sourc-
es of the injury events were documented
for both the farming and non-farming
related injuries. The primary sources of
the farming operation-related injuries were
machinery (23 percent), animals (18 per-
cent), general farm sources (16 percent),
and tractors (12 percent), while sports and
recreational sources (38 percent), vehicles
other than farm machinery (12 percent),
and home activity sources (12 percent)
were primarily involved in the non-farming
related injury events. These data, together
with other comprehensive data that have
been collected, provide a basis for identify-
ing potential risk factors that might be
investigated through specifically designed
analytic efforts and serve as a springboard
for development of prevention and control
strategies.

Descriptive information pertinent to the
injury can also be generated from this type
of effort. The three major types of
farmwork-related injuries were sprains and
strains (27 percent), contusions (17 per-
cent), and fractures (14 percent). Similar
types of non-farmwork related injuries

Surgeon General's Conference on Agricultural Safety and Health - 1991                769


Surveillance - Agriculture-Related Diseases, Injuries and Hazards

were also identified: sprains and strains (28
percent), lacerations (18 percent), and
fractures (17 percent).

Of particular relevance are the proportions
of injury cases that required hospital-
ization-8 percent of the farmwork-related
injuries and 10 percent of the non-
farmwork related injuries. As indicated
previously, this finding has implications
pertinent to the limitations imposed when
only hospital-based surveillance is used.

Consideration of restricted activity must
also be taken into account when assessing
the total impact on the farming operation.
The fact that a large proportion of injured
individuals were actually restricted for a
week or more as a result of either a farm-
ing-related injury (21 percent) or a non-
farming related injury (24 percent) is'very
important when looking at the overall
impact. Moreover, a large proportion,
when interviewed, still had some type of
persistent problem, including some perma-
nent disabilities (farming and non-farming
related injuries, 27 percent and 25 percent,
respectively).

These findings constitute only a very small
proportion of the total analyses, but give
an indication of the possibility of identify-
ing the extent of the problem in a compre-
hensive manner. OATS data were also
used as a basis for conducting sub-studies,
including analytic efforts, to further ad-
dress the agricultural injury problem.
These efforts included a case control study
to identify human and environmental risk
factors for farming-related injuries.33

In addition, a pilot on-site investigation of
machinery-related injury events was con-
ducted by a team of engineers and epidem-
iologists to identify factors for consider-
ation in subsequent engineering studies."
A sub-study of inter- and intra-rater

770

reliability in the assignment of ICD E-
codes provided a further contribution to
the use of this system for classifying far-
ming and non-farming-related injuries.%

Regional Rural Injury Study

The research design that was evaluated in
OATS served as a basis for the current
Regional Rural Injury Study (RRIS),=
involving Minnesota, Wisconsin, North
Dakota, South Dakota, and Nebraska.
This new project has been designed to
serve as a national model for conducting
surveillance in agricultural populations. In
addition to its value as a comprehensive
surveillance system, the five-state RRIS
also provides a basis for specific analytic
studies, as well as the potential for ongoing
surveillance that can facilitate evaluation
of specific intervention efforts.

In the RRIS, data were collected from
4,201 households, identified through a
stratified random sampling process, using
the USDA Master Sampling Frame.
These data were collected in two phases to
cover a 12 month period (January 01-June
30, and July Ol-December 31, 1990) To
accomplish this, the data collection instru-
ments designed for OATS were converted
to a computer-assisted telephone interview
(CATI) system, which facilitates the inter-
viewing and the data management and
analyses.

The interviewing has been completed and
initial analyses have been implemented.
The final analyses will include age- and
gender-specific rates for farmwork and
non-farmwork related injuries in the region
and for each state. Rates adjusted accord-
ing to hours worked on the farm will also
be calculated.

Analyses, including types of injuries, body
parts affected, and relevant sources and

Papers and Proceedings


Surveillance of Injuries in Agriculture, May 1, 1991

mechanisms, are integral to this effort.
Other more comprehensive and analytical
analyses will be conducted on a variety of
substudies, including case-control studies
focused on animal-human injuries and
tractor rollovers.

This effort will also result in a workshop in
July 1992, at which time the regional par-
ticipants as well as other experts and the
investigators involved will meet to develop
state action plans for the prevention of
agricultural injuries. Data generated from
the RRIS will be used as the basis for
development of prevention and control
strategies in the five-state region that may
also be applied at the national level.

SUMMARY

This presentation has provided a back-
ground on the surveillance of injuries and
specifically with regard to agricultural
injuries. The need for ongoing, systematic
data collection, not only to identify the
magnitude of the problem but also to
provide a basis for analytic studies, is clear.

Identification of specific risk factors will
facilitate more appropriate planning and
implementation of strategies. Finally,
application of surveillance to monitor the
effects of prevention and control programs
that have been implemented will enable
evaluation of their efficacy and identify
necessary modifications to ensure optimal
reduction of agricultural injuries.0

TABLE II. Data Sources Utilized in Agricultural Injury SurWiflanCe:
         Advantages and Limitations

DATA SOURCES    AGENCIES/        ADVANTAGES        LIMITATIONS
             AUTHORS

Occupational     o Bureau of Labor               o Approximately 95% of all
Safety and Health   Statistics                        farms are not covered
Administration                             under OSHA, i.e., those
                                 with 10 or less employees.

Workers' Compen-                          o Limited proportion of
sation                                       farms included.

Fatal Accident    o National High-   o Detects roadway farm    o Off-roadway vehicle
Reporting      way Traffic Safety  vehicle-related fatalities.     events not included.
System (FARS)    Administration                     o No identification of
           o Gerberich,                   specific type of vehicle.
           Robertson, Gibson
         et al, 1991"

Surgeon General's Conference on Agricultural Safety and Health - 1991

171


Surveillance - Agriculture-Related Diseases, Injuries and Hazards

DATA SOURCES  "AGsT"Hcd;;/        ADVANTAGES          LIMITATIONS

Death Certificates  o Welsch et al.,   o Easily accessible.      o Fatality rate less that
          1 98912         o Includes intentional and   1 /lOO of 1% assuming no
           o Gunderson, et   unintentional events.      more than one farmer per
         al., 1990"                          farm.
                                  o Extremely difficult to
                                                  assess accurate
                                 count--occupation. fre-
                                 quently misclassified.
                                  o Information inadequate
                                        on death certificate relevant
                                 to primary/secondary
                                           causes of death.
                                 o "at work" box infrequently
                                        checked.
                                o Source/mechanism of
                                injury information limited
                                 and/or missing.

o National Institute
for Occupational
Safety and Healtt+
National Traumatic
Occupational
Fatalities (NTOF),
Myers, 1990%

o Excludes individuals
under 18 years of age.
o All limitations, identified
above, apply.

Newspaper Clip-
ping Services-
National/State
Newspaper Clip-
ping Services

o Welsch et al.,   o May facilitate recognition of
1 98912       emerging as well as persistent
o Gunderson et al., injury problems.
1 9905         o Authors included death
           certificates for verification.
           aDetects fatal events not
         readily accessed through
           death certificate data

o Identifies agricultural-
related fatalities and
catastrophic injuries.
o 50% of fatalities may be
missed as well as a large
proportion of non-fatal
injuries.
o Reporting is biased ac-
cording to gender/other
variables.

172                                  Papers and Proceedings


Surveillance of Injuries in Agriculture, May 1, 1991

DATA SOURCES                  ADVANTAGES         LIMITATIONS

Hospital Records   o Gerberich et al.,  o Identification of specific    o Confidentiality makes
          1989,1990,1991  diagnosis and treatment.     records difficult to access.
         (Used to validate                 o Bias--only most severe
         telephone inter-                injury cases included.
        view)"* la                    o inadequate data on cir-
                                       cumstances of event.
                                o Non population-based.
                                  o Oriented toward diag-
                                  nosis, treatment and, pos-
                                 sibly, rehabilitation.
                                  0 Long-term consequences
                                         not identifiable.
                                 0 very few persons are
                                hospitalized; only 8% of all
                                 farming-related injury
                                                        cases.
                                       o Miss those who die
                                before reaching hospital or
                                      are transferred elsewhere.
                                 o Biased due to type of
                                 insurance, if any.

Hospital Records-
All hospitals (n = 25)
in 15 county sample

Emergency Room  o McKnight, 1984%  o Provides national estimates.  o Product-related injuries
Cases U.S. Con-                            only .
sumer Product                            0 Sample of emergency
Safety Commission                          rooms is not representative
(CPSC), National                              of those in the United
Electronic Injury                                  States.
Surveillance System                              o identification of manufac-
(NEISS)                                    turer not released.

o Fuortes et al.,
1 9903'

o Active system employed.

0 Selection of sample not
identified.
o Occupation-related in-
juries only.
o Procedures regarding
confidentiality not iden-
tified--cases were followed
up by investigators with no
apparent consent
procedures.
o No indication of par-
ticipation rate of either
hospitals or patients.

Emergency Room  o Jansson, 19873Q  o May facilitate recognition of  o Descriptive data on in-
Cases Part of     o Jansson and   emerging as well as persistent jured cases only
project to develop  Svanstrom, 1 98g4' problems.          o No exposure data col-
systems for con-                                  lected.
tinuous and periodic
injury surveillance

Surgeon General's Conference on Agricultural Safety and Health - 1991

773


Surveillance - Agriculture-Related Diseases, Injuries and Hazards

DATA SOURCES    AGENCIES/        ADVANTAGES          LIMITATIONS
             AUTHORS

Emergency Room
and Urgent Care
Cases

Outpatient
Facilities

Primary Care Prac-
titioners

In-Person Inter-
views

Telephone-Based
Interviews-Olmsted
Agricultural
Trauma Study
(OATS); Provided
basis for Regional
Rural Injury Study
adn Subsequent
Surveillance (valida-
tion with medical
records)

o Stueland et al.,   o May facilitate recognition of
1991"       emerging as well as persistent
         Injury problems

o Potential to detect greater
range of severity.

o Potential to detect greater
range of severity.

o National Safety  o Contact reportedly every
Council        three months--minimized
           recall bias.

o Gerberich et al.,
199115       o Population-based, enabling.
         o Utilized U.S. Department of
         Agriculture's (USDA) Master
         Sampling Frame to identify all
         farms in Olmsted County.
         o Ensured qualification as an
         operating farm during period
         of study.

o Collected demographic and
farm exposure injury data on
all participating farms in the
county.
0 Overall participation rate =
82%, full interview par-
ticipation = 75%.
o Provided a basis for the
following multiple sub-studies,
including:
1) Case-Control Study of
Farmwork-Related Injuries.
2) E-Coding Study.
3) .Follow-up site visit,
machinery-related studies.

o Descriptfve data on in-
jured cases only
o No exposure data col-
lected.

o Diagnosis may not be
ascertained initially.
o No denominator infor-
mation.

o No denominator infor-
mation (age/gender com-
position is overestimated,
Eylenbosch and Noah,
1988).'
o Typically a passive sys-
tem.
0 Quality of classification
underestimated.

0 Sample selection unclear
0 Use of local volunteer
interviewers.

o Confidentiality of records
necessitates access
through USDA office
resources only.

174

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Surveillance of Injuries in Agriculture, May 1, 1991

DATA SOURCES                   ADVANTAGES          LIMITATIONS

Telephone-Based   o Gerberich et al.,
Interviews-Regional 1989-199235
Rural Injury Study
(RRIS) Provides a
basis for national
surveillance

Mailed Question-
naires
545 dairy farms in
Otsego County

o Stallones, 198642  o Ease of contact.

Mailed Question-
naires

* Fuortes et al.,
1 9903'

o Ease of contact.

o Population-based, enabling  o Confidentiality of records
identification of specific rates.  necessitates access
a Utilized USDA Master    through USDA office
Sampling Frame to select    resources only.
stratified random sample of
farms in fife states.
o Ensured qualification as an
operating farm during period
of study.
o Collected demographic and
farm exposure injury data on
participating farms in five
states.
o Participation Rate-78%.
o Data are entered directed
into the Computer Assisted
Telephone Interview (CATI)
system, enabling efficient
monitoring, data management,
and analysis.
o Provides a basis for multiple
studies, including the foi-
lowing:
1) Case-control study of trac-
tor rollovers.
2) Case-control study of
animal related injuries.

o Response rate 45%
o Self-selected sample.

o Response rate 41%.
o Biased populations of
hospitalized individuals.
o Identification of oc-
cupation relatedness and
event characteristics in
medical records are
notoriously poor.
o No control for days of
hospitalization.
o High potential for
misclassification.

Surgeon General's Conference on Agricultural Safety and Health - 1991

775



Surveillance - Agriculture-Related Diseases, Injuries and Hazards

REFERENCES

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PoUack, Es, Keimig, DG: Counting Injkes and Illnesses in the Workplace: Proposals for a Better System.
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Eylenbosch, WJ and Noah, ND Editors: Surveillance in Health and Disease, Commission of the European
Communities, New York: Oxford University Press, 1988.

Webster's New Twentieth Century Dictionary, Second Edition, New York: Simon and Schuster, 1979.

Committee on Trauma Research, Commission on Life Sciences, National Research Council, and the
Institute of Medicine: Injury In America: A Continuing Public Health Problem, Washington, D.C.:
National Academy Press, 1985.

Gunderson, PD, Gerberich, SC, Gibson, RW, Adlis, S, Carr, WP, Erdman, AG, Elkington, JM, French,
LR, Melton, LJ III, and True, JA: Injury surveillance in agriculture, American Journal of IndustliaZ
Medicine 18:169-178, 1990.

Panel on Occupational Injury Prevention, Draft Position Paper on Occupational Injury, June 3, 1991. -
Presented at the Third National Injury Control Conference, Denver, Colorado, April 1991.

National Safety Council: Accident Facts. Chicago: National Safety Council, 1990.

Bureau of Labor Statistics, United States Department of Labor: Occupational injuries and illnesses in the
United States by industry, 1989, Washington: Bureau of Labor Statistics 1990.

Bell, CA, Stout, NA, Bender, TR, Conroy, CS, Crouse, WE, Meyers, JR: Fatal occupational injuries in
the United States, 1980 through 1985. Journal of American Medical Association 263 (22): 3047-3054,
1990.

10. Kraus, JF: Fatal and nonfatal injuries in occupational settings: A review, Annual Reviews of Public Health
6: 403-418, 1985.

11. Rivara, FP: Fatal and nonfatal farm injuries to children and adolescents in the United States, Pediatrics.
76(4): 567-573, 1985.

12. Welsch, A, Gerberich, SG, Gunderson, PD: A unique approach to surveillance of severe and catastrophic
injuries: An agricultural case study, Proceedings: Public Health Conference on Records and Statistics,
National Center for Health Statistics, USDHHS, PHS, CDC, July 1989; pp. 474-480.

13. Stallones, L: Surveillance of fatal and non-fatal farm injuries in Kentucky. American Journal of Industtial
Medicine 18: 223-234, 1989.

le. Gunderson, PD, Gerberich, SG, Gibson, RW, Melton, IJ III, French, LR, Renier, CM, Erdman, AG,
True, JA, Carr, WI', and Elkington, JM: An analysis of variables potentially associated with trauma in the
agricultural community, Proceedings: First World Conference on Accident and Injuly Prevenfion
Stockholm, Sweden, September 1989.

15. Gerberich, SG, Gibson, RW, Gunderson, PD, French, LR, Melton, LI, III, Erdman, AG, Smith, P, True,
JA, Carr, WP, Elkington, JM, Renier, CM and Andreassen, LR: Tke Olmsted Agricultural Trauma shrdy
(OATS): A Population-Based Effoq Report to the Centers for Disease Control, 1991.

16. Layde, PM: Beyond surveillance: Method&logic considerations in analytic studies of agricultural injuries,
American Journal of Industrial Medicine 18: 193-200, 1990.

176                                     Papers and Proceedings


Surveillance of Injuries in Agriculture, May 1, 1991

17. Gerberich, SG, Gibson, RW, and Carr, WP: Minnesota Injury Prevention and Control Program I.
(Comprehensive review of the surveillance literature and documentation of all data sets pertinent to
injury in Minnesota; initial evaluation of suitability for surveillance) Minneapolis: Report to the
Minnesota Department of Health, 1987.

18. Gerberich, SG, Gibson, RW, Gunderson, PD, Melton, W III, French, LR, Renier, CM, Erdman, AC,
True, JA, Carr, WP, and Elkington, JM: Validity of trauma reporting in the agricultural community,
Journal of Occupational Accidents 12: 200, 1990.

19. Gerberich, SG, Gibson, RW, San Juan, L, and Carr, Wp: Minnesota Injury Prevention and Control
Program I.. (Comprehensive feasibility analysis of Minnesota injury data sets for use in surveillance of
injuries), Minneapolis: Report to the Minnesota Department of Health, 1990.

20. Vogt, RT, Larue, D, Klaucke, DN, Jillson, DA: Comparison of an active and passive surveillance system
of primary care providers for hepatitis, measles, rubella, and salmonellosis in Vermont, American JoumaZ
of Public Health, 73: 795-797, 1983.

21. Thacker, SB, Redmond, S, Rothenberg, RB, Spitz, SB, Choi, K, and White, MC: A controlled trial of
disease surveillance strategies, American Journal of Preventive Medicine 2(6): 345 350, 1986.

22. Thacker, SB and Berkelman, RL: Public health surveillance in the United States, Epidemiologic Reviews
10: 164-190, 1988.

23. Ing, RT: Surveillance in injury prevention, Public Health Reports lOO(6): 586-588, 1985.

24. Robertson, LS: Injuries: Causes, Control, Strategies, and Public Policy, Lexington, Massachusetts:
Lexington Books, Incorporated, 1984.

25. National Injury Prevention and Control Committee (NIPCC): Injury Prevention: Meeting the Challenge,
American Journal of Preventive Medicine, Volume 5 (Number 3), New York: Oxford University Press,
  1989.

26. French, LR, Carr, WP, Gerberich, SG, Gunderson, PD, Gibson, RW, Melton, LJ III, and Elkington, JM:
Reliability of "El'-coding farm-related injuries using the International Classification of Diseases, Ninth
Revision (ICD-9) and a modified version of ICD-9, American Journal of Epidemiology 130(4): 826,
  October 1989.

27. Gerberich, SG, Robertson, LS, Gibson, RW, and Renier, CM: An epidemiological study of roadway
fatalities related to farm vehicles, In review, 1991.

28. Melius, JM, Sestito, JP, and Seligman, PJ: IX. Occupational disease surveillance with existing data
sources, in Baker, EL, Editor: Surveillance in Occupational Safety and Health, American Journal of Public
Health Supplement; 79:46-52, 1989.

29. Baker, EL, Editor: Surveillance in Occupational Safety and Health, American Journal of Public Health
Supplement; 79:1-63, 1989.

30. Marine, WM, Garrett, C, Keefer, SM, Vancil, R, Hoffman, McKenzie, L: Occupational Injury Deafhs in
Colorado 1982-1987. Denver, Colorado: Colorado Department of Health, 1990.

31. Thornberry, OT: An experimental comparison of telephone and personal health interview surveys, Data
Evaluation and Methods Research, Series 2, Number 106, United States Department of Health and

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Surveillance - Agriculture-Related Diseases, injuries and Hazards

Human Services (USDHHS) Publication Number Public Health Service (PHS) 87-l.380, HyattsviIIe,
Maryland: USDHHS, PHS, National Center for Health Statistics, August 1987.

32. Gerberich, SG, Gibson, RW, Gunderson, PD, Melton, LJ III, French, LR, Renier, CM, Erdman, AG,
True, JA, Carr, WP, and Elk&ton, JM: Validity of trauma reporting in the agricultural community,
Proceedings: Occupational Accident Prevention Conference, Stockholm, Sweden, September 1989.

33. Elkington, JM: A Case-Control Study of Farmwork Related Injuries in Olmsted County, Minnesota,
Doctoral Thesis, Minneapolis, Minnesota: University of Minnesota, December 1990.

34. Kolstad, OC, Erdman, AG, Elkington, JM, True, JA, Gerberich, SG, Gunderson, PD, Gibson, RW, Carr,
WI', and Renier, CM: Hazard analysis of farm equipment, Proceedings: American Society of Agricultural
Engineers Annual Meeting Chicago: December 1990.

35. Gerberich, SG, Gibson, RW, Gunderson, Pb, French, LR, Martin, FB, True, JA, Shutske, J, Carr, WP,
Renier, CM, and Stasch, BD: Regional Rural Injury Study, Funded Grantxenters for Disease Control,
  1989-1992.

36. Myers, JR: National surveillance of occupational fatalities in agriculture. American Journal of Industrial
Medicine 18:163-168, 1990.

37. Fuortes, LJ, Merchant, JH, Van Lier, SF, Burmeister, LF and Muldoon, J: 1983 occupational injury
hospital admissions in Iowa: A comparison of the agricultural and nonagricultural sectors, American
Journal of Industrial Medicine, 18: 211-222, 1990.

38. M&night, RH, Hetzel, GH: Annual trends in farm tractor and machinery deaths, 1975-1981, Paper
number 84-5507. St. Joseph, Missouri: American Society of Agricultural Engineers, 1984.

39. Jansson, B: The yield of systems for continuous and periodic injury surveillance in emergency care with
emphasis on farm-work-related accidents, Scandinavian Journal of Social Medicine 15: 247-252, 1987.

40. Jansson, B and Svanstrom, L: Evaluation of a system for injury surveillance in Swedish emergency care,
Scandinavian Journal of Social Medicine 17: 7-l&1989.

41. Stueland, D, Lee, B, and Layde, PM: Surveillance of agricultural injuries in Central Wisconsin:
Epidemiologic Characteristics, Journal of Rural Health 7(l): 63-71, 1991.

42. Stallones, L: Reported frequency of dairy farm associated health hazards, Otsego County, New York,
1982-1983, American Journal of Preventive Medicine, 2: 198-191, 1986.

Reprints: Susan Goodwin Gerberich, Ph.D., Division of Environmental and Occupational
Health, School of Public Health, University of Minnesota, Box 807-UMHC-420 Delaware
Street S.E., Minneapolis, Minnesota 55455, Telephone: 612-625-5934, Fax: 612-626-0650.

178

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Surgeon General's Conference on Agricutturai Stity and Health
FARMSAFE 2000 . A National Coalition #br Local Action
Convened by the National Institute for Occupational Safety and Health
April 30 - May 3, 1991, Des Moines, lows

MUSCULOSKELETAL DISORDERS AND HAZARDS

    By John 1. Coumbis, M.D.
       Oak Ridge Fellow
Agency for Toxic Substance and Disease Registry

There have been numerous and, in my
opinion, quite excellent presentations on
the basic principles of surveillance, and I
will try in my talk not to repeat them too
much as I think they were made quite
clear.

What might be of particular interest to you
is how you get started. In the previous
presentations some very elaborate studies
were spoken about. You should not feel
that you necessarily need to have the world
of resources or help from the most tech-
nical government agency. The study that I
am going to present is one that I did dur-
ing my training in occupational medicine,
my master's thesis. It concerns health
effects in greenhouses.

How many of you have ever been in a
greenhouse? May I have a show of hands?
That is good. Does anybody own a home
greenhouse? Well, there will be more of
you next time we have a conference.

The first record of a greenhouse dates
back to ancient Greece half a century
before Christ, the Gardens of Adonis. But
there was a physician of a famous Roman
named Tiberius Caesar who also made
quite a milestone when he prescribed a
cucumber a day for Caesar. Caesar in turn
told his gardener, "You have to provide me
with a cucumber a day." So, this fellow
did, indeed, model a greenhouse and was
able to produce a cucumber a day, from
what I have read. History looks favorably
upon the gardener who, is nameless, and

the physician is fortunate in that his name
has been lost.

But the modem greenhouse is founded on
technologies that are drawn from
agricultural/engineering sciences. It is a
very specialized environment that produces
homeostatic conditions that are favorable
for the growth of plants.

Well, you might say, Why study green-
houses? That is usually the question I am
asked when I talk about my master's thesis.
This audience already has a handle on that
to some degree.

In the greenhouse you find an unusual
ensemble of physical and chemical hazards,
each of which have been identified else-
where as a human health hazard. The
second reason would be to safeguard the
health of thousands of greenhouse workers
and address the public health concerns
surrounding environmental hazards for
those who live around greenhouses.

I am a city boy: grew up in Flushing, New
York. Greenhouses can be found in New
York City and can be found in other com-
munities, and very often there are ques-
tions that come up about, well, am I at risk
of being contaminated via the greenhouse
chemicals? What of the washoff? That is
another subject, but I just wanted to make
mention of it, because I think it is a very
important issue. It is, also, one that con-
cerns the Agency for Toxic Substances and
Disease Registry.

Surgeon General's Conference on Agricultural Safety and Health - 1991

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Surveillance - Agriculture-Related Diseases, Injuries and Hazards

I should mention that what I intend to do
is show you that you can do a very infor-
mative study without a lot of money and
resources, but you should take advantage
of those that are free, and there is a net-
work of clinics called the American
Occupational Environmental Clinics. I
believe that the Iowa City Medical School
is a member of that. In fact, they have the
only other program, besides the University
of Kentucky, where the word "occupation-
al" appears in the name of the Department
of Preventive Medicine.

Let us go on and talk about the green-
house industry. The 1988 figures, which
are released in a recent USDA pub-
lication, would suggest that it is a greater
than $7 billion industry and is one that is
growing. I believe that there is a great
market for greenhouse vegetables in the
future as different chemicals become more
restricted, because so many fewer chemi-
cals are needed to produce food in an
enclosed environment.

DEMOGRAPHICS

The number of farms has jumped con-
siderably from 1982 to 1987, as well as the
actual size of the greenhouse capacity.
Most important of all, though, this study is
about people-people who love flowers,
people who grow their own food. We want
to make sure that they are healthy.

The objectives of this study were to deter-
mine the demographics of greenhouse
workers, to ascertain the nature of green-
house work, to identify the materials as
well as an understanding of how they were
used, and to survey the workers themselves
for self-reported health effects. I am really
grateful to Dr. Dosman, who pointed out
that surveys are a useful tool in surveil-
lance studies.

780

I would like to point out that there were
eight greenhouses that participated in this
study. Only one declined. There were 62
workers out of 92 potential workers that
were there. So, it is a very high participa-
tion rate.

The workers in their 20's and their 30's,
together, made up 61 percent of the work
force. This is a very young work force.
The females outnumbered the males three
to one. Females were very well represent-
ed, being highest at either extreme of age.

Now, what is an important thing to know
about this? Is it a good job? Is it a bad
job? That is generally a function of how
long people stay.

When you add up those who worked less
than a year and those who worked one
year and two years, that is already 55 per-
cent of the work force. I found that 64
percent of the workers with less than two
years of exposure were less than 30 years
of age. Those with more than five years of
experience, they were not represented at
all in the population less than 30.

What I am trying to bring across is the
point that a lot of information can be de-
rived just by defining the characteristics of
the work force. Here you have an industry
with primarily young people, primarily fe-
male, and with a very high turnover. That,
in and of itself, suggests that there is
probably something wrong there.

Well, let us go into the greenhouse, and
we will talk about what is to be found
there. I am very fortunate that I did not
do the study in the summertime because
the temperatures would have been out-
rageously high. The other problem is that
greenhouse work is very seasonal. There
is not much going on in terms of growth of
new plants.

Papers and Proceedings


In the greenhouse you have lots of water.   with water, and air is blown in, which
It is a very hot and humid environment.   produces cooling by evaporation.
Water not only comes from hoses, but
through water conduits. You also have the
same sort of conduits that go into ceramic  You might ask, Why am I telling you all
                    these things? Well, the reason is that I

cylindrical structures that are placed right
inside the bed so that erosion does not    want to impress upon you that you have
                   got to know these things if you are going

occur.

to be able to communicate with the green-
house operators and workers. This is the

A feature that is only found in the most   basic premise that transcends oc-
modem greenhouses is a water       cupational/environmental medicine.
modification area, where different nutri-
ents or a diverse ensemble of chemicals   Asbestos is no longer used as a construc-
can be added. That water mixture, in turn,  tion material in greenhouses, but it is still
is distributed widely throughout the green-  a part of old greenhouse (planting bed)
house.                  construction. In fact, if they wanted to
                   dispose of it, it would be quite an expen-

A primary mechanism of cooling the     sive process. The asbestos does not
greenhouse is by circulating tremendous   weather, but the edges of it do get de-
volumes of air. In the more modern     stroyed through use and, of course, release
greenhouse, the top of the glass houses will  dust.
open according to a temperature sensor.
If the wind becomes too great, it shuts    Well, not only plants grow in greenhouses,
down so that the entire door will not be   algae does too. Also, around the green-
torn off.                 house you see a tremendous growth of
                    other plants, which were not intended.

Many greenhouses have a heating device
that I presume works with propane or    A surveillance technique used by the
some sort of natural gas. These have the   greenhouse operator is a specialized fly
potential to produce large amounts of    paper. Based on what will be stuck on the
carbon monoxide, but I am not aware of   paper, the farmer will know when to use
any reports of carbon monoxide poisoning,  chemicals to control pests. The advantage
but certainly where you have such an in-   is that, because it is ongoing, you can make
strument there is that potential.       early intervention and you do not have to
                   do prophylactic or periodic spraying with

Another means of heating a greenhouse is   different chemicals.
through pipes that go underneath the plan-
ting beds. They transfer hot water. This is  Steam is used to sterilize soil, and
a better system because it distributes the   chemicals-particularly dibromochloro-
heat to the roots of the plant; they grow   propane, which is an extremely hazardous
much faster. The heat sources are      chemical-have been used. Of course, if no
generally provided by coal stoves, which is  one follows this population, it would be
the least expensive form of fuel.      very hard to find out if there were any side
                        effects from that chemical.

A crude air conditioner has strips of
cardboard-like material. They are sprayed

Musculoskeletal Disorders and Hazards, May 1, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991

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Surveillance - Agriculture-Related Diseases, Injuries and Hazards

Other kinds of material are used. One is
called Perlmix. It is a mixture of peat,
perlite, and vermiculite. Each of those
substances carries its own health problems.

Workers are exposed to tremendous
volumes of this material on a regular basis.
One worker took the process outdoors as a
means of mitigating exposures.

ERGONOMICS

Let us get into some of the hard-core
problems of ergonomics. A worker will
prepare either flat trays or different kinds
of potting material or fill the pots with the
potting material.

The workers take small immature plants,
called plugs, and place them in larger
trays. It is a series of transplantations and
is very labor-intensive. It is quite difficult
to pick them up. It is a pinching
maneuver.

I found a loose electrical line on a vapor-
izer. I am sure that it would be recognized
as a severe electrical hazard, even by
non-electricians. I also saw an electrical
wire just strung across the top of the
vaporizer and an unenclosed electrical box.

1

. . . you find some of the reports of back
pain in roughly a third of the work force,
pain in multiple joints in 19 percent, pain
of the upper extremities in 11 percent of
the workers, lower extremities in 8 per-
cent, and neck pain in 2 percent.

Pathways were not level, which was from
the constant accumulation of the potting
materials. It is not just the potting materi-
als, but it is all the other chemicals that

182

have been used. Residues will also persist
there.

Ideally, if the grower had enough funds, he
would make the whole floor cement. That
way it is much easier to keep clean,

Pipes that I saw, which were in the way of
workers, can be corrected with modern
tables that are commercially available.
They place the heating pipes up just un-
derneath the level of the table. The height
of the table is also critical.

Imagine a woman who has just started her
shift. She is going to manipulate every
plant on the table all the way down its
length, most likely without even taking a
break. That is a lot of stuff to move. The
table is wide, and later, she will be stretch-
ing out further over it. That, of course, is
not a very natural position to assume, and
it predisposes workers to back problems
and shoulder and neck pains.

A different greenhouse that I saw had
three or four different levels, if you count
the hanging baskets above. Hanging bas-
kets are wonderful because they increase
the space without having to add extra
tables, but you are working over your head
when you have to manipulate those plants.
The metal line that held them up was
barbed so that the plants would remain in
place and not slide.

I saw a cutting tool that a worker was
operating. It did not have a particularly
good ergonomic design because he had to
extend his wrist. Fortunately it did not re-
quire a whole lot of pressure to cut the
plants.

Pinching of flowers (by fingers) is done for
two reasons. One is to make older plants
of equal height so that they will fit in a
box or wherever they are putting them.

Papers and Proceedings


Musculoskeletal Disorders and Hazards, May 1, 1991

It is also done in a process called disbud-
ding, where you will have different buds
and either you will remove the center one
or you will remove the peripheral ones.
Imagine doing a whole row of plants. That
is a tremendous volume.

FREQUENCY OF MUSCULOSKELETAL
SYMPTOMS

Now, those that reported any form of mds-
culoskeletal pain were 31 workers, which was
half the work force. Approximately half of
those were taking analgesics. I did not dif-
ferentiate between prescription and
nonprescription. I found reports of back pain
in roughly a third of the work force, pain in
multiple joints in 19 percent, pain of the upper
extremities in 11 percent of the workers, lower
extremities in 8 percent, and neck pain in 2
percent.

I would like to hold off here because this is
where the musculoskeletal portion ends. The
other components were respiratory; related to
skin changes; mouth, throat, and nose ir-
ritation; certainly all the respiratory findings
are also quite striking. But considering the
late hour I think we can end it right here.

The take-home point is that this is a study that
was done. The costs were the transportation
from one place to another and the film used
and, perhaps, some xeroxing for the surveys.
A lot of information can be derived about an
industry in a local area without terrifically big
resources.

Thank you very much. I hope you all enjoyed
the session.0

Surgeon General's Conference on Agricultural Safety and Health - 1991

783


Surgeon General's Conference on Agricuttwa/ Silrety and Health
FARMSAFE 2000 o A National Coalition for Local Action
Convened by the National Institute tk Occupatkmel Safety and Health
April 30 - May 3, 1991, Des Moines, lowa

A GOVERNMENT PERSPECTIVE /

      By Todd M. Frazier, Sc.M.
       Chief, Surveillance Branch
Division of Surveillance, Hazard Evaluation and Field Studies
National Institute for Occupational Safety and Health

It is presumptuous of me to talk about the
government's perspective. My first
disclaimer is that much of what you will
hear here today is my interpretation of the
government's perspective. I want to talk
about three aspects sf the government
perspective: the challenge that we
received, the response that we have given
to date, and some ideas that we have
gleaned from the conference during the
past few days.

THE CHALLENGE

First, I would like to talk about the chal-
lenge. The challenge came to us in 1988,
as a result of attendance at the National
Coalition for Agricultural Safety and
Health (NCASH) meeting and the subse-
quent publication of Agriculture at Risk, the
NCASH report. Specifically, the challenge
appeared as a legislated initiative designed
to promote surveillance, research, and
interventions. The specific challenge was
to the National Institute for Occupational
Safety and Health (NIOSH) to conduct a
National Occupational Hazard Survey for
Agriculture and to survey agricultural
workers exposed to certain risk factors.

The second challenge was from the ap-
propriation language in two programs that
comprise the surveillance component. I
will talk about one; Dr. Freund will talk
about another of the NIOSH agriculture
initiatives.

784

The third challenge is something that we
have been aware of for some time and
periodically read about in such scientific
journals as Anierican Demographics or its
parent publication, The WaZZ Street Journal.
On the 24th of April, the Journal carried
this article, front page, left-hand side,
"Iowa Towns Shrivel as Young People
Head for the Cities." They were talking
about Alden, Iowa.

From my reading of the map, that is a
little tow-h probably about 50 or 60 miles
or so north of Des Moines. It is a towh in
which the young people are leaving and
the old people are staying behind to farm
and to run the town, The article gives
some very interesting demographics about
the State of Iowa, demographics that may
apply to other agricultural states.

I will just give you a couple of these. The
new data from the 1990 census show that
29 of Iowa's 99 counties had more deaths
than births, a natural decrease. During the
5 years that preceded 1990, only four coun-
ties reported natural decreases. So, here
in Iowa, they have gone from 5 counties to
29 counties with a natural decrease.

Natural decrease is an unusual
demographic phenomenon. Most of us
think in terms of continued growth of a
country and a natural increase about 1
percent, but here we have a natural
decrease. The median age of Iowa's

Papers and Proceedings


A Government Perspective I, May 2, 1991

   \
O FFHHS
A RN
+  Cancer

+

*  Centers
+ Health Promotion

Figure 1. N-91 NIOSH Agricultural Initiative Programs.

population increased from 30 in 1980 to
more than 33 in 1989.

Read on. The situation is so bad that 3
years ago Iowa became only the second
state in the nation where the number of
people over 75 was greater than the num-
ber under 5. I will let you guess at the
other state. If you guess Florida, you are
right.

Because I am from a public health back-
ground and have always been interested in
the population at risk, these demographics
spell out to me a very serious challenge
that we are facing when we look at
projects that address the problems of farm
families in generally rural areas. With that
background, I would like to go on to tell
you a little bit about the response to some
of these challenges.

Now, the demographic challenge goes on.  The response from NIOSH is broad. It in-
The flight of young people and mid-     cludes surveillance, research, and inter-
dle-aged people from Iowa's rural towns   vention. Our particular interest here today
has spawned a sub-crisis of its own: an   is in the surveillance component. I would
aging population of people who not only   be remiss, however, if I did not remind you
have no doctors nearby but no young    that we are part of this triad that uses
relatives or neighbors to look after their   surveillance signals to trigger either
health or even do their marketing if they   research or intervention. The same sur-
are sick.                 veillance systems may be useful later on to

Surgeon General's Conference on Agricultural Safety and Health - 1991

785


Surveillance - Agriculture-Related Diseases, Injuries and Hazards

evaluate the effectiveness of these inter-
vention stratagems.

Figure 1 shows a map of the total NIOSH
agricultural initiative FY-1991 funding.
The different codes show the different
types of programs being funded by NIOSH.
I will speak about the Farm Family Health
and Hazard Survey (FFHHS); Dr. Freund
about the nurses in rural communities.

There are cancer projects in four states.
There are two centers of excellence, and, I
believe, 15 health promotion states.

You can see how there is a clustering in
certain states. That provides an oppor-
tunity for collaboration or a symbiotic
relationship between these projects. You
will also note there are parts of the
country that have nothing.

Now, a few words about FFHHS. The
purpose of this descriptive survey is, first
of all, to describe the health status of farm
families and to recognize work-related
hazards-chemical, physical, biological
hazards.

In doing this, we are borrowing some of
the techniques used by our colleagues in
the National Center for Health Statistics
(NCHS). They are expert in survey design,
questionnaire development, training of
interviewers. We are also borrowing from
our own experience with the National
Occupational Hazards Survey, the National
Occupational Exposure Survey, and the
recognition of work-related hazards.

We have, in effect, two groups working on
this project. One group is concerned with
the health effects. That group is headed
up by Ms. Nina Lalich. Her colleague on
the hazard side Dr. Alice Greife, heads
the hazard section of our unit. We have
now decentralized to a point where we

186

have the specialists working with the states
that we have funded.

In late FY-1990, we awarded six
cooperative agreements. I am sure that
some of you in the room know what a
cooperative agreement is because you have
been awarded one. It is positioned bet-
ween a grant and a contract. It allows our
staff to work very closely with the awar-
dee's staff.

We feel that it is an excellent way to begin
to build the kind of infrastructure and
continuing collaboration that we have been
hearing about in this conference, The
average award was $194,000 per year with
the expected duration of 5 years.

The awards went through the competitive
process and were awarded to two health
departments and four university-based
awardees, spanning from the east to the
west coast of this country. We are busy
working with these people now.

They have all visited Cincinnati, and we
are about to undertake a series of visits to
each site. We are also preparing our
OMB packages for clearance with the
questionnaire part of the surveys.

As you might expect, these are quite
diverse surveys. Agriculture has a long
tradition of being state-based. We see this
in the strength of the land-grant university
system. We see it in the county extension
agent system. We felt that it was impor-
tant to build on the existing infrastructure.

We had a hard decision to make whether
to try to do a national survey with limited
resources or to do a state-based survey in
states where there was the capability, the
interest, and the likelihood of carrying
surveillance findings on into research,
intervention, and, ultimately, prevention.

Papers and Proceedings


We elected to do state-based surveys.
Given that construct, it is not surprising
that we encounter many variables that are
state-determined. For example, some
states elected to look at a particular com-
modity.

Other states, in terms of the geographic
coverage, elected to go to a subset of
counties rather than statewide. In one or
two states, there was a demographic slice,
and they elected to look at a sample of
young and old farmworkers-the very young
and very old.

This is both a disease and injury survey.
There is no question that injuries are a
very important part of the farm family's
assessment of their hazards. They see this
every day on their own farm; they see it
with their neighbors. Injuries predominate.

That is reflected in many of the proposals.
We are looking at injury patterns. We are
doing this in collaboration with our col-
leagues in the Division of Safety Research
in Morgantown.

In addition, we are looking at disease
components. Here again we are col-
laborating with the Division of Respiratory
Disease Studies in Morgantown.
Dr. Castellan has been a faithful and valu-
able contributor to this aspect of it. Be-
yond that, we are trying to look at a wide
spectrum of disease and also look at the
hazards, the physical, chemical, and
biological hazards that cause these diseases
or injuries.

This is an attempt to show in matrix form
a summary of health interview and
examination topics that were elected by
the six states. I should point out that we
were insistent on one or two topics.

A Government Perspective I, May 2, 1991

We want a good demographic base. We
felt we should have consistency in age, sex,
and race types of questions. That presents
very little problem.

We are all used to using the kind of ques-
tions the Census and NCHS use to get that
kind of information. Beyond that, we
wanted to look at medical access.

What are the barriers to medical care?
Do people have health insurance? If they
have it, how did they get it?

Many of these people are self-employed.
Does the health insurance come as a result
of one, or maybe both, adult members of a
family taking employment off the farm in
order to be eligible for health insurance?
These are questions that I think are par-
ticularly important in juxtaposition with the
Wall Street Journal article I referred to,
which made the point about the break-
down of the medical care delivery system
in rural America. The barrier-the
economic barrier-may not be the problem.
It may be that there is nobody in practice;
there is no hospital. These are things we
need to find out.

Injuries are being recorded. We are also
interested in musculoskeletal, respiratory,
dermatologic, mental health, neurologic,
cancer, spirometry testing, and hearing and
audiometric testing. These are the types
of things that are being built into surveys
using what we call modules.

We developed these suggested patterns or
models. States are picking up on one or
more modules and putting these in their
survey proposal. The proposal will then be
packaged for OMB review and approval.

Hazards are next. Borrowing from our
experience with the National Occupational

Surgeon General's Conference on Agricultural Safety and Health - 1991                187


Surveillance - Agriculture-Related Diseases, Injuries and Hazards

Exposure and Hazard Surveys, we are
working toward an on-site walk-through in
much the same way we would walk
through an industry or industrial setting.
We are looking at pesticides. We will do
some sampling. We will look at chronic
trauma. We will look at safety risk factors,
injuries, ergonomics, rollovers, PTO's, and
secondary occupations.

We need the information on secondary
occupation for a number of reasons. One
I cited was health insurance. The other is
a bit more along the lines of traditional
industrial hygiene interests. If a person
has an off-farm job that has certain
hazards that may result in a disease, we
want to know about that job. We want to
know the potential for those hazards.
Otherwise, we may attribute that particular
disease to something that is being done on
the farm. It is very important to look at
the relationship between off-farm and farm
employment.

[REMARKS FOLLOWING NEXT
SPEAKER]

Mr. Todd M. Frazier: One thing about a
conference like this is that you are hit with
so many thoughts and ideas that it is hard
to put them all together in any meaningful
way. I am not going to attempt to do that
for even a small part of this conference.

I went back through my notes last night
and picked out words-words that, if you
forced me to, I could attribute to a speaker
but right now they are just words. They
are words that I am going to take home
from this conference to see if what we are

doing somehow addresses the concerns we
have heard from people at the Surgeon's
General's Conference.

Here are some of the words. Of course,
"change." Times are changing. For most
of us in NIOSH it went from a smokestack
to haystack type of change (i.e., change in
the direction of our own organization).

"Cooperation, communication,
education"-in many different forms, we
have heard that. "Infrastructure"-we are
dealing with that. That is why we are here
in many respects. "Children." "Women."
"Older farmers." "Disabled farmers." "Ta-
rget groups." "Exposure assessment."
"Weaving the ideas of industrial hygiene
into agricultural aspects." "Shortage of
rural health care personnel." "Stress."

Back to the WaZZ Street Journal. Here is a
man whose kids are leaving the farm. He
says:

"We expected to live here forever. Be sur-
rounded by our family. We planned on
it, but things change; and I'm seeing that
all change is not for the better. Things
aren't going to work out the way I
thought they would."

So here is a 70-year-old man who is going
to farm whether he likes it or not.

You have farmer-provider interaction.
You have that phrase I do not want to
forget. John May used it, "teachable
moment."

Then, I have to say this. Did you read the
paper this morning about that old guy that
pitched his seventh no-hitter? So, if we
build it, they will come.0

188

Papers and Proceedings


Surgeon General's Confemce on Agtkdtud Safety and Health
FARMSAFE 2000 o A National Coalition Ibr Local Action
Convened by the National Institute for Occupational Safety and Health
April 30 - May 3, 1991, Des Moines, Iowa

  A GOVERNMENT PERSPECTIVE II

     By Eugene Frecm$ Jr., M.D.
        Chief, Surveillance Branch
Division of Surveillance, Hazard Evaluation and Field Studies
National Institute for Occupational Safety and Health

Over the past two days I have been sitting
in the audience and hearing talks from
people who are able to report vast experi-
ences with agriculture and farming. So it
is with some trepidation that I got up here.
I reminded myself, "Hey, Gene, you have
more than 35 years of experience as an
end-user of agricultural products and that
is it." But I do know what it is like, briefly,
to be a practicing physician, seeing agricul-
tural injuries, and-when I recognize
them-illnesses, Frequently, I did not know
where to go for preventive as opposed to
curative or palliative help.

Nurses have a long history of public health
care. They are in immunization programs,
in tuberculosis control, women, infant, and
children programs, STD programs-virtually
all aspects of public health. What I want
to do now, with these few minutes, is de-
scribe what we are doing. We are calling
it the Nurses' Project, which will extend
that model of public health nursing into
the agricultural-occupational arena. I will
try to fit this program into what I have
heard from other talks.

It is still developing. It is already a pro-
gram that will act locally and, I believe,
has national impact.

May I go to that first slide with the map of
our projects (Figure 1). The Nurses' Pro-
ject is the green triangles. I think I will
center the world on Iowa today and do an
Iowa-centered perspective. You can see

that we have the Nurses' Project located in
Iowa, Minnesota, and North Dakota. New
projects have just been awarded starting in
July in Ohio and Kentucky. The project is
also in California, Georgia, New York,
Maine, and North Carolina.

Each project has three to five nurses.
They will be, for the most part, regionally
located. That varies from state to state.
They are all in state health departments,
but they will be based in districts, counties,
or quadrants of the state, depending on the
state and its population and the differences
that each applicant engineered into its
programs.

The important part is that each of these
nurses is expected to become involved with
the target communities. That means get-
ting to know health-care providers of all
types, getting involved with the Extension
Service, land-grant universities, educational
institutions, the Farm Bureau, the Grange,
or whatever is important in taking care of
the health and safety of the population,
which they will be helping.

I think of the program as providing a pub-
lic health infrastructure. It does that with
three functions. Two of them are part of
the surveillance, intervention, and research
triad-surveillance and intervention. Those
are enabled by what I expect to be the
nurses' ability to forge links between their
efforts, their health department's efforts,
and other efforts and resources from

Surgeon General's Conference on Agricultural Safety and Health - 1991                789


Surveillance - Agriculture-Related Diseases, Injuries and Hazards

Agricultural Projects

Figure 1. States with NIOSH Projects.

NIOSH projects, such as the Farm Family
Health and Hazard Survey (FFHHS) that
Todd just described, to all the groups I
have mentioned, extension, educational
groups, and the like.

I want to use Bill Halperin's surveillance
topology from yesterday to help think
through the surveillance aspects of this
program. Inasmuch as the nurses, through
their interactions with providers, can do
case surveillance, they can help with the
recognition of problems that may not be
identified in the community.

For example, they may hear from a physi-
cian about a case of diagnosed or suspect-
ed organic dust toxic syndrome. They can
identify that as a problem and trigger ef-

190

forts to prevent it from happening again.
Since they will be located in their own
regions, they will often be able to identify
all cases of a given condition, tractor roll-
overs or power take-off injuries. They can
identify the scope of those problems, use
that information to target intervention
efforts, and after intervention efforts, eval-
uate how effective they have been.

The case surveillance also can work for
targeting efforts in and of itself. An identi-
fied case of a sentinel event, which should
not happen, such as a child injured from
falling off a tractor on a farm, could trig-
ger educational campaigns, press releases,
on whatever would be appropriate in the
community. This is active surveillance for
these conditions because they will be there.

Papers and Proceedings


A Government Perspective II, May 2, 1991

The other function is intervention. There
are a number of ways to intervene.

Some are education (not just by going to
schools and talking, which is something the
nurses could do); giving presentations
(sometimes it is very helpful to have
someone who is a health professional
provide that information); and also
working with the already considerable
efforts of the Extension Service. Another
intervention is educating providers by
giving them lists of reportable or desired
reportable conditions or putting them in
touch with contacts in the academic com-
munity, or referral sources that they are
aware of.

Another educational intervention, which I
think has the potential to be very powerful,
is the dissemination of surveillance and
research results. If they can show a com-
munity that these problems are real and
happening to their neighbors, I think they
can have an impact on people's behavior.
Again, they can be links to other resources.

The Extension service have people who
know how to retrofit tractors with rollover
protection, if that is something someone
wants to do. We at NIOSH have quite a
lot of expertise in doing health hazard
evaluations. That is an intervention that,
when appropriate, could be performed.

By having some utility to providers in the
community-and this brings things full
circle-they can have an influence on sur-

veillance. If you are asked to contribute to
surveillance, you as a provider or an indi-
vidual in the community are asked to con-
tribute to something you perceive as use-
ful. You, therefore, are going to be more
likely to contribute.

That is the outline of the infrastructure,
which with variations through our 10 coop-
erative agreement partners is being imple-
mented. We have got a number of chal-
lenges ahead of us. We have work to do
in terms of defining the most appropriate
target conditions for this project.

I think ihjury clearly has much potential.
Physicians are able to identify it. Some of
the work on illness remains to be seen.

I believe that there are physicians and
other providers out there who, as I have
done, would-with a structure to support
them in their interest in doing public
health efforts-be eager to report. They
would be eager to get their patients and
their communities plugged into a public
health system to prevent illness and injury.

There is plenty of work to be done in
designing interventions. Of course, evalu-
ating and identifying are the most success-
ful elements of the varied projects that are
part of this program. All these tasks need
to be taken in concert with those at the
local level that these people will be work-
ing with, the farmers, the Extension Ser-
vice, the providers. All of these have a
stake and a potential contributi0n.U

Surgeon General's Conference on Agricultural Safety and Health - 1991

191


Surgeon General's Conference on Agriculturai SatWy and Health
FARMSAFE 2000 o A National Coalition lix Local Action
Convened by the National Institute for Occupational Salty and Health
April 30 - May 3, 1991, Des Moines, Iowa

THE CONSUMERS' PERSPECTIVE

  By Craig Merrilees, BA.
Director, Consumer Pesticide Project

Thank you very much, and thanks to
NIOSH and to the Surgeon General for
inviting consumer and environmental spea-
kers here today. We appreciate the plural-
istic way you have approached "coalition
building," the theme of this conference.

I have been inspired by many of the folks I
have met at this conference during the past
couple of days, and cannot help but notice
that your tone is upbeat. Many of the
participants are activists. You are consid-
ering new approaches.

We all know these have not been the best
of times for occupational safety and health,
so coalition building has become even
more important. It is essential for making
progress and improvement in the work-
place, particularly on the farm.

I want to tell you about some of my back-
ground and orientation. I work closely
with the National Toxics Campaign. This
is a federation of over 1,000 grass-roots
environmental activist organizations. Most
of these people are angry. They are un-
happy-

They feel that environmental policy is out
of their control. They are demanding that
industry and government be more account-
able to the community and workers. Most
of the members are women. Many of
them are directly concerned about environ-
mental occupational issues in agriculture.

792

On a personal level, I have been involved
in these issues from four perspectives:

1. Public health: I am a former county
health commissioner and took a great
interest in farmworker safety and
health when I served in that position.
Also, I helped establish a neighbor-
  hood-based health maintenance or-
ganization to deliver affordable, high-
quality health care services.

2. I am heavily involved in environmental
policy and politics right now. I
recently finished work on the 1990
Farm Bill and other legislation.

3.  I have members of my family that are
still surviving on a farm-God knows
how-in Ohio. They are trying to grow
corn and soy beans for a living. They
will not be in business much longer for
reasons that I am going to explain. I
am deeply concerned about the future
of family farming in this country and
the way in which smaller-scale agricul-
ture is being destroyed by Federal
policies that have brought about
tremendous changes on the farm-and
not necessarily for the better-from an
occupational or an environmental
perspective.

4. Finally, I have worked as a journalist.
I investigated many stories about oc-
cupational hazards and environmental
  scandals.

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I will begin talking about coalition building
and about some practical experience that
our organization, the National Toxics Cam-
paign, has had in building coalitions and in
promoting what we call "source reduction,"
removing of fundamental problems. In
this case we are removing pesticides by
utilizing consumer and environmental
pressure, along with cooperation from
farmers and industry people, to eliminate
use of the most dangerous classes of pesti-
cides.

However, first I want to quickly talk about
the structure and the politics of agriculture
in this country, how that bears on health
and safety issues. If you were here earlier,
you heard that there are some interesting
trends under way. We have an increasing
number of large capital-intensive farms.
We have a decline in small family farms.

If you had a chance to analyze some of the
data we heard earlier, you would have
found that by the end of the day we will
have lost 50 family farms in this country;
125,000 farms will be gone by the end of
this decade. That is a sentinel event.

Something is wrong in the country. Some-
thing fundamentally dangerous is under-
way, particularly if you happen to live on a
farm or if you live in a community region
or city like Des Moines. I was walking the
streets last night. You can see the conse-
quence of that policy in the boarded-up
stores and empty office buildings.

The third element is a direct link between
the intensification of agriculture, a policy
that has been promoted by the U.S. De-
partment of Agriculture (USDA) and indi-
rectly by the Congress and the Administra-
tion, and the increased use of chemicals in
agriculture, at a rate of 500 percent since
World War II. That has a direct bearing

The Consumers' Perspective, May 2, 1991

on occupational safety and health prob-
lems.

Yields are up. Incomes are down. Is that
not strange? People work hard, they pro-
duce more, and they get paid less to do it.
Ask any farmer in the Midwest.

Ask any farmworker in California. They
have not reaped many of the benefits from
increasing productivity. Those benefits
should have included improvement in
occupational safety and health.

Health and safety improvements come
only when people are organized and when
they are able to control their own destiny.

L

If you were to compare, for example, the
budget the USDA is advocating for bio-
technology versus their budget for low-inp-
ut sustainable agriculture, you would get a
clear picture of where the priorities are in
this country. They are wrong and detri-
mental for farmers and farmworkers.

I think if we have learned anything in the
past, it is that health and safety problems
are influenced by these policies. Health
and safety improvements come only when
people are organized and when they are
able to control their own destiny. I want
you to look at some priorities that the
USDA is currently pursuing.

Just look at the way the U.S. Government
is promoting the development of herbicide-
tolerant plants. This is serious issue that
has been ignored in terms of the health
and safety effects.

We know that farmers who work with
certain classes of pesticides have

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Surveillance - Agriculture-Related Diseases, Injuries and Hazards

non-Hodgkin's lymphoma at five and six
times the rate of those who do not. We do
not know exactly why, but we think it has
something to do with pesticides.

Do you not think it is curious, then, that
the USDA is currently promoting programs
to increase the use of these herbicides by
promoting and subsidizing the develop-
ment of herbicide-tolerant potatoes? They
are doing some of these experiments in
California. The pesticide that they are
using is 2-4D.

The same thing could be said for bromoxy-
tolerant cotton, or atrazine, which is re-
sponsible for extensive ground-water pollu-
tion. There are 40 states now that have
serious ground water pollution, much of it
caused by atrazine.

Why is the USDA working so hard to
promote atrazine-tolerant canola? Some
of the work is being done in Canada. I
can guarantee you, however, it will not be
long before the USDA is petitioning to
encourage our farmers to use those
products here.

Farmers are the ones who drink more
contaminated water than those of us that
live in the cities. Farmers are the ones
who are exposed more to pesticides and
other hazards.

I want to have some dialogue with you
about how some of my people view science
and research. A lot of my activist friends
have, I believe, false hopes in scientific
research.

The victims, as they call themselves,
demand the EPA come in and ATSDR
come in. Their basic position is, "We are
sick. We are being poisoned. We know
this is happening. We want you to
document it."

194

You come in. You spend thousands, som-
etimes millions of dollars. Then you come
up with negative associations or no associ-
ations whatsoever between the exposure
and any negative outcomes. Folks walk
away disgruntled and angry.

They think there is a conspiracy or cover-
up. This is wrong. I think our people are
increasingly wondering whether this is a
good use of resources.

I think they are going to be questioning
whether we should be doing this kind of
epidemiological research. I say this,
knowing that their naivete has led them to
believe that scientists can prove and
document environmental damage to people
when, in fact, it is much more elusive. It
may require a different approach than
scientific proof obtained through
epidemiological studies.

I also think there is some naivete on the
part of researchers and academics who
believe that somehow, if we could simply
document facts, things will change. They
believe somehow political leaders will be
influenced by facts and rational arguments.
This is not how things change in this coun-
try-

I would challenge anyone here to give me
an example where facts and rational argu-
ments alone persevered in the face of
strong, powerful corporate interests. The
facts and scientific evidence were available
long before OSHA set lead standards,
mercury standards, asbestos standards, and
benzene standards. That evidence was
clear for decades before the Congress and
the Administration even saw fit to estab-
lish OSHA! Every single sentinel health
improvement in this country came because
two things were present:

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1.  There was scientific research to show
it; but that was never the determining
  factor.

2. People were organized where they
worked. They had political power.
They built coalitions. They made
change.

Those are the ways that changes have
happened and health outcomes have been
improved in this country. Therefore, I
think it calls for all of us to have a much
closer relationship with workers and their
organizations.

Look no further than the agriculture-im-
plement lobby here today. This lobby has
blocked rollover protection in this country
for 30 years with knee-jerk, protective,
self-interested arguments that continue to
allow farmworkers to die in this country,
out of their narrow interest.

That is wrong. The reason that it hap-
pened is not because we have not done
enough scientific research to document the
problem.

What kind of research can make a differ-
ence? I think we have a phenomenal
amount of talent here. People are doing
all sorts of interesting studies. People are
beginning to reach out to ATSDR. OSHA
is maybe waking up from a deep sleep and
a very depressed situation that they en-
countered after being savaged during the
Reagan and the Bush years.

I think there are good examples where
universities are trying to work with people
who are facing these problems firsthand,
Some of the extension folks are doing that.
Look at the excellent work done by Don
Villarejo at the University of California at
Davis.

The Consumers' Perspective, May 2, 1991

We have to ask if money is being wasted
on research. I question, for example, whe-
ther money in my state was well-spent to
try to look into the problems of the cancer
cluster at McFarlane. What we found is
that there were an excess number of can-
cers and too many kids that had cancer,
according to the statistics. We ended up
spending millions of dollars to research
that problem, however.

The one fact that the research turned up
was that most of the people there have
terrible health care because they are poor.
They do not have good quality primary
health care and that may have something
to do with the outcomes that were
generating cancer.

It may; it may not. What we found is that
70 percent of the people who live in that
community do not have any decent health
care. That is the most profound finding
we discovered.

It leads us to the conclusion that more
communities should be demanding ser-
vices. They should be demanding changes
in the health care delivery system so that
they receive more services and put less
emphasis on empirical scientific studies
that try to prove slight elevations in certain
rates are occurring in their community.
That is what we are thinking about.

We recognize that environmental solutions
will require good scientific research: epi-
demiology and surveillance. In many cas-
es, the science is already finished. We are
going to be focusing on eliminating haz-
ards that are known, that are understood.

We know that parathion is a dangerous
chemical. We have known that for 30
years. We know that it kills people. We
know that there is no reason for it to be

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Surveillance - Agriculture-Related Diseases, Injuries and Hazards

used. There are safer substitutes that are
out there.

There are different ways to organize agri-
culture that can produce the results we
need in terms of productivity without using
that pesticide. There are people in this
country who will pay a lawyer $300 an
hour to work around the clock to lobby
EPA to keep that product in the market-
place. No matter how many studies you
do and how many deaths you document, it
is going to keep being sold despite the
scientific evidence.

Therefore, our campaign is going to focus
on getting rid of that pesticide. We are
going to focus on the acutely toxic pesti-
cides, the ones with strong neurotoxicity,
the ones that are potent carcinogens.
There is no reason for those pesticides to
be on the market and to be used.

We are going to be emphasizing the need
for new technology. We are going to be
exposing the hidden cost of using these
products. There is no reason that these
costs have to be socialized in this country
when the folks who benefit do not socialize
their profits.

I will talk about a strategy we have devel-
oped that may be of interest to you in
terms of how to achieve these reductions.
You know that we failed in California
when we proposed that all of the B2 carci-
nogenic pesticides-those that EPA says are
probable human carcinogens-be phased
out over an &year time period. That was
considered to be an extreme proposal.

It was opposed by the Farm Bureau. It
was supported by family farmers. The
Farm Bureau and the major chemical
companies worked together in a coalition
to defeat that proposal.

196

What we have done in California is to
promote more dialogue with people that
could make a difference, the farmers that
are growing the fruits and vegetables.
Fruit and vegetable production has dou-
bled in past decades.

That means there are going to be more
farmworkers out there, more exposure.
With the kind of intensification we are
using, there will be more exposure to
dangerous pesticides.

We went to the farmers. We went to the
supermarket industry.

We said to the farmers, "How would you
like to receive a slight premium for the
fruits and vegetables that you grow, if you
could grow them with fewer and safer
pesticides? Not necessarily entirely with-
out pesticides right off the bat, but those
of you that can move into an organic sys-
tem or a regimen of pesticide reduction,
do it. We will support you. We will lobby
for you. We will try to get your products
carried in the stores. Those of you who
could reduce your use of the B2 carcino-
gens and provide lettuce grown without
DBCP's, we want to support you.

We went to the supermarket industry. We
said, "How would you folks like to be able
to sell a product that has a unique environ-
mental distinction and that provides you
with a marketing niche?" This is an indus-
try that is viciously competitive, where
executives live or die over fractions of a
tenth of market share. Some of these
executives were interested in ex-
perimenting with pesticide reduction. The
environmental and consumer groups also
were interested. They want to see change
happen. It is not happening now in gov-
ernment.

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Finally, the farmworker organizations, as
well, were obviously concerned about this.
Probably the most important reason agri-
culture has done so poorly in terms of
occupational safety and health is because
there are practically no unions there. And
I think the single strongest correlation bet-
ween mediocre safety and health outcomes
has to do with the lack of organization
within that industry.

We did work a little bit with farmworkers,
together with farmers, supermarkets, and
consumers. What we did is arrange a deal
that benefited everyone.

Not long ago, we had 1,200 supermarkets
that represented $10 billion worth of pur-
chasing power in the country who went on
record that USDA EPA, FDA, the Califor-
nia Department of Food and Agriculture,
and other organizations have spent too
much of their time defending the status
quo. They said, "We are on record calling
for the phase-out of all B2 carcinogens."
Period. End of discussion.

We are going to be favoring growers who
can provide us supplies of fruits and vege-
tables without pesticides that are acutely
neurotoxic, eliminating pesticides that lack
any practical analytical detection method.
They took a very progressive policy.

They were immediately attacked by the
USDA, by the FDA, and by the EPA as
unnecessarily alarmist, threatening the
integrity of people's confidence in the food
supply. The Administration wanted the
rest of the industry to continue mimicking
their mantra, which is that "We have the
world's safest food supply; the food supply
is safe; do not worry, be happy; do not
worry about the people who work on a
daily basis with these pesticides. Trust us.

The Consumers' Perspective, May 2, 1991

The system will protect you and the envi-
ronment."

That position is wrong. That position has
to change. It is a dinosaur position. It is
one that is based on defending the status
quo; eventually those people will lose out.

In the meantime, we have built an interest-
ing coalition with supermarket executives.
They are not a liberal bunch, on the
whole. They do have an economic advan-
tage in promoting this, which we are happy
to support.

We think that is a great thing. To the
extent that we can use market forces to
encourage these things, we are going to do
that.

Certainly the farmers are happy to see that
they can demand and receive a small pre-
mium. That is the kind of coalition that
we have attempted to build.

The National Toxics Campaign has pro-
moted some similar approaches in more
traditional industry, One of them is
replacing TCE (trichloroethylene) solvent
with detergent compounds for washing
circuit boards.

Before we negotiated we spent our time
beating up some of the major electronics
firms. They refused to acknowledge that
there were safer alternatives that would
not cause some of the occupational and
environmental problems that TCE was
causing. After a certain amount of head
banging, and a certain amount of rational
argument, and a certain amount of objec-
tive studies, things got to the negotiations
point. Now, IBM and other major industry
leaders have replaced TCE solvents with

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Surveillance - Agriculture-Related Diseases, Injuries and Hazards

more benign detergent compounds to wash
their circuit boards.

The same things happen with refineries.
We lost a chemical plant yesterday that
killed eight people. Refinery work is one
of the most dangerous occupations in the
country, after agriculture, of course. We
have fought a major battle with Chevron's
Richmond refinery that has released tons
of benzene and other chemicals every year
into a black neighborhood.

That is now going to end. It did not end,
however, because the government made it
happen. It happened because we used
third-party pressure to make it happen.

In fact, the government was giving
Chevron a permit every year to dump that
benzene into the air and dump heavy
metals into the water. That is something
that the government was willing to
tolerate, but we were not.

I believe what it is going to come down to
is this: we want to work with you. We
want to see interesting, provocative re-
search. We hope that it is going to be
oriented towards helping farmworkers and
helping farmers and moving it down to
that level.

Too much of our research has tended to
benefit people that already have the re-
sources to do their research. We need
research that can help the folks who are
working in the granaries and the mills, the
folks who are picking those fruits and
vegetables, and the farmers who are strug-
gling to make a living in these difficult
times for family farmers. We would like to
work with you to make sure that your
research is appreciated and that it does the
most good for the most people.0

198

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Surgeon General's Conference on Agricultural S&ly and Health
FARMSAFE 2000 o A National Coalition lor Local Action
Convened by the National institute for Occupational Safety and Health
April 30 - May 3, 7997, Des Moines, Iowa

AN AGRICULTURAL SAFETY PERSPECTIVE

By Dennis Murphy, Ph.D.
Professor, Penn State University

The first thing I want to say is that, being
an agricultural person, my opinions are
unbiased. Everything I am going to tell
you is completely unbiased. I did not
realize what a miracle person I was, grow-
ing up on a farm and being happy. I did
not realize I was so abused.

I thought I had a relatively happy child-
hood. I continue to know a lot of people
who are pretty happy about being out on a
farm. I am probably confused, but I
thought that our life expectancy was in-
creasing instead of going down. I thought
people were still dying to get into this
country instead of out of it.

I was not asked to make a presentation per
se. Rather, I was asked to get up and
respond to other presentations. I think
that has been called a "rebuttable," or
something like that.

Dr. Herrick said "don't worry about actual-
ly preparing something." Since I do not
pay attention to a lot of things, I went
ahead and prepared something.

I am glad that I did because I have not
heard many people talking about the con-
cepts of dealing with surveillance issues.
Very few people have talked about that.

We have had actual research studies pre-
sented, which is one thing. That is fine.
This does not mean that all positions and
all the things that have been talked about

are not important. They are not the things
that I consider important issues in surveil-
lance of agricultural safety and health
hazards and problems.

I am going to get to the categories of
specific exposure groups because we have
talked about descriptive statistics. We are
finally getting beyond descriptive statistics.
Some of the papers presented earlier have
illustrated this.

In the last two, three, or four years, public
health has gotten more interested in
agricultural safety and health issues, and
particularly in certain aspects of them. I
keep reading papers that are just dis-
covering that there is a problem out there.
We keep discovering the same problem
over and over and over.

There are a whole bunch of new people
here again. I am afraid that in the next
couple of years we are going to keep read-
ing a lot of papers that are saying the same
thing over and over again.

The descriptive stuff is out there and has
been for 20 or 30 years now. I strongly
encourage you to get beyond that. If that
is all that you can do, you are not going to
contribute very much to literature.

STANDARD TERMINOLOGY

We talked about the standard terminology.
What I keep hearing here through the use
of agricultural statistics, is that we are

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either the first, second, third, or fourth
most hazardous industry. We heard all of
those numbers within an hour and a half
the other day. That is because we define
things in different ways.

If we are going to let data guide us, we
have to get to some specific categories to

One of the things we talked about earlier
was that 300 kids are killed every year on
the farm. If you go back and look at the
original study, those really were children
and adolescents. I have not heard the
work "adolescents" used at all at this con-
ference. That statistic included adoles-
cents through the age of 18. It was all
fatalities on the farm.

It was not agricultural work. Yet
everybody uses agricultural work as a justi-
fication for getting into this area. A lot of
those fatalities were hunting accidents and
other leisure types of things. This 300
number is firmly entrenched and everybody
uses that number.

They fail to mention that it involves
adolescents, not just children. Nobody
identifies that it is not just farm work
fatalities included in that statistic.

There is much to do in straightening out
our language. I am not sure that the pub-
lic health people are really addressing this
issue.

Category-specific exposure data is an issue.
I think it is very important. We have
heard about exposure assessment. We are
moving in that direction. I know that the
family farm health surveillance program is
dealing with this.

200

What I would caution is that it is not total
exposure that is important. If we are going
to do something meaningful, we have to
get down into categories. Not all expo-
sures are equal.' The quality of exposure is
not necessarily equal when you get into
tractors, or into age groups, or into other
machinery or respiratory hazards.

If we are going to let data guide us, we
have to get to some specific categories to
have some guidance. Otherwise, we are
throwing away money, effort, and a lot of
time on something that may or may not
exist.

The same is true with categories. The
"children" category is one of the best exam-
ples. Again, we have heard much about
children and about the elderly. Thus far,
"children," at this conference, means every-
one 19 and under, 18 and under. We just
had 17 and under; 16 has not been men-
tioned yet, but 15 and 14 have been men-
tioned. So, what is the "children" catego-
ry?

I do not think it is as important whether it
is 14, 16, or 18. It is important that we all
should use the same thing. When you look
in the literature, it is all different. Every-
body has a different group. It is hard to
understand and communicate with each
other exactly what the problem is with
children because they are all different age
categories.

The same thing is happening with the
elderly. We have 55, 60, and 65 for most
of the elderly categories. It is not helping
us to have these different categories.

We have the same problem with other
categories. Sometimes machinery includes
tractors and sometimes it does not. That
makes a big difference on the farm when
you are talking about statistics, whether

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you are including tractors in agricultural
machinery. I am suggesting that we need
to take time to work on some of these
kinds of things before we rush out and do
something that might prove to be inappro-
priate or ineffective.

Another issue is useful categories. From
the beginning, we have known that there
are more injuries among kids during the
summer months than there are during the
school year.

That makes a lot of common sense to me.
They are out there during the summer
months. The rest of the time, they are in
school. Their exposure is lower and ob-
viously they are hurt less often.

There is data that says that tractors are
involved in injuries at certain times of the
year. That is because they are being used
more at some times of the year than oth-
ers. These are common sense things that I
am hoping the public health researchers
are not going to go back and tell us again.

Data is already there. It has been there
for a long time. We need to define groups
and categories and come to some agree-
ment on what those are.

I am not saying that what I do is the right
thing. It is just that we all should get
together and come to some kind of
agreement on these kinds of issues.

DATA AND NONFATAL DIFFERENCES

Another issue is the fatality and nonfatality
descriptions. They are different. This is
combined with the priorities issue. What
are our priorities, long-term or short? I
find myself in a difficult position because I
have to argue something in order to get it
identified as a issue.

An Agricultural Safety Perspective, May 2, 1991

When we talk about fatalities, the picture
is clear. You may not realize it but there
is a very clear picture of the fatalities on
farms, fatalities associated with farm work
and with farm worksites.

If we are concerned about doing some-
thing, about saving somebody's life next
week, next month, or this year, we need to
work on that. We need to let that give us
some guidance.

If we are taking a longer view, we look at
nonfatal injuries because they involve a
different group of exposures, different
kinds of agents. So, we approach things
and we do some things differently.

LONG-TERM AND SHORT-TERM
VIEWS

Much of the discussion during this confer-
ence has been about pesticides and chemi-
cals. The public health system is obviously
knowledgeable and concerned about chro-
nic health effects, whether from pesticides
or respiratory or other kinds of things.

When we talk about those issues from my
perspective, those are quality-of-life issues.
I am worried about keeping the poor guy
alive to begin with.

I may not be right, but I think that is an
issue. We do not talk about it as an issue.
We are jumping on all kinds of bandwag-
ons and talking about things that affect
people 15 or 20 years down the road; that
is important.

That is why I have difficulty talking about
this because I am not trying to argue
against being concerned about long-term
effects. Given the real world and limited
resources to put into anything, if we are
going to prioritize, and if we are going to

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use data to help do that sort of thing, I
think this is an issue we have to discuss.

DEATH CERTIFICATES

Another issue that I think has been clearly
identified is death certificates. Death
certificates are not a very good measure of
what is going on.

They are a starting point. That is about
all. You can follow up to get better infor-
mation, especially in terms of whether the
injury was occupationally related.

OUT-OF-FIELD LITERATURE

The next issue I have is the awareness and
availability of out-of-field literature. This
goes back to some of the earlier com-
ments. We already know to a large extent
what the acute problem is.

I will not say we know so much about the
long-term, about the pesticides, and long-
term effects from that perspective. From
the short-term perspective, that infor-
mation is already known. You need to
look beyond the public health literature,
however, to find it.

There is the National Institute for Farm
Safety literature. There is the American
Society of Agricultural Engineers litera-
ture. There is the Agricultural Division of
the National Safety Council.

There are other groups that have been
doing things for a long time that some-
times have been published and sometimes
not. A lot of the people in these groups
do not publish in refereed journals because
that is not their purpose or mission.

You can scan medical ioumals and think

that you are going
on in agriculture.

202

find out what is going
a large extent, it is

past history. There is literature out there
but you need to try to find it. Then we
will not keep saying that there are no
studies, there is no documentation, there is
nothing. That is not true.

LOCAL DATA

The last thing I see as an issue is that
educational and intervention efforts need
more localized data if we are going to do
something that is meaningful. There is a
purpose for state and national surveillance.
I understand and strongly support that. I
am involved with it. When it comes to
doing something about the problem, the
national data in particular is not going to
guide us very well.

We need local level data to help guide us,
pizT--I

There are some issues, the ROPS issue is
the most typical one, that we can approach
from a national perspective. That is just
one part of the problem. There are doz-
ens and dozens of problems out there.
When used on a local level, one to one, or
with small groups of farrn people, they see
right away that what you are talking about
is not a problem in their area.

I tried to talk about respiratory hazards to
a group of poultry and potato farmers. I
was using the Iowa information, I said
"Iowa has done a lot of great things. This
is the information that is coming from
there." They said, "That doesn't mean
anything to us; that is in Iowa."

I then spent the next half hour, instead of
talking about respiratory hazards and what
they can do to protect themselves, talking
about how a hog in Pennsylvania is the

Papers and Proceedings


An Agricultural Safety Perspective, May 2, 1991

same as a hog in Iowa. They did not be-   ledge of the culture and values of farm
lieve that what I was using was relevant to  people. You do not need to understand
them, the types of diseases they get.     that you will be going off on some tangents
                   that are not going to be productive. We

Again, this is for the people who are newer  need to get down to local levels. We need
in this area who do not have a working   local level data to help guide us, not just
knowledge of farms and a working know-   national data.0

Surgeon General's Conference on Agricultural Safety and Health - 1991

203


Surgeon Qeneml's Confimncs on A@ultural Satkv and Heatth
FARM&FE 2000 o A National Coalition tibr Local Action
Convened by the National Institute k~,r Omqational SaMy and Health
April 30 - May 3, 1991, Des Moines, Iowa

AIRBORNE DUSTS

    By Susanna Von Essen, M.D.
Assistant Professor of Medicine, University of Nebraska

OVERVIEW

Exposure to airborne dusts has long been
known to cause illness. Rarnazzini wrote
that measurers and sifters of grain were at
risk for respiratory problems and irritation
of the eyes in his book De morbid artijicum,
published in 1713.'

Hypersensitivity pneumonitis (HP) in
farmers was formally described in modern
times by Campbell, in the year 1932. He
recognized the relationship between ex-
posure to spoiled hay and a febrile illness
with cough and an interstitial pattern on
chest X-ray.

HP is a disease about which much is
known. A variety of etiologic agents and
measures for treatment and prevention
have been identified. However, a great
deal still remains to be learned about this
disease.

Organic dust toxic syndrome (ODTS),
originally called pulmonary mycotoxicosis,
is a disorder that was first recognized in
the 1970's in dairy farmers after heavy
exposure to moldy silage." The disorder
was called "silo unloaders' syndrome" when
it was recognized that the symptoms likely
were not caused by fungal poisoning."

A similar illness, originally called grain
fever, was seen after exposure to dust from
stored grain? ODTS shares many features
with acute hypersensitivity pneumonitis but

204

is without clearly identified long-term se-
quelae.

Most studies have shown that chronic
bronchitis is more common among farmers
than in the general population.611 The
majority of farmers with chronic bronchitis
have a history of exposure to grain dust,
which has been linked to this problem in
grain workers," or of work in animal con-
finement units. However, not all resear-
chers agree that exposure to airborne dust
places farmers at increased risk for chronic
bronchitis.13

Exposure to grain dust causes cough, chest
tightness, and dyspnea in some in-
dividuals.`"" The environment of swine
confinement units causes cough, chest
tightness and dyspnea acutely in many
individuals who are without chronic
symptoms.1'25 It is unclear if there is a
relationship between repeated exposures to
airborne dust followed by symptoms sug-
gesting acute airway inflammation and the
subsequent development of chronic
bronchitis.

It has long been known that individuals
with asthma become more symptomatic
after exposure to airborne dusts. Charles
Thackrah, a British physician, described a
relationship between asthma and in-
halation of corn dust in a book published
in 1832.% A variety of organic dusts have
been associated with the onset of asthma
symptoms.~-N Whether exposure to these
dusts can actually cause asthma remains
controversial.

Papers and Proceedings


Eye, throat, and nasal symptoms, termed
mucous membrane irritation, are ex-
perienced after exposure to airborne dusts,
including grain dust, as well as to the en-
vironment of dairy barns and swine con-
finement units. Mucous membrane ir-
ritation symptoms have been mentioned
but not described in great detaiL"

HYPERSENSITIVITY PNEUMONITIS

Hypersensitivity pneumonitis is the best
characterized of the disorders described
after airborne dust exposure in the agricul-
tural setting.% Acute HP is an immuno-
logic reaction to antigens present in or-
ganic dust. It has the following clinical
features: fever, chills, muscle aches, a dry
cough, and malaise experienced four to
eight hours after exposure to a causative
antigen.

Laboratory and X-ray findings include
hypoxemia, leukocytosis, infiltrates on
chest X-ray, and restriction and a low
diffusing capacity for carbon monoxide
(DLCO) on pulmonary function testing.
The symptoms usually improve over 12-24
hours. Repeated exposures to the offen-
ding antigen may lead to further attacks.
A small number of the individuals at risk
for this disease actually develop HP. At
this time, there is no predictor for suscep-
tibility to this disorder.

Occasionally, HP presents as a subacute
process, lasting for weeks. The course of
this illness can be shortened using systemic
corticosteroids. Rarely, HP leads to pul-
monary fibrosis and respiratory failure.

At this time, it is not possible to identify
those individuals with HP who are at risk
for pulmonary fibrosis. There are no firm
recommendations for surveillance
Programs, using pulmonary function testing

Airborne Dusts, May 1, 1991

or other means, for identifying those who
are likely to have this outcome with con-
tinued exposure to the offending antigens.

The cause of HP is known to be repeated
exposure to antigens from a variety of
substances, including the microorganisms
Faeni rectivindga (previously known as
Micropolyspora faeni), Thermoactinomyces
and Aspergihs spp. and others that are
found in spoiled hay and grain as well as
in silage. Avian proteins, including those
from chickens, and wheat weevils have also
been implicated as causes for HP.

The dairy farm is an environment where
HP is common. However, this problem is
also seen in other agricultural settings,
including farms where grain is stored in
drying bins, in poultry houses, and in
mushroom growing facilities. Estimates of
prevalence of HP, or farmer's lung, on
dairy farms range from l/1,000 to 2 to
4/ 10,000? 3a Epidemiologic studies remain
to be done to determine the prevalence of
this problem in other farm settings.

Epidemiologic studies are complicated by a
lack of definitive means of making a
retrospective diagnosis. Many farmers do
not seek medical care for episodes of HP,
so that there is no supportive information
available from medical records.

Serum allergic precipitins identify in-
dividuals who have been exposed to
antigens that can cause HP, but do not
point to the subjects who have the disease.
Serum allergic precipitins may have
become negative after a bout of HP ex-
perienced in the remote past. Open lung
biopsy reveals characteristic findings in the
presence of the disease, but should not be
performed routinely for this problem.

Surgeon General's Conference on Agricultural Safety and Health - 1991

205


Research - Chemical and Biological Hazards

Additional difficulties are posed by the
similarity between the clinical pcture of
acute HP and that of ODTS.m  In ab-
sence of a clear history of repeated
episodes of illness and supportive labora-
tory and X-ray information, it is often
impossible to determine which disorder is
or was present.

Recently, a study was published that in-
dicated that use of corticosteroids shortens
the course of subacute HP." However,
there is no agreement on the dose and
duration of treatment required.

There is some evidence that episodes of
HP may be prevented by the use of dust
masks or full-face respirators.`l In spite of
being aware of the potential benefit of
wearing protective devices, farmers often
fail to do so.

Reasons given include lack of comfort as
well as excessive expense. There is a need
for better designed devices to reduce ex-
posure to airborne dust as well as formal
testing of the efficacy of these products. In
addition, it is possible, though still
unproven, that improved ventilation in
farm structures will decrease the risk for
HP.

ORGANIC DUST TOXIC SYNDROME

ODTS is a febrile illness associated with
myalgias, malaise, dry cough, chest
tightness, and headache, which begin 4-12
hours after eyosure of large amounts of
organic dust.* 1% `MJ Common causes of
ODTS include uncapping of silos on dairy
farms, cleaning of grain bins and moving
moldy grain. Recently, it was also des-
cribed as bein  common in swine confine-
ment workers. fi It is possible that it will
be identified in other farm settings as well.

The exact incidence of ODTS is unknown,
because of difficulties similar to those for
HP in making a retrospective diagnosis
results of previous studies conducted in
Scandinavia indicate that the incidence of
ODTS ranges from 10 to 190/10,000." A
more complete understanding of the
epidemiology of ODTS, as well as other
disorders caused by airborne dust, has
been hampered by a lack of validated
questionnaires tailored for use in the farm
environment. A recently published ques-
tionnaire designed specifically for evaluat-
ing organic dust exposure likely will help
solve this problem."

ODTS may occur without prior sen-
sitization, which is required for HP.
Laboratory findings are notable for the
presence of leukocytosis but an absence of
hypoxemia, restriction, and a reduced
DLCO on pulmonary function tests and
infiltrates on chest X-ray. However, there
is a need for more specific diagnostic tests
indicating the presence of this disorder.

Farmers with ODTS have been studied
with bronchoscopy and bronchoalveolar
lavage, revealing neutrophilic airway
inflammation.44 52 A neutrophilic lower
respiratory tract inflammation is also seen
in acute HP.%

However, the mediators of inflammation
present in the lung, or systemically, have
not been identified. Organic dust toxic
syndrome typically resolves in 24 hours,
but may last 2-5 days. Therefore, it can
cause significant morbidity and time lost
from work. Corticosteroids have been
used as treatment in several patients with
ODTS, but little is known about their
efficacy in this disorder.n

There have been no sequelae described for
ODTS, unlike for HP. However, farmers

206

Papers and Proceedings


with bronchial hyperactivity often attribute
the onset of their asthma to an organic
ODTS-like episode occurring after an
abnormally severe dust exposure. Others
date the onset of their chronic bronchitis
or an increased susceptibility to having
respiratory symptoms back to an episode
which may have been ODTS.

A small study published recently did not
definitively establish a connection between
airway disease and a history of ODTS."
More work needs to be done to determine
if a relationship exists between ODTS and
chronic pulmonary disease.

Farmers are often told to wear dust masks
to prevent ODTS when heavy exposure to
airborne organic dust is anticipated.
However, there are no studies published
that attempt to answer the question of
whether or not ODTS can be prevented by
wearing dust masks. Again, improved ven-
tilation may reduce the amount of airborne
dust present and, therefore, might decrease
the risk for developing ODTS.9P6'

The component(s) of airborne organic dust
that causes ODTS remains controversial.
There is strong evidence that endotoxin
causes ODTS, as it is present in high levels
in the environments where ODTS is com-
mon.624 In the laboratory setting, en-
dotoxin has been shown to cause fever and
neutrophil influx into the lung.*@ How-
ever, there has been a study suggesting
that the risk for ODTS did not correlate
well with endotoxin levels70 Since ODTS
is often reported after exposure to moldy
organic material, mycotoxins must also be
considered as potential causes of ODTS."

Tannins are polyphenols present in various
plant materials. Work done with tannins
found in cotton bract has demonstrated
their ability to cause neutrophilic lower

Airborne Dusts, May 1, 1991

respiratory tract inflammation, raising a
question of their potential contribution of
the inflammatory changes seen in ODTS.72

CHRONIC BRONCHITIS

Chronic bronchitis, defined as bringing up
phlegm on most days for at least three
months per year for at least two con-
secutive years, has been shown to be more
common in farmers than in the general
population.47 In several studies, a two- or
three-fold difference is demonstrated. The
healthy worker effect may help lower the
number of farmers with chronic bronchitis
after airborne dust exposure as well as
other pulmonary disorders, leading to an
underestimation of the problem.

Extensive epidemiologic work done with
subjects exposed to airborne grain dust has
indicated that this likely is a factor in the
causation of chronic bronchitis in farmers.&
lzn However, their airborne dust exposures
are more heterogeneous than those of
grainworkers, creating difficulties when
attempts are made to determine the
precise cause of the airway inflammation.

At this time, it is not possible to identify
those individuals who are at risk for the
development of chronic bronchitis caused
by inhalation of airborne dust. The role of
airway hyperactivity as a predictor of
chronic bronchitis remains controversial.
Other tests, such as measuring the group-
specific component, may prove useful in
the future."

Many farmers have exposures to airborne
dust in animal confinement units as well as
from working with grain. Recent studies
conducted in Iowa swine confinement
workers indicate that up to 25 percent of
these individuals suffer from chronic
bronchitis.=

Surgeon General's Conference on Agricultural Safety and Health - 1991               207


Research - Chemical and Biological Hazards

Gases present in confinement units,
including ammonia and hydrogen sulfide,
may contribute to the symptoms observ-
ed. ls, 19, y The airborne dust in swine con-
finement units is heterogenous, consisting
of feed particles, animal dander, bacteria,
and endotoxin.76 Identifying a component
of hog dust which is particularly noxious is
difficult.

Poultry farmers also appear to have
respiratory risks, similar in symptoms to
those of the swine confinement workers."
Dust, endotoxin, and ammonia have also
been implicated as a cause.

Pulmonary function tests performed on
farmers with chronic bronchitis do not
reveal the presence of severe obstruction
in most individuals unless they are
cigarette smokers. However, farmers in
swine confinement units do have small
decreases in FEVl and FVC values over a
workshift.

Confinement units are a relatively new
innovation in farming, so no individuals
have had a lifetime of exposure to air-
borne dust and fumes in this setting. It
remains to be seen if significant airway
obstruction develops in farmers who have
been exposed to this environment for their
entire working life.

Cigarette smoking is the most common
cause of chronic bronchitis. It is likely, but
not definitively proven, that exposure to
grain dust or the swine confinement en-
vironment in addition to cigarette smoke
works addictively to cause airway obstruc-
tion. 20124,78 The mechanisms of this interac-
tion are unknown.

Several forms of pharmacologic treatment
have been approved for use in chronic
bronchitis, including inhaled corticosteroids

208

and ipratropium bromide. It has not been
demonstrated whether or not these drugs
are useful for the treatment of chronic
bronchitis caused by organic dust.

The components of airborne dust that
cause chronic bronchitis are largely
unknown. It may be speculated that en-
dotoxin, mycotoxins and tannin play a role.
Plant lectins have been isolated from grain
dust." Lectins cause lymphocyte pro-
liferation, which could contribute to ele-
vated airway immunoglobulin levels seen
in individuals acutely exposed to grain
dust.=

Most of the work done in the laboratory
looking at the effects of inflammatory dust
has been done with grain dust extracts.=
Repeated inhalation challenge of rabbits
with grain dust extracts causes lower res-
piratory tract infiltration with macro-
phages.

Macrophages are known to release a
variety of mediators of inflammation,
which could play a role in the development
of chronic bronchitis." Neutrophils,
present in increased numbers in the airway
of many individuals with chronic
bronchitis, could function in a similar
way.8"

ACUTE BRONCHITIS

The acute pulmonary effects seen after
airborne dust exposure include dyspnea,
chest tightness, and a cough, which may or
may not be productive of sputum. In the
non-atopic subject, these symptoms are
consistent with acute bronchitis. This has
been described in grain farmers as well as
in swine confinement workers.

A preliminary study done in grain farmers
during harvest using bronchoscopy with

PaDers and Proceedinas


BAL revealed evidence of airway inflam-
mation without changes in spirometry."
One study has described signs of lower
respiratory tract infhunmation in swine
confinement workers by also using bron-
choscopy with bronchoalveolar lavage.a6

Airborne Dusts, May 1, 1991

include animal dander, pollen, storage
mites, and grain. There is no consensus,
however, regarding the ability of these
substances to cause asthma in the farm
setting in a subject who has no have
previous exposure to them.

Farmers symptomatic after other types of
occupational airborne dust exposure have
not been studied in this way. It might be
useful to better characterize any changes in
the lower respiratory tract in order to find
therapy specific for these problems.
Therapies that could be used prophylac-
tically would be optimal.

The components of airborne dust that
cause acute pulmonary effects have not
been identified. Endotoxin is again
suspected to play an important role.
However, it has been shown that giving an
inhalation challenge of grain dust extract
to guinea pigs causes greater acute neutro-
philic lower respiratory tract inflammation
than a challenge with endotoxin alone,
given in an amount equivalent to that pre-
sent in the grain dust extract (unpublished
data).

When added to cultures of bronchial
epithelial cells, grain dust extracts also
cause cell death and the release of neutro-
phi1 chemotactic factors.87 Whether or not
these observations help explain the pre-
sence of acute pulmonary symptoms after
airborne dust exposure in the farm setting
remains unknown.

ASTHMA

Exacerbation of asthma by airborne dust is
a well-described phenomenon, both as a
response to specific allergens and as a
nonspecific reaction.34Va89 A host of sub-
stances present in the farm setting contain
antigens that trigger asthma. These

A host of substances present in the farm
setting contain antigens that trigger
asthma.

Ethical considerations complicate studies
designed to answer the question raised
above. Specific antigen challenges, using
extracts made from airborne dusts, can be
given in the laboratory in order to help
determine the cause of asthma in farmers
suspected of having occupational causes
for their bronchospasm.

There is some evidence that farmers have
increased bronchial reactivity presumably
related to airborne dust exposures.259o
More work remains to be done relating
bronchial reactivity to acute and chronic
respiratory symptoms in farmers.

MUCOUS MEMBRANE
INFLAMMATION

Symptoms of eye and nasal irritation as
well as dry throat are common after ex-
posure to airborne dust. This is a common
reaction to airborne dust in subjects with
allergic rhinitis. However, symptoms of
mucous membrane irritation are also seen
in individuals without a history of atopy.

With some grain dusts, the offending agent
appears to be a part of the plant, which
causes mechanical irritation. However,
endotoxin and mycotoxins must also be

Surgeon General's Conference on Agricultural Safety and Health - 1991

209


Research - Chemical and Biological Hazards

considered as possible causes for this
problem.

The presence of inflammation is a com-
mon theme in these disorders.  I

It has not been demonstrated that wearing
respirators commonly in use in the farm
settings reduces incidences of these
complaints. Also, no pharmacologic
therapy has been found for these
symptoms. Attempts should be made to
find agents that prevent as well as treat the
symptoms.

Little work has been done in the
laboratory to further define the problems
described. It has been shown that aerosol
challenge of human volunteers with grain
sorghum dust extract causes an influx of
neutrophils into the nose, as demonstrated
with nasal lavage.91

SUMMARY

A variety of disorders are associated with
exposure to airborne dust in the farm
setting. These include hypersensitivity
pneumonitis, organic dust toxic syndrome,
chronic bronchitis, acute pulmonary
symptoms, asthma, and mucous membrane
irritation. Better ways of preventing these
problems must be found, through the use
of protective devices and agricultural en-
gineering innovations, as well as perhaps
by pharmacologic means.

The presence of inflammation is a com-
mon theme in these disorders. Resear-
chers are faced with a variety of challenges
in better defining the inflammatory chan-
ges. In particular, the causative com-
ponents in the airborne dust and the
mediators of inflammation must be better
described so that specific therapies can be
identified.0

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44. May JJ, Stallones L, Darrow D, Pratt D. Organic dust toxicity (pulmonary mycotoxicosis) associated with
silo unloading. Thorax 1986; 41:919-923.

45. May JJ, Pratt DS, Stallones L, Morey PR, Olenchock SA, Deep lW, Bennett GA. A study of silo
unloading: The work environment and its physiologic effects. Am J Industrial Med 1986; 10~318.

46. Lecours R, Laviolette M, Cormier Y. Bronchoalveolar lavage in pulmonary mycotoxicosis (organic dust
toxic syndrome). Thomx 1986,41:924-926.

47. Brinton WT, Vastibmder EE, Greene JW, Marx JJ, Hutcheson RH, Schaffner W. An outbreak of
organic dust toxic syndrome in a college fraternity. JAu4 1987; 2.58:1210-1212.

48. Malmberg P, Rask-Andersen A, Palmgren U, Hogliind S, Kolmodin-Hedman B, Stalenheim G.
Exposure to microorganisms, febrile and airway-obstructive symptoms, immune status and lung function
of Swedish farmers. Stand J Work Environ Health 1985; 11:287-293.

49. May JJ, Pratt DS, Stallones L, Morey PR, Olenchock SA, Deep IW, Benent GA. A study of dust
generated during silo opening and its physiologic effects on workers. In: Principles of Health and Safety
in Agriculture. JA Dosman, DW Cockcroft, eds. CRC Press, Inc. Florida, 1989,76-79.

50. Malmberg P, Rask-Andersen A, Hogliind S, Kolmodin-Hedman B, Guernsey JR. Incidence of organic
dust toxic syndrome and allergic alveolitis in Swedish farmers. Int Arch Allergy Appr Immunoll988;
  8147-54.

51. Rask-Andersen A. Organic dust toxic syndrome among farmers. Brit J Industrial Med 1989; 46:233-238.

52. Husman K, Terho EO, Notkola V, Nuutinen J. Organic dust toxic syndrome among Finnish farmers.
Am J Industial Med 1990; 17:79-80.

53. Von Essen S, Robbins RA, Thompson AB, Rennard SI. Organic dust toxic syndrome: An acute febrile
reaction to organic dust exposure distinct from hypersensitivity pneumonitis. Clin Toxicology 1990;
  2R389-420.

54. Mahnberg P, Rask-Andersen A, Hogliind S, Kohuodin-Hedman B, Guernsey JR. Incidence of organic
dust toxic syndrome and allergic alveolitis in Swedish farmers. In: Arch Allergy Appl Immunol 1988;
  8147-54.

55. Rylander R, Peterson Y, Donham KJ. Questionnaire evaluating organic dust exposure. Am JIndusltial
Med 1990; 17:121-126.

56. Fournier E, Tonne1 AB, Gosset P, Wallaert B, Ameisen JC, Voisin C. Early neutrophil alveolitis after
antigen inhalation in hypersensitivity pneumonitis. Chest 1985; 88:563-566.

57. Emanuel DA, Marx JJ, Auk B, Roberts RC, Kryda MJ, Treuhaft MW. Organic dust toxic syndrome
(pulmonary mycotoxicosis) a review of the experience in central Wisconsin. In: Principles of Health and
Safety in Agriculture. Dosman JA, Cockcroft DW, eds., Boca Raton, Florida: CRC Press, 1989:72-75.

58. May JJ, Marvel LH, Pragg DS, Coppolo DP. Organic dust toxic syndrome: A follow-up study. Am J
Industrial Med 1990 17:111-113.

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Research - Chemical and Biological Hazards

59. Clark S. Report on prevention and control. Am J Inakstnkl Med 1986; 103267-273.

60. Hogliind S. Prevention of respiratory problems in agriculture. Am J Industrial Med 1986; 10:245-247.

61. Watson RD. Prevention of dust exposure. Am J Industrial Med 1986; l&229-243.

62. Olenchock SA, Lenhart SW, Mull JC. Occupational exposure to airborne endotoxins during poultry
processing. J Tox Environ Health 1982; 9:339-349.

63. Clark S, Rylander R, Larsson L. Airborne bacteria, endotoxin and fungi in dust in poultry and swine
confinement buildings. Am Ind Eiyg Assoc J 1983; 44~537-541.

64. Lundholm M, Pahngren U, Malmberg P. Exposure to endotoxin in the farm environment. Am J of
Industial Med 1986; 10~314-315.

65. Donham, KJ. Hazardous agents in agricultural dusts and methods of evaluation. Am JIndustriaZ Med
1986; 10:205-220.

66. Brigham, KL, Meyrick B. Endotoxin and lung injury. Am Rev Respir Dis 1986; X33:913-927.

67. Rylander R. Role of endotoxins in the pathogenesis of respiratory disorders. Eur J Respir Dis 1987;
  Y&136-144.

68. Olenchock SA, May JJ, Pratt DS, Piacitelli LA, Parker JE. Presence of Endotoxin in Different
Agricultural Environments. Am J Industrial Med 1990; 18:279-2&I.

69. Hudson AR, Kilbum KH, Halprin GM, McKenzie WN. Granulocyte recruitment to airway exposed to
endotoxin aerosols. Am Rev Respir Dis 1977; ll5:89-95.

70. Rask-Anderson A, Malmberg P, Lundholm M. Endotoxin levels in farming absence of symptoms
despite high exposure levels. Br J Industrial Med 1989; 46:412-416.

71. Sorenson WG. Mycotoxins as potential occupational hazards. J Industrial Microbial 1990; 31:205-211.

72. Laque DE, Hempel SL, Schroeder MA, Hyatt RE, Rohrbach MS. Evaluation of the contribution of
tannin to the acute pulmonary inflammatory response against inhaled cotton mill dust. Am J Path 1988;
  133: 163-172.

73. Warren CPW, Manfreda J. Respiratory symptoms in Manitoba farmers: association with grain and hay
handling. CMA J 1980; 122:1259-1264.

74. Horne SL, Cockcroft DW, Dosman JA. Possible protective effect against chronic obstructive airway
disease by the GC2 allele. Hum Hered 1990; 40:173-176.

75. Donham KJ, Merchant JA, Lassise D, Popendorf WJ, Burmeister LF. Preventing respiratory disease in
swine confinement workers: intervention through applied epidemiology, education and consultation. Am
J industrial Med 1990; 18~241-261.

76. Donham KJ, Scallon LJ, Popendorf W, Treuhaft MW, Roberts R. Characterization of dust collected
from swine confinement buildings. Am Ind Hyg Assoc J 1986; 47:404-410.

214

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Airborne Dusts, May 1, 1991

77. Leistikow B, Pettit W, Donham K, Merchant J, Popendorf W. Respiratory risks in poultry farmers. In:
Principles of Health and Safety in Agriculrure. Dosman JA, Cockcroft DW, eds., CRC Press, Inc., Boca
Raton, Florida 1989; 6265.

78. Dopico GA, Reddan W, Tsiatis A, Peters ME, Rankin J. Epidemiologic study of clinical and physiologic
parameters in grain handlers of Northern United States. Am Rev Respir Dis 1984; X30:759-765.

79. Chen Y, Horne SL, McDuffie HH, Dosman JA. Combined effect of grain farming and smoking on the
prevalence of chronic bronchitis. Am Rev Respir Dis 1991; 143zA99.

80. Cotton DJ, Graham BL, Li KYR et al. Effects of grain dust exposure and smoking on respiratory
symptoms and lung function. J Occup Med 1983; 25:X31-141.

81. Olenchock SA, Lewis DM, MulI JC. Composition of extracts of airborne grain dusts: Lectins and
lymphocyte mitogens. Environ Health Perspec 1986; 66:119-123.

82. Thompson AB, Von Essen SG, Robbins RA, Sears KK, Linder J, Rennard SI. Grain dust exposure is
associated with alveolar inflammation. Am Rev Respir Dis 1987; l35:A236.

83. Von Essen SG, Robbins I&4, Thompson AB, Ertl RF, Linder J, Rennard S. Mechanisms of neutrophil
recruitment to the lung by grain dust exposure. Am Rev Respir Dis 1988; l38:921-927.

84. Sibble Yves, Reynolds, HY. Macrophages and polymorphonuclear neutrophiis in lung defense and injury.
Am Rev Respir Dis 1990; 141:471-501.

85. Von Essen SG, Thompson AB, Robbins RA, Jones KK, Dobry CA, Rennard SI. Lower respiratory tract
inflammation in grain farmers. Am JIndustrial Med 1990; 17~75-76.

86. Pedersen B, Iversen M, Dahl R. Bronchoalveolar lavage of pig farmers. Am J Industrial Med 1990;
  17:118-118.

87. Von Essen SG, O'NeiU DP, Robbins RA, Koyama S, Rennard SI. Grain sorghum dust extract causes
epithelial cell cytotoxicity. SEP-SEPCR, London, England, September 1990.

88. Grammar LC, Patterson R, Zeiss CR. Guidelines for the immunologic evaluation of occupational lung
disease. J Allerg Clin Immunol, 1989; 84~805-814.

89. Smith, AB, Castellan RM, Lewis D, Matte T. Guidelines for the epidemiologic assessment of oc-
cupational asthma. J Allerg Clin Immunol 1989; 84794-804.

90. Iversen M, bahI R, Jensen EJ, Korsgaard J, Hailas T. Lung function and bronchial reactivity in farmers.
Thorax 1989; tiz645-649.

91. Von Essen SG, McGranaghan S, Cirian D, O'Neill D, Spurzem JR, Rennard SI. Inhalation of grain
sorghum dust extract causes respiratory tract inflammation in human volunteers. Am Rev Respir Dis
1991; 143:A105.

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Surgeon General's Corjfemnce on Agricultural SatXy and Health
FARMSAFE 2000 o A National Coalition lb Local Action
Convened by the National Institute fix Occupational SatMy and Health
April 30 - May 3, 1991, Des Moines, lowa

INFECTIOUS DISEASES

       By Russell JK Cunie~ D.ViM.
Bureau Chief of Environmental Epidemiology and Chronic Diseases
       Iowa Department of Public Health

INTRODUCTION

The infectious diseases associated with
farming and agricultural practices are
broad in terms of diversity and-owing to
general health improvements and signifi-
cance of reductions of livestock zoonotic
diseases-minimal in terms of morbidity.
Nevertheless, there are continuing infec-
tious disease problems, mostly sporadic in
nature and occasionally episodic, that af-
fect agricultural workers and occasionally,
via the food chain, their urban counter-
parts.

Many excellent disease-specific reviews are
available to interested parties for further
study.13 This review, while not comprehen-
sive in nature, is offered to define the
scope of current problems as reported and
investigated by public health workers and
health care givers. Much of this informa-
tion was obtained through a recent survey
of state epidemiologists and related staff.

The review will be divided into four major
groups of infectious conditions by nature of
source or form of transmission: interper-
sonal illness, food-borne illness, environ-
mental and vector-borne disease, and
zoonoses (not covered in the aforemen-
tioned groups). Comment on improved
management of these conditions and ex-
posures will be provided, as well as recom-
mendations for improved prevention and
control, including research needs to ad-
dress these problems more effectively.

216

INTERPERSONAL ILLNESS

This category focuses almost exclusively on
migrant farm workers (MFWs) and will be
confined primarily to human-host illness.
Tuberculosis and sexually transmitted
diseases (STDs) are both problems in
migrant worker populations.

California reports a recent outbreak of
chancroid in a migrant camp in Orange
County? STD problems were the fourth
most prevalent problem at two migrant
health clinics in Maryland?

Tuberculosis (TB) remains a serious public
as well as personal health problem in
MFWs. Ciesielski and colleagues" reported
on a large random-sample population-
based 1988 study of farm workers (n= 543)
in three North Carolina counties and
demonstrated that skin-test positivity
ranged from 33 percent in Hispanics to 54
percent in US-born blacks and 76 percent
in Haitians. Active tuberculosis disease
occurred in 3.6 percent of US-born blacks
(300 times the average U.S. rate) and 0.47
percent of Hispanics.

This investigation indicates that TB among
MFWs is an occupational problem, not an
imported one. Among black American
migrant farm workers, risk factors as-
sociated with farm work and years of such
work were far more important than age,
gender, and history of familial TB. These
investigators offer strategies to control
tuberculosis among MFWs, including:

Papers and Proceedihgs


2

.

In states with large migrant populations,
establish a separate registry, e.g.
Florida's special registry.

3.

Increase funding for migrant health-care
centers.

4.

To avoid false negatives, consider use of
recall antigens when administering skin
tests among high-risk groups.

5. Regulate labor contracts more closely.

6.

Occupational Safety and Health
Administration (OSHA) should promul-
gate regulations addressing TB control.

During August 1990, the Wisconsin
Department of Health investigated an
outbreak of gastrointestinal illness affect-
ing an undisclosed number among approxi-
mately 1,000 MFWs and their families
residing in 40 camps in 3 counties.9 Some
infections were due to Giardia and appear-
ed to spread through migrant day care
centers (DCC).

Initial infection is postulated to originate
from exposure to contaminated water from
a sewer back-up into the shower of the
residence of the index case. Known
symptomatic cases totaled 21. Other cases
of illness in this population were due to
Shigella Jexneri 1 and 2 and, owing to
limitations of obtaining accurate history
and limited microbiological studies of food
and water, the exact chain of infection
could not be established.

1.

Adhere to recommendations of the
Strategic Plan for Elimination of Tuber-
culosis in the U.S. and TB Among
Foreign-born Persons Entering the
United States.`. *

Infectious Diseases, May 1, 1991

Enterically transmitted viral and bacterial
diseases among MFWs do occur at about
10 times the rate of the general
population. This can be attributed to a
variety of factors, but primarily to poor
water and toilet hygiene.

Outbreaks subsequently can affect consum-
ers of the produce. In August 1990, an
outbreak of Salmonella javiana in
Minnesota was associated with the con-
sumption of contaminated raw tomatoes
from a South Carolina distributor.

Mary Proctor, an epidemiologist with the
Wisconsin Division of Health, has
reviewed the literature and cites reports
implicating hepatitis A with frozen
raspberries and fresh lettuce." Shigella
infections have also been implicated in
commercially distributed lettuce which
were thought to be contaminated at the
harvest site.

In 1979, Iowa and several other states with
Amish settlements sustained polio
transmission in these agri-populations; no
transmission to surrounding communities
was reported.12 More recently, rubella has
been reported in Amish settlements in
Tennessee.13

In addition to the diseases mentioned, a
variety of personal health problems in
MFWs and their families are also
reported; these problems are influenced by
substandard living and working conditions,
and include parasitic infections, urinary
tract infections, gynecological problems,
respiratory infections, and pediatric infec-
tions.14* l5 Migrant and farm workers also
have a higher percentage of children not
immunized against vaccine-preventable
diseases."

Surgeon General's Conference on Agricultural Safety and Health - 1991

277


Research - Chemical ahd Biological Hazards

FOOD-BORNE ILLNESS

Improvements in food processing and
packaging, coupled with livestock disease
control programs, have reduced many
zoonotic diseases formerly affecting con-
sumers." Examples include tuberculosis,
brucellosis, and trichinosis. Since a great
deal of this reduction has been effected
through improved processing and pas-
teurization, many pathogens continue to
infect farm workers who consume produce
without adequate safeguards or
preparation.

Unpasteurized milk is a vehicle that still
infects large numbers of farmers and their
guests. Potter and Currier have sum-
marized the hazards of raw milk, but
episodes continue to occur.`& l9

A report by Blazer describes an outbreak
of Campylobacter infection in a fraternity
group which visited a member's farm
farnily.m In this outbreak, 22 of 25
students (88 percent) who consumed raw
milk for the first time became infected;
two who had not consumed raw milk were
not infected.

Residents of the farm were not affected by
virtue of long-term raw milk consumption,
and had elevated levels of CampyZobacter.
Jejuni-specific serum antibodies provided
apparent immunity to symptomatic infec-
tion. Numerous episodes and case reports
exist in the literature of CampyZobacter
outbreaks in children and visitors touring
farms and dairies where unpasteurized
milk consumption resulted in infection.

SaZmoneZZa infections have also been assoc-
iated with numerous episodes where raw
or inadequately pasteurized milk was con-
sumed. It is reasonable to assume that
families and workers on dairy farms ex-

perience related illness, although less fre-
quently from raw milk.

In 1987, Vogt reported a case of listeriosis
in a 76-year-old female who lived on a
dairy farm. Blood culture isolated L.
monocytogenes." Isolates subsequently
obtained from two cows and the bulk tank
were identical to the patient's, as charac-
terized by isoenzyme typing and ribosomal
RNA typing.

The patient regularly consumed raw milk
from her farm on her cereal each morning
but consumed no other food products from
her farm. In addition, North Dakota
health officials are currently investigating a
case of E. coli 0157:H7 transmitted
through raw milk to a farm patient.=

In the past 5 years, eggs have been
implicated in numerous cases and episodes
of gastroenteritis due to SaZmoneZZa
enteritidi.s.23 The role eggs play and the
extent to which they cause salmonellosis in
farm workers are unclear.

Brief reports and unpublished inves-
tigations have implicated ungraded farm
eggs in "home-made ice cream" in
transmitting salmonellosis.% These in-
cidents may attest to the lack of understan-
ding farm workers and families have con-
cerning basic food hygiene, and may
contribute directly or indirectly to the
larger problem.

Trichinosis continues to decline in the
United States, but in any given year the
rate of cases may double or triple as
influenced by one or two community
episodes. A large outbreak affecting 15 of
25 individuals from four related farm
families in Nebraska was investigated in
1973.= Source of infection was uncooked
pork-beef sausage from two pigs and one

278

Papers and Proceedings


beef animal; these animals were raised in
open lots or pastures on the farms and
were slaughtered on the premises.

Again, there was an apparent lack of con-
cern for trichinosis owing to tradition.
During 1990, 90 cases of trichinosis in cen-
tral Iowa were traced to raw pork con-
sumption from a locally procured carcass
attesting to the disease's continued pre-
sence in swine.% In many states, expanded
garbage feeding practices, although well
regulated, may serve to enhance
transmission to pigs.

Overall, food-transmitted illness to farmers
is isolated, sporadic and perhaps not al-
ways recognized. It points to the need for
educating these producers about risks, food
sanitation, and desirability of consuming
adequately processed, pasteurized, or cook-
ed food. It is conceivable that elderly
persons on farms, very young children, and
farmers with coexistent health problems
would be at increased risk of infection or
its complications.

ENVIRONMENTAL AND
VECTOR-BORNE ILLNESS

Farmers and farm workers pursue their
activities in a diverse environment of land-
scapes, buildings and livestock collections.
Vector-borne disease does present occa-
sional risks to farm workers in outdoor
settings.

Sylvatic plague, Rocky Mountain Spotted
fever, Colorado tick fever, and tularemia
(tick and deer fly transmitted) are infre-
quently transmitted to farm and ranch
workers during ordinary work activities.
Oregon and Utah report recent isolated
cases of arthropod-borne tularemia in farm
and ranch workers.nv28

Infectious Diseases, May 1, 1991

More recently, Lyme disease is being
recognized in some farm workers in upper
Midwest states. Concern exists not only
for exposure to deer ticks in field settings,
but also exposure to infected cattle.

In a Wisconsin study (to be published
later), of 246 dairy workers tested using
CDC ELISA, 21 (8.5 percent) had sig-
nificant B. burgdo$eri antibody levels, while
6 (4.9 percent) of the 123 crop farmers
were seropositive (p C 0.2).9 Concern exists
for the role of spirochetes in cattle urine
splash as a means of Lyme transmission.
Additional studies are planned.

In another Wisconsin seroprevalence sur-
vey conducted in 1987 at the Marshfield
Clinic on asymptomatic residents of north
central Wisconsin, the seropositivity rate
for farmers was 32 percent versus 16 per-
cent in non-farmers.29 Obviously, farm
workers are at increased risk from Lyme
disease where vectors and conditions favor
its presence, and it should to be included
in differential diagnoses.

Malaria is of greater concern, especially
since this disease had been eliminated
from the United States in the 1940's.
California reports increased activity
relating to MFWs. A summary of the
California experience from its state mor-
bidity report is provided verbatim:

Since 1950, California has experienced 16
episodes of introduced autochthonous
malaria (malaria acquired by mosquito
transmission in an area where malaria
does not occur regularly) accounting for
120 cases, all due to P. vivm Ten coun-
ties have been the sites of exposure with 7
in the Sacramento Valley and adjacent
Sierra Foothills (Butte, El Dorado, Glenn,
Nevada, Sacramento, Sutter, and Yolo), 2
in the San Joaquin Valley (Fresno and

Surgeon General's Conference on Agricultural Safety and Health - 1991               219


Research - Chemical and Biological Hazards

Kings) and San Diego County along the
state's southernmost coast. Only 2 coun-
ties have experienced more than 1 episode,
Sutter (4 episodes), and San Diego (4
episodes).

The confirmed or presumptive sources of
introduction were an army veteran just
returned from Korea and agricultural
workers from India (4 episodes) or Mexico
(8 episodes). In 3 introductions, the
source cases were uncertain but most likely
from India or Mexico. Transmission of
malaria occurred from May to September,
with 3 anopheline species being the likely
vectors (An. freeborni and An. punctipennis
in the central valley and An. herd in San
Diego County).

The largest of these outbreaks was in 1952
when 35 cases occurred in a group of
Campfire Girls exposed in Nevada County.
The second and third largest episodes were
in 1986 and 1988 involving 27 and 30
cases, respectively, in San Diego County.
The remaining 13 introductions resulted in
1 to 5 cases each.

Since 1986 there have been several impor-
tant changes in the epidemiology of intro-
duced malaria in California. The inci-
dence of introductions has risen sharply; 9
(56 percent) of the 16 introduced episodes
since 1950 have occurred in the last 4
years. Before 1986 all episodes (7) had oc-
curred in Sacramento County northward
and in 5 (71 percent), the source(s) of
introduction were associated with immi-
grants recently arrived from northern
India.

Since 1986, activity has shifted with 6 of
the 9 (67 percent) introductions occurring
south of Sacramento County and 8 of 9 (89
percent) being associated with MFWs from
Mexico. Until 1986 all outbreaks of

mosquito-transmitted malaria had involved
only permanent California residents. Since
1986, the great majority of cases (59/71)
have occurred in migrant workers though
local residents have also been involved in
all outbreaks.

Paralleling these trends in the epidemi-
ology of introduced malaria in California
has been a sharp rise in the incidence of
malaria in Mexico and the number of
imported malaria cases in persons entering
the State from that country. Malaria cases
reported in Mexico have risen steadily
from 25,774 in 1980 to 166,271 in 1988
( > 6 fold increase) while the number of
California malaria cases reported in
travelers and immigrants from Mexico has
risen steadily from 12 in 1980 to 83 and 81,
respectively, in 1988 and 1989 (> 6 fold
increase).

The episodes of local mosquito transmitted
vivax malaria since 1986 (particularly in
San Diego County) have features in com-
mon which include:

1. Remotely located encampments.

2. Inadequate shelters for MWs residing in
areas with Anopheles mosquito vectors
capable of transmitting malaria.

3. The reluctance of MWs to seek medical
care because of limited access and con-
cerns about being identified as undoc-
umented aliens.

Once a parasitemic individual introduces
malaria in such settings, these factors allow
substantial transmission of malaria to
evolve before outbreak foci can be iden-
tified and control measures instituted.

Mosquito transmitted viral encephalitis
also presents risks to farm workers and

220                                   Papers and Proceedings


rural residents. St. Louis encephalitis
(SLE) and western equine encephalitis
(WEE) are transmitted by vector mos-
quitoes that breed in field irrigation run-
off pools. During 1989, California report-
ed 29 confirmed cases of SLE but no cases
of WEE." While specific occupation was
not recorded, cases tended to be older, live
closer to fields, and were more likely to be
outdoors in the evenings (when mosquitoes
are active) prior to illness when compared
to cases of viral CNS disease who were
seronegative for SLE.

Other environmental exposures focus on
fungal diseases. Histoplasmosis is fre-
quently diagnosed in farm personnel clean-
ing up litter and debris from poultry
houses, sheds, and barns.

A recent outbreak occurred in Iowa during
a family reunion, when attendees retreated
to a seldom-used barn to seek refuge from
a thunderstorm. Old debris and the
presence of droppings from birds gaining
access through broken windows provided a
milieu for the fungus to flourish, and when
disrupted by guests, resulted in 10 cases of
histoplasmosis among 25 guests exposed to
the barn.32

Coccidioidomycosis, or valley fever, is
endemic in arid rural areas of western
states, particularly California. The ratio of
infections that cause clinical disease is very
small; children and adolescents display
milder illness than adults, and African-
Americans, Latinos, and Filipinos tend to
have more serious disease when it occurs.

New residents in endemic areas are more
apt to become ill than permanent resi-
dents. Roberto reports that immigrants,
especially Philippine natives from cocci-
free areas of the world who are employed
in farming in the Central Valley of

Infectious Diseases, May 1, 1991

California, may develop severe illness and
chronic complications.

Injury incidental to farming activities often
results in cellulitis and at least suggests the
need for tetanus-toxoid immunization
among adult farm workers-a group that
may not be current on vaccine history.
Kansas reports three recent adult cases of
tetanus in rural/farm individuals."

In Iowa, the special class of farm injury
relating to inadvertent syringe needle sticks
incidental to livestock health programs was
studied in 1990.`-' A total of 28 exposures
were recorded; 10 involved sticks to legs or
feet and 18 sustained injury to hand, wrist,
or arm. One involved anaphylactic reac-
tion to blood drawn from a vein. Hospital-
ization was required for another case of
cellulitis of the leg from a syringe stick.

While most of these exposures resulted in
cellulitis, it is also worth noting that animal
vaccines often contain very irritating ad-
juvants that enhance tissue injury. There
is a definite need for a compendium of
patient-management guidelines for in-
dividuals with syringe stick exposures to
veterinary injectables.

In summary of this segment, environmental
contaminants do play a role in infectious
disease of farm workers. Frequently infec-
tions secondary to injury from a variety of
sources are the mechanism of transmission.

Arthropods also serve to expose farm-
ranch workers to disease agents, but are
geographically localized and generally
sporadic-to-rare in incidence. Systemic
fungal diseases also occur, are often
episodic, and primarily affect new residents
or nonresident workers in agriculture set-
tings.

Surgeon General's Conference on Agricultural Safety and Health - 1991               221


Research - Chemical and Biological Hazards

NON-VECTOR-BORNE ZOONOSES

This is a broad, diverse group of disease-
causing organisms. Tuberculosis due to M
bovk is functionally eliminated from dom-
estic livestock, and does not present a
threat to farm workers or related person-
nel.

Nevertheless it should be noted that cer-
tain wild or exotic species (e.g., bison, feral
swine, and non-human primates) may still
be infected and potentially serve as reser-
voirs for reinfecting cattle.% This reality
speaks to the need for ongoing surveillance
programs to monitor potential introduc-
tions.

Also of concern is the increased commerce
in wild exotic animals that may be in-
fected. During the past 3 years an eastern
Iowa family unsuccessfully managed and
finally depopulated their llama herd due to
M. bovii infection.

Brucellosis has been greatly reduced these
past 40 years through livestock control
;ylgrams.% Total U.S. cases for 1989 were
  .

Earlier employment of the milk ring test
that monitors producing dairy herds has
eliminated "undulant fever" in mostly farm-
family consumers of raw milk; pas-
teurization assured safe milk for consumers
even before herd eradication schemes were
successful. During the 1970's and early
1980's, swine brucellosis was eradicated
and cattle brucellosis eliminated in all but
a few southern states.

Wild animal foci of brucellosis also exist,
e.g., among bison, elk (Yellowstone
National Park), and feral swine." It ap-
pears that most recent brucellosis cases
remain confined to packing-house workers

and international travelers exposed to
contaminated foods. Farm workers are
rarely still infected from handling aborted
feti and placental membranes from infect-
ed cows.

Standard febrile agglutinin tests are
available to diagnosticians who are
evaluating farm workers with fevers of
unknown origin Serology and often blood
culture are of critical importance to early
diagnosis and, thus, effective treatment of
this disease.

Exacerbation of earlier infections still
occurs, often decades later, especially in
older farmers infected with B. JGS. Other
infections may result from B. aborhrs,
Strain 19 vaccine from inadvertent syringe
sticks, and splash in the eye.

These events still occur and call for
prophylactic treatment with tetracycline or
one of its analogues and streptomycin.36
The exact number of human brucellosis
cases by occupational category is not con-
veniently available.

Leptospirosis cases for 1989 totaled 93,
reflecting sporadic incidence except for
Hawaii, which contributed 69 cases to the
total." Over the past five years (1986-
1990), there have been 192 cases of lep-
tospirosis reported in Hawaii, including
five fatalities.

For this period, 18.75 percent of the cases
were in agricultural occupations, while 20.8
percent of the cases had agricultural ex-
posure and 9.9 percent had agriculture-
related exposures (gardening, yard work).%
Again, as in brucellosis, serology is critical
to establishing the diagnosis and optimal
treatment.

222

Papers and Proceedings


Tularemia., as noted earlier, when
transmitted by arthropods can result in
transmission to farmers. Rare and isolated
cases of pneumonic tularemia from grain
dust aerosols presumably contaminated
with rodent excreta have been recently
recorded from Iowa and Oregon.% Here,
too, tippropriate cultures and especially
serology are critical to diagnosis and ef-
fective treatment.

Chlamydial bacterial infections (psittacosis)
are occasionally recognized in farm
workers incidental to exposure to pigeons
and domestic fowl, especially turkeys.
Interestingly, turkey psittacosis may result
in explosive outbreaks in poultry-plant
workers after stress of transport and
slaughtering processes creates infectious
aerosols. Rarely is illness recognized in
personnel at the turkey grower-sites of
infected flocks.

Q fever, anthrax, erysipelas, and other
bacterial zoonoses are very infrequently
diagnosed in farm workers nationally.
Sporadic cases of Q fever have been
reported from Arizona in personnel
handling aborted feti and bagging sheep
manure for commercial sale as fertilizer."

Parasitic zoonoses are an eclectic group of
minor problems. Giardia infections have
resulted from servicing irrigation systems
in Utah.28 Echinococcosis, introduced to
western sheep-raising states by immigrant
shepherds, has been eliminated.

Beef cattle infected with cycticerci from
Taenia sagirzata continue to be recognized
by federal meat inspection service. The
occasional recognition of "measly beef" at
slaughter speaks to the need of adequate
toilet facilities for MFWs in feedlots and
cattle production operations.

Infectious Diseases, May 1, 1991

There are no known cases of recent
transmission of these tape helminths to
farm personnel (or consumers). Anecdotal
cases of cryptosporidiosis have occurred in
farm personnel and are of minor sigriifi-
cance to immunocompetent individuals.42

Viral zoonoses, especially rabies, continue
to result in exposures to farm workers.
Cattle pose special risks, are highly suscep-
tible to rabies, and are rarely immunized
for the disease. When cattle are unwit-
tingly cared for during clinical rabies, ex-
tensive exposure to saliva may occur and
prompt need for immunoprophylaxis. This
is especially true for registered breeding-
cattle that often are valued at multiples of
market price.

During January 1991 in Iowa, a registered
beef bull with rabies and a dairy cow with
the disease used in an ovum transplant
program resulted in 26 farm workers' and
veterinarians' being administered vaccine
boosters or full immunoprophylaxis."3
During the period 19851989, laboratory
diagnoses of cattle rabies in the U.S.
ranged from 150-200 cases.@

in earlier Illinois study estimates a ratio
of one farm worker's being prophylaxed
for each case of cattle rabies." The last
recognized case of rabies in a farm worker
from cattle exposure occurred in California
in 1939.&

The real significance of cattle rabies is the
uncertainty and anxiety of exposure that
prompt farm workers to receive costly-and
probably unnecessary-immunoprophylaxis.
In Iowa, cats-especially rural and farm
cats-are serious vectors of human exposure
since these animals frequently exhibit
furious behavior and are prone to bite.
Farm family members are the single

Surgeon General's Conference on Agricultural Safety and Health - 1991

223


Research - Chemical and Biological Hazards

largest occupational group exposed to this
species.47

Other viral zoonoses exist that occasionally
infect farmers, including orf and swine
influenza. Specific surveillance informa-
tion is unavailable and precludes meaning-
ful comment. Other retroviruses and len-
tiviruses infect a broad range of animals
maintained on farms, e.g. bovine leu-
kenlia, feline leukemia, etc. Their role in
any human illness is conjectural at this
time and remains to be demonstrated if it
exists.

COMMENT

Infectious diseases unique or incidental to  2. Migrant worker health clinics are now
agricultural activity can be conveniently   networked, which facilitates follow-up of
divided into migrant-worker-related illness  diagnostic and treatment services, par-
and a variety of zoonoses. In the former   ticularly tuberculosis. States with large
category, many of these MFW illnes-    migrant populations should maintain a
ses-often episodic-are human host infec-  separate TB registry such as Florida's. All
tions that may relate to country of origin   states should adhere, as much as practical,
(e.g., malaria and echinococcosis) or to    to CDC published guidelines for TB con-
substandard living or working conditions   trol in general and foreign-born cases in
(e.g., tuberculosis and Shigella dysentery).   particular.

All these illnesses pose risks to the non-
agricultural community through personal
contact and potential contamination of
foods or environments. For these reasons,
as well as for humanitarian considerations,
migrant farm workers need resources of
improved medical care, education, and
adequate living and working accom-
modations to reduce their burden of mor-
bidity and suffering.

The second category mentioned above is
infectious disease incidental to farm en-
vironmental exposures, primarily zoonoses.
Since their occurrence is often sporadic
and generally infrequent, problems of
recognition and optimal management are
obvious.

Clearly they are underdiagnosed and
underreported. Primary care givers should
improve diagnostic acumen through more
active consultation with infectious disease
specialists and increased use of micro-
biologic studies, especially serology.

RECOMMENDATIONS

1. Migrant worker health concerns are
paramount, as noted in this review. Clear-
ly OSHA should exercise more authority in
this sector of agricultural activity to assure
adequate living and working standards for
migrant and non-migrant or permanent
employees.

3. USDA should improve regulation of
food production and harvesting to assure
field sanitation measures are adequate to
assure wholesome product. Indirectly, this
would increase incentives for producers to
provide improved working conditions for
both domestic employees and MFWs.

4. Where not already accomplished, state
and local health agencies should establish
regulatory standards and inspection ser-
vices addressing minimal living and health-
care accommodations for MFWs, including
day care centers.

5. State-federal minority health programs
should also include components targeted to
MFWs.

224

Papers and Proceedings


6. Conference of State and Territorial
Epidemiologists and CDC should require
"occupation" on all investigative surveil-
lance reports. Summaries should include
categories of farm workers, farm service
personnel and MFWs.

7. Enhanced recognition of agriculturally
related infections through increased
utilization of serology is needed. This
educational role can be best instituted by
state health agencies and laboratories.

8. Since many agricultural disease
problems are localized or exist in specific
regions (e.g., leptospirosis in Hawaii),
federal research grants to study these
problems should be targeted to state-level
health agencies. This is currently being
done by CDC for Lyme disease. Examples
of possible research projects include42

a. What is the potential for transmission
of enteric pathogens such as Salmonella,
Yersinia, and Campylobacter between
animals and animal caretakers?

b. What is the role of urine shedding, if
any, in Lyme disease transmission bet-
ween cattle and humans?

c. What is the character of viral shed-
ding of rabies in cattle and horses (to
facilitate meaningful quarantine or obser-
vation periods)?

d. What is the role of stray and rural
farm cats in terms of health risks, e.g.,
rabies, toxoplasmosis, and visceral larva
migrans?

9. Federal agencies which license injec-
table veterinary biologics (USDA) and
drugs (FDA) should require manufacturers
to distribute specific management guidance

Infectious Diseases, May 1, 1991

to all poison control centers concerning
accidental exposures.

10. In at least one state, there has been
an increasing trend of using treated sewage
effluent for irrigation of crops.* Outbreaks
of gastrointestinal illness have occurred in
Israel from this practice. Specific surveil-
lance studies of enteric illness in personnel
exposed through employment or food con-
sumption of produce from this practice
would be indicated.

11. Indirectly, infectious disease in farm
workers and family members may be ad-
versely influenced by several psychological
and economic factors. Many individuals
who live on farms are less able to afford
health care due to lack of health in-
surance. Most are self-employed without
sick leave and workers' compensation, as
noted. Also, the availability of health care
may be limited or difficult to access.
Sociological and epidemiology studies are
needed to put these issues and concerns in
perspective to reduce morbidity and its
attendant cost.4S

12. State-federal regulation of commerce
in exotic and wild animals should be
increased to assess presence of infectious
diseases or vectors among livestock that
may adversely affect domestic livestock
and their handlers, ultimately including the
consumer. Economic studies are needed
to determine feasibility of indemnity
payments for depopulation programs.

13. Enhanced research on farming prac-
tices that increase the risk of food-
microbial contamination and/or may en-
hance risk of human exposure to infectious
diseases should be implemented. Positive
developments should be published for the
agricultural community.

Surgeon General's Conference on Agricultural Safety and Health - 1991

225



Research - Chemical and Biological Hazards

SUMMARY

Infectious disease remains a serious
problem in U.S. agriculture in two distinct
populations:

o Migrant farm workers experiencing
human-host illnesses, often episodic and
exacerbated by substandard living and
employment conditions.

o All other farm workers experiencing
sporadic, isolated illness that is most fre-
quently zoonotic, vector-borne, or environ-
mentally acquired in nature.

REFERENCES

Both populations may present risk of ex-
posure to the non-farm population through
personal contact, indirect exposure (enviro-
nment or vector), or contamination of food
produce. Obvious innovations and tech-
nologies exist to improve disease recog-
nition, management, and control for both
groups specifically, and non-farm in-
dividuals generally. The broad and varied
scope of this problem is presented,
including areas that should be targeted for
additional research or enhanced program
support.0

1. American Public Health Association, Control of Communicable Diseases in Man. Benensen AS ed, 15th
Ed; 1990.

2. Amer Vet Med Association, Zoonoses Updates (published compilation), JAKU4. Amer Vet Med Ass'n,
Shaumburg IL; 199Q.

3. Currier RW. Iowa Department of Public Health, Des Moines IA; March 1991.
4. Roberto RR. Personal communication. California Department of Health Services, Berkeley CA; April
  1991.

5. Armstrong CW. Personal communication. Virginia Department of Health, Richmond VA; April 1991.

6. Ciesielski SD, Seed JR, Esposito DH, and Hunter N. The epidemiology of tuberculosis among North
Carolina migrant farm workers. JAMA 265: 17151719; April 3, 1991.

7. Centers for Disease Control. A strategic plan for the elimination of tuberculosis in the United States.
MMWR. 1989; 38: S-3.

8. Centers for Disease Control. Tuberculosis among foreign-born persons entering the United States:
recommendations of the Advisory Committee for Elimination of Tuberculosis. M.. 1990; 39(No.
RR18).

9. Davis JP. Personal communication. Wisconsin Division of Health, Madison WI. March 1991.

10. Proctor M. Unpublished investigation. Wisconsin Division of Health, Madison WI. 1990.
11. Proctor M. Internal agency report. Wisconsin Division of Health, Madison WI. 1990.
12. Centers for Disease Control: Poliomyelitis Surveillance Summary 1979, Issued April 1981.
13. Hutchins R. Personal communication. Tennessee Department of Health, Nashville TN. April 1991.

226                                Papers and Proceedings


Infectious Diseases, May 1, 1991

14. Stevens GA. Testimony prepared for the Occupational Safety and Health Administration on Proposed
Field Sanitation Standards. Dehnarva Rural Ministries. July 1984.

15. Federal Register, 29 CFR Field Sanitation; Final Rule Vol52, No 84, p 16049-16096. May 1, 1987.

16. McChesney TC. Personal communication. Arkansas Department of Health, Little Rock AR. April
  1991.

17. Centers for Disease Control. Summary of notifiable diseases, United States, 1989 . MMKQ. 1989 ; 38 (
54 ) .

18. Potter ME, Kaufman AF, Blake PA, and Feldman RA. Unpasteurized milk: The hazards of a health
fetish. JAMA. 252~1048-2052. Ott 1984.

19. Currier RW. Raw milk and human gastroenteric disease: problems resulting from sale of legalized raw
milk. J of Pub Health Policy 2~226-234, Sept 1981.

20. Blazer MD, Sazie E, Williams LP. The influence of immunity on raw milk-associated Campylobacter
infection. JAMA. 257: 43-46. Jan 1987 .

21. Vogt RL, et al. Liig environmental and human strains of Listeria monocytogenes with isoenzyme and
ribosomal RNA typing. Eur J EpidemiolO392-299O:p 229-230. June 1990.

22. Shirely LA. Personal communication. North Dakota Department of Health. April 1991.

23. St Louis ME, Morse DL, Potter ME, et al. The emergence of grade A eggs as a major source of
Salmonella enteritidis infections. JAMA. 259: 2103-2107. 1988.

24. Gunn R4 and Markakis G. Sahnonellosis associated with homemade ice cream. JAMA 240:1885-1886.
  1978.

25. Currier RW, Rapp WF, Juranek DD. A community outbreak of trichinosis in Nebraska: report of an
epidemiologic investigation. Nebraska Medical Journal. Jan-Feb, 1982.

26. Centers for Disease Control. Trichinella spirilis infection - United States, 1990. MMKR. 1991; 40 : 57-60.

27. Williams LP. Personal communication. Oregon Department of Health, Portland OR. April 1991.

28. Staff Epidemiologist. Personal communication. Utah Department of Health, Salt Lake City UT. April
  1991.

29. Marx J. Unpublished data. Marshfield Clinic, Marshfield WI. April 1991.

30. California Morbidity. Mosquito-transmitted malaria in California: 1988-1989. Part 2 of 2. Nr 52, Jan 5,
1990. (Pub1 by Calii Department of Health Services.)

31. California Morbidity. Arboviral disease surveillance - California, 1989. Nr 21/22. June 1, 1990.

32. Fuortes L. Unpublished data. College of Medicine, Univ of Iowa, Iowa City IA. April 1991.

33. Wood C. Unpublished data. Kansas Department of Health and Environment, Topeka KS. April 1991.
34. Currier RW. Farm injury surveillance (SPRAINS Program) - unpublished data. Iowa Department of
Public Health, Des Moines lA. Feb 1991.

Surgeon General's Conference on Agricultural Safety and Health - 1991               227


Research - Chemical and Biological Hazards

35. Thoen CO. Zoonoses Update: Tuberculosis. JAKV.4 (Pub1 collection of Zoonoses Updates.) 132-135.
  1990.

36. Currier RW. Zoonoses Update: Bruceiiosis. JAK'v&4 (Pub1 collection of Zoonoses Updates.) p 25-27.
  1990.

37. Music S. Personal communication. Wyoming Department of Health, Cheyenne WY. March 1991.

38. Sasaki DM. Personal communication. Hawaii Department of Health, Honolulu HI. April 1991.

39. Williams LP. Personal communication. Oregon Department of Health, Portland OR. April 1991.

40. Durfee PT, Pullen MM, Currier RW and Parker RL. Human psittacosis associated with commercial

processing of turkeys. JAK'U 167: 804-808. Nov 1, 1975.

41. Doll J. Personal communication. Arizona Department of Health, Phoenix, AZ, April 1991.

42. Smith KA. Personal communication. Ohio Department of Health, Columbus, OH, April 1991.

43. Iowa Department of Public Health. Bovine rabies in Iowa. Iowa Disease Bulletin. Feb 1991.

44. Centers for Disease Control. Rabies surveillance - 1988. Issued Aug 1989.

45. Martin RJ. Personal communication. Illinois Department of Health, Springfield, IL, April 1991.

46. Baer G. Personal communication. Centers for Disease Control, Atlanta, GA., 1990.

47. Currier RW. Unpublished data. Iowa Department of Public Health, Des Moines LA. 1990. 48. Sewell
CM. Personal communication. New Mexico Health and Environment Department, Sante Fe NM.
March 1991.

228

Papers and Proceedings


Surgeon General's Conference on Agricultural Safety and Health
FARM&FE 2000 . A National Coalition for local Action
Convened by the National Institute ftr Occupational Safety and Health
April 30 - May 3, 7991, Des Moines, Iowa

AN OVERViEW OF POTENTIAL HEALTH HAZARDS AMONG FARMERS
           FROM USE OF PESTICIDES

By Aaron Blair, Ph.D.
Occupational Studies Section
National Cancer Institute

Beginning in the mid-1940's, pesticides
have become an increasingly important
weapon in the attempt to control
troublesome agricultural pests. Conse-
quently, agriculture has become a major
consumer of pesticides and now accounts
for about 65 percent of the total domestic
use.' Pesticide use varies by the crops and
livestock raised, but a majority of farmers
report application of some.

In a 1982 survey, approximately 75 percent
of the farmers with crops and 70 percent
with livestock used pesticides.' With 2
million farmers, 6 million additional farm
family members, and nearly 3 million hired
farm workers, there is a large number of
persons with potential contact with pes-
ticides through agricultural use.3

Use of pesticides has been an integral
component of the agricultural revolution,
which over the past 50 years has greatly
increased yields. Losses that would occur
without the use of pesticides are difficult
to estimate, but they could be sizable."

Despite efforts to tailor the toxicologic
properties of pesticides to specific pests,
the fundamental similarity of all organisms
at the subcellular level raises concerns
about potential pesticide exposure of a
large segment of the population.

Although we should not lose sight of the
benefits pesticides provide, the purpose of

this review is to evaluate the potential for,
and evidence of, adverse health outcomes
from pesticide exposure in humans. Acute
effects have been well established, and the
major focus of this presentation will be on
chronic effects.

ACUTE EFFECTS

Effects from acute exposure to pesticides
are well established, but statistics on injury
and death from acute exposures are in-
complete for the United States as a whole.
Some results indicate that the number of
fatalities fell between the 1950's and the
1970's? Based on extrapolation from a
survey of a small number of hospitals,
EPA estimated that there were fewer than
3,000 annual admissions to hospitals for
pesticide poisoning.'

In California, however, where physicians
are required by law to report suspected
pesticide poisonings to the Department of
Food and Agriculture, approximately 2,000
poisonings have been reported annually in
recent years.' About 50 percent of these
were from occupational exposures.

More effective reporting systems are
needed before the magnitude of adverse
health conditions from acute exposures can
be well monitored. Assessments in agricul-
ture should include migrant workers, farm
laborers, and dependents of farmers, as
well as farm operators.

Surgeon General's Conference on Agricultural Safety and Health - 1991                229


Research - Chemical and Biological Hazards

CHRONIC EFFECTS

Of growing concern are chronic health
outcomes that do not occur immediately
after exposure, including carcinogenic,
developmental, immunological, reproduc-
tive, and neurological effects.&' The
lengthy interval between exposure and
chronic effects makes risk assessment for
these outcomes more difficult to evaluate
than acute effects.

As testing procedures have improved,
concern has increased over long-term
health effects from pesticides. Today sig-
nificant efforts are devoted toward ex-
perimental and epidemiologic evaluation
of pesticides. The quantity and quality of
the data available, however, vary by
disease outcome.

Establishment of a formal testing program
by the National Cancer Institute (NCI) in
1968 and continued by the National
Toxicology Program (NTP) in 1978 gave
carcinogenicity screening of chemicals, of
which pesticides were an important con-
cern, an early start. This experimental
effort stimulated epidemiologic inves-
tigation of pesticides and cancer.

The availability of cancer registries also
enhanced opportunities for cancer research
by providing a readily available source of
well-diagnosed cases. Registries for other
chronic disease endpoints are only begin-
ning to be established. Since we lack some
of these resources, the occurrence of non-
malignant chronic disease from pesticide
exposure has not been evaluated as
thoroughly.

CARCINOGENIC EFFECTS

Some 47 pesticides have been evaluated in
the NCI-NTP bioassay program (Table I)."

Information from other sources is
available, but is not considered here
because study protocols sometimes deviate
from the preferred model and because the
purpose of this paper is to provide an
indication of hazards presented by pes-
ticides and not to provide a comprehensive
review of all available data.

In the NCI-NTP assays, six pesticides, or
13 percent(chlordecone, dichlorvos,
aminotrizole, sulfallate,
dibromochloropropane (DBCP), and EDB)
were positive in both sexes in mice and
rats. Another 10 (21 percent) were
positive in both sexes of one species
(chlordane, chlorobenzilate, dieldrin, hep-
tachlor, tetrachlorvinphos, toxaphene,
nitrofen, captan, chlorthalonil, and
dichloropropene). Five (11 percent) were
positive in one sex of at least one species
(aldrin, dicofol, piperonyl sulphoxide,
chloramben, and trifluralin). For 19 (40
percent) there was no evidence of car-
cinogenicity in any sex/species group and
seven (15 percent) provided inadequate or
equivocal evidence for carcinogenicity.

Several of the pesticides positive in bioas-
says are no longer on the market, or their
use is severely restricted, but others are
widely used. The 16 chemicals positive in
both sexes in at least one species include
organochlorine and organophosphate in-
secticides, herbicides, fungicides, and
fumigants, suggesting that no chemical
class of pesticides can be considered
problem free.

Pesticides are selected for testing for
various reasons, including suspicion of
carcinogenicity. With 45 percent of the
pesticides tested showing some evidence of
carcinogenicity, the concern about chronic
human exposure would seem well founded.

230                                   Papers and Proceedings


An Overview of Potential Health Hazards among Farmers from Use of Pesticides, May 1, 1991

Table 1. Results of Carcinogenicity Testing of Pesticides from the National Toxicology Program of
Bioassays in Mice and Rats (modified from reference 10).

INSECTICIDES

Aldicarb
Aldrin
Azinphosmethyl
Chlordane
Chlordecone
Chlorobenzilate
Coumaphos
Diazinon
Dichlorvos
Dicofol
Dieldren
Dimethoate
Dioxathion
Endosulphan
Endrin
Fenthion
Heptachlor
Lindane
Malathion
Maloxon
Methoxychlor
Methyl parathion
Mexacarbate
Parathion
Phosphamidon
Photodieldrin
Piperonyl butoxide
Piperonyl sulphoxide
Tetrachlorvinphos
Toxaphene

MICE

I!!!
v








+



+

+

+





t

t

+



I


E

t









t

+

t

t

t

RATS

I!!!
?





E
E

L





t







I

HERBICIDES

Aminotriazole
Chlorambene
Fluometuron
Monuron
Nitrofen
Sulfallate
Trifluralin

FUNGICIDES

Anilazine
Captan
Chlorthalonil
Fenaminosulf
0-Phenylpheno-I
Pentachloro-
nitrobenzene
Triphenyltin-OH

M
7





t
:



+

+









t

FUMIGANTS

DBCP                t
Dichloropropene     I
EDB                 t

E = Equivocal
I = inadequate evidence
M = Male
F = Female

MICE

t

t

+

RATS

M
.





t

:

t









t

t

t

t

Pesticides may exert their carcinogenic
effects through several mechanisms,
including mutation, inhibition of gap-
junctional cellular communication,

in vivo and in vitro tests, the nine chemicals
were found to, be active in most assays.
These included organophosphate insec-
ticides (acephate, demeton, mono-

pcroxisome proliferation, and other
promotional activities." In an evaluation   crotophos, and trichlorfon), phthalimide
of genetic damage from 65 pesticides in 14  fungicides (captan and folpet), and thio-

Surgeon General's Conference on Agricultural Safety and Health - 1991

231


Research - Chemical and Biological Hazards

carbamate herbicides (diallate, sulfallate,
and triallate).`*

Another group of 26 chemicals were
positive in some tests, but were generally
less active than the nine chemicals above.
Pesticides in this group included phenoxy
herbicides (2,4-D and 2,4-DB); organo-
phosphate insecticides (azinphos-methyl,
crotoxyphos, disulfoton, and methyl
parathion); ethylenebisdithiocarbamate
fungicides (manzeb, maneb, mancozeb, and
zineb); and pyrethroid insecticides (allet-
hrin, chrysanthemic acid, and ethyl chysan-
themate). Thirty pesticides gave no
evidence of genetic toxicity.

Some pesticides may influence the car-
cinogenic process in an epigenetic manner.
For example, inhibition of intercellular
communication can disrupt development or
promote cancer."

Broad occupational surveys from around
the world have noted rather consistent
excesses of leukemia, non-Hodgkin's
lymphoma, multiple myeloma, soft-tissue
sarcoma, and cancers of the brain, skin,
lip, stomach, and prostate among
farmers.

A number of pesticides have been shown
to inhibit gap junction intercellular com-
munication including DDT, dieldrin, chlor-
dane, heptachlor, Kepone, mirex, and
endrin.14 Several of these pesticides have
been shown to have a promotional effect
on liver carcinogenesis in the rat.l'

Peroxisome proliferation and the resultant
increased generation of hydrogen peroxide
represent another possible non-genotoxic
carcinogenic mechanism. Phenoxy acid

herbicides appear to be peroxisome
proliferators in several rodent species."
Much of the epidemiologic data available
on the carcinogenicity of pesticides comes
from studies of persons employed in
agriculture.

Broad occupational surveys from around
the world have noted rather consistent
excesses of leukemia, non-Hodgkin's lym-
phoma, multiple myeloma, soft-tissue sar-
coma, and cancers of the brain, skin, lip,
stomach, and prostate among farmers."-"
These excesses occur against a background
of lower overall mortality, particularly for
heart disease and other cancers including
lung, colon, bladder, kidney, esophagus,
and liver. This pattern of low mortality
from most causes of death, but excesses for
a few cancers, suggests a role for work-
related factors.

The low prevalence of smoking among
farmers is probably related to their more
favorable rates for heart disease and can-
cers of the lung, esophagus, and bladder.15
High levels of physical fitness may
contribute to their lower rates of colon
cancer and heart disease."

Case-control and other studies provide
further evidence that farmers are at higher
risk for selected cancers than the general
population. In a recent survey of the
literature," excesses among farmers were
seen in 12 of 13 studies of leukemia, 12 of
15 studies of Hodgkin's disease, 14 of 19
studies of multiple myeloma, 18 of 29
studies of nqn-Hodgkin's lymphoma, three
of three studies of lip cancer, three of
three studies of skin cancer, five of seven
studies of brain cancer, three of five
studies of soft-tissue sarcoma, six of six
studies of stomach cancer, and two of
three studies of prostate cancer.

232                                  Papers and Proceedings


The excesses for specific cancers among   Although farmers come into contact with a
farmers may have broad public health    variety of potentially hazardous substances,
implications, since several of the high-rate  pesticides have received the most attention
tumors appear to be increasing in the    in epidemiologic studies, possibly because
general population of many developed   several pesticides are carcinogenic in
countries.le Of special interest are the    bi0assays.l' Early epidemiologic inves-
rising rates for multiple myeloma, non-   tigations evaluated cancer risks associated
Hodgkin's lymphoma, melanoma, and    with pesticide exposure in general.
cancer of the brain.           The International Agency for Research on
In England and Wales" and the United   Cancer (IARC) in a recent deliberation
State?, prostate cancer has also been    concluded that exposures occurring during
increasing. Changes in diagnosis and    the application of insecticides were
reporting may account for some of the   probably carcinogenic in man." Cohort
increase for these tumors."*"       studies of applicators and manufacturers of
The rising rates for non-Hodgkin's lym-    insecticides have tended to show excesses
phoma, multiple myeloma, and leukemia in  of cancers of the lung and the lymphatic
agricultural areas of the central United   and hematopoietic system, although some
States, however, is a further indication of  investigations show deficits.lO~ll
the possible involvement of agricultural
exposures. Excesses of cancer of the brain  In these studies it was not possible to
and lymphatic and hematopoietic system   determine the specific chemicals accoun-
have also been observed in rural farm   ting for these excesses, but most subjects
populations in Quebec."2         were employed during a time when or-
                 ganochlorine insecticides were the
Risks were correlated with pesticide usage  chemicals used predominately. Although
and were observed among women, as well  many epidemiologic studies have evaluated
as men, raising the possibility of effects   cancer risks among farmers and other
from nonoccupational exposure. The    pesticide-exposed workers," only recently
specific agricultural factors that might    have there been attempts to assess risks
account for the cancers excessive among   from exposure to specific pesticides."
farmers have not been definitively iden-
tified, but a number of etiologic clues exist.  Among those studies that have, soft-tissue
                 sarcoma, Hodgkin's disease, non-Hodgkin's
Exposures of interest include pesticides,   lymphoma, leukemia, and lung cancer have
fertilizers, fuels and engine exhausts, or-   been associated with DDT;42"`28 non-
ganic and inorganic dusts, solvents,     Hodgkin's lymphoma with organophos-
ultraviolet light, and zoonotic viruses.3   phates;25 soft-tissue sarcoma with a variety
Many, perhaps even most, of the members  of animal insecticide?; leukemia with
of the general population may also have   crotoxyphos, dichlorvos, famphur, pyreth-
contact with some of these substances.   rins, methoxychlor, and nicotine%; and non-
Studies of farmers may, therefore, provide  Hodgkin's lymphoma'5*29-33 and soft-tissue
explanations for the rising incidence of cer-  sarcoma34'38 with phenoxyacid herbicides. A
tain cancers among the general population.  potential problem for other cancers is
                 suggested by an important study of workers
                 engaged in the production of 2,4,5-

An Overview of Potential Health Hazards among Farmers from Use of Pesticides, May 1, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991               233


Research - Chemical and Biological Hazards

Table II. Pesticide Effects on the Immune System (modified from reference 39).

Pesticide       Species Summarv of Effects

t ORQANOPHOSPHATES

Methylparathion . . . . . Rabbit  Thymus atrophy and reduced DTH response.
              Mouse  Decreased host resistance to infection Salmonella typimurium.
Parathion . . . . . . . . . . . . Mouse  Altered colony forming activities of bone marrow stem cells.
Malathion . . . . . . . . . . . Mouse  Suppression of CTL response in vitro.

b ORQANOCHLORINES

DDT . , . . . . , . . , . . , , , . , Rabbit  Thymus atrophy and reduced DTH response.
Mirex . . . . . . . . . . . . . . . _ Chicken Decreased IgG levels.
Hexachlorgbenzene . . Mouse  increased sensitivity to endotoxin and malaria challenge.
              Rat   Increased humoral immune responses to tetanus toxoid and delayed-
               type hypersensitivity to ovalbumin.
Dieldrin  . . . . . . . . . . . . . Mouse  Decreased AFC response and increased susceptibility to viral infection.
Chlordane . . . . . . . . . . . Mouse  Decreased contact hypersensitivity after in utero exposure.
              Mouse  Suppression of AFC responses and T-cell activity in a MLC reaction
               following in vitro exposure.

p CHLOROPHENOXY COMPOUNDS

Pentachlorophenol . . . Mouse  Decreased host resistance to virus-induced tumor metastases.
2,4-D . I.. . . . . , . . , , . . . Mouse  Enhanced T- and B-cell responses following dermal application.

t CARBAMATES

Carbofuran . . . . . . . . . . Rabbit Reduced DTH response.
           Mouse Decreased host resistance to Salmonella tvphimurium infection.
Aldicarb . . . . . . . . . . . . . Mouse  Decreased AFC response to sheep erythrocytes.
              Human  Increased response to Candida antigen, increased number of lym-
              phocytes expressing CD8 markers and decreased CD4 + /CD8 + cell
               ratio.
             Mouse  No alterations in AFC response, B- or T-lymphocyte mitogenesis, host
               resistance to influenza virus infection, CTL response or percentages of
               T-cells, T-cell subpopulations or B-cells.
  DTH = delayed-type hypersensitivity.
  CTL = cytotoxic T lymphocytes.
  AFC = antibody-forming cells.
  MLC = mixed lymphocyte culture.

trichlorophenol and derivative herbicides,   those employed for less than one year.
products contaminated with 2,3,7,&tetra-
chlorodibenzo-p-dioxin.3' In this report, 20  Risks were elevated for soft-tissue sar-
years after first exposure, a significant 50   comas and cancers of the esophagus, stom-
percent excess of total cancer occurred    ach, intestines, larynx, lung, and prostate.
among workers employed for more than   In the 20-year latency category, lung can-
one year while no excess occurred among   cer increased with duration of exposure

234                                   Papers and Proceedings


with standardized mortality ratios (SMRs)
of 96, 126, 146, and 156 for duration of
exposure categories of C 1 year, 1 to < 5
years, 5 to < 15 years, and 15 or more
years, respectively.

Immunologic evaluations of pesticide ex-
posure in humans are in their infancy.
Effects observed in animals are not always
seen in human studies.40 For example,
altered numbers of T-cells and a decreased
ratio of CD4/CD8 T-cells were found in

IMMUNOLOGIC EFFECTS        women exposed to aldicarb-contaminated
                   drinking water." In investigations of al-
Pesticides have immune effects that are of  dicarb in mice, one noted an inverse dose-
interest in their own right, but they may   related suppression of antibody response,44
also be an important mechanism in car-   while the another study did not.45
cinogenesis. A critical role for suppression
of immune responsiveness by pesticides has
been demonstrated for infectious disease    A critical role for suppression of im-
and maybe for other diseases.39        mune responsiveness by pesticides has
                            been demonstrated for infectious disease

Pesticides have displayed a variety of ef-
fects on the immune system (Table II),     and maybe for other diseases.
including suppression of cytotoxic T lym-
phocyte (CTL) response by malathion,
thymus atrophy and delayed-type hypersen-  There is also the possibility of a linkage
sitivity (DTH) response by methyl-     between immunologic effects from pest-
parathion and DDT, decreased antibody-   icide exposure and cancer. It is well
forming cells (AFC) responses from     documented that patients with naturally
dieldrin and chlordane, enhanced T-and B-  occurring or medically induced immuno-
cell responses by 2,4-D, and reduced DTH  deficiencies experience striking excesses of
and host resistance by carbofuran. As with  non-Hodgkin's lymphoma.46M
carcinogenicity, immunologic effects are
observed from pesticides in various     In addition, excesses of leukemia and
chemical classes (organochlorines, or-    stomach cancer have been observed among
ganophosphates, carbamates, and phenoxy-  persons with primary immunodeficiency
acids). In vitro studies of human leukocyte  syndromes, while increases of soft-tissue
functions have also shown inhibition of    sarcoma, melanoma of the skin, and
blastogenic stimulation".          squamous carcinomas of the skin and lip
                   have been observed in renal transplant

Lymphocyte PHA stimulation was reduced  patients.""" The fact that several of the
10 percent by carbamates, 11 to 18 percent  tumors excessive among farmers (e.g., non-
by organophosphates, and 11 to 17 percent  Hodgkin's lymphoma, leukemia, skin, lip,
by organochlorines. Contact dermatitis   and stomach) also occur among im-
and allergic chemical dermatitis are well-   munodepressed patients could be a coin-
recognized health effects from pesticide   cidence, but it may suggest that effects on
exposure and can occur from exposure to  the immune system play a role in farming-
various insecticides, fungicides, and       related cancers.
fumigants.4uz

Epidemiologic investigations of alterations
of the immune system are difficult because

An Overview of Potential Health Hazards among Farmers from Use of Pesticides, May 1, 1991

SUrQeon General's Conference on Agricultural Safety and Health - 1991                235


Research - Chemical and Biological Hazards

of large interindividual variability and the
confounding effects from infections, drug
use and other factors that influence im-
mune responses. Alterations in immune
responses may also be short lived.

Monitoring of the immune system over an
extended period may be necessary to
determine the relevance of any alterations
to subsequent disease risk. Consequently,
it may be necessary to rely primarily upon
experimental investigations in the near
future. Thomas, et aE.,"O note two impor-
tant criteria in extrapolating experimental
results to humans.

b First, the pharmacologic pattern for the
pesticide should be the same in humans as
in the animal model. This is difficult to
achieve because information on absorption,
distribution, biotransformation and excre-
tion for the chemical of interest is rarely
available in both humans and the animal
model.

b Second, the human end point of interest
must be appropriate for the species
selected.

NEUROTOXIC EFFECTS

The nervous system of the pest is the tar-
get for many pesticides, so the fact that
there are acute neurotoxic effects in
humans is not surprising. Anecdotal case
reports and epidemiologic studies also
suggest that some neurologic symptoms
may persist for years.`l

Chronic effects observed include tremors,
anorexia, anemia, muscular weakness,
hyperexcitability, EEG pattern changes,
insomnia, irritability, convulsions,
headache, dizziness, and depression.
These occur from various insecticide class-

es including organochlorines, organo-
phosphates, and carbamates.S1

Many of the above symptoms developed
among workers with prolonged exposure to
Kepone (chlordecone) in the Hopewell
incident.s2 The symptoms gradually disap-
peared over an 18-month period, but symp-
toms persisted after several years in seven
of the 23 most severely affected patients.n

Less information is available concerning
neurotoxic effects from herbicide exposure.
Neuromuscular rigidity has been observed
in rats after phenoxyacid exposure (2,4-D
and MCPA)SIV 55 and peripheral nerve con-
duction velocities were slowed among
workers engaged in the manufacture of
2,4-D and 2,4,5-T.=

Other nervous system conditions may be
associated with pesticide exposure. A case
report of Guillain-Barre syndrome noted
recent skin exposure to the cotton de-
foliant, merphosn

An association with spraying of pesticides
was reported in a case-control study of
idiopathic Parkinson's disease.JB Risk of
Parkinson's disease was also associated
with longer duration farming and exposure
to pesticides in a study in Hong Kong.s

In another case-control study, however, it
was associated with a rural residence and
drinking well water, but not with use of
pesticides."0 The subjective end points
noted in most human studies of neurologic
conditions make epidemiologic investiga-
tions difficult.

Evaluation of these end points is generally
not possible in animals. Closing the gap
between the two approaches is critical for
a thorough evaluation of neurotoxic effects
of chronic pesticide exposure.

236                                   Papers and Proceedings


REPRODUCTIVE EFFECTS

Mattison et al. classify reproductive
toxicants as direct-acting or indirect-
acting.6l Direct-acting toxicants may

increased estrone metabolisms by liver
microsomal enzymes by lindane, reduced
egg production by organophosphates, and
reduced fertility by carbamates.

resemble a biologically important molecule  CONCLUSIONS
and function as agonists or antagonists in
the reproductive process.         Experimental and epidemiologic inves-
                   tigations indicate that pesticides can cause
They may also have direct effects because  a variety of adverse effects including car-
of their chemical reactivity. Most     cinogenicity, immunotoxicity, neurotoxicity,
chemically-reactive substances are      and reproductive
cytotoxic, carcinogenic, or mutagenic.    toxicity. From this brief review several
                    points stand out.
Indirect-acting reproductive toxicants
include chemicals that must be meta-    b First, the carcinogenicity of pesticides
bolized to produce effects, those that inter-  has been more thoroughly evaluated than
fere with critical enzyme systems, or those  other toxic effects and approximately 45
that enhance or suppress secretion or    percent of the chemicals tested had an
clearance of critical control chemicals.    effect in at least one sex of one species in
Some chemicals may act both directly and  NCI-NTP bioassays. If this experience is
indirectly. For example, activities for or-   relevant to other end points, the potential
ganochlorine insecticides are suspected to  for any type of adverse outcome from
act directly through estrogen receptors and  pesticide exposure could be considerable.
indirectly through prohormone hepatic
induction.                b Second, the specific pesticides that are
                  positive in the various toxicologic tests do
Reproductive effects of specific pesticides  not appear to be restricted to a few
have recently been reviewed by Mattison et  chemical classes. Effects are noted from
al., 1990."' Adverse outcomes in experi-   insecticides (organochlorines, or-
mental and/or epidemiologic investigations  ganophosphates, carbamates, and pyreth-
have been reported for DBCP, chlorde-   rins), herbicides, and fungicides.
cone, ethylene dibromide, and carbaryl in

males and DDT, chlordecone, lindane, or-  b Third, adverse outcomes have been
~~~a~~sosphates, and carbamates among   noted in epidemiologic, as well as ex-

       .                perimental investigations, indicating that
                        humans are also at risk.

Effects among males have included disrup-
tion of spermatogenesis by DBCP, reduced  RECOMMENDATIONS
sperm motility and viability by chlorde-
cone, abnormal sperm morphology and    1. Given the evidence for adverse health
sterility by ethylene dibromide, and sperm  outcomes from pesticides, enhanced efforts
abnormalities by carbaryl. In animals,    are needed to control exposures in agricul-
studies have noted reduced egg shell thick-  ture and elsewhere.
nesses from DDT, reduced egg production
and number of offspring from chlordecone,

An Overview of Potential Health Hazards among Farmers from Use of Pesticides, May 1, 1991

Surgeon General's Conference on AgriClJkUral Safety and Health - 1991               237


Research - Chemical and Biological Hazards

2. More thorough evaluations (experime-
ntal and epidemiologic) are needed to
more fully characterize the potential ad-
verse effects that may occur from pesticide
exposures.

3. Epidemiologic investigations must focus
on exposures to specific pesticides. This
will require detailed exposure assessment
procedures to characterize the type and
intensity of exposures.

4. Studies of farm populations should
receive a high priority given the
widespread use of pesticides in agriculture
and the potential for exposure among

farmers and farmer laborers, and their
dependents.

Retrospective designs can be used to ad-
dress specific questions, but prospective
studies should also be initiated. Prospec-
tive investigations provide the opportunity
to obtain information on exposure as it
occurs, which would eliminate the potential
for response bias and would minimize
exposure misclassification. Once exposures
are well characterized, prospective designs
can also be used to evaluate a number of
adverse health outcomes, a highly efficient
approach in these times of funding
limitations.0

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Surgeon General's Confemnce on Agricultuml Safety and Health
FM&&FE 2000 . A National Coalition for Local Action
Convened by the National Institute f0f Occupational Safety and Health
April 30 - May 3, 7991, Des Moines, Iowa

GASES, VAPORS, LIQUIDS, AND DRUGS

  By WZliam Popendorf, Ph.D., C.I.H.
Institute of Agricultural Medicine, University of Iowa

INTRODUCTION

A wide range of gaseous and liquid
hazards exists in agriculture (Table I).l*'
Virtually all of the gaseous hazards from
which we can anticipate health effects exist
in one form or another in general industry.

While we know of their existence in
agriculture, only a few of these hazards
have been surveyed in farm settings. We
do not know how frequently (on the aver-
age) farmers are exposed to individual
agents. We do not know the range of con-
centrations of such exposures. We do not
know the extent of the health effects ex-
cept for the occasional severe case report
or fatality.

And if we really did know these para-
meters, we face yet another challenge; how
to translate them into "agricultural

hygiene," the industrial hygiene paradigm
of "anticipation, recognition, evaluation,
and control" learned in general industry
over the past 50 years., As we begin to
apply this paradigm, another challenge is
to understand the limitations of rote
transfer-ml of this paradigm from general
industry to agriculture without also
understanding its nature and its culture.

This presentation will begin with a review
of some of these agents, their sources on
the farm, and some of the limitations of
the traditional hierarchy of controlling
these hazards either at their source, along
the pathway of the exposure route, or at
the receiver (in this case the farmer or
farm worker). A discussion of health ef-
fects will be minimized except for agents
that are by-and-large unique to agriculture.

Table I. Typical Toxic Agricultural Liquids, Gases, and Vapors.

Ammonia  ............................. from urine, urea, and anhydrous
Carbon dioxide ...................... animal respiration and combustion
Carbon monoxide ................... combustion sources
Hydrogen sulfide .................... manure gas
Nitrogen dioxide ..................... from fresh silage
Oxygen Depletion ................... asphyxiation in confined spaces
Pesticides ............................. primarily dermal absorption hazards except fumigants
Welding ............................... fumes and gases
Fuel storage .......................... leaks and fires
Fuel and waste oil ................... skin cancers and dermatitis
Ltquified Propane [LPI gas ........ fires
Liquified anhydrous ammonia ..... dermal injury

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Research - Chemical and Blologlcal Hazards

DEFINITIONS

I feel obliged to define a few terms and
concepts ingrained into industrial hygiene
folklore. The first (Figure 1) is the para-
digm of anticipation, recognition, evalua-
tion, and control. Historically, this process
began with the recognition of adverse
health effects existent within a working
population.

Anticipation Is the prospective application of
dose-response knowledge generated either
in the laboratory or in other industries.

Recognition requires the commitment of
farmers, interested farm groups, and
governmental agencies to survey both the
farming environment and the health status of
farmers.

Evaluation must develop new ways to
interpret surveillance data from the farm set-
ting for the agricultural population.

Control includes not only "hazard com-
munication" but also modified sources and
interruptions in the pathways of exposure
before the farmer, with or without personal
protection, is dosed.

1

Figure 1. The Agricultural Hygiene Paradigm.

Today, we can anticipate (and hopefully
avoid) adverse health effects based on
toxicology or prior experiences in other
work settings. To evaluate the degree of
risk, we have developed a system of "per-
formance based" exposure limits guidelines
(guidelines called Threshold Limit Values
[TLVs] and their regulatory equivalents
called Permissible Exposure Limits
[PELs]), the goal of which is to prevent

244

adverse health effects by keeping expo-
sures and doses to acceptable low levels
without specifying the method or "work
practices" to achieve those levels.

The second is a concept that adverse
health effects are the culmination of an
often-complex chain of events beginning
with the agent emanating into the working
environment from a sometimes nebulous
source and traveling through a physical
pathway to create either an airborne,
dermal, or even oral dose; the dose is
generally dependant upon the duration of
exposure and the degree of personal pro-
tection being used by the worker; the
agent may act at the site of contact or be
absorbed into the body and be transported
to some biological target organ where it
acts toxicologically to create a clinically
identifiable effect.

Over the years, a hierarchy of control
options has been inculcated into the
profession whereby controlling the source
is the preferred option, controlling the
pathway between the source and worker is
the second option, and controlling the re-
ceiver is the third and least preferred op-
tion. Hygienists believe that respirators or
other forms of personal protective equip-
ment are not a quick cure-all, contrary to
popular belief. And even when they are
recommended, good practice dictates (and
OSHA now requires) that the respirator
should be selected based on the measured
level of exposure.

GASES AND VAPORS

The following history of silo gas is
representative of the fragmented progres-
sion of anticipation, recognition, evalua-
tion, and control of a potentially common
agricultural health hazard.

Papers and Proceedings


Gases, Vapors, Liquids, and Drugs, May 1, 1991

Occupational hazards associated with silo
gas were first reported in 1914 via case
studies of four fatalities of farmers working
in and among their freshly filled silos.
Their deaths were attributed to carbon
dioxide (CO,).

It was not until the 1950's (30 to 40 years
later) that investigations revealed the
presence and importance of nitrogen
dioxide (N01).46 The major portion of
toxic NO, appears to be produced from
organic nitrates, aggravated by the addition
of heavy nitrate fertilizer and/or drought
conditions.6

The process of NO, production begins
within hours of ensilage, peaks in three to
seven days, but may last for up to two
weeks. Levels of NO, as high as 200 ppm
have been reported seven days after fill-
ing;" this is well over its current TLV of 3
ppm (with a 5 ppm STEL).

Our broad understanding of the magnitude
and frequency of this hazard is limited by a
lack of systematic environmental surveil-
lance and poor reporting of farm injuries
and fatalities. Our understanding of its
overall impact on the health of farmers is
further limited by the difficulty in diag-
nosing nonfatal cases of the disease due to
the multiple and usually latent phases of
its clinical manifestations.`l' Thus, the
severe and fatal cases of silo fillers' disease
that are reported probably represent the
tip of the proverbial iceberg.

A few systematic surveys have recently
been made of chronic gaseous hazards in
modern semi-enclosed animal production
buildings. Mulhausen" found that air
quality in poultry barns frequently ex-
ceeded exposure limits of 25 ppm for am-
monia (NH,) during fall and winter and

sometimes even exceeded its S'I'EL of 35
ppm; H,S was undetected. Donham

et al." l3 surveyed similar swine barns and
found 50 percent exceeded the TLC for
ammonia; many of these buildings also ex-
ceeded the TLC for CO, H,S, and CO
(from un-vented space heaters).

Source: urine (urea)-wet floors, slats,
    gutters, etc.

Anticipated Health Hazards:

Irritating to eyes, nose,
trachea (wet body parts) . . . . . . . . . . IO-15 ppm

TLV = recommended exposure
limit (for gas) . . . . . . . . . . . . . . . . . . . . . . 25 ppm

Absorbed into an aerosol may provoke
bronchitis, asthma, or other
pulmonary effects . . . . . . . . . . . . . . . . , ~20 ppm

Figure 2. Ammonia (NH,).

At these concentrations, ammonia by itself
would only be a strong irritant to the eyes,
nose, and throat. However, in both poultry
and swine farm settings, it may be impor-
tant to consider the simultaneous presence
of both ammonia and organic dust aerosols
at levels often in excess of 5 mg/m3. The
hypothesis here is that the pulmonary
damage caused by ammonia could be con-
siderably greater if the gas were adsorbed
onto a respirable-sized aerosol (Figure 2).

In addition to hydrogen sulfide, mercap-
tans and organic acids (such as methyl and
ethyl-mercaptan, carbonyl-sulfide, skatole,
and propionic, butyric, and valeric acids)
have been identified in the gases
emanating from the anaerobic decay of
manure typically stored in a pit under most

Surgeon General's Conference on Agricultural Safety and Health - 1991               245


Research - Chemical and Biological Hazards

hog and some dairy barns.14dU It should be
acknowledged that under normal barn
conditions, hydrogen sulfide is not at levels
of great health concern (Figure ,).I2 I3

Source: anaerobic manure digestion

Anticipated Health Hazards:

Threshold of odor detection . . . . . . 0.1-0.2 ppm
Offensive odor . . , . . . . . . . . . . . . . . . . . . 3-5 ppm
TLV = recommended exposure
limit , , . . . , . . . , , . . . . . . . . . . . . . . . . . . 10 ppm
Olfactory paralysis
(cannot be smelled) . . . . . . . . . . .25-100 ppm
Serious eye injury (gas eye) . . . . .50-100 ppm
Bronchitis (dry cough) . . . . . . . . . loo-150 ppm
Pneumonitis and pulmonary
edema . , . . , , . . . . . . . . . . . . . . . . 200500 ppm
Rapid respiratory arrest (death) . . > 1000 ppm

Figure 3. Hydrogen Sulfide (H,S).

However, when the manure is agitated
prior to pump-out to be returned to the
fields as fertilizer, it is rapidly released
into the air above the frothing liquid.lsW19
During agitation, the author has measured
levels of H,S as high as 300 ppm at pig
breathing height and 1500 ppm in the pit
(Figure 4).

o Methyl-mercaptan  o Propionic acid
o Ethyl-mercaptan   o Butyric acid
o Carbonyl-sulfide   o Valerie acid
o Skatole

Figure 4. Mercaptans and Organic Acids As-
sociated with Hydrogen Sulfide from Manure.

Manure gas deaths often involve multiple
victims during futile rescue attempts.17,20
As was the case with silo gas, manure gas
deaths even as recently as 1989 are

sometimes m&diagnosed as asphyxiation
from methane.M

Control of agricultural respiratory hazards
should rely first on reduction at the source,
second on ventilation or some other
physical barrier to its movement, and third
on personal protection. Control of the
source of most of the above agents will
require further research before the process
of gas generation is sufficiently understood
to be reduced or avoided.

High rates of ventilation of farm shops or
animal confinement building is often
resisted by operators who prefer to
conserve heat in cold winter climates, and
if too much ventilation were installed
without consideration of make-up air re-
quirements, high levels of CO could be
drawn back down heater exhaust vents
(Figure 5).

Source: improperly adjusted heaters or no
    make-up air

Anticipated Health Hazards:

TLV = recommended exposure
limit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 ppm
Induces spontaneous abortions
in swine . . . . . . . . . . . . . . . . . . . . 100-l 50 ppm
Asphyxiation dependent upon duration
of exposure . . . . . . . . (2-3 hours at 500 ppm)
            cl5 mins >2000 ppm

Figure 5. Carbon Monoxide (CO).

As in any other industry, the use of
respirators should be considered a temp-
orary and supplemental protection. In agri-
culture there are no trained persons avail-
able to assist in the selection, fit, or main-
tenance of respirators. Thus, when pur-
chased at all, respirators are selected

246

Papers and Proceedings


without knowledge of measured
levels of exposure and often
without even the benefit of an
adequate "work practices"
evaluation as shall be discussed
below.

Table II. Major Groups of Field-Use Agricultural Pesticides.

INSECTICIDES

LIQUIDS

Pesticides are formulated as
solids (such as granules and
wettable powders), liquids, and
gases and vapors (mostly
fumigants). Pesticides can
present a hazard to applica-
tors,21-P to harvesters re-entering
a sprayed field, 24* 25 and to rural
residents via air, water, and
even food contamination.s28

Organophospates . . . . . . . . . . . . . . . Counter, Parathion, Guthion,
                Lorsban, Rabon
Carbamate . . . . . . . . .._........ . . ..Temik, Furidan, Lannate, Sevin
Organochlorines . . . . . . . . . . . . . . , . , Dieldrin, Lindane, Chlordane
HERBICIDES
Phenoxy-aiiphatic acids . . . . . ...2.4-D. 2,4,5-T, Trioxone
Bipyridyis . . . . . . . . . . . . . . . . . . . . . _ Paraquat, Diquat
Triazines . . . . . . . . . . . . . . . . . . . . . . . . . . Atrasine, Blasex, AAtrex
OTHER/MISCELLANEOUS
Thiocarbamates (fungicides) . Thiram, AAtack, Mabam,
                Maneb, Zineb

Arsenicals (herbicides) , . . . . . Paris Green, Cacodyiic acid
Acentaniiides (herbicides) . . . . . Alachlor, Lasso, Ramrod
Dicarboximides (fungicides) . . . Difolitan, Captan
Dinitrotoluidine (herbicides) . . . Amex, Prowl, Treflan

Toxicologically, the major field-

use pesticides can be broken down into six
major chemical groups shown in Table II.
Most of these agricultural chemicals
present dermal hazards either from ab-
sorption directly through intact skin and/or
from dermatitis. Some of these insect-
icides are also used indoors, especially in
greenhouses were exposure is often
higher,.

Gases, Vapors, Liquids, and Drugs, May 1, 1991

Common Commercial Names

There are two additional groups of non-
field agricultural chemicals: one is
fumigants (such as phosphine [usually
aluminum phosphide or Phostoxin] or a
volatile organic like carbon disulfide or
ethylene dichloride) used in produce
storage areas, and the other is disinfectants
(such as chlorine, quaternary ammonia
compounds, organic iodides, and cresol-
based compounds) used in indoor animal
production facilities.' Certain of these
chemicals present respiratory hazards par-
ticularly when used in combinations; other
of these liquid chemicals present a risk of
contact or an allergic dermatitis.30

While a review of pesticide toxicities is
being presented separately, they are
presented here because they demonstrate
an approach to anticipation, recognition,
evaluation, and control quite different
from general industry. Some level of an-
ticipation was available from the time of
registration, but much of that interest was
directed toward consumers rather than
users who are exposed at much higher lev-
els.

Given that starting point, it is unfortunate
that the recognition of hazards to users has
often been a protracted process, in some
ways no better than the history of many
chemicals used in general industry. How-
ever, evaluation of exposure, when it final-
ly started to be conducted, was not site nor
user specific but was conducted in re-
sponse to more recent EPA pesticide regis-
tration requirements.

EPA then promulgated what amounts to a
"use practices standard" in the form of

Surgeon General's Conference on Agricultural Safety and Health - 1991               247


Research - Chemical and Biological Hazards

label instructions, which specify the ways
the chemical can be safely and legally
used. The implication is that if all users
follow these instructions, exposure will be
sufficiently low to prevent adverse health
effects. This process contrasts sharply with
general industry where employers are ex-
pected to "assure a workplace free from
recognized hazards."

Controls under these circumstances have
also differed from general industry. It can
be argued that the registration process is
itself a form of controlling the source,
screening out chemicals deemed too hazar-
dous for agricultural use and restricting
certain others to "licensed users."

In that sense, a form of hazard com-
munication was adopted by agriculture a
little before general industry. However,
the EPA registration and labelling process
has yet to address the machinery control-
ling the pathway of exposure.

When it comes to personal protection,
control has for a long time been mis-
directed at airborne versus the dermal
route of exposure; and those respiratory
controls which are specified, were estab-
lished without a decision logic common to
general industry for over 30 years3'p3'. I am
happy to report that EPA is currently
developing a respirator selection decision
logic at least consistent with a "use prac-
tices standard."

One might ask why a "use practices stan-
dard" versus a "performance standard"
approach used in agriculture. The one
asking the question must not be a farmer.

Even if the administrative and support
structure were in place to conduct on-site
monitoring at each farm or "place of
employment," the activities, working en-

vironments, and chemical exposure levels
in most agricultural settings vary suf-
ficiently by season, day, and even by hour
as to make such measurements moot,
which is not to say that measurements and
even performance standards have no place
in agriculture.

For instance, work in animal production
facilities is amenable to the application of
traditional TLVs, environmental
monitoring, and respirator selection
criteria. "Use practice standards" have
their own limitations; they must account
for many variables, thus often making
them overly restrictive conducive to low
compliance. It remains a challenge for the
future to define the conditions favoring
either form of standard or to determine if
either is even adequate.

The other category of agricultural
chemicals is fertilizers. Anhydrous am-
monia is the most heavily used fertilizer in
production agriculture. Anhydrous am-
monia is hazardous to the skin and
especially to the eyes because it is highly
hygroscopic, highly caustic, and extremely
cold (-280F under pressure).

Almost any eye contact with this chemical
will result in permanent blindness." In-
haling high concentrations of ammonia can
result is severe damage to the upper
respiratory tract, resulting in bronchiectasis
as a possible sequela."

Most of the occupational injuries from
anhydrous ammonia occur because of
faulty couplings, bleeder valves, shutyoff
valves, broken hoses, or plugged applicator
tips. In addition to an established program
of preventive maintenance, a pro-active
hazard communication for both commer-
cial and private applicators is essential to
establish consistent wearing of eye protec-

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Gases, Vapors, Liquids, and Drugs, May 1, 1991

Table III. Skin Conditions of Agricultural Workers (adapted from
reference 2).

Classification of Skin Condition

Irritant contact dermatitis . . . . . . . . . . . . . . . . .

Allergic contact dermatitis . . . . . . ._. . . . .

Photo-contact dermatitis . . . . , . . , . . . . . . . . .

Sun-induced dermatoses .................
Infectious dermatoses .....................
Heat-induced dermatoses ................
Arthropod-induced dermatoses ..........

Aaents (examblesl

ammonia fertilizers
animal feed additiies
vegetable crops and bulb plants
insecticides, herbicides, and
fumigants
herbicides and insecticides
antibiotic feed additives
plants
creosota
feed additive
plants containing furocoumarins
sunlight
cattle, swine, and sheep
moist and hot environments
chiggers, bees, and wasps

tion and ensuring the availability of clean
water to flush eyes and skin in case of
contact.

In addition to their fire hazard and intrin-
sic toxicity, many of the liquids involved in
agriculture can produce dermatitis (Table
III). Compared to other occupational
groups, farmers have a proportionately
higher prevalence of skin diseases.","

Irritant contact dermatitis is perhaps the
most common type of agricultural der-
matoses.3539 Irritant substances are ubi-
quitous and include ammonia fertilizers,
several pesticides, soaps, petroleum
products, and solvents. Avoidance
schemes must include work practices to
eliminate or reduce exposure to the most
irritative substances and/or the use of
personal protection equipment.
Allergic contact dermatitis is typified by
Poison ivy or poison oak reactions. These
are exquisite sensitizers as are certain

herbicides and pes-
ticides? These reactions
are more difficult to
control, because suscep-
tible farmers are ex-
quisitely sensitive to very
small amounts of offen-
ding liquids.

VETERINARY DRUGS

Veterinary drugs are
broadly divided into two
classes of biologicals and
antibiotics (Table IV).
Biologicals are made
from living products to
enhance the immunity of
an animal to a specific
infectious disease or
diseases.

Users of biologicals are at risk of either
accidental inoculation or splashing the
product into the eyes, mucous membrane,
or broken skin. Users at risk include not
only veterinarians and their assistants, but
also farmers, ranchers, and their
employees, except for certain diseases for
which a government-regulated control
program is in effect (e.g., brucellosis,
rabies, pseudorabies).

The most frequent reports of occupational
illnesses associated with biologicals involve
veterinarians, whether splashing brucellosis
strain 19 in their eyes or accidental
inoculating themselves. Symptoms may
include infection, inflammation, severe
localized swelling and pain, and/or an
allergic reaction. The infection mimics the
acute infection seen from acquisition of
the disease directly from either cattle or
swine. Disability may last for days to
weeks in the worst cases."'

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249


Research - Chemical and Biological Hazards

Table IV. Veterinary Drugs Potentially
Hazardous to Users.

Biologicals

Brucellosis strain 19
Newcastle disease vaccine
Contagious exthyma (orf) vaccine
Jhone's disease bacterin
Escherichia co/i bacterins
Erysipelas vaccines

Antibiotics

Penicillin
Tetracycline
Sulfamethazine
Erythromycin
Virginiamycin

Other products that have been associated
with occupational illnesses include New-
castle disease vaccine, contagious ecthyma
vaccine, Jhone's disease bacterin, ES-
clzetichia coli bacterins, and erysipelas
vaccines. Newcastle disease and con-
tagious ecthyma (orf) vaccines are live
products used in chickens and sheep,
respectively.

Workers may contaminate their eyes with
Newcastle vaccine as it is being applied
inside poultry buildings via a nebulizer,
resulting in a moderate conjunctivitis with
influenza-like systemic symptoms. Orf vac-
cine can cause the same pox-like lesions at
the site of inoculation as a naturally ac-
quired infection.

Both of these diseases are self-limited and
disability will only last for a few days,
unless the orf lesions are numerous.41342
Injuries induced by the bacterins for
Jhone's and E. Coli, and by most erysipelas

vaccines are limited to the inflammatory
response induced by the adjuvants.

Control of these hazards again resides
largely in "use practice standards," good
animal handling techniques and facilities to
prevent the uncontrolled and untimely
movements of stressed animals." The use
of pneumatic syringes, lock-on needle
hubs, and multiple dose syringes will also
help reduce injuries.

Eye protection is indicated in many instan-
ces. A full-face respirator is recommended
while aerosolizing vaccines such as New-
castle, but the other components of a full
respirator program are rarely instituted.

Antibiotics are products derived or syn-
thesized from living organisms, mainly
mold species of the genus streptowtyces.
Antibiotics are used to treat infectious
diseases therapeutically or to improve the
rate of gain and feed efficiency in cattle,
swine, and poultry.

Again not only veterinarians but also live-
stock producers and feed manufactures
and formulators are exposed to these
agents via aerosols of antibiotic-containing
feeds within livestock buildings or via
aerosols or direct contact while preparing
feeds either on the farm or in feed manu-
facturing plants. The two main occupa-
tional hazards are allergic reactions and
the development of antibiotic-resistant
infections.

The main products used as feed additives
include penicillin, tetracycline, sul-
famethazine, erythromycin, and vir-
giniamycin. These same products plus
many more are used therapeutically. Pen-
icillin is the primary agent that may induce
an allergic reaction manifest in the form of
a skin reaction from direct contact, or

250                                   Papers and Proceedings



possibly a systemic reaction from inhala-
tion or inoculation.

A variety of these agents may induce
development of resistant organisms in the
gut flora of exposed individuals. In one
case, a severe resistant salmonellosis was
traced to animal contact by people who
were treated with antibiotics for a con-
dition unrelated to salmonella."

Again the importance of antibiotics as an
agricultural health hazard is unknown
either in terms the frequency or the mag-
nitude of exposure levels or health effects.
It seems that the evaluation of risk from
antibiotics is amenable to air sampling and
the development of "performance" oriented
exposure guidelines.

Control should strive toward removing as
feed additives those antibiotics used for
humans and rotating the use of those still
added. Other prudent control measures
where antibiotics are used include en-
closing feed formulating, grinding, mixing,
and storing operations, and utilizing
general dust control procedures in small
feeding operations, supplemented by dust
masks.

CONCLUSIONS

The industrial hygiene paradigm of "an-
ticipation, recognition, evaluation, and
control" can, in principle, be applied to
agriculture with the following translations:

1. Anticipation of health and safety
hazards in agriculture can be accomplished
with the prospective application of dose-
response knowledge generated either in
the laboratory or in other industries.

2. Recognizing health and safety hazards
in agriculture requires the interest and

Gases, Vapors, Liquids, and Drugs, May 1, 1991

commitment of farmers, farmer groups,
local community organizations, manufac-
tures, and governmental agencies to survey
both the farming environment and the
health status of farmers.

3. Evaluation of health and safety hazards
in agriculture can in most cases use exis-
ting surveillance technologies, but new
ways must be developed to interpret sur-
veillance data from settings for farmers.

4. Controlling health and safety hazards in
agriculture must go beyond "hazard com-
munication" to modify the sources and
interrupt the pathways of exposure before
the farmer, with or without personal
protection, is dosed.

Organizationally, the hazards from gases,
liquids, vapors, and veterinary drugs are
not uncontrollable. By and large, we can
anticipate the health effects of individual
agents, and we know how to measure both
the agents and their effects in a
population.

We have not utilized these skills in agricul-
ture as yet, probably both because of the
cost of surveillance studies in such a scat-
tered and diverse population and because
of the perception that "agriculture" was not
interested in someone intervening in their
affairs. We are at the dawn of the age
where the interest and funds are being put
into agricultural health and safety.

I hope that in our rush to study and
improve the statistics upon which future
preventive health and safety decisions will
be made, we do not lose sight of agricul-
ture as way of life. Kelley Donham and I
recently have been referring to agricultural
hygiene as the application on farms of in-
dustrial hygiene principles learned in
general industry.

Surgeon General's Conference on Agricultural Safety and Health - 1991

251


Research - Chemical and Biological Hazards

We like to think (with tongue in cheek)
that agricultural hygiene is a growing op-   to be easier to train industrial hygienists
portunity. The open question is, is it going  about farming than it will be to train
                  farmers to be agricultural hygienists?0

REFERENCES

1.

W. Popendorf, K.J. Donham, D.N. Easton, and J. Silk. A synopsis of Agricultural Respiratory Hazards.
American Industrial Hygiene Association Journal. 46(3): 154-161, (1985).

2.

W. Popendorf and KJ. Donham: Agricultural Hygiene. Chapter 19 in Pafry's Industrial Hygiene. 4th
Edition, pages 575608, J. Wiley & Son, NY 1991.

3.

4.

E.R. Hayhusrt and E. Scott, Four Cases of Sudden Death in a Silo. JAVA 63:l570-1572, (1914).

R.R. Grayson, Silage Gas Poisoning: Nitrogen Dioxide Pneumonia, a New Disease in Agricultural
Workers. Ann. hf. Med., 45:393-408, (1956).

5.

T. Lowry and L.M. Schuman. Silo-filler's Disease: A Syndrome Caused by Nitrogen Dioxide. JM
162: 153-160 (1956).

6.

W.H. Peterson, R.H. Burris, S. Rameshchandra, and H.N. Little. Production of Toxic Gas (Nitrogen
Dioxides) in Silage Making. Agric and Food Chem, 6:121-126, (1958).

7.

B.T. Commins, F.J. Raveney, and M.W. Jesson. Toxic Gases in Tower Silos." Ann. Occupational Hygiene
14:275-283, (1971).

8.

R.J. Ramirez and A.R. Dowell. Silo Filler's Disease: Nitrogen dioxide-induced Lung Injury. Long-term
Follow-up and Review of the Literature. Ann. Intern. Med. 74569-576, (1971).

9. E.G. Scott and W.B. Hunt. Silo-filler's Disease. Chest 63:701-706, (1973).

10. E.D. Horvath, GA. do Pica, and RA. Barbee et al. Nitrogen dioxide-induced pulmonary disease.
Journal of Occupational Medicine. 20:103-110, (1978).

11. J.R. Mulhausen, E.E. McJilotn, P.T. Redig, KA. Janni. Aspergillus and Other Human Respiratory
Disease Agents in Turkey Confinement Houses. American Industrial Hygiene Association Journal.
48(11):894-899, (1987).

12. K.J. Donham, M. Rubino, T.D. Thedell, J. Kammermeyer, Potential Health Hazards to Agricultural
Workers in Swine Confinement Buildings. Journal of Occupational Medicine. 19(6):383-387, (1977).

13. K.J. Donham, M. Rubino, T.D. Thedell, J. Kammermeyer. Ambient Levels of Selected Gases Inside
Swine Confinement Buildings. American Industrial Hygiene Association Journal. 46:658-661, (1985).

14. JA. Merkel, T.E. Hazen, and J.R. Miner. Identification of Gases in a Confinement Swine Building
Environment. Trans. ASAE. 12:310-315 (1969).

15. W.C. Banwart and J.M. Brenner. Identification of Sulfur Gases Evolved from Animal Manures. Journal
of Environmental Quaky. 4(3):363-366, (1975).

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Gases, Vapors, Uquids, and Drugs, May 1, 1991

16. D.L. Morses, MA. Woodbury. Death Caused by Fermenting Manure. Journal of the American Medical
Association. 245(1):63-64, (1981).

17. K.J. Donham, L.W. Knapp, R. Monson, K Gustafson. Acute Toxic Exposure to Gases From Liquid
Manure. Journal of Occupational Medicine. 24(2):142-145, (1982).

18. S.R. Hagley, D. L. South. Fatal Inhalation Of Liquid Manure Gas. Medical Journal ofAustralia. 2:459-
460, (1983).

19. A. Phelps. The Hidden Hazard. Hog Farm Management. 25(4):38-39, 1988.

20. Anonymous. Fatalities Attributed to Methane Asphyxia in Manure Waste Pits - Ohio, Michigan, 1989.
MMWZ, 38(33):j583-586, (1989).

21. H.N. Nigg and J.H. Stamper. Exposure of Spray Applicators and Mixer-Loaders to Chiorobemilate
Miticide in Florida Citrus Groves. Arch. Environmental Contamination Toxicology. 12:477-482, (1983).

22. J.M. Devine, G.B. Kinoshita, R.P. Peterson and G. L. Picard. Farm Worker Exposure to Terbufos
[phosphorodithioic acid] during Planting Operations of Corn. Arch. Environmental Contamination
Toxicology. 15:113-119, (1986).

23. W. Popendorf. Mechanisms of Clothing Exposure and DermaI Dosing during Spray Application. In:
Performance of Protective Clothing: Second Symposium. ed. by S.Z. Mandsorf, R. Sager, and A.P.
Nielsen. Amer. Sot. for Testing and Materials. Phii. PA, 611624, (1988).

24. W. Popendorf and J.T. Leffmgweh. Regulating OP Pesticide Residues for Farmworker Protection.
Residues Reviews. 82X25-201, (1982).

25. H.N. Nigg, J.H. Stamper, R.M. Queen. The Development And Use Of A Universal Model to Predict
Tree Crop Harvester Pesticide Exposure. American Industrial Hygiene Associafion Journal. 45(3):182-
186, (1984).

26. J. Maybank, K. Yoskida, and R. Grover. Spray drift from agricultural pesticide applications.  J. Air
Pollution Control Association. 28:1009-1014, (1978).

27. National Research Council. Regulating Pesticides in Food, National Academy Press, Washington, DC,
(1987).

28. D. Fairchild. Ground Water Quality and Agricultural Practices. Lewis Publishers, Inc., Chelsea, MI
(1987).

29. J.H. Stamper, H.N. Nigg, W.D. Mahon, A.P. Nielsen, M.D. Royer. Pesticide Exposure to Greenhouse
Foggers. Chemosphere. 17(5):1007-1023, (1988).

30. R.L. ZuehIke. Common cutaneous problems in agricultural work. In: Proceedings of Conference on
Agricultural Health and Safety. Society of Occupational and Environmental Health, Environmental
Sciences Laboratory, 100th Street and Fifth Avenue, NY, pp. 54-67, (1975).

31. F-A. Patty. Industrial Hygiene and Tom'cology. 2nd Edition. Pages 352-354, Interscience Publishers, NY
(1958).

32. N.J. Bohinger and R.H. Schutz. Guide to Industrial Respiratory Protection. DHHS (NIOSH) PubI. 87-
116, (1987).

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33. S. Helmers, F.H. Top, and L.W. Knapp. Ammonia Injuries in Agriculture. J. Iowa Med. Society.
61(5):271-280 (1971).

34. I. Kass, N. Zamel, CA. Dobry, and M. Holzer. Bronchiectasis following ammonia burns of the
respiratory tract: A review of two cases. Chest, 62982-285, (1972).

35. D. Hogan and P. Lane. Dermatologic Disorders in Agriculture. Occupational Medicine: State of the Art
Reviews, 1:285-300, (1986).

36. C.L. Wand. The Problem of Skin Diseases in Industry. Washington D.C., Office of Occupational Safety
and Health Statistics, U.S. Department of Labor, U.S. Government Printing Office, (1978).

37. R.M. Caplan. Cutaneous hazards posed by agricultural chemicals. Journal of the Iowa Medical Society,
59(4):295-299, (1969).

38. D. Burrown. Contact dermatitis in animal feed mill workers. British Journal of Dermatology, 92167-170,
(1975).

39. R.D. Peachey. Skin hazards in farming. British Journal of Dermatology, 105(Supp.21):45-50, (1981).

40. W.W. Spink. The Significance of Bacterial Hypersensitivity in Human Bruceliosis; Studies on Infection
due to Strain 19. Brucella Abortus. 41861-873, (1957).

41. A.H. Keeney and M.C. Hunter. Human infection with Newcastle virus of fowls. Archives of Opthul-
mology. 44:573-580, (1950).

42. U.W. Leavell, Jr., M.S. McNamara, R. Mueliing, et al. Orf-Report of 19 human cases with clinical and
pathological observations. JAMA, 204~109-116, (1968).

43. T. Grandin. Animal Handling and Farm Animal Behavior. Veterinary Clinics of North America: Food
Animal Practice, 3:324-336, (1987).

44. R.W. Lyons, C.L. Samples, H.N. DeSilva et al. An Epidemic of Resistant Salmonella in a Nursery-
Animal-to-Human Spread. JTAMA 243:546-547, (1980).

254

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Surgeon General's Conference on Agricultural Safety and Health
FARMSAFE 2000 o A National Coalition fix local Action
Convened by the National Institute fix Occupational Safety and Health
April 30 - May 3, 1997, Des Moines, Iowa

MIGRANT WORKERS' PERSPECTIVE

      By E. Roberta Rydq BA.
Executive Director, National Migrant Resource Program, Inc.

I am coming to you from Buffalo, New
York, where I have been for six days par-
ticipating in the National Migrant Con-
ference, which is a joint group with
migrant education, migrant health, migrant
head-start, and migrant labor. So, I am
running a little ragged here in my throat,
and I ask you to bear with me for just a
little while.

NATIONAL MIGRANT HEALTH
PROGRAM

I am going to give you a brief synopsis of
the organization that I work with because I
think there are some resources there that
some of you might be interested in. The
National Migrant Resource Program is
located in Austin, Texas. It has been there
for almost 20 years.

We act as a resource not just to migrant
health centers but to any other interested
parties around the country. We are a
private, non-profit corporation. We have a
newsletter, a directory, and a number of
publications, perhaps the most exciting of
which is one that was just completed by
Dr. (inaudible) who is an epidemiologist
with Mercer University in Georgia.

I am going to read you one sentence out of
this report. It is an analysis of migrant
farmworkers in the midwestern stream.
He says, "The results of this study are
significant, shocking, and convincing. The
findings are based on a sample of migrant
and seasonal farmworkers living and

working in the U.S., yet their demographic
patterns, socioeconomic conditions, lifes-
tyle characteristics, and disease categories
reflect agrarian third-world conditions
rather than those of the most powerful and
affluent nation in the world."

This monograph is available for all of you
if you want to contact me. Our name is
listed in the back of the roster of par-
ticipants.

I come from a farming background. I am
the daughter of a farmer, and I am also
the ex-wife of a farmer.

I have been a health center administrator
and worked with migrant farmworkers
since I got out of college in 1972. I would
also like to let you know that we are
doing-if any of you have an interest in it
we would like to hear from you-some
work with EPA on expert meetings on the
topics of children and pesticides and on
biological monitoring alternatives.

COMMENTS ON PAPERS

I am going to go directly to the presen-
tations that were made yesterday. I would
like to state that of the four, some of them
were more directly applicable to migrant
farmworkers than others. Even the one
that was least directly applicable, i.e.,
Dr. Popendorfs presentation on gases,
liquids, vapors, and veterinary drugs, con-
tained significant concepts that are very
valuable when applied to the field of mi-

Surgeon General's Conference on Agricultural Safety and Health - 1991                255


Research - Chemical and Biological Hazards

grant health. I speak particularly of his
paradigm of anticipation, recognition, eval-
uation, and control.

The other concept that he presented was
that adverse health effects are the cul-
mination of an often complex chain of
events beginning with a nebulous source
and traveling through a physical pathway.
This concept is very important, especially if
you think for the moment of the father of
a farmworker family, say 50 years old, who
comes into a clinic with chronic headaches,
gastric problems, or dermatitis.

We cannot figure out what the problem is.
How do we determine what series of
events or exposures led him to this state?
After 40 years of exposure, traveling in
maybe one or two streams, a multiplicity of
states, and working with a range of crops
that go from apples to mushrooms to zuc-
chini - what kinds of exposures has he
had? Certainly the case is complex beyond
that of the grower, the farmer, who stays
on one farm, one piece of property, over a
40- to 60-year span of time.

We do not know what the chronic effects
of low-level continuous exposure are, but
because we do not know, we sometimes
hide our heads in the sand and pretend
that they are not problems, much like we
did with cigarette smoking 20 years ago.
Good judgment and common sense advised
us that smoking was not healthy.

To touch on Dr. Popendorfs theory, we
could anticipate potential problems, we
could recognize the questionability of put-
ting such a substance in our bodies, but yet
for economic and political reasons we got
stuck on evaluation before we could move
on to control. Are we going to wait until
we can prove, irrefutably, that exposure to
chemical and biological substances is

hazardous to the health of farmworkers,
farmers, and consumers before we use this
God-given good judgment and anticipate
or recognize the danger and take action?

You might wonder why I mentioned the
consumer here. Those of us who work in
migrant health believe that the migrant
farmworker and the farmer are, in essence,
the "canaries." Do you all know what I
mean by that concept? The indicator of
risks that are shared with the consumer.

I speak here not only of chemical hazards
but of biological exposure. A colleague of
mine testified before a joint session of the
Congress in the early years when we were
trying to promulgate the field sanitation
regulations which, by the way, were only
finally passed in 1987. He said, "Just tell
me, sir, exactly what amount of fecal mat-
ter present on a strawberry is a tolerable
level."

All of the presentations touched on issues
which are of significant impact to
farmworkers. I would like to run through
that list briefly with you at this time.

We spoke of infectious diseases for which
farmworkers are at high risk, because of
their working and crowded living con-
ditions. TB, STD, HIV, parasites,
gastroenteritis, Salmonella, Shigella,
hepatitis A, UTI's, and respiratory infec-
tions-all of them very clearly problems
that we see in the farmworker population.
One of the reasons that I referred you to
Dr. (inaudible) study is that he does an
analysis of the frequency of these diag-
noses in this study.

Dr. Von Essen spoke to us of airborne
dust. Certainly hypersensitivity
pneumonitis is less of a problem with the
migrant farmworker population, since only

256                                Papers and Proceedings


The Migrant Workers' Perspective, May 2, 1991

small numbers of them work in dairy or
grain operations. I have a foster child who
lives with me and is 20 years old. I have
known Danny since he was three, and I
had him in day care in southwest
Michigan.

He is the child of a farmworker family that
is home-based in the Little Rock or Bates-
ville, Arkansas area. When they are not
migrating north, they work in the poultry
industry. Danny, at the tender age of 20,
has chronic bronchitis from having been in
and out of the poultry settings and the
freezers of the processing plant. This is
clearly a problem, but in less significant
numbers than the larger portion of the
population that works primarily in fruits
and vegetables.

I would like to draw attention to the fact
that for farmworkers, we are talking about
chemical and biological exposures, but
there are a number of other hazards that
people often do not think about as being
agriculturally or occupationally related.
For example, automobile accidents with
farmworkers who are traveling 1,200 miles
up and down the stream in cars that I
would not drive 200 miles in are signifi-
cantly related to occupational employment.

I would like to go to Dr. Blair's presen-
tation. It is most exciting to me in that it
takes a very honest approach to the dif-
ficulties in assessing the chronic effects of
acute exposure. Certainly clusters of can-
cer among farmers which cannot be
explained for other reasons are alarming
enough to motivate us to anticipate and
recognize the problem so that we can then
control it. Let us not get bogged down in
the assessment, or we will lose all of our
canaries.

What are the solutions? Certainly there
are some laws on the books which need to
be fully implemented. I had originally
jotted down the word "enforced," and I
crossed that out and used the word
"implemented," because, quite frankly, our
enforcement is not working.

We have people here from OSHA.
Someone asked me a question just before
the conference started as to how things
were going with OSHA in Texas. Enforce-
ment does not happen.

Specifically, the laws that are on the books
include such things as field sanitation, use
of child safety restraints in automobiles,
minimum wage, and re-entry times, but
these are not always observed. Then there
are other laws that have yet to be promul-
gated.

I speak specifically here of the loopholes
in current laws, which exempt migrant and
seasonal farmworkers and farmers from
basic worker protection standards afforded
to all other workers and child labor laws
which do the same. There is movement
towards promulgating both of those at this
time. One of my colleagues, Dr. Paul
Monahan who is sitting in the back row,
has information on each of those. The
group within migrant health that takes a
strong advocacy role is the migrant
clinicians' network, and I believe he has
copies of the posrtron papers on both of
those laws.

Currently worker protection standards
within the Environmental Protection Agen-
cy are bogged down in a political morass
where they have been for years. They
need to get out of the red border status '
and be promulgated.

SWeon General's Conference on Agricultural Safety and Health - 1991

257


Research - Chemical and Biological Hazards

Once this is achieved, they merit careful,
independent, academic evaluation from
professionals like yourself with an eye to
modifications. Let us push now to get
them on the books because if we try to
inject modifications at this time into the
political process, I am afraid we will never
have the standards.

Is it really acceptable that such a large
portion of our population be relegated
to the edge for the duration of their
lives?   I

Unfortunately, laws alone are not going to
improve conditions for farmworkers. I
would like to propose to you that
farmworkers and farmers are literally in
the same field--or boat as you might
say-not only when it comes to exposures,
but economically and politically.

It is very clearly recognized that farm and
farmworker families have lived their lives
on the edge between survival and des-
titution for at least the last 10 years. Many
farm families have lost that struggle
through suicide and bankruptcy. We do
not see, visibly, tangibly, the demise occur-
ring in the numbers of the farmworker
population because there has always been
another family to take the place of one
that settles out. So we can not quantify it
for farmworkers the way we can for
farmers.

The theory of the hierarchy of need tells
us that safety, shelter, and nourishment are
the three basic needs of any human, and
that without assurance of them,
self-actualization will not occur. Is it really
acceptable that such a large portion of our

population be relegated to the edge for the
duration of their lives?

Sometimes the farmworker's plight is er-
roneously blamed on the farmer or on the
laziness of the farmworker. So who do we
blame for the farmer's plight?

I blame the ignorance, selfishness and
greed of the consumer and all of the mid-
dlemen in the food production system.
Perhaps where humanitarianism and
altruism are not strong enough to create
change, consumer self-concern may.

We can certainly look at the examples of
Alar in the Pacific Northwest, the con-
sumer reaction, and the practice of its use
among growers. We can look at the
European Economic Community and the
purchase of beef with steroids. We can
look at the safe tuna model for examples
of where consumer pressure has certainly
brought about change. We know that it is
a powerful entity.

RECOMMENDATIONS

I have 10 recommendations:

1. I would like to suggest that it is very
important that we continue to mainstream
farmer and farmworker issues, especially in
arenas such as these, and I would like to
volunteer to be one of several linkages
that can help to bring participants- par-
ticipation of migrant farmworkers themsel-
ves to sit and be a part of your
negotiations. Not all farmworkers are
monolingual, and several of them are very
outspoken in English as well as Spanish.

2. Enforce protection standards where
they exist.

3. Promulgate laws where necessary.

PaDers and Proceedinas


The Migrant Workers' Perspective, May 2, 1991

4. Educate both farmers and farmworkers  decide where our values lie and promul-
as to the risks that they face.        gate and implement legislation accordingly.

5. Educate the consumer and the general
public.

6. The academic world needs to feel free
to speak out about the risks, even where
proof does not exist. Let good judgment
prevail.

7. Promote economic market changes that
assure that farmers and farmworkers
receive a decent wage or profit for their
work, because truly it is the economic
market that drives the situation. In this
manner, both farmers and farmworkers can
be pushed back from the edge where they
currently teeter.

9. Anticipate that the Free Trade
Agreement between the United States and
Mexico is going to blow us all out of the
water, at least for the first five years, and
then recognize that the short-run, political
solutions and protections must be put in
place in order to protect not only the
farmer and the farmworker but the con-
sumer, in that we do not control the use of
toxic substances in Mexico.

8. Recognize the difference between farm
families and huge, multi-level, diversified
agribusiness, which is making a profit, and

10. Just as it took Surgeon General
Koop's audacity to challenge the economic
and political bastions of the tobacco in-
dustry and to state that cigarettes smoking
is hazardous to our health, so too can
Dr. Novello have the audacity, as a pedia-
trician and a woman and, I dare say pro-
bably a mother, to speak out on behalf of
the hazards faced by our farming com-
munity.0

QUESTIONS

Anonymous: You used the term "blow us out of the water," on the Free Trade Agreement. Could you
clarify that?

Roberta Ryder: The question is, What do I mean by "blow us out of the water" on the Free Trade
Agreement? I have a sense that the long-term benetits of the Free Trade Agreement are going to be of
significant value to this country and so, therefore, I personally am not opposed to it, but when you look at
the fact that the production of a watermelon, for example, basically costs the same in Mexico as it does in
the United States with the exception of the labor factor, what we are going to fmd is that the importation of
agriculture into the United States will be far more prevalent than it is right now.

We will also find that some of the larger, healthier farms are going to actually move into Mexico, and there
will be others who cannot sustain that kind of change that will go under. That is the impact on the farm.

For the farmworker, what we are going to find is that there are a number of second-generation agricultural
farmworkers that have been here in the United States traveling along all of the streams, that are truly
America's working poor. They are not a welfare population, and they are not going to have work. That is
going to be a burden on American society just as it is in our inner city areas where we have large welfare
populations.

I do not think that it is going to have a significant impact on the cost of produce for us as the consumer, but
I do think that it will actually cut, pull the rug out from under our feet on, any of the consumer safety
Protections that have been put in place to control the use of certain substances because, in Mexico, things

Surgeon General's Conference on Agricultural Safety and Health - 1991

259


Research - Chemical and Biological Hazards

like DDT are still being used quite frequently without any control at all. We are going to be consuming that
produce.

Anonymous: To come back to the local level, how do we educate our migrant workers on all these things
that are going on... (inaudible).

Roberta Ryder: The only way that I know of is through outreach. Our clinics have gone from being very
basic, simple, community-level organizations to somewhat more sophisticated-nicer buildings, better trained
doctors, and in the process, what we find is that we are not reaching the farmworkers.

As our health centers have become more and more a part of the industry and our highly trained physicians
sit in the clinic and wait for the patients to come to them, we are reaching smaller and smaller numbers of
the total population. We know-and dollar resources are clearly the issue here-that the only way to reach
them is through outreach, through use of lay rich people, employment of the best and the brightest of the
migrant farmworkers themselves, and through paraprofessionals and mid-level practitioners to go out into the
labor camps and the housing, the colonias in the Valley of Texas, and take care of the basic level things. I
am speaking in health, because that is the field that I am most familiar with, but I think you can apply that
to education whether it is health education or safety education.

Anonymous: Can you get that through, say, migrant clinics?

Roberta Ryder: You definitely can. Migrant clinics have the expertise and the know-how. They have the
models. Right now what they are lacking is the resources, and they are committed to health education and
worker protection status.

Anonymous: Do you have a list of migrant clinics?

Roberta Ryder: The question is, "Do I have a list of migrant clinics ?" I have a directory that is produced
out of our office in Austin, Texas, and that is available free of charge. It includes all of the grantees funded
through the Federal Department of Health and Human Services and each of their satellites, including names
of the health professionals that work in them and the services that are provided. Included in that directory is
also a list of pediatricians around the country who are members of the American Academy of Pediatrics who
provide services to farmworkers on a volunteer basis.

260

Papers and Proceedings


I do not know whether to say thank you to
Kelley Donham or not. This morning I
was asked to give a foundation's perspec-
tive on the papers and presentations that
were made yesterday. As Kelley has sug-
gested, it probably is easier for me to give
a layperson's perspective.

In a sense, I hope to give a community
perspective, and quite frankly, a perspec-
tive of a young midwestern farm youth and
one from my involvement in agriculture as
a farmer. In fact, I continue to farm today
and had the opportunity in 1989 to pur-
chase a farm in Michigan and continue to
be involved there.

Although my bias and experience and
exposure to the issues of agricultural
health and safety clearly lie on the safety
side, I will talk about that in just a minute.
I first want to clear up Kelley's story. As
Kelley mentioned, one day while shearing
sheep on the farm, I contracted orf virus.

Surgeon General's Conference on Agriculturai Safety and Health
FARMSAFE 2000 o ? National CoaMon fix Local Action
Convened by the National InStitute for Occupational Safety and Health
April 30 - May 3, 7991, Des Moines, Iowa

A FOUNDATION'S PERSPECTIVE

   By Gene F. Graham, MS.

Assistant Program Director, W.K. Kellogg Foundation

Dr. Kelley J. Donham: The next speaker is a person who I had the privilege of meeting just a little
over a year ago, he revealed to me this morning that he got an infection once from one of his
animals and since that time I think he has become quite a leader and promoter, very much so, in the
whole area of agricultural health and safety. Gene Graham was born on a farm. I guess you have to
have that stamp of approval, almost, to be here. If we keep this up, we are going to have so many
people up here doing this stuff and not farming maybe we will not have to worry about those
problems anymore, but . . . we need to keep in mind and perspective who we are working for and
what we are trying to do. Anyway, Gene was born on a dairy farm in Michigan, a little ways north of
Lansing. His project, perhaps more of a hobby than an actual economic unit on the farm, was
pure-bred sheep. Gene went to Michigan State University and got a degree in education and
specifically agribusiness and natural resources education and went to work in real life in a high
school, in Laingsburg, Michigan, as an agricultural instructor, until 1989. He then went to work for the
Kellogg Foundation in Battle Creek. Starting about one year ago, Gene was the stimulant to get an
agricultural health and safety initiative going within Kellogg, which has helped to move this whole
process along in a very big way. So, without further ado, I would like to introduce Gene Graham:

It was the first time that I had come to
grips with some of the relationships bet-
ween agriculture and health, although I
had read about and understood, at least at
a very rudimentary level, some of the
potential that health issues in agriculture
pose.

I think, though, that what stirred me more
was a series of experiences as I grew up in
a very rural community, as Kelley said, not
far from Michigan's capital, in Ingham
County, Michigan. I think about two very
good friends, Ron and Steve, who, in
separate tractor accidents, were either
killed while working on a farm or while
driving a farm tractor down the road.

One, in fact, was struck by a car and killed.
I also think about Gary, who, as a
sophomore in high school, had a full chop-
per box roll onto him. He lost his left leg
just above the knee.

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267


Research - Chemical and Biological Hazards

I think about Sarah, in probably the most
devastating experience that I could ever
imagine, who walked too close to a sickle
bar mower and lost both her feet.
Somehow, in the miracle of what has gone
on in health care in this country, Sarah had
both feet successfully reattached. As one
of the presenters alluded to yesterday,
when you are in some of those situations,
you do not look up at the doctor and say,
"How much is it going to cost?"

Also, when I was a graduate student at
Michigan State University, I remember
very specifically, a good friend got stuck by
a needle with animal vaccine, for the third
time in his young life, and died within just
a few hours of that experience. I think
about five members of a family, in an
accident that many of you heard about in
Michigan's Upper Peninsula, where one
after another each individual attempted a
rescue from an underground manure pit
and all five lost their lives.

Just last year, in the school district where I
grew up, in a small rural community, the
local people went through the pain of one
suffocation/asphyxiation in an upright
grain silo and a second accident where a
young man lost his legs and a big share of
his future as the result of a sweep auger in
the bottom of a grain bin. So, all of these
experiences wear and bear on my mind as
I think about these issues and what we
heard about yesterday.

With respect to a foundation's perspective,
the foundation that I represent is not one
that is very typical or traditional. It is one
that says as its motto, "The application of
knowledge to the problems of people." So
that does not qualify me very well to stand
today and reflect about the presentations
that were made yesterday.

For the Kellogg Foundation, it is an issue
of the complimentary relationship between
research and community intervention,
where each bears directly on the other. It
is a fundamental and naive belief that
models and demonstrations can be estab-
lished which will, at some point, affect
policy even at a very local or regional
level. It is the application of knowledge
for community intervention.

A foundation can only bring limited
resources to this or any other important
issue. It cannot do work by itself. In fact,
foundations have no role except to
contribute some pieces to the equation of
research, surveillance, education, and inter-
vention.

For the Kellogg Foundation in Battle
Creek, Michigan, this work represents an
opportunity to bring financial resources,
networking, and an expectation of in-
novation. In our particular initiative, the
expectations include collaborative,
comprehensive, responsive, intensive, con-
tinuous, cost-effective (however that can be
measured), creative, and effective
programs at a community level.

COMBINED FACTORS OF RISK

As I reflect on the presentations which
were made yesterday, I will only talk about
where I see some potential next steps in
relationship to what I heard. First, I would
address an issue that was raised regarding
combined factors of risk. The context of
this issue could include factors outside of
agriculture, such as cigarette smoking,
which complicates our understanding of
agricultural risk for exposure to the lungs.

Another example which was given yester-
day was the case of two pesticides and
what equations are appropriate, and what

262

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A Foundation's Perspective, May 2, 1991

do the results of the equations really
mean? Have we got that figured out in a
scientific and meaningful way?

A final example that I would give, and I
think this may be a midwestern perspec-
tive, is the combination of wood smoke
and a livestock confinement building.
These are conditions and circumstances
which exist on farms today. These are
things at a community level which are very
relevant; that young people and adults, in
rural communities, who work and live on
farms and tend to get exposed to more
than one pesticide, to more than one type
of animal confinement, to more than one
risk must face a combination of oc-
cupationally and non-occupationally
related risks.

ADDITIONAL STUDIES

Secondly, I want to comment on the sug-
gestion of additional studies. Yesterday
Dr. Blair suggested a study of farmers. He
said, perhaps a massive study which would
be long-term in nature, of 100,000 farmers.

I said to myself, Who? Who are we in
American agriculture? What 100,000
farmers are we?

The question generates out of my concern
for a regional and locally diverse agricul-
ture. Clearly, American agriculture is a
regionally diverse agriculture. We all
understand that fact. Moreover, the con-
text of any one particular region is based
on farming systems and farming practices,
which are locally diverse.

In fact, as I move to that and think about
exposure to risk, farming practices and
farming systems come back again to the
forefront and cause me to reflect in a
second way, by thinking about a reduction

of exposure to risk. Certainly our rural
neighbors knew 30 years ago that when
one generation on the farm grew up
severely asthmatic, they had to design and
develop different ways to harvest and feed
forage on our community dairy farms.

These are things at a community level
which are very relevant; that young peo-
ple and adults, in rural communities,
who work and live on farms and tend to
get exposed to more than one pesticide,
to more than one type of animal con-
finement, to more than one risk must
face a combination of occupationally
and non-occupationally related risks.

Today, I think that we need to refocus on
those efforts, and how we reduce risk in a
meaningful way with respect to forage and
grain handling, feeding systems, and
milking systems. Why is it that some of us
went to milking parlors as opposed to
staying with our stall or stanchion barns?
The examples, in the context of any
regional production system and the diver-
sity of local production strategies and
production techniques, are all there.

ECONOMIC INCENTIVE

A third factor, one with which I was
especially impressed this morning as I
listened and reflected in the plenary ses-
sion, is one of economic incentive. As we
think about the very traditional models of
prevention and assistance in agricultural
health and safety, we historically depended
on enforcement, education, and en-
gineering. I am still convinced, even as I
read the policy statements and voluntary
equipment standards proposed in this
country, that there must be economic in-

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Research - Chemical and Biological Hazards

centives in order for agricultural producers
to change practice and in order for them
to be able to provide leadership for their
workers to change practice.

ETHNIC AND CULTURAL DIVERSITY

The fourth area that I raise as a concern is
the ethnic and cultural diversity of the
prospective target population. This mor-
ning I listened as Dr. Pamela Elkind
talked about the worker acceptance levels
of yellow gloves versus black gloves.

I was saddened, as two of my fellow con-
ference participants looked at each other
in disbelief as to say, `This is silly," and I
said to myself that it does not seem silly to
me. On Saturday morning, while I am
watching cartoons, I put on my yellow
house work gloves and polish my shoes,
because I do not want shoe polish all over
my hands.

The issue of cultural sensitivity is relevant
though. I do not wear those yellow gloves
in front of anybody else.

1

I want to challenge you all about how it
is that we can develop meaningful op-
portunities for enfranchisement, access
to the institutions of society, and the
much needed occupational safety and
health interventions for migrant and
seasonal workers.

It seems to me that there are learning style
differences, cultural sensitivities, a need for
the reduction of cultural barriers, and need
of a more comprehensive understanding of
the referent values and attitudes for
various cultural populations involved in
American agriculture. Traditionally these

264

groups have been, at best, slighted and, at
worst, alienated. I am terrifically disap-
pointed that with the exception of Bobbi
Ryder and a few others who are here, very
few migrant and seasonal workers or
workers' representatives are present.

I am saddened that this meeting was
scheduled on top of a national meeting
which deals more specifically with the
issues of migrant and seasonal labor. I
want to challenge you all about how it is
that we can develop meaningful oppor-
tunities for enfranchisement, access to the
institutions of society, and the much
needed occupational safety and health
interventions for migrant and seasonal
workers. At a very philosophical level, in
this great American experiment and
interesting American fabric, we have a
great opportunity.

Some would say that we are not up to this
challenge, yet we, as Americans, have
established so many new ideas and
institutions in our desire to find better
ways. I would point to the Land Grant
system, which established that technical
and scientific education was important for
the whole populace, as opposed to only the
wealthy or the gentry in this country.

I would point to the whole system of
public school education, which has a fun-
damentally different meaning in this
country than in others and, in the develop-
ment of, and now our transition away
from, the one-room schoolhouse. I say to
myself and to you, let us not lose our
perspective or sight of our opportunity for
innovation in this area.

In fact, let me restate this challenge dif-
ferently. Less than 50 percent of the par-
ticipants in this meeting represent those
issues concerning non-owner operators,

Papers and Proceedings


those who either are unpaid workers or
who are paid what are clearly substandard
wages and live in substandard conditions
across the country, then we have done a
less than adequate job in identifying the
issues. There must be enfranchisement of
all people in this country involved in
agricultural production, or we will not have
addressed the issues of agricultural health
and safety in an adequate and meaningful
way.

LESSONS FROM OTHER
INTERVENTIONS

Fifth, I would say that there are lessons
from other safety and health interventions,
lessons which I did not hear referenced
enough and which I am still curious about.
These include seat belts, child restraints,
helmets, and smoking laws,

Please do not misunderstand me. I am not
an advocate of additional levels of
regulation, but I do think that there needs
to be a balance between research,
regulation, surveillance, education and
behavioral change, and improved service
delivery. I strongly believe that there are
models from the progress made in the
areas of cigarette smoking, in helmet use,
in seat belt use, and as was raised yester-
day by Dr. Popendorf, in the process and
sequence of industrial hygiene, and how
science can be applied to American
agriculture.

SURVEILLANCE SYSTEMS

Finally, and in closing, a sixth area that I
would raise is that of surveillance systems.
I continue to be very frustrated about our
lack of a comprehensive and unified sur-
veillance system. This is especially chal-
lenging for someone who is a relatively
new entrant, as an individual, into the field

A Foundation's Perspective, May 2, 1991

of agricultural safety and health. I have
been very frustrated while working with
others to conceptualize systems that will
eventually serve populations at the local
level.

It is very clear to me that in a society that
is losing its grasp on the availability of
resources and on where we should put
resources, we will have the opportunity to
invest only in those programs and places
where we know interventions are effective.
Presently, we do not even have a system of
baseline surveillance data that is uniformly
agreed upon.

Even so, I hold out hope. I hold out hope
for evolution in the NIOSH or other
related programs as was mentioned yester-
day, in the surveillance system that is being
developed here in Iowa. I hold out hope
for what others have done on a state-by-
state basis, and for what more traditional
safety organizations have done to
document injury in agriculture in this
country.

I am convinced that we have not achieved
even the very basic goal of accurate injury
and illness data yet. We need to continue
to work towards this goal so that we can
measure the eventual effectiveness of
interventions.

Well, that brings me to the closure of my
remarks. For me the priority is community
intervention. Yesterday was a phenomenal
experience for me to again listen as some
of the health issues in agriculture were
raised, issues which it is difficult to become
familiar with, based on their chronic
nature as opposed to their traumatic
nature.

In sharing a closing thought, it seems to
me that as a nation we are more con-

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Research - Chemical and Biological Hazards

cerned than ever about the protection of
the resource base upon which American
agriculture is built. As evidenced by some
of the speakers in this morning's plenary
session, we have developed a greater con-
cern for the issues of land and water
management as reflected in agriculture.

These concerns cross all levels: local, state,
regional, and national. As I reflect on the
issues of sustainability, and I believe that
this renewed importance on the wise use

and protection of our resource base is
important, I ask myself, can the challenge
posed by the greater protection of all
workers in American agriculture, and in
the prevention of occupationally related
injury and illness merit any less attention,
as an issue for the sustainability of our
great agricultural system? My answer, and
hopefully, our common answer must be
that the protection of human resources in
agriculture is an area of critical impor-
tance.0

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Surgeon General's Conference on Agricultural Safety and Health
FARMSAFE 2000 . A National Coalition for Local Action
Convened by the National Institute for Occupational Salty and Health
April 30 - May 3, 1991, Des Moines, Iowa

A CLINICAL PERSPECTIVE

    By Dean T. Stuelanci, M.D.
Medical Director, National Farm Medicine Center

I am going to come at this primarily from
the point of view of a clinician and with
that I would like to make two quick com-
ments to Bobbi Ryder. One of the things
about someone who spends first six days in
Buffalo and then three days here in Des
Moines is that she cannot be accused of
exactly seeking the garden spots of the
country.

The second thing is you have a sore throat
and headaches. Why do you not take two
aspirin? If you take good care of your
cold, it will be over in seven days; if you
do not, it will last a week.

I have three parts to my presentation. The
first is some of the difficulties that I
believe a clinician in practice experiences
when trying to deal with the farming
population and, specifically, some issues
that were discussed yesterday. Second, I
want to look at some of the specific things
that were in each of the presentations.
Third, I want to make some short recom-
mendations.

DIFFICULTIES IN CLINICAL PRACTICE

As a physician, one of the real issues clear-
ly is what I would call a cultural gap bet-
ween the clinicians and most of their
clients, or patients in this case. We often
have to learn, so to speak, a language that
is different from what we would ordinarily
speak.

As an example, I can even report-and it is
nice of Kelley to speak as well as he did of
the Marshfield Center-but I can give a
report of my own colleagues having some
difficulty in confusing silo gas ex-
posure-that is, nitrogen dioxide-from
organic toxic dust syndrome or hypersen-
sitivity pneumonitis. The point, of course,
as was pointed out well yesterday, is they
occur at two completely different times.

They both can occur in silos. They have
different settings. Prognostically they are
worlds apart. But, in point of fact, when a
physician sees someone short of breath
who has just been in a silo, he says, "Well,
I suspect this is silo gas exposure," when, of
course, especially if it is in the spring, it is
not.

The same thing might go on when we get
to talk about more specific exposures. I
know one of the things that we think we
should do is encourage patients, that is the
farmers in this case, to know the exposures
that they have endured and be able to
speak to them with some intelligence, and
I think that is very good.

On the other hand, I can tell you as a
practicing clinician, everybody has all kinds
of strange exposures which they believe
they have incurred, and it is often difficult
to sort out fact and fancy. Although these
are worthwhile recommendations, it just is
not as easy as it may seem.

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Research - Chemical and Biological Hazards

Another thing we often talk about is the
age of machinery and its poor repair. But
we need to recognize that change in far-
ming practices actually occurs quite rapidly
and so those of us who left the farm at say
18 or 20 have to recognize that things are
being done significantly differently now
than they were then.

This is especially true if we deal with the
issue of chemicals. I think if you look at,
for example, the information on the back
of a pesticide bag and so on, it is all there.
It strikes me about as useless as a PDR
and nobody gives you any idea what is
important and what is unimportant; the
information is basically confusing,

Finally, I want to point out that I think
there is some sort of a feeling that farmer
and farm groups are in some sense not
particularly cooperative. I think we all
recognize they want to work and want to
get back to work.

There is always a tendency in any society
to blame the victim, and that is clearly the
case here as well-and especially, as we've
pointed out already, certain sub-groups are
especially difficult in the sense of not being
able to communicate to us well. For
example, migrant families have already
been spoken of, and likewise certain
secluded groups that tend to be in agricul-
ture.

Locally we have such groups as Amish;
obviously they speak English with us. For
example, as was pointed out in
Dr. Currier's discussion, they may not have
the simple vaccinations that we expect
most people to have had.

Second, I want to speak about difficulties,
for the physician, in some of the diagnostic
methods. When you go through, for

example, some infectious disease, you will
see references to serologic methods.

Serologic studies are very good in telling
you what has transformed from previously
negative to positive and they give you
some indication of what is occurring in the
population, but in terms of a specific
patient, you usually only get a diagnosis
after the fact. So if we can develop diag-
nostic studies that are more specific to
disease, we certainly can aid the clinician a
great deal.

In that regard, I would like to comment on
the issue of pesticides and viruses and the
relationship to cancers that are well recog-
nized. There is probably not a great deal
of difference from a clinician's point of
view as to the etiology of the cancer, un-
less we know something about preclinical
diagnosis or screening methods and can
make recommendations in that regard.

Clearly, recommendations with regard to
screening at least certain populations have
been fairly effective. If we can make those
sorts of recommendations-that is, who
should be screened, how often, and by
what method, or if there are some
preclinical diagnostic methods, who is at
risk-1 think we have come a long way.

As I have said, the diagnosis of the cancer
probably is not a particularly difficult issue
for the clinician, as treatment protocols are
well publicized. The issue of preclinical
diagnosis remains an issue which may have
social as well as medical implications.

Third, I think you have to recognize that
most practicing clinicians do not have a
great deal of public health or preventive
medicine orientation. We are taught, and
I probably more than most as I practice
primarily emergency medicine, how to deal

268                                    Papers and Proceedings


A Clinical Perspective, May 2, 1991

with things on an acute basis. We have a
very strong fii in terms of how to treat and
the need to treat. That is a real problem.

It is relevant, for example, if you look at
such things as control of hypertension or
control of cholesterol. Here you have a
number and an intervention that you can
follow.

It fits very well into the treatment model
because you can pick a disease by
definition, have an effective treatment, and
perhaps alter the patient's risk. But for
most of these things that we are talking
about, that is not true.

The issues then with regard to prevention
and exposure are sometimes dissatisfying
to both the physician and the patient who
find that there is no delivery of what they
consider to be health care even though
treatment may be very effective.

In that regard, I would just like to say a
couple of words about surveillance. I think
that many times it is useful to have clinical
cooperation with surveillance methods. I
want to just suggest that there are three
things that one needs to recognize in terms
of deriving cooperation from physicians in
surveillance methods.

b First, we clinicians are very good at
saying we are busy. Believe it! If you do
not believe it, just ask our families. So,
you have got to come on-even if it isn't
true-and say, "I understand you are busy."

b Second, it is looked at as an intrusion.
Since there is a perception that there is
already too much intrusion, you need to
make the point that that is not the intent.

' Third, if you point out that this is likely
to be useful, then it is going to go a long

way. Of course, in point of fact, I think
most clinicians are verv interested in
providing very good uskful information to
providing very good uskful information to
help prevent problems. I think most
help prevent problems. I think most
clinicians are found to be fairly
clinicians are found to be fairly
cooperative.
cooperative.

b Fourth is the issue of knowledge base.
It is important to remember that when we
talk about medical practice, we emphasize
the word "practice." Over a period of time
one develops a skill of being able to recog-
nize and do certain things particularly well
and other things less well.

Even with a well-developed left brain,
there is only a certain amount of infor-
mation that can stay anywhere near the
forefront. Even in a rural practice, the
agricultural illnesses are going to be only a
small portion of the overall practice. So
something needs to be done to keep that
information in the forefront.

We had here yesterday four very good
experts who spoke very well, and very
clearly, and very lucidly to the issues that
were raised. But for a particular physician
in a typical family practice, these are all
going to be blurred together and have to
be dealt with simultaneously. There need
to be some ways to get this information to
the clinician in ways that are more pala-
table.

One of the things people talk a great deal
about are data and information banks. I
have not particularly observed that my
colleagues are very quick in researching
those for care of a specific patient.

As an example, I just want to talk briefly
about the issue of cellulitis related to
needle sticks or puncture wounds, which
may occur in barns or areas where an-
tibiotics are used frequently. There are

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Research - Chemical and Biological Hazards

several people who will speak to the obser-
vation that the bacteria that are con-
taminating those wounds, when they
develop infection, are multiply resis-
tant-much different from the usual bac-
teria that clinicians have been told to ex-
pect in a skin infection. As far as I can
see, we do not yet have a science to pre-
dict what those bacteria are going to be
nor what antibiotics should be given to
treat such an infection.

Finally, in terms of problems, it makes no
sense to speak to the issue of agricultural
problems in medical practice without
speaking to the issue of the whole rural
health care delivery problem, itself. Clear-
ly, at the present time, the infrastructure is
being challenged in many ways.

As was alluded to yesterday, rural hospitals
are being significantly threatened.
Someone suggested that 25 percent are in
difficult straits. That is after 10 percent
have already left the practice. Although we
understand the need to reformat and
downsize, I think it is also important to
remember that at the present time, and I
want to emphasize "the present time,"
hospitals are usually the key to the medical
community. Hospitals do not necessarily
have to be the basis for a rural medical
community, but that does mean we are
going to talk about a different model.

The rural health practitioner generally
feels that he has a lack of support, that he
has difficulty probably with his professional
life and education, and that the working
poor are a particularly difficult problem in
terms of finances. Rural populations in
general have more than their share of
working poor, as has already been pointed
out in this session. Agricultural groups
probably have even a higher represen-
tation.

ISSUES RAISED IN THE
PRESENTATIONS

Next, I would like to speak to specific
issues that I think were raised in each of
the four talks, and hope here I will be a
bit more provocative.

The first difficulty is talking about the
differentiation between hypersensitivity
pneumonitis and toxic organic dust
syndrome. The differential diagnosis is
clearly important prognostically and per-
haps even clinically, but it is actually, I
think, much more difficult than it appears.
If one knows a specific allergen that is
expected in a specific region, then a very
useful test, of course, is the presence or
absence of that precipitant. At least that
tells you whether that specific patient is at
risk.

On the other hand, the differentiations
based on a chest x-ray, which I think many
times can be clinically quite subtle, or
arterial blood gases which usually are bor-
derline, can be very difficult. So, when you
are trying to tell the patient whether this is
an important exposure or not, whether the
prognosis is difficult or not, I find is not as
easy as it would appear. I guess I would
appreciate it if Dr. Von Essen could speak
to that a little bit at the end.

There is also an issue of acute and chronic
bronchitis. Although we recognize that
such things as buildings, particularly con-
finement buildings, are a risk, it is unclear
to me what difference that makes in terms
of clinical practice except from prevention.
I am unsure if you know of specific an-
tibiotics or specific treatment or prevention
protocols that would apply in a particular
exposure.

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Finally, I agree with the point that there
seems to be a relationship between organic
toxic dust syndrome and asthma; at least
many people seem to feel that is true from
an empirical or episodic point-of-view, but
I am not sure if there is exactly science or
statistics to support that, and I am not sure
if that is a clinically relevant issue or not.

Next I want to speak to some of the infec-
tious disease issues. First, I want to com-
mend Dr. Currier for stressing the problem
of the migrant farmworker who has the
whole family at risk because of living con-
ditions.

I might point out that it would be unwise
to speak of sexually transmitted disease as
occupational exposure. But that does
stress the importance of recognizing the
whole family and the environment as part
of the agricultural business. The risks are
not just that of work but also of the living
environment. This, of course, applies in a
large measure to the non-migrant farmer
as well.

I believe food-borne illnesses are primarily
an issue in the rural environment in
general. I think it is an increasing
problem, and I am not sure if you have
specific suggestions in that regard or not.
Clearly one issue is knowledge. For
example, the physician assistant with whom
I work can regularly diagnose giardiasis
because we see it so frequently. Again, it
is not necessarily an agricultural problem;
it seems to be rural in general.

1 also appreciate the emphasis on
populations at risk, especially the elderly
and the children. I want to emphasize
with regard to the infectious diseases that
the new practices lead to new problems, or
sometimes resurfacing of old problems. It
is good to keep before the clinician how

A Clinical Perspective, May 2, 1991

things are changing in agricultural practice,
because it is going to change in their prac-
tice as well.

Next, I want to discuss pesticides. It is
probably appropriate that the discussion of
acute pesticide exposure was largely ig-
nored because it is probably better recog-
nized in practice anyway. At any rate, it is
actually, from a statistical point of view,
not a big part of anyone's particular prac-
tice; I am not making any points about
that.

With regards to chronic effects, I would
like to ask for more information. First is
in regard to neurologic symptoms. It
seems to me that in a clinical practice, one
hears this issue asked about a great deal,
not only by the agricultural worker or
family but the people across the fence
from them.

Please remember that even in the most
rural of communities, close to half of the
people are just rural dwellers and not
agricultural farmers or workers.
Neurologic symptoms tend to be vague.
They tend to be similar, whatever the
cause. There seem to be ineffective inter-
ventions, and the prognosis seems to be
very difficult to ascertain. So any further
information that we can get in that regard,
and especially good diagnostic studies, I
think would be very helpful.

With regard to cancer, I concur with by
Dr. Blair, also alluded to earlier, that the
farmer may well be the "canary" or the test
animal for cancer in our society. We are
seeing an increase in many cancers, and so
this is very relevant information.

I think the idea of synergism between
chemicals is basically a given. For
example, there is the farming practice of

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Research - Chemical and Biological Hazards

applying two herbicides for a specific weed
where it is recognized that plants are
developing resistance. If they need to use
synergism against the pests, I suspect that
synergism applies to the unfortunate vic-
tims as well.

Finally, looking at the issue of gases and
vapors, one of the difficulties that I have
as a clinician is obtaining good, adequate
measurements. That is not necessarily
because of the fact that there are not good
industrial hygiene methods, but we have to
appeal to people like those in Iowa to turn
out these people much more quickly and
with an agricultural background. Clearly
we need that kind of consultation.

We need to close the loop between what
is happening on the farm and what is
happening in medicine so that people
understand each other.  I

A specific problem is the allergic responses
to some of these substances such as pes-
ticides, antibiotics, or whatever chemical
you wish. Both farmers and clinicians
need to recognize that many of these are
sensitizers, so the chemical that has not
been a problem in the past may become
one in the future; at least clinically that
appears to be the case. Otherwise, the
farmer and clinician tend to dismiss the
idea that a particular chemical may be the
problem.

Second, I want to speak to the issue of
antibiotics again. My bias is that a big
part of the problem with feeding an-
tibiotics to animals is not residual an-
tibiotics in the animal, but the change of
the local environment in which the animal
is present. Perhaps these antibiotics may

be an allergen, especially for the farmer,
and not necessarily for the person ingesting
the food.

I think it is good that Dr. Popendorf
pointed out that the manure gas is, for
example, something that needs to be
understood much better by clinicians. For
example, the case in the Upper Peninsula
of Michigan to which Mr. Graham referred
was reported in some sources as methane
poisoning. Although methane was undoub-
tedly present, I agree with Dr. Popendorf
that the most likely agent was hydrogen
sulfide.

The relevance is in emergency medical
practice. Hydrogen sulfide, if you are
going to treat it, should be treated with the
nitrates in the cyanide kit; whereas if you
are dealing with methane, it is primarily an
issue of oxygenation and ventilation, which
does not necessarily need specific treat-
ment.

RECOMMENDATIONS

Finally, I would like to close with just five
recommendations.

1. We need to work to help the clinician
and, therefore, the farmer on specific diag-
nostic methods and treatment methods for
agricultural problems. If there are specific
treatments that should be different for
different types of agricultural exposure, we
need to know those.

2. We need to look much better at the
issue of promulgation of this information
as reference works. We need to close the
loop between what is happening on the
farm and what is happening in medicine so
that people understand each other.
Because of the distance typically between

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A Clinical Perspective, May 2, 1991

the clinician and the farmer, that will not
happen without specific efforts.

3. We need to increase the status of such
entities as state and local health
departments and industrial hygiene and
provide adequate resources for them to
respond to the clinical needs of farmers.

4. We need to deal with the issue of the
rural medical infrastructure in general. If
the rural medical infrastructure is in dif-
ficulty, then these agricultural health
problems cannot be addressed well.

5. One of the things that I find personally
important-and I think many of my col-
leagues would agree-is the positive aspects
of medical practice in the rural, and
especially agricultural, communities. The
patients generally are very appreciative of
the care they get. They are very willing to
go into rehabilitation. In fact, most
clinicians complain that rural patients want
to go back to work before they are well.0

Surgeon General's Conference on Agricultural Safety and Health - 1991

273


Surgeon General's Conference on Agricultural Safety and Health
FARMSAFE 2000 o A National Coalition for Local Action
Convened by the National institute for Occupational Safety and Health
April 30 - May 3, 1991, Des Moines, Iowa

FARM MACHINERY AND VEHICLES

    By Thomas L. Bean, Ph.D.
Safety Leader, Ohio Cooperative Extension Service
      Ohio State University

Preparation for this presentation included
the review of literature, accident reports,
unintentional injury data, and technical
and professional papers from the United
States and foreign countries. One of the
earliest was a 1931 study by J.R. Jewel1
from the Cooperative Extension Service,
University of Nebraska. After such an
extensive review, it is appropriate to pro-
vide a broad, general brush to this topic
and indicate the most significant items that
stood out as general findings, which
seemed to run as a thread or recurring
theme in much of the literature.

volving" tractors were the most common
type of machinery-related trauma.

Tractor over-turns, it appeared, were in-
volved in the majority of agricultural fatali-
ties. Many studies indicated that youth
and the elderly were most often associated
as an at-risk population.
The studies varied, though, when you com-
pared those using statistics from govern-
ment agencies that were not gathering the
appropriate and associated data with
youth.

AGRICULTURE, A HAZARDOUS
OCCUPATION

The most obvious finding was that agricul-
ture, based upon statistical studies, was
usually classified as a hazardous industry
or occupation. Most early studies concen-
trated on on-farm injuries as occupational
in nature. In either case, the majority of
studies indicated that farm equipment was
the single factor most associated with on-
farm injury.

Farm equipment accounted for 40 to 60
percent of deaths and injuries in the ma-
jority of studies, followed very closely by
livestock injuries and falls. Numerous
types of farm machinery have been im-
plicated in all studies, Since the majority
of farm machinery is associated with trac-
tors, it stands to reason that injuries "in-

In either case, the majority of studies
indicated that farm equipment was the
single factor most associated with on-farm
injury.   I

Injury data for youth under a certain age
was often excluded from the data base.
Many studies conducted by those of us in
the field have included unintentional inju-
ries, which have occurred in the lower-age
group, and recognize the associated prob-
lems.

GENERAL DUTY

The opportunity presents itself to include
some homespun theory. This happens to
be a theory of mine: on family farms,
older tractors and equipment are often
reserved for general duty while newer

274

Papers and Proceedings


pieces of machinery are delegated to more
production types of tasks. The general
duty may be more hazardous than the
normal production tasks on farms.

As a result, general duty is often done by
the youth or the elderly. The typical farm-
er, the principal operator, is using the
newer machinery to plow and till the field,
etc., while the older machinery may be
relegated to cutting the fence rows or ditch
banks and stationary operations that may
be more hazardous than doing field-related
operations. As a result, when you combine
the inexperience of youth and the dimin-
ished capacity that comes with aging (be-
cause the elderly or youth usually do this
general duty) with the inherent danger of
the equipment, you have an increased
potential for trauma.

HIGHWAY HAZARDS

Few studies have centered on farm ma-
chinery and the hazards associated with
highway travel. This is an area that needs
additional study.

A recent study by Farm Journal surveyed
100 of their readers. Those readers indi-
cated that traveling on roads to reach the
field was one of their primary safety con-
cerns. Of concern to these readers were
faded slow-moving-vehicle (SMV) em-
blems, implements without brakes or lights,
no turn signals, no clear differentiation
between the turn signal and the flashers,
and no stops or pins to hold the equipment
in transport. Some equipment is held in
transport by the hydraulics.

There is also a problem of farm vehicles
being exempted from state motor vehicle
laws. These exemptions are based on
agriculture being a protected class, similar
to the farm exemption by OSHA. The

Farm Machinery and Vehicles, May 1, 1991

protection agriculture is given as a protect-
ed class varies from state to state.

A review of state laws will reveal that a
farm tractor is usually well-defined, which
means that many state legislatures can
recognize a farm tractor. However, when
you explore legislative definition of imple-
ments of husbandry, farm machinery, farm
wagons, farm trailers, or special vehicles
(another term in many state laws for such
farm equipment), you discover a gray area.
The typical legislature fails to define them.

Exemptions are set by definition or the
lack of definition. This is the problem. It
is a learning activity that needs to be con-
ducted with state legislatures.

Farm vehicles-varying, again, from state to
state-may be exempt from registration.
They may be exempt from any kind of
inspection, adequate lighting requirements,
braking requirements, or other require-
ments, which are normally associated with
other types of vehicles.

As an example, if you study the West Vir-
ginia laws, you will find that farm vehicles
may be exempt from braking requirements.
If you do not have to have brakes, you are
exempt. As for a driver's license, most
states exempt agricultural vehicles and,
therefore, the people that run them, from
any kind of licensing requirement.

Age or physical condition does not make
any difference. They are exempt by defini-
tion. It is a problem.

An eight-year-old can operate a farm vehi-
cle on roadways. Yet all other drivers may
need a driver's license to operate motorcy-
cles, cars, buses, trucks, etc. This is not so
for farm machinery. This is a sample of

Swwm General's Conference on Agricultural Safety and Health - 1991                275



Research - Mechanlcal and Physical Hazards

the many other exemptions caused because
agriculture is a protected class.

STUDIES IN OHIO

Some of the studies that we are doing in
Ohio, I will briefly present to you.  We
have a project now with a special agricul-
tural population, the Amish.

Buggy Safety

If you were to view Ohio highway safety
statistics, you would find there are three
classes of agricultural highway accidents.
One is tractors, the second one is farm
machinery, and the third one is buggy
accidents. Are buggy accidents part of the
agricultural problem?

The answer is probably, because the Amish
really only use buggies for two things:

1. To do some activity concerning the
farm.

2. To go to church.

So buggies can be a potential agricultural
problem. We are embarking now on an
effort to work with Amish youth in their
schools on safe buggy operation.

Highway Safety

We are conducting a second project in
cooperation with our Highway Safety Of-
fice. In the fall, we will be conducting a
survey of 1,200 farms in an effort to get
the farmers' perceptions of the hazards of
operating agricultural equipment on the
state and county highways in Ohio:

1. What type of equipment is actually
being operated on the roadways?

2. What are the conditions under which
farm machinery is moved on the road-
ways?

3. What are the major problems with op-
erating farm equipment on roadways?

4. What is the road worthiness of farm
equipment?

RECOMMENDATIONS

Although there are many that could be
made, the following are some recommen-
dations for research and action,
1. We need to continue efforts in research
on human sensors and automatic shut-offs.
If a person is too close to the tractor in a
given situation, it should not start or con-
tinue to operate.

2. Research on roll-over protection on
older tractors should continue.

3. There should be aggressive inclusion of
safety in all of ASAE and other standards.

4. There should be research conducted on
the lighting and marking of agricultural
equipment.

5. There should be some consideration for
a uniform motor vehicle code on farm
tractors and machinery used on the high-
ways, including set definitions of types of
agricultural equipment. This would pro-
vide a model for states to consider in fu-
ture legislation.

6. There should be continued studies on
agricultural safety educational techniques
that work.0

276

Papers and Proceedings


Farm Machinery and Vehicles, May 1, 1991

REFERENCES

1. Jewell, JR; Farm and Home Accidents: Their Cause and Prevention. Extension Circular 5578,
University of Nebraska (1931).

2. Ottey, Audra and Charlene Finch; "Farm Journal Survey Shows Road Travel Tops List of Safety
Concerns." Farm Journal, Volume 115, Number 3, February 1991.

QUESTIONS

John Hahn: I am with the Iowa Division of Labor. Regarding the ROPS, the rollover protection on the
tractors, I have heard no mention about the need to use a seat belt or a safety harness to keep from being
thrown out of the tractor on to the ground where you can be crushed by the crush-proof cage as it rolls over.

Dr. Thomas Bean: Deftitely that is a problem. We-1 say we-a lot of us know that that is a problem. I can
go to any farming group, and I ask how many have rollover protective structures-&her cabs or poles-and
get a good many hands. Then I ask the next question, "How many use their seat belt?" You will probably
find zero or very few. We realize that it needs to be addressed as a behavioral problem. Farmers tell me
the reason is because they get off and on their tractor so many times. Something has to be designed or
implemented or there has to be education about what is acceptable to that group as far as belting them in on
the tractor. Often I try to use the example of highway safety and ask them, "Do you use it when you ride on
the highway, at least ?" Still the answer is very, very low.

John Hahn: With seat belts on things like tractors-I once looked into seat belts on forklifts, and there is a
big controversy on forklifts, and there is something that they call the fly swatter effect. That is, when you fall
off an elevation on a forklift, is it better to be fastened in there so that when you hit, your head goes bump,
bump, bump against the pavement, or is it better to be unrestrained ? There probably is some of that in
agriculture also.

(inaudible): I am back. One thing on your comment on the forklift. Generally, other construction
equipment works with a seat belt. What some companies have done to keep the guy's head from being
pounded into the ground is just to take metal screening or expanded metal and put it on the side and that
way he can just cut his head up once against the screening when he goes.

John Hahn: I was talking about forklifts. I just might add, I know that there are a lot of problems on the
issue of seat belts, when you put a screen or that type of thing on. I know it is more of an issue in logging
than it is, maybe, in farming, but the idea is that once you put that screen in, you have now taken that
person, and if he has the seat belt on, he can become a human pincushion. The point I was trying to make
is, this whole issue of seat belts is a very tough one because, depending on what industry you are working in,
there were a lot of complaints when NIOSH talked to OSHA and recommended seat belts on skidders in
logging. The main complaint we had was you had screening devices on those skidders to provide something
like a cage for that person whiie he is in the skidder. When it rolls or rolls over or while he is moving
through the woods, if sticks, and that kind of thing comes in through that mesh, he cannot get out of the way
if he has his seat belt on. I have not heard that complaint yet from farmers, but at the same time, these are
the types of issues that you have to learn to resolve when you start talkiig about the use of seat belts on this
type of equipment. There are other factors that we have to be aware of and we cannot make just a blanket
statement that seat belts are the best until we start getting some good information and look at some of the
other types of alternatives, such as possibly a seat bar. We are not sure what is going to work.

(inaudible): I just have a comment on the seat bar versus seat belts. In Canada, log skidders are being
equipped with seat bars, and it looks like they are getting very popular.

Surgeon General's Conference on Agricultural Safety and Health - 1991

277


Surgeon General's Conference on Agricultural SaMy and Health
FMMSAFE 2000 o A Nafional Coalition for Local Action
Convened by the National Institute for Occupational Safety and He&h
April 30 - May 3, 1991, Des Moines, Iowa

MUSCULOSKELETAL HAZARDS

         By David Cochmn, Ph.D.
Industrial Engineer, U.S. Occupational Safety and Health Administration

Good afternoon. I feel a little out of wa-
ter in that my specialty is not in agricul-
ture. I have been asked to talk about
ergonomics, musculoskeletal disorders, and
agriculture.

As I started thinking about the agricultural
environment, I realized that I see it as a
hostile environment. It is about as hostile
an environment as we have in this country.
We have chemical and dust hazards, ma-
chines that can take your bodily parts
rather easily, slips and falls, amputations,
death, noise, and temperature hazards,
including cold stress and heat stress. We
also have whole body and segmental or
limb vibration, explosions, and infectious
diseases. Lastly, on my list, we have
musculoskeletal hazards.

Quite honestly, I think most of you and
most people in agriculture do not consider
musculoskeletal disorders or musculoskele-
tal hazards very much. If you do, you
think of back injuries. Back injuries prob-
ably are far and away the biggest problem
that my discipline, which is ergonomics,
deals with.

There are, however, cumulative trauma
disorders of other sorts. I consider back
injuries cumulative trauma. In many cases
it is a one-instance injury, but in most
cases we strongly believe that they are
cumulative. The more times you lift exces-
sive weight, the more times you stress your
back or strain it, the more likely it is that

278

you will have a back injury. It is a cumula-
tive problem.

In addition, we have problems of the up-
per extremities. I am going to go into that
in a minute. I thought, that problem is
probably not present in agriculture.

I was talking to a friend of mine, Barbara
Silverstein, who was with the University of
Michigan and is now in the state of Wash-
ington. She was telling me that the top oc-
cupational category suffering from tendini-
tis in the state of Washington is
farmworkers. They do not have the foggi-
est idea why or where it is occurring.

Ergonomics and cumulative trauma do
exist in agriculture, and probably a lot
more than we realize.

CUMULATIVE TRAUMA DISORDERS

Now, being a professor I have to educate a
bit, just in case you do not know some of
the things that I think are important. I am
going to talk about some of the cumulative
trauma disorders. These can be of the
upper extremity or the lower extremity-not
necessarily concentrating on the back.

Tendon-related Disorders

First, tendon-related disorders usually
occur by overuse of, or stretching of, or
excessive forces exerted by these tendons.
The most common is tendinitis, inflamma-
tion of the tendon tissues. Another very

Papers and Proceedings


common illness is tenosynovitis, separate
or concomitant inflammation of the tendon
and its sheath.

I normally think of it as the sheath. I do
not know how good your anatomy is, but
we have tendons. Tendons really are ca-
bles in the body. Around those, in strate-
gic locations, we have soft tissue that pro-
tects the tendons, called sheaths. They are
a lubricated tissue. As the tendon slides
around a corner or moves past bones, it is
protected by the tendon sheath.
When the sheath becomes inflamed, it is
normally called synovitis. Sometimes when
the tendon is involved it is tenosynovitis.
This is common in normal manufacturing
operations. It probably is common in
farming or in agriculture, but we do not
have much data.

Carpal Tunnel Syndrome

Second, carpal tunnel syndrome gets all
the press. It is a problem in the wrist.
One of the nice things about this one is
that all the reporters are suffering from
this. Since they are suffering from it, they
write about it. There is nothing like hav-
ing an interest in your own preservation.

Carpal tunnel syndrome is indicated by a
numbness or tingling on the palm side of
the first two fingers, part of the third fin-
ger, and the thumb. It is the damage to
the median nerve that goes through the
carpal tunnel.

The carpal tunnel is in the wrist. It is
bordered on three sides by bones and on
the fourth side by a strong ligament. None
of these give very much. So when you use
your tendons a lot, you get tendinitis or
tenosynovitis.
swell.     When you do that, things

Musculoskeletal Hazards, May 1, 1991

When they swell in a confined space, they
compress on each other. You get a circu-
lar problem in that the more they swell,
the more they are damaged, the more they
want to swell, the more they are damaged,
and it keeps going around and around. It
gets worse and worse.

The best thing to do is quit doing whatever
you were doing that made it happen. It is
like the dentist I went to one day. I said,
"You know, my teeth hurt when I do like
this," and he said, "Well, do not do that."
It is the same way with carpal tunnel syn-
drome and all of these things.

If you back off and do not do whatever is
causing it as much, frequently it goes away,
and you do not have to end up in very
expensive surgery. You do not have to
end up disabled.

Raynaud's Syndrome

Third, Raynaud's syndrome, or occupation-
al white finger, is a shut-down of the circu-
latory system. It is caused by exposure to
vibration in the hands. I am not familiar
with this disorder in the feet, but it might
happen there. So segmental vibration or
arm and hand vibration can bring this on.

I have not driven many tractors, but the
ones I have driven vibrate. Old tractors
are the only ones I have ever driven, be-
cause I do that kind of work you are talk-
ing about. I have a farm. I am a city boy,
but I bought a farm. I have an old Ford
tractor, and it does vibrate. There is a lot
of vibration out there.

There is also non-occupationally caused
Raynaud's syndrome. Some people get if
without being exposed to vibration; mostly
it is women who acquire it this way.

Surgeon General's Conference on Agricultural Safety and Health - 1991

279


Research - Mechanical and Physical Hazards

Let me go back-there are just a few of the
agriculture-related cumulative trauma
disorders. There are twenty-some repeti-
tive motion related disorders of the upper
extremities. There is rotator cuff, pronator
teres syndrome, cubital tunnel syndrome,
and epicondylitis. These are just examples.
Do not get the idea that there are just a
few of these disorders.

What do you do about cumulative trauma?
First, I am getting the cart before the
horse, but you have got to work on what is
causing it, and so you work on the tools
and the work station. Normally I deal with
a fixed work station, and in agriculture that
is not necessarily true. So the problem is
more difficult to deal with.

We work on the methods: how people do
their job, how they do the tasks. I put
training and monitoring in there. It is hard
to deal with changing behavior; because I
do not have a lot of faith in training if it is
easier to do something one way than the
other.

I do not think we have a problem with
work pace in agriculture, certainly not in
the farming part of agriculture, maybe in
other places. I am going to skip idle time;
that is production-line-oriented.

RISK FACTORS

There are six risk factors that we look for
in cumulative trauma.

Repetition

First is repetition, high repetition. If you
are doing something highly repetitive over
and over again, it tends to cause these
problems. Repetition is rampant in things
like processing of fish, meat packing, and
luggage making.

Is high repetition present in farming? I do
not know. I do not think anybody knows.
My guess is that repetition is not where the
major problem is.

At the other side of the curve, statically
maintaining muscles causes problems.
Statically loading muscles causes them to
be exerted. They build up metabolic
by-products. A lot of the time the circula-
tion is cut off so that nutrients are brought
into the muscles and the by-products are
not carried off and you get rapid fatigue.
Very static operations are a problem and
very dynamic or repetitive operations are a
problem.

High Force

The next factor, high force, is probably
present in spades in agriculture, especially
in maintenance-type things. Farmers and
agricultural workers are notorious for ig-
noring good sense and picking up things
they should not pick up. They exert high
forces.

Things that require pinch grasp go along
with that. Anytime you start using the tips
of your fingers to exert force, you are not
mechanically effective. It puts the body at
a bigger disadvantage than normal.

So we have pinch grasp, we have static
grasp, and what I call a press grasp, any-
time you are pressing with hands. In in-
dustry when you are boxing things or when
you are folding boxes or you are pressing
down on tape, you start getting incidences
of carpal tunnel syndrome. Those motions
tend to be highly repetitive and with a
press at the end of them.

Gloves cause problems. Gloves cause
people to overexert for two reasons: they
interfere with the grasp, and they interfere

280                                    Papers and Proceedings


with the feedback, so people tend to over-
grasp. Gloves are worn a lot in agricultur-
al work.

Posture

First, let us talk about shoulder posture.
Anytime you are reaching down and be-
hind or you are putting your elbow up in
the air, you are doing something that a
meatpacking company I have dealt with
calls winging of the elbows. When they
look at any kind of a task, they look for
that. That causes problems with the ten-
dons and the nerves.

Repeated inward and outward rotations,
especially when you are going from the
maximum of one to the other, is called
pronation and supination. Inward and
outward. Think about rotating the fore-
arm. If you do that frequently, it causes
problems such as cumulative trauma
disorders.

When tasks are highly repetitive or are
highly forceful and involve bending the
wrist, they cause the tendons to wrap
around a corner. They are pressing
against those soft tissues that are supposed
to lubricate their movement. Sometimes
they press against the median nerve and
do damage. We want to keep the wrist in
a neutral posture as much as possible.

Mechanical Stress Concentrations
Anywhere on the Skin

If you have somebody who has to maintain
a pressure on the hand or anywhere else, it
is a problem. Resting their arms on sharp
edges or lack of a good armrest can cause
nerve damage. It can cause circulatory or
circulation damage.

Musculoskeletal Hazards, May 1, 1991

If they use their hand as a hammer, like
banging hubcaps on, banging things loose
with the palm of their hand or the base of
their hand, this causes nerve and circula-
tion damage. Mechanical stress concentra-
tions anywhere on the skin can cause prob-
lems.

A lot of the tools we use-pliers, screwdriv-
ers, things like that-press right in the palm
of the hand where you have the tendons
and the nerves running, and they do dam-
age.

Vibration

There are probably people in this audience
who know a lot more about vibration than
I do. We have whole-body vibration, and
we have segmental vibration. Dealing with
each is different.

The frequencies that cause problems are
different. As far as I can tell in reading
the literature, there is no good number as
to what is excessive and what is not.
There are some guidelines.

NIOSH put out a publication on this with-
in the last year.' It is pretty good, but as
far as I could tell there is no magic num-
ber that says, "When you start exceeding
this number, you have got problems."

Cold

Now, when you throw in cold with any of
these other factors, it accentuates it.
When you throw in vibration with any of
these other factors, it accentuates it. If
you put cold in the environment and you
get cold hands or cold muscles and ten-
dons, it accentuates the problem. If you
are doing some of these things and your
body is vibrating, it accentuates the prob-
lem.

Surgeon General's Conference on Agricultural Safety and Health - 1991                281


Research - Mechanical and Physical Hazards

If any of you are familiar with industrial
hygiene or familiar with chemical hazards,
you know that OSHA sets permissible
exposure limits (PEL's). Those are based
on single-chemical exposures or
single-agent exposures.

She was telling me that the top
occupational category suffering from
tendinitis in the state of Washington is I
farmworkers.

No one knows what the combined pres-
ence of toluene, gasoline, and carbon mon-
oxide does to you and at what concentra-
tions that combination is a problem.

WORK DESIGN

It seems to me in agriculture that we have
a problem of work design. We have the
task that people are doing. We have the
machinery and equipment they are using.
We have the products that they are pro-
ducing and the products that they are us-
ing. All of these combine to be potential
problems.

One of the things that I am interested in is
packaging. Things that people use on the
farm are packaged in anywhere from 5- to
loo-pound quantities. I have seen people
picking up 50-pound containers or
loo-pound containers and standing in pre-
carious situations and pouring them into
hoppers or whatever.

The same thing in ergonomics occurs. We
have repetition here. We have force. We  It is no surprise that we have back injuries.

have posture. We have mechanical stress-  It is no surprise that we have slips, trips,

es. We have cold and vibration. All of   and falls. In fact, if these were in regular
these things combine in some way to cause  industry-if I were not working for OSHA

problems.                at the moment-I would say, "OSHA might
                        shut them down." It is hazardous.

One of the main questions I get is, "How
many repetitions are too many reps? How
much force is too much force?" We do not
know because the problem is almost al-
ways in combination with something else.
You cannot isolate them. We know that
almost no force is required if the repeti-
tions are high enough, because we have
people that sign for the deaf that get car-
pal tunnel syndrome.

This is far and away the easiest to read
and best book on cumulative trauma of the
upper extremity.2 It was originally put out
by NIOSH, and it is now available from
Taylor and Francis for about $23. There is
an 800 number. They are located in Phila-
delphia.

RESEARCH NEEDS

I could not find data or anybody who knew
of any data out there relating to cumula-
tive trauma disorders, and there is not
much relating to back injuries in agricul-
ture, which I see as the number one re-
search need. We have a dearth of data.

My understanding is NIOSH is beginning
to act on this and that there are several
programs. I think there are about three
programs that may start to collect more
data. I will admit that I may be ignorant
of some of the data that has already been
collected.

1. From my point of view, we need to
determine the nature and the extent of the

282                                 Papers and Proceedings


Musculoskeletal Hazards, May 1, 1991

problem. We also need reporting. It is
my understanding that most farmers have
never heard of an OSHA-200 log.

2. We are going to need epidemiological
studies.

3. We are going to need studies on pack-
aging and how to repackage things.

4. We need studies of what are the high-
incidence tasks out there. Now some of
them you know, but I would venture to say
that if we ever arrive at cumulative data, if
it is out there, we will find some tasks we
do not know about now.

5. We also need to research what can be
done in machine and equipment design to
minimize cumulative trauma disorders, if
that is what is causing them.

6. We need to figure out what the costs
and the benefits are.

7. Lastly, and not necessarily least impor-
tant, we have to come up with things that
are acceptable to the people doing the
work.

You know as well as I do that there is no
more independent group than farmers.
Maybe truck drivers challenge them, but
farmers are very independent. You put
guards on machinery, you do things that
are supposed to be for their benefit, and
they blow it off. We have to come up with
solutions that are acceptable to this com-
munity.0

REFERENCE

Putz-Anderson, Vern; Cumulative Trauma Disorders: A Manual for Musculoskeletal Diseases of the Upper
Limbs. New York: Taylor & Francis, 1988.

QUESTIONS

Ronald Schuler: I am from the University of Wisconsin, Madison. Dr. Co&ran, have you heard of milker's
knee, and is that a cumulative disorder?

Dr. David Cochran: I have heard of it. I am not familiar with it. My guess is yes, but I do not know. Tom,
do you know?

Dr. Thomas Bean: It is very similar to miner's knee. It is a bursitis, an inflammation of the bursa of the
joints, because of the constant bending, and the repetition, and the force as you are kneeling against the
ground.

Dr. Wesley F. Buchele: I am Wes Buchele from Iowa State University, retired. Dr. Co&ran gave a list of
things you ought to conduct research on. I would like to add to that list, if I might, putting a screen over a
wagon to permit people from sinking in the grain when they happen to be on grain. I happen to be one that
thinks we should put extra seats on the tractor, with seat belts, because people are going to ride tractors and
are going to have more than one person on the tractor. Therefore, we ought to start taking care of the
problem as they do in Europe. I also think that we should think about putting floor boards on tractors to
eliminate people being run over by tractors, which they are from time to time-run over by either a front
wheel or a back wheel. We no longer put planters and cultivators in that area. I think we also ought to put
a seat bar like on a ferris wheel or on forklifts. They have taken care of the forklift problem by putting a

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Research - Mechanical and Physical Hazards

seat bar on the skid steer loaders. We should have seat bars on tractors. We should also promote the use
of guards by retrofitting. I think that we need to retrofit roll bars on tractors, guards on power take-off
shafts, and guards on augers.

Mark Veazie: I am from the Johns Hopkins Injury Prevention Center. Dr. Co&ran, have you done or are
you aware of any assessments that have been done on cumulative trauma risk with manual harvesting typical
of migrant and seasonal farm work?

Dr. David Co&ran: I am not aware of any, but there may be.

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Surgeon General's Confrmnce on Agricultural Safety and Health
FARMSAFE 2000 9 A National Coalition for Local Action
Conumed by the National Institute for Occupational Saristy and Health
April 30 - May 3, 1991, Des Moines, Iowa

ELECTRICAL POWER

       By Robert McLymore
Extension Safety Specialist, North Carollna State University

Dr. Glen Hetzel contributed a lot to this
presentation, as well as some of my other
colleagues. In the event that I did not call
you to get some background information,
do not feel bad. When they have the pan-
el presentation tomorrow, you can answer
some questions.

Electrical safety areas of concern are elec-
trical wire components, electrical wiring
systems, overcurrent protection, ground-
fault interrupters, and grounding. These
terms may not be important to you now.
Maybe as you think in terms of what you
do at your home, these terms can have
some significance.

ELECTRICAL WIRING SYSTEM

The reason why I am talking about electri-
cal wiring components is that we need to
know where power is coming in on an
operation.

We know that it is coming in several plac-
es-at the service entry riser and the meter.
You may have a meter on your home.
Think about it. There are meters on
farms.

Farming is not like that picture that you
saw-that poster-where you see them out
in the fields smiling, laughing, carrying on,
and having fun. It is much more. There is
power somewhere on that farm: overhead
power; there is underground power coming
to that farm. It all has to go through a
certain code.

Figure 1. An Example of a Wiring Box.

For these components, you should only
have licensed electricians install that elec-
tric wiring, and it has to be inspected.
This may be what one of those wiring
boxes looks like (Figure 1).

You have never opened one up, have you?
You have never opened your fuse box up

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Research - Mechanical and Physical Hazards

at home, have you ? It does not look like
that. It has circuit breakers in it, has it
not? This assures that the wiring will meet
the requirements of the National Electric
Code (NEC), as well as local safety codes,
which may be in your home or in your
state.

There are requirements for agricultural
buildings in Article 547 of the NEC that
specifies the type of materials to use for
safety and protection is the environment in
which this wire is contained. Dusty or
damp conditions exist in agricultural build-
ings, which may create explosive atmo-
spheres or corrosive conditions for electri-
cal metal fixtures and equipment.

Did you ever think about that? These
things, in themselves, may be explosive.
That explosion may be in the form of a
fire. That is what those conditions may be.

Figure 2. The Atmosphere of a Chicken Barn.

How many of you know about poultry.
You ate it today at lunchtime. Was it
good? Those are dusty, damp, dirty condi-
tions-if you did not catch it in the last
slide, that is what dust looks like when it is
in suspension in the air (Figure 2).

This is what dust looks like when it is
coming out of that vent that is adding air
into that house (Figure 3). It is collecting
particulate matter. Will that dust bum? Is
it truly just dirt, or is there partially dry
material in with that material?

OVERCURRENT PROTECTION

The next part is overcurrent protection.
There are specific types of overcurrent
devices. You have the plug, the cartridge
fuses, and the breakers.

Figure 3. Dust on an air vent from a Chicken Barn.

Fuses

This is what they look like (Figure 4).
There is the fuse (right, center in Figure
4). You have seen this type at home be-
fore, a screw-in fuses.

That is another type of cartridge fuse (also
in Figure 4). Some are delayed so that
when a surge of power goes through
them-too much electricity-they are de-
layed. They protect the conducting wire.

You are probably more familiar with
breakers in a box at home (Figure 5). The
fuses and breakers are installed to protect
the circuit, not the appliance.

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Figure 4. Examples of Fuses.

Figure 5. Examples of Breakers.

There are special fuses that are available
to protect the electrical equipment, and it
is important that we realize that
overcurrent devices are sized to carry no
more current than the circuit wire is rated
to carry. Is that important to you? Is it
important to that farmer?

Yes, it is important because he has some
expensive equipment that he is using, and
overcurrent protection is needed to protect
it. What about for his own personal life?

Electrical Power, May 1, 1991

Think about you and the overcurrent de-
vices that may be in your home.

You have wires like this that are made to
carry a specific amount of electricity. If
contact is made with a live part, will the
overcurrent device trip and protect human
life? No.

Well, I used to work at a funeral home, so
I have seen it, too. The human body will
receive a lethal shock if the current that
flows through the body is 0.01 amperes or
greater. A fuse or breaker will not provide
protection to the human body. The wire
protected by the proper size of the fuse or
breaker will not allow the temperature of
the wire to exceed safe operating condi-
tions and cause what we have on some
farms-explosions in bins and fires where
material may be stored, like hay or dry
feed.

GROUND-FAULT INTERRUPTER

The ground-fault circuit interrupter
(GFCI). Are you familiar with that term?
Do you know about it? You have seen it a
lot? You buy devices, appliances, that
have GFCI's on them. It is the most re-
cent device that is used and designed to
protect human life from shock.

It is designed to detect minute amounts of
current, 0.005 amperes or greater leakage,
from the circuit. It is supposed to trip the
circuit off.

The overcurrent power and the conven-
tional tripper turn the circuit off when
there is a current flow that is in excess of
the rated value of the breaker. The GFCI
may be a separate device or it may be
incorporated within a breaker. It is de-
signed to give protection from that lethal

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Research - Mechanical and Physical Hazards

shock in a fraction of a second. It can be
used on any 120-volt circuit.

It is also required in places at home by
NEC. These places are in the kitchen, in
the bathroom, in the garage, and exterior
sockets on the house.

How many of you use extension cords
outside to, perhaps, vacuum the car? Has
the circuit ever tripped off for you when
you were outside ? Be thankful that they
invented the GFCI. You would not be
here at this conference without its protec-
tion.

Think about farmers. Are they always in
dry locations when they are utilizing some
of their appliances, some of their tools,
like a skill saw or maybe a hand grinder?

There is one particular person who was
using his welder when it was raining. He
could not work outside, but he had some
welding work that he needed to do.

He did not want to use the welder inside
his shop because it was too small, too tight
of an area, and there would be too many
welding fumes. He laid down a piece of
sheet metal; he pulled out the piece of
equipment he was going to do some weld-
ing on, and he hooked it up to the welder.

The coroner tells us what happened to him
next. He was shocked and killed. It was
raining. There was the metal. There was
the electrical appliance, with the electrical
source coming in through the welder, and
the welder was not properly grounded.

There are three types of and locations for
these devices. We will find that these
GFCI' scan be at a distribution box to
protect the entire circuit or they can be at

a receptacle box. They can also be in an
extension cord.

GROUNDING

Do you see the third leg (Figure 6)?
These are designed to give you continuity,
to give you the grounding so that you do
have a proper ground in that extension
cord. That term "third-wire" ground and
bonding should be understood for safety.

Electrical bonding means to connect all
metal parts in the building together and
that this be connected to the system of the
ground.

The proper grounding of the system helps
prevent stray voltage, which is a term that
a lot of my colleagues know about. It is
not voltage that wanders around aimlessly
saying, "I am looking for a victim." It is
voltage in itself that is not going to a prop-
er ground. It provides a low resistance
path for the neutral current to go to the
ground.

That third-wire ground is the conductor in
the wiring system that extends from the
ground to the main distribution panel to
the electric device and looks similar to that
(shown in Figure 6). That is what is
plugged in for your hot side and cold side.
That is the ground that goes in. This is
what it looks like on the other side, on the
male side.

That is the female receptacle and the male
receptacle (Figure 7). That is why bonding
is so important-I talk about it twice be-
cause a lot of injuries and deaths could be
avoided if the electrical bonding process
was followed.

The last slides I have are getting more
back to the topic of what to do from an

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Electrical Power, May 1, 1991

Figure 6. Example of Three-wire Receptacles.

Figure 7. Male and Female Receptacles.

agricultural perspective, or even from just
regular people's perspective.

GENERIC PROBLEMS

When you start thinking about your uses of
electricity, there are generic problems I see
that may arise on the farm.

Wire Damage

One is damaged wire resulting from crush-
ing or cutting incidences where wire can be

enclosed in a conduit material or exposed.
In Figure 8, you see wire that is encased -
either a metal case-like conduit or in the
hard rubber, plastic, or the other material
that you have that wire comes in.

When you are working around a
farmplace, you are using a lot of equip-
ment. Farmers are using equipment that
backs onto it.

Two-Prong Adapters

These are what I call pseudo-outlets (Fig-
ure 9). These are two-prong plugs. The
significance of these two-pronged plugs is
that there are two-prong adapters being
used with various equipment that requires
that third wire ground; that third leg, so
they can properly ground the electricity
that is flowing through.

Figure 8. Examples of Wiring.

How many of you have remodeled your
homes lately, or done anything inside the
home where you changed a light fixture or
maybe have changed a wall socket? They
sell what I would term pseudo-outlets for
you.

They were originally designed for two wire
and replaced with a cover for a third wire

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Research - Mechanical and Physical Hazards

Figure 9. Two-prong Plug and Adaptor.

ground. It looks like it is grounded prop-
erly, but it is not. This is what it may look
like (Figure 10). You have them there.
Who is to say that has just been put into a
two-prong outlet or through the wall sock-
et. Assume it is not grounded unless you
look behind it.

I
f.
i

Figure 10. A Three-prong Receptacle.        Wire Nuts

Do you know whether or not it has been
grounded properly ? Can you tell? Can
you walk up to and look at the socket and
tell that it has been grounded?

Some people, when they replace their wire
nuts, do not necessarily use the wire cover
on the nuts (Figure 11). They may use
plastic. They may use tape. They may
squeeze them together. But it may call for
the wire cover, the wire nut, the yellow cap

That is why those 250 fatalities occur.
Some of them did it before, some of them

did not. This is a term which is not a
scientific term, but I like it. Have you
heard of a term called "shade tree mechan-
ics?" This is what I call the "jack-leg" wire
mechanic. That means that he is not fol-
lowing codes for the types of materials he
uses. This is a faulty method of installa-
tion.

There is a hot wire that goes through the
wire. There is a hot side and there is a
cold side. You can hook the hot side
through the switch and the cold side
through the switch so the wire is running
through the white side.

When you shut if off,. the switch goes off,
but it is still hot. You start working on
that socket. You start taking it out of the
wall to repair it; it is still connected. The
power is still flowing through it. Was it
installed using NEC codes?

Figure 11. A Wire Nut.

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to go over that wire where that connection
has been made.

A lot of jack-leg wiring will go on like this.
You have a conduit box there designed to
carry only so many connectors inside.
They are rated because of the amount of
heat that is given off by each connector.
They build up additional heat inside.

This situation is an excellent point for a
fire to occur, unsuspectedly, for the wiring
itself to degrade from the heat, causing it
to touch the metal casing and the metal
conduit around it. A person could then
touch it and die.

Overhead Wires

I would be remiss without talking about
what we traditionally think about on the
farm where we have equipment that is
being pulled around: getting in contact
with overhead wires. There are labels.
There are safety shields and warnings in
place to help people to avoid that situa-
tion.

Most people, farmers and agriculture
workers, do try to obey this. Sometimes,
however, they get too busy, and they forget
for a few moments. That moment of care-
lessness may end up with that piece of
equipment getting in contact &th that line.
We know how electricity kills. It is going
to go through what is grounded the most.

A cartoon character can live through it.
The human body cannot.

CONCLUSION

Inspections Need to be Made

In conclusion, I would like to offer the
following. Inspections need to be made on

Electrical Power, May 1, 1991

the farm. They need to be made on a
scheduled basis and immediately when
things are damaged. These inspections will
reveal problems before they become life-
threatening situations.

Those conduits, if they are bent, need to
be checked. How many times have you
put down an electric cord and said, "Well,
I am only going to use this temporarily
here; get some power to do this little func-
tion."

NEC Codes Should be Followed

Five years later you still have that same
electric cord in place. Think about it at
home. You have an electric cord you have
been using someplace, have you not?

That moment of carelessness may end up
with that piece of equipment getting in
contact with that line. We know how
electricity kills.

The NEC should be followed. It helps
everyone on that farmstead or that place.
They can have some assurance that there
is some safety, that they know that it is
supposed to be working like this. You
know what kills a lot of people-things that
"were supposed to be," (and were not) and
sometimes we do not find out until after
the fact.

Safety Procedures Adopted

There are safety procedures that should be
adopted. First, if you are going to do your
own work, you need to have someone
there who can check it over before you
start using it. What happens with people

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Research - Mechanical and Physical Hazards

doing their own work is that they are al-
ways trying to save on budgets.

Other problems are putting things up and
not checking to make sure that they have
been wired or that they have been ground-
ed properly. Maybe someone cut down on
the materials that are being used because
he or she is just going to add some power
to a particular room or building on the
farm.

I have seen places where you have wires
extended over here, hanging down-a light

bulb extended hanging down from the
rafter. That in itself is an accident waiting
to happen. They can be avoided.

We are trying to get codes followed, in-
spections made, and safety procedures
adopted. When you work with electricity
outside, make sure that you do not use
equipment unless it has been properly
grounded with that third wire. Make sure
that everything has been bonded together
so that it is properly grounded. Only then
can we address this problem effectively.0

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Surgeon General's Confetmce on Agticuttural Safety and Health
FAR&&FE 2000 o A National Coalition for Local Action
Convened by the National Institute for Occupational Safefy and Health
April 30 - May 3, 1991, Des Moines, Iowa

NOISE AND STRESS

   By Matthew Marvel, M.D.
Attending Physician, Oneonta Health Center

It is indeed a privilege to speak to this
dedicated and distinguished group. I ap-
preciate being invited to speak here.

The topic of my talk today is noise and
stress. Let me preview a little bit what I
am going to talk about.

In a few words, I am going to be talking
about noise and its potential to cause
stress. I am not going to talk about stress
to any great extent. Most of my expertise
is in the area of noise and noise-induced
hearing loss in farmers.

I am going to discuss those topics. For
those of you who are not familiar with the
subject, I am going to define noise and
what constitutes dangerous noise.

I will be reviewing OSHA guidelines gov-
erning noise exposure, show some sample
farm-equipment sound levels, and review
the characteristics of noise-induced hearing
loss. I am going to give an overview of
studies that examined hearing loss in farm-
ers and finish with suggestions for future
research.

NOISE AND STRESS

First, a few words about noise and stress.
Can noise cause stress? Yes. For exam-
ple, if this microphone were to start having
feedback, I think both you and I would
start to have stress after a little while.
There are ample studies in animals that

have documented the ability of noise to
cause stress-related physiological changes.

In humans, noisy jobs have been associated
with higher rates of various diseases.
Noise can cause stress by interfering with
communication, disturbing concentration,
and acting as a noxious stimulus leading to
activation of neurohumoral mechanisms.

Noise results in elevated blood pressure,
heart rate, and respiratory rate, as well as
affecting other systems. All these contrib-
ute to increased levels of fatigue and, ulti-
mately, injuries.

DANGEROUS NOISE

Noise is loosely defined as an undesirable
sound. It is a subjective definition and one
that is a matter of taste. For example, one
man's noise is another man's music.

Potentially hazardous noise, on the other
hand, can be simply defined as something
greater than 85 decibels and is indepen-
dent of the source. It is a function of the
intensity, as measured in decibels, and of
the duration of the sound.

This governs industrial workers and not,
for the most part, farmworkers. It can be
used as a guideline and should be used for
farmworkers. After all, a hundred decibels
in a factory is no different than a hundred
decibels in a barn or in a field.

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Research - Mechanical and Physical Hazards

Where I am from, Ostego County in New
York. Various types of equipment operate
above this 85-decibel level. A cab added
to a tractor can have a protective effect, on
lowering the exposure to sound.

Chain saws are loud. Some people might
find surprising their including chain saws
on this slide, but in my part of the country
particularly they are widely used on the
farms, in wooded areas for clearing and for
cutting firewood.

We have heard, at various times in the
talks this week, how engineering is improv-
ing things for farmers. That is true in the
area of sound production as well. Newer
equipment is engineered to be quieter, but
there is a lot of older equipment still in
use. A survey of upstate New York found
that the average age of tractors in use on
farms is about 20 years. There is quite a
bit of equipment out there being used that
has not benefitted from this improved
engineering.

NOISE-INDUCED HEARING LOSS

Noise-induced hearing loss can be either
permanent (PTS stands for permanent
threshold shift) or temporary (TTS refers
to temporary threshold shift). Established
noise-induced hearing loss is permanent,
but moderate exposures to noise may
cause temporary threshold shifts.

Repeated temporary threshold shifts may
become permanent. Noise-induced hear-
ing loss is sensorineural. In noise-induced
loss, opposed to conductive types of losses
that are due to middle ear disease, there is
actual damage to the neurological struc-
tures of the inner ear. It tends to be bilat-
eral but may often be directional, as some
of the studies have shown. In addition
noise-induced hearing loss presents &ally

at higher frequencies, with a characteristic
loss that occurs at 4?000 Hz. This is com-
monly called the noise notch.

This has implications for hearing conserva-
tion measures as well. Noise-induced
hearing loss develops more rapidly at the
higher frequencies, and speech comprehen-
sion is affected. Consonants are heard at
the higher frequencies, whereas vowels
tend to be in the lower frequencies.

It once was thought that speech was mostly
a phenomenon that occurred between 500
and 3,000 Hz. The work of Alice Suter
and others, however, has shown that accu-
rate speech comprehension requires the
perception of higher frequencies and that
we need to be looking at those as well.'

STUDIES OF HEARING LOSS

I would like to now turn to the overview of
some of the studies on hearing loss in
farmers. It is not a large body of evidence
at this point, compared to a lot of other
fields.

Again, I am going to give an overview of
the different published studies from the
scientific literature covering hearing loss in
farmers. The first reported study was by
Glorig in 1957, who reported the results of
hearing tests done on visitors to the 1954
Wisconsin State Fair.2

He found that farmers aged 50 to 69 had
significantly more hearing loss in the 2,000
to 6,000 Hz range than office workers of
the same ages. The frequencies affected
pointed to noise-induced hearing loss as
the culprit.

Lierle and Reger reported, in 1958, on the
adverse effects of tractor noise on the
hearing of farmers.'

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The next reports did not appear until the
mid-1970's, when Karlovich tested the
hearing of an unselected rural population
in Wisconsin', and Townsend studied a
similar group in rural central Michigan.
Townsend used a mobile van to visit rural
communities over an g-week period and
tested over 1,300 adults.

The purpose of the study was to depict a
profile of hearing sensitivity of rural mid-
western adults. His findings were that, on
the average, hearing loss was greater than
could be expected by aging alone.

There was no significant difference in
hearing, however, between those with a
history of industrial work and those with-
out. He concluded that in addition to
occupational noise exposure another noise
exposure, perhaps recreational such as one
gets during hunting, boating, or the use of
snowmobiles, seemed to be a prime con-
tributor.

Thelin re-examined what Glorig had found
from the 1954 study to see if the discrep-
ancy between the hearing of older farmers
and office workers could still be shown and
if there had been a change, and to deter-
mine if younger farmers were also at risk.
The sites were the 1979 Missouri Farmer's
Association Agri-Fair and the 1982 Shelter
Insurance Health Fair."

He tested 161 farmers and 75 non-farmers
at the Agri-Fair and 130 office workers.
His findings were that older farmers were
still at risk for high-frequency hearing loss
as were younger farmers, which Glorig had
not found. Like Townsend, however, he
also found a higher rate of hearing loss in
non-farmers at the Agri-Fair. The
non-farmers' hearing was not as bad as the
farmers' but was worse than the office
workers.

Noise and Stress, May 1, 1991

Karlovich, in 1988, published reports of his
testing of 812 visitors over a 5-year period
to the Wisconsin Farm Progress Days.'
The purpose of this study was to
re-evaluate the prevalence and characteris-
tics of noise-induced hearing loss in a rural
population. The findings were similar to
the overall trends that Glorig had found in
the 1950's.

Males continued to acquire noise-induced
hearing loss sufficient to affect their ability
to commumcate. It was seen as early as
age 20. One out of four of the males had
the beginnings of a communication handi-
cap by age 30; one-half of them had a
communication handicap by the age of 50.

Again, both farmers and non-farmers dem-
onstrated noise-induced hearing loss, sug-
gesting a non-occupational source of noise
like firearms use. Only 25 percent of
noise-exposed males reported consistent
use of hearing-protective devices.

Broste, et al., in a 1989 publication, exam-
ined an even younger group for evidence
of noise-induced hearing loss.8 He studied
872 high school students from Wisconsin to
determine whether students engaged in
farming had evidence for more hearing
loss than their non-farming peers. He
found that about twice as many students
involved in farming had evidence of early
noise-induced hearing loss as compared to
non-farmers.

Less than one out of ten of the students,
however, used hearing protection. The left
ear was more severely affected, and for the
first time in this series of studies, precau-
tions were taken to exclude or to try to
control for temporary threshold shifts.

I have a study that is due for publication
this year. It will be appearing in the Arner-

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ican Journal of Industrial Medicine.' We
tested 49 randomly selected, full-time dairy
farmers from Ostego County, New York.

Ours is the first study to examine a ran-
dom selection like this. We also tested 49
age- and sex-matched rural non-farmers.
The purpose of our study was to assess the
prevalence and nature of hearing loss in
this population.

Like Broste, we controlled for temporary
threshold shifts, but we used hospital-based
equipment. We found an alarming rate of
hearing loss in the farmers, while the
non-farmers had losses not far from what
one might see due to the effects of aging
alone. High-frequency ranges (HFA), is
an average of the frequencies at 3,000,
4,000, and 6,000 Hz.

Sixty-seven percent of the farmers had
abnormal hearing as opposed to 37 percent
of the non-farmers, at the high-frequency
ranges. The PTA4, which measured the
mid-frequency ranges of 500, 1000, 2000
and 3,000 Hz, showed somewhat lower
levels, but still a big difference. The farm-
ers had a 37 percent rate of hearing loss,
whereas the non-farmers had 12 percent.

As to the results of the subjects who were
younger than the mean age of 43 years.
At the higher frequencies, where we would
expect to find noise-induced hearing loss,
we saw lower average thresholds for the
farmers.

We also found that the left ear was more
severely affected, as did Broste. Through
correlation regression analysis of the data,
we were able to support our hypothesis
that the differences found were due to
farm noise exposure.

I am aware of one other study that is going
to be published this year. The preliminary
reports were presented at a hearing con-
servation conference in San Antonio. This
is by {;alle, who is from northern Iowa."

Looking at the troubles that some of the
studies have had in separating occupational
noise exposure from recreational, he
sought to select a group of 30 farmers who
had only occupational noise exposure. He
compared them to a group of age-matched
non-farmers who had no significant noise
exposure. There were three groupings-age
30, age 40, and age 50.

The 30-year-olds had no significant differ-
ence at any of the frequencies tested. The
40-year-olds had significant differences in
the 3,000 to 8,000 Hz range, again where
you might expect noise exposure to start
showing. The 50-year-old group had signif-
icant differences at all frequencies tested.
I was pleased to find that his audiometric
data looked similar to what I showed you
on those two graphs. Our results look
similar.

The cumulative summary of the findings,
then, showed that farmers have
higher-than-expected rates of hearing loss.
This is true in all studies.

The rates exceed those of the general
population, and loss starts in the teen years
or before. Farm noise appears to be a
major factor.

In addition, non-occupational noise may be
contributing, as Thelin, Karlovich, and
Townsend have reported. This is also
something very important to recognize and
address. If you are only working on occu-
pational noise exposure and people are
still losing their hearing while hunting, you
are not gaining much.

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That summarizes the studies that have
been done to date. Despite the evidence,
some people still have not heard the mes-
sage. Therefore, more work needs to be
done.

FUTURE RESEARCH

What are the areas for future research?
First of all, we have barely scratched the
surface of this problem. There is plenty of
room for more research. The number of
studies so far is still small, and it is a large
and diverse industry with many different
risks.

We also might find some high-
technology solutions like using sound
cancellation.   I

We ought to be testing other regions of the
country, other types of farming practices,
and other types of farmers.

Research should be done for more effec-
tive methods of hearing conservation and
education. We should be doing dosimetry
studies to better define noise risks. I was
pleased in looking through the pamphlet
showing the poster sessions. It looks like
somebody is presenting something on that.

Noise and Stress, May 1, 1991

We need more research on the possible
synergistic effects between noise and cer-
tain agents like carbon monoxide. We
need some more research into engineering
advancements, greater developments for
quieter equipment at the source, ways to
improve baq-iers to sound transmission like
tractor cabs. This is needed not only for
improved new ones, but perhaps more
economical ones that farmers could retro-
fit.

We also might find some high-technology
solutions like using sound cancellation.
Improvements could be made in hearing
protective devices, to improve the fit, the
comfort and convenience and, consequent-
ly, the likelihood that farmers would wear
them.

It would be nice to be able to better pre-
dict the risk of noise-induced hearing loss
from noise exposure levels and early au-
diometric changes. Naturally, it would be
good to see more basic science research
into the anatomic, physiologic, and genetic
bases for presbycusis and noise-induced
hearing loss.

In conclusion, through research, let us
continue to look for ways to better de-
scribe the nature of the problem so that
through the spread of this knowledge those
at risk for noise-induced hearing loss may
see the ways to prevent it.0

REFERENCES

1. Suter, Lempert B and J Franks; "Real-ear Attenuation of Earmuffs in Normal-hearing and Hearing-
impaired Individuals." Journal of the Acoustical Society of America. 87 (5): 2114-2117, 1990.

2. Glorig, A; "Some medical implications of the 1954 Wisconsin state fair hearing survey." Trans American
Academy Ophthalmology Otolatyngology 61:160-171, 1957.

3. Lierle, DM and SN Reger; "The effect of tractor noise on the auditory sensitivity of tractor operators."
Ann Otol Rhinoi Laryngol 67:372-388, 1958.

Surgeon General's Conference on Agricultural Safety and Health - 1991                297


Research - Mechanical and Physical Hazards

4. Karlovich, RS, and TL Wiley; "Spectral and Temporal Parameters of Contralateral Signals Altering
Temporary Threshold Shift." Journal of Speech and Hearing Research, Vol. 17, No. 1, pp. 41-50, 1974.

5. Townsend, TH, FH Bess, and WA Fishbeck; "Hearing Sensitivity in Rural Michigan." American Industrial
Hygiene Association Journal, Vol. 36, No. 1, pp. 63-68.

6. Thelin, JW, DJ Johseph, WE David, DE Baker, MC Hosokawa; "High frequency hearing loss in male
farmers of Missouri." Public Health Rep 98:268-273, 1983.

7. Karlovich RS, TL Wiley, T Tweed, DV Jensen; "Hearing Sensitivity in Farmers." Public Health Reports,
Vol. 103, No. 1, pp. 61-71, 1988.

8. Broste, SK, DA Hansen, RL Strand, DT Stueland; "Hearing loss among high school farm students."
American Journal Public Health. May: 79(5): 619-22, 1989.

9. Marvel, ME, DS Pratt DS, LH Marvel, M Regan, JJ May; "Occupational hearing loss in New York dairy
farmers." American Journal of Industrial Medicine, 20(4): 517-31, 1991.

10.  Plakke, BL, and E Dare; "Occupational hearing loss in farmers." Public Health Rep 107:188-192, 1992.

298

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Surgeon General's ConRmnce on Agricultural Sakty and Heatth
FARMSAFE 2000 o A National Coalition br Local Action
Convened by the National Institute for Occupational Safety and Heatth
April 30 - May 3, 1991, Des Moines, Iowa

TECHNOLOGY TRANSFER

      By Mumy M&en
Product Safety Engineer for Agricultural Equipment
      Deere and Company

There are opportunities for inventions,
discoveries, innovations, and improvements
that will help reduce the traumatic and
acute injuries that occur in agriculture.
These opportunities exist in both hardware
and software technology, and I contend
their impact can be achieved more fully
and in a more timely manner through
better technology transfer. I will explain
that as we go.

o By hardware, I mean the sheet metal,
machines, parts, and gears.

o By software, I mean the safety signs,
safety messages and operator's manuals,
promotional brochures, posters, human
factors interfaced with the machine, and
much more.

o By technology transfer I am talking
about not only what moves the infor-
mation going from here to there, but
also the process that drives it, how the
information gets delivered from point A
to point B.

We are engaged in this conference to help
protect the men, women, and children who
come in contact with agriculture. I am
especially interested, of course, in that part
of agriculture that relates to agricultural
machinery such as farm tractors.

1 am also talking about the things that
plow the fields and turn the soil. I am
going to run through some of these quite

rapidly to give you a flavor for modern
production agricultural equipment. They
are the plows that turn the soil; the plant-
ers and tractors, combines and other har-
vesters; the mowers; the windrowers; the
loaders; the manure spreaders, wagons,
and much more.

That is a grain drill, a minimum-till grain
drill, and a corn planter. You might notice
there (on the planter) the dry chemical
transfer system Deere and Company devel-
oped with American Cyanamid, the "lock
and load" system.

That is a spectrum of some agricultural
tractors, one at closer range. A combine is
shown in wheat as well as corn. There is a
cotton picker, for those of you from the
south and west, and you from Arkansas
may be more familiar with cotton strippers.
You see a self-propelled forage harvester,
a rotary cutter, a rotary mower or mower
conditioner, a windrower, and front-end
loader with a large, round bale.

There is a product that probably no one
stands behind, a manure spreader. You
see a cotton stripper, hay equipment,
all-materials transport utility hauler (which
distinguishes it from an ATV or all-terrain
vehicle), self-propelled high-cycle sprayer,
and a blank slide that gets me on to the
important part of my conversation with you
today.

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Research - Mechanical and Physical Hazards

I have a very strong preference for preven-
tion before injuries happen, for the lever-
age of design over safe practice control. I
recognize, however, the need for a compat-
ible blend.

I am delighted that you are here. I wish
that more people could be. I am also
extremely impressed with the attendance at
this conference and encouraged about the
steep learning curve that all of us are on
for these few days that we are together.

My plan is to move from the broad per-
spectives to suggestions for improved tech-
nology transfer. I plan to give you some
kinds of research that I believe are appro-
priate and necessary. I will close with
three general directions.

BROAD PERSPECTIVES

You have all seen the FFA signposts that
declare, "Agriculture is more than farm-
ing." It is technically farms, dairies, nurser-
ies, orchards, vineyards, cranberry bogs,
hatcheries, and more, that produce crops
from artichokes to zucchini and livestock
from Angus to zebra. Agriculture is done
in fields, buildings, and under water. It in-
cludes agricultural services such as veteri-
nary care, farm management, landscaping,
tillage, and crop protection.

Agriculture includes tree farms, tracts,
nurseries, and those engaged in gathering
forest products. And it includes commer-
cial fishing, hatcheries, preserves, and
commercial hunting and trapping. While
our typical "mind's eye" picture may run to
the serene dairy in Delaware or to the
cotton of California, that is only part of the
real picture.

Yes, there are household products used on
farms. There are hand tools, grinders,

welders, saws, drills, motors, mills, and
much more. There are ATV's, trucks,
crawler tractors, and punch presses. My
remarks focus on agricultural field and
farmstead or farmyard equipment, typically
on wheels or mounted to tractors that have
wheels.

Many farms have a full line of modem
production machinery. Others use tractors
and machines that are 50 or more years
old. Sometimes equipment is in mint
condition; other times it is not, or modi-
fied, or built from scratch in a local shop.

In all cases, new equipment must be com-
patible with the old. A great deal has
been accomplished through the voluntary
standard system, such as the American
Society of Agricultural Engineers (ASAE),
to achieve the essential level of inter-
changeability and compatibility.

Each day technology and our understand-
ing of it-how to use it; how product users
will interface with it-increases. It leads to
improved products-products with greater
productivity, products with less cost, and
products with improved safety. All of
those are happening now.

We are on the brink of future technology
that will dwarf the revolutions of the 20th
century. Semiconductors and the associat-
ed inventions have led to innovative new
products, like computers, and to improve-
ments in others, like radios. Mechaniza-
tion, electronics, and biotechnology must
be considered the technological revolutions
of this century. Perhaps photo&s, the
gathering and processing of information
transmitted by means of light, will join
them.

I wish that I had the ability to predict what
the next inventions will be. But who

300                                    Papers and Proceedings



knows what they will be or where they will
come from? Perhaps one can only do it in
a somewhat Buck Rogers' fashion. Most
likely we would be in error in timing or
content, but we will do some of that for a
little fun as we go.

We have seen innovations in agricultural
equipment, the modern sound-guard body
with its noise reduction, its vibration isola-
tion, and its fatigue-reducing aspects. We
have also seen roll-over protective struc-
ture (ROPS) development and the recent
development of retractable or foldable
ROPS for those essential applications
where you must go into a building that is
shorter - not as tall as your tractor's
ROPS.

While some may tend to associate technol-
ogy transfer only with hardware, it is also
appropriate to realize that technology
exists in product safety software as well.
That includes the safety signs, the safety
messages, the human factor. Most often
there is the need to deliver a compatible
blend of both hardware and software.

I do not, in any way, intend to imply that
we should stop doing or not do research
that discovers why things work and new
information. I think that is a valuable
aspect of learning that we should never
lose. I also believe that there will be safe-
ty impacts of any research that is not spe-
cifically aimed at safety.

I would also say to those of you who won-
der about ROPS that since 1985 virtually
every tractor produced has been sold with
a ROPS on it or right at the fingertips.
Since 1970, virtually every tractor could
have a ROPS put on it, and some have
since 1960.

For example, reduced through-put combine
harvesters may reduce the entanglement
potential and keep the operator away from
moving machinery parts. Improved moni-
toring and sensing may keep the operator
in the relatively protected environs of the
operator station instead of out where he or
she is more vulnerable.

In addition, we have open-throat designs   Essentially everyone who is on the receiv-
on large round balers. We have service   ing end of new information about a tech-
tether systems on cotton pickers for doing  nology is participating in technology trans-
the essential maintenance and cleaning    fer. It is not only the "what" but the "how,"
functions that are appropriate for that    the product and the process, the deliver-
machine.                     able and how it is delivered.

Improvements have been prevalent as we
talk about modem implement-to-tractor
driveline guarding; the controls, the steer-
ing, and the brake systems; the guarding
on the exterior for thrown objects and
blade contact; and improvements in the
area of lighting and marking. Not revolu-
tionary, perhaps innovative, all of these
changes have made an improvement in the
level of safety that is being provided, and
we are, indeed, making the best better.

The Technology Transfer Process

We need to do more to improve the tech-
nology transfer process. U.S. government,
universities, non-profit research organiza-
tions, industries, and others encompass an
astonishing array of research capabilities.
To be of greatest value, technology must
be put to use. To measure its value, we
must look at how well we ultimately trans-
fer it.

Technology Transfer, May 1, 1991

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Research - Mechanical and Physical Hazards

Not since the Smith-Lever Act of 1914,
which established the Cooperative Exten-
sion Service, has there been such interest
in increasing technology transfer. It is
obviously not a one-way proposition limit-
ed to dialogue between industry and the
Federal government research community.

It is more than that, and it is not a simple
task. It seems to me that one of the things
we ought to do is understand who is doing
what in the area of safety research in vari-
ous parts and regions of this country.

Sometimes equipment is in mint condi-
tion; other times it is not, or modified, or
built from scratch in a local shop. I

Many companies supplement their research
and development on a scale not seen in
the past and establish aggressive links and
liaisons with the external environment. All
of this serves to unite the research com-
munity with those who really must deliver
a product that is attractive to the user.

Research and development expenditures
are expected to be $155 billion for 1991,
according to a Battelle Report. About half
of that is being spent by industry and the
other half, slightly less, being spent by
Federal government. Industry will focus
on electronics, composite materials, com-
munications, advanced machinery, and
energy-efficient products.

Defense, Energy, and Health and Human
Services will dominate Federal research
and development with over 90 percent of
their half of the total. The same Battelle
Report suggests that all agencies will be
improving and enhancing their technology
transfer effort.

Interest in agriculture is building. The
funding looks like it is there. We are here.
Our ability to transfer the technology, to
transfer the research, to transfer the infor-
mation needs to be built. One part of that
will be the need to deliver technology,
which "understands" the needs and the
application. So I direct the next portion of
my remarks to the needs.

The Needs

Much has been said about the National
Safety Council (NSC) injury statistics. We
need representative data that can be dis-
sected and provided in a meaningful way.

That needs to be on the national agenda.
The now-outdated NSC Farm Accidents
surveys, conducted overlapping both ends
of the 1970's decade, encompassed 127,000
farm family members and 57,000 full- and
part-time workers.

The rough conclusion from those surveys
still used today is an estimate that
one-third of the agricultural injuries can be
associated with machinery. A parallel kind
of estimate is that roughly half of the agri-
cultural fatalities are associated with ma-
chinery.

Looking at some other data, the seven
state surveys that were done with support
and help of NIOSH delivered a 60 percent
response rate and 5,079 returns. On ag-
gregate, approximately 11 percent of those
returns reported an accident during the
past 12 months.

If one looks at the composite information
from these surveys, tractors and machinery
total about 30 percent or one-third. Ani-
mals are second at 16.9 percent, and fol-
lowing that are falls on surfaces.

302                                   Papers and Proceedings


A 1985 study in Arkansas showed farm
machinery to be involved in about 38 per-
cent of all injuries and about 80 percent
were to farm family members. Here is
something you should note: three of ten,
30 percent occurred while working off the
farm.

Based on narrative descriptions for the
most recent injuries, these ten narratives
describe roughly 80 percent of the experi-
ence reported in those NIOSH- supported
and state-run surveys. Livestock handling
topped the list at 19.4 percent, machinery
at 13.4 percent, and falls or slips from
ladders, equipment, elevated platforms, at
12.2 percent.

This information gives you a feel for the
severity and kind of injuries that are being
experienced. The most frequent injuries,
all of the types that we have seen in this
kind of survey, have severity toward the
lesser severity end of the scale. On the
other end of the scale are the fatalities.

NSC estimates work deaths, and divides
them among agriculture and the other
seven standard industrial classifications.
NIOSH, BLS, and NCHS also monitor
fatal occupational injuries. There is con-
siderable disparity in the numbers as well
as in how to categorize them. The 1980 to
1985 average for non-transport fatalities on
farms puts machinery at 45.6 percent of
those fatalities and firearms and drownings
a distant second and third at around 12
percent each.

As noted in virtually any discussion of farm
fatalities, tractors are associated with about
two-thirds of the machinery-related deaths
or about one-third of the deaths in agricul-
ture. The dominant tractor accident sce-
nario is an overturn, which may contribute
to over 50 percent of the tractor fatalities.

Technology Transfer, May 1, 1991

Thus, tractor overturns are about one-half
of two-thirds of one-half the agricultural-
related deaths, approximately 15 percent of
all agricultural deaths.

Another 25 percent are related to deaths
when someone falls into the path of a
tractor. Sometimes operators fall while
the tractor is in motion, or they get off
before it stops, or they start it in gear from
the ground, or one of the riders falls off.

It is unacceptable to have a rider on a
tractor with or without a cab. About 5
percent of tractor deaths are reported to
involve the power take-off (PTO). This
category is somewhat suspect since, pre-
sumably, there is a PTO-driven piece of
equipment attached to it at the time.

In addition to overturns, and runovers,
PTO entanglements, and the other things,
the "other" category for tractors includes
things like contact with overhead electrical
powerlines and road transport collisions.
Imagine yourself driving down the rural
country roads of Iowa, perhaps just recent-
ly attending the Surgeon General's Confer-
ence in Des Moines, "tooling" down a
farm-to-market road-perhaps graveled-at
your regular road traffic speed then crest-
ing a knoll behind a tractor-implement
combination. The results can be startling.
In some cases it does not make a differ-
ence whether there are lights on that
equipment or not.

In other cases such as in turns, or when
there is good visibility ahead, or at night,
better lighting and marking could and
should be developed.

There is a potential for research in trac-
tors. When we talk about
cresting-the-knoll, perhaps there is room
for over-the-horizon detection or for mom

Surgeon General's Conference on Agricultural Safety and Health - 1991               303


Research - Mechanical and Physical Hazards

toring from above that can deliver the
kinds of warnings necessary to avoid colli-
sions.

We want to make sure in all of this that
we are addressing the right problem. For
example, is it really the lack of lights, or
the lack of good enough lights, or the lack
of the right color, or the right position?
Maybe more effort should be devoted to
improving the connections so that they are
more likely to get connected.

Consider a product which is hooked and
unhooked dozens of times a day. Will it
get reconnected? Will it get reconnected
on products that never, or seldom, venture
onto a roadway? When they do, will it still
work?

Research may discover a way to multiplex
information, control signals, and control
power so that it is no extra effort to get
the safety value at the same time that you
get the desired productivity.

The lighting and marking issue is still an
open one and some of you may be inter-
ested in pursuing in more detail the kind
of research that is being launched at Ohio
State University on lighting and marking
for equipment. Research is necessary in
some cases.

In other places we need to apply more of
what we know. We just looked at the
more frequent yet less severe farm machin-
ery injury picture, and we looked at the
most severe injury death. It is likely there
are similar kinds of injuries in between-in
the middle ground.

It is also likely that there are more severe,
but less frequent kinds of injuries in that
middle ground. We would generally call
them entanglements.

Entanglements occur in the belts, chains,
and gears that run auxiliary drive systems
like cooling fans for engines. They occur
as we transfer power from one part of the
machine to another part of the machine:

1. In the crop gathering, or picking, or
intake mechanisms.

2. In the parts that thresh, or transfer, or
clean the material that is flowing
through the machine.

3. In the discharge.

4. At the tractor PTO.

5. Along the PTO drive line.

Professionals like those in the NSC Agri-
culture Division and the National Institute
for Farm Safety would likely divide these
kinds of entanglements into three major
categories of concern: those areas where
we gather the crop, those where we are
transferring power around the machine,
and those where we are processing the
crop.

A proposed revision to the ASAE standard
for agricultural equipment includes a speci-
fication for an automatic means to stop the
crop-gathering mechanisms and the intake
mechanisms of self-propelled agricultural
machines. This would be before potential
entanglement of the operator, not after.
Typical applications have been an
operator-presence seat switch on combines
and the service tether system that I showed
you earlier on cotton pickers.

In responding to suggestions for those
kinds of systems, the Ontario Implementa-
tion Committee rejected the usefulness of
interlocking safety cut-off switches as a
means for accident prevention. This com-

304                                    Papers and Proceedings


mittee claimed to be aware that some
accidents have occurred because of the
presence of those kinds of systems. When
investigating emergency stop systems for
that PTO drive line, they could not resolve
the differences between the "invitation" for
many to risk entanglement and the poten-
tial to lessen the severity of some acci-
dents.

Research may discover the way to protect
maintenance personnel and bystanders
from that programmed, unmanned ma-
chine that swarms through the wheat field
and vacuums up heads of wheat, flowing
centimeters off the ground.

We may also find a way to detect and
respond to the presence of a person who
should not be in a protected zone. Per-
haps the beginnings for that have already
been laid at the University of Illinois with
work on the capacitance of discharge sys-
tems. Maybe it starts with the radar, ob-
stacle avoidance work in the auto industry.

Part of why we are here at this conference
includes this kind of visioning. What is
needed relative to nanotechnology where
those micromachines with engines
one-third the width of a human hair will
be released to swarm across the field and
devour preselected bugs from a population
of pests?

Perhaps we need a more sophisticated
ability to anticipate and successfully avoid
tractor overturns, like the work at Penn
State University, or to alter collision cours-
es. Clearly, an early understanding of the
application will lead to research that is
more readily available.

Having identified some needs, it is impor-
tant to also consider how those needs will
be met in the real world where the opera-

Technology Transfer, May 1, 1991

tor must interface with the machine; where
human factors become the field of exper-
tise; where work, the man, the environ-
ment, and the machine come together
surrounding the task.

We must be cognizant of the somewhat
limited ability we have to modify the man
successfully; the relative leverage of chang-
ing the machine, if that is possible and
appropriate; and not forget the ability to
adjust the task.

Some would say that accidents can be
attributed to unsafe actions of operators.
Therefore, we ought to focus our research
on those behaviors and how to modify or
eliminate them.

Others would say that the machine's design
dictates how the operator will behave.
Therefore, we ought to design the machine
to not allow errors, to make it difficult to
err, to not invite unsafe behaviors or to not
accommodate unsafe behaviors, and to
encourage safe ones.

There are, more likely, opportunities in
between than at either end of these polar-
ized points of view. I believe it is impor-
tant to understand that those possibilities
exist and not to forget the option of modi-
fying the task.

Research is needed to accommodate the
physical and behavioral aspects of the
people in and around farm machines. I do
not, however, advocate identifying any of
what you might call generic or typical
operator safety behaviors. Identifying new
concepts in education and solidifying those
guiding principles for educational training,
in general, seems to be fertile ground.

It may relate to the positioning of incen-
tives. It may also relate to cognitive risk

Surgeon General's Conference on Agricultural Safety and Health - 1991                305


Research - Mechanical and Physical Hazards

avoidance versus situations where the re-
wards are greater for risk-taking.

Perhaps it springboards from some of the
work on injury control strategies and
farmworker behavior which will be pub-
lished by ASAE between Penn State and
the University of Illinois. Where do we go
when the weight of what is being published
today questions the ability of safety signs
to alter-to measurably alter-behavior?

I want to express a few things of impor-
tance to you, somewhat slowly and careful-
ly, because a good friend of mine asked
me to do it that way. If you will breathe
deeply with me and reflect a moment-the
current engineering design community,
myself included, as well as students and
teachers needs capabilities and tools to
better incorporate human factors into what
we do.

Research on how to build those capabili-
ties and the tools themselves are needed
for our organization's development and for
curriculums. How does safety become the
cultural value that permeates all that each
of us does? After all, are we not safer
than the people out there? What are the
skills needed to excel in hazard recognition
during the earliest stages of design? Can
such skills be learned? What is a capable
process for identifying and communicating
safety research issues?

How do we rationally evaluate alternatives,
none of which are without safety risks?
What is the measure of safety improve-
ment at a stage when we are comparing
conceptual alternatives, when we have no
injury experience?

We are learning more each day about the
attractiveness of safety in the user's mind
and in the user's perspective. How do we

keep the momentum going? How do we
tap that latent potential demand? How do
we serve those safety needs and wants of
our customers? All this could benefit from
more research.

Consider, for example, how to convince the
owner of a 30-year-old tractor worth, at
most, $1,000, to put a $500 ROPS on it.
The University of Illinois, NIOSH, and the
University of Iowa are doing research to
help find some of those kinds of answers.
A ROPS that provides protection and still
meets the needs of users under limbs,
vines, and rafters holds promise.

It is likely that this kind of roll over pro-
tection will produce more acceptable de-
signs for the user. Perhaps it may not
produce as much protection as users have
become accustomed to with larger or more
conventional roll over protective structures.
Is there an opportunity for validating ac-
ceptable ROPS for more compact tractors?

In general, research has evolved from
centers isolated from commercial consider-
ations to centers in touch with the applica-
tion, in touch with the network, and with
the people who must deliver. My final
comment is about better technology trans-
fer. It is for the researchers to participate
in the safety network or, as Dr. Roper
called it, the infrastructure.

Researchers must learn the needs, find the
funding, know what is being done, share
the findings, gain application insights, gath-
er and synthesize information, learn, estab-
lish contacts, and establish conduits. All of
these help prdmote tHe results of the re-
search, to participate in sustained improve-
ment with those engaged in agriculture.

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Papers and Proceedings


Technology Transfer, May 1, 1991

GENERAL DIRECTIONS

I hope to have whetted your research ap-
petite and to have given you perspectives.
Now to boil my sense for direction down
to three points:

1. Overturn protection, refurbished
guarding, and proven effective educational
training relative to products in use.

2. Integrated approaches to hazard con-
trol, primarily aimed at entanglements,
which blend the latest injury prevention

hardware and software, particularly soft-
ware as it relates to behaviors.

3. New technologies for sensing, antici-
pating, and responding to the potential for
an injury. This is not only in the sense of
hardware. I mean it in the sense of the
users and their abilities. And I mean it in
the sense of those who are striving to pre-
vent the first or the next injury from hap-
pening.0

Surgeon General's Conference on Agricultural Safety and Health - 1991

307


Sumeon Qmstai'8 Cmhmncr on Agticultml Saibty and Hmith
FARMSAFE 2000 o A National Coalition hbr local Action
Conwned by the Nat/one/ InrtlMu Ibr Occupationa/ Sahty and Health
April 30 - May 3, 7997, Des Molnrs, Iowa

THE MANUFACTURERS PERSPECTWE

      By Mr. John HI Cmwky, M.BA
Director of Safety Programs, Equipment Manufacturers Institute

The Equipment Manufacturers Institute, or
"EMI," is the nrincinal association in the
USA `for manufacturers of farm
My remarks will be in two parts. equipment.

o First, I will give an overview of farm
machinery safety research needs as
identified by EM1 member companies.

o  Second, I will address some of the
points raised yesterday in the plenary
sessions, particularly the questions that
Dr. Myron Johnsrud suggested for dis-
cussion in these sessions. One on these
was "Where do we focus our resources
to be of most success?"

Allow me to preface my remarks with a
word on the role of surveillance as it re-
lates to injuries involving farm equipment.
Surveillance is said to be important to
provide the foundation and direction for
both research and intervention.

Manufacturers already know quite a lot
about how accidents involving their prod-
ucts happen from information available to
them. They have a good sense of the
relative magnitude of product-related acci-
dents in terms of the frequency and severi-
ty of injury that can result from them.

Nevertheless, better injury data, expressed
quantitatively, which should be forthcom-
ing from the current NIOSH-sponsored
initiative, are needed to identify problems
at the regional and national levels, to es-
tablish prioritized objectives, and to mea-

308

sure progress. Manufacturers need better
data on the association, if any, between
machinery and cumulative trauma disorder,
noise-induced hearing loss, and illness
related to the handling and application of
pesticides.

RESEARCH NEEDS

The industry has identified several areas
for additional safety and ergonomic re-
search. Two years ago, EMI's Agricultural
Safety Committee looked at the accident
and injury data base, the product-related
safety standards, and the innovative work
that Murray Madsen described in his pres-
entation that individual companies are
doing. The committee developed a ques-
tionnaire to survey equipment manufactur-
ers throughout the industry to find out
where they thought additional research was
needed.

The responses fell into two groupings.
One was safety-related research that was
thought to be appropriate for public sup-
port.

The other concerned items for which in-
dustry concluded it had the necessary ex-
pertise itself to carry out. I would like to
revisit the results of this survey with you.

The survey identified eight areas that were
deemed to merit public support. I will
present them in no particular order.

Papers and Proceedings


Behavloral Research

Not surprisingly, in view of much that has
already been said by others at this confer-
ence, the industry identified a need for
research into behavior of equipment users.
Manufacturers' experience based on in-
depth evaluations of numerous accidents
indicated that the manner of use of equip-
ment was a significant factor in accidental
injury. The equipment manufacturer's
view is that there is a need for basic re-
search aimed at developing a better under-
standing of behavior with respect to safety
and risk-taking in the agricultural environ-
ment.

Behavioral research is needed to guide
engineers on how equipment can be de-
signed for safer operation and mainte-
nance. It must also be designed for devel-
oping effective educational and training
programs and other measures aimed at
inducing fundamental, lasting behavioral
changes.

Behavioral research is needed to guide
engineers on how equipment can be de-
signed for safer operation and mainte-
nance.   I

EM1 was familiar at the time of the survey
with the work of Dr. Dennis Murphy of
The Pennsylvania State University and
Dr. Robert Aherin of the University of
Illinois in examining attitudes, underlying
cultural beliefs, and other factors as possi-
ble determinants of behavior.

J.I. Case, a member of EMI, has sponsored
a literature review, which is being done by
Drs. Murphy and Aherin. This work is
nearly complete, and the results will be

The Manufacturers' Perspective, May 2, 1991

provided to J. I. Case in a few weeks.
Case has asked the American Society of
Agricultural Engineers (ASAE) to publish
the results. We understand that publica-
tion may occur by the end of July, 1991.
The study will look into four elements:

1. A review of the characteristics of farm-

ing and farm-accident statistics.

2. Injury- control strategies.

3. Approaches to modifying safety behav-

iors.

4. Effective ways of communicating the

safety message.

EM1 has received proposals from several
organizations in response to a Request for
Proposal (RFP) it issued to do additional
work in the area of behavior. The propos-
als are being evaluated, and EM1 will seek
other sponsors to help fund this particular
research project. Broad sponsorship by
both private- and public-sector entities is
being encouraged.

Injury Data Collection

The second area identified for public sup-
port was agricultural injury data collection.
The industry strongly supports the work of
NIOSH to develop a uniform national
reporting system and database.

For our purposes, better data is needed on
the relationship of machinery characteris-
tics to such things as hearing loss, effects
of whole-body vibration, and the signifi-
cance of such factors as age, fatigue, and
environmental variables. EM1 encourages
public-sector research in these areas.

Surgeon General's Conference on Agricultural Safety and Health - 1991

309


Research - Mechanical and Physical Hazards

Lighting and Marking of Equipment

The third area is the lighting and the
marking of agricultural field equipment.
Dr. Thomas Bean of Ohio State University
spoke on this subject. We concur in his
view that additional work of a research
nature is needed. EM1 has issued a RFP
for research on the effectiveness of current
lighting and marking systems for agricultur-
al equipment.

Five responses were received. These have
been evaluated and a study contractor
selected. The study contractor will look at
alternative ways of effectively identifying
slow-moving vehicles, extremity lighting
and marking of equipment that travels on
roads and highways, and turning indica-
tions.

The system now in use in agriculture to
indicate turning is somewhat different than
the system for motor vehicles. The signifi-
cance, if any, of the differences will be
evaluated.

The study will also look at the adequacy
and effectiveness of the slow-moving vehi-
cle emblem and reflectors as specified in
the standards of the ASAE. The project
will include both simulation and field eval-
uation using subjects.

There is a need for additional funding for
the lighting and marking research study.
The cost of the study is about $220,000. It
is 75 percent funded now and we are look-
ing for additional sponsors for the remain-
ing 25 percent.

Protection During Chemical Handling

The fourth area identified in the industry
survey concerned protection when handling
agricultural chemicals. The focus is on

equipment for handling and mixing and
transfer of chemicals from original contain-
ers to field application machinery.

Development of a standardized "closed'
system for the mixing and transfer of pesti-
cides would provide increased worker
protection, guard against damage to the
environment from accidental spills and
possibly eliminate the need to dispose of
excess mixture. EMI and the National
Agricultural Chemical Association have
undertaken a joint effort to develop such a
system. We are not sure that additional
research is needed at this particular point.
It appears to be more a question of engi-
neering development and standardization.

Air Filtration Systems

The fifth area is air filtration systems that
can effectively reduce the hazard of expo-
sure to pesticide vapors, dusts, and aero-
sols. Tractor cabs now have effective fil-
tration systems for most particulate matter.
Additional research is required to deter-
mine whether a reliable system is feasible
to reduce to acceptable levels concentra-
tions of fine pesticide dusts, aerosols, va-
pors, and gases.

ASAE has begun a study on this question.
It is also being looked at by the Interna-
tional Organization for Standards (ISO).
EM.I is participating in both the ASAE and
IS0 initiatives.

Whole Body Vibration Reduction

Sixth, the industry identified improving
tractor seat design to limit whole-body
vibration as important. The industry has
not done any work in this area through
EMI. However, some individual compa-
nies are looking at it. Manufacturers look

310                                   Papers and Proceedings


to human factors specialists for guidance
here.

Hazardous Atmospheres Detectors

Seventh, devices to detect hazardous atmo-
spheres are needed. Reports abound con-
cerning suffocations and toxic exposures in
confined space environments such as ma-
nure reception pits and silos. There is a
need for a reliable, inexpensive, and easy-
to-use device for on-farm use in confined
spaces where oxygen deficiency or toxic
gases are present. EM1 looks to the public
health sector, which has the expertise and
the funding, to take the lead in addressing
this research need.

Broaden Research Sponsorship

Lastly, "research" could be conducted to
identify effective ways to gain the interest
and support of entities outside the agricul-
tural health and safety community to help
sponsor the eight kinds of research that I
have just described.

INDUSTRY-BASED RESEARCH

Next, I will discuss certain safety-related
areas identified in the EM1 survey that the
industry believes it can do either through
the Institute or as individual manufactur-
ers. These are areas for which industry
believes it has sufficient expertise and
resources to do the work itself, with some
exceptions. There were three such areas
identified by the survey:

1. Small tractor roll-over protection struc-
tures (ROPS) and seat belts.
2. Safety systems and devices.
3. Product safety signs.

The Manufacturers' Perspective, May 2, 1991

ROPS for Small Tractors

The first of these was ROPS for small
farm tractors. In the late 1950's and early
1960's, extensive research and development
work was done by the industry to establish
the efficacy of ROPS designs for the kinds
of tractor overturns that can occur in nor-
mal farming and road transport.

Manufacturers began supplying ROPS
commercially in the late 1960's. The expe-
rience in both the United States and
Europe has proven ROPS to be an effec-
tive safety device.

There is a need for additional research on
small tractors' ROPS. The standard "pro-
tective zone" around the tractor operator,
which controls the size of the ROPS enve-
lope, was defined on the basis of the ergo-
nomic data that existed in the 1950's and
1960's. The zone remains essentially un-
changed today.

EM1 sponsored a literature review of the
different protective zones used for the
design of several kinds of vehicles, includ-
ing aircraft, automobiles, racing cars, farm
equipment, construction equipment, and
mining equipment. This study, which was
performed by Triodyne, Inc. of Skokie,
Illinois, has been completed. Publication
will be through both the Society of Auto-
motive Engineers (SAE) and ASAP before
the end of 1991.

The basic conclusion of the Triodyne study
was that it did not appear, from the kinds
of systems that are in place, that sufficient
research had been done that could serve as
the basis for making the protective zone of
a ROPS, as specified by current standards,
for smaller small tractors. Small tractors
are often used in low overhead clearance

Surgeon General's Conference on Agricultural Safety and Health - 1991               377


Research - Mechanical and Physical Hazards

settings-in vineyards, orchards, storage
buildings, and machine sheds.

The higher the profile of a ROPS relative
to an overhead object such as a tree
branch, the greater the likelihood that a
farmer will not want to equip a tractor
with ROPS or, if there is one on a tractor,
to keep it in place. Clearly, there is poten-
tial safety value in making the ROPS as
compact as possible without compromising
protection in the event of a tip-over.

As Murray Madsen mentioned in his pre-
sentation, one approach to addressing this
situation is to make ROPS that can be
raised or lowered. They telescope or fold
down for temporary use in the lowered
position under low clearance conditions.
There are some companies that have such
ROPS on the market today.

Industry's research capabilities concerning
ROPS are limited to mechanical and struc-
tural aspects. There is little more to be
done there with the exception of the small
tractor ROPS.

Accident data identify tractor roll-overs as
the leading cause of machinery-related
death on the farm. Therefore, perhaps the
most pressing challenge for behavioral
researchers and health professionals is to
find an effective way to ensure, short of
compulsory measures such as regulation,
that ROPS are installed and kept on trac-
tors.

EM1 believes that behavioral research in
this area holds promise of effecting a sub-
stantial reduction in roll-over injury and
fatality rates. The starting point for such
research, we submit, may be recognition
that over one million of the approximately
3.6 million agricultural tractors in use
today in the United States do have ROPS

on them. There are over one million
farmers who chose to equip their tractors
with ROPS when they purchased them.

The question should be asked how these
farmers arrived at their decision to equip
the tractors with ROPS. Was it because of
the OSHA rule? Was it because manufac-
turers were able to package the ROPS in a
cab that was noise-insulated and isolated
from vibration of the tractor? It provided
air conditioning, heating, and stereo; i.e., it
was made so attractive in other respects
that the farmer was willing to pay for the
ROPS cab.

Or were there other factors? The key to
getting ROPS on the over-2.5 million trac-
tors that do not now have them may in-
deed be found by examining the factors in
the decisions of the approximately one
million farmers who did decide to equip
their tractors with ROPS.

Safety Systems and Devices

The second area identified for further
industry research was safety systems and
devices. There was some discussion about
safety systems and devices yesterday, spe-
cifically, the concepts of interlocks for
barrier-type guards and operator restraint
devices.

I would like to identify the criteria that
manufacturers use for evaluating concepts
or proposals for safety systems and devices,
or for that matter most engineering design
concepts. There are five such criteria.

1. The first criterion is that a design con-
cept must be technologically feasible. The
archives of the U.S. Patent Office contain
millions of concepts, inventions, and ideas.

372                                   Papers and Proceedings


Many have proven to be successful. Many
others have not. Much more is needed
than mere technological feasibility as dem-
onstrated by the existence of a patent.
This is where the other criteria come in.

2. The second criterion is effectiveness. A
safety device or system must be effective.
There are two necessary qualities for effec-
tiveness.

b First, the system or device must substan-
tially reduce or eliminate the hazard. The
tractor ROPS is incontrovertibly effective
in this respect. In contrast, there is a type
of device with which most of us probably
are familiar, the ubiquitous, audible back-
up alarm used on heavy equipment.
OSHA requires back-up alarms on con-
struction equipment such as front-end
loaders, forklifts, and dump trucks that
have bi-directional movement while work-
ing.

The alarms "beep" every time the machine
goes backward. There is much evidence
that workers quickly become desensitized
to the audible back-up alarm. They hear it
going on and off all the time.

If there are several pieces of construction
equipment with back-up alarms working on
a site it can become difficult to distinguish
the back-up alarm of one machine from
that of another. The effectiveness of audi-
ble back-up alarms is generally recognized
to be questionable. Alternative approach-
es to addressing the hazard of moving
machinery in the presence of workers are
being investigated.

b The other necessary element for effec-
tiveness is that a device be reliable when
called upon to perform its function. I will
ask rhetorically, how many of us would buy
an automobile if the dealer said: "The

The Manufacturers' Perspective, May 2, 1991

brakes will perform 999 times out of 1,000
when you apply them, but one time out of
a thousand they are not going to work."

A type of device that has been proposed
for use in agriculture is the electrical-prox-
imity-warning indicator. This is an elec-
tronic device that is supposed to sense
electromagnetic field or capacitance
around energized overhead power lines. It
either signals an alarm or deactivates a
mobile machine before it gets too close to
the lines.

Tests sponsored by the U.S. Mine Safety
and Health Administration (MSHA) re-
vealed that when such a device was in-
stalled on cranes it gave both false positive
and false negative indications. No one has
yet been able to perfect a device that will
accurately and reliably detect a hazardous
electrical field when one is present and
will activate only under the hazardous
condition. EM1 encourages further re-
search and would welcome the discovery of
an effective electrical proximity warning
device that could be used on tall farm
equipment such as portable grain augers.

b The third essential criterion is that a
safety device must not by its presence,
introduce different risks that would not
exist without it. Murray Madsen referred
to a study that showed that some accidents
occurred because of an operator presence-
type device.

I am reminded of a situation that existed
several years ago when OSHA, with all
good intent, promulgated its ROPS rule
for agriculture. As it turned out, there
were some small tractors that had
backhoes mounted to the three-point hitch,
with a separate seat for the operator af-
fixed to the backhoe frame behind the
tractor.

Surgeon General's Conference on Agricultural Safety and Health - 1991               373


Research - Mechanical and Physical Hazards

Without the ROPS there was not any
problem. It was discovered that when a
ROPS was installed on a tractor with the
threepoint-hitch-mounted backhoe, a crush
point between the elevating backhoe boom
and the rigid ROPS structure was created.
A number of fatalities occurred because of
that condition.

The solution was to do away with the
three-point-hitch-mounted backhoe or
redesign the ROPS or both. A combina-
tion of these measures was implemented
through various field rework programs to
eliminate the hazard.

v The fourth requirement is for a safety
system or device to be economically feasi-
ble. As we have heard from others at this
conference, there are strong economic
disincentives to safety in American agricul-
ture.

In the mid-1970's, when OSHA promulgat-
ed the tractor ROPS and the guarding and
shielding regulations, both original equip-
ment manufacturers and independent sup-
pliers of these safety devices produced
them in large quantities in the expectation
that there would be a substantial increase
in demand. Unfortunately, the demand
was not there.

On the other hand, as I have mentioned,
the ROPS-equipped tractor cab was attrac-
tive to the purchaser. Companies do at-
tempt to establish the economic feasibility
or salability of products and safety devices
before putting them on the market; this is
not always easy to do.

b Lastly, a purported safety system or
device must be functionally practical.
Even if the other requirements I have
mentioned are met, the safety device can-
not unduly interfere with the basic function

of the machinery. This requirement is
found in the ASAE Safety Standards and
in the OSHA safety rule for agriculture.

Consider the intake guard of the portable
grain auger. The function of a portable
grain auger is to move grain from ground
level to the top of a grain storage structure
and dump it in. The bottom end of the
auger, into which the grain flows, has a
guard around the inlet opening, that is in
the form of a rigid wire mesh cage or
screen.

Portable grain auger manufacturers, based
on the results of extensive experiments
with various kinds of grain, determined the
optimum size of the wire mesh openings.
The size of the openings in the guard is
specified in an ASAE standard.

In determining the optimum size, industry
engineers were aware that if the openings
were made too small the guards would
plug up. The auger would no longer move
grain. If that were to happen, farmers
would be inclined to take off the guards,
thereby totally exposing the very hazard
that the guard was intended to cover.

It was known when the standard was writ-
ten that the openings were not small
enough to prevent passage of a small hand
or foot through them and into the moving
machinery. Thus, it was found to be nec-
essary to have a portable grain auger in-
take guard that struck a balance between
the compelling need to preserve function
and safety. In doing this, the intake guard
necessarily provided less-than-perfect pro-
tection.

There is evidence of a predisposition on
the part of people to be unwilling to ac-
cept inconvenience in the interest of safety.
Recall the 1974 automobiles with the man-

314                                   Papers and Proceedings


datory interlocking seat belts. The cars
could be started only if the seat belts had
been fastened.

A political decision was made to drop the
requirement because many consumers
became enraged when they found that the
safety feature caused inconvenience and
sometimes interfered with function. One
can conjecture that, to the extent that
awareness on a personal level of the im-
portance of safety can be increased, there
will be greater acceptance by the in-
dividual, in the interest of safety, of per-
ceived impairment of function. Industry
hopes that behavioral scientists can pro-
vide insights and contribute to the develop-
ment of strategies to bring about changes
in farmers' attitudes and beliefs, strategies
that may be necessary before meaningful,
lasting changes in safety behavior can be
effected.

Research and development work on safety
systems and devices is done by individual
companies, not through EMI. Manufactur-
ers subject the safety designs that they
eventually put on the market to rigorous
evaluation.

When tractor ROPS were being developed,
manufacturers' test programs included
actual roll overs of tractors with experi-
mental ROPS designs at different attitudes
and speeds.  There is a need, in many
cases, to verify that a new safety feature
will be acceptable to the farmer.

Manufacturers conduct pilot studies in
which designs are placed on a number of
machines. They are provided to select
groups of farmers to determine whether
they are acceptable to the customer under
a variety of usage conditions.

The Manufacturers' Perspective, May 2, 1991

Product Safety Signs

The third and last area for industry re-
search identified by the survey was product
safety signs. The Institute is represented
on the committee of the American Nation-
al Standards Institute (ANSI) to develop a
new approach to hazard pictorials and
safety signs. Soon national standards re-
flecting that committee's work will be
issued. Much of the recent innovation in
safety signage is already embodied in
ASAE Standard S441- Safety Signs.

The ANSI standards will provide addition-
al information including a methodology for
measuring the effectiveness of hazard pic-
torials on signs. The designation of the
standard covering the design and testing of
hazard pictorials will be ANSI 2535.3.

The methodology contained in ANSI
2535.3 calls for an approach using subjects
to evaluate the effectiveness of hazard
pictorials in terms of two criteria: recogni-
tion of the hazard depicted in the pictorial
and the intensity of the impression the
pictorial makes on the subject. Industry
successfully used the draft ANSI 2535.3
methodology to test a number of pictorials,
which subsequently were put into produc-
tion on new farm equipment.

CONCLUSION

I will conclude my remarks by addressing
some of the points that were raised in the
session yesterday. Dr. Thomas Bean dis-
cussed farm machinery and vehicle safety.

He gave an insightful review of the litera-
ture and his own interpretation of injury
data that indicated that agriculture was
classified as one of the most hazardous
industries. Tractor overturns were the

Surgeon General's Conference on Agricultural Safety and Health - 1991               375


Research - Mechanlcal and Physlcal Hazards

most serious equipment-related type of
accident.

Older tractors were often used for general
utility work, and youth and the elderly had
especially high injury and death rates.
Information available to the industry lends
support to the observations made by
Dr. Bean.

We noted that four of Dr. Bean's six rec-
ommendations had to do with farm ma-
chinery. Among these was the recommen-
dation that research be conducted on hu-
man sensors, automatic shutoff's, and
means to effectuate the installation and
use of ROPS on older tractors.

Dr. Bean also called for aggressive inclu-
sion of safety in all ASAE standards and
research on improved lighting and marking
of agricultural machinery on roads. EM1
concurs with these recommendations,
which are consistent with current industry
safety programs.

The question was raised yesterday regard-
ing the efficacy of putting "seat bars," or
restraining devices similar to those used on
skid-steer loaders, on tractors. The skid-
steer loader safety standard, SAE J1388,
calls for a means to prevent the lift arms
from lowering when the operator is enter-
ing or leaving the machine.

As a point of clarification, the kinds of
devices discussed yesterday were not neces-
sarily intended to be an operator restraint
device, but a device of the kind called for
by SAE Standard J1388. There are several
approaches used in the industry to meet
the SAE requirement. Some companies
have interlocking switches in the seats.
One company uses an interlocking gate at
the front entry point; another uses an in-
terlocking safety belt.

It was said yesterday that in Canada, log
skidders were being equipped with seat
bars. There is research and development
being done in Canada on an operator
restraint system for log skidders.

EMI has been following this very closely.
The understanding that we have from the
Canadian Research Institute is that a de-
vice may be made available for production
use toward the end of 1991.

This concludes my remarks on the subject
of safety-related research needs and pro-
grams for farm equipment. I wish I could
tell you about the many "intervention" type
programs of the Institute, such as our co-
operative programs with equipment dealers
to promote equipment safety at the com-
munity level. This will be a subject for
another time.0

316

Papers and Proceedings


Surgeon Qenemh Conlbnnce on Agth'tuml Salty and Heatth
FARMSAFE 2000 o A Nationa/ Coal/t/on br Local Action
Conwned by the Natlonal Instttuie tbr Oocupatbnal Safety and Health
Apti/ 30 - May 3, 1991, De8 Moines, lowa

A FORESTRY PERSPECTWE

  By Penn A. Peters, P.E.
U.S. Forest Setvlce, Morgantown, WV

My purpose in being on this panel is to
present a forestry perspective on agricul-
tural safety. The hazards to the farmer in
the woodlot are similar to those of the
professional logger. My remarks will con-
sist of an introduction to logging safety, a
response to the technical panel, notable
quotes heard at this conference, and rec-
ommended future directions.

AN INTRODUCTION TO LOGGING
SAFETY

Dr. Louis Sullivan introduced logging safe-
ty in his introductory remarks when he
quoted the logging fatality rate as 200 per
100,000 workers, the highest of any occu-
pation. The national average for all occu-
pations is eight fatalities per 100,000 work-
ers.

Approximately two-thirds of the logging
fatalities occurred while the worker was
felling trees with a chainsaw or was in the
felling area (OSHA, 1988). Over 100
loggers and about 30 farmers die each year
in the United States while felling trees.
In addition, some farm tractor accidents
undoubtedly are caused by attempting to
transport logs or trees unsafely; these,
though, are reported as tractor accidents.
The connection with forestry does not
appear in the statistics.

NOSH lumps the principal factors contrib-
uting to a felling fatality into a single cate-
gory, "struck by" accidents.' Based on

OSHA fatality reports, in 26 percent of the
deaths, a hangup fell on the victim.'

o A hangup occurs when a felled tree
hangs in the crown of another tree. A gust
of wind, vibration from mechanical equip-
ment, or the falling of another tree can
dislodge a hangup. Many fellers have
been killed by a falling tree that had a
hangup only minutes earlier.

o Another major factor is working too
close to the feller. Often a co-worker will
walk into the area as the tree falls.

o A third cause is the crown of a falling
tree either breaking or pulling a tree di-
rectly behind it, which strikes the feller
from behind. Poor felling technique ac-
counted for 15 percent of fatalities.

Examples of poor techniques include fell-
ing a tree with a hangup in it, failing to
put in a notch cut to control the direction
of fall, or not following a notch cut imme-
diately with a back cut to fell the tree.

Snags were involved in 25 percent of the
cases and were the principal factor in 8
percent of them. Snags have no root sys-
tem and easily break in pieces when struck
by another tree.

Butt rebound, another cause, occurs when
the bole of a falling tree strikes the top of
a neighbor tree causing the butt to re-
bound toward the feller.

Surgeon General's Conference on Agricultural Safety and Health - 1991

317


Research - Mechanical and Physical Hazards

Broken limbs or tops occur when a tree
with a large crown hits another tree, caus-
ing the top or limbs to be broken off and
thrown back at the feller. In one fatality,
the top 25 feet of a black cherry tree,
weighing approximately 50 pounds, was
thrown 65 feet. It struck the feller, who
presumably was standing in a safe place 20
feet behind the felled stump.

The situation in logging safety has been
summarized as:

Loggers and farmers do not recognize
the hazards.

Compliance with the proposed OSHA
logging rules would reduce injuries.
However, the rules do not effectively
address the problems of butt rebound,
broken limbs or tops, or being struck
from behind.

Hardwood partial cuts are dangerous;
56 percent of felling fatalities are relat-
ed to a felled tree hitting another tree.
Hardwoods are involved in many inju-
ries.

The harvesting trends of more use of
hardwoods, more use of partial cuts,
and more snags left standing will make
logging more dangerous.

Use of a hazard recognition procedure
before felling each tree would reduce
injuries.

Research should be conducted on the
dangerous reactions that occur when a
felled tree strikes another tree.

Injury investigations frequently fail to
report critical research information
such as tree species, heights, diameters,
and separation distances.

318

RESPONSE TO THE TECHNICAL
PANEL

The presentations of the technical panel
were impressive. Most of the agriculture
safety problems have a counterpart in
forestry. Some of the successful interven-
tion strategies that have been used in agri-
culture perhaps can be used in forestry and
vice versa.

Dr. Bean stressed the need to install Roll-
over Protective Structures (ROPS) on farm
tractors and to evaluate highway travel
hazards of agricultural vehicles. The forest
industry had a serious problem hauling
tree-length southern pine, resulting in a 20-
foot overhang on some trucks.

Dr. Cochren discussed cumulative trauma
injuries. A forestry example was the dis-
ease called "white finger." This is caused
by poor circulation and traced to vibration
of early chainsaw designs. The problem
was solved by engineering design.

Mr. McLymore discussed electrical haz-
ards. A common electrical hazard in for-
estry occurs when a falling tree or piece of
logging equipment contacts a high power
line.

Dr. Marvel compared hearing loss of farm-
ers with that of similar people who did not
work on a farm. Similar comparisons
should be done in forestry. One applica-
tion could compare the accident experi-
ence of loggers who have had safety train-
ing with similar loggers who have not.

Mr. Madsen spoke on technology trends,
including smarter machines, automatic
control, computers in machinery and safety
devices, and proximity detectors. Proximity
detectors may have an application in for-

Papers and Proceedings


A Forestry Perspective, May 2, 1991

estry to indicate when someone has walked
into a felling area.

NOTABLE QUOTES HEARD AT THIS
CONFERENCE

"Prevention is the key." Certainly this is
true of logging injuries; some you would
almost not want to recover from.

"One logger odt of five experiences a
lost-time work injury in a year." An
amazing statistic!

"Logging fatality rate is 200 per 100,000
workers." Twenty-five times the national
average.

"Develop the infrastructure for preven-
tion." Who determines the effective
intervention strategy, and who imple-
ments it?

"Build coalitions." Coalitions are need-
ed for political and financial support of
organizations and programs. Coalitions
also are needed to attack safety prob-
lems effectively. Using the felling safety
problem as an example, organizations
that can contribute to solving the prob-
lem include the U. S. Forest Service
Research, NIOSH, OSHA, insurance
companies, logging companies, trade
organizations, universities, and consul-
tants. Cooperation exists among these
organizations in the fotm of information
sharing. Building of cooperative work-
ing relationships, however, to make a
concerted attack on a problem is diffi-
cult.

"Injuries are assumed to be unpredict-
able." Most injuries are predictable.
They occur over and over again, only to
different people.

o "We blame the victim." There is almost
always some failure on the part of the
victim. If nothing else, he or she failed
to recognize the hazard. Have we given
workers the information. They need to
recognize the hazard?

o "ROPS is a proven intervention strategy.
Why can we not implement it?" Is the
problem the cost, the infrastructure, the
regulation, or the legal system?

o "Do we include logging in the agricul-
tural safety and health program?" That
is a good question. Logging injury sta-
tistics are included in some farming
injury statistics, making farming look
more dangerous than it is. This may be
an argument for including logging statis-
tics. On the other hand, information
targeted to reach farmers is unlikely to
reach loggers, and vice versa.

o "We see what we iook for." How often
do we overemphasize a minor problem
area because of personal interest or
because it fits our skills and fail to see a
significant problem area?

RECOMMENDED FUTURE
DIRECTIONS

Detailed accident surveillance data should
be used to identi@ problem areas and to
set priorities for safety research and pro-
grams. NIOSH is prdgressing in this-area.
Expert opinion can be used to confirm the
problem areas that have been identified.

For example, NIOSH has identified "struck
by" injuries as a major logging injury type.
Experts confirm the problem and know
that it occurs most often in the act of fell-
ing trees. The experts typically are people
who work with groups of loggers or farm-
ers, or are association professionals.

Surgeon General's Conference on Agricultural Safety and Health - 1991               379


Research - Mechanical and Physical Hazards

Research by qualified researchers with
knowledge of the indust 7 should be con-
ducted on the causes an potential cures.
A high-priority research area is in the
injuries that result from a felled tree hav-
ing hit another tree, which includes hangup
fell, broken limbs or tops, and butt re-
bound.

A high-priority research area is in the
injuries that result from a felled tree hav-
ing hit another tree, which includes
hangup fell, broken limbs or tops, and
butt rebound.

The research would identify timber stand
conditions and geometry that result in
felling injuries. It would develop means

for loggers and farmers to recognize the
hazards. Injury investigations could con-
tribute to an excellent database.

For example, the OSHA logging fatality
investigation summaries (1988) were
adequate to identify causes of "struck by"
accidents, but failed to report information
(tree species, diameters, heights, and sepa-
ration distances) in several cases that
would help identify potential cures. Train-
ing of injury investigators would be useful
here.

Intervention strategies should be devised
based on the results of research. A num-
ber of pilot intervention programs should
be funded. The programs should be
tracked by research studies or surveillance
data in order to identify successful pilots as
models for large-scale funding and national
implementation.0

REFERENCES

1. Peters, Penn A; `Logging Fatalities and Injuries Due to Felling Trees." ASAE Pap. No. 907536. St.
Joseph, MI: Am. Sot. Agrk. Eng. p. 21, 1990.

2. Cole, William; "Selected Occupational Fatalities Related to Logging as Found in Reports of OSHA
Fatality/Catastrophe Investigations." Occupational Safety and Health Administration. Washington, DC.
p. 157, 1988. Available from: NTIS, 5285 Port Royal Road, Springfield, VA 22161, PB 89-142-954.

3. Smith, Frank, Jr. ' Logging Operations: Notice of Proposed Rulemaking." Occupational Safety and
Health Administration. Fed. Reg. 54(83): 18798-18817.

320

Papers and Proceedings


Surgeon General's Conference on Agricuthml SaWy and Heatth
FARM&FE 2000 o A National Coalition kr Local Action
Convened by the National Institute for Occupational Sat&y and Health
April 30 - May 3, 1991, Des Moines, Iowa

A REGULATORY PERSPECTIVE

        By Thomas H. Seymour, P.E.
Fire Protection Engineer, Occupational Safety and Health Administration

I have some overheads I would like to
show you so that you can see some of the
things that the Occupational Safety and
Health Administration (OSHA) has done.
To pick up on what Mr. Peters just talked
about, the OSHA has been compiling data
to report the various sorts of the fatality
investigations that our field staff have
made over the years (e.g., logging). We
have about 16 of those reports now. We
are continuing to write those on various
subject matters like industrial trucks.

OSHA has had its ups and downs in the
agricultural arena. When we had our
initial standards published, there were a
number of standards that involved agricul-
ture. The way the Occupational Safety
and Health Act was written, we were to
utilize national consensus standards in our
initial set of standards.

In those days of President Nixon, his peo-
ple wanted us to issue those standards as
promptly as possible. We attempted to do
just that.

Looking at the input from the agricultural
community, there were only four standards
that they had been actively involved in.
These standards were issued in May of
19'71. There were these four areas:

1. We had temporary labor camps, which
is one of the 1910 standards.

Sweon General's Conference on Agricultural Safety and Health - 1991               327

2. Next was anhydrous ammonia. We
used the ANSI K61 Standard for han-
dling anhydrous ammonia on farms.

3. Pulp-wood logging is next. Farmers,
especially in the northeast, would do
this kind of work in the off-season win-
ter months-to make some extra money.
So pulp wood logging was also covered.

4. The slow-moving vehicle emblem from

the American Society of Agricultural
Engineers (ASAE) was one of the other
standards that we used as part of the
ANSI sign and tag standard.

OSHA was aware of the death and injury
rates among farmers, at least as the Na-
tional Safety Council described them in the
early 1970's. We were trying to develop
what we considered a balanced program
for agriculture. We were looking for out-
reach efforts and training of agricultural
workers and farmers.

AGRICULTURAL ADVISORY
COMMITTEE

In order to effect this kind of effort, the
agency formed an Agricultural Advisory
Committee. Our Assistant Secretary was
in charge of the standards office back in
those days.

We formed the Agricultural Advisory
Committee in 1972. You can see in
Figure 1 that Rollin Schnieder was the
initial Chairman of the Committee. Gary


Research - Mechanical and Physical Hazards

Erisman, who was one of the speakers
here this week, was also on the Cornmit-
tee.

The tripartite arrangement was that we
had professional, state, and Federal repre-
sentatives. There were employ-
er/employee representatives, and there
were representatives from the West Coast,
the Midwest, and the East Coast (Figure
1). We tried to get a broad representation
of agricultural interests into our committee
activities.

Roll-over Protection

The committee divided itself into working
groups to develop suggestions and recom-
mendations in the areas of training, and
also in the needs for standards like ROPS
and machine guarding. In 1972, the full
committee recommended its first standard.
They recommended that we do a roll-over
protective structure (ROPS) rule for farm
tractors.

The first agricultural standard that OSHA
issued under its normal rule-making was

EMPLOYEE

Rubin Contreras      Robert H. Discoe
McMinnville, OR      Paxton, NE

John C. Ramirez
King City, CA

Peter A. Andrade
Western Food Processing
Division
Burlingame, CA

EMPLOYER

Will Gill, Jr.        Joseph H. Price      Richard V. Thornton   J.S. (Alice) Van Mert
Will Gill & Sons     Texas Cotton Ginners' Grower, Shipper     Hampton, IA
Madera, CA         Association       Vegetable Association
             Dallas, TX         Salinas, CA

           STATE                         FEDERAL

Glenn J. Hertzler      James Wiles       Pr. Jon R. May       Robert 0. Gilden
Commissioner of     Administrator,       National Institute for    Extension Service
Agriculture         Workmen's       Occupational Safety   U.S. Department of
Cheyenne, WY      Compensation Board    and Health        Agriculture
            Salem, OR        Rockville, MD      Washington, DC

                        PROFESSIONAL

Chairman:         Dr. John G. Erisman   Dr. Mayland Hayes, Jr.
Fr. Rollin D. Schnieder  Illinois State University   Vanderbilt  University
University of Nebraska   Normal, IL         School of Medicine
Lincoln, NE                     Nashville, TN

Figure 1. Standards Advisory Committee on Agriculture.

322

Papers and Proceedings


the ROPS standard. We proposed that
back in 1975, we finalized it in 1975, and it
became effective in October 1976.

It dealt with all farm tractors made after
October, 1976; they had to be equipped
with the ROPS. The standard is based on
the ASAE Standard, 511-94. The complete
text of that Standard was put into the
OSHA standard.

Even though tractors were required to
have ROPS, we continue to see deaths of
tractor operators from roll-overs. We have
seen seat belts cut off or cut out; seat belts
were not used in several roll-over deaths.
Obviously, we have not seen the results
that the Swedes have achieved with their
standardization efforts.

OSHA wants to see its standard evaluated.
We want to see this standard looked at
very thoroughly to see why it is not work-
ing.

What can we do to modify it, to make it
work, to become more effective? We
know that seat belts are considered by
many farmers and farmworkers as a hassle
in hooking and unhooking, especially when
you have to get off the tractor a number of
times.

What other means can we use in lieu of
seat belts to keep the person inside the
ROPS area? How can training be made
more effective? What are the weaknesses
of our standard? These are some of the
things that we need to look at and evalu-
ate.

The new ASAE Standard, 521-9.4, is a
revision of this effort. We have said
publicly that the standard is acceptable in
meeting our ROPS standard that we re-

A Regulatory Perspective, May 2, 1991

quire here. We have done that adminis-
tratively.

The International Standards Organization
(ISO) is also involved in writing standards
for ROPS, and the IS0 Standards 5700
and 34-63 are additional new ROPS stan-
dards. Our ROPS standard is not as strin-
gent as theirs.

In our opinion, if you have a ROPS design
that meets all the tests of the IS0 Stan-
dards, that will be acceptable in meeting
the OSHA Standard as well. However, the
seat belt requirements of the IS0 Standard
are not quite as stringent as our Agricul-
tural Engineer's Standard at OSHA.

Machine Guarding

In 1973, the full committee went on to
recommend that we propose a standard for
machine guarding. This standard was
finalized and became effective in March
1976, and became fully effective in June
1977.

This standard is also not working the way
we had hoped. We need to refine ways of
evaluating this Standard to see why it is
not working. We have seen some power
take-off (PTO) guards that are
hinge-operated. Those seem to be working
much better than those that you unbolt
and bolt back on again.

We need to make guards-to use a term
from the computer age-"user friendly,"
especially those on equipment that one has
to get into frequently. Then, it will not be
a hassle to move the guard off or move it
out of position so you can make the ad-
justment and then put it back into place.

Augers are another area where we have
serious problems. We are looking for

Surgeon General's Conference on Agricultural Safety and Health - 1991               323


Research - Mechanical and Physical Hazards

some practical solutions for a variety of
farm machinery which people are still
getting caught in and ground up by.

Publications

The full committee also looked into train-
ing and guidelines. They thought those
items should be part of the overall out-
reach effort of the agency. The committee
formed a publications group and came up
with a list of things that needed to be done
in the form of slides, tapes, publications,
and even training films for ranchers,
farmworkers, and ranch hands.

The publications were to be printed for
those with low reading comprehension.
Another set was printed for normal read-
ing level for farmworkers and ranchers.
Also, we had Spanish-language translation
that we wanted to do for the agricultural
commLmity.

We got involved in this and entered into a
contract with Purdue University's Agricul-
tural School to help develop these publica-
tions. We were off to what I thought was
a good start.

THE APPROPRIATIONS RIDER

Several U.S. Senators and others from the
farm-belt states, however, began to severe-
ly criticize the agency for its standards
effort and its outreach effort. We got
raked over the coals.

The low-reading-comprehension booklet
was a target for criticism. OSHA made a
valiant effort to explain what we were
trying to do. We hoped that the Advisory
Committee was going to be one of our
entrees to get the word out to the farm
commuTlity.

We obviously did not have the kinds of
coalitions and liaisons that we needed.
The criticisms got to be blistering political-
ly. As we were getting some of the book-
lets to press, the political pressure mount-
ed against the effort.

Reason no longer prevailed. We came to
a complete halt. OSHA withdrew their
effort, and the critics continued to howl
about OSHA.

The Agriculture Committee continued to
work on other subjects like electrical and
personal protective equipment, even field
sanitation and transportation of
farmworkers. No action was ever taken on
any of these Agriculture Committee sug-
gestions.

In Fiscal Year 1977, the Congress slapped
a restriction or rider on the appropriations.
The intent was to stop OSHA from carry-
ing out its mandates under the Occupa-
tional Safety and Health Act. The Con-
gress passed a law and told us to do it;
they came back and told us they did not
like the way we were doing it. They told
us to stop doing it.

They did not want us doing more in this
area, farms with 10 or fewer workers.
Therefore, that rider said no enforcement,
no standards-making, no investigations of
fatalities or complaints would be allowed,
nor would money be spent for these kinds
of efforts.

The rider stopped OSHA, and that rider is
still in the appropriation bill every year up
to today. The Farm Bureau and other
major organizations in the agricultural
community are advocates for that rider.

324

Papers and Proceedings


The Congress put it on. We think that the
Congress needs to be the one to take it
Off.

OSHA IN THE 1980'S

Let us take a look at the decade of the
1980's. Little action was taken by OSHA
in the agricultural area during the 1980's.
OSHA defines agriculture covered by Part
1928 to be those operations involved in
planting, raising, and harvesting crops;
animal husbandry including feedlots; aqua-
culture; cotton ginning; and others such as
on-farm storage for grain handling.
This is when a farmer is going to store
several seasons of grain in his own storage
facilities. That is considered part of our
definition of farming under Part 1928.

Logging

We do not consider logging operations to
be an agricultural area. We have a pro-
posed rule to address those kinds of haz-
ards.

Hazard Communication

OSHA issued two standards during the
1980's to add to Part 1928. Both were
Federally court-mandated. OSHA was
directed to issue both these standards
which apply to farms with 11 or more
workers.

The first one was hazard communication.
This is one standard that applies to all
workplaces that OSHA covers today, ex-
cept for farms with 10 or fewer workers,
These farms are the only ones that are not
protected by the standard.

A Regulatory Perspective, May 2, 1991

Field Sanitation

The next one was field sanitation. We
went through the long, laborious steps to
get the standard issued, a lot of agony.
There was a lot of interaction in the Fed-
eral courts.

There was a strong desire by certain ele-
ments in the agricultural community to see
this standard promulgated. They were
successful, through the court system, at
getting it into place.

OSHA IN THE 1990's

Where are we heading in the 1990's?
OSHA continues to support NIOSH in its
injury surveillance efforts, the injury pre-
vention and control research, Fatal Acci-
dent Circumstances and Epidemiology
(FACE) investigations by NIOSH, and the
hazard alerts NIOSH has done like the
oxygen-limiting silo problem. More needs
to be done in this area on real problems
on the farm and on the ranches.

OSHA wants to see its existing standards,
like ROPS and farmstead machinery
guarding, fully evaluated. What works?
What does not work? Why does it not
work? How can we make it so that it is
effective?

We want to see a better injury and trauma
data-gathering system. We want to analyze
these data to help us better understand
what are the causes of deaths and serious
injuries on farms and ranches.

OSHA has about 5,000 slides that can be
put into slide programs that are available
to NIOSH and USDA These are also
available to our consultation program that
we have in all 50 states. These were made
during the 1970's, before the rider on the

Surgeon General's Conference on Agricultural Safety and Health - 1991               325



Research - Mechanical and Physical Hazards

appropriation bill, to help as outreach
efforts.

To date, our consultation people have not
had a rush of requests from the agricultur-
al industry or community and the farmers
and ranchers to conduct on-site consulta-
tion visits. Obviously, we need to find
ways to reach those people. We have not
found those ways yet.

In the OSHA history of writing rules,
regulations and enforcement, we have
found that the people who are interested
i  in trying to correct these problems need
to be on board and in support of the
process.

We need to find ways to evaluate injury
intervention strategies to promote those
that are found to be effective and work.
We need to have the farmers and ranchers
actually involved in helping with the eval-
uation.

In the OSEIA history of writing rules, regn-
lations and enforcement, we have found
that the people who are interested in try-
ing to correct these problems need to be
on board and in support of the process.
They need to find that these kinds of solu-
tions work. Then, we can carry the mes-
sage to the non-believers or the
"stick-in-the-mud" types who need to be
pulled along a little harder.

OSHA is looking forward to the day when
the Congress no longer considers riders on
its appropriation bill to be necessary.
OSHA hopes to be a full-fledged partner
in the outreach and consultation efforts
that help the farm community, the agricul-
tural community generally, with assistance
so that the injury and trauma problems can
be brought to a much more acceptable
level.

We want to see this assistance given in all
50 states, territories, and the Comrnon-
wealth of Puerto Rico to reduce trauma
and tragedies.0

326

Papers and Proceedings


Surgeon General's Conference on Agricultum/ Safety and Health
FAR&&FE 2000 o A National Coalition for Local Action
Convened by the National Institute for Occupational SatWy and Health
April 30 - May 3, 1991, Des Moines, Iowa

FARMING METHODS AND SYSTEMS ANALYSIS

By Gary Erisman, Ph.D., CAP.
     Private Farmer

Dr. David S. Pratt: The first speaker today is-l am very pleased, harkening back to some of the
comments we heard this morning-someone who is involved as a stakeholder and a person directly
involved in agricultural production. Gary Erisman was born and raised on a family farm in Stanford,
Illinois. He got a bachelor's degree and master's degree, both from Illinois State University, one in
agricultural education and the other in traffic and safety education. He went on to receive a Ph.D. in
health and safety from the University of Illinois in Urbana, and then has gone on to become a
Certified Safety Professional. He has had numerous experiences and has taught and been involved
in occupational safety and health at the university level for a number of years. At the present time,
and since 1980, he is an active farmer and also serves as a safety consultant in farming.
Dr. Erisman:

As I view it, my primary task as lead-off
man for this session is to establish a per-
spective on the topic. It has been conclud-
ed for many years that accidents are a
particular problem to those engaged in
farming.' This conclusion has resulted
from intuition and the use of epidemiolo-
gy, the scientific method of studying epi-
demics in a particular population.

PROBLEMS WITH THE
EPIDEMIOLOGY APPROACH

Epidemiology is a staple method of investi-
gative evaluations of health problems.
However, there are some problems with
epidemiology when used to investigate
accidents.

1.

In epidemics, the agent (germ) is usual-
ly a constant, a single, identifiable or-
ganism with predictable properties.
That finding is not true with accidents.23
For example, all cases of chicken pox
result from one organism. However,
not all tractor accidents result from the
same organism (tractor). Tractors vary
in size, weight, ballast, age, etc.

2. Little can be done to change the germ.
In epidemiology, most success has been
achieved by reducing the human's sus-
ceptibility to disease through vaccina-
tion, administration of drugs, or educa-
tion. However, data has consistently
shown the most success in preventing
accidents is achieved through changing
the agent or environment through
redesign.`, `9 6

3. In epidemiology, the illness must mani-
fest itself. It is an "after the fact" meth-
od of problem solving. When compared
with alternative methods, it is an ineffi-
ciency.

4. Perhaps the biggest problem with epide-
miological studies of accidents is that
they rarely tell us the most crucial infor-
mation. Epidemiological studies answer
the questions "who," "what," "where,"
"when." They do not answer "why."3

We have to resort to other techniques to
answer the latter question. For example,
we may find 70 percent of all farm acci-
dents in Iowa occur between the months
April and October.

Surgeon General's Conference on Agricultural Safety and Health - 1991                327


Intervention - Worker Protection from Environmental Hazards

However, that may be because of chance
alone; that is the time span during which
most farming activities are conducted.
When we pool data from different states, it
produces even more uninterpretable data;
April has a different significance to farm
activities in Iowa than it does to farms in
Georgia.

The output of such studies is data, which
serves as the basis of conjecture. It is little
basis for scientific, effective counter-
measure development.

Epidemiological studies of accident prob-
lems already in existence are of value to
isolate problem areas that justify more in-
depth investigation.

THE SYSTEMS APPROACH

A more proactive, modern technique to
use with accident and injury control is
referred to as the systems approach. It is
the approach to accident control that has
been used with considerable success in
areas such as highway transportation sys-
tems, air travel and traffic control, and the
space program.

We need to define some terms as we go
along. I will use the systems method to try
to establish a perspective on farm acci-
dents. A system is defined as an orderly
arrangement of components that act and
interact to perform some task or function
within a given environment.'

1. Note that a system is defined according
to some task or function it is to per-
form. Examples include the digestive
system of a human, the postal system,
or an air traffic control system.

2. A system is made up of components
that act or interact (the components are

328

related); each component affects the
function of other components, and ulti-
mately, the output of the system.

When using the systems approach, the first
consideration is to identify the purpose of
the system. What is the system supposed
to achieve? What is the system's output to
be?

The second consideration is the develop-
ment of a thorough understanding of how
the system functions. How do the com-
ponents or activities relate to each other?
What happens to the system if one compo-
nent fails? For example, it would be im-
possible for a physician to competently
practice medicine unless he or she knows
the systems of the body, the components of
the systems, and how the systems interre-
late. Extending this example, it is impossi-
ble to effectively use the systems analysis
technique, without first gaining a thorough
knowledge of the system in question.

Systems are designed and maintained on a
two-priority basis. The first priority of a
systems designer is to produce a system
that will do the job for which it is intend-
ed. The second priority is to determine if
the system will work within an acceptable
degree of safety.

Systems can be evaluated using two types
of criteria, systems criteria and human
criteria.' I would like to use these two
criteria in an evaluation of our American
farming system.

Systems Criteria

Following the procedure set out, I must
ask the question, "What is the purpose of
the U.S. farming system?" From a national
perspective, the purpose is to insure a
reliable supply of food and fiber for our

Papers and Proceedings


citizens and other people abroad. It can    Since then, economic demands have
be argued that America's greatest natural
resource is its capacity as a food factory.    brought a major shift from subsistence

The climate, soil types, water supply, tech-   farming to a specialized, commercial-

nology, distribution system, economic sys-    ized form that predominates today.

tem, and creativeness of the farmers and
workers, when put together, comprise the   6. U.S. farmers produce a variety of com-

best collection of agricultural resources     modities for domestic apd export mar-
(components) in the world.          kets. The 1987 Census of Agriculture
                          lists more than 200 different commodi-

1. Each farmer in Japan produces enough
food to supply himself and 3 others; in
Russia, 11 others. But each American
farmer produces enough to support
himself and 114 others.'

2. The reliability of the American food
machine is so high, it is largely taken
for granted in this country. We have
never known the starvation experience
of European, Russian, and Asian coun-
tries during and after World War II.
Nor do we know the famine that exists
in a host of countries today.

3. Americans spend a smaller percent of
their disposable personal income for
food than in any other country in the
world.g

ties produced in the U.S. If a single
word were chosen to describe U.S.
production, the best word would be
"diverse".

7. Each commodity produced represents a
specific subsystem with specific opera-
tions equipment, timetables, labor, and
marketing demands.

In addition, a majority of farms still com-
bine two or more subsystems--one superim-
posed on the other-that usually have syn-
ergistic effects. Examples are hog-corn
farms; cattle, corn, bean farms; etc. Each
farm represents a unique subsystem of
activities and risks, with no two exactly
alike. Perhaps the greatest strength of the
overall system is the creativity of the com-
ponents; each farmer tries to build a better
mousetrap.

4. American agriculture is big business. It
makes up about 18 percent of all the
nation's jobs (20 million jobs). Howev-  It is important, at this point, to make a
                   distinction between the system's purpose
er, only 19 percent of that 18 percent
(3.8 million) are actually involved in   from a national perspective, and the pur-

farm production-farmers, hired labor,   pose of the system from the producer's
                    perspective. From the farmer's perspec-
and workers in forestry, fisheries, and   tive, the purpose of the system is a means
agricultural services.           of earning a living, or supplementing in-
                                     come.

5. The American production system has
evolved from the hunter-gatherer system  True, there are many secondary motives-
of our Native Americans, through slash
and burn systems, largely through no-   pride of ownership, a way of life, per-

madic systems, and through the subsis-  petuation of the heritage, etc. But the
                    primary purpose, to earn a living, should
tence form of farming that          never be allowed to become obscured.
predominated well into the 1950's.

Farming Methods and Systems Analysis, .May 1, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991               329


Intervention - Worker Protection from Environmental Hazards

1. Farmers seek to bring about an opti-
mum mix of land, labor, and capital
inputs to maximize output, which is
ultimately measured in dollars.

This technique of mixing inputs is the basis
of doing business in America. It is
referred to as entrepreneurship, "the ability
of one to organize, manage, and assume
the risk of a business or enterprise" (dictio-
nary). Thus, to enter farming is to volun-
tarily expose ourselves to risks, economic
and personal. There is evidence to suggest
that people psychologically differ in their
willingness to expose themselves to risk."

That does not make them "bad" people. It
adapts them to tbe demands of the job
others could not perform successfully or
happily. Other occupational groups of this
type would include such people as astro-
nauts, pilots, stock and real estate brokers,
athletes, police officers, and fire fighters.

2. The most telling single statistic that
depicts the system's performance for
producers was released by the USDA
recently.

In the middle 1970's, $0.34 of every food
dollar was returned to the farm level.
Today, that figure has been reduced to
$0.24. The margin of profit per unit of
operation continues to shrink. There is
only one way to maintain or increase prof-
itability under those conditions, operate or
produce more units.

Usually, for one operator to increase in
size, another must shrink. This may sound
like Darwinism, but it is not that simple.
A farmer may be extremely efficient.

With no opportunity to expand, however,
i.e., no additional land to rent, he can be
economically reduced to the point that his

330

primary income must shift to off-farm
sources. The enterprise is taken up by
another, who remains economically viable.
The result is that the big get bigger. There
are more and more part-time farmers.
The middle-sized operations continue to
disappear.

3. The trend in farm size leads to another
finding with implications for safety.

The trend toward fewer, larger farms
has reduced the number of family work-
ers, but it has increased the average
farm's hired-labor requirements.

1

Today, 50 percent of the hours worked on
farms are worked by farm operators; 16
percent by unpaid fqrrn workers, such as
family members; and 34 percent by hired
farm workers.' The trend toward fewer,
larger farms has reduced the number of
family workers, but it has increased the
average farm's hired-labor requirements.

4. The trend toward fewer, larger farms in
not necessarily a healthy one either for
those engaged in farming or those de-
pendent on the U.S. food system.

There is a point where concerns about
quantity override concerns about quality.
For example, one operator may operate
more acres, but may do a poorer job per
acre. Yields per unit may begin to dip a
bit. These events are insidious and some-
times hard to measure.

The ultimate result is a detrimental effect
on total system output. The system, in
total, reaches a point of diminishing re-
turns. It is not a situation of the operator's
choosing, making, or desire. It is some-

Papers and Proceedings


thing the economic system is imposing on  problems, and others. I am unaware of
them. It is an event that ultimately will
have to be addressed.          studies that have attempted to compare
                  the fitness to work of today's farmers and

To summarize, based on an evaluation of  other workers with those of the past. I
systems criteria, the U.S. food production  would postulate farmers today are less
system is found to be extremely productive.  physically fit as a group than those 20
It is also found to be changing toward     years ago.
fewer, larger components, which, in turn,      o
threaten continued capacity to increase     The average age of an American farmer

production.                today exceeds 50 years of age.


                                             o  Farm work has become more erratic.
Human Criteria                 The subsistence farms of the 1950's re-

A second group of criteria can be used to    quired work every day year around.
evaluate systems. They are referred to as    Today, with specialization, the physical
                         demands are much more seasonal.
human criteria, and as identified by

McCormick and Sanders,' are made up of
4 subcriteria.

1. Human Performance Measures elements
such as individual demands on sensory,
mental, and motor activities.

Nevertheless, farmers today try to oper-
ate units that fully use their capacity
(equipment). This trend tends to pro-
duce more pronounced periods of un-
derwork and overwork. Partially offset-
ting are contributions from industry that
reduce physiological demands, i.e., air-

It is obvious, due to increased mechaniza-
tion and specialization, that physical
demands on farmers and other workers are

conditioned cabs, power assists, etc.
Nevertheless, farming still remains
among the most physically demanding
of all forms of work.

being reduced. It is equally obvious, due
to economic demands, that mental stresses
are being increased.           3. Subjective Criteria: This critically impor-
                    tant area refers to people's evaluation

The luxury of being able to survive a sea-
son of bad weather or inaccurate business
decisions no longer exists for some opera-
tors. It resembles playing in a poker game
with increasingly high stakes. Each year
more and more producers find they have
their whole stack of chips in the pot.

of the system.


Thus, design is the most critical stage
for the prevention of hazards and haz-

There is no acceptable alternative to being
correct. That is stress!           It is often inaccurate. However, it is the
                   perspective that drives decisions. From a
2. Physiological Crzleria indicators of the   national perspective, farming may appear
effects of the work load on people.    to have the characteristics of farming 30
                   years ago. The public perception is often
Examples might include blood pressure,   that of the farm when they left it. Little
heart rate, respiration rates, chronic health

Farming Methods and Systems Analysis, May 1, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991

337


Intervention - Worker Protection from Environmental Hazards

public understanding of the true dynamics
of modern farming exists.

By contrast, those directly involved in
farming are acutely aware of the realities
of modern activities. The opinion of many
is that it is not as much fun, nor as enjoy-
able as it used to be. It is approached
more as a cold-blooded, demanding, unfor-
giving business.

4. Accident Frequency: It should be noted

that accidents are just one of several
criteria used to evaluate a system.

The value of any system is contrasted with
the cost to operate it. That statement may
sound insensitive. It is an accurate as-
sessment of the way the world works.

When viewed in the systems concept, an
accident represents one form of system
failure. When the system breaks down,
output is reduced or stopped. Systems are
designed to minimize or eliminate break-
downs in any form.

Farming ranks at or near the top of the list
of accidental deaths per 100,000 workers
exposed to risks.`, lo These findings have
been documented by more than one
source.

Translated into system terms, this docu-
ments a system that breaks down more fre-
quently because of a specific reason (inju-
ries) than most other systems. Further, it
documents that consequences of this sys-
tems failure are more serious than others.
The breakdown involves a death or serious
injury.

The question is, "Why?" That is a question
for which we do not have a definite scien-
tific answer. In my evaluation, we have a
great number of opinions, conjecture, and

332

over-generalization. We do not have de-
fendable data. That finding is the direct
result of the inadequacy of the
epidemiological methods primarily used to
study the problem.

HAZARD EVOLUTION

Perhaps the greatest single value of the
use of the systems approach is the preven-
tion of the problem before the problem
manifests itself in the form of an injury. I
will discuss one example of its use.

When we view the development of any
device, i.e., hammer, screwdriver, or trac-
tor, we find that in each stage of move-
ment, an opportunity for degradation from
design criteria exists. Examples are incor-
rect assembly, repair, and wear.

It has long been recognized that the safety
of a device can be no better than it is
found to be at the design stage. Thus,
design is the most critical stage for the
prevention of hazards and hazardous prod-
UCtS.S' 4 '

When products are found to have prevent-
able hazards resulting from design inade-
quacies, it suggests that two further evalua-
tions are in order:

1. The academic preparation of the engi-
neers and the content of the curricula
through which engineers are or have
been prepared, and

2. The degree to which administrative
environments encourage or reward
contributions toward sound systems and
human factors design.

Papers and Proceedings


Farming Methods and Systems Analysis, May 1, 1991

SUMMARY              Accident frequencies suggest a high fre-
The U.S. production system is a model of  quency of system breakdowns that must be
productivity when viewed from the outside.  addressed. System approaches should be

Economic trends have left much to be    used to evaluate why these breakdowns are
desired to producers and others who work  occurring. What system modifications can
in the system and make the system work.   be made to reduce the system failure
                          rate?0

1. National Safety Council. Accident F&s - 1990 Edition. Chicago: The Council, 1990.

2. Halsey, Maxwell; Editor. Accident Prevention. American Public Health Association. New York:
McGraw-Hi& 1961.

3. Jacobs, Herbert, et al. Behavioral Approaches to Accident Research. New York: Association for the Aid
of Crippled Children, 1961.

4. Klein, David and Julian Wailer. Causation, Culpability, and Deterrence in Highway Crashes. U.S.
Department of Transportation. Washington, DC.: Superintendent of Documents, 1970.

5. Marshall, Gilbert. Safety Engineering. Monterey, California: Brooks/Cole Engineering, 1982.
6. Walier, Julian. Injzq Control. Lexington, Massachusetts: D.C. Heath, 1985.

7. McCormick, Ernest, J and Mack S. Saunders. Human Factors in Engineering and Design. 5th Edition.
New York: McGraw-Hi& 1982.

8. Meyer, Don. McLean County Cooperative Extension Service, University of Illinois, 1991.

9. Americans in Agriculture - 1990 Yearbook of Agriculture. Washington, D.C.: United States Department of
Agriculture, 1990.

10. Erisman, J. Gary. "The Relationship Between Emotional Immaturity and Accident Involvement of
Illinois Male Farm Operators." Research Report No. 7, Safety and Driver Education Laboratory, Cham-
paign-Urbana: University of Illinois, 1971.

11. Master, David. Conceptual Aspects of Human Factors. Baltimore: John Hopkins University Press, 1989.

Surgeon General's Conference on Agricultural Safety and Health - 1991

333


Surgeon General's Conference on Agricothmt Saf&ty and Health
FARMSAFE 2000 o A National Coalition for Local Action
Comtmed by the National Institute for Occupational Sakty and Health
April 30 - May 3, 1991, Des Moines, Iowa

ERGONOMCS

      By Professor Stephun Konz
Department of Industrial Engineering, Kansas State University

Dr. David S. Pratt: We have another presentation that I think is going to shed some important light
on agriculture from a perspective that we, unfortunately, seldom hear from very much, and that is
ergonomics. Dr. Steve Konz is going to speak next. He received his Ph.D. in Industrial Engineering
from the University of Illinois. He has been at Kansas State University since 1964. He has been a
prolific writer and contributed to the scientific literature with over 170 publications, and he has a book
that is very popular, Work Design: Industrial Ergonomics,' which is currently in its third edition
and was just recently re-offered in 1990, and it is used at more than 25 American universities. We
are, indeed, delighted to have Dr. Konz with us today to talk about Ergonomics.  Dr. Konz:

SUMMARY

Ergonomics deals with the interaction of
man and machine in a physical and social
environment. For agricultural safety, two
ergonomic recommendations are:

1. Focus on unsafe conditions, not unsafe

acts.

2. Redesign rather than use training or

warnings.

ERGONOMICS

Overview

The word ergonomics was coined by Pro-
fessor Murrell in Wales in 1949 from the
Greek words erg (work) and nomos (laws,
rules).' Thus, it referred to the study of
work. Over the years, the meaning has
broadened to the study of the interaction
of people and their environment. The
work environment is just one possible envi-
ronment.

One aspect of ergonomics that has
received considerable attention is the study
of the characteristics of the individual per-
son. When focused on a person's dimen-

334

sions and strengths, this is called anthro-
pometry. When focused on the cardiovas-
cular and muscular systems, this is called
work physiology.

Information flows from the man to the
machine through controls. Information
flows from the machine to the man
through displays.

Thus, it was logical that much of the early
work in ergonomics focused on controls
and displays. Note that displays include
not only instruments (active displays) but
also letters and number arrangements such
as text, tables, and graphs (passive dis-
plays).

The man and machine are in a physical
environment (visual, noise, climate, chemi-
cal). Therefore, ergonomists also study
these variables.

Most ergonomists attention has been fo-
cused on the visual environment. Ergo-
nomists' interest in noise and climate
(temperature, humidity) has focused on the
degradation of performance due to noise
and climate.

Papers and Proceedings


Finally, this activity occurs in a social and
organizational milieu. The person inter-
acts not only with machines but with other
people. This area presents many challeng-
es as people are much more difficult to
modify than machines.

One of the basic philosophies of er-
gonomics is the primacy of people over
machines. The idea is to adjust the ma-
chine, not the man.

This is in contrast to a common en-
gineering philosophy of designing a
machine, then assuming the personnel
department will be able to find someone
to be able to yun the machine. Thus:

o Adjust the machine to the man, not the
man to the machine.

An alternative statement is:

o Adjust the procedure to the person, not
the person to the procedure.

PROFESSIONAL BACKGROUND OF
ERGONOMISTS

As might be imagined, the professional
background of ergonomists is very diverse.
As a very broad split, ergonomists are
divided into those interested in product
design and those interested in occupational
ergonomics.

The ergonomists interested in product de-
sign, however, usually are not designers or
engineers but staff consultants to designers.
Very commonly, they will have a
background in psychology- usually a M.S.
or Ph.D.

The ergonomists interested in occupational
ergonomics include consultants. More
commonly, they include industrial engi-

Ergonomics, May 1, 1991

neers, medical practitioners, and safety
specialists. These occupational er-
gonomists tend to have a small amount of
training in ergonomics (50 to 100
classroom hours) grafted onto a basic
specialty such as industrial engineering,
industrial hygiene, occupational medicine,
etc.

The occupational ergonomists tend to have
BS degrees. (During the 1950's and
1960's, ergonomics was the province of the
Ph.D. In the 1970's, it changed from a
science to a technology. Ergonomics
knowledge was obtained by those with
M.S. and B.S. degrees. In the 1990's,
training materials are beginning to appear
for blue-collar workers.)

There are many professional homes for
occupational ergonomists in the USA. The
largest ergonomics society, the Human
Factors Society (HFS), has "technical inter-
est groups" for Safety (582 members as of
January 1, 1990) and Industrial Ergonom-
ics (506 members). They are the second
and fourth largest of the seventeen interest
groups in the HFS.

The Institute of Industrial Engineers has
an Ergonomics Division of about 1,050
members. The International Foundation
for Industrial Ergonomics and Safety has
about 300 at their annual meetings. There
is considerable interest in ergonomics in
other organizations (National Safety Coun-
cil, American Society of Biomechanics,
etc.).

Ergonomics is widespread outside the
USA. There are 18 countries that have an
ergonomics society belonging to the Inter-
national Ergonomics Association (IEA), as
well as some countries that have not yet
joined the IEA. Total membership is
about 15,000.

Surgeon General's Conference on Agricultural Safety and Health - 1991

335


Intervention - Worker Protection from Environmental Hazards

AGRICULTURAL SAFETY AND HEALTH
CHALLENGES

As a broad generalization, safety and
health problems can be divided into three
categories:

1. Injury: An accident causes an injury.
The time frame is short-a "sudden event."
An example would be a hand mangled in a
power takeoff or a burn from a grass fire.
It enters government statistics for deaths,
lost worktime, medical treatment other
than first aid, loss of consciousness, restric-
tion of work or motion, or transfer to an-
other job.

2. Cumulative trauma: The body (mus-
cles, ligaments, joints) suffers "insults" over
a time period usually measured in months
or years. Examples would be carpal tunnel
syndrome, back injuries, or hearing loss.
In general, the problem is due to a
"physical" agent (weight, noise, vibration)
or motion of the human body itself. In
government records, cumulative trauma
(also called repetitive strain, occupational
over-use syndrome) is considered an
illness. Back problems, however, are con-
sidered injuries.

3. Illness: An organ of the body is
injured, generally by a chemical or a bio-
logical agent. The time period is variable,
with times of minutes (acute) for skin ir-
ritants and allergies to years (chronic) for
silicosis and occupational cancers.

Note that the present government statistics
do not have this division into three catego-
ries. Present statistics are divided into
injuries and illnesses.

Most of the cumulative trauma problems
are in the illness category although back
problems are considered injuries. Figure 2

336

shows how cumulative trauma has become
a larger percent of reported illnesses.

Table I gives, for agriculture, injury and
illness statistics for 1988 (last data
available). A key point is that, although
cumulative trauma is increasing in impor-
tance among illnesses, total injury cases
(per 100 workers) are about 20 times more
frequent than total illness cases.

ERGONOMICS FOR AGRICULTURE

As pointed out in the previous section, the
major problem of safety and health is
safety. Although ergonomics has a broad-
er orientation than just safety, two ergo-
nomics concepts will be discussed in rela-
tion to safety.

Table I. Injury and illness sta!istics per 100 full-
time workers for agriculture in 1988.'

            Aaricultural  Forestry
          Production Services

                      v       v        7
Injury
Total cases       11.7 9.2   11.9
Lost workday cases 6.1 5.0 6.3
Non-fatal cases with-

out lost workdays 5.6 4.2 5.5
Lost workdays    108 91    136
Illness
Total cases        0.54   0.45   0.47

Focus on unsafe conditions, not unsafe
acts. Most accidents and injuries can be
considered to be a result of either unsafe
acts or unsafe conditions. For example:

o A farmer is injured when a tractor tips
over on a slope. The injury could be con-
sidered to be from the tractor having a

Papers and Proceedings


Ergonomics, May 1, 1991

McCarthy et al.4, after reviewing 400 papers, reported that there is very little evidence that
warnings work-that is, change behavior. Any cigarette smoker emphasizes this point. There are
literally thousands of warnings about the dangers of smoking. Yet, people continue to smoke.
The acronym Present, Read, Understand, Memory, Act, Effective (PRUMAE) points out some of
the challenges.

P (Present): The warning must be present. If the warning is in an instruction manual, which
has not been seen, the warning cannot work. If the warning originally was a label on a machine,
but the label is gone, there is no warning.

R (Read): The next problem is to get the warning read. People find many excuses not to
start reading material. (If all else fails, read the instructions.) If they start, they often skip many
parts of the text. We are surrounded by a barrage of messages in newspapers, TV, billboards,
etc., and learn to filter them out. Most injuries concern rare events so there is no reinforcement
from not following the warning. (Remember how in "Peter and the Wolf," Peter ignored repeated
warnings about the wolf and nothing happened to him for a long time until the last time.) Try to
make the warning "stand out" of the background.

U (Understand, comprehend): The reader may not understand the, warning language
(e.g., a Mexican reading English). Even if the reader "knows" the language, the words may be
"too big." Pictographs are an attempt to reduce this problem. Unfortunately, some of them are
as intelligible as wriien Chinese. That is, pictographs are another language that you may not un-
derstand. Understandability can be improved with grammar and layout of the message. The
warning can be divided into four statements: signal, hazard, consequence, instruction. For
example: "DANGER, HIGH VOLTAGE WIRES CAN KILL, STAY AWAY"; or "WARNING, CON-
TAMINATED WATER, ILLNESS MAY RESULT, DO NOT DRINK." The "hazard" statement is the
most important. The "Signal" word and the "Consequences" may be redundant information to
informed users.

M (Memory): Once motivated to input the information to the brain, the person now must
commit it to long-term memory. Then, upon need, retrieve it. Easier said than done.

A (Act): Upon retrieving the information from the brain, the person now must translate this
into action. An important point is the cost of compliance. For example, complying with a
warning "Don't use broken door" was 94 percent if another door was adjacent, 6 percent when
another door was 50 ft. away, and 0 percent when another door was 200 ft. away. Reducing the
cost of compliance (reducing the cost/benefit ratio) should improve compliance.

E (Effective): The person then needs the necessary ability to do the desired behavior and
then the skill and training to do it effectively.

For a warning to work, all six steps must succeed.

BOX 1. Warnings.

Surgeon General's Conference on Agricultural Safety and Health - 1991

337


Intervention - Worker Protection from Environmental Hazards

high center of gravity or from an unsafe
act of the farmer (farmer makes too sharp
of a turn).

o A farmer is injured on a power takeoff.
The injury could be considered due to an
inadequate guard or an unsafe act (farmer
fails to maintain the guard),

o A farmer falls from the second floor of a
barn. The injury could be considered due
to an inadequate railing or an unsafe act
(farmer tripping over tools on the floor
near the edge).

To reduce future accidents and injuries,
the best approach is to consider all acci-
dents as due to unsafe conditions. That is,
the "machine" is at fault. The "machine"
should adjust to the "man," not the con-
verse. If the man had "problems," then the
"machine" or procedure should adjust, not
the man.

Psychologically, the "machine is at fault"
approach results in a positive approach to
solving the problem. If a "man is at fault"
approach is used (i.e., the accident was due
to an unsafe act), the problems of chang-
ing human behavior seem so overwhelming
that often nothing is done.

There is a need for research on how to get
people not to commit unsafe acts. Why do
people do things that they know are un-
safe? And, an even more difficult problem,
how can their behavior be changed?

FOCUS ON DESIGN RATHER THAN
USE TRAINING OR WARNINGS

A safety challenge can be reduced by
warnings, training, or design. For example,
a farmer could fall into a silo. One possi-
bility is to warn the farmer against fklling
into the silo. The second possibility is to

338

train the farmer not to fall into the silo.
The third possibility is to redesign the
procedure or machine to prevent falls.

o Warnings

Box 1 discusses warnings in more detail?
The key point is that warnings do not work
well. Many things have to occur for the
warning to work.

Another problem with a warning is that it
is a temporary solution, not a permanent
solution. That is, each person exposed to
the danger must be warned and the wam-
ing must be repeated over time, or it is
forgotten.

o Training

Training can be effective, but it is expen-
sive since everyone exposed to the danger
must be trained. It is difficult to give
training to "visitors" and "bystanders."
Another problem of training is that it is
temporary and must be repeated over
time, or it is forgotten.

o Design

Designing out the problem is the best
approach because it is a permanent solu-
tion. For the silo problem, design solu-
tions might be a safety harness or railings.

It may help acceptance of design solutions
to focus on the annual capital cost rather
than the initial capital cost. For example,
railings may cost $500 but then last 25
years. Give the cost as $20 per year rather
than $500.0

Papers and Proceedings


Ergonomics, May 1, 1991

1. Konz, S. The Rise of Ergonomics, Proceedings of the Int. Ergonomics and Safe9 Conference. Cincinnati,
London: Taylor and Francis, 1989.

2. Occupational Injuries and Illnesses in the United States by Industry, 1988 (Bulletin 2366). Bureau of
Labor Statistics: Washington, Supt. of Documents, August 1990.

3. Konz, S. Work Design: Ina'ustrial Ergonomics. 3rd edition, Scottsdale, AZ Publishing Horizons, 1990.

4. McCarthy, R., Finnegan, J., Krumm-Scott, S. and McCarthy, G., Product Information Presentation, User
Behavior, and Safety. Proceedings of the Human Factors Society1 8445, 1984.

Surgeon General's Conference on Agricultural Safety and Health - 1991

339


I am going to talk about-and I was a little
daunted by being the only person to talk
about a subject this broad-personal pro-
tective equipment. I have done research
in this area, but as all of us who do re-
search know, we know a lot more about
the particular problems that we have stud-
ied than the general issues that might be
raised by all of the farming activities in the
United States,

As a result, this talk is going to focus more
or less on applicators and, perhaps, field
workers and their exposure to pesticides
and the use of protective equipment under
those circumstances as opposed to, say, the
use of such equipment in silos or in swine
confinement and all the other kinds of
activities that are involved.

The pesticide application problem and the
residue problem with harvesters tend to
be, in some sense, generic-not that there
are not differences across the regions, The
processes have some similarities, and we
are able to make some general statements
about the use of personal protective equip-
ment during these kinds of activities.

Surgeon General's Conkmmce on Agricultural Sat&y and Health
FARMSAFE 2000 o A NatIonal Coalition Ibr Local Action
Conwned by the National hwtitute fi~r Occupational Safety and Health
Apti/ 30 - May 3, 1997, Des Moines, lowa

PERSONAL PROTECTIVE EQUIPMENT

By Richard A. Fen&e, Ph.D., M.P.H.
Associate Professor, Industrial Hyglene Program
     University of Washington

Dr. David S. Pratt: The next speaker is Dr. Richard Fenske. Dr. Fenske received both his Master's In
Public Health and his Ph.D. from the School of Public Health at the University of California at
Berkeley. Following his preparatlon there, he spent slx years on the faculty at Rutgers University In
New Jersey and worked with the Agricultural Experiment Station In New Jersey. Recently, and I must
say to the lament of the agricultural community of New Jersey, Richard has left and Is now with the
University of Washington, School of Public Health and Community Medicine. Dr. Fenske is going to
talk about Personal Protective Equipment. Dr. Fenske:

WORKER PROTECTION STRATEGIES
IN THE AGRICULTURAL WORKPLACE

I am going to start out by discussing a lot
of options other than personal protective
equipment. In industrial hygiene and in
occupational health in general, we tend to
talk about controls of exposure or hazards
in terms of a hierarchy that involves engi-
neering, administrative controls, and per-
sonal protective equipment.

This hierarchy is actually explicitly ad-
dressed in the Occupational Safety and
Health Act, and this point has already
been made earlier-that the best solution is
to engineer the hazard out of the process,
if we can do that. Increasingly, regulators
have turned to personal protective equip-
ment because given the kinds of risk as-
sessments that are being produced for
pesticide applicators and field workers,
under current practices, it would appear
that many compounds could not be
registered if we were not using personal
protective equipment.

I am going to be a little bit critical of this
point of view, but at the same time sympa-
thetic to the dilemmas that are faced by
regulators and by farmers who have a

340

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pressing need for certain chemicals to be
registered at the present time. Let us go
through these options before we get into
our main subject.

Engineering Controls

Regarding engineering controls: we have
already had some examples of closed mix-
ing and loading systems. I think this is an
understandable concept. If we can avoid
direct contact of the worker with chemi-
cals, we are going to reduce the hazard.

We can have applications conducted with
closed tractor cabs. If these types of sys-
tems are used properly, they do tend to
reduce exposure among the workers. We
can also have changes in the way in which
we conduct the applications.

Quite a bit of research is going on in the
way of agricultural engineering, attempting
to get more of the material on the target
and less as drift and on areas of the envi-
ronment where we are not interested in
having the compound. We can also make
innovations in formulation.

Microencapsulation comes to mind as a
good example of a formulation technology
that gets the active ingredient out there,
but in a much less hazardous form. So
there are many opportunities, if we are
creative, to reduce the hazard before we
ever have to worry about personal protec-
tive equipment.

Administrative Controls

In terms of administrative controls, I think
one that is given a lot of lip service but, I
know from my own experience, does not
get much funding is integrated pest man-
agement. That is selective use of agricul-
tural chemicals and the use of other kinds

Personal Protectbe Equipment, May 1, 1991

of pest management processes. This, obvi-
ously, reduces the hazard of chemical ex-
posure.

I might add to this list alternative cultiva-
tion practices. One of the interesting
points in the earlier talk had to do with
the evolution of farming practices, from
subsistence to specialization. With that
specialization comes the need to use in-
creased amounts of chemicals, given mono-
cultural agricultural systems.

I think a lot of farmers actually are taking
a second look at this. Mixed cultivation,
rotation of crops and such, is a means of
reducing the use of chemicals. It is
cost-effective in some cases, and it certain-
ly reduces the hazard.

So there are many opportunities, if we
are creative, to reduce the hazard before
we ever have to worry about personal
protective equipment.

Product substitution: EPA is trying to find
safer substitutes for the kinds of com-
pounds that we use in the agricultural
work place, but given the review process
and the complexities of the regulatory pro-
cess, we know this is very difficult. Also,
at this stage in the game, to create a new
chemical, a chemical manufacturer has to
invest literally tens of millions of dollars
prior to that compound coming onto the
marketplace.

It is a very risky game at this stage for
chemical manufacturers, and we have seen
a thinning out of the industry. A number
of agricultural chemical companies have
disappeared from the scene in the last five

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Intervention - Worker Protection from Environmental Hazards

to ten years because of this kind of pres-
sure.

Of course we have worker education and
training, something I think is being dis-
cussed quite a bit in this (conference). We
are going to talk a little bit more about
how important that is for personal protec-
tive equipment. It is a control that can be
exerted to reduce hazards that can be
quite effective. Of course, when you are
talking about agricultural field workers,
people who enter fields that have been
treated and may come into contact with
the residues, we do have a formal ad-
ministrative control called a re-entry inter-
val. I believe, EPA is changing the name
of the reentry interval to restricted entry-a
period of time during which no one is
allowed into a field so as to allow residues
to decay to an acceptable level as judged
by a risk assessment process.

Personal Protective Equipment

Our third and, one should say, final resort:
In general in industrial hygiene, it is con-
sidered that personal protective equipment
is the final resort and also a temporary
resort.

No one may consider that temporary may
mean years of time to bring a new engi-
neering control into the marketplace to
avoid the use of these things, but I think
philosophically we need to treat personal
protective equipment as a stop-gap mea-
sure, however necessary it may be today,
and try to look beyond the use of this
equipment to some process that does not
require the need for this equipment.

The first question to ask about personal
protective equipment is, "Can we make
equipment that does the job?" I think the

342

answer is-with American ingenuity behind
us-yes, we can. We have seen it done.

For workers conducting some mechanical
operations on the moon, their protective
equipment is doing a very good job of
protecting them from absolutely nothing.
In this sense that is profound, for without
these suits there would be a hazard, in-
deed.

We put these same kind of suits on work-
ers right here on earth. If you can imagine
yourself working for eight hours a day
under these circumstances, I think you can
imrnediately see some of the problems
associated with protective clothing. Cum-
bersome, etc. We will detail some of
these.

Now, in the agricultural work place, unfor-
tunately a farmer's view of farm work is
this. I point out this fellow who is dressed
like a true westerner. This is a picture in
South Dakota. (Slides are not illustrated.)

My experience in working with farmers
throughout the United States is that this is
their image of themselves, not of the previ-
ous slide of a hazardous waste worker or
some other kind of specialist in chemical
hazards, because the use of agricultural
chemicals, which are acutely or chronically
toxic, is only one relatively small part of
the job of being a farmer. I think we have
some farmers in the room who can attest
to that.

These workers would much prefer to be
dressed like this during their work, or with
short sleeves, or whatever and leather
boots: all the things we tell them they
cannot do when they are working with
pesticides. That is the reality, and I think
it is quite a legitimate point of view. I

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would rather work like this than work in
the kind of gear that I showed you before.

Now, we can dress workers up to wear
equipment, and they can use it properly.
That is clear. We have gloves; we have a
nonwoven coverall; and we have a mixing
process here going on. But we know that
lots of workers would rather dress like this
when it is 90"F, 90 percent relative humidi-
ty in Florida, in July.

You can see the open shirt, no gloves, no
rubber boots-just jeans. Mixing. Loading.
Exposure under these conditions with an
open loading system like this is inevitable.
The issue is a balance between protection
and comfort, It is very hard to persuade
workers in these environmental conditions
that protection is more important than
comfort.

We can get workers to put on suits, but
sometimes they do not wear their gloves.
In some cases we can get people just load-
ing, putting on their respirator but seeming
to be totally oblivious to the fact that some
of these compounds go through the skin
and the dermal route of exposure is a very
important one.

Here we have someone dressed in his
street clothes with no gloves, loading
50-pound bags of an organophosphate
insecticide-I might add with the propeller
blade running. I use this in class. How
many things are wrong with this picture?
So we do have problems in education and
communication, in awareness of hazards.

Here we can have someone who looks like
he is dressed up just about as well as we
are going to do it: rubber gloves, a full
coverall, respiratory gear, some kind of cap
anyway-but then we find him doing some

Personal Protective Equipment, May 1, 1991

strange things. He only wants to use a
portion of his bag.

He has ripped open the bag, measured out
a wettable powder in the breeze, and
turned out to be the highest-exposed per-
son in the study we were conducting, de-
spite all his protective gear on. He is
doing something that he should not be
doing, but no one is going to go there and
enforce any regulation on him.

Then we have people right here in the
state of Iowa who will tell me that since
they are just mixing an herbicide, and it is
not toxic-and they mean acutely toxic, of
course-that they do not need to wear
gloves or protective clothing.

Then we have people out on the bean
buggies spraying herbicides in the soy bean
fields who are dressed without a thought to
personal protection. Here we have to
consider that this young woman is a pesti-
cide applicator who is trying to get a sun-
tan at the same time, working quite a bit
at odds with our idea of personal protec-
tion from skin exposure.

We have a wide range of people to consid-
er and to protect, and we should remem-
ber-1 think it is obvious from this confere-
nce's emphasis-but these children are
pesticide workers. They are agricultural
workers too, exposed to pesticides in the
fields behind them.

They are ready to go out and do some
harvesting and will inevitably come into
contact with pesticide residues. All of
these people in some way or other have to
be helped, and protective clothing is not
necessarily going to do the job.

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Intervention - Worker Protection from Environmental Hazards

PERSONAL PROTECTIVE EQUIPMENT

Limitations

Here are some of the limitations that I see
as important for using protective equip-
ment. In general, whatever it is gloves,
respirators, or these whole-body gar-
ments-it is uncomfortable. That decreases
your ability to do and enjoy the work that
you are supposed to be doing.

If you are wearing a respirator, it puts
stress on your respiratory system, which
can be a problem. You lose dexterity
when you use gloves.

A whole-body garment that is nonwoven
cannot breathe, and can cause heat stress.
All of these things are very well known,
but I am recounting them because I think
they are all important to keep in mind.

Use Requirements

Some people would argue that it is easier
to use protective equipment than to do the
administrative or engineering control. In
fact, if you have a good protective equip-
ment program, it is not easy at all. You
have to deal with training your personnel.
That is not a one-time thing. It is a con-
tinuous process.

You have to determine that people are
using the equipment you have given them,
using it properly. The equipment has to
be maintained.

Somebody has to be made responsible for
the maintenance. Is it the worker? Is it
the employer ? Who takes care of this?
Equipment has to be replaced.

A judgment has to be made about when it
is replaced. That judgment is often made

344

on the basis of economics rather than on
the basis of safety. We have a whole host
of things where is unclear whose responsi-
bility it is for all of these items. That is a
problem in itself.

Selection Criteria

Let us look at respiratory protection first
and then we will go to other kinds of pro-
tection. When a respirator is required on
a pesticide label, a process has gone on at
the regulatory level.

A toxicological evaluation of a particular
compound has been conducted. A permis-
sible exposure limit has been calculated.
To some extent, an estimate of what peo-
ple are actually exposed to has to be gen-
erated. If it appears that one needs a
respirator-that the hazard is sufficient to
require a respirator-then it has to be de-
cided what kind of respirator deals with
the particular associated hazard.

Is it an aerosol? Is it a vapor? Are we
talking about large dust particles? This all
is a complicated regulatory process, but we
have it pretty well worked out.

Respiratory Use Requirements

Now, at the use level, there are some very
important things to remember, and again,
they complicate the use of protective cloth-
ing. When someone is using a respirator
and conducting labor, they need to be
tested in terms of their respiratory capacity
to make sure that that respirator is not
going to put excessive stress on them. The
issue of fit testing, which is commonplace
in industry in a work place that is well-def-
ined and may have an industrial hygienist
on staff, is very problematic out in the
agricultural work place.

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Who does the fit testing? Most farmers do
not know how to do fit testing. Fit testing
actually can become quite a sophisticated
process. My experience is that there is no
fit testing in practice going on in agricul-
tural workplaces. So, if the respirator does
not fit, it is not an effective means of re-
ducing hazard.

Then we have the inspection and
maintenance of this equipment. Most
farmers and farm employees are not in a
position to decide if a respirator is no
longer in good condition.

Finally, one problem with the kind of car-
tridges that are traditionally used on pesti-
cide respirators, for example, is that you
never know when they are saturated. They
have a finite capacity, and a lot of farmers
change them once a season.

Some do it by smell, which is a real prob-
lem because the hazard usually occurs
prior to the odor threshold. We do not
have a good system for that.

All of the responsibility for these things is
placed on people who are very busy doing
something quite different; they are produc-
ing food. They are dealing with crops.
They are mechanics.

They are all the other things that we have
talked about, and here they are also having
to be experts and specialists in protective
clothing evaluation. It is a big problem in
terms of a realistic expectation that we
place on people.

CHEMICAL PROTECTIVE CLOTHING

If we turn to what I am calling chemical
protective clothing, where we are talking
primarily about garments that cover the

Personal Protective Equipment, May 1, 1991

skin and attempt to put a barrier between
chemicals and the skin.

Regulatory Selection Criteria

We go through a similar kind of regulatory
selection criteria with a toxicological evalu-
ation and exposure scenario, making sure
that the particular material matches the
kind of exposure. There is an infinite
variety of combinations of material and
hazards. One material is fine against one
chemical, but is readily penetrated by an-
other. EPA has worked on a very compli-
cated process in the last few years, but
they would be the first to admit that there
is a lot more that needs to be done.

Cost and availability: A lot of farmers do
not know what is out there. Also, it looks
like it has a pretty high price tag, especial-
ly the nonwoven coveralls that have be-
come popular.

They are supposed to be throw-away gar-
ments. It is very tempting not to throw
those garments away but to use them over
and over again, because they can be ex-
pensive.

Worker acceptance: It is fine to give a
worker one of these garments, but he may
not be wearing it if he is under your super-
vision. Once he is out of sight he may not
be wearing this garment properly. We
have seen plenty of evidence of that out in
the field with zippers pulled down, cover-
alls with the top part tied around the waist
-all sorts of ingenious ways of keeping
cool under the kind of work that these
workers do.

Testing

If you are interested in research for a
lifetime here is an area where there is

Surgeon General's Conference on Agricultural Safety and Health - 1991                345


Intervention - Worker Protection from Environmental Hazards

plenty of work. We have all agreed that
there is no such thing as an impermeable
garment, and it is a very important concept
to get across.

This breakthrough is a function of time.
Some garments may be impermeable for
days or weeks, but they are not infinitely
impermeable, and breakthrough time has
become a primary criterion for testing
garments.

We have standard laboratory tests, which
are actually quite good for testing break-
through times. Whether this simulates
field conditions or not-actual use
conditions-is open to question. We only
have limited field performance tests, and
we need more of that kind of work if we
are going to say to farmers, "Wear this
garment. It will reduce the hazard that
you face." I think there is a serious ques-
tion at this point as to whether we can
make that statement or not for very many
garments.

FIELD PERFORMANCE EVALUATION

Orchard Applicator Exposure

What I would like to show you is some
work that we have conducted down in
Florida the last few years-a very short
summary of it-that gives you a couple of
examples of why I am expressing skepti-
cism about the use of chemical protective
clothing. We conducted a study under
EPA sponsorship in the citrus orchards in
Florida.

But this is the kind of application process
called an air-blast applicator-a trac-
tor-pulled rig that has 1,000 gallons of
material that is sprayed to basically satu-
rate these trees to provide complete cover-
age. It is a very high exposure potential

346

situation for the worker who is sitting
there in an open cab and can end up tak-
ing a shower.

We were specifically testing a couple of
nonwoven coveralls to see if they could
improve the situation for these workers.
Workers did not like them very much, but
they were willing to wear them for our
half-day study period. We found some
problems with these garments very quickly.

They were not designed to step on and off
tractors. One gentleman, within 30 min-
utes of wearing this garment, ripped it. He
is about 40 minutes from his home base.
So if he does not have any spare clothing,
he has a problem. He has less protection
than he would have had had he just been
wearing his regular clothes.

Another fellow had the same problem. I?e
was reaching up to work some equipment.
It turns out that these garments do not
have a lot of play in them. They are used
to working in cotton, so maybe this is a
problem that can be addressed eventually,
but it certainly was a startling one for us to
see for these workers.

We use a technique that introduces a fluo-
rescent material into the spray system and
then allows us, under black lights and
darkened conditions, to see patterns of
exposure on the skin. We saw some inter-
esting ones here-and unexpected ones.

Here you can see that this worker was not
wearing gloves and there is material on his
hands. This person was wearing a long-
sleeved garment and look at this material
that goes up here. You can see the mate-
rial goes all the way up to the elbow, and
yet he is wearing a longsleeved garment.

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This person is even more impressive. We
had material on his hands, quite a bit on
the forearm. Here is the elbow. Material
went up the elbow. We actually saw mate-
rial down around the armpit of this work-
er-material that was being blown right up
the sleeve of these garments.

I do not know if you noticed in the previ-
ous slides, but these garments have rather
large sleeves. They are made as
one-size-fits-all.

Of course, having an open sleeve allows a
certain amount of ventilation, since the
garment does not breathe, but it also al-
lows a lot of material to be blown right up
the garment and onto the skin. We also
saw cases of actual breakthrough of these
garments.

You can see here material that went down
through the neck, but here is material on
the upper arm that was quite isolated and
was evidence that the garment had broken
through-and this was in about a two-hour
spraying period. He might wear this gar-
ment for eight hours a day. So the
breakthrough is happening relatively early.

When we use this fluorescent technique,
we develop an exposure score when we
attempt to quantify this. I show you this as
a baseline for four types of garments: a
work shirt, a woven fabric that is a cotton
coverall, and two different types of
nonwoven fabrics that we were testing.

We measured the exposure to the head,
and we saw that, more or less, these work-
ers were getting the same type of exposure.
We had controlled the conditions, and we
expected to see this. This more or less
confirms it. This is the head exposure, and
you can see that it is substantially higher
than the exposure to the torso-the trunk

Personal Protective Equipment, May 1, 1991

of the body. But, again, the exposure in
this region seems to be very similar.

Look what happens when we take a look
at the forearms, which are the white bars,
and the upper arms, which are these other
bars. We have an actual increase in expo-
sure as we move from a work shirt up to
these nonwoven garments. That is simply
a quantitative verification of what you saw
in those slides.

In the cases where people were wearing
these nonwoven garments, sleeve openings
allowed substantial material to move up
and deposit on both the forearms and the
upper arms. You can see the same trend.
So, actually, the woven garments proved to
be more protective under these particular
conditions.

Now, you can seal up the sleeves and you
can prevent these problems, but unfortu-
nately most of the garments are designed
without any kind of seal on them; and
most farmers are unaware of this kind of
problem.

When we looked at exposure to the thighs,
using patches above and below the cloth-
ing, here again we found something very
interesting. Although for the work shirt
material-I guess this was for the tor-
so-there seemed to be a little bit more
penetration. We could not make any dis-
tinction, between the cotton coveralls and
the nonwoven coveralls.

What is important is that all of these gar-
ments were breaking through. There were
measurable residues of pesticides
underneath virtually all of these workers
after a two-hour application period, and
that is a small fraction of their normal
application period.

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Intervention - Worker Protection from Environmental Hazards

The problem that I see, and I am going to
illustrate it with another study, is that the
workers believe, because we tell them, that
they are receiving protection by wearing
these garments. This study at least sug-
gests that under these particular condi-
tions, they were not receiving any greater
protection, and for the arms they were
actually receiving less protection than if
they had been wearing cotton garments.

So our conclusions from that study were
obvious:

1. Nonwoven fabrics tear,

2. The garment design is the problem in
terms of the arm exposure, all of these
garments exhibit penetration.

3. These are important findings in terms
of trying to evaluate these clothing ar-
ticles realistically.

Greenhouse Applicator Exposure

The second study had to do with
greenhouse application and was funded by
NIOSH. We had a problem that we did
not anticipate. We were traditionally look-
ing at the applicator as spraying an aero-
sol. We were worried about the aerosol
deposition. Would it penetrate the cloth-
ing?

We ran into a different problem-that the
foliage in these greenhouses overhangs the
benches. The worker comes into contact
with that foliage, and we knew from other
studies that the clothing gets some contam-
ination on it. Here is a worker spraying in
a greenhouse wearing blue jeans and a
workshirt, and he is brushing up against
that material when he bends over the
bench.

348

We did our fluorescent tracer technique,
and this is a real useful slide for male
workers, when you point out to them ex-
actly where they are getting exposed. It
motivates them to think about what they
are doing.

Also, if they wear this clothing home, this
becomes their lap, and that is where their
child sits. When you tell them this, they
really do think about it, and we have seen
some startling changes in behavior.

I think what we found that was even more
interesting is that when you have a worker
dressed up in one of these garments that is
nonwoven and is advertised as protective,
we see a breakthrough within one hour of
spraying. These are the knees and the
material is clearly associated with the
height of the bench and the foliage where
the contact is occurring.

You can see that it was very extensive,
virtually all the way up to the top of the
thigh, down to the knee, and halfway down
the leg on both the front and the side of
both of the thighs. This is a substantial
body surface area, and when we talked to
the worker about this, he had no idea that
this breakthrough had occurred.

He is wearing basically a plastic garment.
He is sweating underneath that garment.
He is unaware that there is moisture tra-
versing that garment and contaminating his
legs.

We stopped him after one hour. He nor-
mally sprays three or four hours a day and
uses this same garment all day and tends
to use one garment for three days before
he throws it away. This breakthrough is
occurring in less than one hour. We clear-
ly had a problem; the greenhouse where
we did this work has certainly made some

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changes in terms of the protective clothing
that they offer their workers. They were
quite happy to find this out.

Our conclusions were that:

1. There is a particular hazard of contact

with wet foliage.

2. The breakthrough can happen relatively

quickly.

3. Workers are unaware of the break-

through.

Unfortunately exposure is a very compli-
cated issue. Unless we do these kinds of
field studies, which tell us which clothes
perform in what way under what particular
conditions, it is difficult for us to give good
advice to farmers regarding the use of
chemical protective clothing.

AGRICULTURAL WORKER
PROTECTION STRATEGIES

To sum up, I think that we can look at the
problem in two different ways.

Adapt the Worker

We can adapt the worker to the work
place-and in the greenhouse, unfortunate-
ly, given the economic constraints, we
cannot convince greenhouse growers to
move their benches further apart. It is
very expensive to operate a greenhouse,
and they want as many plants in that build-
ing as possible.

So, the worker is going to come into con-
tact with that material. That is an example
of where we cannot adapt the work place.
The worker is going to have to somehow
adapt to the work place.

Personal Protective Equipment, May 1, 1991

Adapt the Work Place

There are, however, opportunities to adapt
the work place to the worker. I would
suggest as a general strategy that we think
about it in these terms.

I think the commercial applicator whose
livelihood depends on this and who, in a
sense, becomes through practice an expert
at the use of hazardous chemicals, is a
legitimate candidate for requiring protec-
tive clothing and requiring a high level of
training, knowledge about the use of the
clothing and such-all the ingredients that I
talked about that make personal protective
equipment so complicated.

When it comes to these other groups-the
owner applicator, our family farmer whom
we talked about, or the worker who occa-
sionally applies but is doing 90 other things
on the farm, or the agricultural field work-
ers who are walking into a field after
spraying has been conducted and are as-
suming that it is safe because their employ-
er told them they could-we have to devel-
op, long-term strategies to adapt the work
place to those workers to create a safe and
healthy working environment for them.

We are a long way from that, I admit, and
protective clothing can, under particular
circumstances, serve an extremely useful
role. I do not think it is going to serve us
as a long-term strategy.

I am quite hopeful that with the kind of
work that we have talked about in this
conference and the kinds of initiatives that
NIOSH has taken recently, we are going to
see more work directed at solving some of
these problems higher up on the scale-that
is in the engineering and administrative

Surgeon General's Conference on Agricultural Safety and Health - 1991

349


Intervention - Worker Protection from Environmental Hazards

sides-so that we can ultimately reduce our
reliance on personal protective equip-
ment.0

QUESTIONS

George Cook: I am George Cook, University of Vermont Extension System. Those slides showing the
break&roughs through this supposedly protective clothing-are there any recommendations as far as what
people should use?

Dr. Richard Fenske: I want to clarify that what I have presented here are specific hazards that produced
that. If you are thinking about greenhouses and the contact with wet foliage, people have gone to using-in
Florida-overalls that are basically rubber or polyvinyl chloride. They are quite thick and are resistant to
water penetration. That is one recommendation that we worked out with those commercial growers.

The EPA has spent the last five years developing a document for their use in terms of recommending
personal protective equipment to users. I think EPA is going to have a data base that is primarily based on
laboratory data but also a review of field studies. That is going to be our best evidence. Unfortunately, the
answer to your question is that there are no guarantees that the use of this material that has been tested
under particular circumstances may or may not be appropriate under other circumstances.

Thomas Seymour: Could you describe the fluorescent material you added into the material, as to its particle
size and so on? Did it enhance penetration or permeation, or do you know, in looking at some of the
material tests, whether it had any effect one way or the other on the performance of the material itself?

Dr. Richard Fenske: Well, we have not extensively tested that particular tracer compound with materials in
a laboratory setting. We have done quite a few field studies with it. It is a fluorescent whitening agent that,
in some cases in the past, has been added to plastics to make them bright or to laundry detergent, It is a
powder. It is partially soluble in water. We mix it into the aqueous system. The fluorescept material and
the active ingredient of the pesticide are being sprayed onto a surface, and we can only co&m that the
pesticide penetrates through these garments by doing chemical analysis with samples underneath the
garment. We have done such and found the pesticide. It is not necessarily true that this is an exact sur-
rogate fol any particular pesticide. We have approached it more from a generic point of view. But we have
confirmed repeatedly that when we see this material going through a garment we, indeed, can find the active
ingredient under that garment as well.

(inaudible): You are taking a sample of the material (inaudible) material (inaudible) pesticide (inaudible)
look at how it penetrates as a mixture. Is here any synergism there to actually enhance permeation or is
here any difference (inaudible) breakthrough (inaudible)?

Dr. Richard Fenske: That is certainly worth investigating. It has had a rather low priority because the con-
centrations we are using are very low. I think from a chemical point, having spoken with chemists about it,
there was no feeling that there would be that kind of a effect.

350

Papers and Proceedings



Surgeon General's Confimnce on Agricultural Sai%y and Heat&
FARMSAFE 2000 o A National Coalition for Local Action
Conmned by the National lnsthte rbr Occupational Safety and HeaM
April 30 - May 3, 1991. Des Moines, Iowa

MACHINE DESIGN

       By Sverker Hogliiltd, M.D.
Director, Swedish Farmers Safety and Preventive Health Association
           Stockhoim, Sweden

Dr. David S. Pratt: it is a distinct pleasure to introduce now, Dr. Sverker Hogiiind. Dr. Hogiijnd grew
up on a farm in northern Sweden, completed his education as a physician, and went on to obtain
specialty training-first in hematology and then in internal medicine and occupational health. He is
currently an Associate Professor at the institute in Stockhoim, and he has worked actively in
occupational health since 1974. in 1980, he became the Medical Director of the Swedish Farmworker
Safety and Preventive Health Association - a very important model I think many of us could learn a
great deal from. He is currently also the First Vice President of the international Association for
Agricultural Medicine and Rural Health and also the Secretary of the Scientific Commitiee on
Occupational Health-a part of the international Commission, Please welcome Dr. Sverker Hogiiind
from Stockholm:

Agriculture is a risky operation. Statistics
from many parts of the world show that
accidents and work-related diseases are
frequent among farmers and agricultural
workers.

Often, however, statistics are insufficient
because farming, in many countries, is
based on small enterprises run by the
farmer, his family, and few employees.
The ambition to report accidents and other
health injuries is probably limited.

In Sweden severe accidents causing fatali-
ties are, fortunately, rather few in agricul-
ture. However, compared with the total
worklife in Sweden, it is obvious that farm-
ing is over-represented among fatalities
due to work accidents.

It has been shown that about 20 percent of
the fatal accidents in Swedish worklife
occur w&hin agriculture ahd forestry. Only
about 3 percent of the total workforce are
occupied within this field. Recent studies
in our organization have shown that the
real incidence of work accidents is about
twice what is reported from official statis-
tics. Moreover, work-related diseases have

been shown to be cotion among farmers
and agricultural workers.

Forestry work by self-employed farmers is
the most ris@ operation in the total
worklife in Sweden. Work injuries, as well
as work-related diseases, are to a high
extent related to agricultural work using
different kinds of machinery. Machine
cl;tf2e;herefore, iS an important factor to
    .
        .

THE PROBLEM

Machine design may be related to hazards
of two kinds. One is accidents causing
acute injuries. The other is chronic inju-
ries or illnesses because of long-term,
unfavorable effects on the body during
work operations. Symptoms from the loco-
motor organs are most common because of
bad ergonomics, vibrations, etc. Hearing
loss due to damaging noise is also very
frequent.

Accidents

In Sweden, approximately 150,000 persons
are occupied within agriculture and forest-

Surgeon General's Conference on Agricultural Safety and Health - 1991               351


intervention - Worker Protection from Environmental Hazards

x-y. However, only about 50,000 are occu-
pied full-time at this.

According to official statistics, about 6,000
work accidents occur yearly. This informa-
tion is based on the reports of injuries for
workers' compensation. The compensation
is less well developed for the self-em-
ployed farmer. Therefore, the ambition to
report accidents is less strong.

During 1988, the Swedish Farmers' Safety
and Preventive Health Association studied
20,000 farmers concerning work injuries
that had occurred during 1987. The study
was performed as a postal inquiry and a
telephone interview with those who had
reported an injury in the inquiry.

Machine design may be related to
hazards of two kinds. One is accidents
causing acute injuries. The other is
chronic injuries or illnesses because of
long-term, unfavorable effects on the
body during work operations.

From the results of this random sample, an
estimation of the total frequency of work
accidents within agriculture and forestry
among self-employed farmers and forestry
owners could be made. It showed that the
real frequency during 1987 was at least
double that of the official statistics.

The most common cause of agricultural
accidents (just above 25 percent) was han-
dling animals. Falling, on the same level
or to a lower level, was almost as common
a reason for accidents. Machine-related
accidents were about 12 percent in
agriculture, and in forestry about 20 per-
cent.

352

Of those accidents related to tractor driv-
ing, about 50 percent happened when
climbing up and down the tractor ano
about 35 percent when connecting equip-
ment to and disconnecting it from the
tractor. In these respects, the design of
the machinery plays an important role.

The turnover of tractors is still an impor-
tant reason for severe accidents, as is un-
shielded power takeoff (PTO). Tractor
work may also cause injuries driving on
uneven surfaces. Headbumps and hits
from the inside of the tractor cabin are a
risk, as are hydraulic devices with oil under
pressure. Sometimes exhaust gasses may
cause problems.

One important machine that is commonly
used in agriculture and forestry is the
chainsaw. It may cause accidents by kick-
backs of the sword.

Chronic Injuries and Diseases

More than 50 percent of the diagnoses at
physicians' consultations with farmers con-
cern locomotor organs. Neck and shoulder
symptoms, back problems, and hip and
knee diseases are common.

A special interest has been focused on hip
arthrosis. Recent studies in our country
have shown a significant increase of this
disease in farmers compared to the general
population. The disease occurs about 8 to
10 times more often in farmers. Still, only
limited studies have been performed relat-
ing different factors in farmwork to the
disease.

So far results indicate that there is a posi-
tive correlation between tractor work and
the disease. One reason might be the de-
sign of tractors where, even in modern
machines, the driver has to sit in a bent

Papers and Proceedings


Machine Design, May 1, 1991

and twisted position to survey the equip-
ment behind the tractor.

It has been suggested that the twisted
position in the tractor chair may cause a
rotation in the hip joint. It can also cause
unfavorable pressure on the cartilage,
which may cause damage.

Other well-known machine-related chronic
injuries are, for instance, white fingers
caused by vibration in chainsaws and steer-
ing wheels on tractors. In farmers and
forestry workers, hearing loss is frequent
because of noise exposure from tractors
and other vehicles, threshing mills, and
chainsaws.

INTERVENTION

There is still a lack of knowledge concem-
ing hazardous effects of different environ-
mental factors in agriculture and forestry
and further research is needed about caus-
al relationships. However, today sufficient
knowledge exists to start to improve the
work environment in order to reduce the
health hazards. The outline for an inter-
vention program could consist of three
main parts.

1. There may be legal actions taken in
order to prevent extreme hazards.

2. There should be strong enforcement on
constructors, manufacturers, and dealers
of agricultural machines in order to
improve the working environment.

3. Information and education must be in-
tensified and directed to dealers of ma-
chinery, extension service officers
(agents), farmers, farm workers, and
forestry workers.

Legal Considerations

In most countries there is some legislation
concerning work environment and protec-
tion from health hazards. The extent to
which legislation should be used is always
under debate. The ambition is to have as
little legal enforcement as possible.

In Sweden in 1959 the law was put forward
concerning safety frames (roll-over protec-
tion structures) in new tractors. It was also
decided that employed agricultural workers
were not allowed to work in tractors lack-
ing such frames. Self-employed farmers
and family members for many years were
excluded from this law and could use old
tractors without frames in farm work. A
new tractor, of course, had this device.

In 1983 the law was extended to include
family farmers. It was later decided that
even old tractors had to have frames if
they were to be used in agricultural work.

The effect on fatalities due to tractor turn-
over since the year of legislation was strik-
ing. It is obvious that this action from the
authorities, unpopular as it might have
been, has had quite a significant effect in
preventing severe accidents. Side effects
of this safety frame law have resulted in
proper cabins on the tractors protecting
the worker from noise, dust, wet, cold, etc.
This is also quite a step forward concern-
ing work environment.

Another example of effective legislation
concerns chainsaws. When they came into
frequent use, it was soon obvious that they
could cause severe damage to the user by
so-called kickbacks. In 1971 in Sweden, it
was enforced by law that a special protec-
tive device should be applied to all saws.

Surgeon General's Conference on Agricultural Safety and Health - 1991

353


intervention - Worker Protection from Environmental Hazards

It operates so that when the sword is flung
backwards, the device causes the chain to
stop. The drop in severe injuries from
chainsaw operations is also significant from
the time the law was introduced.

Improvement of Machine Design

Legal actions can only be taken into con-
sideration concerning specific work envi-
ronment factors causing severe injuries of
high frequency. However, many hazards
remain where improved design of the ma-
chinery could reduce the risk. It is impor-
tant that occupational health professionals
have the possibility to transmit knowledge
about health effects of different factors to
the designers of machinery, the producers,
and dealers. In industry more work has
been done in this area, mainly due to ef-
forts from workers, and representatives in
trade unions, etc.

In agriculture and forestry, labor unions
are weaker and the workforce is
dominated by self-employed farmers. The
individual farmer has very little possibility
to get his opinion known to the machine
designers.

One major task for occupational health
organizations in agriculture is, therefore, to
improve communication between manufac-
turers and users. When designing new
equipment, they must understand the im-
portance of also considering work environ-
ment factors.

In Sweden, we have been able to produce
a specification of the demands for good
and healthy work environments in tractors.
It has resulted in a checklist. The work
has been performed in close collaboration
with the National Institute for Occupation-
al Health, the organization of the machine
manufacturers (LELA), and our organiza-

354

tion. The checklist now also exists in an
English version.

It is our hope that it should be accepted
and used on a broad international basis.
We have planned to invite representatives
of tractor manufacturing companies to a
seminar concerning this topic a year from
now.

There is, of course, standardization work
going on internationally considering work
environment factors. However, this check-
list goes much further and aims to create a
work environment that is healthier in all
aspects.

We have recently used the checklist per-
forming a test of new tractors from the
ergonomic and work environment point of
view. The result has been published in the
weekly farm magazine called Land. It has
been very much appreciated by the farm-
ers.

The manufacturers who got many stars for
their tractors are, of course, happy. Those
with fewer stars have been rather angry
with us. We think, however, that it is our
job to take this kind of action.

Our experience is that, after the first disap-
pointment and angry reactions, the dealers
with less than good results usually come
back and ask for our opinion on how they
could make their equipment better. This
is exactly what we have wanted with our
action.

Today it often occurs that a manufacturer
of some equipment asks for our opinion
when he is planning a new product. When
this happens, we think that our work has
been, to some extent, fruitful.

Papers and Proceedings


To prevent injuries, there is still much to
wish for in tractor design. The power-
take-off shield is often of bad design and
broken in many older tractors, which caus-
es a significant risk.

In collaboration with the Institute of Agri-
cultural Engineering, we have been en-
gaged in the construction of a new device.
This seems to be a significant step forward.

The coupling of equipment behind the
tractor often causes injuries. The rapid
coupling systems, which exist on the mar-
ket are not ideal and little used by the
farmers. Properly used, they cause a sig-
nificant reduction of work loads and health
hazards.

A big part of the injuries related to tractor
work occur when the driver is climbing up
and down the steps. They are often of a
miserable design and get slippery by dirt.
Simple devices can improve this.

The chronic diseases concerned with trac-
tor driving are neck, shoulder, back, and
hip problems related to the driver's twisted
and bent position while controlling the
equipment behind the tractor during long
working hours. Knee problems are com-
mon in tractor driving and are related to
too-heavy clutches. As much as 600-700
newtons have been found in new tractors.

In the new ergonomic check list, 150 newt-
ons has been appointed as acceptable.
Valmet, the only Nordic tractor construc-
tor, presented a new model a couple of
years ago where many of these problems
have been considered.

The driver's seat, steering wheel, and ma-
neuvering devices could be turned 180
degrees so that the driver might sit in a
backward position when much work had to

Machine Design, May 1, 1991

be done with equipment behind the trac-
tor. There was no clutch because of hy-
drostatic driving of the machinery.

Two important improvements from the
work environment point of view were
achieved by this construction. The need to
sit in a twisted position was markedly re-
duced, and the clutch operation was no
longer needed. We need more of this new
and brave thinking in the machine design
for the future. Because of other technical
reasons, the model still is experimental.

It still happens that kickbacks cause in-
juries concerning chainsaws. A Swedish
doctor has constructed a new protection
device, which should be more effective. It
is now tested. The Swedish firm,
Husquama, is going to provide some
models with this new and safer device.

Increased Awareness

In spite of legal considerations and
improved machine designs, there will still
be hazards concerned with machine
operations. It is, therefore, important,
along with other actions, that knowledge
about health hazards and how they can be
prevented is increased. This is needed
among the users of agricultural machinery
and also among advisers within different
branches of extension services to farmers,
and among dealers of agricultural machin-
ery.

It is a difficult task. Farmers are usually
very busy and get much information of dif-
ferent kinds. They have very little time to
consider different offerings. Written infor-
mation often is neglected. The motivation
to consider information about health haz-
ards is usually low among people who are
quite healthy and do not consider
accidents a reality.

Surgeon General's Conference on Agricultural Safety and Health - 1991               355


Intervention - Worker Protection from Environmental Hazards

One way to improve the possibility to get
information through is by an occupational
health service. In Sweden since 1978,
occupational health service for farmers and
farm workers has been organized and now
covers the whole country.

It has about 60,000 affiliated members.
Our customers are offered services consis-
ting of regular health checkups, infor-
mation meetings, farm visits, short courses
concerning specific health problems, first
aid, back and neck schools, etc.

They also have access to health care in
case of medical problems related to work.
It has turned out that the awareness of
health hazards has increased considerably
during the last years.

The farmers inquire about work-environ-
ment factors when they are buying new
machinery more than previously. They are
also inclined to use the personal protective
equipment more frequently. Nurses per-
forming health checks on farmers, physio-
therapists, and safety engineers visiting
farms pointing out ergonomic details to the
farmer on his tractor have golden opportu-
nities to provide information to motivated
farmers.

It is also possible to concentrate on one
specific problem and to broaden the infor-
mation by educating advisers to the
farmers. An ongoing project is to produce

information materials concerning the new
ergonomic checklist and to give the ex-
tension service officers and safety engi-
neers education on how to use it in their
work with the farmers. Teachers at agri-
cultural schools and dealers of agricultural
machinery are also invited to these cour-
ses.

CONCLUSION

Today's knowledge about health hazards in
relation to machine operations is fragmen-
tary but, in many cases, enough to start
prevention programs. Thus, the hazards
may be reduced and health and well-being
improved among farmers, farm workers,
and forestry workers.

Legal actions may considerably reduce
specific risks associated with machine de-
sign. By influencing constructors and man-
ufacturers, improved work conditions can
be achieved.

By effective information and education
awareness of hazards, preventive measures
can be augmented. A branch-specific oc-
cupational health service for agriculture
and forestry is a valuable tool in this re-
spect.0

356

Papers and Proceedings


Surgeon General's Conkrence on Agricuttural Safety and Health
FARM&WE 2000 o A National Coalition rbr Local Action
Convened by the National lnstituie riv Occupational Safety and Health
April 30 - May 3, 1991, Des Moines, Iowa

VECTOR CONTROL

       By Robert R Pinger, Ph.D.
      Public Health Entomology Laboratory
Department of Physiology and Health Science, Ball State University

Farmers, ranchers, and others employed in
agriculture are, by the very nature of their
work, at significant risk for acquiring cer-
tain vector-borne diseases. Some of you
may ask, "What is a vector-borne disease?"
or, for that matter, "What is a vector?"

A vector is an invertebrate animal, usually
an arthropod, that transmits disease from a
reservoir of infection to a susceptible host.

What is an arthropod? An arthropod is a
joint-footed animal with a hardened exos-
keleton such as an insect or a tick. Exam-
ples of arthropod vectors are mosquitoes,
flies, fleas, lice, and ticks.

Vector-borne diseases are caused by mi-
croscopic agents such as viruses, bacteria,
protozoans, or worms transmitted by these
vectors, usually when they bite. Examples
of vector-borne diseases that occur here in
the United States include at least four
arthropod-borne encephalitides, malaria,
dengue fever, Rocky Mountain spotted
fever, and Lyme disease.

Before I discuss these diseases, I should
like to state that those in agriculture are

Dr. David S. Pratt: We are going to move along to this morning's program with Dr. Robert Pinger.
Dr. Pinger got his undergraduate training at San Jose State in California, and received a master's and
a Ph.D. from Iowa State University, right here in the great state of Iowa. He has worked extensively
with vector control and entomological research both at the National Research Council at Waiter Reed
Army Institute of Research in `74 and `75, and then also had some tropical experience in Brazil as an
associate research scientist at the National Research institute of the Amazon. Since 1977, a little less
tropical, he has been at Ball State University in Muncie, Indiana, and his current research interests
include mosquito- and tick-borne diseases. Dr. Pinger's going to talk about vectors and agricultural
safety and health. Dr. Pinger:

also exposed to a variety of arthropod-
related health problems. The insects or
arthropods are themselves the agents of
disease or injury.

In these cases, the arthropods affect health
directly, rather than indirectly (as vectors).
Direct effects include entomophobia (an
unrealistic fear of insects), annoyance and
blood loss, envenomization caused by bit-
ing and stinging, dermatosis, myiasis, and
allergies.

ENVENOMIZATION

My students are sometimes confused about
the difference between biting and stinging.

Biting

Biting refers to interactions in which the
arthropod uses its mouth parts. Biting
insects include, but are not limited to,
mosquitoes, horse flies, fleas, lice, and
bugs.

Biting arachnids include ticks, such as the
American dog tick, the lone star tick, the
deer tick, and chiggers. Venomous arach-

Surgeon General's Conference on Agricultural Safety and Health - 1991               357


Intervention - Worker Protection from Environmental Hazards

nids include the brown recluse and the
black widow spider.

Stinging

Stinging refers to interactions in which the
arthropod uses its tail (usually a modified
ovipositor) to inject venom. Stinging ar-
thropods include bees, such as the recently
arrived Africanized honey bee; wasps,
including the newly introduced German
yellow jacket; and in the South, fire ants
and scorpions. Male entomologists, who
are easily in the majority, generally enjoy
pointing out at a time like this that virtual-
ly all of this biting and stinging is done by
female arthropods.

Although all too familiar, and at times very
annoying, these occurrences are of relative-
ly minor public health importance com-
pared with the disease transmission capa-
bilities of arthropod vectors. Today I will
describe some of these vector-borne dis-
eases, discuss vector control strategies and
outline personal precautions that can re-
duce the likelihood of vector-borne disease
transmission in the agricultural setting.

VECTORS

We can divide vectors into two major
types: mechanical vectors and biological
vectors.

Mechanical Vectors

As mechanical vectors, insects can be
thought of as contaminators. They carry
disease-producing agents from an
unwholesome environment, such as septic
tank overflow, to a clean environment such
as the top of your beverage can or sand-
wich.

358

In some rural settings, house flies may
become so numerous that they represent a
significant health problem. The variety of
disease-producing agents that have been
recovered from house flies is staggering.
The list includes those agents that cause
amebic dysentery, typhoid fever, cholera,
shigellosis, trachoma, poliomyelitis, and
infectious hepatitis.'

Another mechanical vector is the cock-
roach, from which about 40 strains of path-
ogenic micro-organisms have been isolated.
These microorganisms include four strains
of poliomyelitis virus, cholera, diphtheria,
pneumonia, tuberculosis bacteria, and
numerous intestinal protozoans. Mechani-
cal transmission can also occur when a
blood-feeding insect, such as a horse fly or
stable fly, is interrupted while feeding
upon an infected host, then completes its
feeding on a susceptible host.

Although mechanical transmission by flies
and cockroaches can be of public health
concern in some agricultural settings, bio-
logical transmission of diseases by arthro-
pods is much more important. In biologi-
cal transmission, the disease microorgan-
ism undergoes developmental changes
and/or multiplication in the vector.

There is also an incubation period during
which the arthropod is infected but not
infectious. It is unable to transmit the dis-
ease. After incubation, the arthropod be-
comes infectious, and remains so for life.

Biological Vectors

Examples of biological vectors include
mosquitoes, ticks, fleas, lice, and certain
other biting flies. Mosquitoes, the most
notorious of all insect vectors, are capable
of transmitting at least 3 species of filarial
worms, 4 species of malaria, and a large

Papers and Proceedings


number of disease-producing viruses. Of
the roughly 500 different arthropod-borne
viruses catalogued, 249 have been isolated
from mosquitoes.2

Ticks also transmit a variety of disease
agents including those that cause
babesiosis, Lyme disease, Rocky Mountain
spotted fever, Colorado tick fever, and
Powassan fever. Disease agents transmit-
ted by other insects include murine typhus
and plague, transmitted by fleas; epidemic
typhus and trench fever, transmitted by
lice; and a multitude of viruses, bacteria,
protozoans and worms transmitted by bit-
ing flies and gnats.

On a worldwide basis, vector-borne diseas-
es continue to affect the health of agricul-
tural workers on every continent. In Afri-
ca the tsetse fly and sleeping sickness not
only cause 7,000 human deaths per year,
but also limit cattle production over 10
million km'. Therefore, they contribute to
the severe protein malnutrition on that
continent.

Malaria and mosquito-borne encephalitis
affect rice farming in Sri Lanka and el-
sewhere in Asia.3 Yellow fever afflicts
those clearing forests for farming in parts
of Central and South America.

In the United States, most of the vector-
borne diseases that have an impact on
agriculture and agricultural health are
zoonoses, diseases of animals transmissible
to humans. Among the best known zoono-
ses are those caused by four mosquito-
borne viruses: the St. Louis encephalitis
(SLE), the California encephalitis (CE)
viruses, the western (WEE) and eastern
equine encephalomyelitis (EEE) viruses.
Each of these diseases has its own
geographical distribution and pattern of
transmission.

Vector Control, May 1, 1991

While periodic outbreaks of these mosqui-
to-borne viral encephalitides occurred, no
doubt, long before the arrival of Europe-
ans", accurate records of outbreaks date
only to the 1930's. Between 1930-1945,
mosquito-borne encephalitis killed an
estimated 300,000 horses and mules in the
U.S.5 Human illnesses were often associat-
ed with these epizootics.

For example, in 1941 North Dakota alone
reported 1,080 human cases with 96
deaths.6 During the period 1956-1969,
reported human cases of arthropod-borne
encephalitis numbered more than 3,000.

In 1975, both SLE and WEE were epidem-
ic and epizootic throughout much of the
United States. There were more than
2000 human cases,' many of them in farm
workers. The WEE epizoodemic spread
into Manitoba, where the importance of
outdoor exposure is illustrated by the dis-
tribution of 14 human cases.

All but three of these cases were men.
Interestingly, all three women who con-
tracted the disease were widows who pre-
sumably then did more outside chores than
their married counterparts.

Why do we not hear about these diseases
anymore? Are they still around?

Let me call your attention to last year's St.
Louis encephalitis outbreak in Florida.
Although case investigations are still being
completed, the first case occurred in Fells-
mere, Florida, an agricultural area. At
least some of the cases were in farm work-

ers.

The economic impact of this outbreak is
still being felt. Disneyworld receipts were
off lo-25 percent for October through
December. The annual costs of mosquito

Surgeon General's Conference on Agricultural Safety and Health - 1991                359


Intervention - Worker Protection from Environmental Hazards

control ran $2-4 million above the normal
cost, and there was a $270 million short-
fall in Florida's tax revenue for 1990.8

It is true that the current epidemics and
epizootics seem less pronounced than
those of 50-60 years ago. There are sever-
al reasons for this. First, there are fewer
horses now than there were in the 1930's
and 1940's.

Second, vaccination of many of the
remaining horses against WEE and EEE
has no doubt contributed to the elimina-
tion of large epizootics in horses. This
does not explain the decline in human
cases, however, particularly when there is
no evidence of a decrease in the level of
virus activity in nature.

Gahlinger, Reeves, and Milby postulate
that changes in people's behavioral pat-
terns have been responsible for the decline
in human cases in California. Their study
demonstrated that the advent of air condi-
tioning and television substantially reduced
exposure to infectious mosquitoes. People
were found to prefer remaining indoors
during the peak feeding times of the pri-
mary vector, Culex tarsalis.g

Others suggest that the low number of
confirmed cases is a product of our dis-
ease-reporting system. This phenomenon
has been referred to as the "vector-borne
disease iceberg."

In this model, we see that most of the
cases of mosquito-borne encephalitis are
never reported because of misdiagnoses,
poor follow-up, and no confirmatory serum
sample. Grimstad and coworkers deter-
mined that the ratio of reported cases to
actual cases in Indiana is about 1:250 for
St. Louis encephalitis. The ratio of report-

ed cases was l:l,OOO for the Lacrosse
strain of California encephalitis."

Some cases are reported incorrectly as
aseptic meningitis or "unspecified viral
encephalitis." Cases often end up in this
category when no convalescent or follow-
up blood sample is submitted. The season-
al distribution suggests, though, that they
are, in fact, arthropod-borne illnesses.

A failure in reporting is less likely to occur
when there is a severe or fatal case. It is
important to note that, in addition to the
pain and suffering associated with a severe
case, there can be significant medical costs.
This is particularly true if the patient is a
child who requires many years of institu-
tional care.

Leaving the encephalitides, I want to men-
tion two other mosquito-borne diseases
that affect those in U.S. agriculture: ma-
laria and dengue fever. Malaria, transmit-
ted by Anopheles mosquitoes, is once again
becoming a concern in California where
there have been 60 introduced cases in the
last 5 years, virtually all in farm workers in
San Diego County."

Florida suffered its first introduced case in
43 years in 1990. An introduced case
differs from an imported case in that it is
one in which transmission occurs within
the state.'

Another somewhat vector-borne disease
that we have thought of in the past as an
exotic disease, but which now poses a very
real threat to many in agriculture is den-
gue fever. Health officials are concerned
that the dengue fever virus, imported from
the Caribbean into California or Florida
with the migrant workforce, could also be
transmitted within the United States.

360

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This becomes increasingly more likely with
the spread of the Asian tiger mosquito,
Aedes albopictzq which is now considered
to enjoy a statewide distribution in
Florida.' This specie, which arrived in the
United States from Asia in imported truck
tires in 1984 or 1985, is a more aggressive
biter and a more efficient vector of the
dengue fever virus than the yellow fever
mosquito, Aedes aegypti.12 l3

Since the early 1980's, tick-borne diseases
have received much more publicity than
mosquito-borne diseases. Who has not
heard of Lyme disease?

For those who have not, Lyme disease is a
systemic, bacterial, tick-borne disease with
protean manifestations including dermato-
logical, arthritic, neurologic, and cardiac
abnormalities. It is caused by the spiro-
chete, Borrelia burgdorferi, which is trans-
mitted by ticks in the Ixodes ricinw group.
It is often the nymphal stage of these ticks
that transmits the disease. The most
noticeable early sign is a red rash emanat-
ing from the site of the bite.

The disease has spread rapidly in the
United States since its discovery in 1975.
It has now been reported from 47 states
including, most recently, New Mexico.14

Actually during the period 1983-1987, tick-
borne diseases made up more than three-
quarters of all reported cases of vector-
borne disease in the United States."
Rocky Mountain spotted fever actually
declined during the 1980's from a high of
0.52 cases per 100,000 in 1980, to 0.25
cases per 100,000 people in 1989.`""

Meanwhile, Lyme disease showed a dra-
matic increase over the same period from
0.10 cases per 100,000 in 1980, to more
than 3.5 per 100,000 in 1989. The 1990

Vector Control, May 1, 1991

case data are still incomplete for some
states. It appears, however, that the num-
ber of reported cases of Lyme disease may
be leveling off or even declining slightly.
This may be due to a change in the case
definition, which now requires laboratory
confirmation of clinical cases without a
rash.

VECTOR CONTROL

The title given to this presentation was
Vector Control. Obviously, in the time
remaining, I cannot tell you how to control
all of the species of mosquitoes, ticks, flies,
and other vectors that are of importance to
the occupational health of American farm-
ers.

I can review some widely accepted guide-
lines, however. There are three approach-
es to vector control: physical control,
chemical control, and biological control.

Physical Control

Physical control is the modification of the
environment to reduce or eliminate vector
populations. This type of vector control is
the most desirable because it is the most
permanent. Populations of mechanical
vectors such as house flies and stable flies
can be reduced or eliminated by maintain-
ing proper sanitary conditions.

For example, the regular removal of live-
stock and pet manure, soiled bedding,
straw, garbage, and all other decaying
plant and animal matter will reduce breed-
ing sites for house and stable flies. Sirni-
larly, cockroach problems can be reduced
or eliminated by the proper construction of
human dwellings, regular cleaning, proper
food storage, and food waste disposal.

Surgeon General's Conference on Agricultural Safety and Health - 1991

361


Intervention - Worker Protection from Environmental Hazards

The distribution of the mosquito-borne dis-
eases correlates closely with the
distributions of their primary mosquito
vectors. Since all mosquitoes are depen-
dent upon standing (or very slow moving)
water during the early stages of their de-
velopment, proper water management in
agriculture can substantially reduce the
risk of infection with these diseases.

In the west, physical control means effi-
cient water management with respect to
irrigation and other methods of watering
crops. In the east and midwest, those in
agricultural settings should strive to elimi-
nate all standing water near the home.

This means ditching, draining, or filling
low areas near homes whether under cul-
tivation or not. It means maintaining
steep, weed-free banks in man-made ponds
and lakes. It means removing all man-
made and natural water holding containers
from near the home.

Integrated Pest (Vector) Management
(IPM) is the use of the safest and most
appropriate combination of methods
(physical, chemical, and biological) to
control vector populations.

These containers afford breeding sites for
the vectors of Lacrosse encephalitis.
Examples of containers that should be
eliminated are rain barrels; used car, truck
or tractor tires; paint buckets; and plastic
containers of all kinds. Tree holes that are
found should be filled in with sand or
cement.

Physical control methods for ticks include
the removal of ail unnecessary shrubs and
vegetation from near living quarters, the

362

extension of the mowed portion of the
yard, and the regular and close mowing of
grass for at least a 50 foot perimeter
around the house. The greatest enemy of
ticks is desiccation. By removing vegeta-
tion you reduce the survival time of ticks.

Chemical Control

Chemical control is the use of chemical
agents (pesticides) to reduce or eliminate
vector populations. Chemical control is
best viewed as an adjunct to physical con-
trol.

When properly applied, it can be of great
assistance in lowering the risk for disease
transmission on a temporary basis. There
are many excellent chemicals on the mar-
ket for mosquito and tick control.

However, we are all familiar with the
problems associated with extensive reliance
on chemical control. These include the
development of resistance, the destruction
of non-target organisms, and cost.

Biological Control

Biological Control is the use of biological
agents, such as microorganisms, other ar-
thropods, or vertebrates, to reduce or elim-
inate vector populations. In' sqme respects,
biological control is a promise that has
never been fulfilled. Nonetheless, the use
of mosquito fish, Gambusia, and the spore-
forming bacteria, Bacillus thuriqqiensis var.
`israelensis, have been moderately success-
ful in mosquito control.

Integrated Pest Management

Integrated Pest (Vector) Management
(IPM) is the use of the safest and most ap-
propriate combination of methods (physi-
cal, chemical, and biological) to control

Papers and Proceedings


Vector Control, May 1, 1991

vector populations. In medical en-
tomology, IPM means the reduction of a
vector population to a level below that
which poses a significant health risk.

PERSONAL PROTECTION

Personal protection offers another avenue
for lowering your risk of acquiring a vec-
tor-borne illness. Personal protection is
the practice of health-directed behavior
that reduces the risk of acquiring a vector-
borne disease infection. Examples include
the following:

1. Avoiding areas where and when vectors
are present.

2. If you must enter these areas, wearing
the proper clothing (long pants and long
sleeved shirt, socks, and shoes).

REFERENCES

Use repellents properly and ap-
propriately.

Removing ticks promptly using the
correct method. Prompt removal great-
ly reduces risk of disease transmission.
Grasp the tick as closely to the skin as
possible and pull slowly and directly
out.

Notifying a physician if illness occurs.
Be sure to mention a tick if you are
suspicious.

knowledge of vector-borne diseases, a

sound understanding of approaches to vec-
tor control, and a familiarity with
procedures for personal protection can
reduce the risk of contracting a vector-
borne disease.0

1.

2.

3.

4.

5.

6.

7.

8.

Harwood, Robert F. and M.T. James. Entomology in human and animal health. 7th Ed., New York:
MacMillan Publishing Co., 1979.

Karabatsos, N. (Editor). International Catalogue of Arbovimses Including Certain Other Kruses of
Vertebrates. 3rd Edition, San Antonio, TX, American Society of Tropical Medicines and Hygiene, 1985.

Lacey, LA. and C.M. Lacey. "The Medical Importance of Riceland Mosquitoes and Their Control Using
Alternatives to Chemical Insecticides," Journal of the American Mosquito Control Association. June 1990.
(Supplement No. 2.) pp. l-93.

Chamberlain, R.W. "Historical Perspectives on the Epidemiology and Ecology of Mosquito-Borne Viral
Encephalitides in the United States," American Journal of Tropical Medicine and Hygiene. 37(3). (Supple-
ment): pp. 8-17, 1987.

Steelman, C.D. "Effects of External and Internal Arthropod Parasites on Domestic Livestock Produc-
tion," Annual Review of Entomology. Vol. 21, pp. 155-178, 1976.
Leake, J.P. "Epidemic Infectious Encephalitis," Public Health Reports. U.S. Public Health Service, 56(11)
39: pp. 1902-1905, 1941.

Centers for Disease Control. Encephalitis Surveillance Report Annual Summary 1975. Issued May 1977. l-
23.

John A. Mulrennan, Entomologist, State of Florida, HRS, P.O. Box 210, Jacksonville, FL 32231, Personal
Communication, April 25, 1991.

Surgeon General's Conference on Agricultural Safety and Health - 1991               363


Intervention - Worker Protection from Environmental Hazards

9. Gahhnger, P.M., W.C. Reeves and M.M. MiIby. "Air Conditioning and Television as Protective Factors
in Arboviral Encephalitis Risk." American Journal of Topical Medicine Hygiene. 35(3) pp. 601610.

10. P.R. Grimstad, C.L. Barrett, R.L. Humphrey, and MJ. Sinsko. "Serological Evidence for Widespread
Infection with Lacrosse and St. Louis Encephalitis Viruses in the Indiana Human Population." American
Journal of Epidemiology, 1 19; pp. 913-930, 1984.

11. Bruce F. Eldridge, Department of Entomology, University of California, Davis, Personal Communication,
April 19,1991.

12. Hawley, WA. 1988. "The Biology of Aedes albopictus, " Journal American Mosquito Control Association.
December, 1988, Suppl. No. 1. pp. l-40.

13. Francy, D.B., C.G. Moore, and DA. Eliason. "Past, Present and Future of Aedes albopictus in the
United States," Journal American Mosquito Control Association. 6(l); pp. l27-l.32, 1990.

14. Centers for Disease Control, Division of Vector-borne Infectious Disease. "Update on Reported Cases of
Lyme Disease 1989," Lyme Disease Surveillance Summay. l(2), p. 1, 1990.

15. Centers for Disease Control. "Lyme Disease-United States, 1987 and 1988," Morbidity and MortaZity
Week& Report. 38(39), pp. 668-672, 1989.

16. Centers for Disease Control. "Rocky Mountain Spotted Fever and Human Ehriichiosis-United States,
1989,"Morbidity and Mortal@ Week& Report. 39(17), pp. 281-284, 1990.

17. Centers for Disease Control. "Summary of Notifiable Diseases, United States, 1989, "Morbidity and
Mortality Weekly Report, pp. 38(54). 1989.

364

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Suqeon General's Conference on Agrkuhuml Satkty and Health
FARMSAFE 2000 o A National Coalition for Local Action
Convened by the National Institute for Occupational Safety and Health
April 30 - May 3, 1991, Des Moines, Iowa

A CONSULTING ENGINEER'S PERSPECTIVE

     By Ray H. Crammonrt, P.E.
Consultlng Engineer, Crammond Engineering Company

Dr. David S. Pratt: The first perspective we will have is from a consulting engineer. Ray Crammond
is a consulting engineer born here in Iowa and a graduate of Iowa State University. He has an
extensive career and background both with county government and also as a private engineering
consultant, at least since 1978. He has extensive knowledge dealing with farm-related and rural
resident Issues. We are very happy to have A Consulting Engineer's Perspective.
Mr. Ray Crammond:

First of all I would like to say I appreciate
the opportunity to be here to speak to you  I have been asked why I got involved in
today, and this is an issue I have a lot of   consulting work. The best way to put it is
                   I figured it was easier than farming. I

interest in. I am glad that the session
carried over to this afternoon, because I
was tied up this morning in a deposition.
It did not have to do with personal injury,
just manure run-off between two neigh-
bors.

grew up on a farm in Southeast Iowa, and
I am still involved in the farm, but I always
figured there had to be a better way of
doing things. So that is how I got into the
agricultural engineering.

A lot of times misunderstandings come up  We talked some about stress the past day
                    or two. In the 1950's, wheat was $3 a
when you try to talk about a subject. As   bushel and psychiatry was $3 an hour.
an example, I was reminded of an agricul-
tural engineer who had phoned a veteri-   In the 1960's wheat was only $3 a bushel,
narian, and he said, "Say, DOC, I have got a  psychiatry was a little bit better operation;
sick cat. He just lays around and licks his   it was $20 an hour.
paws. He has no appetite. What should I
do?" The guy replied, "Give him a pint of  In the 70's, wheat was still $3 a bushel.
castor oil." Somewhat dubious, the agricul-  Psychiatry was a little bit fancier digs, and
tural engineer forced the cat to take the    it was $60 an hour.
pint of castor oil and a couple of days later
he met the vet in town, and the fellow    In the 1980's the farmer was into the psy-
said, "Well, how's your sick calf." He says,  chiatrist at $100 an hour, and the wheat
"Sick calf? That was not a sick calf; it was  was still $3 a bushel. That is the way
a cat." He said, "Well, you did not give
him the castor oil, did you." "Sure did,"   things have gone, and that is one of the
                         reasons for the stress that the farm com-
said the agricultural engineer, "last time I  munity is facing.
saw him he was going over the hill with
five other cats. Two were digging, two    On the other hand, some people have the
were covering up, and one was scouting for  idea that an engineer has a life where he
new territory."              can just sit back and say, "Yes, I went
                  through your plans a few minutes ago, and
                         that's all there is to it."

Surgeon General's Conference on Agricultural Safety and Health - 1991               365


Intervention - Worker Protection from Environmental Hazards

ENGINEERING

This was a quote from Herbert Hoover
who was an engineer as well as a number
of other jobs that he had. He talks about
it being a great profession:

. ..the fmcination of watching the pigment
of the imagination merge through the aid
of science, to a plan on paper, that moves
to realization in stone, or metal, or energy;
and it brings jobs and homes to man; and
then it elevates the standards of living and
adds to the comforts of lve.  That is the
engineer's high privilege.

The great liability, of the engineer, com-
pared to men of other professions, is that
his works are out in the open where all
can see them. His acts, step-by-step are in
hard substance. He cannot bury his rnis-
takes as a-you can kind of fill in the blank
with other professions.

He cannot argue them into thin air or
blame someone else. He cannot cover his
failures with trees and vines, and he can-
not screen his shortcomings by blaming his
opponents and hope the people will forget.
In other words, if he screws up, he is
responsible.

On the other hand, his is not life among
the weak; destruction is not his purpose;
quarrels are not his daily bread. That is
one of the reasons why a lot of engineers
do not like to get involved in liability cases
or product suits.

To the engineer falls the job of clothing
the bare bones of science with life, com-
fort, and hope. No doubt, as the years go
by, people forget which engineer did it,
even if they ever knew, or some politician
puts his name on it, or they credit it to

366

someone else who used other people's
money.

But the engineer himself looks back at the
unending stream of goodness that flows
from his successes with a satisfaction that
very few professions may know. The ver-
dict of his fellow professionals is all the
accolade he wants.

I think that holds true in a lot of cases for
the people in the engineering profession.
The problem is that in some cases,
depending on a person's temperament,
training, background, or whatever, the
engineering procedure can start you out
with a simple premise that the sum of two
quantities in the form of one plus one
equals two; but then as you study and get
deeper into your subject matter you know
that one equals log of e and that one
equals sine' x plus cosine2 x and so forth.

You get down there and rewrite all those
equations. At this point it should be obvi-
ous that equation three is much clearer
and more easily understood than equation
one. Other methods could be used to
clarify equation one, but these are easily
discovered once the reader grasps the
underlying principals.

I think too many times what happens when
you talk about whether it is the design of a
product or a tax code, whatever it might
be, you know that one plus one equals two,
but to get back to it, after going through
what is on the bottom line there, you won-
der where you are at.

This is one of the definitions I like about
engineering; It is the art of directing the
great sources of power and nature for the
use and convenience of man.

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Another thing regarding engineers is the
study of both human needs and natural
phenomenon. These two fields of study
give essential unity to the profession for all
engineers, whatever their specialty, must
know both human ways and natural forces.

Human Needs

One of the biggest problems I have seen in
the 20 years since I have gotten out of
college, in the work that I do, is that the
engineer-if I am looking at a particular
problem on a site or whatever-has looked
at only the natural forces. They ignored
the human forces - whether by their na-
ture, the course of study, or whatever, they
tend to drop one-half of the input there.
That is where a lot of problems occur.

So, I think the biggest problem is people
71
I had one engineer say, on a grain bin case
that, "Well, if there was a warning saying
that it should only be piled to a certain
level, by gosh that is what it should be.
The grain should be put in at that level."

Knowing how farmers operate and how
equipment operates, if you have a building
that is about 200 feet wide and over 600
feet long and you are running grain in
there at 17,000 bushels an hour, you prob-
ably will not hit that line right on the nose.
You had better figure that what can be put
in there up to the eaves is going to be put
in there up to the eaves. If you do not
design to that, you are only fooling your-
self.

A Consulting Engineer's Perspective, May 2, 1991

So, I think the biggest problem is people
who ignore the human input. It is where
they run into trouble.

Natural Phenomenon

It would be a lot easier these days to be,
another type of engineer than an agricul-
tural engineer because on top of every-
thing else that we have got to contend
with, just when we think we have got all of
our data down we have to deal with some
new factor. Whether it is growth hormone
that suddenly changes the dimension of the
stalls or the strength of the animals, or
whatever it might be.

You can also run into unexpected natural
phenomenon, after having, in the past 15
months or so, drilled 200 or 300 holes in
Iowa for waste storage basins for livestock
facilities. I have run into situations like
that.

SYSTEMS DESIGN

Now a couple of quick definitions from my
perspective. I get involved in product de-
sign, but more in systems design. If you
are talking about a contractor, well then
you are generally talking about a gambler
who never gets to shuffle, cut, or deal. A
bid opening is a poker game in which the
losing hand wins. There is the bid that is a
wild guess carried out to two decimal
points. The low bidder is the contractor
who is wondering what he left out. The
engineer's es&rate is the cost of construc-
tion in heaven. Meanwhile, the project
manager is the conductor of an orchestra
in which every musician is in a different
union.

Critical path methods, which some of you
may have used, is the management tech-
nique for losing your shirt under perfect

Surgeon General's Conference on Agricultural Safety and Health - 1991


Intervention - Worker Protection from Environmental Hazards

control. An auditor is a person that goes
in for the wounded after the war is lost
and bayonets the half maimed. A lawyer
is the person who goes in after the audi-
tors and strips the bodies.

"Free" Advice

I guess one of the things I have run into is
the value of free advice might be worth
less than what you paid for it. Too many
times I have seen situations where some-
body relied either on their good buddy or
friend, or whomever; maybe even on tech-
nical personnel, and come to find out that
they got into deep trouble when they relied
on a situation where they thought they
were getting a good deal.

Another case involved ventilation systems.
Well, the fellow himself was not so much
personally injured as he lost $50,000 worth
of hogs. You know, any fool can design a
ventilation system, a lot of people will say,
and so many do.

I have run into cases where you can lead a
client to enlightenment. We have been
talking about training and so forth. That is
all fine and good, but there are some cases
where they just simply will not pay atten-
tion to you, or go on about their business
and ignore you completely.

Disclaimers

Disclaimers should not be used to protect
poor design. How many times I have been
involved in grain bin cases-whether bin
drownings or bin collapses-somebody has
a decal or a warning saying, regarding roof
vents for instance, that they should be kept
cleaned out. The only way to get to them
is to tie yourself off on a rope and swing
out there like Tarzan to get to it, and

368

there are no ladders, nor access to it.
Does that make any sense?

Does it make the home office feel better
that you have got a disclaimer on there so
you are protected. To me it is just ridicu-
lous, and you are not fooling anybody,
especially the courts. You might find your-
self in a lawsuit.

Training

The other thing is it is easier to teach rules
and to train rules than to train judgment.
That is an area where we have to focus on
in training judgment, and we end up trying
to legislate common sense.

Poor Engineering

Poor engineering entails failure and mis-
fortune, inconvenience, suffering, death.

In one case three people died in a manure
pit when they went down to fix a pump
malfunction. In this situation could we
have pulled the pump out without having
to go down into a pit so a father and his
two sons would still be alive?

I remember on a project one time when I
was talking to a banker in 1974. He said,
"What do we need an engineer for? The
building company does all that?"

It turned out later - a few weeks later - I
got a call. He wanted me to work on this
particular project. Since that time, I have
had numerous referrals on similar projects.
But in this case they had a $300,000 build-
ing coming in a few weeks, and they had
made no provisions or planning on where
they were going to put this thing. So, they
finally came around to realizing that may-
be the building company does not do all of
that.

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Another comment that I hear out in the
field, "I got a special deal on this. How do
you like it." A lot of times not very well
because it usually leads to either failure or
injury; but, the guy got a good deal on it
so, to him, it was okay.

A farmer has a choice as to whether he
wants to buy this option or accessory item.
I think back to the time I sat through a
seven-hour deposition involving a bin
drowning. We started at nine in the mom-
ing and ended up at four. We did not
even break for lunch.

The poor court reporter's fingers were
about ready to drop off, I think. Some-
body brought in some candy bars at about
1:30 p.m. The question was given to me,
"Could this farmer buy these roof vents as
an accessory item?"

In this particular case I said, "In your own
manual it says that if the roof is installed
in a certain way with roof clips in the
down position where there's no gap, that
there must be one roof vent for every so
many cubic feet per minute of fan capaci-
ty." In this case, I think it figured out five
or six roof vents.

This 42-foot diameter bin had no roof
vents on it whatsoever. The fellow was in
there trying to poke down the corn with a
rod, trying to get it broken up so it would
feed into the unloading auger. They found
him in the middle of the bin about six feet
off the bottom.

It had just been minutes before that his
nine-year-old son was in there. If his wife
had not insisted that the son get out of the
bin, while she went to fix dinner that eve-
ning, he would have been in there, too.

A Consulting Engineer's Perspective, May 2, 1991

I pointed out to the attorney who asked
me that question, "In their own manual it
says that if the roof is installed in this
position, there must be a roof vent for so
many CFM of fan capacity. How can you,
in good conscience, tell me that this is an
accessory item?" He never asked me an-
other question.

That is where I think we get into the sys-
tems approach. In this particular case, the
farmer never got the manual, or he might
have discovered there was a problem that
he could have acted on differently. We
found in discovery that the manual was on
back order, and he never received it.

Why did you build at this site? "Well, the
salesman said it would work." That has
created a number of problems, in some
cases the health of people; in some cases
their pocket book. One case where people
spent over $300,000 were ready to move
some livestock into a building. They were
sued, and they had to change things.

"A bin is a bin," spoken by a farmer, a
social studies teacher, or someone who
bought a bin company because he wanted
to get into a business of his own. He put
up over 40-thousand bushel bins, and the
roof was blown out and disrupted the
farmer's income.

He was not around the bin at that time,
but he lost the bin, he lost the farm, he
lost his wife through the protracted, final
settlement. Meanwhile, this guy had been
warned by the bin company just a few
months before. He was given decals to put
on his customer's bins, which warned that
there was a problem. He just ignored it.
He never went out and contacted anybody.

The other thing relating to that is when we
took the deposition of one of the engineers

Surgeon General's Conference on Agricultural Safety and Health - 1991

369


Intervention - Worker Protection from Environmental Hazards

for the bin company. He had been with
the company for over 30 years. He had
been in every phase of it, and you would
think he would know what was going on.
He was asked, "On this warning we are
talking about, `Do not run the fans during
icy conditions,' define what that meant?"
He said "I don't know."

So, here is a company that charges an
engineer with writing up a warning label.
He has had 30 years experience with the
company.

He writes a warning label that he cannot
even interpret, but they can stick it on
their manuals or out on the bin and say,
"Okay, it is up to you, farmer, to guess
what this means." They think they are in
the clear. It is things like that, which real-
ly burn me up.

CONSULTATION

Sometimes you run into, "That Product B
is no good." You ask them where they get
their information. "Oh, the salesman for
Product A said so."

I think one of the problems in agriculture
is there are very few independent consul-
tants or consulting engineers who have
been able to look at a situation and make
recommendations regarding some of these
factors.

Another thing that was brought up is that
we are dealing with, especially traditional
agriculture, a farmer who feels that he is a
jack of all trades. That being the case,
they try to do most of their own repairs a
lot of times, sometimes not with the best
results.

As an example of designing out problems,
about 10 or 12 years ago a fellow came to

370

me. He wanted a tank designed for ma-
nure storage. I changed his original con-
cept. There are half-inch diameter steel
cables that are enclosed within panels that
go all the way around the tank. There is a
special jacking panel where they come out.

One of the problems you can run into on
these tanks is the build-up of ice. In this
particular case it was a couple or three
feet of ice. All of a sudden a big sheet of
ice collapsed. That is a lot of force.
There have been metal tanks that I know
of that have just split in those situations.

In this case, there was a tremendous noise.
The guy went running off and two fellows
who were near the tank went running off.
A guy coming back from the field could
not figure out what was going on. They
thought the thing was collapsing. Instead
of collapsing it held together. That is what
factors of safety are for in design.

The panels had holes that are cast right in
the panels. What happened was the top
cable snapped; when you have 20 tons of
force, a cable snaps. I thought back to the
time when a friend of mine from high
school was in the Navy over in Viet Nam
on an aircraft carrier, and when one of
those cables snapped, it cut him in half. I
thought, well if you are designing a tank
like that, if you have cables on the outside
and a cable broke, what would happen.

In this case it was completely contained.
Nothing happened. In fact, they went on
and used it for a year or so, and then the
guy came back and threaded in a new
cable. So, that is just one example of how
problems can be designed out.

I guess from this standpoint, we have
heard about the gas from livestock causing
problems. We have to decide whether we

Papers and Proceedings


A Consulting Engineer's Perspective, May 2, 1991

are going to encourage and train people or
are we going to hit them with regulations
and say that, you know the Ten Command-
ments or whether it is going to be the
Golden Rule. How would you do it so you
would not cause problems for somebody
else?

TECHNOLOGY

The other thing that is affecting this whole
situation of injuries and accidents is misap-
plication of technology. After my sopho-
more year in 1968, I worked during the
summer for a company in Burlington,
Iowa.

I remember being impressed at that time
as I was putting together drawings from
several different departments of a new
crawler. One of the other engineers was
walking by the drafting table, when he
stopped and looked. He never said a thing
to me. I was just a student trainee that
year. Then he looked at that again. He
went and got some other fellows.

They looked at it again, and they had a
conference. I did not know what was go-
ing on. It turns out that when I had drawn
in where the track would go around near
the operator's platform, there had been a
situation one time, where somebody had
been injured or a problem had come up
with clearance between the track and the
platform for the operator. They caught it,
and the design was changed to rule out
that problem.

You always have to deal with the question
that came up yesterday that if somebody
does suggest a change, who is going to pay
for it, and whether or not we try to
squeeze it out of the price that the farmer
gets for the product that he sells. In any
case, something needs to be worked out
because we do need him and her. If not,
food prices are going to be a lot higher,
and I think our way of life is going to be
changed quite a bit.0

Surgeon General's Conference on Agricultural Safety and Health - 1991

377


Surgeon General's Conference on AgrfculWa/ SaMy and Health
FARM&E 2000 o A Natlonel Coalition Ibr Local Action
Convened by the National lnetitute Ibr Oecupationai Sakty and Health
April 30 - May 3, 1991, Des Moines, Iowa

AN EXTENSION SPECIALIST'S PERSPECTIVE

   By Rollin D. Schnie&r, MS.
Extension Safety Specialist, Universtty of Nebraska

Dr. David S. Pratt: Rollin Schnleder has been in safety In American agriculture for 35 years. He is
one of the real pioneers and leaders. He is someone I cettalnly have admired over a long period of
time. Right now, he Is professor of Blosystems Engineerlng at the Unlverslty of Nebraska in Lincoln.
For 35 years, he has been on staff there. He has helped to write the hlstory of the Emergency
Medical System (EMS) program and the communications program In Nebraska. Dr. Schnieder has
written a great deal and been a major contributor to the understandlng of safety in agriculture. He
has also been collaborating with the people at the medical center in a way that Is allowing the two
branches at the university, in both Lincoln and Omaha, to collaborate with each other. Although the
medical college and Lincoln campus have worked together before, they are hoping to blaze new
trails. Today, Roilin Is going to speak to us as only he can. He will speak to us from An Extension
Safety Specialist's Perspective on this issue with a long history. Help me welcome
Mr. Roiiin Schnieder:

Dr. Pratt asked me to show this book to
you. In 1965, when the Department of
Transportation (DOT) was coming into
being we had 16 parts of DOT. One of
them was clean-up, One was the trans-
portation of people.

I can remember vividly the night in Sep-
tember of 1965, in the Cornhusker Hotel,
where we had a group of about twenty
people that were looking at the EMS pro-
gram and also the communications pro-
gram. Looking at EMS, in 1983 or 1984, I
told Dr. Ken Kimball, who was on this
committee, and Brigadier General Don
Penterman, who was looking at com-
munications, that:

We ought to write a book of what we
know about the history of EMS and com-
munications in the state.

There is only one other that I am aware of
in the nation. That is Wyoming. They
have a 190-page pictorial booklet. We put
ours in the form of writing.

There will be another book coming out
soon, probably 165 pages on farm accident
rescue. The American Academy of Ortho-
pedic Surgeons will publish it.

Dave Morgan from our staff, who is a
tractor test engineer and EMT instructor
in his own right, and I wrote this up.
Hopefully, this will be published by late
fall.

I am going to use a little different
variation from Ray's (Crammond) presen-
tation. I was most impressed with the
speakers that we had yesterday. I wanted
to add a few things as I sat there and lis-
tened.

So we did.

STATISTICS

This came out in 1985. It is a 264-page
manual on the whole history.

Dr. Hoghind spoke of statistics. He said
that there is a variation in statistics. You
had better believe me; there is a variation

372

Papers and Proceedings


in statistics. When you try to compare the
United States to Sweden to Denmark to
England to Germany, there is a real varia-
tion.

Dr. Gary Erisman did not say it, but he
and I have talked about this before.
Gary's point was that we talk about the
number of fatalities and the number of
injuries we have. He has told me that
"there are a lot more out there than we
know about." I feel exactly the same way.

In 1978 or 1979, after OSHA had been in
force for a few years, we had some people
comment, "My gosh, here we have got
OSHA and the statistics are going up."
No, they were not going up. They were
out there all the time.

People were just finding them. Gary and I
were advisors to OSHA from 1972 to 1976
so we had a good background on what was
taking place.

I remember that there was a new safety
specialist in Colorado. He called and
wanted to know if I would train him.

A few months later Sid said, "I am glad we
don't have the problem that you have in
Nebraska." I replied, "Sid, you have it in
Colorado. I know my problem. I am
going after the figures. You are not."

That is what happens. We also know that
some of these statistics are hidden. So, I
appreciate the comments regarding statis-
tics.

I was back at a meeting with John Pollock
and Dr. Pratt a few years ago. They had
reinstituted a farm injury study in New
York.

An Extension Specialist's Perspecthre, May 2, 1991

It amazed them to know that they had 35
fatalities in that first year of their study.
They were working with the Farm Bureau
in New York. They could not believe that
they had that many.

They were there all the time. They just
found out where they were. When you live
in a little community, you might hear
about the one in your county. You do not
hear about the ones statewide.

I can tell you that we have had 853 fatali-
ties in Nebraska from 1969 through the
present day. These are broken down by
the type of accident. Even then I am sure
that I might have missed a few.

Sometimes the victim gets transported
across state lines to medical facilities. It
may be a Nebraskan who is taken to a
Sioux City Hospital. That report comes
into Des Moines and it eventually gets
back to Lincoln.

Sometimes there is a delayed one and I
may not find it. So even I miss a few of
those. So, to Gary and Sverker Hoghind, I
appreciate your comments.

DESIGN

John Etherton is sitting back here. It is
John's job to come up with a statement
about roll-over protective structures, retro-
fitting.

There are a lot of people who say, "Let's
retrofit everything." This all sounds well
and good, but you change a tractor when
you do that.

For example, when we came out with the
roll bar, people were complaining about
the noise. You had the tuning fork con-
cept or added noise. I had a lot of calls,

Surgeon General's Conference on Agricultural Safety and Health - 1991                373


Intervention - Worker Protection from Environmental Hazards

What can we do?" We can dampen.
Some were putting sand down in the up-
rights to dampen the noise. Some were
putting loaded springs across to dampen
them, anything to get this noise down.

You can change characteristics of tractors.
You have to realize that a lot of the equip-
ment that we have in agriculture is not
totally designed. This is what Ray
(Crammond) was saying.

For example, the first totally designed
tractor came into being in 1971. We had
tractors that were designed; then we had
after-market cabs put on. That was not a
part of the design and there were some
noise problems.

You have to realize that a lot of the
equipment that we have in agriculture is

In 1971, there were two totally designed
tractors. One was a Deere, the other one
was Allis-Chalmers. They designed the
whole unit and had the cab as part of it.
They came in with a noise level of 80 or
less. It was right around 80 db at that
time. This was a whole new concept.

Now those tractors are running down
around 74 db, because they are designed
as a total unit.

This concept is true with other machinery.
I was involved in a lawsuit 28 or 29 years
ago, where a little boy lost a leg in an
auger. The auger was built by one com-
pany; another part was built by another
company. '

There were four people who went together
on this, and they all thought, `The other
one is going to put the safety features on."
Nobody did. You have to look at the
totally designed system.

We can look at anhydrous ammonia as
another example. You buy the running
gear, order so many at a certain price.
You buy the tank, order so many at a
certain price. You buy the pop-off valves,
so many at a certain price. Put a hose on.
They are all component parts.

One of those is the weakest part of the
system, and so we have problems. We
have to look at the total problem, not
components.

There is another thing we have to realize.
It was alluded to yesterday. I do not know
if it was Gary (Erisman) or Sverker
(Hoghind). Many times engineering is
overruled by advertising. I have seen this.

We are going to put a product on the
market. It is maybe not what we want, but
we are going to get it out there. I think of
one tractor whose advertising said, "We're
going to boost the pump up a little bit to
get two more horsepower at the drawbar."
When they did this, they also got more
noise out of it.

Advertising wanted the horsepower; they
did not care much about the noise. The
engineers were put at a disadvantage.

They can do their best design, but they are
put at a disadvantage if marketing makes
the final decision. I think Steve Konz
alluded to this in his presentation this
morning.

374

Papers and Proceedings


PROTECTION

Dr. Richard Fenske yesterday talked about
protection. I am going by a few comments
that people made. He talked about the
closed tractor cabs for pesticide protection.
This is good.

In fact, Cornell did some work on this in
1978 or 1979. It is of benefit. The thing
we have to watch is that if people mix the
pesticide and then get in the cab, they take
it in on their clothing. I have been on a
pesticide-training program since 1978.

Our recommendation is that if you have
two people, have one do the mixing and
one do the application. Or take your
clothing off before you get in the cab if
you are working alone.

There is another thing that Richard talked
about yesterday. It regards a question that
I get all the time. How do we tell when
the cartridge or the canister is loaded? I
give the same answer that he gave yester-
day.

Right now we talk about time and con-
centration. We can look at acidity, and we
take litmus paper and test for acidity.

Is there some way that an engineer, or
epidemiologist, or somebody could design
a cartridge or a canister that when the cat-
ion/anion process gets to 90 percent being
loaded (somewhat like the working device
for telling when the turkey is done), it
could send up a little flag or a change in
color? It is a very simple process, and
maybe there is a way that we could take
care of this question.

I made one comment. There was a ques-
tion yesterday about coveralls in the green-

An Extension Specialist's Perspective, May 2, 1991

house and the material going through.
Nothing was said about an apron.

One of the things we point out in our
program is the need for hand protection,
eye protection, and apron protection. We
know that the hands constitute a major
point of entry in to the body. The label
still reigns supreme. It must be followed.

Another thing came up about re-entry into
fields. We have had some close problems
(poisoning) with county agents. We have
had farmers who have asked county agents
to look at their field for insects. I think of
one that we had where the farmer did not
tell the agent that the night before he had
sprayed his field with parathion.

This has a 4%hour re-entry. The agent
who was asked to go in there is 6 feet 5
inches and weighs 300 pounds. He was
sick when he came out of that field. He
was going to head back home. He did not.
He sat along the roadway for about 2
hours.

We had another instance. A young man
was asked to go into the field. His situa-
tion was almost identical.

I think back when I was a young lad. Dad
and I would go along the back roads, and
if we saw a cornfield that looked good, we
would want to walk out and see how that
corn was. We would walk out in that field
and check the neighbor's corn. I would
never think of doing that today because
you do not know what the plants might
have on them.

OTHER PROBLEMS

This morning we heard a talk about vec-
tors that was very interesting. We do not
have some of those problems.

Surgeon General's Conference on Agricultural Safety and Health - 1991               375



Intervention - Worker Protection from Environmental Hazards

You were talking on a world scale, an
international scale, however, and that is
big. We do not have much of a problem
with equine encephalitis. When we do
have it, we encourage the people to stay
in.

In the Midwest our biggest problem with
the farmer will be the infections they may
get from being scraped when they work
with confinement housing. Some of these
can really be problems.

Tetanus is one of the things I talk more
about than I do about the vectors; we do
have some people that can be affected by
anaphylactic shock, and this is the one
where the bee stings will get the individu-
als. Again, I was glad that you were talk-
ing about the worldwide problem, because
I know that Panama has a different prob-
lem than we have; we do have to look on a
bigger scale.

Dr. Konz was talking about some of the
problems of people. I think of milkers'
knee. People say, "What is milkers' knee?"

Dairymen in New York know what milk-
ers' knee is. We talk about tractor drivers'
disease, and that is the one that is back-
related.

Even stepping up on some of those
27-inch-high steps can be a real problem.
I got to thinking about some of these
things that are hidden from us.

We have a young lady here from the
College of Medicine, Dr. Susanna Von
Essen, who has been doing a lot of work
on respiratory problems. We are glad to
have her. I started looking at this com-
munity of respiratory therapists.

376

One of the things that blew my mind was
when I found out that the Phelps County
Hospital at Holdredge, Nebraska, last year
had 370 cases of respiratory problems.
That is a lot of people.

Yet our respiratory therapists are not or-
ganized. I was going to say they are loose-
ly organized. They are not organized at
all. We have a lot of peopli: who we can
gather all kinds of information from, but
they are isolated because nobody has ever
gotten them together. I am hoping that
Susanna can do this. We have a lot of
information out there that is just waiting to
be gathered.

LESSONS FROM BILL STUCKEY

Dr. Erisman and I had a mentor, Bill
Stuckey from Ohio State University. Ray
Forsythe who is in attendance, did also.
Bill Stuckey was an Extension Safety
Specialist at Ohio State.

I will never forget a few things that Bill
taught me. One of the things he taught
me was "You never know until you ask."
That is why when I go after statistics, a lot
of people say I will get turned down.
Well, you do not know until you ask. So I
go ask them. I have never been turned
down yet.

We have a new generation of people com-
ing along. When you listened to Dr. Konz
this morning, you almost thought he was
anti-education. He is not anti-education,

Bill Stuckey had a little saying. He said
there were those who "Knew not Joseph."
What did this mean? Joseph was the king
of a nice little kingdom for 48 years, and
everybody loved Joseph. Joseph went out
of power and a new king came in. Within

Papers and Proceedings


An Extension Specialist's Perspective, May 2, 1991

a year, there were those who knew not
Joseph.

We have some little boys and girls being
born today who know not safety. Some-
body has to teach them. That is where we
in extension come in. They have to "know
Joseph"; they have to know safety.

TRAINING AND EDUCATION

A couple of comments came up here about
training people. It has been my idea that
you train people with the right idea.

I have raised golden retriever dogs since
1958. I run them in trials. People say,
"Okay, you are a dog trainer. How do you
keep dogs from chasing cars?"

That is simple. I keep them kenneled up.
I take them out and train them. I teach
them what I want them to know. That is
it. I do not worry about their chasing cars
because they never run free. Those dogs
are not imposed on because they love it
when we get out. That is our time.

You heard the comment the other day by
Dr. Johnsrud about 23,000 youth trained in
Nebraska in tractor safety. There are
going to be about 24,500 trained by the
end of this year.

I raised two boys. I believe that young
people have to work. They have the same
needs that I have. They have a need for
money so that they can buy things. This is
why we have trained these young people.

Some interesting things. At North Platte,
there are a lot of ranchers who will take
the kids into the sand hills and keep them
there for 2 weeks while they are putting up
hay. They will not take a youth up there if
they have not had the safety training.

One rancher told me 20 years ago that
"One of your students was with me. The
boy told me I was doing something wrong."
He said, "That boy was right." He wanted
trained students.

So we keep on training them. We lost
two of our trainees in accidents, both in
1971. They were both extra riders; both
14. This was within a 3-week period.
They were extra riders on tractors and fell
off. That is it. I guess they did not listen
too well.

Dr. Konz questioned in education that
maybe we did not get the information
across to them, maybe we did not educate
well enough. Gary alluded to this yester-
day.

This has been an excellent opportunity for
me to comment on these five papers.0

Surgeon General's Conference on Agricultural Safety and Health - 1991

377


It is a pleasure to be here. I would like to
tell you a little about my experience on the
farm. Then you can evaluate the biases
and perspective of my comments.

I am from Brandon, Manitoba, Canada.
With few exceptions, farming near Brand-
on is no different from farming in North
Dakota. Farm life and farm issues are
much the same.

I grew up on a family farm that was passed
to my father and my uncle from the grand-
parents. It was a traditional succession in
farms in those days. They operated that
farm as a partnership.

There were two houses on that farm, a
couple of hundred yards apart. I had two
older brothers and in the other family
there were four children, three boys and a
girl. I was the youngest of seven children.

Somewhat by the accident of birth, being
the youngest, I was the one who had to
leave home. The choice was made on an
economic basis, rather than any concern
for personal safety.

Today, my brother operates the farm that
,he has expanded to about 2,000 acres.
" me farm is on the upper slopes that sur-

Surgeon General's Conference on Agricultural Safety and Health
FARMSAFE 2000 o A National Coalition kr Local Action
Convened by the National Institute k~br Occupational SafWy and Health
April 30 - May 3, 1991, Des Moines, Iowa

AN AGRICULTURAL ENGINEERING PERSPECilVE

     By L. Dale Baker
Product Safety Engineer, J.I. Case Company

Dr. David S. Pratt: We next have L. Dale Baker. Dale is trained in agricultural engineering from the
University of Nebraska. He spent two years at Michigan State University in the Agricultural
Engineering Department. Closer to my home turf, he was in Ithaca at Cornell University as the
Agricultural Extension Safety Engineer. He spent 10 years in product safety engineering with
International Harvester and JI Case. Currently, he is the Manager of Safety and Legislation,
Agricultural Equipment Group, with JI Case. Mr. Baker:

rounded a glacial lake bed, many thou-
sands of years ago.

The land at the bottom of the lake bed
will provide adequate income for the farm
family. On the surrounding land, it is
difficult to obtain adequate crop yields to
financially survive. Therefore, my brother
and his wife also have full-time jobs off-
the-farm.

My brother works full-time as a welding
instructor at the local community college.
His wife is a full professor at the local
university. With that income, they are able
to sustain the lifestyle that they chose, to
live on the farm.

My brother has some beef cattle and grows
grain primarily to support the cattle. They
also raise malting barley, as there is a
premium for malting barley.

My sister-in-law likes to raise horses, train
those horses for riding, and sell them. She
has a total herd of about 45 horses.

One of those cousins who grew up with me
has been in a relatively new business for
about 15 years. He is collecting pregnant
mares' urine. He has a herd of about sixty
horses that he puts in the barn every fall.

378

Papers and Proceedings


They are strapped to a harness that col-
lects the urine from those pregnant mares.
That urine is refined for estrogen. This is
not traditional agriculture.

That snapshot leads to several observations
that illustrate the bias of my comments
about safety on the farm:

When I get concerned is if someone makes
the assumption that this design philosophy
should be the legal requirement. As an
example, it is impossible to build a ma-
chine that may resemble a tractor that will
not roll over. Such a machine will not
function as a tractor. I am not yet aware
of how we can build a functioning tractor
that will not overturn.

+ Farming is becoming a very diversified
business.              I repeat, however, that we are in agree-
                       ment with those ideas and concerns in er-
o Many farmers are in an economic
squeeze but continue to live and work   gonomics as a design philosophy. You will
on the farm as a choice in life-style.    see those kinds of concepts on new prod-
                              ucts.

o This is a family-farm environment
where there are no migrant workers.

o Many farmers are relatively well-educat-
ed.                                        I

I am not yet aware of how we can build
a functioning tractor that will not over-
turn.    I

o It is generally the family who is the pur-
chaser and operator of agricultural     OLD AND NEW TECHNOLOGY
equipment.              Let us take a moment to compare tractors

HUMAN FACTORS

in use today with automobiles in use today.
Consider a 1971 automobile and a 1991

In commenting on the presentation by    automobile. They are quite different.
Dr. Konz, I agree with the concepts that
were presented this morning. We, as an   Items on new cars include the center-
industry, wish to promote and are promot-  mounted stop lamp, rear-impact bumpers,
ing human factors or ergonomics in our   improved door latches, anti-lock brakes,
Pro                  crush resistance in the roof, side protection
ducts.                 in the door panel, and improved tires.
                   These are all innovations that are signifi-

1 am a member of the Human Factors    cant to the development of the 1991 auto-
Society. There are quite a number of     mobile.
practitioners or consultants at work in our
industry. I agree with the concept, as a   A 1991 tractor is also quite a different
design philosophy, that the machine should  creature than the tractor that was built 20
adjust to the man.             years ago. Many of the same innovations
                         on cars are used on tractors. The in-

We should be designing the machine to fit  gress/egress, control, steering, and interior
the man. As a design philosophy, we are   styling of many new tractors are compara-
working to do that.               ble to 1991 automobiles.

SWeon General's Conference on Agricultural Safety and Health - 1991               379

An Agricultural Engineering Perspective, May 2, 1991


lntetvention - Worker Protection from Environmental Hazards

What do we see in terms of 20-year-old
automobiles on the highway? How many
do you see? Five percent? I think it is
less than that.

I think that when you do see them that
they are on display or going from one auto
show to another. They are antiques. How
many of the tractors that are in use today
are more than 20 years old?

About a third of the tractors out there, in
use today. That is, probably a million
tractors, for a round number, are more
than 20 years old.

Another interesting phenomenon is that a
tractor design can survive for about 15
years; it may go a little longer. You will
find considerable variation in the design of
new tractors on the dealer's lot due to this
delay in the design cycle.

Some of the features that Gary (Erisman)
mentioned are already available on some
tractors. Hydraulic controls, couplers, and
hoses are labeled with numbers and flow
direction on most newly designed tractors.

Changes in technology allow us to do
things now that were not possible 20 years
ago or 10 years ago. Many of you will
remember the problems that President
Carter had in trying to send some helicop-
ters into Iran in 1979. About ten helicop-
ters were sent. Many of them had prob-
lems and the mission was abandoned.

Compare that with what just happened in
Desert Storm. There were tremendous
changes in the reliability of the equipment.

In those days (pre-1979), transistors were
experiencing 100 percent burn-in. That
means that when you bought an electronic
controller, "the black box," you would

380

check 100 percent of those transistors.
Now, the transistors are not checked at all
because there is fantastic reliability of the
transistors coming from the supplier.

Because the electronic "black box" now
available is very reliable, new electronic-
based systems can now be added to farm
equipment. One example is an operator's
presence system now used on combines. If
the operator is out of the combine seat for
more than 5 seconds, the combine header
will shut off.

Other new applications of electronic tech-
nology will depend on the development of
reliable sensor technology. The sensor
must be as reliable as the electronic con-
trol box. This reliability should develop
much like the reliability of transistors has
evolved.

Another important development is the
customer acceptance of this new technolo-
gy. There seems to be a general accep-
tance of new safety innovations that may
stem, in part, from Lee Iacocca advertising
air bags.

ROLL-OVER PROTECTION

We have had a great deal of discussion, in
this session, about Roll-over Protection
Structures (ROPS). We have all seen the
slide, many times, of the success of ROPS
in Sweden.

In 1985, we had a commitment by the
North American tractor manufacturers to
make ROPS standard on all tractors. With
a few exceptions of tractors that are being
imported into this country and those that
are for orchard applications, all tractors
since that time are equipped with ROPS.

Papers and Proceedings


By 1970, ROPS in this country became
available on virtually all major
manufacturers' product lines. There was
no demand for them. Therefore, we have
a significant number of tractors in opera-
tion in the U.S. that were built in that
interval between 1970 and 1985 that are
not equipped with ROPS.

I would suggest, in gross terms, that there
are about a million tractors that are
equipped with ROPS or that have ROP
structures built into the cab. About a
million tractors that are out there could
have a ROPS installed on them but do not.

Another million tractors that are in use
were built prior to this introduction of
ROPS and here installation of ROPS be-
comes a real technological issue. Now we
should look at those two issues separately.

Pre-1970 Tractors

In putting ROPS onto tractors that were
built prior to 1970, there are some signifi-
cant technical issues. Will the tractor
structure survive an impact with this ROPS
attached? The structure was not built for
that kind of use.

New frames could be designed, possibly, to
accommodate the design by sharing the
load forward to the transmission housing.

There is now a need to develop that new
structure. There were many applications
for those old tractors where implements
were attached to the same location that we
would attach this ROP structure. If you
destroy that, you have destroyed the utility
of that tractor.

There is also the issue of the economics of
putting those ROPS on old tractors. If
there is to be a program of that nature, it

An Agricultural Engineering Perspective, May 2, 1991

is going to have to start with the develop-
ment of some pubic policy change that will
create that demand. Is anyone going to
invest the time and effort to develop new
designs unless there is, in fact, a demand?

19704 985 Tractors

The issue for tractors built in the interval
between 1970 and 1985 where a ROPS can
be installed becomes an issue of how to
create an environment where the public
demands those ROPS. They are available.

A demand undoubtedly could bring down
the cost that was mentioned earlier. Until
there is a demand, there will not be any
initiative that will cause that to happen. It
is the chicken and the egg situation.

If you could decrease the cost, maybe you
could increase the demand. You cannot
decrease the cost, however, until there is a
demand. We are now again looking at
what is a public policy issue of how you
create that demand.

Is anyone going to invest the time and
effort to develop new designs unless

I would say to you that my brother is
aware of the issues of ROPS and tractor
overturns. But fatal tractor overturns are a
rare event (a farmer is far more likely to
be killed in a car accident than a tractor
overturn).

Virtually all farmers are aware of the issue
of fatal tractor overturns in the same sense
that farmers (and the general public) are
aware of the issue of cigarette smoking

Surgeon General's Conference on Agricultural Safety and Health - 1991

381


Intervention - Worker Protection from Environmental Hazards

causing cancer. What does it take to cause
people to stop smoking cigarettes?

We could also talk about our desire, as a
general public, to drive cars, which have an
air bag and have anti-lock brakes. Clearly,
as a general population, we are safer if all
of the cars in use by 1995 have air bags
and anti-lock brakes. What does it take to
make you and me invest in new cars or
stop smoking? Solving these same kinds of
issues, I think, solves the issues for the
farm population.

CONCLUSION

I would make one quick comment on sta-
tistics. In virtually all the groups at this

conference, we have been talking about
this issue of statistics. We are all talking
about such diverse numbers that some of
us are loathe to mention any numbers at
all.

Injury statistics should be a number one
priority. I hope that this message is com-
ing through from all of the other groups.

What are the recommendations that I
would make based on what we have heard
in this conference, especially in this room?
I think we are looking at some significant
public policy issues in which the fm popu-
lation needs to be involved in creating the
answers.0

382

Papers and Proceedings


Sugeon General's Confemce on Agricuttuml Salty and Health
FARMSAFE 2000 o A National Coalition fix Local Action
Conrnened by the National Institute fir Occupational S&ty and Health
April 30 - May 3, 1991, Des Moines, Iowa

HEALTH EDUCATION

   By Rodney Gilmore, B.S., BA.
   Injury Control Program Manager
North Dakota State Department of Public Health

Dr. Walter J. Armbruster: Let me turn to our first presenter, Rodney Gilmore, who is with the Injury
Control+r, I should say-is the injury Control Program Manager for the North Dakota State
Department of Public Health. His topic is Health Education as an intervention related to safe
behavior among adults and children. Mr. Gilmore:

I have been with the State Health
Department approximately one year. Prior
to that, I worked with the North Dakota
State Worker's Compensation Insurance
Fund in the area of occupational health,
particularly looking at injuries and rehabil-
itation.

Injury Conference in Denver. The story
was told by an attorney.

I come from a farm family in North
Dakota. I am a native of North Dakota,
and my family still farms. I guess if it
were lucrative enough, I would be back
farming instead of being here today.

I have had a strong interest in farm safety
and agricultural safety. We have heard
some of the testimonies of some of the
individuals that have had direct involve-
ment in farm injuries. That is some of my
background.

An attorney had a farmer on the witness
stand who had sustained an injury in a
pick-up roll-over. He was suing the indi-
vidual that ran him off the road. The
defendant's attorney had him on the wit-
ness stand and said to this farmer
"Mr. Farmer, I want you to answer this
question yes or no. Is it true that when
the highway patrolman got to you when
you were laying in the ditch and you had
just gotten up, that he asked you how you
felt and you said, `Just fine'?" The farmer
said, "Yes, but. . .`I The attorney said,
"Wait a minute, I said yes or no." He sat
down.

I lost my grandfather to a farm-family
injury and also my best friend's dad, when
I was in high school. Those two things
have stayed with me for a long time. I
welcome the opportunity to be able to
work in this area and to hopefully have
some impact on it.

Even though it is a serious field, we still
have to look at life and enjoy life and, I
guess, look for some humor in it.

The farmer's attorney said to the judge,
`There are some extenuating circumstanc-
es, and I would like for the plaintiff here
to be able to tell his side of the story."
The judge said, "Okay." The farmer said,
"Well, the reason I said I was okay." He
said, " The accident happened when I was
coming around a curve. I had just come
back from a sale. I bought a brand new
bull, I should say, a new bull; I bought this
prize bull and paid quite a bit of money
for him. I had him in the back of my
pick-up and came around this curve.

I would like to start out the presentation
with a joke I heard last week at the CDC   Here were these two vehicles coming at
                   me. One of them had passed on a double

Surgeon General's Conference on Agricultural Safety and Health - 1991

383


Intervention - Safe Behaviors Among Adults and Children

yellow line. He ran me off the road, and I
went down the ditch and rolled the pick-up
over and the bull went flying one way and
the pick-up went the other way. I ended
up getting thrown out of the pick-up."

"Right after the accident happened this pa-
trolman walked up, looked at me, and he
walked over and looked at my bull. Then
he walked back to me and said, `Your bull
looks in pretty rough shape,' and I said,
`Yes, he is.' With that the patrolman
walked over, drew his pistol out and shot
the bull between the eyes. Then he walked
back over to me, with the pistol in his
hand, and he looked down at me and he
said, `Now, how do you feel?"'

To start it out, I would like to give you a
preview of North Dakota and what it is
like up there. The Department of Tourism
is not paying for the trip, even though it
may seem like it. I would like to give you
some information we have gathered on
statistics that we have been monitoring in
the state before we get into our programs.

There is a train in North Dakota, and I
guess the farming practices are just as
varied as the train is. In eastern North
Dakota our land is flat. In fact, water
hardly drains off, and a lot of farmers have
equipment to level the land because in the
Red River Valley the rain will just sit on
it. The ground is very fertile. We have
sugar beets and potatoes, two of our big-
gest crops in eastern North Dakota. Even
though the land is so flat, we still have a
tendency to have tractor roll-overs in the
eastern part of the state.

We have got a lot,of row crops. As a
consequence, we do have migrant workers
come up in the summertime to work our
sugar beets and potatoes. Approximately

384

17,000 to 18,000 migrant workers come
into the state every year.

As you get to the central part of the state,
it is typical high plains, much more rolling.
You have interspersed agriculture with
cattle and ranching. I guess a pretty good-
-sized farm in central North Dakota is one
of our typical farms.

We have approximately 34,000 farms in
North Dakota. We have 115,000 farmers
directly involved in farming. When you
add in the families, we are looking at
275,000 farm family members who are
involved in agriculture in some shape or
form.

The central part of the state has both
agriculture and pasture. As you move fur-
ther west in the state, you get into the
Missouri River drainage. The land starts
becoming much more rolling and much
hillier. We do have large equipment in
the state. Our average size farm is approx-
imately 1,100 acres. So it is pretty good
sized. We do have a lot of ranching in the
central and western parts of the state.

As you move farther west, the land does
get quite a bit rougher. When people talk
about North Dakota, they generally think
of it as fairly flat agricultural land. The
western part of our state, however, is pret-
ty scenic. Again, this is not pitched by the
Tourism Department, but out in western
North Dakota it is pretty. We have a lot
of rough terrain out there and a lot of
wildlife: bighorn sheep, deer, antelope, etc.

Activities out there are hazardous. A lot
of ranchers have gotten away from utilizing
pick-ups to go out and check their cattle
and run through their pastures because
they were finding out it did not take too

Papers and Proceedings


long to beat up and wear out a $24,000   the date of the injury. We began that in
pick-up.                 April of 1985.

They have gone back to utilizing $1,000
horses for checking fence and working
cattle. Most of the western part of the
state is considered semi-arid.

We developed an injury report card that
went to the medical facilities, and we
asked them to complete it. We tried to
make it as short as possible.

We do have some areas out there that
have been very dry the last three years.
Before I came down here, we did start to
get some moisture, which was welcome.

There are two sides to this, to solicit their
cooperation and to try not to make it too
complicated. We did that from 1985
through December of 1990.

We have this tendency in South Dakota
and in Montana to put old thrash
machines up on a hill. I have not the
faintest idea why it is done. We have
talked to a lot of people, and it just got to
be a fad. Farmers will take an old thrash
machine and stick it up on a hill where
people can see it when they drive by on
the roads.

Beginning in January 1981, we started with
a different case definition. With concur-
rence of the CDC, we are looking at only
the injury events that are fatal, disabling,
or result in the injured person being hospi-
talized for 24 hours or more. We are
trying to look at more of the severe inju-
ries.

There has been a program to eradicate
these. That was being conducted by peo-
ple who have had one too many beers at
the local tavern. They go out there at
night and push them down the hill!

The farm injuries in North Dakota are a
serious matter. We have begun taking
them much more seriously. We have fair
media coverage in North Dakota as to
what has been happening in the area of
farm safety. Some of the media coverage
and their support has led to much more
interest in safety. This has led to the de-
velopment of some of our programs.

We redid our injury report card and hand-
ed that out to all of the medical facilities
in the state. Reporting in North Dakota is
purely voluntary. We did not mandate
reporting. The North Dakota Head Injury
Foundation did get a bill passed two years
ago mandating that head injuries be re-
ported to the State Health Department.
We do collect data on that.

We started out back in 1985 with a CDC
grant looking at doing injury surveillance
in the state. At that time, we asked medi-
cal facilities to report any injury that was
fatal or disabling, or kept the injured per-
son from effectively participating in their
normal daily activities for one day beyond

We look at the injuries, and we classify
them by ICD-9 Codes and E-codes. Two
of our major hospitals in the state, metro-
politan hospitals, are going to start report-
ing injuries by E, their trauma centers.
They will do a computer run for us and
send it to us every month. They will break
it down by head injuries, agricultural inju-
ries, and just injuries in general.

We talked at the CDC Injury Conference
and decided that mandating E-coding or
getting E coding in all medical facilities
will be a primary key to developing a good

Health Education, May 1, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991

385


Intervention - Safe Behaviors Among Adults and Children

surveillance system. This will enable us to
find out what is going on out there, partic-
ularly in the agricultural area.

When we first started out, in 1985 and
1986, our injury reporting was way up. By
1989 it had dropped drastically. The rea-
son for that was really the fault of the
program personnel.

We learned that in order to keep a good
surveillance system going, you must keep
direct and frequent contact with the medi-
cal facilities and with the providers who
are giving you the information.

i

We had some budget constraints and the
position was open for about one year.
One of the things we learned is that there
is a constant turnover in personnel in the
medical fqcilities, particularly in medical
records. The emphasis on reporting would
get pushed to the side as people came into
the jobs and were trained.

Unless there was contact from the Health
Department or from our program, report-
ing got pushed way down. Consequently,
the numbers dropped off. We learned that
in order to keep a good surveillance sys-
tem going, you must keep direct and fre-
quent contact with the medical facilities
and with the providers who are giving you
the information.

Agricultural injuries dropped off, as far as
what was reported, comparable to overall
injuries on a reporting system. Again, that
was as a result of our program not keeping
contact with the providers. We are look-
ing at breakdown of injuries, and it mimics
the national statistics. Tractors and
machines accounted for the lion's share of

386

our injuries that were reported through the
surveillance system.

When we looked at the age groups, again,
we ran pretty much in line with Federal
and national statistics. The age group of
20 to 29 has the highest incident-rate of
injuries. When we looked at male/female,
we saw the breakdown of about 95 percent
injured being males.

When we started looking at injuries and
fatalities, we had a drop-off of our injuries
reported due to the program. We get the
fatalities from the death certificates that
are available in the Vital Statistics Division
of health departments. Our fatalities have
dropped somewhat from 1985 through
1987, down to 13 in 1989 and 11 in 1990.

On the fatalities, again, we saw tractors
and machinery as being the major cause of
farm-related fatalities.

When we looked at the age group on our
fatalities from 1985 to 1990, there were
two age groups that we were of particular
concern: the O-to-19 age group and at 50
and over. Our older farmers were having
a disproportionate share of the
farm-related fatalities.

eight now we are going back to do case
reviews on the fatalities. We will deter-
mine what interventions we need to do for
that particular age group to develop a
program that is going to target older farm-
ers, looking at causation on farm-related
fatalities.

We did have the greatest share of the
fatalities during the time period from our
spring planting in April to the end of our
harvest season in September and October.
We did, however, have fatalities through
all the months of the year, even when it

Papers and Proceedings


was cold, and people were indoors as
much as they could be in the wintertime.

We found males as having 90 percent and
females just about 10 percent of the fatali-
ties, which was a little higher ratio for the
females than it was on the injuries.

Also, we find more farm-related, or agri-
culture-related, suicides as compared to
suicides in general in the state. They have
stayed somewhat constant over the course
of the last 10 years.

This past year, for farm injuries that were
reported during 1990, we saw all types of
machinery as the primary cause of
agricultural-related injuries that were seen
in the state. This past year we saw a shift
into the age group of 30 to 39 having a
higher share of the agriculture-related
injuries compared to overall statistics of
age group 20 to 29. Utilizing that informa-
tion, we applied for and received grant
information from the Centers for Disease
Control for injury-intervention programs in
North Dakota targeting agricultural groups.

One of the first programs we developed
was with the North Dakota Emergency
Medical Technicians (EMT) and Emer-
gency Transmatic Cars (ETC) Association.
We have approximately 125 ambulance
and rescue squads scattered across the
state. Most are in rural areas; they are
volunteer squads.

Each year we had 20 ambulance squads
putting on a farm safety program. It is on
the cover of the handbook that goes with
the Farm Injury Prevention Program. It is
a three- to four-hour program. The re-
sponse from the agricultural community
has been tremendous.

Health Education, May 1, 1991

It targets farm family members, In the
rural areas the EMT squad will take 1 or 2
nights, publicize a local program, and offer
some type of barbecue dinner or a social
get-together to bring the farm family mem-
bers together. Surprisingly, we have had
several communities with only 100 to 150
people have upwards of 265 people come
and sign up for this program. They are
willing to sit down for 3 to 4 hours to go
through an educational program.

There is a video presentation that goes
with this handbook. It is set up in an
instructional manner where they will view
the video for 15 to 20 minutes.

They break down into groups and work for
15 or 20 minutes in a group with different
stations. The EMT squad wanted to be
able to do some basic first aid and some
resuscitation, in addition to the safety pro-
gr=-

They also look at doing First Response on
how to contact the EMS service. One of
the things the dispatchers were finding in
North Dakota, through EMS, is that we do
have a lot of Norwegians and Swedes in
North Dakota.

Someone would call up and say, "Hurry up.
Get out here. There's been an accident at
the Olson farm." The dispatcher would
look at his listing for that area and there
are 15 Olson farms. Then he wonders,
Which one is it?

They get back on the phone and start
calling around, hoping someone was still in
the house that they could contact. One of
the things that this program teaches (not
only to the adults but to the children in the
family) is if an adult is injured, the correct
manner of calling EMS is how you give the
location, and if you know a basic descrip-

Surgeon General's Conference on Agricultural Safety and Health - 1991               387


Intervention - Safe Behaviors Among Adults and Children

tion of the injury, what type of injury it
was. Then EMS can prepare themselves
on the way to the farm site.

The EMS would get to farm sites and
could not find where the person was. The
caller did not say if it were out in the field
or what type of field; if it was a barn, or if
it was in a silo. The EMS would have to
drive around the farm looking for the
injured person because all the farm family
members were out there.

That was another component on which we
put a strong emphasis, the correct manner
in contacting EMS. The time frame from
the time of the injury until the individual
receives medical care is critical. If we can
cut that down by a number of minutes, it is
going to help as far as recovery and save
some lives.

Twenty communities are putting on the
EMT programs, safety programs, this
spring and summer. They are scattered
across the state.

Normally, EMS is broken up into five
regions. We try to take four or five com-
munities in each region so that we get a
good cross section across the state.

At the central bottom part of the state are,
Emmons, Logan, McIntosh counties.
Those three counties were settled by (it is
part of my background) Russian-Germans
or German-Russians. That area has a
pretty hard-headed group of people. For
years that area of the state has been
known as the "Iron Triangle."

This is because anything governmental that
comes to that area is going to get rejected,
whether it is economic development or
whether it is EMS. They did get some
EMS programs going down there. We

388

have yet to get a community in those three
counties that is willing to participate in our
farm safety program; we have a waiting list
for the rest of the state to get on the pro-
gram for next year.

The North Dakota Farm Bureau is also
doing one of our farm safety programs.
The Farm Bureau in North Dakota and, I
believe, in the upper Midwest, has a pro-
gram called First Care. They use nurses
and EMT people out in their areas. They
are scattered in all 52 counties in North
Dakota to do a First Care presentation
and first aid training across the state.

We were able to go into their network and
train their First Care trainers in farm safe-
ty to incorporate, in addition to their First
Care Program, a farm safety program.
They were not only doing first aid, First
Care, and First Response training, they
were also doing farm safety training for
their Farm Bureau members. A workbook
was developed from that.

The program was called ABC on the
Farm, Always Be Careful. The program
was targeted at farm children for Safety for
Farm Children. The target audience is the
farm family adults, and the workbook is
generally given to the kids. There are
puzzles on farm safety and a number of
different activities for them to do in this
booklet.

One of our other programs was
co-sponsored by REC, a Rural Electric
Cooperative. We went into 13 schools.
Originally, we targeted six, but we had
thirteen schools request our Farm Safety
Program for Children.

This program is put on for two different
groups-ages K through 3, and grades 4
through 6. It is a l-hour presentation. It

Papers and Proceedings


is done in the classroom, but put on by
somebody that comes from outside the
school, not their normal grade-school in-
structor. We have completed all 13 pro-
grams in those schools.

The response has been tremendous from
the school administrators, the teachers, and
the parents that were surveyed. We did a
pre-program survey, and we are going back
in to do a post-program survey.

Specifically, we are looking at attitudes of
the parents. What are they allowing their
children to engage in? At what ages do
they think the children should engage in
certain farming activities?

We are also utilizing an occupational nurse
program that was being administered
through a NIOSH grant. The primary
purpose of the occupational nurse program
is to put five nurses in rural areas across
the state.

They will assist in farm surveillance, partic-
ularly looking at farm illnesses: respiratory
illnesses, dermatological conditions, and
toxic exposure to pesticides. These indi-
viduals are also assisting in education ef-
forts across the state. They are represent-
ed at Farm Safety Awareness booths at
local farm programs that are put on in the
wintertime, county fairs, community activi-
ties, folk festivals-that type of thing.

One of the areas we are investigating is
the operator safety checklist, how to rein-
force that.

We looked at hazards of flowing grain in
all of our programs. We use a gravity box
for demonstration with the program pre-
sentation. Particularly for the children, we
show how easily and how quickly one can
become submerged in flowing grain. And

Health Education, May 1, 1991

we try to point out particular hazards that
we have seen in our injury reports.

We also review all the EMT Association
and EMS trip tickets. We pull out the
agriculture-related trip tickets to assist in
our surveillance and look at causation.
We look at auger injuries and tractor roll-
overs. Tractor rollovers are still a major
source of fatalities in the state.

Power take-off (PTO) shafts are dangers.
Buildings are dangerous. Children run
across openings, go into a shop where the
tractor is running. The parent is backing
out unaware that the child has come into
the building.

We also are going to our major agriculture
shows across the state and setting up and
staffing a farm safety booth. The winter
show, our biggest agricultural show in
North Dakota, runs about 11 days. Atten-
dance is approximately 130,000 people.
When you only have about 640,000 in the
state, that is a lot of people to attend a
show.

Also, we have cooperated with Centers for
Rural Health and the Dakota Conference
on Rural Health. We are on their pro-
gram schedule and have set up a farm
safety awareness booth. I guess on that
last one, what we have done is seek help
from businesses.

Most of the booths cost a fair amount of
money to set up. Normally the commer-
cial accounts are at these shows. We ap-
proached farm manufacturers in the state
and implement dealers to ask for their
assistance in getting information out on
farm safety. We have got the backing of
the North Dakota Implement Dealers
Association.

Surgeon General's Conference on Agricultural Safety and Health - 1991

389


Intervention - Safe Behaviors Among Adults and Children

We have had financial assistance in
co-sponsoring some of our farm safety
booths. If we have a sign up with the
name of a particular implement dealer, it
seems that it helps to persuade the farmers
to stop, pick up the information, and talk
to us. It is just a booth display that we
have set up.

As the son of a conservative farmer, one of
the things I know is that government help
is not generally well-accepted in the rural
community and in the agricultural sector.
We have heard people talk about regula-
tion and enforcement, the clause that pro-
hibits OSHA from investigating or doing
any work on farms that employ less than
11 people, which is about 96 percent or 98
percent of the farms.

Even though there is a lot of involvement
in government as far as the farm programs,
there is a very strong resistance out in the
agricultural community to government
involvement. This is particularly true when
you come in and say, "Well, I'm from the
government and I'm here to help you."
Right away it turns them off.

We have enjoyed reasonable success. The
focus of our programs is going to continue
along this line in the future. We will be
able to solicit the cooperation of farm
groups, the Farm Bureau, North Dakota
Farmers' Union, the local EMT squads, by

utilizing the local people to do program
presentation. It adds credibility to the
program, adds validity to the program, and
it allows us access.

If I went in saying that I was from the
State Health Department and put on a
presentation similar to what the EMT
squads are doing, we would be lucky if we
got 30 or 40 people there. As I have said,
in some of our communities we have had
200 or 250 people show up. That is more
than they get at a local basketball game, a
big drawing card in the local communities!

I think it is very important, when you are
developing educational programs, to be
able to utilize local resources and local
people to add that credibility. It allows
you to get your foot in the door.

I still go out and do presentations and am
involved with a lot of the programs, but
the programs are mainly sponsored and
put on by local individuals. It has helped
tremendously for our program to be ac-
cepted. We feel that by continuing to
utilize our local resources and our local
farmers, getting them involved, we will be
able to reduce the amount of agricultural
injuries and fatalities in North Dakota.

Eventually, all of our people can continue
to enjoy our beautiful sunrises and our
beautiful sunsets in the state. That is our
primary goal.0

390

Papers and Proceedings


Surgeon General's Confamnce on Agricu/tura/ Safety and Health
FARMSAFE 2000 o A National Coalition for Local Action
Convened by the National Institute Ibr Occupational Safety and Health
April 30 - May 3, 7997, Des Moines, Iowa

  VOCATIONAL AGRICULTURE
     By Robert Graham, M.S.
      Assistant Executive Director
National Vocational Agriculture Teachers' Association

Dr. Waiter J. Armbruster: The next speaker will be Robert Graham, who is the Assistant Executive
Director for the National Vocational Agriculture Teachers' Association. He will address the inter-
vention for safe behaviors among adults and children from the perspective of Vocational
Aariculture.  Mr. Graham:

First of all, let me say it is a pleasure to be
here in Iowa. I have never been before.
It is quite an experience. It is also a real
pleasure to be at the conference on
FarmSafe 2000.

I am from Louisiana. Has anybody detect-
ed an accent? No? I suppose it did not
show up.

I represent the National Vocational Agri-
culture Teachers' Association. We are the
folks that are out there in the schools on a
daily basis in this country giving profes-
sional instruction in and about agriculture.
We are the only specifically United States
Department of Education group that is
given the task of teaching agriculture in
the classroom. We had our beginning in
1917 with the Smith-Hughes Act. Right
now we have about 7,000 departments in
the secondary programs.

I will tell you a little bit more about our
staff as we go along.

First I wanted to point out something that
is very important about what we are here
to discuss in promotion of farm safety.
This is an emphatic effort for us to try to
improve the quality of our life.

In order to do that, we study our environ-
ment. We study it so that we can discern
those things that will help us with tech-

niques to change our behaviors to have a
safer lifestyle.

This safer lifestyle has been something we
have tried to accomplish in the industrial
world for quite some time. We have been
working toward the same end for many
decades in the rural and farm community.
It is not simply enough that we establish
what behavior or mechanization improves
the safety of our daily environment.

The discoveries of our efforts in research
must be delivered and promoted. That is
what teachers are about: the delivery and
promotion of research development. Only
when safe techniques are utilized as a
common practice is it possible to improve
the quality of life as well as its duration.
We all want a greater duration. I know I
do.

We are in the secondary programs, but
that is not the only place that you will find
us. This teacher, myself, is working with
secondary students.

We also have teachers who are out there
working with young farmers, adults, and
college students. Tomorrow on the pro-
gram you are going to have a gentleman by
the name of Wayne Sprick speak to you.
He is the Executive Director of the Na-
tional Young Farmers' Association.

Surgeon General's Conference on Agricultural Safety and Health - 1991

397


Intervention - Safe Behaviors Among Adults and Children

The young farmer and his instructor are
found in junior colleges or community
colleges. We also have them in vocation-
al/technical programs throughout the
country.

Part of what I am going to discuss today is
our premier award. Our premier group is
represented here at this conference by our
National President of the FFA, Mr. Mark
Timm. We are all very proud of Mark.
He represents about 400,000 young people
out there like himself.

One of the things that you need to know
about secondary education is what we are
about-education in all subjects associated
with agricultural science and business. We
start with a basic study in animal science
and plant science in the secondary pro-
gram. Then we try to take 27 areas, insert
proficiency, and enlarge the specific data
base. Every proficiency area has a specific
section that deals with safety practices.

We are all familiar with beef production,
especially here in Iowa. We dedicate safe-
ty study to practice of safe handling
dealing with mechanical and health prob-
lems that may arise from working with
livestock. Teachers are doing this at all of
the levels I previously mentioned.

We utilize this model in order to broaden
the classroom/ laboratory instruction with
a supervised agricultural experience and
then we incorporate the FFA organization
into it.

We try to encourage the involvement of
the community into the classroom. We
encourage young people through the FFA,
in classroom action, and laboratory instruc-
tion at the site, and we branch out into
supervised agricultural experience. We try
to get those experiences in all the areas

392

that I have just mentioned-the 27 profi-
ciency programs.

THE NATIONAL CHAPTER SAFETY
AWARD

Our premier promotion project right now
is the National Chapter Safety Award.
This project is sponsored by the Equip-
ment Manufacturers' Institute (EMI). We
try to get these 400,000 secondary people
to get involved.

We are trying to branch out into other
areas in the National Young Farmers'
Association, as well as both secondary
schools and community colleges with this
type of promotion activity. It is not
enough simply to teach safety. It is vitally
important that you promote those people
who are out there doing these voluntary
activities so it will be an ongoing and
growing process.

We in agricultural education discovered
this a long time ago. About 25 years ago,
we got hooked up with the EM1 and the
National FFA Foundation. We found
money to put on a national competition.

The four basic steps are identifying the
i
need defining objectives and plans taking
action, and evaluating the results.

We also promote the safety award for
eight objectives: one, to study current
safety activities in the community. The
application is set up so we do that. You
have to know what kind of safety practices
you need. I think our first speaker was
pointing that out to us, evaluating what
you need in the community and then trying
to design plans to deliver that type of

Papers and Proceedings


instruction. Then it will be adopted and
utilized. Create an understanding of safety
in the conmumity.

There is a great lack of understanding by
people who are afraid of being regulated
and having their procedures on the farm
changed by some governmental interven-
tion. One thing for sure, all of us farmers
are a little bit on the hard-headed side.

We encourage students to sit down and
do a community review by interviewing
resource people with organizations, such
as the community health organizations,
the district representatives of OSHA and
NIOSH, the Farm Bureaus, and National
Grange Affiliates.

By encouraging members of the FFA to
realize the importance of agriculture safety
in their community, we are all trying to
instill a change in behavior in the young
people; that is a major objective. If you
change the young people's attitudes to-
wards safety practices, you are going to
change how the occurrence of accidents or
the misuse of chemicals occurs in the
future. They will be more conscious about
the activity around them.

Identifying collaborative groups and joining
forces is another important feature of what
we are here about. That is coalition build-
ing. To try to create and to carry out
successful safety chapter programs, specifi-
cally for our award, we are in the habit of
involving the community.

A PLAN FOR ACTION

In the application itself, we try to get the
teacher and the student to sit down and

Vocational Agriculture, May 1, 1991

develop the correct approach to analyzing
any situation. The four basic steps are
identifying the need, defining objectives
and plans, taking action, and evaluating
the results.

The last one is very important, evaluating
results. I have heard some discussion by
all the speakers concerning what we are
talking about in this FarmSafe 2000 coali-
tion. When we get through here, how are
we going to come back and evaluate what
we have accomplished one year from now,
two years from now?

Identify Needs

It is important that you know and identify
the needs. We encourage students to sit
down and do a community review by inter-
viewing resource people with organizations,
such as the community health organiza-
tions, the district representatives of OSHA
and NIOSH, the Farm Bureaus, and Na-
tional Grange Affiliates. All these people
have other resources you can utilize for
identifying the needs of that community.

Define the Objectives

An example would be in Indiana one year,
they defined their objective at a particular
school as lowering the incidence of traffic
accidents involving 16-to 25-year-olds by 10
percent.

They had a specific goal. It was measur-
able. They could come back and take
statistics that were available through the
health unit and verify whether or not the
effort had lowered the statistics. These are
all things that we look for when we begin
to evaluate the applications for National
Safety Award.

Surgeon General's Conference on Agricultural Safety and Health - 1991

393


Intervention - Safe Behaviors Among Adults and Children

Take action

Once you have a plan in place, you have to
get it in action. Utilize the people who
helped develop this information by putting
them into the plan. Then you set out to
accomplish the task of lowering the num-
ber of car accidents for persons between
16 and 25 years of age. Do this through
posters, pamphlets, audiovisual aids.

All of these things are suggestions that we
try to put into the packet we send to pro-
mote the utilization on this project. Also,
we tell young people to examine the laws
and regulations. We find that there are a
lot of people in the community who are
unaware of the laws and regulations at
their fingertips to help improve their local
community. We encourage them to first
go to the legal sources. Find the laws and
regulations. See what is on the books that
will help you enforce or help you promote
what you are trying to accomplish.

I would like to encourage everybody to
attend the poster session tomorrow. There
are at least six posters there that have
been done by Gold Emblem Outstanding
Chapters. I think you will get an overview
of what we are trying to do in some 7,700
chapters. That is our goal.

Evaluation

The evaluated results are a critical part, to
see whether or not it has been a successful
project. Is there something more to con-
tinue?

We suggest things such as pre-tests and
post-tests. These are things that can be
actually statistically proved. Survey the
people. Get an opinion survey of what
they perceive the problems were. How do
they perceive, at the completion of the

394

project, what was accomplished? Was
there an actual attitudinal change?

Self-reflection: you have to sit down with
a group of resource people that you have
put together from the community, business,
professions, education, and government.
Have them evaluate. How did you see
what was accomplished? Understand that
this is an annual, ongoing process to try to
comply with.

The evaluation is vitally important. We
have seen a tremendous increase in the
number of chapters since we have started
this project. It is not enough, however.
We started with around 500 chapters par-
ticipating in our programs back in 1972.

We did not collect statistics the first year
we started. We are up to over 1,600
chapters in the year 1991. That is 1,600
chapters participating out of a possible
7,700 at the secondary level.

We currently do not have an active nation-
al contest for safety at the post-secondary
level. We are beginning to get into the
middle-school level. The potential for
growth and delivery of this information
through our particular promotional process
is immense.

One of the reasons it has not grown more
is because we personally have found flaws
in how we deliver the safety information.
Teachers (and ours are not unlike any
others) have a tremendous number of
activities that they have to tend to on a
daily basis. A lot of these activities are
around that local school site. We found
that if we will develop the materials, and
hand-deliver those materials rather than
mail them in a package, we get better
results.

Papers and Proceedings


PILOT TESTS

The next question is how we do that. We
have come up with a system that we are
going to pilot test around three new pro-
jects. We have broadened our area of
attack. We have gone to agricultural sci-
ence, food safety, and also ground water
quality. We have two new projects. One
was mentioned by Mark, the one about the
food safety development project. It is a
new curriculum project. It is curriculum
for infusion.

As educators and teachers, what that word
means is that, instead of trying to give us
another task to do on top of everything
else, we are trying to supplant something
already being done, or to supplement in-
formation with more current data.

I am going to use ground water quality as
an example. How do we deliver our mate-
rial so that it is utilized and does not end
up as another fantastic piece of material
sitting on a shelf somewhere on which
$300,000 or $400,000 worth of grant money
was spent?

We have designed as a management infor-
mation system. We are going to pilot our
ground water quality project through that
management information system. We are
going to train 40 trainers (master's degree
or above people), classroom teachers,
college professors who are willing to par-
ticipate.

They will deliver this particular subject
matter on food safety and ground water
quality by conducting 10 workshops directly
to teachers. It will not be open only to
agriculture teachers. It is going to be a
broad system that is open to all teachers of
science, health, safety; even physical educa-

Vocational Agriculture, May 1, 1991

tion instructors may find a use for it in
their curriculum.

The object is that people go to a site locat-
ed so that no one instructor would have to
come more than 35 to 40 miles from
school. It is an after-school project. That
way it does not interfere with the normal
day.

By delivering the actual material into their
hands, with a video to back it up and a
workshop to go with it, it is more likely it
will be utilized. This, in the past, has been
proven by local universities. It works bet-
ter when hand-delivered.

The problem comes in our particular area
of education. Agricultural education is not
one of the required courses. Since the
Nation at Risk reports came out in 1983,
we have had a tremendous amount of
pressure on us, as local educators, to prove
that there is a need for us to be in the
public school system.

CONCLUSION

Once again, I am excited about this partic-
ular conference and the opportunity to
speak and present our particular method
of delivery on farm safety information and
rural community and health education
information. We need you to know that
that light of discrimination is being shined
upon us rather strongly and has been for
some time. In order to expand the pro-
cess, we need to form a tighter and broad-
er coalition to deliver additional informa-
tion on rural health and economic develop-
ment.

I look forward to working with the rest of
the groups that are here. I have enjoyed
what has been said by Dr. Novello and
look forward to proceeding with this coali-

Surgeon General's Conference on Agricultural Safety and Health - 1991               395


intervention - Safe Behaviors Among Adults and Children

tion. We can change the risk that is out
there among farm and rural communities.0

QUESTIONS

(inaudible): Do you have an example of a pre- or post-test they can use?

Robert Graham: Okay. I will use one from my personal experience. I spent 11-l/2 years in the classroom.
A pre-test that we used in our community had to do with how many actual safety programs the people in our
community had been to and observed in the course of the last 24 months.

We circulated this around the community door-to-door on a Saturday. We put out about 500 of them. We
had drop-offs for them.

We got 300 of them back. It was the local post-office. The postmaster cooperated with us in the rural com-
munity.

We actually checked on how many had been to safety programs dealing with drunken driving and safe
operation of vehicles and farm vehicles on the highway. We got back a little over 300 of them. We evalu-
ated the results and there was a small number. I do not remember the exact number, but about 15 percent
of those had actually been. I know it was under 20 percent. Over the course of the next six months, we
planned four types of seminars. We involved the Farm Bureau Federation, the national and the local health
community, and some Rural Electrification groups that had some promotional films. We did three night
programs and one school program.

Then we went back and surveyed the attendees as to how many of them had received our survey. About 35
percent of those people had actually gotten our forms and turned them in.

It is not an accurate survey of what we did there. We found that out as we went through. We saw an
increase in the number of people who had actually gotten our forms, turned them in, and been to those
programs at that time. There were more of those. It was about 25 percent. We figured about 20 to 25
percent of the population had increased their attendance at a program on education about operation of
vehicles on the highway.

That is not a good example of a pre- and post-test. There are other ways to do it by analyzing the statistics
in your immediate geographic area. What are the accidents? Model your program on one that was done by
a chapter in southern Louisiana dealing with power take-off (PTO) injuries. There was a high rate of these
injuries in a particular county in that state. They evaluated them by doing a countywide program over the
period of one year. They had at least one program every other month dealing with the accidents. They
measured the accidents through this year; and there was a reduction of about 10 percent. Those are rough
examples. There are some others. The gentlemen who created these posters have better examples. They
are the national ones, I am just a local one.

396

Papers and Proceedings


Surgeon General's Conference on A@cuttuml Salty and Health
FAM%FE 2000 o A National Coalition tiw Local Action
&mmned by the National institute for Occupational SaWy and Health
April 30 - May 3, 1991, Des Moines, Iowa

THE MASS MEDIA AND AGRICULTURE

By Cheryl Tevis, MA.
Senior Farm Issue Editor
Successful Farming Magazine

I am glad to be here this afternoon and to
have the opportunity to share some
thoughts with you about farm safety and
health. I am the Farm Issues Editor at
Successful Farming Magazine. Successful
Farming is a national farm magazine with
500,000 subscribers. It is based here in
Des Moines.

We are published by Meredith Corpora-
tion, which also publishes Better Homes
and Gardens, Midwest Living, Ladies' Home
Journal, Metropolitan Home and several
other magazines. I have written for Suc-
cessful Farming for 12 years.

I did grow up on a farm in northwest Iowa,
near Sioux City. Like many farm teenag-
ers, I left the farm when I graduated from
high school. I did not know what my col-
lege major would be. I was pretty certain,
however, that my life's work would not be
related to farming at all.

Somehow, as part of the requirements for
completing my master's degree in Journal-
ism at the University of Missouri at Co-
lumbia, I wrote a series of articles about
agriculture. That led to a decision to
specialize in agricultural writing.

I worked at a farm magazine in Milwaukee
for three-and-a-half years before coming to
Successful Farming. Then, almost 7 years
ago, I completed my 360-degree revolution
by marrying an Iowa grain and hog farmer.
Although my life has taken a somewhat
circuitous route, I am a farmer's daughter

writing for a farm magazine and married
to a farmer. That is my background.

I have been asked today to talk about the
media's role in helping to promote farm
safety and health. Obviously, I can not
speak for the entire media. My personal
experience is with farm magazines and,
most specifically, with Successful Farming.
I will concentrate on that.

For years the general public has perceived
that the farm is a great place to live and
raise a family. In many ways that is true.
For those of us who have lived on farms or
in farm communities, farm health and
safety always have been concerns. I am
proud that Successful Farming has taken
the lead in covering many of these topics
and that my involvement with farm health
and safety issues is not an overnight devel-
opment.

For instance, in the late 1970's, I
remember writing about farmer's lung
disease and the work being done at what is
now the National Farm Medicine Center,
to help afflicted farmers. Successful Famz-
ing also had an early focus on the effects
of stress on farmers. I wrote a story on
this subject back in October of 1980. My
stories about disabled farmers began in
1981. I wrote about microsurgery follow-
ing a farmer accident in 1983.

At about the same time, we had an editor
who was a fitness advocate. With his en-
couragement, I wrote an article called

Surgeon General's Conference on Agricultural Safety and Health - 1991               397


Intervention - Safe Behaviors Among Adults and Children

"Being a Farmer Does not Make you Fit
and Trim." In those days it was something
that you did not think about. Naturally,
farmers are supposed to be in good health
and good physical condition. We felt that
there were some areas there to work on as
well.

In December of 1981, I edited an article
by Kelley Donham, at the University of
Iowa's Institute of Agricultural Medicine
and Occupational Health. It was entitled,
"Farming Can be Hazardous to Your
Health." A year or so later, I worked with
Kelley again to write a sidebar about farm-
er's lung, pesticide poisoning, respiratory
illness, well-water contamination, and toxic
fumes poisoning.

In March of 1984, Successful Farming be-
came the first farm magazine to feature a
regular rural health page. Today I think
this feature still does distinguish our maga-
zine from others. We have covered topics
from skin cancer, to fitness, to hog farm-
er's lung, to histoplasmosis. More recently,
we have featured occasional articles about
non-farm related illnesses and conditions
such as lupus, infertility, and Lyme disease.
It is our belief that farmers do not receive
many magazines that deal specifically with
health issues. Yet they are interested in
reading about it.

The safety of farm children has become a
personal and professional issue of mine.
In 1983, I wrote a story about the death of
a 17-month-old girl in a farm accident.
Soon afterwards I married a farmer and, in
1986, our daughter was born. I found my-
self coming back, both for professional and
personal reasons, to the topics of children
and farm safety and farm-related health
hazards.

398

Farm children have been injured and
killed for years. I was too young to remem-
ber a tragic tractor roll-over accident that
claimed the life of our neighbor's son.
Years later I remember finding the yel-
lowed and brittle newspaper articles about
it that my mother had saved. On looking
back, I think that that accident may have
had a lot to do with the fact that my broth-
ers were not expected to function as hired
hands at a young age.

Despite the fact that children have been
the victims of farm accidents for years, the
issue of children and farm accidents was
not a hot topic. In fact, my 1983 article
about Bill and Ann Friend's daughter was
unusual for farm magazines. I have to give
Bill Field, at Purdue University Extension,
a safety specialist, most of the credit for
bringing this tragic situation concerning
children to my attention. I think he took
the leadership in tracking injuries and
deaths of farm children.

Since that first article, I have found that
focusing on children is a way to get at the
complacency factor among adults concern-
ing farm safety. Initially, my editor was
not excited about writing safety articles.
After all, he pointed out, people feel that
they already are safety conscious. They
have their own mind set about it and it is
difficult to engage them on that topic.

By taking steps to reduce or eliminate
safety hazards on the farm for the sake of
their children, in many cases adults also
are protecting their own lives. It helps to
penetrate that adult mind set and get them
to at least think about safety.

Therefore, three years ago I prepared a
one-page story featuring an Earlham, Iowa,
farm woman, Marilyn Adams. I was
moved by the death of her young son,

Papers and Proceedings


Keith, in a gravity flow grain wagon and by
her efforts to do something to try to spare
other farm families the grief that this acci-
dent had caused her. Just before the arti-
cle was to go to press, I found out that we
had a commercial sponsor, DowElanco,
who was willing to provide enough adver-
tising to allow expansion of that topic from
one to twelve pages. I was elated.

The article, "We Kill Too Many Farm
Kids," contained original research. Here is
a copy of it. I have copies of this article as
well as other ones that we have done up
here in the front for you to take with you
today. This article had original research
that was based on our 1,200-member farm
panel, concerning farm safety attitudes and
practices.

For instance, we found that 65 percent of
farm boys were driving tractors without
supervision by age 12 years. According to
our survey, more than 70 percent of farm
parents believe that the risk of a child
riding as a passenger on a tractor is low,
very low. More than 85 percent allow
their children under age 9 to ride.

The response to this article has been
gratifying. With the assistance of Marilyn
Adams and her organization, Farm Safety
for Just KY&, we estimate that more than
20,000 copies of the insert have been dis-
tributed.

The article has been reprinted twice since
its publication. It has enjoyed widespread
distribution to 4-H clubs, farm families,
FFA, and extension safety specialists.

A video based on our 12-page editorial
was produced, again with the sponsorship
of DowElanco and the distribution by
Farm Safety for Just Kids. More than 2,000

The Mass Media and Agriculture, May 1, 1991

copies of the video have been distributed
in the past two years.

In addition, FFA chapters, churches, hospi-
tals, 4-Her's, and farm men and women
have written or called to tell us about their
efforts to take the information in the story
and the video one step further.

Two years later we are still receiving re-
quests for this article. As a result, in mid-
March of 1991, we published a five-page
follow-up featuring many of these ideas,
events, educational efforts, and projects.
We want to provide information and guid-
elines to others so that they can plan and
conduct events as well.

This is the five-page insert that we did with
ideas and projects and things that can be
done on a community basis to improve
farm safety, specifically for children. Last
year, "We Kill Too Many Farm Kids" was
selected as a finalist in the category, per-
sonal service, of the National Magazine
Awards.

In 1990, sponsorship again provided Suc-
cessful Fuming the opportunity to publish
a 1Zpage story called, "Staying Alive: The
Struggle to Save Farm Accident Victims."
It focused on near-fatal farm accidents told
from the perspective of the farmers who
had survived them, and provided vital in-
formation about what steps individuals can
take to improve the quality of rural emer-
gency rescue in their communities. The
article also featured examples of what
communities are undertaking to improve
their emergency rescue skills.

As you have heard today, about 75 percent
of the rural emergency medical services in
the U.S. are comprised of volunteers.
Many victims of farm accidents are not
discovered for hours or have to travel

Surgeon General's Conference on Agricultural Safety and Health - 1991

399


intervention - Safe Behaviors Among Adults and Children

miles to the nearest hospital without first
aid. Since 1981, 190 rural hospitals have
closed their doors. It is estimated that 22
percent of hospitals in rural America are
at serious risk of closing. The medical
attention that farm families receive at that
accident scene is more vital today than
ever before.

Last fall we offered the Institute for
Agricultural Medicine and Occupational
Health access to our farm panel for further
research into farm accidents. We found
that proper shielding is not placed on
power take-offs (PTO's) on 64 percent of
the farms. Only 64 percent of farm chil-
dren use seat belts in farm pick-up trucks.
When parents were asked to select the
factors used to determine when their chil-
dren were old enough to drive a tractor, 48
percent replied that they or other children
in their family drove at that age.

Economic factors also ranked high. A
total of 31 percent in the Iowa group sur-
veyed said one reason for the decision to
let their child drive was that extra help was
needed. Another 21 percent said that the
kids", wanted to do it."

When asked, "If cost were not a consider-
ation, would you use roll-over protection?"
89 percent said they would; 96 percent
would use safety shielding; and 50 percent
would use day care. These figures may be
slightly high. We all know it is good to
have good intentions. Most of this group,
92 percent, said they know that tractors
and other machinery are the largest source
of accidents involving children. Many of
the safety recommendations buck tradition,
values, and economic needs on farms.

We featured the results of this study along
with an article about the farm family safety
walk-about program developed by the

400

Institute of Agricultural Medicine and
Occupational Health. We contributed
funding and featured an article last year
about the farm safety day camps for kids,
pioneered at a hospital in Cedar Falls,
Iowa.

Living on a farm 60 miles from Des
Moines, I frequently see and hear about
farm neighbors and relatives who exhibit a
casual disregard for dangerous situations
involving children. Child care is a crucial
problem. A survey of 1,500 Minnesota
farm women reinforces the fact that find-
ing affordable, quality child care in rural
areas is difficult. Of these women sur-
veyed who are employed off-farm, 44 per-
cent use child care.

Even women who do not work off-farm, in
that survey said that they needed child
care options to allow them to accomplish
their farm work. Being married to a farm-
er and being the mother of a four-year-old,
I understand the problems of keeping
children safe while growing up on the
farm. I have child care arrangements for
our daughter.

Occasionally, as any other parent in that
situation knows, arrangements do fall
through. Many times it is hard to even get
a high-school babysitter in the evenings in
rural communities.

Sometimes I have to fall back on my moth-
er-in-law. That creates concern on my
part. She is usually involved in the field
work or the hog chores. Fortunately, my
husband shares my view that a tractor cab
is no place to babysit children and a far-
rowing house is not a play area.

On the other hand, I see the dangers of
never allowing our daughter to venture
under supervision beyond the house yard.

Papers and Proceedings



This would not prepare her very well for
following in the family tradition of raising
hogs as 4-H projects and knowing generally
what goes on on a farm.

We know that about half of farm women
pzirr--1

As a result, Successful Farming has
featured child care stories. This is another
departure for farm magazines. It is a risk,
of course, since a certain percentage of our
readers do not approve of child care. I
could read you their letters.

We know that about half of farm women
work outside the home. If they do not
work off-farm, they are often expected to
help with the livestock or drive and oper-
ate equipment during planting and harvest.

Our most recent child care article featured
an Iowa day care center and a farm
woman's role in helping to lead a cornmu-
nity effort to expand that center. We con-
tributed a modest amount to its comple-
tion as a sign of our support for the impor-
tance of this issue to farm safety for chil-
dren.

Last year, I made a comment in my
monthly magazine column that a tractor
cab was no place for a small child. That
provoked a very forceful letter from a
Michigan farm woman. She said that tak-
ing a child in a tractor cab was safer than
in a car travelling sixty miles per hour.

1 ran her letter in a subsequent column
and asked readers to comment. I received
about 30-35 letters in response, a fair
amount of response for any item in the
magazine.

The Mass Media and Agriculture, May 1, 1991

The letters reflected a mixture of opinions.
There were many from women who agreed
with my Michigan critic. Many women
who were grandmothers wrote to say that
they had taken their children with them as
they worked on the farm and never had
any reason to regret it.

Other younger farm women said that their
labor was needed on the farm today. They
did not, number one, have enough money
to pay someone to watch the children, or,
two, close relatives who were available for
babysitting.

As a result, five-year-olds are playing in
pick-up campers or pick-ups parked at the
end of the field. Their mothers are check-
ing on them at the end of each round.
Smaller kids are riding in the tractor cab
and combine. The mothers feel as if they
have no choice.

On the other hand, I received a good num-
ber of letters from women and men who
said that taking children in the tractor was
unsafe. The children could suffer from
hearing damage, dust, and fumes. They
said they would not try to care for a child
in a moving tractor as they would not in a
moving car.

The topic of farm safety, particularly for
children, is now in the limelight. When
the awareness level is high, we have a
golden opportunity to make the leap to
changing behaviors.

In farm health, we are confronting
obstacles such as inadequate financial
resources in rural communities, lack of
health insurance among rural individuals,
and a financially threatened network of
hospitals. These problems are compound-
ed, in some cases, by uninformed policy
makers.

Surgeon General's Conference on Agricultural Safety and Health - 1991               401


Intervention - Safe Behaviors Among Adults and Children

For instance, just last week I picked up an
article featuring an interview with the
chairman of a nonprofit health policy re-
search organization in Minnesota called
Interstudy. I cannot tell you how amazed I
was to learn that:

There's very little evidence that the lesser
amounts of health resources in the upper
Midwest rural areas are having an ad-
verse effect on people's health. Perhaps,
because they live healthy lives. They're
not exposed to the detrimental effects of
the city like pollution, for example, and
they generally get more exercise. So, I am
not persuaded that the lesser intensity of
health care that's available in rural areas
is necessarily bad for rural residents'
health.

I am here to tell you today that farm life is
not necessarily healthy. As you know,
there are people living in urban areas who
worry about applying pesticides to their
lawns to make their lawns look more at-
tractive. How would they like to apply
pesticides to 1,400 acres of land every year
to make a livelihood?

Urban people do not have to worry about
the long-range effect of pesticide and ni-
trate residues in their well-water. They do
not get hog lung from their life's work.
OSHA is there to help protect them from
being injured and killed on the job. Rural
people, especially farmers, are exposed to
a host of hazards and illnesses that
demand adequate health care as well as a
medical profession that is trained in these
unique occupationally related illnesses.

I believe that the consciousness of the
farm community is being raised concerning
farm safety and health. In fact, the Farm
Family Survey conducted by the University
of Iowa showed that farm safety and health

402

ranked equal to or higher than other con-
cerns such as farm commodity prices, so-
cial erosion, and environmental issues.

This same survey showed that farm maga-
zines ranked as a top source of informa-
tion for farm families and a great vehicle
for health and safety articles. There is no
question that the media can play a large
role in keeping people interested and
aware of farm safety and health. I must
say that it is difficult for farm magazines
like mine to sustain heavy coverage of
farm health and safety articles without,
number one, considerable research and
activity in this area by other interested
parties; and, two, positive feedback from
our readers demonstrating readership of
these issues.

1

More recently, as a member of the farm
media, I have been reminded of the re-
sponsibility not only to write about these
issues but also to portray proper safety
and health practices throughout the maga-
zine in the photographs that we feature.

For instance, as I mentioned earlier, in the
late 1970's and early 1980's, it was less
common to feature farm safety and health
in our magazine. My editors would tell me
that we are not in the business of "remind-
er journalism." That means that because
farming is hazardous, and we are a farm
magazine, we cannot write an article every
month reminding our audience that they
need to be careful. That is unless, of
course, we have a news angle or new re-
search to feature.

For many years, extension safety
specialists, such as Bill Field, at Purdue
University, and Rollin Schnieder at the

Papers and Proceedings


University of Nebraska, were laboring
trying to make a difference. This was
despite government cutbacks in funding
farm safety at land-grant universities.
They were and still are operating on a
shoestring. It is difficult for the few of
them who work so hard to generate
enough research or programs to keep up a
continuous flow of agricultural health and
safety stories for the media.

Now other organizations, agencies, and
institutions have begun to focus on farm
safety and health as an issue and to obtain
funding for activities and research. It is
much easier for me to propose a story and
have it accepted by my editors. The topics
of safety and health still need to compete
for space in our magazine with articles
about production and business.

More recently, as a member of the farm
media, I have been reminded of the re-
sponsibility not only to write about these
issues but also to portray proper safety and
health practices throughout the magazine
in the photographs that we feature. For
instance, if a photographer takes a picture
of a farmer driving a tractor with an extra
rider and we use it on the cover of the
magazine, are we giving tacit approval to
this unsafe practice ? Or if a photographer
shows a farmer applying chemicals without
proper protective clothing and equipment,
are we encouraging unsafe behaviors?

This is a difficult area. In reality, of
course these situations are the norm in
farm communities. Another factor is that
virtually all of our photographers are
freelancers who have no farm background.
I am a member of the Iowa Farm Safety
Council. At their suggestion, I am contact-
ing all of our freelancers, sending them
materials explaining the need to portray
safety and health in photos as well.

The Mass Media and Agriculture, May 1, 1991

It is an uphill battle, and we will not ac-
complish as much unless we all work to-
gether. As I interview sources and write
stories about farm safety, however, I have
become aware of professional jealousies
and heard harsh criticisms.

The issue is not, I think, which group has
done the most. We are all needed. This
includes traditional groups such as exten-
sion safety specialists, who have paved the
way, as well as hospitals and universities
who have begun to make a substantial
contribution. Each group has its own
strengths and weaknesses.

We are working on an issue that affects
people's lives. As a farm writer, I appreci-
ate the perspectives of the entire spectrum
of individuals committed to the cause of
farm safety and health.

It is great to think that the Surgeon
General's Conference is focusing on farm
safety and health. It is gratifying to see so
many of you here today. As I look out
over the audience, however, I can not keep
myself from thinking about others who are
not here today to benefit from these ses-
sions about farm safety and health.

For instance, I think about Lloyd Hinshaw.
He was a 41-year-old farmer who killed
himself, a victim of depression and stress.
In the winter of 1981, I interviewed his
widow and two other farm couples
attempting to cope with financial stress.
Then I wrote an eight-page article about
the effects of stress on farm families.

I wish that we could turn back the hands
of time so that Indiana farmers Bill and
Ann Friend could be here today. I grieved
with them at their kitchen table 8 years
ago over the loss of their 17-month-old
daughter in an accident in their farm

Surgeon General's Conference on Agricultural Safety and Health - 1991               403


lnterventlon - Safe Behaviors Among Adults and Children

driveway. I wrote about their nightmare in
the magazine in 1983. For several years
afterwards, Bill could not bear to continue
his volunteer work as an EMT. Today,
however, he is back helping others in his
community again, at accident scenes.

It is too late for Jim Arnold. After study-
ing accounting and agricultural economics
for 3 years, he quit college to return to
farming. His love of farming and over
powering desire to make it his life's work
despite the obstacles is not unique. In
Arnold's case, however, the challenges are
greater. The 36-year-old Nevadan lost
both arms and legs 10 years ago in a
powerline accident on a farm. Successful
Farming helped to sponsor two national
conferences for disabled farmers. We also
sponsored the Iowa Easter Seals Farm
Program and are breaking new ground at
Purdue University.

I think about Jeannie Johnson of Canton,
Missouri, who was widowed with a 5-

month-old son and a 7-year-old daughter.
She will never forget the day 9 years ago
when her husband was killed in a grinder-
mixer accident. Her story appeared in our
magazine 4 years ago.

I do not believe that I will ever forget
these people or their stories. I wish that
they could have benefited from the atten-
tion that farm health and safety is getting
here today. It is my hope that, as a result
of this conference, in the future others will.
We are all here today because we are
involved in safety and health issues. I am
grateful for the opportunity, which my job
gives, to me to meet people like you who
are so vitally involved. As concerned indi-
viduals and members of the medical pro-
fession, we all have a role to play in the
future health and safety of agriculture and
its people.

Thank you very much for your attention. I
would be happy to visit with you after-
ward.0

404

Papers and Proceedings


Su~eon Qensrah Conrhncr an Agriculhm/ Safi~v and Heetth
F& 2000 o A National Coalithm tbr Local Action
Conwned by the Natlond lnrtthito tbr OccupatIonal Safety and HeaM
April 30 - May 3, 1291, Des Moines, Iowa

MULTILINGUAL TRAINING

By Malanie Zavaih, B.S.
Farm Worker Safety Coordinator
University of California-Davis

Although the topic is multilingual training,
my own expertise is Spanish-language
training specific to pesticides. I am going
to limit my comments to those two particu-
lar aspects of this larger question. That is
what I know.

My job at the University of California is to
develop and present pesticide safety train-
ing material to the people who handle
pesticides on the farms and who are not
necessarily certified. They have not passed
any examination or had formal study on
how to handle pesticides. I also provide
training for farmworkers who never handle
the pesticides but work around them.

In California and a lot of other states,
many people who work in the field are
foreign. Certainly, the largest percentage
are Spanish-speaking people, from Mexico
mostly, and also from Cuba, and a number
of other countries, as well as from Puerto
Rico.

These people will require some training in
California if they handle pesticides. In
other states, the training is not required,
but these people need to know a lot about
pesticide safety, because they are working
with or around them.

In California, there are stories every year,
and you have already heard some of them.
Ellen Widess yesterday mentioned the
story of a crew that was directed to go into
a field that had been recently sprayed.

They all got sick because they had gone in
too soon.

There were no re-entry signs up warning
them to stay away, and since they did not
know the symptoms of pesticide poisoning,
they did not know what was happening to
them. Even their crew leader did not
know what was happening. That is not a
good situation.

What I plan to do in this presentation is to
talk about some of the requirements for
developing successful and creative pesti-
cide safety training material and any kind
of safety training material for people from
other language culture groups. Even
though my comments are going to be limit-
ed to Spanish-speaking people, I am pretty
sure this sort of information can be
extrapolated and would fit any culture or
group.

Also, I want to talk about some of the
common errors and problems that come up
when you are trying to develop educational
materials to reach other language groups,
and finally to suggest, perhaps, some ways
to facilitate effective communication.

REQUIRED SKILLS FOR SUCCESSFUL
COMMUNICATION

Let me talk about some of the required
skills for doing a good job of developing
multilingual pesticide or other kind of
informational training material.

Surgeon General's Conference on Agricultural Safety and Health - 1991

405


h First-some of this is going to seem pret-  . Finally, what you need to have for a suc-
ty obvious or simple-minded to you-but   cessful training or information provision to
you would be surprised, however, how    other language groups is a basic under-
often it comes up-the translator, or the   standing of the social characteristics of the
interpreter, the communicator, the person  target group. To put it differently, you
who is either translating the material or    need a cultural awareness. For instance,
who is talking directly to the target group,  suppose you are a graduate student in
needs to have a reasonable understanding
of the subject matter.           Spanish. Your Spanish is great. You can
                   speak very well. That is just fine, if the
                   people you are communicating with are

It is not enough to speak both languages.   people with similar cultural and social-eco-
You need to know the appropriate terms.   nomic backgrounds,
You need to know enough so that when
you are doing your translation, you do not   You would know how to talk to them.
misinterpret something that is written in    You would be able to communicate with
English or that was told you in English, in  them in English too. But that does not
such a way that it means something else   necessarily mean that you are able to
when it is said in Spanish or the other    speak to a typical farmworker.
language. I have seen this happen
frequently. So it is important that person  The register of the language is different.
have that skill, that they must know some-   The kinds of terms that farmworkers are
thing about the subject they are talking   familiar with are going to be different.
about.                  Often you see the mistake of somebody
                   using language that is too technical with

b Second, the person needs not only to be  terms that people do not know, and that
able to speak both languages, but they also  mistake needs to be avoided.
need to be articulate in both languages. It
is one thing to be bilingual or multilingual  In order to successfully teach something,
and another thing to know how to effec-   you need to understand a number of things
tively communicate in the language(s) you  about your audience. You need to under-
speak. Suppose you were raised in a    stand their prior learning and reading
Spanish-speaking home, for instance. You  experience. Frequently Spanish-speaking
grew up speaking Spanish. You learned   people who come to this country to work,
English in school. English is a preferred    and I am sure this is true of other cultural
language for you, which is usually the case  groups as well, have a sixth-grade or less
for kids who grow up in another-language   education.
home. You know how to speak Spanish.

                    Somebody like that is not going to want to
That does not mean you can put together   sit down and read an eight-page leaflet. It
articulate sentences and communicate with  is not something that is going to appeal to
people. It is not the same thing. Interpre-  them. I am not saying that they cannot.
tation and translation require very real and  Certainly, there are people who come here
very significant skills. That is something I   who have had a better education and who
am afraid is often overlooked.         would be comfortable with this means of
                    communication. It is not the kind of thing

406                                   Papers and Proceedings

Intervention - Safe Behaviors Among Adults and Children


that is going to be real appealing to the
majority. That is just a fact.

Another thing you need to keep in mind is
when you are presenting information to
somebody, you have got to consider their
background, opinions, or assumptions re-
garding the subject matter. In the case of
pesticides, it is common in Spanish to refer
to pesticides as rnedicinus, medicines for
the plants.

This means that even though pesticides
have gotten bad press and people are very
nervous about them, for many farm work-
ers pesticides are seen as something good.
They are good, of course. They have a
very important function. But at the same
time, they are dangerous.

It is hard to communicate the idea of som-
ething being dangerous to a group of peo-
ple if they think of it as medicine. You
need to deal with that kind of assumption
first and clarify to people that pesticides
indeed are dangerous. This is again just
one example.

Another thing about pesticide information.
When people get poisoned by pesticides in
the field, it is usually through skin contact.
Normally, most people think of poisoning
as something that happens when you swal-
low a poison. So you need to get past that
idea and get people to understand that
pesticide poisoning can, and indeed does,
occur because of skin contact. These are
just a couple of examples of the sorts of
assumptions that people come into meet-
ings with, or start reading something with.
You have to take that into account and
deal with these assumptions at the very
beginning so that understanding is reached.

Multilingual Training, May 1, 1991

I think we need a knowledge of the kind of
reading and educational materials that the
people are used to seeing.

The University of California just developed
a training booklet to help farmers comply
with the California regulations requiring
that all people who handle pesticides, who
have not passed an examination for cer-
tification, receive training. This training
covers a number of specific points, and is
pesticide-specific.

If you train a worker to use malathion, and
next week he is going to be using
Round-Up, then he must be retrained for
that other material. This pesticide training
must be repeated each year, so that when
a year has gone by, and he is starting to
use Round-Up again, the training must be
repeated for Round-Up. That is a very
good law.

It is important that pesticide handlers
understand about pesticide safety and how
to take care of themselves and protect
other people and the environment when
handling these materials. Unfortunately,
with a labor force like the one in
California where almost everybody in the
field is Spanish-speaking, it is very difficult
to do that training. So this publication is
bilingual. It is in English first and then
Spanish, and then there is a picture.

We are hoping that by using this booklet,
the trainer can go over the material with
the trainee, reading in Spanish what the
trainer is reading in English and then the
picture will act as a pictorial link; we are
optimistic that this will make compliance
with training requirements much easier.

We chose a particular kind of "comic
book" format because it is a very popular
form of literature in Mexico. Hispanic

Surgeon General's Conference on Agricultural Safety and Health - 1991

407


Intervention - Safe Behaviors Among Adults and Children

people-I do not know about Puerto Rican
and other Hispanic groups-but in Mexico,
this particular kind of comic format is very
common.

They have what they call novelas-novels
written in a comic book format. So it is
going to be more appealing than just a lot
of words. Plus, I think the pictures help
bring the point home.

COMMON ERRORS AND PROBLEMS
ENCOUNTERED IN CROSS-CULTURAL
COMMUNICATION

I am going to talk about some of the com-
mon errors and problems made when pro-
viding information to people from other
cultures. I already touched on one:
choosing the wrong level of language. As I
pointed out, a lot of these people come
here without an excellent education, and
this is going to make a difference as to
what they can understand in terms of read-
ing-not so much in terms of spoken lan-
guage, I think, but in terms of things that
they are going to have to read. You want
to choose a language that they are going to
feel comfortable with, and this is going to
take some knowledge of where they are
coming from basically.

I already mentioned that if you give work-
ers a multi-page leaflet to read, they are
unlikely to feel comfortable with it. They
might feel uninspired to read it, whereas
the comic format or something like that
would be more readable.

Then of course the language: you do not
want language that is too technical or too
academic. Again, do not misunderstand
me. This is a question of education, cer-
tainly not intelligence, but education is a
very real thing, and it needs to be taken
into consideration.

408

On the other hand, like most Americans,
the majority of workers listen to news
shows and other TV programs, and they
understand the level of Spanish, of course,
that is being spoken on those shows. That
is why when it comes to spoken presenta-
tions the same problem does not necessari-
ly exist as does with written material. The
audience will not have the same difficulty
listening to something spoken as they
would when it comes to the written word,
and they will be able to understand things
at the same level you would use to address
any other audience.

-L

As I pointed out, a lot of these people
come here without an excellent education,
and this is going to make a difference as
to what they can understand in terms of
reading-not so much in terms of spoken
language, I think, but in terms of things
that they are going to have to read.

Choosing informational formats, which the
audience does not like: I have already
talked about that. Again, I cannot encour-
age too much the use of things like comic
books, or photo novelas.

The photo novela is a very popular form of
literature for many Spanish-speaking peo-
ple. A particular photo novela comes to
us courtesy--except I did not tell him about
it--of Jim Grieshop, who is sitting in the
back. He was working in Ecuador for a
number of years developing informational
material, and he and other people came up
with this particular idea.

This is similar to the comic book idea,
where you have got photos of people act-
ing, and then you have the caption. It is
an appealing form of literature and a com-

Papers and Proceedings


mon one, like the comic book, for at least
Mexican people who come to the United
States to work. This is another way to
communicate, and I will have some other
examples as we go on.

Another problem is choosing a translator
or communicator who is not good. This is
so common. When materials need to be
translated, find somebody who knows how
to do it. Especially in states like Califor-
nia, which has a large Hispanic population,
there tend to be a lot of people around
who speak Spanish. You can find
somebody, perhaps, in your office-the
receptionist who speaks Spanish or a staff
member. Knowing both languages is not
the same as being skilled at translating
from one language to another, and I have
seen some remarkably awful translations
because of that.

You need somebody who is skilled, some-
body who is a professional translator. It is
expensive, but I dare say, it is worth doing
when you have such a large number of
Spanish-speaking or other language-
speaking people working in agriculture in
your state. It is worth the effort and the
cost to get it done right. The trouble is, if
you have somebody who does the transla-
tion for you, you do not speak the languag-
e yourself, and you have no way of kno-
wing how good that translation is. How
are you supposed to know?

That is the other thing. You should get
somebody who edits translations so you
have first a professional translator and
then a professional editor who will read
over translated material.

I have got a great example of a horrible
translation. Here is a little example of sort
of a syntactical error, I guess you would
call it.

Multilingual Training, May 1, 1991

In English, you know, you sometimes hear
"where possible"-that is not very common
but you hear it-"where possible, do such
and such." Literal translation of that par-
ticular phrase does not make much sense
in Spanish.

Let me go over another translation. That
is a really good example. "Slow squeeze at
the turn, crossing obliquely on rough to
polish or muddy surface." I will not say
which state agency or from state it came
because I do not want to embarrass any-
body. But the whole thing this came from
was like that. That was the very worst
example. In the first place, there are
wrong words for some things. Everything
that could be wrong with this thing is
wrong. It is a terrible translation.

Anonymous: What is it supposed to say?
Well, my best guess is, "Drive slowly at
turns... slow down when trying oblique
turns on... rough and slick surfaces."

Not getting translations reviewed and edit-
ed by a second person who is also skilled
in the language and knowledgeable about
the subject matter is an error.

Another problem is typos when doing the
final written version of something that has
been translated into or written in a second
language. The person who types written
material is often someone who does not
speak the second language. Therefore
they will not be able to detect their own
typos, and if they are working from hand-
written or poorly typed text, they are sure
to make mistakes.

There is a perceived problem with "differ-
ences in language." There are some differ-
ences between the kind of Spanish spoken
by Puerto Rican workers on the east coast
and Mexican workers on the west coast,

Surgeon General's Conference on Agricultural Safety and Health - 1991                409


Intervention - Safe Behaviors Among Adults and Children

but those differences are not so great as to
preclude understanding by one group of
materials developed for the other group.
This problem seems to be somewhat exag-
gerated in the minds of many people. In
fact, Spanish-speaking people in the U.S.
all listen to the same TV shows and news
programs.

Overconcern with making materials cultur-
ally appropriate, e.g., the pork rinds vs.
potato chips story.

Planning meetings and not getting people
to come: many times these are not people
in the habit of attending meetings.

Agendas: when you are trying to inform
people, present the facts. Try to avoid
hidden agendas, either in the form of "pro-
tecting" employers at the expense of work-
ers, or suggesting to workers that all the
responsibility for their safety falls on the
employer.

1. Talk about employer responsibilities

where it is relevant to the topic.

2. Talk about the worker's role in taking

care of him- or herself.

SOME SUGGESTIONS FOR
EFFECTIVE FORMS OF
COMMUNICATION

Illustrated guides instead of leaflets and
manuals.

Informational videos, which are shorter
than M hour, preferably about 15 minutes.
Make them appealing; put in a little dra-
ma, some cute children, some humor, if
possible.

Using appropriate forms of com-
munication, i.e., find out what the target

410

audience likes to read and look at. Find
out something about traditional forms of
information transfer for your target group
and develop materials using these formats.
Mexican farmworkers often choose to read
comic-style novelas, photo novelas and
humorous comic books. Calendars with
photographs are popular as wall hangings,
and often more than one will be hung on
walls, especially kitchen walls.

Because illiteracy is not uncommon among
Spanish-speaking farmworkers, some picto-
rial materials, as well as the video format,
should be developed to complement writ-
ten materials. Public service announce-
ments on radio and TV are very effective
in reaching large numbers of people.

Use some organizations as a vehicle for
getting people together if you want to give
an informative presentation, such as:

o Secure employer cooperation to provide

safety during work time.

o Hold migrant housing meetings.

o Offer something attractive to attendees,
other than information (food, music).

o Involve organizations to which they will
respond, such as the church.

Find an effective means to distribute writ-
ten material, such as:

o Through church.

o At health clinics.

o Through employers.

. Through TV and radio announcements.

Papers and Proceedings


Multlllngual Training, May 1, 1991

CONCLUSION

There are large numbers of foreign speak-
ing/reading people working in agriculture
in the United States. They are largely
responsible for our cheap food. Since
there are real dangers associated with
agriculture, we have a responsibility for
giving the kind of information to these
people and their families, which will help
keep them healthy.

Going through the motions of providing
information without focusing on the effec-
tiveness of the material we produce is not
enough. Materials that do not get infor-
mation across to the audience can be
worse than no materials at all. Employers,
public officials, health professionals, etc.
may end up believing that adequate warn-
ings, prevention instructions, health hints,
etc. have been given when that is not the
case.0

Surgeon General's Conference on Agricultural Safety and Health - 1991

411


Sugeon Generel's Conlbnnce on Agricultutal SatWy and Health
FARMSAFE 2000 9 A Nationel Coalition Ibr Local ActIon
Convsned by the National Instituts kr Occupational SaWy and Health
April 30 - May 3, 1997, Des Moines, Iowa

COUNW HEALTH EDUCATION

   By Lany Belmont, M.P.H.
   County Health Education
Director, Idaho Panhandle Health Dlstrlct 1

We cannot expect physicians to locate in
all of our small rural communities. Our
next best alternative is to develop new
solutions or new systems of service to
cover those areas. Our rural citizens and
our rural environment are worth protect-
ing, for this is our heartland.

Idaho has such a system and I would like
to show you how we have been able to
serve our rural citizens quite well through
our local public health system of decentral-
ization with coordinated control.

We will focus on the elderly in Idaho be-
cause they make up the growing popula-
tion in our rural environment.

"Rural" is defined as "those counties that
do not have a city of 20,000 or greater
population." This applies to 37 of our 44
counties.

Our presentation describes how our district
health department system implemented an
urban program in a rural environment.
Idaho's regionalized and decentralized
public health system may serve as an inter-
esting model for other states.

Dr. Roper mentioned that the Institute of
Medicine report, The Future of Public
Health,' states that public health in Ameri-
ca is in "disarray," and as a nation we have
"lost sight of" our "public health goals." In
Idaho we decentralized public health ser-
vices, but we maintain coordinated control

412

among seven district health departments.
We are not in "disarray."

The concept of regionalization and decen-
tralization with coordinated control helped
Idaho to develop district health depart-
ments that provide public health services
throughout the state in a coordinated,
efficient, and effective manner.

Regionalization and decentralization with
coordinated control greatly enhance the
Senior Companion Program of the Pan-
handle Health District. This service pro-
vides many part-time volunteer opportuni-
ties for low to moderate income persons
age 60 and over. The program renders
supportive person-to-person services to
older adults.

There are 44 counties in the state of Ida-
ho. Each county is divided into one of the
seven health districts. The PHD, used in
this discussion, is composed of the five
northern counties bordered on the north
by Canada, the east by Montana, and the
west by Washington (Figure 1). The Pan-
handle is in a unique situation and must be
able to respond to several different influ-
ences from two different states and anoth-
er country.

The health districts were formed in 1970
and began operation in 1971. Before that
time, only half of the 44 counties received
local public health services. Now such
services exist in every county.

Papers and Proceedings


CANADA

Montana

Figure 1. Five Counties of the Panhandle Health
District in Idaho.

Walter J. McNearny and Donald C. Riedel
wrote a book entitled Regiondization and
Rural Health Care several years ago. Their
definition of regionalization remains rele-
vant to current health care and delivery
issues. They state "in its simplest terms
applied to the health field, regionalization
refers to the establishment of working rela-
tions among various health facilities and
programs within a defined geographical
area." The health districts have been do-
ing exactly that over the last 20 years.

Some of you may have been around in the
late 1960's and 1970's and recall the Re-

County Health Education, May 1, 1991

gional Medical Programs associated with
medical schools.

1.









2.









3.

Their function was to develop
regionalized medical care systems in
order to improve heart disease, cancer,
and stroke. The Regional Medical
Programs defined some key elements of
a functional region. A region has a
population and needs that are identifi-
able and quantifiable. This can produce
identifiable performance indicators for
specific problems to be attacked and,
thereby, be easily measured.

There are cooperative arrangements
among components of the medical care
system in that region. This certainly
was true with the health districts of
Idaho. For example, we all have con-
tracts with private physicians who work
in our local clinics.

The region should represent a defined
geographical area.

Again, each of the districts is
geographically defined. There are needs
being met by local effort with help coming
from outside the region.

The PHD, as a regionalized, decentralized
public health department, became a spon-
sor for the Senior Companion Program for
several reasons. It extended our home
care in more rural areas. It increased
coverage where Medicare, Medicaid, and
private insurance end. It extended our
continuum or rural health care. In doing
this, we accomplished several of our pri-
mary objectives:

1. To help people assume a greater re-
sponsibility for their own health care.

Surgeon General's Conference on Agricultural Safety and Health - 1991

413


Intervention - Safe Behaviors Among Adults and Children

2. To help people live independently for
as long as possible.

3. To increase referral capacity with other
groups and create a sharing of services,
as in a Medical Model.

Other services offered by our home health
division are professional nursing services,
physical therapy, occupational therapy,
speech therapy, home health aides, health
maintenance services, and consultation
services. Since its inclusion in the home
health division, the Senior Companion
Program has dovetailed with these other
services to become an integral part of the
entire realm of patient care services.

Our Senior Companion Program in the
PHD fulfills several related functions:

1. To develop volunteer service oppor-
tunities through which low-income older
persons can contribute to their cornmu-
nities.

2. To provide a stipend and other benefits,
which enable eligible persons to partici-
pate as senior companions without cost
to themselves.

3. To establish new social service roles for
low income older persons through which
they can maintain a sense of self-worth,
retain physical health and mental alert-
ness, and enrich their social contacts.

4. To provide supportive services to older
adults in an effort to maintain indepen-
dent living.

These functions need special help when
implemented in a rural environment.
Idaho's system provides the mechanism for
this service. The IOM study' supports the
notion of decentralized services, such as

414

Idaho's model, to facilitate flexibility and
self-governance at the local level. The
IOM recommends:

To promote clear accountability, public
health responsibilities should be delegated
only to a zone unit of government in a
locality @. 8).

Where sparse populations or scarce re-
sources prevail, delegation to regional
single-purpose units, such as multi-county
health districts, may be appropriate (p. 149).

In light of Idaho's success with
regionalized health districts and the IOM's
recommendation, Idaho's district health
department concept may be a viable op-
tion for other states.

There is no single entity in charge of the
seven health districts. We are autonomous
and independent of one another. How-
ever, we work very closely together on
statewide issues.

For example, the District Boards of Health
in all seven health districts meet together
to coordinate policy issues. They have just
met with certain legislators in Boise to
negotiate policies concerning environmen-
tal health programs throughout the entire
state.

The District Directors also meet monthly
to coordinate program implementation and
standardize policies on the operational
level. This process also applies to the
nursing directors and the environmental
directors of all seven health districts.

Each district health department has its
own Board of Health, which is appointed
by the County Commissioners within that
health district. They set local public health
policy. The District Directors are hired by

Papers and Proceedings


that Board of Health, and not other bu-
reaucrats in the capital, making the direc-
tor directly controlled by the local Board
of Health and the local County Commis-
sioners who set the budget. Although our
orientation is very local, we must still coor-
dinate statewide policy throughout the
state for certain programs.

The funding of the health districts comes
from several sources. County ad valorem
tax dollars are matched with state contri-
butions. In addition, the state can give the
health district additional assignments and,
hopefully, funding.

We are free to implement our own fees.
Some are standard throughout the state.
Others vary between health districts. Each
district has contracts with the state Depart-
ment of Health and Welfare and other
agencies. We seek grants and additional
federal funding, if available.

A county's contribution to the health dis-
trict is calculated by a very equitable and
fluid formula. Seventy percent of the
county money is based upon the county
population. The remaining 30 percent is
based upon the county's market value for
taxing purposes. This formula allows a
county to adjust its annual contribution
depending upon economic conditions,
which impact both the population and the
market value of property.

The health districts in Idaho are not state
agencies. They are independent, single-
purpose districts much like a school district
in any other state.

The health districts in Idaho are required
by law to provide physical health services,
environmental health services, health ad-
ministration, and health education. The
PHD has, in addition to those basic func-

County Health Education, May 1, 1991

tions, a super-fund project; a specially fund-
ed aquifer project; a home health division;
the Senior Companion Program, which we
will talk about in more detail; and
Women's, Infant's, and Children's (WIC)
Program.

Urban-designed services, like the Senior
Companion Program, benefit greatly from
Idaho's public health concept of decentral-
ization with coordinated control when
applied to Idaho's rural population.

The Senior Companion Program is
authorized by the Federal government
under Title II, Part C, of the Domestic
Volunteer Service Act of 1973. The
program's dual purpose, as mentioned
before, is to create part-time stipend vol-
unteer community service opportunities for
low-income persons aged 60 and over, and
to provide supportive person-to-person
services to assist elderly adults needing
special assistance to remain living indepen-
dently.

Each Senior Companion Program is par-
tially funded by a grant from ACTION, the
Domestic Volunteer Service Agency. A
requirement of these grants is that a sum
equal to 10 percent of the Federal grant
be raised from local sources to contribute
to the program. ACTION awards these
grants to sponsor a program only to public
agencies and private non-profit organiza-
tions, which have the authority to accept
and the capability to administer such
grants, i.e., Idaho's health districts.

There are currently about 140 Senior Com-
panion projects throughout the United
States, which provide 8,000,OOO hours of
service a year to 25,000 clients. As one of
the original pilot projects in the United
States, our program has expanded from
serving about 80-100 clients to the current

Surgeon General's Conference on Agricultural Safety and Health - 1991               415


Intervention - Safe Behaviors Among Adults and Children

average of 260-270 clients served in any
one month.

Volunteers in the program are assigned to
agencies related to specific community
services. These agencies are called volun-
teer stations and they accept the responsi-
bility for the assignment and supervision of
senior companions. Two basic types of
agencies normally serve as volunteer sta-
tions.

b The first type is social service agencies,
which include public agencies, private
non-profit agencies, multi-purpose cen-
ters, community and civic organizations,
and religious groups.

b The second type of volunteer stations is
direct health care providers. Examples
of these include acute care hospitals,
rehabilitation centers, public health
departments, private non-profit health
agencies, visiting nurse's association,
home-health agencies, mental health
agencies, and nursing homes.

Senior companions are supervised by pro-
fessional staff at the volunteer stations to
which they are assigned. This staff devel-
ops an assignment for the senior compan-
ion, which incorporates a written plan of
care for each client served. This plan of
care is coordinated and monitored by the
same staff, providing for periodic evalua-
tion of the client's continued need for a
senior companion. The professional sup-
port of the PHD staff in each county lends
considerable efficiency and credibility to
the program. The volunteer, the client,
and the PHD benefit from this synergistic
relationship.

Senior companions must, in addition to
being age 60 or older, meet a moderate
income guideline based on the size of the

416

household. Companions can work a maxi-
mum of 20 hours a week for which they
receive a stipend of $2.35 an hour and
$0.20 a mile to travel to and from their
clients' homes. These funds are intended
to reimburse senior companions for ex-
penses of volunteering and may not be
considered as wages or income for tax pur-
poses or any government program.

Recruitment of appropriate volunteers to
serve as senior companions is ac-
complished by several different methods,
which include advertising in newspapers
and other media, and by word-of-mouth
referral from volunteers serving in the
program. An unexpected source of volun-
teers has been patients who have been
senior companion clients and have recov-
ered to the point that they wish to volun-
teer their services to the program.

The total budget for the Senior Compan-
ion Program sponsored by the PHD is
$278,542, of which $211,637 is furnished by
the Federal ACTION grant. The remain-
der is furnished by the PHD and other
local sources.

Sixty-four percent of these funds are spent
directly on stipends and travel expenses of
senior companions. With these funds, we
recruit 80 senior companions who provide
approximately 5,400 hours of service a
month to 260-270 homebound clients.

Fiscal viability is another advantage to the
affiliation of the PHD with the Senior
Companion Program. With a sizable por-
tion of the funding being provided through
the ACTION grant and other local funds,
the PHD's financial involvement can be
kept to a manageable level.

Much of the contribution to the program
by the PHD is in-kind assistance, supervi-

Papers and Proceedings


sion, and advice by the professional nurs-
ing staff. Also, this partnership of the
PHD and Senior Companion Program
allows for all yearly physicals for the senior
companions to be done by the nursing
staff, making it easier to pick up any
health problems that might arise. This
affiliation between the program and the
PHD has enabled the program to be estab-
lished in a more medical model than other
similar programs.

The senior companions are given more
specialized training in medical areas and
are viewed as a new type of para-profes-
sional volunteer. This, coupled with the
maximum interaction with other segments
of the health care and social service com-
munity, allows optimum use of the profes-
sional staff at these other agencies.

A by-product of the Senior Companion
Program PHD medical model is an
outreach function provided by the senior
companions. With specialized training and
assignments in rural areas, they serve as
eyes and ears, often detecting problems
with homebound, unseen elderly that may
otherwise have gone undetected due to
their rural location.

The design of the Senior Companion Pro-
gram, as outlined by ACTION, seems to
make the program more geared to location
in an urban area. It is more difficult to
assign persons age 60 and over to rural
clients with less access to professional staff
for advice and assistance.

A prime consideration in placing senior
companions with clients is to match the
volunteer's specific skills to the needs of
the particular client. This holds par-
ticularly true with clients in the very rural
areas where the companion may have
limited access to resources.

County Health Education, May 1, 1991

In continuing the medical model,
specialized volunteer stations have been
established to provide services to clients
with very specific needs. Two examples
are the Alzheimer's Association and the
discharge unit at Kootenai Medical Center
and Acute Care hospital. These volunteer
stations have clients with very specific
needs that are quite different from our
other clients.

The care provided for clients of the
Alzheimer's Association is respite care for
the primary caregiver, enabling the client
to remain at home with the family as long
as possible. Specific training to the senior
companions working with Alzheimer's
patients is provided by the Alzheimer's
Association with ongoing in-service train-
ing providing updates and support for
these volunteers.

Very different although specific training,
enabling volunteers to work with recently
discharged patients from the hospital, is
provided by professional staff in the social
service and discharge units of the hospital.
Specialized volunteer stations with special-
ized training, coupled with access to pro-
fessional nursing staff at the PHD, allows
services to clients not easily found in rural
areas. This helps many clients stay in their
homes longer.

In closing, we will not get physicians into
all of our small towns of Idaho nor Iowa.
That is not all bad. We have other
solutions, other systems of rural health
care.

The concepts of regionalization and decen-
tralization with coordinated control im-
proved the efficiency and effectiveness of
Idaho's public health services in rural ar-
eas. These concepts provide the founda-
tion for expansion of an urban program,

Surgeon General's Conference on Agricultural Safety and Health - 1991                417


Intervention - Safe Behaviors Among Adults and Children

like the Senior Companion Program, into a  Idaho's system of regionalized and
rural environment. It allows us to move   decentralized public health services with
the Senior Companion Program into a    coordinated control works. I hope other
medical model in order to expand our     rural states can benefit from Idaho's suc-
continuum or rural health care.          cess.0

REFERENCE

1. The Future of Public Health. Institute of Medicine, Washington, D.C.: National Academy Press, 1988.

418

Papers and Proceedings


Surgeon General's Conference on Agricuttural Safeiy and Health
FARMSAFE 2000 8 A National Coalition for Local Action
Convened by the National Institute for Occupational Safety and Health
April 30 - May 3, 1991, Des Moines, lowa

A RURAL SOCIOLOGIST'S PERSPECTIVE

By Judith Bortner Heffeman, MA.
    Columbia, Missourl

Dr. Walter J. Armbruster: Judith Heffernan is Executive Director of the Heartland Network for Town
and Rural Ministries located at the University of Missouri in Columbia. Her topic is A Rural
Sociologist's Perspective.  That is a pretty broad topic, which gives her lots of liberty.
Ms. Heffernan wants to focus our attention toward thinking more broadly. Ms. Heffernan:

I would second the motion that many have
made of how honored each of us feels to
be a part of this, and I know that that is
true whether you are a speaker or a partic-
ipant in other ways. It is wonderful that
such a conference could be held.

My colleagues have been sharing a bit
about their backgrounds. I think it is im-
portant to do that at this point.

I did not come to be a practicing rural
sociologist and a real honest-to-goodness
farm woman quite as I might have
planned. I thought the guy I met about 26
years ago and married 25 years ago was
going to be a professor of rural sociology,
and that our lifestyle was going to be an
academic one. While that is, indeed, part
of our "schizophrenic" existence, the other
part of it is being a practicing rural sociol-
ogist.

We will, in the next few months, if the
contractors put the roof on the house soon,
move from our farm of 21 years to the
only farm the state of Missouri ever identi-
fied as "the Model Farm"-120 years ago.

Just so you know that I do understand this
issue of agricultural health and safety, you
need to know that I plant soy beans and
wheat, and I mow and rake hay, sometimes
under duress.

I have been a midwife to more cows than I
care to count, and a substitute mom this
year to sheep-baby lambs-cutest things
you have ever seen. I have gotten sick
from breathing diesel fumes, whether on a
tractor when we were working on one in a
shed or just standing nearby. I have gotten
sunburned from being too long on the
tractor while mowing, and I have been
pinched and poked and clobbered by more
varieties of machinery parts than I care to
tell you.

I have also been chased by angry livestock.
I have unhappily taken out a fence with a
disk, which was not the original intention.
It could not quite turn short enough.

I have been running the combine and the
stalk chopper when one or another part
has broken, and I have had the experience
all too often of driving the pick-up ahead
on a too-narrow road when behind me
were following my husband or our daugh-
ter on too wide a piece of equipment mov-
ing from one farm to another.

I have had the frightening experience of
seeing my husband climb out of the grain
bin after checking its condition and shortly
thereafter become very ill. (We had com-
pleted the wheat harvest in October of
1981 instead of in July because of an ex-
tremely wet summer and the wheat was in

Surgeon General's Conference on Agricultural Safety and Health - 1991               419


Intervention - Safe Behaviors Among Adults and Children

poor shape.) After climbing out of the
bin, he spiked a high fever and laid down.
I recall being so panicked by his condition
that in my confusion to get help, I called
the University's vet clinic! After calling
the Medical Center and not learning very
much, I called the Department of Plant
Pathology at the University of Missouri
and found out that very likely what he was
experiencing a serious allergic reaction to
mold, to toxins in the molds, that were
undoubtedly in the wheat that year. Even
though I had enough knowledge to know
who to call when I did not get helpful
answers from initial contacts with medical
personnel and enough assertiveness to
keep calling, the experience was still
terrifying, to say the least.

I have worried about my husband teaching
our young daughter, at the age of six, to
drive the Ferguson tractor, and to help
him put in an electric fence.

Just last Friday, I had the frightening expe-
rience that many farmwomen share of real-
izing that he should be home, and he was
not. So you leave a note on the counter,
in case you miss on the highway, and you
take off to the field not knowing whether
the reason he is late is because he is in-
jured. I almost break into tears thinking
about it. Fortunately, it was just that I
misunderstood how late he was going to be
home.

Last Saturday, I had another experience
that very much relates to this conference.
I was about to wash a pair of blue jeans
and a dirty shirt of my husband's, when he
said, "Don and I were spraying Round-Up
yesterday, and these really should not be
washed with everything else."

I asked, "What does the manufacturer sug-
gest that I do with them?" I wish that

420

there were on the containers of chemicals
a little "sticky" that you could peel off and
husbands or wives or whoever is doing it
could attach to their clothing that says:

"Will the laundry person please adhere
to the following instructions: Soak
thirty minutes in hot water and deter-
gent or whatever the correct method is."

Would not this be simpler?

The point I am making here is that I am
as personally acquainted with the issues of
agricultural health and safety as I hope I
ever get.

I am also a rural sociologist by training, as
Walter indicated. Since June of 1989 I
have been working with the Heartland
Network for Town and Rural Ministries, a
effort to bring resources for hope and help
and empowerment of churches and com-
munities in America's Heartland. While
the Network is funded mostly by the Unit-
ed Methodist Church, I work ecumenically
with a variety of faith groups.

The remarks that I am going to make
today come out of this context-not only
out of my personal lifestyle, but also out of
my professional training. It seems to me
that if we are to consider the safe behav-
iors of adults and kids, as all of us have
been in the process of doing, it would be
helpful to look at agricultural production
and processing in a larger context. We
know that there is a social, and an eco-
nomic, and even a psychological-emotional
context that impacts all human behavior.

I think we also ought to acknowledge ini-
tially that rural communities differ. There
are some rural communities that are doing
fine. Economically they are thriving.
Retired people with money are moving
into them; or the government continues to

Papers and Proceedings


fund the university, or the prison or what-
ever there is energy; but farming communi-
ties, and forestry, and rural manufacturing
communities are among those that are
hard-hit.

My three-point thrust is 1) the context of
farming as practiced in the 1980's, and
where it appears we are heading in the
90's and beyond, 2) the context of the rural
community, and 3) the proposed future
context of globalizing agricultural produc-
tion and consumption. All three issues
impact on the kinds of safe behaviors that
we look at with regard to adults and
children.

It is my intent to raise some important
issues and ask some thoughtful questions.
My experience over these past 5 to 10
years working with the rural crisis-
especially in the Midwest but also travel-
ling coast-to-coast, into Canada and into
other countries-looking at what has been
happening has changed my world view.
And so, that is partly what I am sharing,

FARMING IN THE 1980's AND 90's

As the structure of agriculture has changed
over the years from a locally oriented,
locally managed, locally run, local profit-
centered kind of agriculture into initially a
regional and then a national, and now an
internationally oriented and controlled
system, the units with which farmers have
dealt have become much bigger, much
farther away, and much fewer. We are no
longer dealing with the folks down the
road, the local suppliers and dealers know.

Decisions are now being made elsewhere
about nearly everything even about what
size cattle processing plants will accept.
Farmers no longer get to decide how many

A Rural Sociologist's Perspective, May 2, 1991

pounds they are going to put on those
steers before they send them off.

In fact, feeding steers *has become so
specialized that if you live in Missouri, you
have to pay somebody to take them to
Kansas, or maybe Nebraska, pay to have
them specially fed-out and pay the trans-
portation. Decisions like that are no lon-
ger made on the farm. They are made in
some office by a processor who says "this is
all we want and only this will we accept."

Competition in the local market has de-
clined. There may be only one buyer at
your local sales barn, or if there are two,
they may be very friendly, and they decide
that SO@ for cattle is just about "m-ax."
When the price goes higher, they leave.
So much for the so-called low of supply
and demand!

With this change, the profits, I might adc
have moved away as well. Profits that
formerly went to management and capita
are no longer available in the local com-
munity.

For the most part, the profits that go to
labor are the only ones that remain.
Frankly, folks, if we put this in a larger
context, it used to be that some of the
profit went to Minneapolis or went to
Omaha, or went to other major U.S. cor-
porate centers.

In Indiana now, when you sell hogs to the
processing plants, those profits go further
away: to Milano, to Tokyo, to London.
You cannot sell a hog to be processed in
Indiana to an American firm. Ferruzzi
and Mitsubishi in Norther Indiana and
British Petroleum with a firm that they
own in Columbus are the two hog slaying
firms in the state. This is the kind of thing
that is happening.

Surgeon General's Conference on Agricultural Safety and Health - 1991                421


Intervention - Safe Behaviors Among Adults and Children

There is a social movement afoot that
environment, food safety, pesticide usage
and water quality among others. We have
heard much of it here.

Larger organizations have, indeed, protect-
ed themselves by their size, their ability to
control markets, and, to some degree, their
diversity. The stories in some of the farm
magazines about whether red meat will be
able to compete with white meat is laugh-
able to some of us who have been watch-
ing what it happening. It is the same firms
that are controlling markets in both red
and white meat, so where is the competi-
tion? It is mostly with the nutritionists.

Those firms have been able to reduce their
own risk and increase their stability and, I
might add, their predictability. Just for the
record, during what was a devastating time
for production agriculture in the 1980's,
most of those firms were able to maintain
at least 20 percent profit. Should we pro-
ducers be envious? The level of profits of
food processing firms in the 1980's was
exceeded only by pharmaceutical firms!

So what economists have come to call risk,
namely the inability to control things in the
environment, which have a great impact on
you, psychologists and sociologists call
stress.

I recently spent some time in the Food and
Agricultural Policy Research Institute
office looking at a few of their publica-
tions. From their 1991 U.S. Agricultural
Outlook, I will read to you the last line of
the "General Outlook. "Net farm income
is small, relative to farm receipts and ex-
penses. So, relatively small changes in
estimates of receipts or expenses result in

422

very large proportional changes in net farm
income estimates." That, by any definition,
seems to me to spell "risk" and also
"stress."

There are other risk factors at the moment
that may very well alter the way farm
families and rural people look at safety
and health issues. There is a social move-
ment afoot that focuses on the environ-
ment, food safety, pesticide usage and
water quality, among others. We have
heard much of it here. All of these con-
cerns add higher levels of unpredictability
and risk in the agricultural system at the
moment.

I know farmers who find going to the Agri-
cultural Stabilization and Conservation
Service (ASCS) office very stressful. I wish
some of you in the Public Health Service
would set up little health screening clinics
right outside the ASCS office doors to
check blood pressures of farmers. I read
with interest an article in the Farm Journal
by a farmer with a computer who analyzed
three different alternatives for working
with the 1990 Farm Bill. As nearly as I
can tell, it was to choose the alternative in
which you lose the least amount of money.
That, to me, is risk-stress.

The uncertainty and complexity of ever-
changing rules and regulations, such as
those administered by government agencies
have increased uncertainty and risk and
have made it very difficult for farmers to
say, "I think I am going to try a new safety
system on this farm. I think I am going to
invest in whatever it costs," although I did
hear myself saying to my husband last
night, "Honey, we have got to buy roll-over
bars." That is on the agenda. But we,
with other income, can probably do that. I
know people who are borrowing money to

Papers and Proceedings


A Rural Sociologist's Perspective, May 2, 1991

put bread on the table who are financially
unable to buy safety equipment.

Another aspect of the stress issue is what
happens to farm families is when they
experience financial difficulties over time.
Many of you are familiar with our data, so
I am just going to spend a few moments
showing you a little bit in more detail.

Figure 1 shows the reaction to stress of the
families that we interviewed in 1985 at the
suggestion of the Department of
Agriculture. We were actually trying to
figure out a number of things that were
going on, and we went into a very produc-

tive county in north central Missouri and
interviewed every family that had left the
farm for financial reasons from January 1,
1980, through January 1, 1985. Many of
you are very familiar with these data.

Those of you in the health services will
recognize this as a list of common reac-
tions to stress. We simply said to hus-
bands and to wives separately, "Please tell
me in the process of losing your farm did
you become depressed? Do you continue
to be depressed over this issue? Did you
experience all of these other things?"
What you will note here is the astonishing
high levels of women and men who be-
came depressed.

                                 Have       Continue to
                             Experiences     Experience
                              Men Women    Men Women
Became depressed  ..........................  97   100  .....  56    72
Became withdrawn from family/friends ............  62    66  .....  26    41
Became nauseous, lost appetite  ................  49    47  .....  18    34
Could fall asleep at night, but would awaken
and be unable to return to sleep  ...............  77    53  .....  41    38
Experienced feelings of worthlessness  ............  74   69  .....  49    41
Became restless, unable to concentrate, agitated  ....  72   81  .....  41    38
Did anything to keep busy   ....................  67    41  .....  46   31
Increased smoking  ..........................  23    25  .....  16    22
Increased drinking  ..........................  18    12  .....  10    6
Showed increased fear of things, people  ..........  38   31  .....  18   25
Became more physically aggressive   .............  49   31  .....  26    9
Experienced great changes in moods,
from low to high and back ....................  67   81  .....  36    47
Became confused                                        .
                 ...........................  54    31  .....  31    19
Became unable to think or respond logically  .......  31    34  .....  18    19
Become unusually silent for periods of time  ........  62   53  .....  44   28

Figure 1. Reactions to Stress (percent).

Surgeon General's Conference on Agricultural Safety and Health - 1991               423


Intervention - Safe Behaviors Among Adults and Children

It goes on further showing increased fears
of things and people, becoming more phys-
ically aggressive, perhaps a measure of
family abuse. One farmer said, "Does that
mean I spank my children more frequent-
ly?" I said, Well that is one way of def-
ining it. You can also see in these data
high levels of confusion, withdrawal and
remaining unusually quiet for long periods
of time.

   Loss of Farm
     1
Loss of Relationships
   Health Status
    Self-esteem
   Occupation
    Symbols
     1
    Depression
     1
Produces Inability to Function

Figure 2. Effect of the Loss of the Family
Farm.

These data and Figure 2 show that the loss
of the family farm was a much greater
catastrophe for those farm families than
many would like to acknowledge. It was
much more encompassing than loss of a
job. The loss we are dealing with was
huge, and I think that has been elaborated.

A psychologist I know is also a Mennonite
clergyperson put this chart together, and I
think it really does give a fair amount of
insight. The loss of the farm led to loss or
change in every relationship the family
had, not only with themselves, but within
the community as well.

It also led to a loss or change as far as
health was concerned. Health was affect-
ed, and those of you who know the statis-
tics on the relationships between stress and
health would understand this well.

Social status was changed. Self-esteem
was altered considerably. You notice the
numbers of those that said they felt worth-
less. Occupational status was changed.
"My granddad homesteaded this, and I lost
it," someone told me. The symbols were
gone.

That kind of loss almost inevitably depress-
es people if they are normal. I would
sometimes tell the farmers, "if you have
gone through all this and are not
depressed, there is something wrong with
you, and you need to go find out what it
is." In some cases the depression led to an
inability to function.

Last year we took the names of every
freshman that entered the College of Agri-
culture at the University of Missouri to do
a study of the ways the rural crisis had
affected them. (We know that rural kids
study in areas other than agriculture, but
we limited our study to just them.) We
knew that they were likely eight years old
in 1980 when things began to worsen on
farms and in rural communities.

While I have not yet written papers on any
of the data, I have shared it with a few
audiences. I have taken the numbers that
we just saw on stress in our 1985 study,
and because we asked the same questions
of the students that had been part of the
farming operation or a rural business from
1980 to 1990, we show their results, in
Figure 3, with those of husbands and wives
in our earlier study.

424

Papers and Proceedings


By the way, a number of the students were
more interested in the spring break in
Florida than they were in my question-
naire, and so our response rate was about
30 percent.

We questioned them, "Did you become
depressed?" The depression level was
about half as high as their parents, but
understand, we are talking about kids here
who were from eight to 18 during the time
on which we are focused. By the way,
would you look at how many of them said
they became withdrawn and experienced
feelings of worthlessness. Forty percent of
the students who were adolescents when
their folks were losing the farm experi-
enced feelings of worthlessness. As you can
see, this goes on, and we could talk about

A Rural Sociologist's Perspective, May 2, 1991

that in far more detail. I am simply indi-
cating to you what we knew was, in fact,
happening. We now have some data to
support that stress was not something that
just mom and dad experienced, but it was
very much infectious, almost in the correct
use of that term, and certainly did perme-
ate through the family.

A number of my colleagues have pointed
out that that continues. Paul Lasley at
Iowa State and Jack Geller at North Dako-
ta have indicated that the levels of farm
stress have sky-rocketed. In Geller's study,
71 percent of over 1000 farmers indicated
that during the previous three years, which
would have been the mid 1980's,. their
stress levels had increased significantly.

                                     Have Exoerienced
                                        Men Women Youth
Become Depressed  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . 97   100 57
Became withdrawn from family/friends . . . . . . . . . . . . . . . . . . . . . . 62   66    57
Could fall asleep at night, but would awaken
and be unable to return to sleep . . . . . . . . . . . . . . . . . . . . . . . 1 . 77    53    14
Experienced feelings of worthlessness . . . . . . . . . , . . . . . . . . . . . . 74    69    40
Became restless, unable to concentrate, agitated . , . . . . . . . . . . I . 72   81    39
Did anything to keep busy . . . . . . . . . . . . . . . . . . . . . . . . , . . . *. 67    41    26
Increased smoking . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . 23    25    0
Increased Drinking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18    12    14
Showed increased fear of things, people . . . . . . . . . . . . . . . . . . . . 38   31     7
Became more physically aggressive . . . . . . . . . . . . . . . . . . . . . . . 49    31    14
Experienced great changes in moods, from low to high and back . . 67   81    39
Became confused . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54    31    32
Became unable to think or respond logically . . . . . . . . . . . , . . . . . 31    34     7
Became unusually silent for periods of time . . . . . . . . . . . . . . . . . . 62    53    28

Figure 3. Reactions to Stress (percent).

Surgeon General's Conference on Agricultural Safety and Health - 1991

425



Intervention - Safe Behaviors Among Adults and Children

Indeed, this led to some real questions
about health and safety. Geller found out
that one out of every five had had an inju-
ry the previous year. Many of them trea-
ted it at home. Many of them said, "well,
you know, it is too far to go, the medical
facilities are elsewhere, there is no health
insurance." So, for however serious it was
people who should have seen physicians
that did not get that kind of help.

Geller found that there was a significantly
higher proportion of injuries among those
who were most financially stressed. This is
where we begin to make the connection
between stress and behavior, i.e. injury.
Those who had over 40 percent debt-to-
asset ratio, which many of you know is a
real bad thing to have-you are on the
edge, going over-had over 60 percent of
the accidents. That was true across age.

The younger you were, also, the more
likely you were to have accidents, and
when he asked these two questions that
bear directly on our considerations here,
he found very interesting results. He
asked:

Is it necessary, under current economic
conditions, to cut comers on safety to
save money?

Of those who reported they had had an
injury the previous year, 30 per cent of
them said, "Yes, it is necessary to cut cor-
ners." Of those who had had no accident,
only 20 percent said yes.

Then he asked, "Have you found it difficult
to concentrate on farm work this past
year?" Of those who had had an accident,
two-thirds of them said, "Yes, I have found
it difficult to concentrate."

426

We now find people who are concentrating
far less on what they are doing. They have
become much more distracted, much more
thinking about the conversation with the,
for example, banker tomorrow. Often
what sets them off is a small thing.

Many of more I have interviewed have
said to me, "You know, I went out behind
the barn...," "I got a message from my
banker...," or, "The feed dealer called me a
liar," and then they would add, "And I took
the gun and I. . .`I These were the conver-
sations I had after they had said, "I'll walk
you to the car." Then they would say, "I've
never told my wife this, but..." and then I
would get the rest of the story.

We are seeing increased pressures on
many farm families. Leslie Whitener of
USDA on this program knows well the
data that indicate the increased numbers
of people with off-farm jobs. What was
found in another study in North Dakota is
fascinating with regard to the topic of
increased stress from multiple jobs.

People who had identified themselves in
one study as underemployed, were inter-
vieweed to find out how underemployed
they were. What the researchers found
out was the respondents were not at all
underemployed. They were, in fact,
under-compensated. Their incomes did
not cover their expenses, but they were
filled to the brim with jobs, pieces of jobs,
part-time jobs, plus a farm. With both
parents under such stress, the kids were
under pressure also.

A friend of mine refers to this as a recipe
for psychopathology. Another one of my
friends simply says, "It's crazy making."
Their commutes of the respondents were
increasing distances from home with spous-
es often going opposite directions. They

Papers and Proceedings


were tired more often. They were cutting
out a lot of social activity.

You who are medical professionals in this
group know well-much better than I-the
statistics that point out that at least 75
percent of all illnesses are stress-related.
Immune systems seem to get weaker the
higher the stress level.

Depression is known by another name-as
"anger turned inward." Many of these
folks could not figure out whom to be
angry with, "and they turned it all in on
themselves. Should we be surprised at
high farmer suicide rates?"

I think it quite.remarkable that with some-
thing like 650,000 farm families losing their
farms in the 1980's that some people con-
tinue to insist that they were simply bad
managers or speculators. Is it possible that
so many got so stupid simultaneously? It
seems to me that it is not really individual
causation when numbers this extraordinary
exit.

I not long ago spoke to a pastor in a rural
community in which the bank had failed in
about 1982 or 1983. He said to me, "Oh,
you've got to know this, I am presently
visiting nine terminally ill cancer patients
in our community." That community prob-
ably does not have 200 people in it. You
have to wonder about the relationship
between such illness and the severe stress.

THE RURAL COMMUNITY

The second context concerns the issue of
the rural community. All you have to
remember in my next illustration is "70
percent of the population of this country."
I am going to use the same percentage. In
1890, 70 percent was rural; by 1960, 70
percent was considered urban; by 1988, 70

A Rural Sociologist's Perspective, May 2, 1991

percent of the population of the U.S. was
said to live within 100 miles of our coast-
lines the great emptying of America.

As a friend said the other day, "we are in
the process of proving that the
Homestead Act was a huge mistake." Ru-
ral communities are in crisis-that is no
surprise to anyone. Many are declining. I
think it must be rather hard to speak about
the concerns of health and safety issues to
folks who are living in increasingly declin-
ing, dysfunctional, despairing communities.

Poverty has been referred to earlier. Pov-
erty is the cause of lots of things. How
many of you saw the NBC story on tuber-
culosis last night? Did any of you say to
yourself, "Wait a minute, in which century
am I living?" "Increasing amounts of tu-
berculosis in this country related to what?"
the announcer asked.

Poverty, became the answer. Migrant
farmworkers are among those who are very
much involved. And then there is the
cholera epidemic in South America.
Which century is this?

The poverty figures have increased and
many of you know them well. There are
also data available that speak to the in-
creasing disparity in rural communities
between those who have and those who
have not.

One of the agencies in Washington put out
the differences in food stamp usage in
rural communities from 1980 to 1987.
While the Northeast, including New York
State, was showing a decline, some Mid-
west states showed 47 percent, 31 percent,
and 35 percent increases in food stamp us-
age.

Surgeon General's Conference on Agricultural Safety and Health - 1991

427


Intervention - Safe Behaviors Among Adults and Children

I know people I interviewed whose kids
were almost starving who would not on a
bet ask for food stamps. So, we can as-
sume that even with numbers showing
increased use that they are being under
utilized.

There has been, as you well know, institu-
tional decline. When I thought I was
about as depressed as I could possibly be
about what is happening to rural America,
I made the mistake of watching Tom
Brokaw's expose on Sunday night and
discovered that the Mafia-give us a break
out here-the Mafia, which controls the
garbage routes in New York and New
Jersey, have decided to dump it in rural
America, and they have been found to
drive their trucks and dump illegally in
places as far away as Nebraska. Grand-
mothers in the hills of Eastern Kentucky
are sitting and writing license plates and
watching trucks owned by the Mafia. I do
not think they know that this could be dan-
gerous dump waste.

We had reference yesterday to the fact
that Californians are eyeing the water in
the Snake River. The point is, communi-
ties are increasingly in conflict,

Farmers who were encouraged and who
thought it was a wise idea to trade more
acreage for fewer neighbors are finding
that they are not now as much better off as
they thought they might be.

It is thought that fewer medical personnel
are now needed since there are fewer
people out there, yet many cannot afford
to pay for the ones who are there. Many
drive a greater distance to facilities. If you
are very lucky, there are volunteer emer-
gency medical technician who might rescue
you from your farm accident-if you are
lucky.

428

Rural mental health is in a shambles in
many places. Rural mental health workers
whose caseloads mount are inundated. I
talk with pastors who tell me, "Judy, I am
the only one in this huge territory that has
any semblance of mental health training at
all and one little old course in clinical
pastoral education does not constitute
being prepared to do serious psychiatry,
but where can we send them?" What can
we do?

Furthermore, at a time when we need
more highly trained professionals in rural
areas, they are less likely to come and to
stay. Many of them are unwilling to sub-
ject their families to living so far away
from some of the amenities.

Frankly, I am absolutely convinced that
rural economic development will not take
place without medical facilities being in
place. I know of situations in South Dako-
ta, where firm was ready to start up and
discovered their they could not get liability
insurance because the hospital had closed
the previous year. Think of it. You see,
the big pieces are beginning to come to-
gether.

While I applaud the notion of volun-
teerism, I am really opposed to allowing
rural America to have "volunteers" and ur-
ban America to have real physicians and
nurses. I am kind of picky about that, and
I am operating under the notion that
"equitable access to services" is a phrase
that few politicians, if they were smart,
would vote against; and the rest of us in
the community need to rise up and say,
"That's what's needed here."

I am not talking about a doctor in every
community. I am realistic, but, folks, we
cannot have rural health care in communi-
ties without trained personnel.

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A Rural Sociologist's Perspective, May 2, 1991

I with to comment on one other aspect of
the quality of life in rural communities.
There was a meeting fairly recently where
Iowa and Mirmesota Agricultural Leaders
of Tomorrow-the Kellogg Leadership
Program--were in attendance. A leading
agricultural economist from the University
of Minnesota told the group of what he de-
scribed as an efficient farming operation of
the future.

I share this because I want you to wonder
whether this is the kind of community in
which you want to live. The suggestion
was that a truly efficient farmer would, of
course, have a lot of land because he
would have large and expensive equipment
over which to run it. The only way to
make the equipment pay would be to run
it 24 hours a day. All of our agricultural
safety people are about to have an instant
coronary.) That is not clever. It is not
healthy. So, what was he saying?

He stated that you were not supposed to
run it yourself, but you were supposed to
hire people who would run it during the
needed time, and when you had finished
with them, you should fire them, ". . . and
then they can go back on the public wel-
fare system."

I do not accept that definition of efficiency
in agriculture, and I do not think-and
maybe you do not either-that it is possible
to have healthy and wholesome and safe
producers and workers that in such a com-
munity or in communities that are sick, de-
clining and despairing. I think that is a
very important issue.

GLOBALIZING AGRICULTURAL
PRODUCTION AND CONSUMPTION

If YOU have not read Wendell Berry's es-
say, "Does Community Have a Value?" in

his book, Home Economics. I strongly rec-
ommend it to you, especially as we think
about the rural families and communities
in a era in which the globalization of our
food production system seems to be en-
couraged.

Policy makers in our world are bringing
about the globalization of our food system.
I point out to you that there is neither an
invisible .hand nor a mythical or mystical
force that is dictating this; that it is, in fact,
becoming a matter of public policy. It has
been decided at the highest levels that this
will happen.

I raise with you some questions about this
because I think it is important in the con-
text of the issue of which we are speaking.
The consequences of this policy, however
unintended, may not have yet been thor-
oughly discussed. The current operational
definition of this globalization can be
found in the General Agreement on
Trades and Tariffs (GATT), and in the
North American Free Trade Agreement
(NAFTA). The destruction of locally
regionally self-sufficient food systems in
favor of a globalized system is being pre-
sented through these two treaties.

If we are to function globally, do we not
then have to broaden our concern to in-
clude the banana packers in Central
America who breathe chemical fumes all
day in the packing plants; to the families
of migrants whom I have seen living in
the colonias on our border?

If these public policies come into being,
how will they change the context in which
American farmers, rural residents, and
rural communities look at their quality of

Surgeon General's Conference on Agricultural Safety and Health - 1991               429


Intervention - Safe Behaviors Among Adults and Children

life? Will the "harmonization" of
regulations that is in the GATT mean a
reduction in health and safety standards?
Some are asking. I am not sure.

If we are to function globally, do we not
then have to broaden our concern to in-
clude the banana packers in Central Amer-
ica who breathe chemical fumes all day in
the packing plants; to the families of
migrants whom I have seen living in the
colon.& on our border? This latter group
is often U.S. citizens whose water comes
from chemical barrels that are now used
for rain catching. I saw that just a year
ago, so it is still a contemporary situation.

Do we need to include the minority
women and poor white women of North
Carolina and other states who work in
poultry plants ? They go into the plant
company healthy persons and within
months some have developed urinary tract
infections (from being not allowed to use
the bathroom as often as needed), or they
have developed repetitive motion syn-
drome (carpal tunnel) so badly that they
are unable to lift their own children. As
someone has said, "they come in healthy
and they are dumped back on the public
system crippled." Do we have to include
them?

What about the cane workers who are
imported with promises and hopes from
the Caribbean (Jamaica) to work in the
cane fields of south Florida. Many find
recruiting promises go unkept.

Or the campesinos all across Latin
America who work for three dollars a day
or less. Our Missouri Agricultural Leaders
of Tomorrow (Kellogg group) just returned
from a trip to Brazil and Argentina, and
my understanding is that the major thing
they have had to cope with, since getting

430

home, is the despair about the obvious ad-
vantages Latin America has for producing
the things we think of ourselves as so effi-
cient at producing. Some of the outstan-
ding young farmers say, "Hey, I might as
well quit now." They may work through
that, but how can American farmers com-
pete with laborers who will work for three
bucks a day. American farmers tend not
to like to live so little. That is an issue of
agricultural health and safety in every
sense of the term.

We could go on. What about the Japanese
farmers who are raising rice in the high
mountain terraces are not very excited
about our rice producers moving into their
markets? (I raise beef and soybeans and
of course I would love to get them to buy
more farm products from the U.S.) How-
ever, if we force our rice into their mar-
kets, the economically more marginal pro-
ducers in Japan (namely those growing
rice in those mountain terraces) will likely
not be able to raise rice as cheaply as
some of our producers and they will go out
of business.

What will then happen to the terraces that
have conserved both water and soil for
hundreds of years ? Will they give way
leading to soil loss and water quality loss?
Now we are talking about a different issue,
but one that clearly must be part of the
discussion of the health and safety of agri-
cultural producers and communities.

Well, as you can see, if we really decide as
a matter of public policy to globalize the
food system, can you and I then be com-
fortable with only focusing on agricultural
health and safety at the national level?

The front page this week of Feedstuffs
magazine talks about the opening of North
America to "free trade." I am troubled by

Papers and Proceedings


A Rural Sociologist's Perspective, May 2, 1991

the statement here that the Administration
refuses, as the Congress has asked, to look
at labor and environmental concerns in-
volved in such trading arrangements. The
Administration has indicated that these
issues will not be discussed; they will not
allow them to be discussed in the context
of free trade negotiations. I suggest to you
that this should be a cause of alarm for us.

We who are part of the community of
faith, we who contribute millions of mis-

sion dollars to improve the lines of the
poor, the exploited and the despairing of
the world, we believe that we have an
important stake in this enlarging issue of
the health and safety of agricultural pro-
ducers, workers and processors around the
world. We are indeed your allies as all of
us seek to improve the conditions of farm
and rural families and communities here
and abroad.0

Surgeon General's Conference on Agricultural Safety and Health - 1991

437


Surgeon General's Conference on Agricultural SatWy and Health
f%idAFE 2000 8 A National Coalition for Local Action
Convened by the National institute Ibr Occupational Safety and Heatth
April 30 - May 3, 1991, Des Moines, Iowa

YOUNG FARMERS' PERSPECTIVE

Wayne Sprick

Executive Director

National Young Farmer Educational Association

Dr. Walter J. Armbruster: Wayne Sprick is the Executive Director of the National Young Farmer
Educational Association. He will present his perspective from the viewpoint of Young Farmers.
Mr. Sorick:

It is a pleasure for me to come before you
and present the perspective of the National
Young Farmer Educational Association
and the young farmers we represent. This
has been an informative session and con-
ference. I am pleased to be part of it.

Before getting into my comments and
reactions, let me take an opportunity to
provide some background on myself and
the organization I represent.

My background is in agricultural
education. Prior to that, I was born and
raised on a dairy farm in Missouri, Frank-
lin County, the town of Washington. This
is located about 50 miles west of St. Louis
on the Missouri River. I went to school at
the University of Missouri, Columbia,
where I received a degree in agricultural
science, in dairy science. At the time of
my graduation, the job that I was looking
for was not available. I chose to pick up
the courses that were needed to be certi-
fied as an instructor of agricultural educa-
tion.

Upon receiving that certification, I went to
work in 1968 and taught for 19 years in
two school systems in East Central Missou-
ri. During that time I worked with second-
ary students, as well as adults, in agricul-
tural education. This was through the
Young Farmer Program, as well as general
adult education. I also had the opportuni-

432

ty to teach part-time in a nearby communi-
ty college.

During that time, I had the opportunity to
buy a neighboring farm to my home place.
Everybody involved in agricultural educa-
tion has to put to practice what they
preach. So, in addition to teaching, I
owned and operated 120-acre general
farm.

I have been involved with the National
Young Farmer Educational Association
since January 1987, during which time I
relocated my family from East Central
Missouri to Alexandria, Virginia. It was a
culture shock, to move from 120 acre farm
to a half-acre lot. We have adjusted quite
well and the family is enjoying it.

Many of you are familiar with other voca-
tional student organizations. There are
three in agriculture. The Post-secondary
Agricultural Student Organization (PAS),
the National Young Farmer Educational
Association, and the National FFA organi-
zation. In addition to these three in agri-
culture, you are probably familiar with the
Distributive Educational Clubs of America,
the Vocational Industrial Clubs of
America, FHA, HERO. There are ten
that are recognized as vocational student
organizations by the United States Depart-
ment of Education.

Papers and Proceedings


We provide opportunities relating to award
recognition, leadership, and communica-
tion skills development for those students
that are enrolled in agricultural education.
The FFA addresses those needs of the
secondary students. The PAS addresses
the needs of those who are enrolled in the
community junior college system generally
in technical programs. We serve those
needs of adults as they are enrolled in
agricultural education.

2. To develop or to assist in developing re-
sources that otherwise may not be avail-
able.

Eighty percent of our membership is be-
tween the ages of 20 and 40. The term
"young" is a relative term. If you would
come to our Institute in Mobile, Alabama,
in December and survey the group, you
will certainly feel that way. I remember
the very first Institute that I attended. I
walked away from it and said, "Good grief,
these are young farmers?" After doing
some checking and research on it, I real-
ized quickly that few people involved in
production agriculture have the opportuni-
ty and resources of both time and finances
to travel and to leave the farm for an ex-
tended period of time.

One of the programs that I am going to
share with you was sponsored by Navistar
International Transportation Corporation.
One of the ways we were able to get those
resources was that we could provide them
with a program that was national in scope
and related to our goals and objectives.
These are to develop and to assist in de-
veloping leadership and communications
skills, to provide identity and unity to the
group-

It also helped to promote the National
Young Farmer Educational Association as
a vital part of the instructional program in
agricultural education. One of the more
important opportunities, as it relates to our
purpose; is to improve the rural community
as a place to live relating to health services
and rural/urban relations.

Those people who do are the older seg-
ment of the farm population. Those peo-
ple who are required to stay home because
of their tie to the business and the high
requirement for family labor are the youn-
ger people. Also, the secondary reason is
that our Institute is held the end of No-
vember and the first part of December.
This coincides with the deer season in
many states. Life is a matter of priorities.

How is this done? We are a member of
the family of agricultural education. Our
programs are administered and conducted
by, on the local level, that instructor of
agricultural education. Yesterday Bob
Graham, representing the National Voca-
tional Agricultural Teachers' Association,
gave you a perspective on that group.

me purposes of our organization are:

The primary emphasis that you picked up
from that presentation was that they work
with the secondary teacher. That second-
ary agricultural instructor many times is
the advisor to the Young Farmer Associa-
tion.

1. To assist young farmers to remain es-
tablished in farming, ranching and    Agricultural safety has been a priority in
                    all of our lives, mine as well, from an early
agribusiness. This goes beyond
production agriculture. You will note I  age. I am not going to go into any of the

said agribusiness.           things that I did as a child and young adult
                   growing up on a dairy farm because at this

Young Farmers' Perspective, May 2, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991

433


Intervention - Safe Behaviors Among Adults and Children

point it is unimportant. The perspective
that the people in production agriculture,
the farmers, have is that they are risk-tak-
ers. A high level of risk-taking exists in all
things that they do. This relates to safety
as well.

My life was impacted when I was a ninth--
grader. A classmate of mine, Ken Kruse,
was killed as a result of a farming accident.
My life was also impacted when my broth-
er sustained eye damage. He was working
in a construction job between his freshman
and sophomore years in college and sus-
tained permanent eye damage. My life
was also affected when my nephew lost an
eye as the result of an object being thrown
by a lawnmower that his father was using.
And the list goes on. I too have sustained
injury as a result of working in production
agriculture.

The setting in the agricultural shop of the
high school at which I taught was also an
area where safety was important.

As we look at the opportunity for interven-
tion as it relates to the reduction of injury
and death from farm accidents, we need to
reflect on some of the presentations that
were made. We just heard a presentation
on the relationship between knowledge
and education versus faulty habits and
attitudes as it relates to the occurrence of
farm accidents. I said that farmers, as well
as all the rest of us, have the knowledge
and know the difference between right and
wrong.

I have a 13-year-old son who is just start-
ing to leave home and to go on his own to
skiing trips and other activities with organi-
zations, including our church group. When
he leaves on these trips, I tell him, "Jon, I
do not need to tell you what to do and
what not to do. You know what is right

434

and what is wrong. What I need to tell
you is that when you are faced with a situ-
ation, you take the time to stop and think,
`Is this right or is this wrong?' Weigh the
circumstances and make the decision."

I used that same example when I was teac-
hing agriculture. I would take my students
to Columbia, Missouri, for the state judg-
ing contest and the state convention. I
said, "If you do not know the difference
between right and wrong, I have been a
failure." In the case with Jonathan as a
parent, or with my students I have been a
failure as a teacher. What I am asking you
to do is to stop and think and weigh the
risks.

People involved in production agriculture
are risk-takers. We assume risk when we
plant the crop. What are the risks? We
are not guaranteed what the weather con-
ditions are going to be. We are assuming
risk. We are not guaranteed what the
price is going to be. We are assuming risk.
We do the same kinds of things as it re-
lates to safety. That kind of feeling comes
through in all that we do.

At the same time, we in education provide
programs and information that should help
that person in production agriculture shift
those risks. What do we have as it relates
to price protection? The futures markets
can be used as a hedge to shift that risk
from the farmer to someone else. As it
relates to weather, there are crop insur-
ance programs that are available.

What ccut we do as it relates to safety?
How can we help that person in
production agriculture shift that risk or,
better yet, eliminate that risk and be acci-
dent free?

Papers and Proceedings


Young Farmers' Perspective, May 2, 1991

Another important factor is awareness.
We in the National Young Farmer Educa-
tional Association just completed a safety
program called Board, EM II. This is a
program that is conducted in cooperation
with the FFA chapters across the country.
We work closely with the FFA chapters,
which provides for a good situation. The
FFA chapters and those younger people
are looking for opportunities to conduct
community-service types of projects.

They have the means and work diligently
in providing the legwork to get the infor-
mation out. At the same time, those peo-
ple out there in production agriculture, the
young farmers as well as the not-so-young
farmers, benefit from the reduction in
accidents and the reduction losses result-
ing from these programs.

The Volatile Fuel Safety Program involved
several areas. One of them was to reduce
the accidents that result from mishandling
and improper handling of volatile fuels,
primarily gasolines. One of the reasons
that this area was identified and initiated
in the mid 1980's was that people were
keeping tractors longer because of the
economic situation. They were also keep-
ing the tractors in a poorer condition and a
lower level of repair and maintenance.

The other thing is that these tractors were
manufactured in the early 1970's, the
1960's, and the 1950's. We even found
some that were manufactured in the late
1940's. The specifications under which
they were built were for the product that
was being used and manufactured at that
time. Now they are being operated on
gasolines that are manufactured primarily
for our cars of today, with the different
octanes and volatility levels.

Tractors are being used for heavier opera-
tions than they were manufactured for.
This causes a higher level of heat.

L

The FFA chapters and those younger
people are looking for opportunities to
conduct community-service types of pro-
jects.   I

The Board EM Program emphasized three
major areas: instruction, awareness, and
the opportunity to update and check equip-
ment to keep it in proper operating condi-
tion.

The awareness aspect of the program was
addressed through decals placed on fuel
tanks and the storage tanks, as well as the
tractor, itself. This called attention to the
idea that when you work with these fuels,
you, as the farmer, know the difference
between the proper way and improper way
of fueling this tractor. It is up to you to
take the initiative to exercise the proper
practice and to follow through.

This program was sponsored by Navistar
International Transportation Corp. Their
primary interest was to reduce their risk
and exposure relating to these kinds of
injuries. As we were seven months into
the period, incidence and injuries was
reduced considerably.

The Young Farmer Educational Associa-
tion presently is looking at other areas and
thrusts for safety programs, Among other
things, this conference is providing me with
names of resource people that I will be
contacting in the future to help us identify
thrusts and available information and re-
sources.

Surgeon General's Conference on Agricultural Safety and Health - 1991

435


lntetventlon - Safe Behaviors Among Adults and Children

I mentioned that the opportunity and the
purpose that we have in addressing the
awareness aspect of safety is important.
The decals that were placed on the ma-
chines were printed and distributed in
English and Spanish, as well as French for
the Canadian provinces.

I would like to react to some of the things
that have been presented. One of the
purposes for my being represented at this
conference is, What can we as a vocational
student organization bring to the table?
What can we do to help in reducing the
incidence of accidents and death?

I heard the statement made yesterday that
there needs to be a bridge built between
the professionals and the farmers. I see
this as being very important. I mentioned
that farmers are risk-takers. We have
heard, also, that farmers are people who
listen to farmers.

They tend to stay within their own groups
and to rely on their same kind for informa-
tion. This is an opportunity for us. We
need to direct our attention to how behav-
ioral changes can come about and be part
of the solution.

Most effective learning occurs when there
is activity involved. Learning by doing is
one of the lines of the FFA motto. We
need to provide the opportunity for posi-
tive reinforcement. People involved in
production agriculture are students, regard-
less of their age. They need to have the
same opportunities for positive reinfor-
cement as our high-school or elementary
students.

We at this conference are not going to be
made effective simply by what we have
heard. We need to take it with us. We
need to involve the people back at home.

436

Teaching values and behavior to our kids
at a very young age is important. This is
where we develop the habits like to use
the seat belts.

When our first-born, Jonathan, came home
from the hospital in 1978, he was in an
infant seat utilizing the seat belt. Irene
and I decided that this was going to be a
priority. Now Joel, who is our S-year-old,
gets in the car and we drive just a short
distance; he wants to be buckled. These
are the kinds of habits we need to work
with in production agriculture as well.

We have heard throughout this conference
that children are a very at-risk population.
We need to address that risk.

I will be here during the remainder of this
conference. If there is not the opportunity
during one of these sessions to ask ques-
tions, I would be more than glad to visit
with you on an informal basis.

In closing, I would like to point out that
when addressing the opportunity for im-
provement and the reduction of farm acci-
dents, it is important that we know the
people with whom we are dealing. I have
a very serious concern about the low num-
bers of people involved in production agri-
culture attending this conference. I can
understand the reason for it when we con-
sider the date of this conference.

On the positive side, however, we are
having an excellent opportunity to gain the
perspective of the Surgeon General as it
relates to agricultural safety. Now it is up
to us to take this information and to see
that it gets to the place where it can be
effective. Thank you very much.0

Papers and Proceedings


Suqpon Qmwal'8 Conhmnce on Agricultural Satbiy end Heat&
F&W&FE 2000 o A Nat/one/ Coal/t/on hr Local Act/on
Conmad by iho Nattonal lnrtlfm ibr Ckcupedond Sahv end Health
Aprlr 30 - May 3, 1991, 088 Molner, Iowa

FARM FAMILY BEHAVIOR PERSPECTIVE

    By Robert Aherin, Ph.D.
      Unhrerslty of llltnols
Professor, Department of Agricultural Engineering

My presentation will focus on farm family
behavior and the issues surrounding effec-
tive safety and health behavioral change
among adults and children. I will com-
ment on some of the issues that I heard
today and yesterday during this conference
that relate to behavioral change. I will
also review some additional issues for con-
sideration in looking at behavioral change
concepts in dealing with the very complex
safety and health issues that face produc-
tion agriculture in this country.

ten awareness and knowledge of farm
safety among farm populations. Some of
the methodologies discussed included
group presentations; using the media effec-
tively; exhibits; demonstration activities;
and learning through interaction. Further-
more, the importance of networking among
organizations for the purpose of sharing
expertise and resources to address farm
safety and health issues was addressed.

THE 4-H PROGRAM

My research activities have focused on    Before I continue with my primary topic, I
analyzing and predicting various safe work  was asked to describe the 4-H program in
behaviors among farm populations through  this country for the benefit of those who
the application of social behavioral psycho-  may not be familiar with 4-H. As a mem-
logical models. I have conducted studies   ber of the Cooperative Extension Service
involving dairy farmers, pesticide applica-   staff at a land grant university, I work
tors, and child safety behaviors on farms.   closely with 4-H.

There has been a lot of discussion at this
conference concerning the uniqueness of
agriculture as it relates to occupational
injury and illness problems. This has in-
cluded the variety of occupational hazards
that farm workers have to deal with; the
variations of economic status among farm-
ers and farm workers; the diversity of work
activities on farms; the periods of high
physical and emotional stress; the extreme
environmental conditions that farmers
often work under; and their limited access
to emergency care.

The 4-H program is another major mecha-
nism of reaching youth, particularly with
agricultural safety and health information
that some of you may not have traditional-
ly been involved with.

It is part of the Cooperative Extension
System and the United States Department
of Agriculture. 4-H combines the coopera-
tive efforts of youth; volunteer leaders;
state land-grant universities; Federal, state,
and local governments; and the U.S. De-
partment of Agriculture.

Yesterday we had the opportunity to hear,
in this session, a number of very good
presentations on ways and means to heigh-

The mission of the Cooperative Extension
System in conducting 4-H programs is to
assist youth in acquiring knowledge, devel-

Surgeon General's Conference on Agricultural Safety and Health - 1991

437


Intervention - Safe Behaviors Among Adults and Children

oping life skills, and forming attitudes that
will enable them to become self-directing,
productive, and contributing members of
society. 4-H's goal is to create a learning
environment for youth that is stimulating
to the development of life skills in three
areas:

b First, competency and knowledge.

b Second, coping and dealing with stress

in their daily living.

b Finally, being contributing individuals of

society by learning the importance of
helping others.

4-H programs are also internationally in-
volved. In addition to the United States, it
is carried out in 82 other countries in the
world. Our country was and is a model for
4-H programs throughout the world.

In the United States, there are currently
about five million youths involved in 4-H
programs. Only 13.7 percent, or about
700,000 of the five million youths involved
in 4-H, live on farms. Approximately 38
percent of 4-H members live in towns
under 10,000. About 20 percent of 4-H
members live in cities larger than 50,000.

Girls make up about 53 percent of the
members. Sixty-six percent of 4-H mem-
bers are between 9 and 11 years of age; 23
percent are between 12 to 14; and 10 per-
cent of the members are between 15 to 19
years.

The 4-H program is operated primarily
through volunteer leaders. There are staff
located at the county or local level, and
state staff that help facilitate programs
throughout each state.

438

A national staff coordinates programs at
the national level. But, primarily, 4-H
nationwide is made up of over 519,000 4-H
adult leaders and 125,000 junior and team
leaders.

4-H volunteers on the average donate
about 220 hours per year preparing club
meetings and teaching youth. Thus, for
each hour a salaried staff person spends in
4-H, a volunteer spends about 12 hours of
time with 4-H members.

Safety is taught through specific projects
on safety topics and as part of other pro-
jects. Members also have an opportunity
to be involved in community safety activi-
ties. Thus, 4-H is a major organization
that has deep roots in rural areas that can
serve as a significant communication link
on farm safety issues.

USE OF EDUCATIONAL MEANS

Now, to go back to my primary topic. I
think it would be good to look at some of
the issues or statements that have been
made by several of the speakers in the last
couple of days that relate to using various
educational means to change safety behav-
iors. I would like to discuss the need to
evaluate the effectiveness of educational
efforts to influence safe work procedures
and relatively new methodologies by which
this can be accomplished.

For example, on Tuesday, Dr. McGinnis,
when speaking on the topic of disseminat-
ing safety and health information through
educational means, stated that "education
alone is not enough." The physical envi-
ronment must be changed.

Further, he stated that there needs to be a
balance between health promotion and
health protection. We need to know the

Papers and Proceedings


facts. We need to build coalitions to do
this job. "Knowledge and attitude change
may not be sufficient" was another state-
ment that he made.

Dr. Sullivan, Secretary of Health and Hu-
man Services, stated that more extensive
educational programs can be effective in
reducing occupational injuries and illnesses
in agriculture. I would say, yes; but there
are some qualifications, and I will discuss
those here in a minute.

Dr. William Roper, the Director of CDC,
made some statements that we must be
able to measure progress with our inter-
vention programs. We must deliver suc-
cessful programs.

Finally, Dr. Myron Johnsrud, Director of
USDA Cooperative Extension Service,
asked a couple of very good questions. He
asked, "Why are educational warnings
going unheeded?" Additionally, he asked,
"What intervention programs are needed
to be effective?"

I have worked as an agricultural safety
professional for over 17 years involving
positions at the University of Minnesota
and now at the University of Illinois. A
very significant portion of my program
involved developing and implementing
safety education programs for farm work-
ers and farm family members.

Normally the success of these programs
was measured by how many people were
contacted and how many programs were
offered. It was assumed that those
exposed to farm safety information through
Some type of educational program would
become aware of the risk, would learn how
to minimize or avoid the risk, and then
would take action.

Farm Family Behavior Perspective, May 1, 1991

As I grew in my professional career, some
of my concerns were, How do we know if
our safety educational efforts are effective?
Are we really changing the person's behav-
ior with educational programs? How can
we do a better job of that? These con-
cerns inspired me to explore these issues.

Mr. Graham stated that there were four
steps needed to be effective in our pro-
gramming efforts. These include identify
needs, develop objectives, take action, and
evaluate the results. I basically agree with
these four points. The problem is that we
have not been very' good at achieving
them.

Identifying Needs and Evaluating
Results

Let us focus on identifying needs and eval-
uating results. Some of the measures typi-
cally used to accomplish these would in-
clude looking at injury and illness data to
learn where some of the problems are in
order to direct some of our efforts.

Once educational intervention programs
are implemented, we evaluate to see if
there has been any change in the injury or
illness data over time. There are some
significant limitations in using injury data
to evaluate safety intervention programs in
agriculture.

Such data can provide us with a lot of
information on what some of the
contributing factors are to agricultural
injuries and illnesses. But utilizing injury
and illness data for evaluation purposes is
basically a long-term measure.

Normally, it takes five to ten years for
most farm safety issues to see if there has
been any significant impact. This is be-
cause there are so many factors such as

Surgeon General's Conference on Agricultural Safety and Health - 1991               439


Intervention - Safe Behaviors Among Adults and Children

sociological, environmental, and economic
that can influence injury and illness rates.

For a variety of reasons, educational pro-
grams have been the primary intervention
means to reduce injury risk in production
agriculture. This is due to the limitations
that have faced other general intervention
efforts.

Furthermore, injury data is a very poor
measure in small geographical locations.
This is because during the short term there
are very few cases to evaluate. The injury
rate in a given area may drop by 10 or 15
percent from one year to the next just
because of natural fluctuations.

There are significantly fewer laws and
regulations that are directed at the safe
work activities of farm workers compared
to workers of most other industries. Fed-
eral and state regulations have been limit-
ed for a variety of reasons. Some of these
include

o  The lack of a concentrated work
force-farms are generally small opera-
tions in most areas of the country that
employ few people at one location.
This makes it difficult and costly to
effectively enforce safety regulations.

o Unorganized work force-most workers
in agriculture are not organized. Labor
unions in other industries have been a
major factor in the promotion of safe
work places through work contracts and
through support for state and federal
regulations for their members.

o Independent nature of farm opera-
tors-most farmers do not like to be told
what to do. They tend to want only
minimal outside intervention into their
livelihood. Thus, most farm organiza-

440

tions have not favored laws and regula-
tions directed at farming operations.

Probably the most effective means of inju-
ry control is the providing of automatic
protection of workers from agents of inju-
ry. This is basically accomplished through
the design of equipment and processes to
eliminate or reduce the potential for injury
by users. While the manufacturers of farm
equipment, structures, and processes have
made major advancements in safety design
these improvements are rarely passed on
to existing equipment or processes.

Most industries have guidelines and re-
quirements for retrofitting older equipment
to bring it in line with current safety tech-
nology. This is generally not practiced in
agriculture at this time. Farmers often see
little economic incentive to retrofit older
equipment.

Thus, these are some of the basic reasons
why the agricultural industry has tradition-
ally relied so heavily on safety educational
measures to reduce injury exposure. While
in the future it is envisioned that a greater
utilization of other injury control measures
might be used in agriculture, education will
continue to play a major role. It is imper-
ative for this reason that more effective
means to utilize educational intervention
efforts to influence safe behaviors of farm
workers be sought.

Many of the safety and health intervention
programs of the past have been developed
on the basis of what we "think" will work
rather that what we "know" will have the
greatest impact. I believe that there are
new theories and models for evaluating
social behaviors that can be helpful in
delineating the intervention need in agri-
cultural safety and health.

Papers and Proceedings


These models potentially could define
safety and health issues to the point of
providing direction for the development
and use of educational measures. Addi-
tionally, these analyses could identify the
limitations educational measures may have
in effecting positive safety change for some
issues.

Much of safety educational efforts of the
past focused on changing attitudes with the
belief that attitude change would result in
behavioral change. As Dr. Elkind pointed
out in her presentation at this conference,
studies conducted in the late 60's and 70's
found little or no correlation with this
hypothesis.

It has been learned in recent times that
attitude measures do not correspond with
behavioral criterions. The early attitudinal
studies would evaluate a very general be-
havioral statement. An example of this
would be when evaluating the potential
purchase of a roll-over protective structure
(ROPS) on a tractor a subject might be
asked to evaluate a statement such as,
"Roll-over protective structures are ."

Behavioral psychologists have learned that
many of the low correlations of attitude
measures with the actual behavior are
because the statement is directed toward
the object of the behavior rather than the
behavior itself. Thus, if researchers are
interested in predicting behaviors through
an attitudinal measure, the attitudinal
measure must be directed toward that
specific behavior, not the object of that
behavior.

A more appropriate evaluative statement
for predicting ROPS purchasing behavior
would be to ask farmers their attitude
toward buying roll-over protective
structures. The attitude question would

Farm Family Behavior Perspective, May 1, 1991

look as follows: "My buying a roll-over
protective structure in the next two years
for one of my non-ROPS equipped tractors
is . n

The attitudinal question must match the
corresponding behavioral criterion in terms
of 1) action, 2) target, 3) context, and
4) time. In the previous example the ac-
tion was "my buying," the target was
"ROPS for one of my (the subject) non-
ROPS equipped tractors," the context was
"general," and time was "within the next
two years."

In summary, there may be a substantial
difference between people's attitudes to-
ward objects (in this example, ROPS) and
people's attitudes toward behaviors associ-
ated with objects (in this example, buying
ROPS). To predict behavior, this distinc-
tion is crucial.

One of the prominent social psychological
models for behavior prediction and analy-
sis is the Theory of Reasoned Action that
was developed by Fishbein and Ajzen.lz
This theoretical model took the question
of behavioral prediction many steps further
than models previous to it by adding vari-
ous concepts to the analysis of social be-
haviors. Figure 1 illustrates the various
components of the model.

The ultimate goal of this theory is to un-
derstand human behavior, not just predict
it. This theory has proven that intention is
strongly correlated to one's behavior and
behavioral intentions are formed by two
basic determinants, one personal in nature
and the other reflecting social influence.

The theory of reasoned action predicts a
behavior (box number 1 in Figure 1) by
asking individuals whether they intend to

Surgeon General's Conference on Agricultural Safety and Health - 1991                441


Intervention - Safe Behaviors Among Adults and Children

perform a specific behavior (box number
2). This "intention," in turn, is determined
by two components: attitude and subjec-
tive norm (boxes 3 and 4 respectively).

The attitude component, as expected,
analyzes a person's attitude toward the
behavior, while the subjective norm com-
ponent analyzes the amount of pressure a
person feels from significant others to per-
form the behavior. Both of these compo-
nents are predicted by qualitatively dif-
ferent beliefs (boxes 5 and 6 respectively).

Within populations for specific behaviors,
some will be more affected by their atti-
tudes while others will be more affected by
social influences. Furthermore, others will
be equally influenced by both attitudes and
social influences. Through the statistical
analysis of the model one can learn what
portions of the population are affected by
the various determinants of the behavior
being evaluated.

By comparing the beliefs of intenders to
non-intenders, the researcher can see what  I have tested this model in a study con-
beliefs need to be changed in order to    ducted among a population of Wisconsin

change the behavior of the unsafe farmers.  dairy farmers and Illinois pesticide applica-
                   tors. The nredictive ability of the model

An advantage of this model is that it pro-
vides very specific recommendations on

showed poktive results in both of these
studies. However, this theory needs to be
further tested on farm populations.

how to change specific behaviors, based on
the farmers involved with those behaviors.

I ntent ion

to perform --LC Behavior

behavior

1

                                 2
    6              4
Normat i ve    1   Subjective '
bel iefs and           norm
mot ivat ion --)- cancer n i ng
to corrply        behav i or

Figure 1: The Theory of Reasoned Action.

442

Papers and Proceedings


I believe the Theory of Reasoned Action
and other behavioral models that have
been developed from it can be significant
tools in identifying the attitudinal and
social beliefs that, need to be modified in
order to change behavior. This level of
analysis can provide strong insights into
whether the behavior being evaluated can
be significantly affected by educational
interventions or if other types of interven-
tions will be necessary, such as economic
incentives or design changes in equipment
or processes.

An example of an issue that might benefit
from Theory of Reasoned Action type of
analysis would be the installing of ROPS
on tractors. Tractor roll-overs are a major
factor in farm work- related deaths.

It is well known that if a tractor has a
ROPS it almost eliminates the death po-
tential in a tractor roll-over incident. But
only about 30 percent of the farm tractors
in the United States have a ROPS. Thus,
at issue is what it would take to persuade
farm tractor owners to install a ROPS on
non-ROPS tractors.

There have been significant educational
programs to promote the purchase of
ROPS among farm tractor owners. But
there has been no significant increase in
the retrofitting of ROPS on non-ROPS
equipped tractors.

If an analysis was conducted among US
farm tractor operators utilizing the Theory
of Reasoned Action, one could learn what
intervention initiatives would be necessary
to effect a significant change in this behav-
ior.

For example, it could be learned how
much if anything farmers would be willing
to spend for a ROPS, their general percep-

Farm Family Behavior Perspective, May 1, 1991

tion of the need for ROPS on their trac-
tors, tractor use problems that they may
encounter with ROPS, and so on. This
type of information would provide focus
for initiatives to deal with this issue rather
than using the traditional "shotgun" ap-
proach of trying anything and seeing if it
works.

Additionally, an analysis of this nature can
be conducted once intervention has oc-
curred to determine if any behavioral
change has developed. Thus, it has poten-
tial to serve as an excellent evaluation
measure.

In conclusion, given the current restraints
that safety and health professionals in
agriculture must work under it is impera-
tive that we identify and utilize interven-
tion measures that are capable of self-
motivating farmers and farm workers to
adopt safe work practices. We must strive
to improve our ability to accomplish this.

There has been practically no systematic
evaluation of the effectiveness of agricul-
tural safety and health education, legisla-
tion, or engineering intervention efforts to
prevent or control agricultural injuries in
this country. It is essential that agricultur-
al safety and health professionals from all
disciplines undertake scientific evaluations
of their efforts to effectively reduce the
risk of agricultural injuries and illnesses for
the farm populations that they serve.

As previously stated, several practical and
cultural considerations suggest education-
oriented intervention approaches will con-
tinue to be an important option for the
prevention and control of agricultural
injuries and illnesses. But I am very con-
cerned by the thousands of dollars and
hours that are spent on agricultural safety
educational programs without seriously

Surgeon General's Conference on Agricultural Safety and Health - 1991               443


lntetventlon - Safe Behavlors Among Adults and Children

evaluating the potential effect that such
efforts will have on the issues being ad-
dressed.

The recently developed theories of social
psychological behavioral analysis and pre-
diction show promise for providing re-
searchers and educators with a more com-
prehensive understanding of safety and
~tJtlt;related behaviors among farm popu-
      .

Agricultural safety and health professionals
need to become more familiar with recent

concepts of applied behavioral analysis. A
limited number of research programs
should be supported that apply social psy-
chological behavioral analysis to selected
agricultural safety and health issues of
national importance. One of the primary
purposes of these studies would be to
further validate the utilization of these
types of analysis for addressing agricultural
safety issues.

Agricultural safety and health issues are
some of the most complex of any industry.
We must continue to strive to identify
means that are effective in addressing
these issues so as to preserve the valuable
human resources who are involved in pro-
duction agricu1ture.U

REFERENCES

1. Ajzen, I, Fishbein, M. (1990). Understanding Attitudes and Predicting Social Behavior. Englewood Cliffs,
New Jersey: Prentice-Hall.

2. Fishbein, M., Ajzen, I. (1975). Belief; Attihtdes, Intention, and Behavior. Massachusetts: Addison-
Wesley.

444

Papers and Proceedings


Sumeon Qmwal's Conhwnce on AgricuHurel SaMy and Health
FARMSAE 2000 o A Nathmal Coalnlon kr Local Action
Conwmd by the National lnsdtuh for Occupational SaMy and Heatih
April 30 - May 3, 1991, De8 Moines, Iowa

SURVEILLANCE - AGRICULTURE-RELATED
DISEASES, INJURIES, AND HAZARDS

    By Henry A. Andmon, M.D.
Chlef, Section of Environmental Epidemiology
Wlsconsln Department of Health and Social Services

Dr. Richard A. Lemen: Our first speaker will sum up the sesslon on Surveillance
Related Diseases, Injuries, and Hazards.                  -Agriculture-
                   Our speaker, Dr. Henry Anderson, is the Chief of the

Section of Environmental Epidemiology with the Division of Health In Madison, Wisconsin.
Dr. Anderson has a medical degree from the Unlverslty of Wisconsin and received his bachelor's
degree from Stanford University. Dr. Anderson:

Over the past several days, we have experi-
enced some stimulating discussions and
presentations. What stands out are the
vivid images that have been evoked.

We are all now familiar with the theme of
the movie Field of Dreams; we have heard
all about "belltollers." We can clearly say
that this conference, among all conferenc-
es, has definitely overcome the "vision
thing."

THE TIME HAS COME FOR ACTION

Our session was to address surveillance of
agriculture-related diseases, injuries, and
hazards. I think we confirmed that the
time has come for action; that there is a
crisis of disease, injury, death, and disabili-
ty on farms and in farm families.

We need to move away from the broad
view to some specific, high-priority activi-
ties.

Our challenge is, "Why can't we prevent
these events from happening in the first
place? Why haven't we, and why can't
we?" What is critical to accomplishing the

goals is that a coalition is forming, and it is
forming around the common interest of
concern and support for the prevention of
agricultural injury and disease.

SURVEILLANCE IS ESSENTIAL TO
PREVENTION

As you might expect from our group, we
feel surveillance is essential to prevention.
We discussed that the role of surveillance
and prevention has four main goals.

b The first is the ability to recognize and
identify problems. We have certainly done
that through existing programs. We have
heard this week about the many problems
that do exist.

. The second activity of surveillance and
prevention is defining the scope of the
problem. In many instances, we are in the
process of trying to do that, but we also
need the second step to continue that.

b The third is to target interventions.
Right now we are in the process, for many
diseases and injuries, of trying to target
where we can get the most bang for our
buck.

Surgeon General's Conference on Agricultural Safety and Health - 1991

445


Elements of a National Agenda

b The fourth role is in evaluating the effi-
cacy of interventions.

For many conditions we are at different
surveillance stages in this scheme. For one
condition that we have heard much about,
that of farm fatalities due to tractor roll-
over, we have identified the problem, we
largely know the scope of the problem, and
we know what needs to be done to target
interventions.

We also have heard this week that we have
not been very successful. Surveillance in-
formation is continually telling us that our
programs are not as effective as we would
like and that we need to bring our coali-
tion together to control these problems.

We discussed a number of issues: hearing
loss, skin cancer, acute pesticide poisoning,
and respiratory illness. All of these are
problems that need to be addressed, and
surveillance can assist us.

TASKS CAN BE ACCOMPLISHED BY A
COALITION

We also discussed defining the coalition.
We all have a fuzzy, warm feeling about a
coalition, but we really need to begin to
define what it is and who it is. We need
to involve government at all levels-that is,
the Federal government, state govern-
ments, local governments, and county
governments.

There is a critical need to have industry
involved. They are key actors and players
to help us intervene.

Communities also need to be involved.
Both the academic community and the
community of the voluntary organizations
that represent individuals need to be in-
volved.

We also heard of a need for grass roots
effort. We need to have individuals in-
volved. The individual farm family must
be committed to this activity and partici-
pate.

The coalition needs to identify a set of
conditions and hazards for surveillance.
We need to move away from the broad
view to some specific, high-priority activi-
ties.

THE NEED FOR PRIORITIES

Our session participants determined that
an initial task of the coalition must be to
establish surveillance priorities and to
provide support to build the infrastructure
necessary to carry out the surveillance
programs.

b Therefore, first we are proposing that
within 60 days the Surgeon General make
every effort to identify resources for a
workshop of coalition members and that
agricultural disease and injury experts
come together to identify conditions for
surveillance.

p Second, after that group has come to-
gether to identify candidate conditions,
that within 180 days the Surgeon General
make every effort to identify resources for
a workshop, which will take up the candi-
date conditions involving all levels of the
coalition. We have, over the past several
days, identified and spoken of a number of
candidate conditions in our group, includ-
ing farm fatalities and the more serious
injuries.

Of course, we talked about roll-overs, but
also we have to be concerned about ampu-
tations and loss of eyes. Skin cancer, re-
petitive trauma, hearing loss, and especial-

446                                    Papers and Proceedings


Surveillance - Agriculture-Related Diseases, Injuries, and Hazards, May 3, 1991

ly respiratory conditions, also, must be
considered as candidates.

CANDIDATE SURVEILLANCE
PROGRAMS

We also discussed various types of surveil-
lance programs. Once these candidate
conditions are identified, we must begin to
move forward for the establishment of
surveillance. A situation such as the need
for continued coding of death certificates
for industry and occupation, as well as that
portion of the death certificate that indi-
cates whether the fatality is work-related
or not, is one candidate surveillance system
that could be easily implemented.

We also need to begin additional surveil-
lance at the local level by health and safety
practitioners. Another example would be
in-depth case investigations of individual
fatalities or individual diseases by health
and safety experts.

Lastly, and parallel with this activity, we
recommend that the Surgeon General and
the coalition, together, need to move for-
ward to identify resources for the further
development and support of the infrastruc-
ture that is necessary to carry out this
mandate.

In conclusion, our group did feel that we
have a vision, but we do not feel that it is
visionary but rather that it is practical.
Prevention can be accomplished, if we are
all committed to achieving the goals. We
feel that this conference is the first step in
getting a coalition formed and allowing us
to begin to make that commitment to
move beyond all of the activity that is
currently ongoing and to make additional
strides for the prevention of disease and
injury.0

Surgeon General's Conference on Agricultural Safety and Health - 1991

447


Steve Olenchock, the rapporteur in our
group, and I worked for several hours last
night to summarize the kinds of messages
that came through over the past two days
in our group. We felt we could best sum-
marize those ideas in about three different
topics.

. Number one, there was a special spirit
that transcended throughout the session
that can best be described by a combina-
tion of urgency, enthusiasm, and commit-
ment.

b What I want to talk about second is spe-
cific facts that were mentioned in regard to
particular agents of disease and the gaps in
the knowledge that were identified.

b The third topic I want to discuss is the
need for a coalition to address the issues.

This was a group that was quite large. We
usually had over a hundred people in the
rqom, very interactive, and I think it was a
very exciting group to be with.

GROUP SPIRIT

Regarding the spirit of this group, I would
like to try to demonstrate this through a
model diagram of a nerve synapse. The
spirit that we felt contained enthusiasm,
commitment, and goal direction.

448

Surgeon General's Conkmnce on A@cultural Safety and Health
FARMSAFE 2000 o A National Coalition for Local Action
Convened by the National Institute kv Occupational Safety and Health
April 30 - May 3, 1991, Des Moines, towa

RESEARCH - CHEMICAL AND BIOLOGICAL HAZARDS

        By Kelley J. Donharn, D.EM.
Professor, Department of Preventive Medicine and Environmental Health
           University of Iowa

Dr. Richard A. Lemen: Our next speaker this morning will be talking about the findings and the
recommendations of the sessions on Research - Chemical and Biological Hazards. To do that
is Dr. Kelley J. Donham, who is a veterinarian who received his degree from Iowa State University
and his undergraduate and master's degree training from the University of Iowa. Dr. Donham:

The spirit really was something that was
sparked or initiated back in 1988 when
there was a conference here in Iowa, enti-
tled "Agricultural Occupational and Envi-
ronmental Health: Policy Strategies for
the Future." This conference resulted in A
Report to the Nation, which indicated that
there was an urgency, a feeling of urgency,
about this whole issue.

I believe since 1988 that urgency has tran-
scended into even a greater and broader
enthusiasm and commitment demonstrated
here at this conference. Clearly, the neu-
rotransmitter substance here was Dr.
Novello's enthusiastic communication to us
of her commitment to this public health
problem of agricultural safety and health.

However, in the background there is the
question about the reality of this commit-
ment in the years to come. The momen-
tum, will it continue? The fact is that the
changes, the actual reduction in injuries
                                    _ -

and illnesses that we hope to see, will take
time and will take long-term commitment.

One of the items that came out of the
group was a call for a sustainable human
resource in agriculture. This was based on
an analogy to the sustainable agriculture
movement from a natural resources con-
servation perspective.

Papers and Proceedings


Perhaps one of the aspects that has not
been thought of or put into the equation of  and a complex such as a combination of
sustainable agriculture is that we must    chronic bronchitis combined with hyper-re-

have a sustainable human resource. We   active airways disease. To sort those out,

need a sustainable human resource that is  the clinician at the community level needs
as free as possible of illnesses and injuries  help in regards to training and newer and
from an economic standpoint as well as a  more specific diagnostic tools.
humanistic standpoint.          Treatment: It is not entirely certain from

FACTS                the physician's standpoint as to what is the
                 best treatment for these agricultural respi-

Dust-Related Diseases

ratory ailments. We know that protection,
perhaps, is the best answer; but when a

Moving now from the spirit of this group
to facts, Suzanna Von Essen reviewed

clinician is faced with these problems in
his or her office, what is the best treat-
ment?

some of the major respiratory diseases
resulting from exposure to agricultural
dust: bronchitis (both acute and chronic);
occupational asthma; organic dust toxic     Fifty percent of the pesticides that are in
syndrome; mucous membrane irritation;    use show some potential for car-
hypersensitivity pneumonitis; and classical    cinogenicity.
allergies (rhinitis and asthma). These are     I
placed subjectively in order of importance,
as I interpreted from the discussion and    Children: There are auestions about chil-
from the presentation. I also noted some  dren who are exposedAt these environ-
gaps in knowledge brought out in the dis-   ments at an early age. What are the issues
cussions.                and problems involved? Are they more
                        prone to allergies ? Are they susceptible to
There were questions about the sequelae   inflammatory agents and long-term sequel-
of repeated acute exposures or acute epi-   ae? It is not known.
sodes of organic dust toxic syndrome, acute
bronchitis, or hypersensitivity pneumonitis.  Pesticides and Fumigants
What are the long-term and outcome se-
quelae? They are unknown. This is where  Aaron Blair had the topic of pesticides and
additional research is needed.       fumigants, and he outlined his presenta-
                   tions emphasizing chronic outcomes in four

There was considerable discussion in re-   areas: cancer, immunologic, neurotoxic,
gards to agents of agricultural respiratory   and reproductive. He concentrated pri-
disease. The exact agents are unknown, as  marily on the potential relationships of
are the specific mediators that result in the  pesticides to cancer, because that is where
biological conditions that are seen.       most of the research has been done.

The difficulty of differential diagnosis was  Fifty percent of the pesticides that are in
mentioned several times. It is not easy to  use show some potential for car-
differentiate between organic dust toxic   cinogenicity, based on a variety of different
syndrome and hypersensitivity pneumonitis  kinds of bioassays, and they seem to span

Surgeon General's Conference on Agricultural Safety and Health - 1991               449

Research - Chemical and Biological Hazards, May 3, 1991


Elements of a National Agenda

the classes of pesticides that are used,
including insecticides and herbicides. Even
though farmers have lower overall risks for
cancers, there are certain cancers that they
have increased risk for, including
reticuloendothelial cancers, multiple my-
eloma, lip, prostate, and soft tissue sarco-
ma among others. Perhaps, in terms of the
evidence relating pesticides to cancers,
non-Hodgkin's lymphoma seems to have
the strongest relationship.

Immunologic Concerns: Perhaps one of
the most interesting facts that was brought
up was that non-farm populations of imm-
unosuppressed individuals seem to have
similar patterns of cancer as farmers.
There are a host of neurotoxic problems
that are at least, I guess, beginning to be
associated with pesticide exposure, but
they are not really well-known at this
point. Then, certainly, there are certain
pesticides that have some effects on both
male and female reproductive outcomes.

Perhaps one of the major gaps that was
noted was the need for a well-controlled,
long-term prospective study; perhaps this is
one of the major ways to try to find out
some of these associations.

Infectious Diseases

Dr. Russell Currier had the assignment of
discussing infectious diseases. He dis-
cussed these in four different categories:
interpersonal, food-borne, vector-borne,
and other zoonoses.

In terms of interpersonal infections, he
noted that there are certain diseases that
have been rare in the past, but are very
prevalent in certain farm populations.
Tuberculosis, for example, is 300 times
more prevalent in the migrant farm popu-
lation than in the white population.

450

Polio and rubella have been noted in the
Amish population. Enteric diseases, gener-
ally speaking, are more prevalent in the
migrant and economically deprived groups.
There is a problem with a combination of
socioeconomic status and cultural situa-
tions that clearly influences the disease
pattern within this population.

There are occasional outbreaks of a whole
host of food-borne diseases within farm
family populations, because of their partic-
ular food preparation methods and use of
food from the farm. Examples include
Campylobacter, Listeria,, Salmonella, and
trichina.

Perhaps one of the most interesting facts
that was brought up was that non-farm
populations of immunosuppressed individ-
uals seem to have similar patterns of
cancer as farmers.

Vector-borne diseases still crop up as occa-
sional problems, ea plague, Rocky Moun-
tain spotted fever, equine encephalitis,
California encephalitis, and even malaria
in certain areas.

Zoonoses, in particular tetanus, were not-
ed. We still do have tetanus, and the fact
is that the immunization status of our
population is not as complete as we would
hope it to be.

Bovine tuberculosis has shown up again
from other species besides cattle. Llamas
and buffalo are species that can harbor the
infection and reintroduce it to the cattle
population, which may in turn expose the
farm population. Then, finally, rabies is
still a problem and will be a problem for
many years to come.

Papers and Proceedings



Gaps in Knowledge of Infectious Disease:
Particularly a lack of information about   such as completely enclosed systems of
infectious diseases in immunosuppressed   pesticide handling, whereas performance
                     standards, would stress methods such as
populations and effects on women of cer-
tain infectious diseases was noted as a    daily monitoring of pesticides.
significant knowledge gap. Needlesticks,
associated with the incidental use of inject-  The lack of industrial hygiene services, the

able antibiotics and veterinary biologicals,  variation in the climates, the work practice,

have been noted as a problem.       seasonality, are all not typical of industrial
                   settings. Therefore, emphasizing practice
                   standards only makes sense.

Gases, Vapors, and Liquids

William Popendorf had the topic of gases,  Gaps in knowledge here include the prob-

vapors, and liquids. He approached it    lem of additive and multiple exposures.

from a rather generic standpoint. He    We do have a situation in agriculture that
discussed a new paradigm for industrial   is, again, different from industry-always a
hygiene in agriculture. He argued that we  variety of different exposures in any one
                    given case.

really have a special type of industrial
hygiene, and that is agricultural hygiene.

There are additive and synergistic health
effects that are unknown. There is a need

What is agricultural hygiene? The old
paradigm for industrial hygiene was recog-  for more agricultural hygienists. There are

nition, evaluation and control. But in    precious few in this country that have the
agriculture here we do not have the typical  particular training and understanding of
industrial setting. We cannot do monitor-  the agricultural processes and of the
                        socioeconomic and cultural differences
ing on a daily basis. So we have to rely on
anticipating the problems that may be    between the industry and agriculture ap-
occurring so that we can target the recog-  proaches, which include cultural implica-
                        tions as well.
nition and evaluation. The key part of this
paradigm is anticipation.            NEED FOR A COALITION

The usual paradigm of control is source,
pathway, and person. Here we have to   Finally, I would like to try to put together

concentrate on the source.         the spirit I mentioned earlier and a para-
                   digm of what a national coalition for local

It is difficult, often impossible, to control   action might be. These thoughts came
the pathway. It is impossible to ventilate a  through in our group in various ways.
strawberry field. It is difficult to put a
respirator and a rubber suit on somebody  If you can, envision in Figure 1 at the
who is working in 1lO"F heat in an or-    center of the circle the farm family and

chard.                   farmworker who are the target. They are
                 surrounded by a community, which in-

The third part of the paradigm is empha-   cludes a variety of different services and
sizing practice standards rather than per-   groups: local extensions, farm groups, the
formance standards in agriculture. Prac-   health care system, the public health de-
tice standards emphasize good practice,   partments, media, and schools.


Surgeon General's Conference on Agricultural Safety and Health - 1991               451

Research - Chemical and Biological Hazards, May 3, 1991


Elements of a Natlonal Agenda

o Communication
o Community
o Surveilence

Medical I Health

Health Departments

Extension        Land Grant

        - -I Universities

Figure 1. A National Coalition for Local Action.

Surrounding that, yet, are the national
resources that we have, including NIOSH,
other Federal agencies, medical and health
universities, land-grant universities, nation-
al extension service, agribusiness, and
foundations. There has to be com-
munication within that outer circle and
between that outer circle, to coordinate
the services that are available.

Also communication is needed directly to
that farm family and farmworker so that
we are working on the problems that are
of concern to them and are real for them
and of importance for them. We must also
utilize the community in which they live
and work to help them solve their own

452

problems.

That whole communication system has to
work. Included in that is the surveillance
and evaluation of the programs that are in
place to make sure. that whatever programs
that are in place are modified according to
the results of that surveillance and
evaluation system.

That is the paradigm that I think can result
in a true "National Coalition for Local
Action." Hopefully with the spirit of this
conference, we can be striving for that. I
think this conference has gone a long way
in helping to realize that end.0

Papers and Proceedings


Su@xm General's Confersme on AgricuttumI Sahiy and Heatth
FAFIMSAFE 2000 o A National Coalition fix Local Action
Conimmd by the National lnstituie br Occupational Salty and Health
ApR 30 - May 3, 1991, Des Moines, Iowa

RESEARCH - MECHANICAL AND PHYSICAL HmRDS

    By Lorann Stallones, M.P.H., Ph.D.
Associate Professor, Department of Environmental Health
       Colorado State University

I                                                                           1

Dr. Richard A. Lemen: Our next speaker will summarize the sessions on Research  - Mechanical
and Physical Hazards.  To do that is Dr. Lorann Stallones, who received her bachelor's degree
from the University of California in Santa Barbara, and her MPH and her Ph.D. from the University of
Texas, School of Public Health, in Houston. Dr. Stallones:

Well, that introduction does not give you a
very good idea about why I am up here
presenting physical and mechanical hazards
when ordinarily these are in the realm of
an engineer or an agriculture safety spe-
cialist. I would like to acknowledge those
people who made a contribution to my
being here. One of them is on the plat-
form with me, Dr. David Pratt; one of
them, I am sure, is in the audience, Dr.
John May. After I finished my Ph.D. in
Houston, I went up to Cooperstown, New
York, where I worked at the Mary
Imogene Bassett Hospital with the two of
them.

There are two things that you have to
know about David. One of the first things
that anybody ever told me about him was
that he could sell ice to Eskimos. I think
in this case, I was the Eskimo. The ice
was that we were in a farming community
and really needed to look at what the
problems were in that particular communi-
ty. As public health professionals, I think
that really is our obligation--one that we
have been remiss in fulfilling the
agricultural safety and health area.

The second thing you have to know about
David is that someone-the same person, of
course-told me that if you sat David down
in the middle of a desert he would start to
count sand. So, there he was in the center

of an agricultural community, and he start-
ed counting. What we wanted to do, be-
cause David is a pulmonary physician, is
look at pulmonary disease among the far-
mers-f course a major problem.

So we put together a very detailed survey,
and we asked a lot of questions about
pulmonary disease. The last day before
this questionnaire went into print David
said, "I've heard that farmers have a lot of
injuries. Don't you think, perhaps, we
should ask that question?" So we did.

When the questionnaires came back, about
10 percent of the farmers had had a work--
related injury in the past 12 months. We
thought that was extremely high and that
gave rise to ongoing surveillance where we
called this same group of farmers every
other month. Much of the data have been
reported in national meetings, and I think
it was an extremely important step in our
development.

From there I went to the University of
Kentucky where I met the other side of
this whole business. He was Larry Piercy,
who is an agricultural safety specialist who
has his master's degree from the University
of Iowa, and who trained at the Institute of
Agricultural Medicine. He and a number
of other people work with the Kentucky
Farm and Home Safety Council.

Surgeon General's Conference on Agricultural Safety and Health - 1991               453


Elements of a National Agenda

My advice to anyone who goes to Ken-
tucky is, if you do not want to become
involved, stay away from that group, be-
cause they get you involved. You will
automatically move through the ranks of
going to the meetings and suddenly one
day you will find yourself president of the
organization. The Kentucky Farm Bureau
is very active in that particular organiza-
tion.

But the person I really want to acknowl-
edge in all this is my uncle, who is a farm-
er in Idaho whose youngest son decided
that after spending quite a number of
years being a carpenter, he wanted to go
back and work on the farm. Really, the
reason we are here is to make sure that
those people who want to go back and
work on a farm will be able to work in a
safe and healthful environment.

MACHINERY AND VEHICLE HAZARDS

We have heard a lot about how important
injuries are among children and the elder-
ly, and I would like to introduce Tom
Bean's (Ohio State University) general
duty clause. The general duty clause that
he proposed in our session was that old
tractors and old equipment are usually
used on the farm for general duty, and the
people who are responsible for that gener-
al duty are the old and the young,

So that gives rise to a situation where they
are at risk of injury because of the age of
the equipment that they are dealing with.
They also are the most vulnerable of the
population in terms of injury risk.

His major recommendations were that we
need to continue to aggressively evaluate
the safety standards that are developed by
the American Society of Agricultural Engi-
neers.

454

The general duty clause that he proposed
in our session was that old tractors and
old equipment are usually used on the
farm for general duty, and the people who
are responsible for that general duty are
the old and the young.

One of the problems that has not been
looked at and that needs to be addressed
is to develop model standards for the tran-
sport of farm equipment and self-propelled
farm vehicles on the highways and public
roads. We may not pick up fatalities relat-
ed to road use of farm equipment, because
the person who dies may be the person
who is in the motor vehicle, not on the
tractor.

This is a very important area because, for
most equipment, there are no highway
standards for the transport of farm equip-
ment. In keeping with this, his proposal
was also to improve the lighting and the
marking of farm equipment. He also be-
lieved that it was very important to contin-
ue studies on educational techniques that
are successful.

MUSCULOSKELETAL HAZARDS

David Cochran is from the U.S. Occupa-
tional Safety and Health Administration,
and he addressed musculoskeletal hazards.
He focused primarily on cumulative trau-
ma disorders, about which we know very
little. If you look at the combined influ-
ences of stress and heat and the type of
work that is done on a farm, there are
some areas of research that are pressing.

His major proposal to reduce some of the
hazards was to consider packaging of ma-
terials to reduce back injuries. Materials

Papers and Proceedings


can come to the farm in anywhere from
l-pound bags to 50-pound bags, which will  begins in the early ages, and that one of

be lifted.               the critical needs in this area is to improve
                   hearing protection in order to make the

The point of view of the people who are

equipment more acceptable for people
who need to wear it.

the moving materials around needs to be
considered in order to package them in a
safer manner. He also thought it was
important to identify hazards and create
solutions acceptable to the farmers.

TECHNOLOGY TRANSFER

Murray Madsen from Deere Company
discussed technology transfer, and he fo-

ELECTRICAL HAZARDS

cused on the need for improved sensors,
radar systems, systems to anticipate and

Robert McLymore from North Carolina

avoid overturns of tractors and systems to
alter collision courses. He believes that

State University discussed electrical power.
There were three basic recommendations.  there is a great need to incorporate human
                  factors into the engineering design commu-

b One is that inspections of electrical wir-
ing are critical and need to be done on a

nity, and he posed some rather interesting
questions, which I would like to read to
you.

periodic basis.

b The second is the need to adhere to the  p How does safety become a cultural value
National Electric Codes on the farms, and  that permeates all that each of us does?
that is frequently not done. Safety proce-   b What are the skills needed to excel in
dures need to be established, particularly
when a farmer does the electrical wiring.   hazard recognition in the earliest stages of
Inspections should be done upon comple-   design?
tion of the work and must be done by a
trained electrician.            b What is the measure of safety
                  improvement at the stage when only con-

b Finally, of course, there is the issue of
overhead wires about which we have no
good solutions, but farm equipment fre-
quently does come in contact with over-

ceptual alternatives are being studied?
In order to have better technology transfer,
researchers need to participate in safety
research and intervention networks.

head wires on farms, and this is the agent
in many deaths.

NOISE

Matthew Marvel from Oneonta Health
Center discussed noise and stress. His
primary focus was on noise.

RESEARCH RESPONSIBILITY

John Crowley from the Farm and Industri-
al Equipment Manufacturers discussed
research and the responsibility of manufac-
turers for doing research and the public
sector responsibility for areas of research.

He said that in those few studies that have  Many of the areas that he touched on were
been done hearing loss is increased greatly  also addressed by surveillance and by the
among farmers, that the loss of hearing   previous speaker, so I will skip over some
                   of those; but I would like to discuss a few

Research - Mechanical and Physical Hazards, May 3, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991                455


Elements of a National Agenda

of the things that have not been addressed
in great detail.

One of them was improving the handling
of agricultural chemicals, including closed
systems, improved worker protection, and
techniques that will minimize the loss of
chemicals so that we can reduce the total
amount of chemicals that are being used.
He also discussed the need for improved
air filtration systems-particularly in trac-
tors and in work environments where you
address not just dust levels but also chemi-
cal, gas, and vapor exposures.

Loggers are at even a higher risk of injury
death than farmers, but many of the risks
they encounter, farmers will encounter as
well because farmers do logging activities. I

He discussed the need for devices to de-
tect hazardous materials, particularly gases
and vapors in enclosed, confined spaces.
We need to develop effective ways to gain
support and cooperation to fund projects.

FORESTRY

Penn Peters from the U.S. Forest Service
discussed the forestry perspective. Deaths
among loggers are about 30 times more
common than among other occupational
groups. Loggers are at even a higher risk
of injury death than farmers, but many of
the risks they encounter, farmers will en-
counter as well because farmers do logging
activities.

There is a marked lack of awareness of the
hazards of logging. Data systems need to
be developed to increase the understand-
ing of the circumstances in which the fatal-
ities and injuries occur.

REGULATION

Thomas Seymour from the Occupational
Safety and Health Administration (OSHA)
discussed the regulatory perspective and
made his three main points.

b One point was that existing standards
need to be fully evaluated.

> Second, we are in need of better injury
data.

b Third, data-gathering needs to be im-
proved so that we can further understand
the problems.

Farmers and ranchers must be involved in
the development of standards, because
OSHA has had problems in the ways that
they have attempted to address safety and
health on farms. National policy guidance
is needed in order to provide focus for
targeting proper areas of research and to
define the scope of research to be per-
formed within priority areas. There is a
need to address the role of behavior in
prevention of injuries and illnesses among
farmers.

Finally, some of the comments from the
audience that should be addressed were
the need for more coalitions, which do
more than raise funds for research but also
raise awareness, the need to identify the
interventions that work, and the need to
promulgate those interventions. Probably
most important was understanding more
about what incentives work so people do
the things that we know and we believe
are right.0

456

Papers and Proceedings


Swgeon General's Conkmnce on Agricuthml Safety and Health
FARHEAFE 2000 o A National Coalition for Local Action
Conwned by the National lnstifute Ibr Occupational Safety and He&h
April 30 - May 3, 1991, Des Moines, lowa

INTERVENTION - AGRICULTURAL WORKERS' PROTECTION
            FROM HAZARDS

       By David S. Pmtt, M.D.
Director, New York Center for Agricultural Medicine and Health
          Cooperstown, NY

I would like to also take a moment not
only to thank Dr. Stallones, but also to
make special note of Jack Parker's contri-
bution to our group. Jack was on the
phone with us on a continuing basis and
did a wonderful job getting our group
organized, and I appreciate his efforts very
much.

About the members of my group: it was
little bit like Dr. Stallones' experience-
here I am a physician. You can see we
have lots of engineers here.

I would like just to make a note that we
were privileged to have an active farmer,
Gary Erisman, in our group. We were also
particularly happy to have Dr. Hogliind
join us, from Stockholm. You will see
some of his materials in just a moment.
Let us look to the future. He really
showed us what a bright and shining future
could look like for American agriculture.

We also had the special expertise of Dr.
Konz, who talked to us about application
of ergonomics-the notion of how people
interact with machines; and he gave some
special insights into how ergonomics might
help in the future of agriculture. You have
already heard about Vector control from
Kelley Donham today. We heard from

Dr. Richard A. Lemen: Our next subject is to deal with Intervention - Agricultural Workers'
Protection from Hazards.  You have heard a much better introduction of our next presenter by our
previous presenter. Dr. Pratt is a physician who trained with his undergraduate degree at the
University of New Hampshire, his medical degree from Tuft University, and was also in the U.S. Public
Health Service for a period of time. Dr. Pratt:

Robert Pinger about some of the Vector
control problems. I will speak more about
some of the pest problems that affect
farmers and farmworkers. Then, finally,
Richard Fenske gave us a very nice discus-
sion approaching personal protective
equipment; I will share some of his slides
as well.

Then we had responders who brought us
back to Earth, told us what it was like in
the real world, and what goes on from the
perspective of a consulting engineer, Ray
Crammond, from the perspective of an
extension safety specialist with a wealth of
information, Rollin Schneider; and then
also from the perspective of an agricultural
engineer, L. Dale Baker, who is involved
every day in design and in product devel-
opment.

We entered the deliberations and discus-
sions by recognizing that the American
farmer and farm family face unique haz-
ards in this environment. In order to
make it safer for these people, we needed
to understand the special risks to which
they are exposed on an ongoing basis,
often recalling that farming and the home
environment are a single, contiguous, and
shared continuum.

Surgeon General's Conference on Agricultural Safety and Health - 1991               457


Elements of a National Agenda

Thus, the children on the farm are at risk
for injuries from equipment, from animals,
and from chemicals on a frequent and
ongoing basis. The farm workforce is
older, as we have heard, and often includes
family members, part-time help, and mi-
grant workers, presenting a special and
unique variety of problems that need to be
dealt with.

The evolution of American agriculture as
it is today has led to decreasing profit
margins and increased levels of stress.
Demands on farmers today are very great,
indeed. As we have heard previously, they
are expected to be meteorologists, econo-
mists, agronomists, crop specialists, repair-
men, livestock breeders, and personnel
experts.

The special health risks and hazards pre-
sented by farm equipment, including the
ubiquitous tractor range from acute
traumatic injuries to chronic musculoskele-
tal disorders. Farmers and farmworkers
also face vector-borne diseases, as I men-
tioned earlier.

Dr. Donham pointed out that we are see-
ing cases of encephalitis in the northeast,
and in Wisconsin we are seeing an in-
creased amount of Lyme disease; also,
interestingly and preplexingly, malaria and
dengue fever. Agri-chemicals are also an
important issue here, and there are
other-in addition to agri-chemicals-toxic
exposures that can occur in this work envi-
ronment. Skin, the major organ systems,
and also the lung are at risk from toxins
and agri-chemicals.

Now, with that background, our group
decided to look at the strategies from the
experts that I told you about. What Dr.
Parker and I did yesterday afternoon at the
conclusion of the deliberations is try to

458

distill from those presentations the
guiding principles that we gathered. major

We also had it emphasized to us that, all
players, including the farmer and the
farmworker, need to be at the table when
we begin to redesign the strategies for
intervention.

Those principles include the following:
There are major interventions available to
us as a community of interested engineers,
scientists, physicians, and farmers. These
would include three major options.

. One is the complete elimination of the
hazard.

b Two would be what we call passive con-
trols; that is, the operator would not neces-
sarily have to do anything to be protected.

b Three is active controls, where volitional
choices need to be made.

We also had it emphasized to us that, as
Dr. Stallones said, all players, including the
farmer and the farmworker, need to be at
the table when we begin to redesign the
strategies for intervention.

ELIMINATION OF HAZARDS

Many of the speakers emphasized that one
must apply the earliest possible interven-
tions to maximally reduce hazard expo-
sures. The elimination of hazards could
include machine redesign, job redesign,
and product substitution, or all three.

Now the benefits of redesign include the
fact that it would eliminate the problem at
the beginning. It is a permanent solution

Papers and Proceedings


to what was the problem, and it has-in the
nature of the design from the engineers-
planned for the potential misuse of that
equipment.

The IPM, as many of you know, often will
have a significant reduction in pesticide
application and frequently prompts the

I would like to give an example of some
extremely innovative product design in the
agricultural realm: a Finnish tractor made
by the Valmet Company.

choice of a less toxic compound in the
work environment.

                  We were also told that the use of integrat-
It has some unusual and unique features   ed pest management (IPM) is a solution
that we were apprised of. First of all, the  that involves product substitution and ad-
controls in the cab, including the steering  ministrative control. The IPM, as many of
apparatus, can rotate through 180". A    you know, often will have a significant
farmer can face backwards with all his con-  reduction in pesticide application and
trols facing the load that he is lifting.    frequently prompts the choice of a less
                   toxic compound in the work environment.

This tractor also is articulated. The wheels  Please be mindful of the fact, as was em-
turn independently, and also it has an    phasized in our group, that hazard elimina-
automatic transmission. So the amount of  tion, at times, may need to be driven by
pressure that would have been needed to   legislation or regulation, especially when
depress a clutch is no longer an issue,    there are severe hazards and recognized
thereby eliminating some of the left knee   effective interventions are available.
problems that had been identified by our
Swedish colleagues.               PASSIVE CONTROLS

In addition, job redesign was discussed in  The next topic for discussion was passive
our group. A Swedish woman was shown   controls. Our presenters and responders
working in a dairy barn, She was carrying  pointed out that in settings where com-
numerous milking hoses.          plete hazard elimination is not possible,
                  then passive controls may be applied.

It was calculated by the Swedish Farm-
workers Health and Safety Association that  Perhaps the best example of passive con-
she would have carried about 270 tons of   trols is roll-over protective structures
equipment during the milking year in a   (ROPS). Now, unfortunately, even if you
60-cow barn. This caused a lot of shoulder  have a ROPS you should not be opening
and neck problems.               the back window of an enclosed cab on a
                    tractor and certainly should never have a

The engineering job redesign group went
out to look at this, and they came up with
a solution: an overhead track on which
YOU can hang the milking apparatus and
slide it from cow to cow. This reduced,
considerably, the workload and also
reduced the rate of injury and problems
with the shoulders in these workers.

child back there.

So, the passive systems are only as good as
the operator, and in this instance some of
the safety features of this cab have been
subverted by removing the rear window.
This breaks the sound reduction, as well as

Intervention - Agricultural Workers' Protection from Hazards, May 3, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991               459


Elements of a Natlonal Agenda

the internal environmental controls and,
indeed, puts a child at risk.

Other examples of passive controls include
special kill-switches on chain saws such
that when they buck or kick back they will
automatically be turned off.

Finally, another example of passive con-
trols includes what are called closed pesti-
cide loading and mixing systems. Those
particular systems allow a completely
closed operation from the container into
the mixing vats, thereby never exposing the
worker.

ACTIVE CONTROLS

The next group of strategies was termed
active controls. Active controls are neces-
sary when full hazard elimination or pas-
sive controls are not possible. Active con-
trols require that the worker carry out a
protective behavior such as donning per-
sonal protective equipment, applying an
insect repellent, or reading and heeding
warning labels.

The ultimate in personal protective equip-
ment was shown. Astronauts were in-
volved in working outside a space shuttle,
which our colleagues at NASA call extra-
vehicular activity. This is a situation where
an active control system is absolutely man-
datory, since one could not even live in
that environment without that kind of gear
and garb.

You immediately recognize that that equi-
pment is wonderful, if you are going to be
in the cargo bay of a shuttle, but it would
be lousy to do your everyday activities,
whether at work or at home, ,in that kind
of a get-up. There are sigmficant limita-
tions in personal protective equipment, and
they were enumerated in our group as

follows: it is uncomfortable, it may im-
pose ventilatory stress, it certainly would
reduce dexterity, and it may lead to heat
loading and heat stress on the workers.
This is especially true in people who work
in warm climates and need to be fully
covered.

Another point I should make about the
limitations: a pesticide worker was shown
wearing a non-woven garment that had a
materials failure, The armpit was torn out.
There was a gap in the underside of the
garment, so that would allow a pesticide to
escape onto the individual.

Finally, we heard that warnings, for all the
emphasis we put on them, frequently do
not work. They are temporary. They can
be wiped off, erased, or removed. They
have serious limitations. That is not to say
that our group completely rejected train-
ing, education, and knowledge. In fact,
one final thing that is shown here is an
attempt to inform, to make sure that the
agricultural population of Sweden is an
informed population, about tractors that
are designed with ergonomics in mind and
with safety in mind.

We saw what you might think of as Swed-
ish "Consumer Reports" of tractors that are
ergonomically sound. The document was
developed by the Swedish Farmers Health
and Safety Association.

It was like a Michelin guide for restau-
rants. Four stars is excellent; three stars is
good; and so on and so forth. Such scor-
ing was resisted by the manufacturers in
Sweden but has been very popular among
the farmers and farmworkers.

Let me conclude by saying that our group
decided that intervention strategies are
most effective when they are applied early

460                                   Papers and Proceedings


intervention - Agricultural Workers' Protection from Hazards, May 3, 1991

in the process. Passive controls are less
desirable but at times may be life-preserv-
ing and life-saving. Active controls are the
least desirable interventions because they
require forethought, modifications of be-
havior and, often, discomfort. Intervention
strategies should always incorporate the
knowledge of the users.

Intervention strategies are most effective
when they are applied early in the pro-
cess.    I

I am reminded of that little aphorism from
Japanese management that says, "The
worker has intimate knowledge of the
process." In this instance it is the farmer
and farmworker who have valuable, inti-
mate knowledge.

Finally, in conclusion, we agreed that seri-
ous attention should be paid to using all
the options to deal with what we all recog-
nize as a clear and present danger to the
American farmer and farmworker.0

Surgeon General's Conference on Agricultural Safety and Health - 1991

461


Surgeon General's Conference on A~r~cultml Safety and Health
FAWSAFE 2000 . A National Coalition Ibr Local Action
Convened by the National institute for Occupational Safety and Heattb
April 30 - May 3, 1991, Des Moines, Iowa

/NTERVENTlON - SAFE BEHAVIORS
AMONG ADULTS AND CHILDREN

   By Walter J. Ambruster, Ph.D.
Associate Managing Director, Farm Foundation

1

Dr. Richard A. Lemen: Our next speaker will look at Intervention - Safe Behaviors Among Adults
and Children.  To do this, we have Dr. Waiter J. Armbruster, who received a bachelor's degree and
a master's degree in Agricultural Economics from Purdue University, and a doctorate in Agricultural
Economics from Oregon State University. Dr. Armbruster:

We know that surveillance and research
are, indeed, often precursors to interven-
tion. Some of the discussion groups appar-
ently did more than work on the necessary
input to intervention, they even delivered
some of our group's ideas for us. Be that
as it may, I hope we will not be too
repetitive.

The rapporteur for our discussion group,
Dr. David Hard, deserves a great deal of
credit for helping me put together an over-
view of what we discussed.

I was admonished by our group not to
generalize our discussion to the point that
we could have written the report before we
arrived. I see some of them in the audi-
ence monitoring my reporting.

I hope they recognize our discussion. In
some ways, Kelley Donham's diagram of a
national coalition for local action could be
viewed as the game plan for our whole
discussion.

Achieving safe behaviors among adults and
children, which we hope to foster through
intervention, is an ongoing challenge. We
grappled with ideas on how to better inter-
vene to foster such behavior, so that it will
avoid unintentional injuries in the agricul-
tural occupations and create a safer and

462

healthier environment in which to live and
work.

Our recommendations consist of a combi-
nation of short- and long-term implications
or suggested actions that are aimed at
immediate as well as future improvement
in agricultural safety and health. While
our discussion considered short- and long-
term differences, the ideas did not lead to
that framework very well.

We will introduce the ideas with the intent
that some are short-term and some longer
term in nature. We need to pay attention
to this as we think about how to imple-
ment these ideas and recommendations.

BEHAVIORAL CHANGE

There was rather widespread agreement in
our discussion group that our overall goal
is to achieve behavioral change that will
result in a safer, healthier living and work-
ing environment for those engaged in agri-
culture. We have a good deal of evidence,
e.g., from automobile seat belts, that pro-
viding education or information is not
sufficient, though we feel it is a necessary
precursor to achieve behavioral change.
What is necessary to change attitudes re-
garding health and safety.

Papers and Proceedings


Mental health is an important aspect of   sary duplication, and provide funding for
overall health and a necessary ingredient   the larger research base, intervention pro-
of safe behavior. We had a bit of discus-   grams and mandated programs.
sion about that, although we did not focus  There was widespread recognition that
on it a great deal.            while local coalitions may be very effective

In trying to achieve behavioral change,    in delivery, they need a lot of help from
                   federal and state levels in achieving or
youth may provide a more readily adapt-   obtaining the resources with which to do
able audience than some of the older cli-   their work at the local level. We need to
ents that we try to reach. Hence, a focus  think carefully about funding to make
on youth education and youth intervention   coalitions functional.
may be very effective in changing their
behaviors for their lifetime. We also be-   At the local level, it was pointed out that
lieve that reaching adults through youth is  even a small amount of money is often
a very effective channel for modifying    quite significant and creates the opportuni-
adult behavior.              ty for leveraging into significant activities
                    that can have a realistic impact. I think

Similarly, we had some discussion about    some of the discussion was in the context
the possibility of working with spouses to   that there is a lot of federal money and let
help them understand the need for behav-  us get it down to the local level where it
ioral change, to reach the farmer whose   will do some good.
behavior we are trying to change. We
discussed it generally in terms of the spou-  As you think about it, the implication may
ses being the wives who would help the    also be that at the local level you may be
husbands change his behavior.         able to raise the funds within the commu-
                    nity to put on some of the educational or

But we all know that there are many wom-  intervention activities that may be very
en farmers, so I assume that it works the   effective. Someone suggested that we
other way also. We had a fair amount of  should not overlook the general businesses
agreement that the husbands listen to the   in our community as a funding source.
wives; we did not have much discussion
about whether it works the other way. So  Knowing that more than half of the farm-
that is a hypothesis on my part. The point  ers in the U.S. receive more than half of
is, indirect access for delivery of messages   their income from off-farm sources, there
as well as direct access, to our target audi-  is a very direct stake in agricultural safety
ences, may be a very effective strategy for
achieving behavioral modification.      and health for those employers who do not
                   necessarily have a direct connection with
                   agriculture. These employees who count

LOCAL EFFORTS            on having healthy employees who can be

We discussed local and state coalitions for  on the job and are not using the insurance
                    benefits from that company's program to
working on agricultural health and safety
issues! educational resources, and access to  recover from injuries because of unsafe

what is available in the various states. The  practices or unhealthy conditions in their
federal role in coalitions is to help coordi-  farming operation.

nate the state efforts, help avoid unneces-

Intervention - Safe Behaviors Among Adults and Children, May 3, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991               463


Elements of a National Agenda

Another point we discussed was the need
to find ways to make it easy for individuals
to achieve change in behavior. One sug-
gestion was that when a farmer buys a
significant amount of chemicals, protective
clothing or protective gear needed to safely
handle the chemicals could be packaged as
part of the total product purchased.

You would not be given just a large can of
pesticides, but rather a large can of pesti-
cides with a safety suit attached directly to
it. Obviously, there are some cost con-
siderations that would need to be taken
into account.

A related point was made about making it
easy for farmers and agriculture workers to
purchase safety equipment in general. In
some cases it is very difficult to locate a
local source. The individual may have to
find catalogs or go to significant effort to
locate the safety equipment needed.

So one of the opportunities or challenges
for local or state coalitions might be to
somehow assure that at least one source of
supply for necessary safety equipment is
available locally-a local cooperative or
some private outlet. Making sure that
those who need to purchase safety materi-
als can find them easily, should they listen
to our messages delivered through inter-
vention, ought to be emphasized.

RESEARCH

Then we turned our discussion to research.
There was a strong feeling that we need
better research on evaluating the effective-
ness of the various intervention programs
that are ongoing. I think somebody al-
ready made this point: if we are able to
measure changes in behavior and sort out
the links that they have to various inter-
ventions, then we can perhaps identify

which of those interventions are more
effective than others. We know that bud-
gets are tight. So that would imply with-
drawing funds from programs that are not
achieving, in order to obtain funding for
those that are successful or for new
programs.

The second issue regarding research that
we talked about was the need for more
basic research on the relationship between
behavioral change and intervention alter-
natives, whether it be education, regulation
or automatic protection from agents of
injury. We do not know the linkages very
well, so it makes it difficult to design new
programs or better programs.

There was some feeling that legislation
may be needed because education or other
forms of intervention are not very success-
ful, but there is also a feeling that legisla-
tion alone is unlikely to be effective. We
have a lot of evidence, again going back to
the seat belt example. Most or all states
have seat belt laws now, but that does not
mean that we have 100 percent of people
buckling up.

We need to motivate individuals and com-
munities, through education, to help modi-
fy behavior and accept or take advantage
of safety equipment and healthy choices.
We have a lot of anecdotal evidence, and I
think more than that, of individuals over-
riding built-in safety features. So we need
to use all of our approaches to achieve
safe behavior in the agricultural occupa-
tions.

COMMUNICATIONS

Finally, we had some discussion about the
important role of communications in achie-
ving behavioral change. We must pay
attention to communications and carefully

464                                   Papers and Proceedings


consider how to deliver intervention in a   educational strategies, or cultural differ-
manner that causes individuals to follow
through to implement the desired changes.  ences, or who is not a proficient translator,
                  may do more harm than good. That per-
n[  son may garble the message or weaken the
                  impact of materials that could have much
                  more effect by getting the proper expertise
through youth is a very effective channel    involved.

                 Another point regarding communications is
                  the use of a range of media, organizations,

We must carefully consider the background  and people to reach the target audience.
of targeted audiences, for example, age-ap-  Direct as well as indirect approaches, as I
propriate programs for youth and educa-   indicated earlier, repetitive messages, and
tion-level considerations, which dictate    varying approaches are needed. Use all
delivery approaches. If you have a farm or  the media, program opportunities, and the
agricultural clientele or agricultural worke-  organizational efforts to repeat messages
rs' group who are not highly educated, you  in various ways.
may have to use cartoons, comic books,
and posters requiring minimal amounts of  Finally, in communication, we need to be
reading.                careful that proper communication takes
                  place not only within coalitions at the

Pictorial images way have to be used to get  local, federal and state levels, but also up
your point across. People with a low level   and down the line.
of education are not going to read a
six-page handout with many details related  We cannot have only top-down ap-
to safe behavior.          proaches. We know they will not work.
                  We cannot have only bottom-up approach-
Similarly, if you are dealing with various   es, because we know we will have difficulty
cultures-Hispanic comes to mind--culture  achieving access to good materials, etc.
is quite important in how messages are    We need to make sure that the communi-
normally delivered or more favorably re-   cations between the coalitions at different
ceived. Pictorial presentations and comic  levels are fully utilized.
book kinds of educational materials appar-
ently have a tradition of acceptance and   Finally, in closing, let me say that despite
use in Spanish cultures.         the admonition of the participants in our
                  group, which was a large and actively in-
A point was made that we need to be    volved group of probably 75 or so, I may
careful that we draw on proper expertise-  have generalized too much in summarizing.
whether we are trying to create age-    A written report will contain some of the
focused, education, or culturally appropri-  richness of discussion that I had to gener-
ate materials. A partial understanding by  alize away from this morning.o
somebody who is an expert in a particular
aspect of health or safety, but who knows
very little about child development stages,

Intervention - Safe Behaviors Among Adults and Children, May 3, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991               465


One of the advantages of speaking abso-
lutely last on a panel is that a lot of the
previous speakers said some of the things
that I was planning to say, so it makes my
job easier.

This is my first chance to attend this con-
ference, because for the last four days I
was in Buffalo, New York. During the
days of your conference, there was another
national agricultural conference-the 1991
National Conference on Migrant and Sea-
sonal Farmworkers. It brought together
over 1,300 migrant educators, farmworkers,
Migrant Head Start educators and direc-
tors, employment training workers, attor-
neys and health care workers-both clini-
cians as well as non-clinicians-people like
the physicians, nurses, and physician's
assistants, as well as environmental special-
ists, health educators, and outreach work-
ers.

The theme of the conference was "United
for Progress." Over the four days, the
conference participants had a chance to
choose from over 160 workshops and ple-
nary sessions. The sessions were heard in

Surgeon General's Conference on Agticultwai Safiaty end Health
FARMSAFE 2000 o A National Coalkion Ibr Local Action
Convmed by the National /nstitute kr Occupational Safeiy and HeaM
April 30 - May 3, 7991, Des Moines, lowe

REPORT ON M/GRANT AND SEASONAL FARMWORKERS

    By Valerie A. Wilk, MS.
Health Specialist, Farmworker Justice Fund, inc.

Dr. Richard A. Lemen: The last speaker whom we have today will provide a Report on Migrant and
Seasonal Farmworkers.  Valerie A. Wilk received a bachelor's degree from Knox College in Illinois,
and a master's degree in preventive medicine and environmental health from the University of Iowa.
She is currently a health specialist with the Farmworker Justice Fund in Washington, D.C. I just want
to read a couple of things that her organization does, and I am sure she is going to tell you more
about this; but, as I see it, they try to make sense out of national and state-level occupational health
policy issues facing farmworkers, and they develop strategies to address these issues. They attempt
to educate the public, and they attempt to develop coalitions about these issues. Secondly, she also
directs the Farmworker Women's Health Project, and she has just returned from a meeting on
migrant and seasonal farmworkers. She will tell us about that meeting, and tell you about some of
the problems that face these farmworkers. Ms. Wilk:

English, some in Spanish only, and some
were bilingual.

I am specifically focusing on the health
workshops of the conference. Then what
I'd like to do is go over some of the recur-
ring themes and recommendations that
came out of that conference and leave you
with a couple of my observations from my
11 years of working with farmworker or-
ganizations.

THE NATIONAL CONFERENCE ON
MIGRANT AND SEASONAL
FARMWORKERS

I know that at least one of the previous
speakers on Monday spoke somewhat
about farmworkers, but I just want to tell
you, when we talk about migrant and sea-
sonal or non-migrant farmworkers, we are
talking about hired workers. In a 1990
demographic report, the Federal Office of
Migrant Health estimated that there are
four million farmworkers and their family
members in the United States.

466

Papers and Proceedings


They are predominantly people of color,   sprayed, so is the home, so are the chil-
They are men and women; they are chil-
dren. They are Hispanic, African-      dren, even if they are not directly working
                        in the fields at that time.

American, Haitian, West Indian, Southeast
Asian, or Native American. They pick the  We also dealt with the issue of farm ma-
fruits and vegetables; work in nurseries,
greenhouses, and mushroom sheds. They   chinery-related injuries, heat disorders, and
                    a major occupational hazard for hired

hoe, weed, thin, and prune crops.

farmworkers, which is transportation-relat-
ed injuries. Farm labor contractors too

Almost one million farmworkers and their
families migrate. Migrant workers travel
throughout most of the United States.

often transport workers in unsafe vans and
trucks. This unsafe transportation has
resulted in deaths and serious injuries of a
number of workers.

The farmworker conference dealt with the
issue of child labor; it dealt with farm    Most recently, in December 1990, in
injuries such as those related to falls from  Florida, four farmworkers were killed and
ladders. We focused on issues of disability  seven were seriously injured when a farm
and injuries from prolonged bending, stoo-  labor contractor's truck was broadsided by
ping, heavy lifting, and carrying, and repet-  a van, and the truck carrying the farm-
itive motion, including the musculoskeletal  workers rolled over repeatedly. The
effects on children and results seen in the  farmworkers had been riding in the back
elderly.                       of the truck on makeshift benches of
                    planks and cement blocks, which is a viola-

One of the workshops dealt with workers'   tion of the Migrant and Seasonal Agricul-
compensation and the fact that in about    tural Worker Protection Act.
half of the states in the United States
farmworkers are not covered at all by     Farmworker advocates in the area had
workers' compensation. We also dealt    reported this particular farm labor contrac-
with the issue of pesticides, including farm-  tor for violations six months previously, but
worker poisonings from direct spray, from  nothing had been done. Because of this
drift, and from residues on the plants,    inaction, four workers died and seven were
                   seriously injured.

We talked about effective methods of
educating farmworkers and employers     We also discussed the issue of field sanita-
about pesticide use and hazards. We also  tion. In 1987 OSHA promulgated regula-
talked about research projects being done,  tions to require that drinking water, toilets
and about farmworker health status in    and hand washing facilities be provided by
general.                 employers for workers with 11 or more
One of the points that came through, and  workers on any given day in the fields.
                     The reality is that compliance is very low.

one of the other speakers on the panel
today has mentioned it, is that the work-
place and home are one and the same-

There have been a couple of studies in the
last year. In 1990, a study done with the
North Carolina School of Public Health

particularly in terms of migrant workers
where migrant labor camps are right in the  found that only 4 percent of farms were in

middle of fields. So when fields are     complete compliance with the Federal
                         Field Sanitation Standard. There was a

Report on Migrant and Seasonal Farmworkers, May 3, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991

467


Elements of a National Agenda

study done in New Jersey in 1990 that
showed a figure of 16 percent compliance.

We discussed strategies to improve em-
ployer compliance and OSHA enforce-
ment. One of the issues that came out in
that workshop was the fact that the threat
of employer retaliation is so great. If you
have to rely on formal worker complaints,
there are very few workers who are willing
to risk their job if they know that OSHA
may not be out to inspect for a week or
two weeks or maybe 30 days. By that
time, the labor crew has already left that
farm and that work.

Another aspect of the field sanitation stan-
dard is drinking water. Common drinking
cups are a major problem, as is clean and
sanitary drinking water at the worksite.

We also talked about children's health and
safety. Children drink and bath in contam-
inated water-water contaminated with pes-
ticides and fertilizers. We also talked
about injuries and about drownings in
rivers and irrigation ditches.

Another workshop that attracted a lot of
attention had to do with farmworker wom-
en and health. In March of this year, the
Farmworker Justice Fund sponsored the
First National Farmworker Women's Con-
ference. It was the first event of our Far-
mworker Women's Health Project.

We brought 63 farmworker women and
trainers to San Antonio for a three-day
conference, and all of the farmworker
women were women of color. They were
Hispanic, African-American, Haitian, and
Southeast Asian.

The meeting was held in three languages:
Spanish, English, and Haitian-Creole. We
will be publishing proceedings of that mee-

ting later this year. We brought two of the
farmworker women, who had been elected
by the
nr oup in San Antonio, to the Buffa-
lo Co erence to present to that confer-
ence about the health priorities and rec-
ommendations that the women made in
San Antonio.

There are a number of health issues spe-
cific to women. For example, with regard
to field sanitation, urinary tract infections.
If there is no privacy or no clean facilities,
farmworker women will wait an entire day
before going to the bathroom. This is
particularly troublesome for women during
their menstrual period and for pregnant
women.

With regard to farmworker women and
their exposure to pesticides, there are
consequences of long-term exposure to the
reproductive system, such as infertility, as
well as the risk of miscarriages and birth
defects. In November of 1989, there was a
mass poisoning near Ruskin, Florida, and
there were about six pregnant women,
most of them in their first trimester, who
were among the workers who were poi-
soned.

Of those women, the medical director of
the clinic who treated the workers knows
of two women-one who miscarried and
another who had a baby with birth defects
of the face and hand. There was another
case, which was unconfirmed, of a still-
birth.

Another issue facing farmworker women is
sexual harassment, rape, and even sexual
slavery in labor camps.

Housing is a major concern and occupied
various workshops at the conference-
substandard housing, overcrowded housing,
or no housing at all.

468                                    Papers and Proceedings


We have had reports of hundreds of work-
ers in Arizona living in the citrus groves,   farmworkers; and that advocacy to correct
                                  occu ational and environmental health
sleeping under tarps with cardboard on the  prob ems was, indeed, preventive medicine
             P
ground. Also, in southern California there
are cases of workers who have been living  and extremely important. I have been
in holes in the ground in the canyons. I   gratified to see over the years that this has
just heard in Buffalo that in at least one   been a growing sentiment among migrant
case, workers were being charged for rent  health and migrant service providers.
for the tree that they were sleeping under.  There was a commitment to continued and
                        better coordination and communication

In a number of the workshops there were
very concrete examples of groups who had
worked in coalition, either within their
community or statewide, on particular
health and safety issues: workers' compen-
sation or field sanitation.

What I have not shown you in these slides  health and safety issues: workers' compen-
are other occupational hazards that farm-  sation or field sanitation, for example.

workers face: tuberculosis, involuntary
servitude, and employer retaliation. I have  Another theme was the importance of the
heard through my office of a number of   need for and the barriers to getting work-
situations where farmworkers have gotten  place information, most strikingly the right
fired simply for asking a question about   to know which pesticides are used and
the safety of farm equipment or about the  when they are applied in the fields. An-

location of field sanitation facilities, or for  other theme was the importance of the use
refusing to return to a recently sprayed   of popular education methods to teach
field, or for taking action and getting out   farmworkers, that is, getting farmworkers
of a field while it was being sprayed.    involved in a egalitarian way in training by
There are no anti-retaliation protections   doing skits and interacting with volunteers

under the Federal Pesticide Law, and    from the audience so you are not just
OSHA's anti-retaliation protections are so  doing straight lecturing about health and
time-consuming that with the seasonality of  safety and pesticide safety.
farmwork, they offer little protection for
farmworkers.               The other thing, which I mentioned earlier,
                    is the extent of farmworker intimidation by

THEMES AND RECOMMENDATIONS   employers, and the lack of protection for
                   workers who demand and who question

What are some of the recurring themes
from the Buffalo conference? First of all,
there was the recognition of the impor-
tance of service providers, particularly
health care providers, being advocates for

Report on Migrant and Seasonal Farmworkers, May 3, 1991

among programs to most effectively use
the resources available. Related to that
was the importance of coalition building
within one's community and beyond on
farmworker health and safety issues. In a
number of the workshops there were very
concrete examples of groups who had
worked in coalition, either within their
community or statewide, on particular

and who actively try to make the work-
place safer.

Finally, I would like to leave you with two
observations. First of all, a National Co-
alition for Local Action, FarmSafe 2000,

Surgeon General's Conference on Agricultural Safety and Health - 1991                469


Elements of a National Agenda

must include migrant and seasonal farm-
workers as equal partners.

Not only must farmworker family occupa-
tional safety and health issues be consid-
ered as seriously and as fully as farm fami-
ly health and safety issues-because so
many of these issues are similar and be-
cause farmworkers are important workers
within the agriculture industry-but also
farmworker leaders, community leaders,
and union leaders need to be involved in
the coalition as equal and active partners.
Farmworker advocacy organizations such
as the Farmworker Justice Fund can help
identify those farmworker leaders to par-
ticipate in this process.

Also, when we are talking about coalition
building, what struck me earlier with the
four components of a coalition, quite fran-
kly, was that two of those partners in a
coalition have been some of the biggest

barriers to farmworkers getting a safe and
a health workplace. Both industry and
government have opposed and have sub-
verted some of the attempts to protect
farmworkers, through legislation and regu-
lation.

A safe workplace makes economic sense,
and society picks up the tab when we have
unsafe workplaces. Action is needed, but
actions as have happened in the past can-
not continue. We need to look at different
ways of working together. We need to
convince industry and government that
changes need to be made, and we need to
support farmworkers in their efforts.

Some of the most cutting edge protection
for farmworkers have happened under
union contracts. We need to look at all
the different models to make sure that
farmworkers are equally protected.0

470

Papers and Proceedings


Surgeon General's Conference on Agricultural SafWy and Health
FAR&&FE 2000 o A National Coalition for Local Action
Conwmd by the National Institute Ibr Occupational Safety and Health
April 30 - May 3, 7991. Des Moines, Iowa

OUTSTANDING FFA POSTER

   By Rice C. Leach, M.D.
Chief of Staff, Office of the Surgeon General

Dr. Richard A. Lemen: Our next session is going to be chaired by Dr. Rice Leach, who Surgeon
General Antonia C. Novello appointed as her Chief of Staff in April 1990. As Chief of Staff, Dr. Leach
is responsible for coordinating the activities of the Office of the Surgeon General (OSG).  Dr. Leach
came to the OSG from the Health Resources and Services Administration, Bureau of Health Care
Delivery and Assistance, where he was the Chief of the Public Health Service (PHS) Recruitment
Program. He began his PHS career in 1966 as a rotating intern at the PHS Hospital in New Orleans.
He has served the Indian Health Service (IHS) in numerous clinical and management assignments
including director of an IHS area, manager of the IHS AIDS program and associate director of the
IHS Office of Research Development. Dr. Leach has also served in the Bureau of Medical Services.
Dr. Leach was born in Lexington, Kentucky and received a B.A. from Amherst College, M.D. from the
University of Kentucky, and a Master of Science in Health Services Administration from the Harvard
University School of Public Health. He completed his preventive medicine residency at the University
of Arizona and an internal medicine residency at Tulane. Dr. Leach has sewed on the Federal
constituency section of the American Hospital Association, the South Dakota Statewide Health
Coordinating Council, the Board of the Arizona Hospital Association, and the education committee of
the Arizona Medical Association. Dr. Leach:

Dr. Novello would like to be with us today
but, as she said earlier, she has other obli-  grounded in Denver and will be here later
                        this afternoon.

gations. There is another physician who
would love to be here today, too,

Dr. J. Donald Millar. He has been de-   At this point in the program, we are going
tained by some occupational health stan-   to the first place award for the best FFA
dards that say something to the effect that  poster presentation. One of the judges
"There will be no planes leaving San    who was recently president of an FFA

Francisco with broken radar."  He is    association made the following statement
                    about the posters:

They were all outstanding. I spent a lot of time talking with the members, and it is obvious
that they take a great deal of pride in their programs. To tell the truth, judging is not nearly
as easy a task as I had thought. My compliments to NIOSH and the Surgeon General's
Conference stafl Thanks for letting me be part of it all.
ple so fired up about safety.            It was exciting to see so manypeo-

Those are the comments of Sheryl Janko,
the immediate past president of the Iowa
FFA Association.

The group judged to have the best poster
is the Amanda Clear Creek FFA Chapter
from Amanda, Ohio. Representing that
group are Mr. Gary Bnnnfield, the Safety
Program Chair, and Mr. Charles E. Miller,
the advisor.0

Surgeon General's Conference on Agricultural Safety and Health - 1991                471


Surgeon General's Confkence on Agticukutal Safety and Health
F~USAFE 2ooO o A National Coalition rbr Local Action
Conwned by the National Institute tbr Occupational Safety and Heatth
April 30 - May 3, 1991, Des Moines, /owe

    OSHA INITIATIVES IN
AGRICULTURAL SAFETY AN5 HEALTH

     By Cynthia DougZass
   Deputy Assistant Secretary of Labor
U.S. Occupational Safety and Health Administration

Dr. Rice C. Leach: Our first speaker is Cynthia Douglass, Deputy Assistant Secretary of Labor,
Occupational Safety and Health Administration in the United States Department of Labor. Ms.
Douglass was appointed Deputy Assistant Secretary of Labor in December 1989. She Is responsible
to the Assistant Secretary for the external activities of the agency. She works with other Federal and
state agencies such as the Congress, the Environmental Protection Agency, labor unions, business,
and others to enhance worker safety and health. Prior to her time with the Labor Department, she
was Administrator of the Research and Special Programs Administration for the Department of
Transportation. Prior to that, she was Special Counsel to the Senate Commerce Committee, which
worked on a wide variety of issues including automobile safety, motor carrier safety, economic
deregulation, and insurance. We have a very qualified spokesperson. I give you Ms. Douglass:

Thank you very much. I am delighted to
be here. I am also delighted to be a par-
ticipant in the first Surgeon General's
Conference on Agricultural Safety and
Health and want to thank Surgeon Gen-
eral Novello and Dr. Millar for inviting the
Occupational Safety and Health Adminis-
tration (OSHA) to participate and speak at
this important meeting. I assure you that
OSHA wholeheartedly supports the Sur-
geon General's attempts to prevent injury
and disease in the agricultural workplace.

My boss, the Assistant Secretary of Labor
for OSHA, Jerry Scannell, wanted very
much to be here to convey to you his con-
cerns about farmworker safety and health.
Unfortunately, as I am sure you all know,
there was a catastrophic explosion at a
fertilizer plant in Sterlington, Louisiana,
two days ago. Eight people were killed in
that explosion, and over 100 people were
injured.

Mr. Scannell flew there yesterday and
could not get a plane out in time to be
here this morning. Jerry believes that it is
important to personally let the community
and the workers know of OSHA's commit-
ment to the workers of that facility. He
also believes that it keeps his heart and
soul focused on the primary goal of
OSHA, which is to assure every man and
woman a safe and healthful workplace.

He asked me to come here and talk with
you about OSHA's program, and I am
delighted to be back in the Midwest, I am
from Kansas and went from there to
Washington, D.C. in 1976. I would note
that I was there in time for the huge farm-
er protest in Washington, which was in
1977, and I believe again in 1978.

I still have a bumper sticker that was given
to me by some Kansas wheat farmers that
says: "If you don't like wheat farmers, don't
talk with your mouth full." Those are my
sentiments exactly.

472

Papers and Proceedings


As I said earlier, agricultural safety and    THE OCCUPATIONAL SAFETY AND
health has been one of Assistant Secretary   HEALTH ADMINISTRATION
Scannell's major concerns since becoming
Assistant Secretary of Labor for Occupa-   I want to tell you a little bit about OSHA
tional Safety and Health. I know he will   and how it operates. OSHA has jurisdic-
be pleased that this conference has been
so successful.              tion over occupational safety and health in
                   more than six million workplaces in
                   America, employing about 90 million

We are all appreciative that the Congress  workers. We operate on a relatively small
appropriated the funds for this conference  budget for that, about $285 million, with
and believe that the conference will help   an authorized staff of a little over 2400
further the education and relationships    people, of whom approximately 1300 are
necessary to reduce the shameful accident-  inspectors.
rate of farming. OSHA, in particular,
wants to develop a good relationship with   Our mission is to ensure safe and healthful
your community, because together we can  working conditions for working men and
make a difference.            women through a variety of means, includ-
                   ing regulations dealing with occupational

The breadth and depth of the subjects that  safety and health, education, training, and
have been covered during the four days of  technical assistance. Of course, we have
this conference is impressive. So is the    an enforcement program.
fact that there has been participation from
members of farm organizations, migrant   In carrying out this mission, we rely heavily
worker representatives, academic institu-   on a partnership that includes labor and
tions, safety and health professionals, the   management, the states, the Federal gov-
states, and the government agencies, all of  ernment-NIOSH, for example-safety and
which play an important role in this vital   health professionals, and academia.
area of agricultural safety and health. This
is truly the kind of national coalition and   Our enforcement jurisdiction in agriculture
partnership that can make a difference.   is limited by law to those farms that em-
                    ploy 11 or more workers. This means that

OSHA's interest in working with you to   we do not enforce OSHA regulations on
reduce the occupational deaths and inju-   the great majority of farms; 86 percent of
ries in American agriculture is evidenced
by the fact that we have 17 staff people   American farms are smaller, part-time
                    operations. We do have enforcement

attending this conference. In addition, a
number of the representatives of states,
which operate their own OSHA-approved
occupational safety and health programs
and OSHA-supported state consultation
programs, are attending. OSHA is com-
mitted to efforts to improve safety and
health in agriculture.

authority in migrant labor camps.

We are all aware that agriculture is one of
the most hazardous of American indus-
tries, with 1,300 deaths and 120,000 dis-
abling injuries in 1989, according to Na-
tional Safety Council figures. Many of
those injuries involve children.

OSHA Initiatives in Agricultural Safety and Health, May 3, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991

473


Actions for the Future

Therefore, OSHA has a big responsibility,
working within the limitations placed on it
by the appropriations language, to seek to
reduce these injuries and fatalities in the
farming industry. OSHA has the authority
to work with small farms. The only prohi-
bition is on enforcement.

For years that appropriation rider was
interpreted by OSHA to mean, just stay
out of the farm and stay away from the
farm community. We do not want
OSHA-we do not even want the word
spoken in the farm community.

But that is not what the statutory language
says. OSHA can give technical assistance
to farmers. We can work with your com-
munities.

The answer lies in education, training,
and increasing awareness of those haz-
ards and how they can be reduced. I

We can help develop materials and train-
ing and educational seminars to aid in
increasing awareness and knowledge about
safety and health problems in agriculture
and the actions that may be taken to mini-
mize these problems. In that connection,
for example, we might seek the aid of
university-based agricultural safety and
health centers and other government agen-
cies, such as the extension service, to pro-
vide necessary expertise and guidance in
training staff members for outreach and
consultation activities.

We can also provide OSHA-supported
consultation services to small agricultural
employers. The consultation program is a

voluntary one and helps develop mutual
trust between farmers and OSHA. I might
point out that the representatives of
OSHA-supported consultation programs
recently met in Tucson, Arizona. One of
the principal items on their agenda was
consultation services in agriculture.

OSHA also reviews existing standards that
apply to agriculture, such as the roll-over
protective structures (ROPS) standard.
We look at whether these standards should
be modified to reflect changing conditions
in the United States, in the world, and in
the industry. We need your help, though,
on reviewing and modifying these stan-
dards, if we are to have good,
common-sense safety standards.

All too often OSHA is only regarded as an
enforcement agency. Enforcement is not
the principal answer to reducing hazards in
America's agricultural worksites. The
answer lies in education, training, and
increasing awareness of those hazards and
how they can be reduced.

My boss, Jerry Scannell, has committed
OSHA to developing a positive commu-
nication goal. He wants to work with
others such as NIOSH and your organi-
zations and believes that if we do that, we
can have a significant impact on agricultur-
al safety and health.

During the 1970's, OSHA had an advisory
committee on agricultural safety and
health. Jerry is considering the re-estab-
lishment of this committee.

We have been working to re-establish a
number of relationships with government
and private organizations, and we hope to

474                                     Papers and Proceedings


continue this. The message is that OSHA  contaminants in agriculture, a regulatory
wants to work with all of you to further   initiative, NIOSH joined with OSHA to
agricultural safety, education, and aware-   explain our respective agencies' work to
ness.                      the attendees. This summer we will ask an
                  occupational health nurse intern serving on

Farmers, themselves, recognize that they   our staff to further update OSHA staff on
work in a hazardous occupation. The    the latest research findings of NIOSH in
National Coalition for Agricultural Safety  agriculture and to determine how OSHA
and Health (NCASH) conducted a survey   can best utilize this NIOSH material to
of New York and Iowa farmers. More    maximize its own efforts.
than 70 percent of those farmers who were
surveyed said that their occupation was    OSHA also has held meetings and discus-
more hazardous than other occupations.   sions with the Rural Safety and Health
                    Committee of the American Farm Bureau;

In connection with that, I am gratified to   USDA officials; the Office of Rural Health
see that one of the concurrent sessions at  Policy; Agricultural Division of the Nation-
this conference dealt with behavioral    al Safety Council; and the Farm Safety for
changes among both adults and children   "Just Kids" organization. These are a few
working on the farms. Strategies must    of the organizations we have met and with
incorporate new and innovative approaches  whom we have been working.
to behavior modification.

                       One of our most successful efforts was
AGRICULTURAL SAFETY AND HEALTH  production of various news feature mate-
                  rial and radio and television spot an-

Let me tell you something about what    nouncements for distribution to 3,500 rural
OSHA has been doing in agricultural safe-  media during the National Farm Safety
ty and health. This is all relatively new, by  Week of the National Safety Council in
the way, just in the last 2 years. We have  September. These public service an-
been holding numerous meetings since    nouncements were designed to call atten-
January of 1990, developing OSHA's plans  tion to the need for improved safety and
and initiatives to carry out a program of    health measures on the farm. The fact
enhanced awareness of work-related haz-   that OSHA is now taking an active role in
ards in agriculture and how to cope with    this area was also communicated.
them.

                        The radio announcements alone were
OSHA is working closely with NIOSH staff  carried by 249 stations, reaching an esti-
from Dr. Millar's office, meeting with our   mated 4.5 million homes with over 14
OSHA executive staff to explain activities  million listeners. We hope to do this again
and to share ideas. We are doing this on a  this year.
regular basis.

                  We have developed a fact sheet on farm
During a series of conferences on the    safety that points out that most of the
permissible exposure limits (PEL) for air   deaths and injuries on the farm are pre-


Surgeon General's Conference on Agricultural Safety and Health - 1991               475

OSHA Initiatives in Agricultural Safety and Health, May 3, 1991



Actions for the Future

ventable. It makes recommendations on
how injuries can be prevented. For exam-
ple, farmers are urged to read and follow
rhe instructions in equipment operator
manuals and on product labels.

The farmers are encouraged to conduct
routine inspections of equipment to de-
termine problems and potential failures
that might contribute to or cause an injury.
They are urged to conduct meetings with
employees and family members to assess
safety hazards, discuss potential injury
situations, and outline emergency proce-
dures.

There are also recommendations aimed at
reducing specific hazards, such as the dan-
ger of injury or death in tractor roll-over
or from moving machinery parts.

OSHA has participated in the National
Conference on Agricultural Safety and
Health of the W. K. Kellogg Foundation
that was held in January in San Diego. In
February, our national office staff held a
successful half-day meeting with represen-
tatives of the Equipment Manufacturers'
Institute and members of the American
Society of Agricultural Engineers to discuss
OSHA's present and future activities in
machine-guarding on farm equipment.

OSHA is considering the concept of target-
ed training grants for non-profit organiza-
tions to develop and to deliver training in
agricultural safety and health to large audi-
ences. The audiences, for example, might
include farmers, agricultural workers, and
children engaged in farm-related work.
There could be regional grants designed to
address agricultural hazards prevalent in a
particular area, as well as grants to nation-

al organizations for training and education
on a national scale.

OSHA has also participated in various
activities of the American Farm Bureau
Federation aimed at improving awareness.
For example, we had an OSHA booth at
the National Farm Bureau meeting in
Phoenix, Arizona, in January of this year.
Jerry Scannell took part in a panel discus-
sion of farm safety and health at that
meeting.

OSHA has recently appointed agricultural
outreach coordinators in each of our ten
regions. These coordinators will continue
to have other duties, but their agricultural-
outreach responsibilities will be a part of
their duties.

They will be the core occupational safety
and health field representatives, as agri-
cultural activities are explored and initi-
ated. These coordinators are being direct-
ed to work with local experts on agricultur-
al safety and health.

They will participate in regional meetings
and seminars to maintain a dialogue with
the agricultural workforce. I had the plea-
sure of meeting with a number of coordi-
nators last night and I can assure you that
they are excited about their work and
eager to work with you.

OSHA also held four conferences across
the United States in which we explained to
the agricultural conimunity why OSHA is
planning to apply its PELs for air contarni-
nants to agricultural worksites. The first
conference was held in January, in Phoe-
nix, and others were held in San Diego,
California, and in Louisville, Kentucky, in

476                                   Papers and Proceedings


March. They were all in conjunction with  May of this year. In July, we will be mak-
significant agricultural activities. We had a  ing a similar presentation to the American
large diversity of people at all of these    Farm Bureau at a meeting back here, in
conferences, and the feedback was very    Des Moines,
positive.

                   It also might be of interest to you that our
We are looking forward to publishing a   current proposal for a motor vehicle safety
proposed rule on PELs in agriculture in   standard, which calls for seat belt use and
September or October of this year. We   brief driver training for those who drive as
will probably be moving towards a final   part of their jobs, also would apply to the
rule about a year and a half from October  agricultural sector. Again, from the en-
or November. Again, we are going to    forcement perspective, we do not enforce
need your help to make sure that we have  on the small farms. Nonetheless, the rule
a good, common-sense approach.      is something that everybody should be
                         interested in.

We also held a two-day OSHA agriculture
training and coordination session in con-   In another area, a member of our staff has
nection with this conference, at the begin-  been comparing the new standard on
ning of the week. About 20 people of the  ROPS for tractors and other vehicles,
OSHA family attended the meeting, in-   which was adopted by the Society of Auto-
cluding all 10 of our newly-appointed    motive Engineers (SAE), to the existing
OSHA regional-outreach coordinators,    OSHA standard. We have received design
representatives of the state-plan states, and  and test data from American tractor manu-
our consultation program states.         facturers and others.

Among the topics discussed were the use   We have made a preliminary conclusion
of agricultural safety and health materials;  that the new SAE standard is equal to or
updates on recent activities by OSHA and  exceeds the current OSHA standard and,
other government agencies including     therefore, is acceptable to the agency. A
NIOSH, USDA, and HHS; and an update  final decision on this will be made shortly.
on the NCASH. Slide and speech modules  Hopefully, this will make it easier for
utilizing the material prepared by the    American farm equipment manufacturers
grantees are being distributed to the ten   to compete in the European market.
regions for use in agricultural-outreach
programs. We are expanding our contacts  As you can see, we are just getting started
with USDA on the state and local levels to  again in the important field of farm safety
increase outreach activities.        and health. We are making progress and
                   are committed to doing more in the future.

We will be making a presentation on the
agency's agricultural activities and the
regulatory process before a meeting of
Midwestern Plains States of the USDA
extension service in Columbus, Ohio, in

We will continue to place emphasis on
creating awareness of the need for im-
proved safety and health for those who
work on farms and on providing them with

OSHA lnltlatkres In Agricultural Safety and Health, May 3, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991               477


Actions for the Future

the necessary information to prevent
deaths and injuries.

To do this, we will need all of your help. I
reiterate that we must have an effective
partnership, which includes all of those in
this room, if we are to have any success in
our goal of removing agriculture from the
list of America's most hazardous occupa-
tions.

OSHA has learned a significant lesson
from the 1970's. Jerry Scannell, our Assis-
tant Secretary, and OSHA are committed

to moving OSHA forward again in occupa-
tional safety and health in the agricultural
community.

Let us do everything that we can to pre-
serve our human capital on America's
farms. Let us give the men and women
and their families working on the farms
our best efforts in safety and health.0

478

Papers and Proceedings


Surgeon General's Conference on AgricuHuraI Sat&y and Health
FAR&AFE 2000 o A National Coalition for Local Action
Conmmd by the National Institute for Occupational Safety and Health
April 30 - May 3, 1991, Des Moines, Iowa

SUSTAlNABLE AGRICULTURE AND SAFETY

   By willir R Ekm
Chairman, Minnesota Farmers' Union

Dr. Rice C. Leach: Our next speaker is Willis R. Eken of the Minnesota Farmers' Union. He was
elected President of the Minnesota Farmers' Union by the full board of directors in April, 1984, and
began serving his first term in August of that year. He has subsequently been re-elected in 1985,
1987, and 1989. He is a lifelong family farmer from Twin Valley, Minnesota, where he and his wife,
Betty, and their three sons raise small grains on their farm in the northwestern part of the state.  He
served seven terms in the Minnesota House of Representatives from 1970 to 1984. He was the
House Majorii Leader and a member of the House Agricultural Committee, House Taxes Committee,
and the Rules and Legislative Administration Committee. During his legislative career, Mr. Eken
initiated numerous bills that benefitted rural Minnesota, its farmers, and its communities. He has been
influential in the passage of legislation designed to help people begin farming, promote family-style
agriculture, provide for fair taxation, and promote many other items of importance to rural Minnesota.
As President of the Minnesota Farmers' Union, he is known for his work in putting together coalitions
that have worked for the preservation of the family farm as we know it today. I give you
Mr. Willis R. Eken:

I want to express the appreciation of our   The term "farm safety" includes the entire

National Farmers Union for giving us an
opportunity to take part in this forum at
your Surgeon General's Conference. Our
national president, Mr. Lee Swenson, has
been asked to appear in Washington, D.C.,
today to meet with a representative of the
agricultural community from the European
Community. He was therefore unable to
attend this meeting. So as a neighbor to
your north, he asked me to share our Na-
tional Farmers' Union comments with you
today.

Our organization has a long history of
working with farm safety issues and cer-
tainly a longstanding commitment to sus-
tainable agriculture as part of our family
farm structure in the United States. When
we talk about farm safety, we talk of some-
thing more than freedom from injuries.

workplace environment. It requires a close
look at other occupational hazards such as
increased risk of cancer and other diseases,
and concern for safe air to breathe and
water to drink and an atmosphere in which
the farmer is free to concentrate on the
tasks in front of him.

Farming is also, and always has been, a
risb business. But, as the National Safety
Council tells us, farmers today face a mul-
titude of workplace hazards that make our
industry among the most dangerous in the
country.

Our organization, also, thinks about
sustainability, the ability to continue an
activity over the long term. In agriculture
that means more than cutting down on
pesticides and farm chemical uses.

Surgeon General's Conference on Agricultural Safety and Health - 1991

479


Actions for the Future

It includes the availability and the appro-
priate use of all our resources including
soil, water, fertilizers, pesticides, the build-
ings on our farms, the animals, capital and
credit, and certainly, not last, the people
who are part of our agricultural communi-
ty. Simply put, where any of these factors
get out of kilter, that farming operation
may not be in business when we look 20
years down the road.

For the National Farmers' Union, sustain-
ability can be seen as a three-legged stool.
The first leg is the sustainability of family
farms. That has been the primary mission
of our Farmers' Union since 1902. We
advocate farm programs that support the
family farm system of agriculture rather
than those that would diminish the impor-
tance of that part of our agriculture-pro-
duction base.

The second leg is the sustainability of
natural resources such as soil, water, and
air. We strongly supported the last two
farm bills' conservation measures. We
have taken leadership roles on other envi-
ronmental statutes, such as the Clean Air
Act and the Clean Water Act. We have
also supported the research that attempts
to find safer and more effective uses for
chemical or non-chemical alternatives.

The third leg of the stool, the Farmers'
Union leg, is the sustainability of our rural
communities. Though few rural communi-
ties or areas are exclusively dependent on
agriculture anymore, a healthy agricultural
economy is still important to local busi-
nesses, churches, health-care facilities,
schools, and other of the towns' basic in-
frastructures, including our transportation
systems.

Today's agriculture is a different industry
than it was even 20 years ago. While some
of our safety concerns have been around
since "man" first tried to domesticate wild
animals and plants, others have come
along with new technology and new atti-
tudes in farming. A combination of tech-
nologies, government policies, global op-
portunities, and demographic changes have
made so-called mainstream agriculture
more concentrated, more monocultural,
and more reliant on labor-saving devices
and capital.

Let us start back in history. For the past
89 years, the National Farmers' Union has
represented the small-and medium-sized
family farm, a unit that some say no longer
has that same meaning in today's agricul-
ture. The longevity of the family farm in
agriculture is under some question.

Our quarter of a million members would
tend to disagree with that philosophy.
Most would admit that the full-time family
farmer has been under enormous pressures
to change in the last 20 years.

The rallying song of lenders, government,
land-grant colleges, and others in the late
1970's seemed to be "get big or get out."
Those of us who followed that message
and got used to the borrowing capabilities
we had to capitalize our farming opera-
tions got ourselves into extended debt and
went through some traumatic experiences
during the mid-1980's.

We now seem to be hearing a second verse
of this theme. I guess you would have to
identify it as one of getting a real job in
town to support your family hobby-your
family farming hobby, part-time farming.

480                                   Papers and Proceedings


Sustainable Agriculture and Safety, May 3, 1991

With these trends have come some new
and more complicated equipment, longer
hours in the fields and barn, and enormous
amounts of pressures and stress. All of
these factors lead to the American farmer
facing hours and hours of diligent work. It
is this stress that has led to a higher rate
of certain diseases and more frequent
injuries.

p First, we will talk about disease. Dis-
eases have always been a problem in rural
areas where access to health care, particu-
larly preventive health care, has not always
been as accessible or as available as it is in
our more urban centers. Some very dis-
turbing correlations are being drawn be-
tween modern agricultural practices and
diseases such as leukemia and stomach
cancer, to name two.

Research done by the National Cancer
Institute and others in Iowa and Nebraska
during the mid-19803 revealed a much
higher incidence of leukemia among corn
farmers than within the general population.
The risk of cancer in general has been
lowered among farmers and in the public
at large.

For some reason leukemia, including the
cancers of bone marrow, spleen, and lymph
nodes, was occurring 24 percent more
often with Iowa farmers than in the public
at large. The figures were even higher for
counties that grew predominantly corn or
were using high levels of insecticides.

b Certainly, when we look at injuries, they
appear to be on the rise in agriculture.
Yet statistics sometimes can be, possibly,
somewhat misleading.

On one hand, agriculture may be looking
much worse by comparison. Other indus-
tries in our communities, such as mining
and construction, have been steadily lower-
ing casualty rates as their unions and the
Occupational Safety and Health Adminis-
tration (OSHA) maintain pressures for
change. On the other hand, there seems
to be a lack of a coordinated system in
place for reporting or tracking agricultural
injuries, and the number of actual mishaps
may be worse than we sometimes realize.

I                       c

I would say that it is something of a
sham if the most effective tool for safer
environmental protection regarding
machinery is a lawsuit.  I

As we understand it, much of the equip-
ment manufactured for agriculture is out-
side the scope of OSHA and the Consum-
er Products Safety Commission. Equip-
ment is getting ever more complex, and
there are no mandatory safety standards in
place. There are only the voluntary efforts
of the American Society of Agricultural
Engineers.

I will not go into the political pros and
cons of regulating farm equipment. First
of all, there is not time. Second, our orga-
nization does not have a formal policy
position on this issue.

I would say that it is something of a sham
if the most effective tool for safer environ-
mental protection regarding machinery is a
lawsuit. The time and expense of litigation
are hard to justify as a sustainable use of
our resources.

Surgeon General's Conference on Agricultural Safety and Health - 1991

481


Actions for the Future

The possibility of suits may keep manu-
facturers from voluntarily improving their
products. The improvement is an admis-
sion that the old product is unsafe to use.

Farmers certainly must accept their share
of responsibility for farm injuries. There
are farmers who remove protective shields
and other safety measures that get in their
way as they use or repair a machine. Un-
like most factory machinery, most farm
equipment will still run without the safety
features in place.

There are farmers who cannot afford to
hire extra help. They simply push them-
selves too hard or rely on their children of
all ages to pick up the extra chores.

One extension agent in a state is not
going to reach everyone necessary to
solve the problem.   I

What seems like the most economical
choice at the time, all too often turns out
to be very costly in terms of medical bills,
the loss of limbs, and sometimes even the
loss of life.

What can we do about this sustainability
and the safety factors involved in agricul-
ture? When it comes down to it, we be-
lieve that safety and sustainability are
interchangeable.

You cannot have one without the other.
There are several areas where more can
be done. The National Farmers' Union
would like to take part in working with you
in these areas.

o Number 1, we believe there must be
some changes in basic agricultural farm
policy. We need to have government pro-
grams that allow a farmer to make a living
on the farm through the marketplace with
some protection in that marketplace
though our farm policies and our farm
programs.

o Number 2, we must insist on more re-
search in farmer education on farm safety
through USDA, through the land-grant
university system, through the private sec-
tor, through OSHA, with education, and
others. We can, working together, do a
better job.

One extension agent in a state is not going
to reach everyone necessary to solve the
problem. Raising the level of awareness of
farm safety problems and making neces-
sary changes in equipment, attitudes, and
behavior must be a team effort.

o Number 3, we must recognize the nega-
tive impacts of concentration in food pro-
duction and processing on the
sustainability of farmers, our natural re-
sources, and our rural communities. Con-
centration has been the trend in many
sectors of our economy over the last 10
years, especially in agriculture. The inde-
pendent owner-operator should not be-
come a relic of the past, whether we are
raising hogs or feeding cattle. Production
and processing are both necessary to the
rural community as a balance of other
resources.

The megafeedlots that are mushrooming in
some states do not buy their feed or other
supplies from local suppliers. Instead, they
will likely bring it in by the truckload or

482

Papers and Proceedings


trainload from another subsidiary feed    Alternative pest control methods must be
company somewhere else.          fully funded.

Too often the community's only in-
volvement, other than a few hired hands, is
in dealing with the waste management
problems caused by many animals in too
small a space. The community must deal
with underemployment caused by running
independent operators out of business.

o Number 6, USDA should fully utilize the
integrated farm management program
options that were created in the 1990
Farm Bill. Here, again, I think we are
going to have a major conceptual change
of our agricultural base. Now we have
gone through a period of more concentra-
tion and specialization in farming.

o Number 4, we must insist on the af-
fordability of quality health care in our
communities. This is one of the most
serious issues facing our rural residents.

Consider the cost and the accessibility of
health insurance coverage. We hear from
our members of instances of $400 to $500
to $600 per month in family health insur-
ance cost coverages, which is diminishing
the opportunity for many of our farm fami-
lies to participate in the private insurance
field.

For example, look at our poultry industry.
In this country it is vertically integrated.
On our farm we have gone out of live-
stock. We are now a cash-crop farming
operation. We have specialized in the
area of our own operation on our own
farm.

What are the barriers to going to a more
sustainable, diversified agriculture? I think
they are in the marketplace.

I saw some statistics recently that indicat-
ed, again, the lack of numbers in terms of
health provider, personnel, in our rural
communities as compared to the per capita
availability of medical resources in more
urban areas. Problems are facing our rural
small hospitals in terms of being able to
have the financial base to continue to
provide health care access for our rural
members.

I believe on our farm, for example, if we
are going to move off a two-year rotation,
which we are primarily in now, between
cereal grains and row crops. We are going
to have to look at using less chemicals and
less commercial fertilizers.

o Number 5, the Congress needs to look at
and fund the re-authorization of the pesti-
cides effort and give the EPA the tools to
complete the re-registration of older pesti-
cides on time. In addition, funding needs
to be there to look at safer pesticides.

We are going to have to look at a longer
rotation process of our crops. Ideally, we
should be looking at a six-year rotation
instead of a two-year rotation. A six-year
rotation would have to include legumes.

We would have to include one year of a
later-planted crop to deal with weed con-
trol. We would have to do with one year
of having a fall-planted crop on our farm.

Sustainable Agriculture and Safety, May 3, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991

483


Actions for the Future

As we look at that kind of a rotation, we
are going to move back towards a more
diversified agriculture. Then, on our farm,
we would be able to have some livestock
as part of that operation to utilize some of
the crops we grow.

What is the biggest inhibitor to making the
change? First of all, economics.

We do not have much of a margin on the
farm anymore. We are into an operation
where we are hesitant to take the risk to
change whatever might diminish that in-
come.

Secondly, it ties back to the marketplace,
in terms of the crops we raise. The crops
that we can raise that are most profitable
in the marketplace do not necessarily fit
into that five- or six- or seven-year rota-
tion.

o Number 7, we must establish a better
reporting system to generate data on farm

safety for both injury and disease correla-
tion. Perhaps this can be done within the
existing USDA agencies such as the Agri-
cultural Statistics Service.

Perhaps we could build on the restricted-
use pesticide record-keeping requirements
found in the Farm Bill. We could even
add health and safety questions to the
agricultural census form.

o Number 8, most importantly, we believe,
we must keep the pressure on the Con-
gress, the equipment manufacturers, and
farmers themselves on the need for a sus-
tainable, healthy American agriculture.
We believe that family farm agriculture
has been a real strength to this country in
terms of producing high quality food at the
lowest cost to the consumers. We look
forward to working with you in a coalition
effort to enhance the sustainability and the
safety of family farm agriculture.0

484

Papers and Proceedings


Sugeon Qensral's Conr29rence on Agrkuttural Sahvty and He&h
FARMSAH 2OOQ o A National CoalMoon for Local A&on
Conwned by the National lnsthto rbr OccupatIonal Safivty and Hem
April 30 - May 3, 199 1, Des Moines, lowa

THE FARM BUREAU'S CONTINUING COMMiTMENT

  By Merlin Plagge
President, Iowa Farm Bureau

Dr. Rice C. Leach: Our next speaker is Merlin Plagge who is serving in his second term as President
of the Iowa Farm Bureau Federation, which Is the state's largest general farm organization. Mr.
Plagge was elected as its president in 1987 and again In 1989. In 1990, he was elected as a midwest
representative to the American Farm Bureau Federation's Board of Directors. As a member of that
board, he sewes on its trade advisory committee and has been appointed by the Secretary of
Agriculture and the U.S. Trade Representative to serve on the U.S. Agricultural Technical Advisory
Committee for trade in oil seeds. On the state level, he serves on the Wallace Technology Transfer
Foundation and on the Boards of Directors for both Blue Cross of Iowa and the Health Policy
Corporation of Iowa. Prior to being president of the Iowa Farm Bureau, he served six years on the
Farm Bureau Board as a District Director for North Central Iowa. His involvement in the Farm Bureau
stretches back to 1958 when he joined the Cerro Gordo County Farm Bureau. At the county level, he
was actively involved and held several leadership positions. Merlin and hls wife, Shirley, are active in
the First United Methodist Church In Sheffield, where he and his son and his wife farm a thousand
acres. The two families run a grain and livestock operation and, In ail, three of the four children in his
family are Involved in agriculture. Mr. Plagge will talk about the Farm Bureau's continuing commit-
ment. Mr. Plagge:

For more than 70 years, one of the Farm
Bureau's major goals has been to improve
the quality of rural life. One of the best
ways to accomplish this goal has been to
reduce the injury rate and to help farmers
make their workplace safe.

The Farm Bureau has been involved with
farm safety activities since the 1940's.
There are few other jobs where the entire
family lives on the worksite and are ex-
posed (24 hours of every day) to the same
occupational hazards as the farmer.

Although we are seeing larger farming
operations, most farms are still family
operations. For this reason, it has always
been difficult to determine if an injury on
the farm is, or should be, classed as an

realize that every injury that occurs on a
farm is not necessarily an occupational
injury.

Farmers believe that safety begins with
each individual. That is why many state
Farm Bureaus have vigorous, active safety
education programs. All farmers want to
be safe and for their families to be safe.
In the Farm Bureau, we are committed to
help them attain that goal.

For many years, the American Farm Bu-
reau and state Farm Bureaus have been
involved in cooperative farm safety activi-
ties with land grant colleges and universi-
ties, the Extension Service, the National
Safety Council, the National Institute for
Farm Safety, Inc., state and local safety

occupational, recreational, home, industri-  councils and committees, and national and
al, or transportation injury. We must all   state 4-H, and FFA programs.

Surgeon General's Conference on Agricultural Safety and Health - 1991

485


Actions for the Future

These ongoing efforts have paid great
safety dividends to the farmer and to farm
families. But it is not enough.

As farmers, we do not relish the distinction
of being considered the nation's most haz-
ardous occupation. Therefore, through
continued individual efforts and coopera-
tion with other institutions, organizations,
and agencies, the Farm Bureau will strive
to promote farm safety and rural injury
prevention.

I                     c

Farmers believe that safety begins with
each individual.    I

Through all of our combined efforts, we
have lowered the numbers of farm fatal-
ities and injuries. Yes, we are all con-
cerned with numbers, but we must relate
directly to family members, neighbors, and
our friends and the numbers that they
represent.

There is not only the emotional loss of a
loved one or friend to be considered, but
the economic impact of a serious injury or
fatality to the farm family. This can be
devastating.

Medical expenses are out of sight. Health
spending will overtake Social Security as
the biggest item in the Federal budget by
the turn of the century.

Rural health is a major concern to farmers
now whether considering quality, availabili-
ty, or cost. The Iowa Farm Bureau will
continue to address this issue with a strong
effort.

Obviously, reducing injuries will, not only
reduce a family's medical expenses, but
alleviate the emotional and economic crisis
that follows an injury. Farm fatalities have
been declining in recent years, but not as
fast as deaths from injury in other indus-
tries.

Since 1950, industry in America has re-
duced the occupational death rate by two-
thirds. Farm deaths from injury have de-
creased by about 16 percent in the past 40
years. That time frame is a bit unfair for
comparison. Between 1950 and 1970 farm-
ers were buying and using more equip-
ment, and deaths from injury were increas-
ing.

But farms have become safer since 1970.
why?

I believe several factors have strongly
influenced farm safety in recent years. In
1968, the Congress passed and the Depart-
ment of Labor issued what is known as the
"the hazardous work orders for youth un-
der 16 in agriculture."

These work orders restrict young people
under 16 years of age from being hired to
perform what are considered to be high-
risk jobs on the farm. While there are
certain exceptions, which involve training
and family exemptions in these orders,
attention was drawn to farm safety for
youth.

In 1970, the Occupational Safety and
Health Administration (OSHA) was creat-
ed. OSHA has had a more direct impact
on reducing injuries and fatalities in other
industries. However, their indirect impact
on agriculture is unquestionable. Even

486

Papers and Proceedings


though they have been prohibited by the
Congress from enforcing their rules on
agricultural operations with 10 or fewer

al average for a group that size would be
five deaths.

employees, knowing they exist has encour-  I do not presume to know all of the an-
aged farmers to work for safer farmsteads.  swers to our agricultural safety and health
                   problems. I do know that university exten-
Due to engineering advances in the last   sion safety specialists and our Farm Bu-
three decades, farm equipment manufac-
turers have incorporated more safety de-   reau safety personnel across this country
                   a.re continuing to prevent farm injuries
vices on their equipment. Integral rotary   through ongoing educational efforts.
shields for power take-off shafts and roll-
over protective structures for tractors have  Many of our state Farm Bureaus conduct a
been two major accomplishments in mak-  wide array of projects and educational
ing farm machinery more user-safe.     programs that address safety and health
                    issues. Presentations are made and pro-
Since tractor roll-overs are involved in a   grams presented at both elementary and
large portion of agricultural fatalities, elim-  high schools, organizational meetings on
ination of this type of incident alone would  the job site or farmstead, and wherever
cause the death rate on American farms to  they are requested. The topics, to name a
plunge. But farmers themselves must    few, are traffic safety, bicycle safety, tractor
make the commitment to run a safe opera-  and machinery safety, chemical safety,
tion.                   chain saw safety, firearm safety, child care
                   safety, all-terrain-vehicle (ATV) safety,
                     first aid, CPR, and wellness.
Even though they have been prohibited
by the Congress from enforcing their     In Iowa last year we funded the develop-
rules on agricultural operations with 10
or fewer employees, knowing they exist    ment of two tractor safety instruction pro-

has encouraged farmers to work for     grams for 4-H youth that produced seven

safer farmsteads.             up-to-date farming videos and two popular
                   hands-on displays. It is important to make
                   farm youth fully aware of potential danger-
                         ous situations on the farm.

The Farm Bureau's Continuing Commitment, May 3, 1991

When they see the dangers and learn the
advantage, safety happens. In Nebraska,   In addition to safety presentations, other
for example, university safety experts have  programs the Farm Bureau has been active
conducted 450 tractor roll-over demonstra-  in are promotion of the slow-moving vehi-
tions since 1970 to convince farmers of the  cle emblem. Recently, through the efforts
dangers.                  of our Farm Bureau women, more than
                   5,000 slow-moving replacement emblems

About 23,000 young people were trained in  have been sent to counties.
tractor safety. There have been two
known fatalities in this group. The nation-  Over 20,000 respiration-hazard education
                    materials have been circulated and pesti-

Surgeon General's Conference on Agricultural Safety and Health - 1991               487


Actions for the Future

tide handling protection kits have been
distributed. Also, 52 counties participated
in a farm and home safety checklist pro-
gram where members surveyed their
homes and farms for safety concerns and
corrected problems.

There has also been development of solid
waste disposal information materials; a
safe on-farm water supply project; distribu-
tion of a safety-practices checklist for farm-
ers, and development and distribution of
safety decals on various hazards.

These decals are now on the grain bins.
Some say: "extra riders, lock it and block
it or don't get under it, and don't jump
start."

In addition, many state Farm Bureaus have
audiovisual libraries with educational safe-
ty and health films, slide sets, and videos.
These materials are available on a free
loan basis.

As I said earlier, farmers themselves must
make a commitment to run a safe opera-
tion but they also need some educational
programs. To the extent that we can in-
volve farmers in developing those educa-
tional programs, the more on target and
successful we will be.

I would leave you today with this thought
- agricultural safety and health are very
important issues to today's farmer and
every farm family. They know that their
livelihood depends on being both safe and
healthy. Your presence here at this con-
ference not only shows your interest and
concern for their well being but illustrates
their importance in today's society.

Thank you for inviting Farm Bureau's
participation in this conference.0

488

Papers and Proceedings


Surgeon General's Contimnce on Agticuttural Safety and Health
FARMSAFE 2000 o A National Coalition for Local Action
Convened by the National institute for Occupational Safety and Health
April 30 - May 3, 1991, Des Moines, Iowa

A VICTIM'S PERSPECTIVE OF THE CONFERENCE

   By Marilyn Adam
President, Farm Safety for "Just Kids"

Dr. Rice C. Leach: Our next speaker has a name everyone knows and certainly will know after this
morning, Marilyn Adams. We have had a lot of people talk about what things are like and what might
happen, but we have the opportunity and the honor to hear from someone who has been on the
playing field for real. Ms. Adams is the leader of a group called Farm Safety for "Just Kids," in
Earlham, Iowa, which I learned is just about 30 miles west of here. In the fall of 1986, Ms. Adams'
eleven-year-old son, Keith, was killed in an accident on the family's Iowa farm. One year after her
son's death, Ms. Adams, realizing that not enough was being done about farm safety, began a
campaign to promote education and awareness, initially by the distribution of danger decals for
gravity wagons through the local FFA chapters. Recognizing the consuming public demand for farm
safety awareness, she formed Farm Safety for Just Kids in October of 1987. They have only three
employees, and the response from people nationwide is overwhelming. Mail and phone calls come
from all over the United States and Canada and are received daily for farm safety information and
merchandise available from the office. Materials available for sale include videos, color books,
decals, T-shirts, hand-out materials, and other miscellaneous items. Farm Safety for "Just Kids" also
compiles and sends out newsletters quarterly. I have a quote from Ms. Adams, but we have
something better than the quote, we have the real thing. I give you Marilyn Adams:

Wayne Sprick asked the question, "What
can we do to shift the risks as they relate
to safety, or better yet, reduce that risk?" I
think the most important point he made
while answering that question was, "Service
types of projects that serve the communi-
ty."

The farmers are the ones who benefit from
these programs in the reduction of injuries.
We all need to look at community service
programs that we can produce and utilize
the youth to serve the communities.

The young people do not have enough
materials to promote farm safety and add
to their programs. If you were to finan-
cially support the vocational student orga-
nizations sufficiently and ask for their
assistance on the community level, it would
be to everybody's benefit.

My experience with the youth tells me that
they are our best bridge to the farm family.
If you take this one step further and train
farm women in tractor safety, chemical
safety, rescue, and the other aspects of
farming along with the youth, Dad and
Grandpa will not have a chance after we
start rocking the boat and making waves.
Another comment I heard from Wayne
was, "Farmers listen to other farmers and
the most effective learning is when there is
activity involved."

We have heard throughout the conference
that children are at very high risk. Yet
there are low numbers of farmers and
youth here at the conference.

Bob Aherin said something about roll-over
protection standards (ROPS) that really
interested me. He said to identify the

Surgeon General's Conference on Agricultural Safety and Health - 1991               489


Actions for the Future

farmers with high risk exposure and to
identify appropriate intervention strategies.

As a farmer, this makes much more sense
to me than suggesting that all farmers
should put ROPS on all tractors. We need
to start somewhere and give the farmer a
realistic picture of the high-risk exposure
with all tractors with end loaders or what-
ever the highest risk is.

My experience with the youth tells me
that they are our best bridge to the farm
family. If you take this one step further
and train farm women in tractor safety,
chemical safety, rescue, and the other
aspects of farming along with the youth,
Dad and Grandpa will not have a
chance after we start rocking the boat
and making waves.

I heard Wes Buchele address the issue of
retrofits. By all means, guarding for the
older equipment needs to be made accessi-
ble and marketed.

It is my personal feeling that dealers
should not resell equipment without all
protective shields. They have a respon-
sibility to their customers to market the
proper shielding for their own products.

I heard talk about child abuse and pros-
ecution of parents. This topic created a lot
of discussion in the halls, and I think it was
intended to do this. One of the concerns I
heard on this topic was, If that happens,
where do you draw the line?

The scenario I can put together from the
comments I heard is: If you prosecute the

father of the child that was identified on
the news as "Seat Belt Murder," then the
farmer, where do you draw the line and
when does it stop ? Do we also prosecute
the parents of the children that O.D., do
not wear bike helmets, drown, become
underage drinkers and take drugs, or the
parents of young kids home alone, or
whose babies get frostbite and severe sun-
burns? Where does it start and stop?
"Neglect" contributes to all of these.

Other things I heard in discussion were
that we need more representation from the
general farm production people here at the
conference, more interaction and group
discussion in the sessions, greater represen-
tation from agricultural support companies,
discussion of the economic realities of
farming, more emphasis on real-life solu-
tions, and information about how to get
the research from universities to applica-
tions in the field and to the farmer.

One of the things I found interesting was
the discussions concerning chemicals, child
labor, and migrant labor. I have little
exposure to these issues that are in Cali-
fornia and Washington and other states.

I was hoping to hear more quoted evi-
dence of what is happening with the mi-
grant workers. I still have some questions
unanswered.

I am not ciear whether the young children
are being hired to work these fields or if
the parents are taking the risk by taking
them to the fields to work for them. I am
also not clear on the chemical use. It
sounds to me like there is a lot of misuse
of chemicals.

490

Papers and Proceedings


That is not clear in my mind at all. I    having ownership of their ideas, we would
would really like to know more facts about  all take advantage from sharing our suc-
this issue.                cess stories along with the stumbling
                          blocks.

Most importantly, it is my personal opinion
that, second to Dr. Novello, the very best   A second component to this is that all
presenter we had at this conference who   groups who attend should sponsor farmers,
summed it up was our 19-year-old Mark   youth, or both to participate. What better
Timm, National President of FFA.  He    team could we have? One of the ideas
said "America needs youth; youth need    that Dr. Novello and others kept referring
adult help, support, guidance, and leader-   to is, "If you build it, they will come."
ship." It was phenomenal!

                   We did that and it worked. I am looking
Every speaker identified youth as part of   forward to our follow-up conference.
the solution. The 4-H, FFA, and the other
vocational youth organizations have limited  Dr. Novello gave the most heart-warming
funding. You ALL need to consider incen-  introduction to our conference. Something
tive grants that are paired with adult and   she said that keeps coming back to me is,
youth organizations.             "The kids don't have a voice, and the kids
                          don't have a vote." Since I am here to

I also heard a great desire to have another  represent the kids on the family farm, I
Surgeon General's Conference on Agricul-  was asked to share a special message
tural Safety and Health. I would like to   brought to you by the kids. I would also
challenge you to consider the next confer-  like to take you for a tour out on a typical
ence having a different focus.        Midwest family farm.

I have been to many conferences since I    [A Video-Tape entitled "Kids Talk
attended the last one here in Des Moines   Farm Safety Stuff' was shown.]
that was the beginning of my full-time
career in agricultural safety and health.   I will close with an invitation for you to
We have identified a definite problem and  become a member of our organization,
everyone has their own agenda.       join our networking system, and help us
                    close some of these gaps. Jot down my

This conference, by far, has been the best
one I have attended. I look back at what
has been accomplished in the last few
years. I would like to see people share
their experiences with each other and all
of us go home with outlines of other pro-
grams to implement in our communities.

address, and remember it is in your ad-
dress book from the conference. I have
three employees besides myself and an
answering machine.

One final thought, I want each one of you
to remember who is running this show. If
you "let go and let God," it works. With

I expect a lot more will be accomplished in
the next few years. Rather than everyone  that, I want to thank you all for coming.
                    Have a safe trip, and God bless you.0

A Victim's Perspective of the Conference, May 3, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991               491


Surgeon General's Conference on Agricultural Safety and Health
FARMSAFE 2000 o A National Coalition for Local Action
Convened by the National Institute for Occupational Safety and Health
April 30 - May 3, 1991, Des Moines, Iowa

CONFERENCE SUMMARY

   By Rice C. Leach, MD.
Chief of Staff, Office of the Surgeon General

Ms. Adams. Do not run off. You are one
terrific person. I am glad I met you. This
plaque is from the Public Health Service
and everyone here. It is with deep appre-
ciation to Marilyn Adams, Farm Safety for
"Just Kids," for her contributions to agricul-
tural safety and health.

Thank you for the opportunity to partici-
pate in this landmark meeting. On behalf
of Dr. Novello, I want to thank everyone
who made this possible and to congratulate
everyone who contributed to the informa-
tion base.

BACKGROUND

Everyone so far has told about his or her
relationship with the farm, and most have
described long standing relationships. I
too have a reason for being here, but it is
not directly related to farming. In fact, my
relationship to farming was short lived.

I grew up in Lexington Kentucky and
worked one week on a thoroughbred race
horse farm. During that week I learned
very quickly that one does not hold the
pitch fork directly above one's head while
shaking out a stall and loading the spread-
er. I learned early on that farming was not
my strong point.

I do however have some saving graces.
First, I still drive the 1966 International
Harvester six cylinder half-ton pick-up

492

truck that I bought when I graduated from
medical school. Second, I spent most of
my career managing health care delivery
systems in the Indian Health Service. In
those assignments I had to pursue the
goals and objectives of the organization in
an environment of constant change...

b Changing technology-New risks.
b Changing labor supply-As the doctors
left.

b Changing funding-Usually less.
b Changing customer expectations -

They wanted more.

Does this sound familiar? It should be-
cause it is similar to the kinds of change
that we have heard about at this meet-
ing-a changing technology with more pesti-
cides, a changing labor supply as the doc-
tors and others leave, a changing economy
as farm profits drop, and changing de-
mands as the population changes.

Working with Indian people provided a
view of life that has served me well as a
manager in a constantly changing world.

The last three days have demonstrated
clearly that the assignment for us is to
determine how to change for the better in
a constantly changing world. As part of
that, Dr. Novello charged us to raise the
consciousness of the public and alert com-
munity leaders about critical issues, build
coalitions among the health, education,

Papers and Proceedings


Conference Summary, May 3, 1991

environmental, labor, and agricultural com-
munities; disseminate the appropriate
information; and encourage action to pre-
vent injuries.

The reports from the concurrent sessions
have provided information on what is
known and what needs to be done about
surveillance, chemical and biologic haz-
ards, mechanical and physical hazards,
worker protection from environmental
hazards, and safe behaviors among adults
and children.

So where do we go from here? We need
to document what happened by publishing
the Proceedings of the Surgeon General's
Conference on Agriculture Safety and
Health, we need to publish the Surgeon
General's Reporf on Agricultural Safety and
Health, and we need to reconvene after an
appropriate time to plan strategy and
assess our progress.

MANAGING CHANGE

What about the time in between? I Sub-
mit that we need to begin to manage
change.

Let me return to my experiences with
Indian people for a minute. I am certain
that many of you saw Kevin Kostner's
other movie, Dances with Wolves. He did a
beautiful job of portraying the intimate
relationship between Indian people and
mother earth.

Most of the over 25 tribes with which I
have been associated over the years have
said in one way or another that their pur-
pose in life is to live in harmony with na-
ture and that the

So I submit that the purpose of this
endeavor or our mission is to prepare
the next generation to live in harmony
with nature.   I

most important activity is to prepare the
next generation. All through the week I
have been struck with the similarity be-
tween those statements and our discussions
of the need to educate people, protect
children, and prevent injuries with regard
to farm safety.

After all, how can you prepare the next
generation to live in harmony with nature
if you do not protect it from poisoning,
cancer, trauma, and premature death. So I
submit that the purpose of this endeavor
or our mission is to prepare the next gen-
eration to live in harmony with nature.

There are several elements to this mission
but the one most closely linked to the
National Institute for Occupational Safety
and Health is to enhance normal growth
and development by reducing or eliminat-
ing environmental hazards.

To respond to the mission element re-
quires setting objectives, which if obtained
will reduce or eliminate the environmental
hazards and enhance normal growth and
development. The concurrent sessions
have again provided information on the
magnitude of the opportunities for inter-
vention and change.

Each of us can set our own individual
objectives but better yet, we can respond
to Dr. Novello's charge to build coalitions
among ourselves to set the appropriate

Surgeon General's Conference on Agricultural Safety and Health - 1991

493


Actions for the Future

national, state, regional, local, and yes,
family objectives. I heard one presenter
say that her family was going to buy the
roll-over protective device for their tractor.
I encourage her to follow through on this
commitment.

It sounds easy, just get some information,
think about it, set some objectives, and
plan how to meet them. It would be easy
if it were not for the constraints placed on
us by the rest of the world.

For example, time was when 70 percent of
the population lived on the farm. Now 70
percent of the population lives within 100
miles of the seacoast. That means that
political power and economic clout is con-
centrated within 100 miles of the coast and
not on the farm. And that means that
people in rural america are going to have
to find new ways to raise awareness and
build coalitions to help them.

Time also was when the profits from in-
vestment in farming stayed in town, in the
county, in the state, or at least in the coun-
try. We are still an economy that allocates
scarce resources based on capitalism, but
the market place has left the farming com-
munity and has become the world. The
profits are not as likely to be in the local
bank to be loaned or in the local tax base
to be invested in schools, roads, and health
care.

To me this means that rural communities
are going to have to develop new ways to
influence the market place.

So we are back to change. I want to share
some personal observations of organiza-
tional and individual behavioral change

and the reasons I think they occurred. I
beg the indulgence of the scientists in the
audience because I am going to use some
anecdotes to develop the points. I know
that anecdotes are not good science, but
they are what constitutes a large part of
the management literature.

I once asked a well known professor from
the Wharton Business School how he could
justify using anecdotes instead of hard
scientific data and he replied:

First, its difficult to do well controlled
double blind studies on human and
organizational behavior and second,
people pay a lot of money to hear my
anecdotes... That is enough for me to
validate the worth of what I say.

Twenty-five years ago I was assigned to
Tuba City on the Navajo reservation and
was put in charge of the TE3 clinic. We
were lucky if we could get 15 people to
come to clinic-partly because all we were
seeing was TB patients, and even more
importantly the treatment standard re-
quired that people with TB go to the sani-
torium in Albuquerque.

This usually meant that the husband or
wife was gone for nearly a year during
which time all kinds of counterproductive
things occurred such as selling all the
sheep to go drinking. This situation result-
ed in dead tubercle bacilli and dysfunction-
al families. The Navajo people, being
quite intelligent, avoided the clinic in
droves.

When I left two years later we had 100
people a month in clinic each month and

494                                   Papers and Proceedings


had to open a second session. What hap-  wealth of new ways of viewing the world to
pened? We gave them what they wanted.   this life.

b First, we agreed to treat the patients at
home and not send them to the sanitorium
if they would take their medicines and
come to clinic.

b Second, we allowed the clinic to function
more like a drugstore. If they needed
cough medicine for grandmother, we got
her chart and wrote the prescription. If
they needed a refill on their birth control
pills, we gave them a one month supply,
and if they needed something for the baby,
we did that too. We wanted to know about
TB, and they wanted service. It was a
win-win.

One of them is that she never misses bus-
ses or planes--she says that the bus left her.
Several years ago we moved from a little
town in Oklahoma to Phoenix, Arizona,
which among other things is known for its
frequent left turn automobile wrecks.
After three years and three sets of fenders
for my cars and those belonging to other
people, I was continuing to tell her to stop
hitting the cars and trees (she got one of
them too). She kept saying that she was
not hitting them, they were hitting her.

In the early 1980's I tried to convince the
staff at the Phoenix Indian Medical Center
to stop smoking and make the facility 100
percent smoke free. We were going to
give people six weeks to change and go
smoke free on the first of October. In the
ensuing six weeks the staff became so
polarized over the issue that imposing a
non-smoking policy would have split the
hospital so I backed down, but I did not
stop the push for non-smoking.

Finally it dawned on me to ask her to do
whatever she could to keep the cars and
trees from hitting her. She has developed
the most incredible series of right turns
and alternate routes you ever see, but she
has had no more accidents, and you know
what, I have noticed that if you pay real
close attention, you can see a tree move
every now and then. The point is that you
have to have faith.

I personally asked the smokers to stop, and
I consulted with them about how we
should manage the program. Over time
smoking diminished, and after four years,
the union proposed making the facility 100
percent smoke free as part of contract
negotiations. The union made the request.
Think about what that means in terms of
organizational change.

On a personal basis, I had several bouts of
atria1 fibrillation in the 1970's and early
1980's.  For the non-clinical types, atria1
fibrillation is to the heart what a loose
distributor cap is to a gasoline engine; it
just goes bobbity, bobbity, bobbity. I
learned that alcohol, and not much of it,
was causing the problem so I stopped
drinking. What was my motivation?

I mentioned my wife earlier. She is from
Guatemala, Central America and brings a

It was not fear of death because I would
be gone. No, it was fear of an internist
with two shiny paddles coming at my chest
with the defibrillator that motivated me.
No way was I going to contribute to im-
proving the chances that one of my col-

Conference Summary, May 3, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991

495


Actions for the Future

leagues would come at me with one of
those devices.

Finally, there is an example from the Har-
vard Business Review. Do you remember
how many fine German and American
cameras were on the shelves of camera
stores in the 1950's and 1960's? Do you
see them now? No.

What happened is that the Japanese sent
their engineers to U.S. camera stores to
learn what people buying cameras really
wanted. Once they learned, they went
home and built it for them. The rest is
history.

The point is that if you are going to stimu-
late change, you can make a lot more
headway if you do it the customer's way.
Find out what motivates a person or group
and meet them halfway, and you are half-
way there. For us, it means involving the
farmers and their representatives as we
determine the requirements and as we
design the system.

PERSONAL OBSERVATIONS ON NE-
GOTIATING REQUIREMENTS

o Go for the win-win.

o Remember that some change takes a
long time.

o Strike while the iron is hot.

o Do not try to swallow the whole horse
at the same time. Break the job down
into manageable components.

o Find the real leaders, and play to their
strengths.

Senator Harkin was like a breath of cool
fresh air on a humid day when he spoke
about health issues the other day. When
you have someone as enlightened as he is,
play to his strengths and feed him as much
as you can on health issues.

Remember the women. Throughout the
ages, the women seem to be the ones that
make the big social changes begirming with
the Greek women who threw the men out
of town until they agreed to stop going to
war all the time.

It was Mother Teresa and not Father Ter-
ry that started picking up the helpless in
India, it was the league of women vot-
ers-not men voters, it was Dorothy Dix
and not Tom Mix that reformed care for
the mentally handicapped, and it was
Mothers Against Drunk Driving-not the
fathers. And I am quite sure that we have
another name to add to the list in Marilyn
Adams who has founded Farm Safety for
"Just Kids."

The Surgeon General charged us to raise
consciousness, and we are talking about
several different age groups. To reach
children, what about the "Nintendo Pesti-
cide Game" or the "Teenage Mutant Ninja
Farmworker." Or for adolescents, what
about "Doobie Howser does Iowa." And
for adults, "Radar Reilly Comes Home."

I am serious about riding the wave of
other's popularity. Can you imagine the
impact of a Saturday morning cartoon on
farm safety or a major network doing a
teenage physician show that acknowledges
agricultural health and safety issues?

496

Papers and Proceedings


Conference Summary, May 3, 1991

We are to disseminate information. What
about Junior and Senior high school class-
es that give academic credit for combined
driving education or tractor education. We
give credit for automobile driver educa-
tion.

What about high school biology credit for
Pesticides One and Pesticides Two. In
talking to the FFA students yesterday, I
learned that they generally have to go
somewhere outside high school to get this
information.

Building coalitions: others will have to
make recommendations on this but in
encouraging action, we can use the tools
available to make change in the political,

economic, and health environment. We
can work in a way that allows those who
currently stand in opposition to save face
and join later on.

In summary, we have been challenged to
build a system whose planning, operations,
evaluation, monitoring, and standards will
reduce hazards and enhance normal
growth and development so we can live in
harmony with nature. Building this system
must involve its joint owners in its design
so their varying expectations and require-
ments can be met.

To paraphrase the Surgeon General and
others who have spoken before, if we build
it, success will come. Thank you.0

Surgeon General's Conference on Agricultural Safety and Health - 1991

497


Surgeon General's Conference on Agricultural Safety and Health
FARMSAFE 2000 o A National Coalition for Local Action
Convened by the National Institute for Occupational Safety and Health
April 30 - May 3, 1991, Des Moines, Iowa

POSTER ABSTRACTS

The purpose of the Conference was to raise consciousness! build coalitions, disseminate
information, and encourage action to prevent injury and disease in agriculture. To help
in fulfilling this purpose the planners of the Conference saw that an opportunity for
networking among its participants should be an important aspect of the meeting. An
opportunity was provided through a poster session.

This session, entitled Making Connections, included posters from research organizations,
governmental and volunteer programs, and individuals as well as a presentation of FFA
posters and video tapes. Moreover, 4-H clubs participated with presentations of songs
and skits during this session to emphasize the youth aspect of agricultural safety and
health.

Figure 1. States from Where Posters Were Presented at the Surgeon GenerGk Conference
on Agricultural Safety and Health (exclusive of FFA Posters).

Other than the FFA posters, 95 posters from 20 states were presented at the Conference.
These posters addressed a variety of programs in surveillance, research, and intervention,
and abstracts of these presentations are provided in the following pages.

498                                   Papers and Proceedings


Poster Abstracts, May 2, 1991

PLAN FOR ARIZONA AGRICULTURAL HEALTH
      PROMOTIONAL SYSTEM

  By Lance Fluegel, B.S.
University of Arizona, Tucson, Arizona

t AREAS TARGETED - Agribusiness and High School, Emergency
Rescue, University and Community College, Youth
t DELIVERY METHOD - Model Programs, Workshops, Classes, Model 4-H Programs.
b KEYS TO IMPLEMENTATION - Direct Mailings, Handbooks, Announcements, Advisory
Committee, Balanced Selection, Identify EMT Teams, Advisory Committee, Training Trainers,
Hands on Training, Financial Assistance, Develop Curricula, Advertise Course, Recruit
Students, Instructor Survey, Hazard Evaluation, and Request Proposals.
b PROJECTED RESULTS - Written Safety Plans, Hazard Correction, Accident and Injury
Reduction, Trained Member in Each Department, Other Instructors Expand Safety Offerings,
Technicians Trained in Agricultural Machinery Accident Extraction, Safety Education, Student
Training, Worker Training, Safety Course Offered Fail/1991, Agricultural Educational Teachers
Take Safety Class, Safety Leadership, and Safety Awareness.

OCCUPATIONAL EXPOSURE TO GUTHION: CORRELATING
          RESIDUE LEVELS TO
         BIOLOGICAL MARKERS

      By Melisa Gonzales
Graduate Student in Toxicology/Industrial Hygiene
  University of Arizona, Tucson, Arizona

Cholinesterase inhibiting pesticides are a potential health hazard for workers who enter
treated areas and have significant contact with the residue-laden foliage. To define this
exposure, the California Department of Food and Agriculture is compiling a database of crop
and task-specific transfer factors relating dermal exposure to dislodgeable foliar residue (DFR).
In this study, DFR for guthion and gutoxon are assessed from the time of application through
the harvest study period. The dermal exposure of peach harvesters is monitored with long-
sleeved T-shirts, hand washes and face, neck, and hand wipes. Urinary dialkyl phosphate
metabolites are quantified to estimate residue absorption. Blood cholinesterase levels are
monitored as a measure of physiological response from absorbed residues. The observed
transfer factor is compared to those previously calculated to further evaluate the organophos-
phate exposure model of the CDFA. This study is also a source of occupational exposure data
on California's agriculture workforce, which is highly mobile and difficult to assess.

Surgeon General's Conference on Agricultural Safety and Health - 1991

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AGRICULTURAL INJURY IN CALIFORNIA: IMPLICATIONS
            SURVEILLANCE

FOR

By Carol Conroy, Ph.D., N Ma&h, L. Rudolph, D. will
California Department of Health Services, Berkeley, California

California agriculture presents unique challenges when designing a survey to assess the
magnitude of occurrence and characteristics of agricultural work-related injury. One challenge
relates to the tremendous diversity of agriculture within the state. There are more than 30
million acres of land devoted to agricultural production or services, more than 83,000 farms,
more than 60,000 farm workers, and more than 250 crops in production within California every
year. The average annual rate for occupational traumatic deaths during 1980-1985 was 16 per
100,000 agricultural workers compared to an overall traumatic occupational fatality rate of 7 per
100,000 workers. During 1988, over 21,000 agricultural disabling work-related injuries were
identified; 47 percent occurred during crop production and 43 percent were related to agricultur-
al services. In order to target high risk farms to survey, multiple data sources were analyzed to
describe the epidemiology of agricultural injuries within California. Injury rates vary by type of
industrial classification within agriculture: vegetable and melon crops have an injury rate of 76
per 1,000 workers while cash grains (such as rice) have a rate of 101 per 1,000; and within
agricultural services the injury rate varies from 13 per 1,000 for veterinary services to 88 per
1,000 for soil preparation. This reflects a variation in risk of injury associated with different
exposures that must be considered during the design of the survey. Another challenge relates to
diversity of the population at risk: farm workers and farm owners and operators. In addition,
interviewing highly mobile and transient migrant farm workers (many of whom do not have a
defined residence), many of whom originate from Mexico or Central America and do not speak
or read English, required a sampling strategy that would ahow these workers to be located. This
sampling plan, based on a stratified random cluster sample, allows operators to be interviewed.
Because farm workers and farm owners and operators are exposed to different hazards, have
different demographic characteristics, and would require different intervention strategies, it is
necessary to survey both to achieve the ultimate goal of preventing agricultural injuries in
California.

500

Papers and Proceedings



Poster Abstracts, May 2, 1991

AGRICULTURAL ACCIDENTS AND ILLNESS AMONG  r-l

CALIFORNIA WORKERS'
COMPENSATION CLAIMANTS

By David F. Goldsmith, Ph.D., James J. Beaumont, Ph.D.
Lynne A. MOE&, B.S., Man: B. Schenkec M.D., M.P.H.
     Unlversity of California, Davis, California

Agriculture has equalled mining as the most hazardous industry in the U.S. As part of the
University of California Davis Center for Agricultural Health and Safety, epidemiologists are
examining California Workers' Compensation (WC) Appeals Board claims to describe the
accident and illness risks among farm employees. Preluninary findings of 80 claimants who filed
between 1946 to 1964 show that all were farm workers (not farmers), and about 90 percent were
white or Hispanic males with a mean age of 46 years of age. Of the 27 respiratory disease
claims, 14 percent filed because they had valley fever (coccidiomycosis), 27 percent had other
(mostly chronic) respiratory illness, 41 percent filed because of pesticide illnesses, and 18
percent filed because of multiple effects of inhaled toxic materials, i.e., solvents and agricultural
burning. Among the 53 farm laborers filing WC accident claims, 11 percent were for hernias, 20
percent were for fractures, 18 percent were for contusions and other wounds, and 52 percent
were for traumatic injuries. Follow-up proportionate mortality ratio (PMR) analysis from 1950
to 1984 of the injury claimants employed in agriculture indicated that these farm workers have
an elevated risk for malignant neoplasms of lung (PMR = 2.39), for vascular lesions of the
central nervous system (PMR = 2.95), and for all external deaths (PMR = 1.95) when com-
pared to U.S. white males. This preliminary study demonstrates that WC data are extremely
useful to describe illness and injury patterns among agricultural workers. Furthermore, the
mortality findings suggest that there is an elevated risk of lung cancer, stroke, and external
causes even after injury claims are filed, New epidemiologic research is needed to elucidate the
risk factors for the excess rate of occupational injury and death now being observed in the
agricultural workplace.

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Making Connections

VISUAL MATERIAL FOR PESTICIDE SAFE7Y LESSONS FROM AN
     ECUADORAN EDUCATIONAL INTERVENTION

  By James I. Grieshop, Ph.D.
University of California, Davis, California

Throughout the world in developing countries such as Ecuador, efforts to transfer technolo-
gies have not occurred without serious problems. This is true in the agricultural sector where
pesticides have rapidly come into widespread use in areas where traditional agriculture had been
practiced. However, the transfer of pesticide technology has not been accompanied by the
transfer of techniques for their safe, effective and appropriate use, thereby leading to human
health problems (poisoning) and environmental damage and serious and justifiable public
concern. In countries such as Ecuador, users of pesticides often are illiterate, and live in
isolated areas. These attributes present particular problems for designers of education and
communication programs. Folk beliefs in relation to pesticides and personal risk also work
against the effectiveness of communication programs. This poster demonstrated the potential
for the use of visual materials, including symbols and pictographs and more highly refined
materials such as photo-novels and posters, for communicating messages about safe and
appropriate use of pesticides. The materials to be highlighted are the products of intensive field
research, primarily in Ecuador, on users of agricultural chemicals. The poster session will
demonstrate the evolution of these materials from relatively simple symbols and pictographs to
much more complex photo-novels and posters and materials developed for use with both
Spanish-speaking and Quechua-speaking rural residents. The relationship of field research using
qualitative approaches and the development of these visual materials will also be a key feature
of this graphic information session. Lessons from these field-based experiments provide lessons
for the development of similar health education interventions in the United States with non-
English speaking and reading farm laborer audiences.

502

Papers and Proceedings


Poster Abstracts, May 2, 1991

  THE U. C. DAM AGRICULTURAL HEALTH AND SAFEN
CENTER: A MULTIDISCIPLINARY CENTER FOR RESEARCH AND
              OUTREACH   `-I,
           By Marc B. Schenker, M.D., M.P.H.

University of California, Davis, California

California is the leading agricultural state in the nation, with 16 percent of all U.S. crop
production, as measured by farm cash receipts. Farm production in California is 60 percent
greater than the second leading state. A review of agricultural production statistics documents
the enormous size and importance of California commodities. For example, California produces
39 percent of all U.S. vegetables and melons, 53 percent of all fruits, nuts and berries, and 24
percent of all nursery and greenhouse products. More than l,OOO,OOO workers are employed
annually in agriculture in California, and there are more than 20,000 disabling injuries.per year
in the state. The purpose of the new U.C. Davis Agricultural Health and Safety Center is to
create a multidisciplinary organization for communication and coordination of research,
education, and illness and injury prevention in the agricultural workplace. The Center will
address occupational and environmental health issues affecting farmers, ranchers, agricultural
employees, farm families, agricultural service employees and visitors and residents around
agricultural work sites. The Center includes multiple academic units within the University of
California, as well as participation by programs and state agencies from outside the University
and interactions from neighboring states. As one of two national centers funded by NIOSH, the
U.C. Davis Center will focus on agricultural health and safety issues most relevant to the
western states. The Center is organized into an administrative core and a research and an
outreach component. Participants from U.C. Davis, U.C. Berkeley, various state agencies and
agriculture organizations are actively involved in both the research and outreach components.
This mixture of the unique expertise of the participants, the diverse resources of the University
and the State of California, and the contacts and involvement of state agricultural organizations
provides an outstanding and unique environment for addressing the health and safety hazards in
agriculture.

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Making Connections

CALlFORNlA AGRICULTURAL HEALTH AND SAFEN
        PROMOTION SYSTEM

By William E. Steinke, Ph.D.
University of California, Davis, California

The California Agricultural Health and Safety Promotion System (CAHSPS) addresses the
need for training across the diversity of California agriculture (more than 250 commercial
commodities workforce through several actions). Many farm workers in California are Hispanic
and have a limited ability to communicate in English. Several other ethnic groups, i.e., Hmong,
Mexican Indian, Vietnamese, Filipino, American Indian, Japanese and Chinese, are also present
in the agriculture workforce in large numbers. The CAHSPS addresses the educational needs
regarding safety in six major program areas. First, a pilot program is being established to
develop training materials and training methodologies for growers, field supervisors, farm labor
contractors and others to use in providing regular and focused safety training for those exposed
to the hazards of agriculture. Second, a formal and rigorous evaluation of the effectiveness of
this type of training is being independently conducted. The third component features grants that
are being offered to ten community agencies for programs that use channels outside the work
place to distribute agricultural occupational safety and health information. The fourth aspect,
which includes data collection regarding causes of fatalities and cases of major trauma, is being
undertaken in collaboration with the State Department of Health Services. As the fifth aspect,
an evaluation of different levels of safety training as they currently are practiced on California
farms is being conducted, with the goal of identifying the key components crucial to a successful
program. The sixth component is development of coursework in the College of Agricultural and
Environmental Sciences regarding agricultural occupational safety and health and injury and
illness prevention programs. The results of this program will make working in California less
hazardous and enable growers to customize their safety programs and training to fit the needs of
their operations and employees.

504

Papers and Proceedings


Poster Abstracts, May 2, 1991

PROMOTING AGRICULTURAL SAFETY AND HEALTH IN
            COLORADO

     By Paul D. Ayers, Ph.D.
Colorado State University Fort Collins, Colorado

i

Agricultural production in Colorado is an extremely hazardous occupation. Many fatalities,
injuries and illnesses can be prevented through education. Colorado State University Coopera-
tive Extension has embarked upon such an educational program through a grant provided by the
National Institute for Occupational Safety and Health. This grant provides funding for several
safety projects including the following topics:

o An up-to-date resource library containing visual aids and literature has been established and
made available to all 58 county Cooperative Extension Offices. A monthly safety newsletter
sent to each Cooperative Extension Office has been implemented as well as news releases
submitted to Colorado's major agricultural publications. County Extension personnel are in a
good position to disseminate safety information to a variety of individuals through their
various production meetings.
o Tractor safety, particularly tractor roll-overs, is always a major concern. Older tractors
without roll-over protection (ROPS) are especially hazardous in a farm situation. Colorado
State is conducting a tractor survey to determine the number of tractors without ROPS.
Tractor survey forms were sent out to 1,000 farmers via the County Cooperative Extension
Offices to ascertain the safety equipment available on tractors currently being used.
Information from this survey will be used to determine areas needing more emphasis such as
seat belts and roll-over protective structures.

o Pesticide safety is another major concern for Colorado agriculturalworkers. Protection of the
applicator can be greatly increased through usage of gloves and respirators. These two simple
items can be easily implemented into the pesticide application operation. County Extension
Offices have been provided with a chemical safety kit which includes gloves, coveralls,
goggles, overshoes, respirators, etc. for demonstration purposes at meetings and field days.
Gloves are also provided at pesticide applicator meetings for each participant completing the
  course.

Each office has also been provided with a video tape on farm chemical safety. Disposal of
agricultural hazardous wastes (unusable pesticides and containers) is a continuous problem.
Steps are being taken to provide guidelines for disposal of such items on a local level for
agricultural workers. The intent of the Colorado State project is to educate Cooperative
Extension personnel about various safety programs so they, in turn, can educate their clientele.
In this manner, more agricultural workers can be reached on a statewide basis.

Surgeon General's Conference on Agricultural Safety and Health - 1991                505


Making Connections

INJURY RISK-TAKING BEHAVIOR OF FARM YOUTH

By Robert A. Aherin, Ph.D.
University of Illinois, Urbana, Illinois

Various state farm accident studies have consistently found a high
incidence of farm-related injuries occurring to children under the age of 15. In an effort to gain
a better understanding of the types of behaviors being performed by children on farms, a study
was conducted to evaluate parental attitudes and behaviors regarding three farm machinery-
related behaviors. A sample of 377 randomly selected farm families, who had children 15 years
of age and younger, participated in the study. The three behaviors evaluated included: 1)
Riding on a tractor with a parent during the past 12 months; 2) Operating a tractor; and 3)
Allowing the child to be within 10 feet of rotating or revolving components on farm machinery.
Twenty-nine percent of the parents felt it was acceptable to allow children 3 years of age and
younger to ride on a tractor with them. Sixty-five percent agreed that children between the ages
of 4 to 6 years of age should be allowed to perform the behavior. Nearly 90 percent of the
parents allowed their 7-to g-year-old children to ride on tractors. More than 70 percent of all
the parents believe the risk of injury for performing this behavior was low. Twenty-nine percent
of the farm boys in the study were allowed to operate tractors. Sixty-seven percent of lo-to 12-
year-old boys and almost all of the 13-to B-year-old boys operated tractors. Girls operated
tractors significantly less than boys. Only 16 percent of parents thought their children between 7
to 9 years should be allowed to be within 10 feet of rotating farm machinery parts. However, 27
percent allowed their boys in this age group to perform the behavior. Of the 377 families who
completed the survey instrument, 16 or 4.2 percent reported an accident. The injuries from
these accidents resulted in 75 percent of the victims needing to seek medical attention while
approximately 12 percent were permanently disabled. As a result of these findings, an educa-
tional program has been developed to assist farm families with their understanding of the
behavioral and physical limitations of children to deal with injury risk associated with farm
equipment.

506

Papers and Proceedings


Poster Abstracts, May 2, 1991

REDUCING THE POTENTIAL FOR ENVIRONMENTAL
EXPOSURE AND HUMAN EXPOSURE TO PESTICIDES-
  A SELF-HELP WORKSHOP FOR PRODUCERS

  By Richard 0. Pope
Iowa State University, Ames, Iowa
   George F. Czapar
University of Illinois, Springfield, Illinois

Public concern about groundwater contamination from agricultural practices remains high.
Recent midwest well water surveys have helped define the extent and frequency of water
contamination. In addition to pesticide mixing and handling practices, well construction, depth
and location are known to affect water quality. Farm*A*Syst is a prototype 12-part agricultural
farmstead assessment program, developed in 1990 by United States E.P.A. Region 5, and the
Extension Services of the Universities of Wisconsin and Minnesota. From this prototype, a
specific program was developed for use in Iowa County pesticide-certification training sessions.
The primary focus of this program is to raise producer awareness and outline recommended
pesticide management practices. This interactive worksheet enables each producer to examine
and improve his or her individual management practices. Results compiled from initial
workshop evaluations will be discussed. This producer feedback is being used to assist program
planning for inter-agency water protection efforts.

Surgeon General's Conference on Agricultural Safety and Health - 1991

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Making Connectlons

A THEORETICAL FRAMEWORK FOR SAFETY BEHAVIOR
          INTERVENTIONS

By James Westaby, Graduate Assistant, Robeti Aherin, Ph.D.
      University of Illlnols, Urbana, Illinois

Occupational injuries and illnesses are a serious threat to farmers. Many farm injuries and
illnesses are the result of dangerous behavior. Reducing injury risk on the farm is a consider-
able task because many farmers are autonomous and self-motrvated. Many farm safety
programs have been implemented, but have not undergone systematic evaluation. It is unclear
whether these programs actually reduce injury risk. Also, many programs lack theoretical
rationale for their interventions. A theoretical approach to reduce injury risk by targeting
specific unsafe behaviors is proposed. Empirically supported theories, such as the Theory of
Reasoned Action, Theory of Interpersonal Behavior, and the Theory of Planned Behavior are
used in the proposed framework. The framework identifies factors that determine behavior.
For example, it has been shown that specific behaviors are determined by specific behavioral
intentions and/or habit processes. Behavioral intentions, in turn, are determined by the
attitudes people have toward the behaviors and their subjective norms (i.e., the pressure people
feel from significant others to perform the behavior). The framework, m sum, should help
pinpoint reasons why farm workers perform unsafe behaviors, target those behaviors with
specific safety interventions, and show which strategies prove effective. Effective strategies, in
turn, could be modelled in large-scale safety programs. More confidence could be placed in
such validated programs.

SAFE COUNTRY

   By James L. Williams
Country Companies, Bloomington, Illinois

Background: Prior to developing this educational program on farm
safety, research was conducted with 1,500 agricultural producers. Research indicated the need
for an educational program, including a video.

The final educational package consists of:

1. Leaders' Guide;
2. An B-minute video;

3. Modules on: Tractor and machinery safety, plus general farm safety and health; chemicals;
animals; ladders; and harvest safety
4. Student booklets; and

5. Promotional material, including news releases, posters and a promotional brochure.

Comments to date indicate its progress is well received. Approximately 3,000 pieces of
student materials have been shipped, indicating excellent usage of the program. It is in use in
four states by the Country Companies and other agriculture interested organizations.

508                                 Papers and Proceedings


Poster Abstracts, May 2, 1991

FARM SAFETY 4 "JUST KIDS"

   By Marilyn Adam
President Farm Safety 4 "JUST KIDS"

In the fall of 1986, Marilyn's 11-year old son, Keith, was killed in an accident on the family's
Iowa farm. One year after her son's death, realizing that not enough was being done about farm
safety, Adams began a campaign to promote education and awareness by distributing danger
decals for gravity wagons through local FFA chapters. Recognizing the consuming public
demand for farm safety information, she formed Farm Safety 4 "JUST KIDS" in October, 1987.
The response from people nationwide has been phenomenal. Mail and phone calls from across
the United States and Canada are received daily for farm safety information and merchandise
available from the office. Materials available for sale are videos, decals, T-shirts, and other
miscellaneous items. Farm Safety 4 "JUST KIDS" also compiles and distributes newsletters to
members quarterly. The increased demand for information has prompted the formation of a
Chapter Operations Department. This department is in the process of developing chapters
across the United States. "If we are indeed concerned about making our farms safer places to
work and live, we need to overcome the sort of conditioned apathy that exists today toward
farm-related health and safety issues. By developing chapters of Farm Safety 4 "JUST KIDS",
we are working to make further improvements in the communities. Education and building
public awareness are perhaps the two most important elements in addressing this problem".

ZOONOSES-HUMAN HEALTH HAZARDS
   ASSOCIATED WiTH ANiMALS

By George W. Bet-an, D. ViM., Ph.D.
Iowa State University, Ames, Iowa

This presentation will represent teaching, research and personal experiences of the author.
On one side, a chart identifying viral infections at greatest hazard of transmission tram animals
to people will be featured, accompanied by a photographic display on rabies. This will show the
wild animals which maintain the infection, the disease in wild animals, farm livestock and
companion animals. It will show preventive measures and an interactive section on myths and
facts about rabies. (If available, a slide system or video monitor could be used to display
additional, rare photographs of the disease in animals). On the reverse side of the display, a
chart will identify bacterial infections at greatest hazard of transmission from animals to people.
The illustrations will depict facets of Lyme disease, the way the disease is spread, the animals
which carry it, the human disease, and measures for prevention. The display addresses health
protection intervention in zoonoses, particularly from the viewpoint of the author as a consultant
in rabies to the World Health Organization.

Surgeon General's Conference on Agricultural Safety and Health - 1991

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Making Connections

TEACHiNG GUIDES AND CLiENT EDUCATiON MATERIALS
  FOR CARDiOVASCULAR SCREENING PROGRAMS

By Constance J. Better@, M.S., RD., Lom'e J. GraaJ RN.
  Iowa Department of Public Health, Des Moines, Iowa

\

Iowa's Cardiovascular Risk Reduction Screening and Education Program Recommendations
advise that all screening programs provide client education. To assure that accurate, consistent
information was given to Iowans at screening sites, staff from the Bureau of Nutrition and
Health Promotion developed teaching guides for public health nurses and one-page fact sheets
for the general public. The teaching guides and fact sheets correspond with the three compo-
nents of the cardiovascular screening program: cholesterol screening, hypertension screening and
diabetes screening. The teaching guides were developed in a standard format consisting of
objectives, a suggested teaching outline, suggested background materials for the professional,
and suggested client education materials. Information from the National Heart, Lung and Blood
Institute and other public organizations was adapted to present a single concept per fact sheet
and to lower the reading level. A formative evaluation was conducted using pre-testing
methodology. The format may be useful for other states wanting teaching guidelines and client
education at screening sites.

OCCUPATiONAL HEALTH NURSES IN AGRiCULTURAL
COMMUNiTiES -A PUBLiC HEALTH NETWORK FOR iNJURY
              CONTROL

  By EZaine DeBoef; RN., M.S., and otherproject nurses
Division of Disease Prevention, Iowa Department of Public Health, Des Moines, Iowa

Agriculture is a major component of the Iowa economy. Much of the food and fiber upon
which America and the world depends is produced on Iowa farms. The Iowa farm lifestyle
embodies many qualities which underlie the strong foundation of our country. Partly influenced
by these factors, this population has been affected by occupational-related disease and injury at
rates which greatly exceed public health standards. The Occupational Health Nurses in
Agricultural Communities Project, funded by NIOSH, through the Division of Disease Preven-
tion, Iowa Department of Public Health will extend surveillance and target injury and disease
control interventions through collaborative efforts with local health and lay service groups. Early
efforts will be directed toward injury intervention development in regions and communities
which are identified as high frequency, high severity areas for agriculture-related acute injury,
using 1990 surveillance data from the Sentinel Project Researching Agricultural Injury Notifica-
tion Systems (SPRAINS) program based in Iowa.

510                                   Papers and Proceedings


Poster Abstracts, May 2, 1991

A STATE PUBLIC POLICY TO IMPROVE FARM HEALTH AND
SAFETYi. IOWA'S CENTER FOR AGRICULTURAL SAFETY AND
               HEALTH

By KeZ1q.v J. Donham, D. EM.
University of Iowa, Iowa City, Iowa

The 1990 Iowa Legislature passed a bill to form The Iowa Center for Agricultural Safety and
Health (I-CASH). This unique program mandates that the College of Medicine (The University
of Iowa), the land grant school (Iowa State University), the State Department of Health, and the
Department of Agriculture and Land Stewardship work together to coordinate and focus
resources to decrease agricultural occupational deaths, injuries, and illnesses. The Center is
housed at The University of Iowa. The day-to-day operation is through the leadership of the
Director, with strong input from the Coordinating Committee, which is made up of represen-
tatives from each of the participating institutions. The Coordinating Committee receives policy
direction and has direct contact to the clientele through an l&person Advisory Committee. This
committee consists of active farmers, members of farm constituency groups (such as Farm
Bureau, Corn Growers and Iowa Pork Producers), rural physicians, rural hospitals, and
agribusinesses. This first-of-its-kind organization has put together a powerful, eclectic group of
farm health and safety experts and clientele groups to develop and carry out preventive
programs in a positive participatory manner. I-CASH has focused on five major areas to direct
the energy and resources of this group. These are: 1) developing a network of hospitals in the
state to provide comprehensive occupational health services for farm families; 2) prevention of
respiratory diseases in swine producers; 3) prevention of injuries in farm children; 4) prevention
of injuries involving tractors; and 5) surveillance of farm injuries. I-CASH has enjoyed excellent
cooperation among the members. A major initial function is to coordinate the various preven-
tive programs in the state that have emerged through the 1990 NIOSH initiative. I-CASH will
also provide additional general programs to meet the needs of the farm families and farm
workers of Iowa. I-CASH may serve as a model for other states as they develop public policies
on this issue.

Surgeon General's Conference on Agricultural Safety and Health - 1991

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Making Connections

IOWA AGRICULTURAL HEALTH AND SAFETY SERVICE
            PROGRAM

  By Jane Gay, B.S. N.
University of Iowa, Iowa City, Iowa

Farming is consistently ranked as one of the top three most hazardous occupations. An
estimated 200,000 farmers are disabled and an additional 2,000 die annually from work-related
causes. The farm family lives in and works at a worksite filled with many hazards. In other
industries, comprehensive occupational health and safety services have been dramatically
successful in reducing job-related injuries and illness. Effective systems to deliver this type of
service in agriculture have not been established. In 1987, The Institute of Agricultural Medicine
and Occupational Health of the University of Iowa College of Medicine initiated a pilot project
for families and agribusiness in the state of Iowa. The project has expanded into a state
network of agricultural occupational health and safety services based in community hospitals.
The Iowa Agricultural Health and Safety Services Project (IA-HASSP) provides a unique clinic
model and implementation plan, technical assistance and health professional training to
community hospitals that are establishing agricultural occupational health and safety clinics.
This model utilizes the community hospital as the primary integrator of existing community
health services and direct provider of new occupational health services. The clinic will coordi-
nate with regional primary-level hospitals and healthcare providers to deliver services at satellite
sites. The service for members includes: occupational health screening, intensive occupational
health and safety education, on-farm hygiene/safety analysis of identified or potential farm-
related health and safety hazards, and availability of personal protection equipment. The project
also provides service at the state level through telephone consultations for local-level healthcare
providers.

572

Papers and Proceedings


Poster Abstracts, May 2, 1991

CARBON MONOXIDE: VENTING PROBLEMS FROM HEATING
             APPLIANCES

By Thomas H. Greiner, Ph.D., Jim Cain
Iowa State University, Ames, Iowa

Excessive house depressurization can result in combustion appliance venting failure and
contamination of household air. Three Iowa homes previously indicating combustion venting
failure were instrumented and monitored to verify and further quantify venting failure and
associated air quality deterioration.

Significant findings of this study included:
o Thermocouple located in the appliance vent and at the dilution device gap can accurately
monitor venting performance.
o Carbon monoxide can reach dangerous concentrations under conditions of excessive spillage
and exhaust recirculation in low-volume rooms.
o Neither carbon monoxide nor carbon dioxide concentration gives an accurate indication of
flue gas spillage in large-volume mechanical rooms.
o Faulty vent design and/or maintenance can result in venting failure without the added ag-
gravation of house depressurization.

Surgeon General's Conference on Agricultural Safety and Health - 1991

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Making Connections

RADON IN IOWA

By Thomas H. Greiner, Ph.D., Jim Cain
Iowa State University, Ames, Iowa

Radon is the second leading cause of lung cancer in the United States. The United States
Environmental Protection Agency (EPA) prediction is that radon in homes causes 21,600 annual
deaths, with an uncertainty range of 8,400 to 43,200 (USEPA 1989). The EPA began to test
homes for radon, but did not include Iowa because the state was judged to be the state "least"
likely to have a radon problem. Although Iowa was not identified by the EPA as a state with a
potential radon problem, survey data collected in 1984 by a local college professor, Conrad
Weiffenbach, found several high levels in eastern and central Iowa (Weiffenbach, 1987). To
help determine if there were a radon problem, Iowa State University, in February of 1987,
began selling radon detectors and collecting data on the radon results. This database now
includes information on 15,111 short-term tests, including 7,100 first-time screening tests. The
arithmetic average of these 7,100 first-time tests is 8.3 picocurries per liter (pCi/l), more than
twice the EPA action guideline of 4.0 pCi/l. Thirty percent of the screening tests gave low
results (4.0 pCi/l or less, 64 percent gave medium results (in the range of 4-20 pCi/l), and 6
percent were high readings (more than 20 pCi/l). Additional testing confirms that more than 70
percent of Iowa homes "fail" the EPA screening guidelines. Despite the risk associated with
radon exposure, less than 6 percent of Iowa residents have tested for radon, and only a few
hundred have taken measures to reduce the levels of radon in their homes. An Iowa State
University Extension Service Iowa Radon Project public awareness survey in 1990-1991 reveals
reasons for the disappointing response of the Iowa public. Nearly 90 percent have heard of
radon, but they do not feel knowledgeable about radon, with two out of three persons reporting
they feel inadequately informed.

514

Papers and Proceedings


Poster Abstracts, May 2, 1991

THE RURAL YOUTH DISABILIN PREVENTION PROJECT  (

By Cheryl Hawlc, M.S., Jane Gay, B.S.N., KeIley J. Donham, D.EM.
        University of Iowa, Iowa City, Iowa

The Rural Youth Disability Prevention Project is an intervention funded by the CDC in 1988
to provide a framework for the development of community-based, pediatric, agricultural injury
control programs. It has a three-stage structure, each requiring input from and feedback to the
farm community to ensure that program development addresses its needs. The first stage is
diagnosis of needs, with provisions for postintervention evaluation, utilizing two instruments: a
survey of local farm families to gather data on safety practices, risk factors and injuries, and the
Farm Family Walkabout guidebook, a family activity designed to identify hazards on individual
farms. In the current project year, the survey was administered to 400 and the Walkabout to
458 Iowa farm families. Results indicated injury-control issues to target:

1. Children in the workplace. Children accompany their parents operating farm machinery from

an average age of 7 and begin operating it themselves by 11.
2. Emergency preparedness. Only 25 percent of adults have had CPR/First Aid training. Fifty
percent have First Aid kits in their homes, and 14 percent have them in their tractors.

In the second stage, communication, these findings are sent as a newsletter to participants
and publicized in local media. Meetings ensue at which farm families and community groups
assess local needs. This leads to the third stage, facilitation of appropriate actions. The specific
issues currently targeted are being addressed on two levels, individual and community-based.
On the individual level, Future Farmers of America groups are working directly with par-
ticipants to implement simple, practical safety projects, such as preparing and selling tractor first
aid kits or distributing lists of emergency phone numbers. An example of community-level
action carried out was a CPR workshop requested by farm families after they received the
report of the Walkabout data and arranged by local health professionals. Post-testing to assess
behavior changes will be carried out in June of 1991. Evaluation of the efficacy of this commu-
nity-oriented program will be completed by the fall of 1991.

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TRACTOR STABlLlP/: HOW STEEP IS TOO STEEP?   \\

IQ Jill Hudrson, Charles Schwab, Ph.D.
Iowa State University, Ames, Iowa

Tractor-related fatalities in Iowa account for approximately 41 percent of the total fatalities
recorded during 1988 through 1990. During 1991, fifty-two percent of all tractor fatalities
recorded in Iowa during 1990 resulted from side overturns. These state figures coincide with
national statistics, making tractor overturns a major agent of death for agricultural workers.
What slope is to steep for safe operation of a tractor becomes an important issue. Static
stability of farm tractors in side overturns on sloped terrain can be determined from the Static
Lateral Critical Angle (SLCA). The SLCA was calculated for approximately 700 two-wheeldrive
models using the center of mass and geometry of the tractor. The SLCA was plotted with
respect to the horsepower capacity of the tractors. The influence of different attachments on
the SLCA was examined. The effect that a front-end loader carrying a hay bale at different
elevations had on the SLCA were determined. Changes of the SLCA with respect to horsepow-
er requirements were developed for the different attachments investigated. Understanding the
influence that attachments have on the SLCA provides background information required for a
proactive assessment of potential tractor side overturn hazards.

516

Papers and Proceedings


Poster Abstracts, May 2, 1991

PESTICIDE SAFETY FOR RURAL FARM YOUTH

By Nancy Jensen, Wendy Wintersteen
Pocahontas County Extension

Spraying weeds with herbicides while riding on a tractor-propelled platform or bean-bar is a
common summer job for many rural youths in the Midwest. However, bean-bar riders are
exposed to more than the sun; they are also exposed to the herbicide spray. A study conducted
by Success-l Farming magazine indicated that virtually all bean-bar riders are contaminated with
herbicide after 2 hours of spraying. Herbicide exposure can result in adverse health effects such
as eye and skin damage and the possibility of future health problems. The severity of these
effects depends on the type and concentration of the herbicide and the area and amount of
exposure. To educate rural youth about herbicide dangers, Iowa State University Cooperative
Extension staff conducted an extensive bean-bar education program in Calhoun and Pocahontas
counties. In cooperation with the local public health department, copies of an Extension
bulletin, Bean-Bar Facts and Safety Tips were distributed to 4,000 students in 14 school districts.
In addition, a slide set on bean-bar safety was developed and presented by Extension personnel
at several programs. Rural youths are taught that bean-bar spraying can be relatively safe when
certain precautions are taken. Wearing rubber gloves, shoes, jeans and a long-sleeved shirt were
emphasized as adequate protection for bean-bar riders in most cases. Goggles, rubber gloves,
and Tyvek disposable coveralls will offer the maximum protection. In case of an emergency,
youth were told to flush out irritated eyes or to rinse skin with large amounts of water. After
work, all bean-bar riders should shower with soap and water. Bean-bar riders were cautioned
against "horsing around" and inadvertently spraying themselves or others with herbicide. And
finally, youth learned to refuse to spray until all the equipment was safe to operate.

IOWA AGRICULTURAL INJURY SURVEILLANCE

   By Shirley K Jones, B.S.N., M.P.H.
Iowa Department of Public Health, Des Moines, Iowa

Acute agricultural injury is recognized by the National Safety Council as occurring at a rate of
nearly five times the rate for all industry. Iowa's Sentinel Project Researching Agricultural
Injury Notification Systems (SPRAINS) Project, funded by CDC/CEHIC, has established a
statewide surveillance system to study acute agriculture-related injury. The project now in its
second year uses reports from designated hospital sentinel reporters and from other volunteer
health care providers and seeks to identify the multiple factor relationships which occur in acute
injuries subsequent to agriculture activity. More than 2,100 acute injuries, including 83 deaths,
occurred and were reported in 1990. Information characterizing these injuries from the first
year of study will be presented in our display. Injury is increasingly being recognized as a high
priority public health problem. Continuing analysis of this data will enable the design of
activities that can be specifically targeted to decreasing the frequency and severity of these
injuries.

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AGRICULTURAL RESPIRATORY HAZARDS EDUCATION  I<

SERIES

    By BonnieJ. Kay, RN., B.S.N.
American Lung Association of Iowa. Des Moines, Iowa

The Agricultural Respiratory Hazards Education Series (ARHES) was produced in 1986 by the
American Lung Association of Iowa (ALAI) in response to a profound lack of comprehensive
material addressing the lung health risks associated with agriculture. The series was developed
in collaboration with the University of Iowa's Institute of Agricultural Medicine and Occupation-
al Health and Iowa State University Extension. It consists of an introduction and a nine unit set
for health professionals and a nine unit companion set for agricultural and community workers.
Each unit is designed to stand alone. Each addresses a different lung hazard commonly found
in agriculture. The series provides an excellent cornerstone for community education programs.
The materials have been used by extension services and lung associations across the country.
Rural hospitals have used the series for community programs, as have Farm Bureau Federa-
tions, 4-H, and FFA youth groups, health fairs, producer groups and farm safety organizations.
Programs for physicians, nurses, and respiratory therapists have been very successful and have
generated much interest. The ALAI has a slide/tape presentation which accompanies the series
and provides a good discussion tool. It has also developed a promotional kit for other organiza-
tions and lung associations to use. The kit includes press releases timed to seasonal tasks and
hazards, public service announcements, public service ads, sample program outlines, and
accompanying letters. A new tabletop display which addresses proper selection and use of
respirators is now available for groups to use. The nature of the education series allows each
user to tailor the program to the specific need. It can be provided at the community level,
directed by local healthcare providers or extension personnel, or used strictly by the individual.
Cost is minimal. An opportunity to display in the project showcase will permit others to see
how the ARHES can complement their programs. We would provide a display presentation.

578

Papers and Proceedings


Poster Abstracts, May 2, 1991

INNOVATIONS AND PERCEPTIONS OF AGRICULTURAL
          SAFETY STUDENTS

  By C.J. Lehtola, M.S.
Iowa State University, Ames, Iowa

People involved in agriculture recognize agricultural safety as a present-day vital concern.
Farmers, agribusiness employees, and extension personnel expressed the desire and need to
learn more about farm safety. Many of these individuals are employed full-time and unable to
attend conventional campus classes. A class in agricultural safety was offered as an off-campus
program for these adult undergraduate and graduate-level students as a solution. The course
was conducted using 13 2-hour video segments and 2 all-day, on-campus sessions. A total of 68
students (ages 22-62) participated in the first class that was offered. Students were required to
identify hazards at their farm or workplace and develop a solution to eliminate hazards. Many
found it effective to conduct the hazard identification by video camera. Many innovative
solutions were developed and presented by the students. Farm safety issues included licensing
of tractor operators on public roadways, child endangerment, babysitting services, regulations,
disability awareness and the responsibility of manufacturers. Their awareness of safety was
increased, as well as the recognition of the complexities involved in farm safety. This course
proved applicable and valuable to the participants. Measurement of the accidents that were
prevented as a result of their involvement, innovation and increased awareness is impossible, but
the participants responded favorably to the class and many students plan to promote farm safety
in their communities.

Surgeon General's Conference on Agricultural Safety and Health - 1991

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Making Connections

AGRICULTURAL CHEMICALS: ACUTE AND CHRONIC
           EXPOSURES

By Linda L. Leverenz, MS., C.H.E.S., Patricia Price, D. 0.
      University of Iowa, Iowa City, Iowa

The Agency for Toxic Substances and Disease Registry (ATSDR) has recognized the need for
educating health professionals throughout the nation on the importance of properly diagnosing
and treating various environmental illnesses. To assist in meeting this need, ATSDR has
provided funding through the Iowa Department of Public Health to the University of Iowa for
the development of a 2-hour physician education program entitled, `iAgriculturul Chemicals:
Acute and Chronic Exposures". It has been estimated that this program has reached approxi-
mately 52 percent of the physicians in the state of Iowa. Agricultural chemicals are used in
every aspect of daily life. Pesticides control insects in agricultural settings, destructive moths
and beetles in forests, and garden and household pests. Other chemicals eliminate weeds, serve
as preservatives in wood products, and are used as fertilizers. The widespread use of these
chemicals often results in overexposures that may cause "flu-like" symptoms and are somewhat
difficult to diagnose. Major effects on human health may result in acute systemic poisoning;
skin, eye, and nose irritation; dermal sensitization; pulmonary damage; and, to a lesser extent,
chronic damage to the kidney, liver, and central nervous system. Objectives of this program are
to provide information that will assist physicians in: 1) identifying pesticides that are responsible
for acute and chronic health effects; 2) establishing clinical diagnostic and treatment protocols;
and 3) offering their patients methods for preventing pesticide poisonings.

520

Papers and Proceedings


Poster Abstracts, May 2, 1991

PREVALENCE OF ANTIBODIES TO ENVIRONMENTAL FUNGI
     IN THE SERA OF SWINE CONFINEMENT

By Daniel M. Lewti, Ph.D., Toni A. Ble&oe, Amy Stasny, Lisa Nicklow
    Immunology Section, NIOSH, Morgantown, West Virginia
           Kelley Donham, D. KM.

Institute of Agricultural and Occupational Health, University of Iowa, Iowa City, Iowa

As part of an epidemiological analysis of the respiratory hazards associated with working in
swine-confinement facilities, we obtained serum samples from 292 persons who either work in
swine-confinement facilities, farmers not engaged in swine production, or age-matched, non-farm
workers. Environmental analyses of swine confinement facilities revealed six species of fungi
were the predominant fungal isolates in these facilities. The sera were assayed for precipitating
antibodies (IgG) by counterimmuno-electrophoresis (CIEP) and reaginic antibodies (IgE) by a
radioallergosorbent test (RAST) to extracts of the fungal isolates. The fungal isolates were
Scopulari0p.G sp., Penicillium sp., Cladosporium sp., Mucor sp., Aspergillus ochraceous., and
AspergiZZus flavum. Only two of the serum samples contained precipitating antibodies and both
were reactive with the Mucor sp. isolate. In contrast, 46 of the 292 sera (15.7-) contained IgE
antibodies to one or more of the fungal isolates. These results will be presented and discussed
with respect to the exposure status of the workers, but the preliminary analysis indicates that
IgE antibodies may be a more sensitive marker of exposure to these microorganisms than
precipitating antibodies.

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HEALTH SURVEILLANCE ACTIVITIES OF A VETERINARY
       DIAGNOSTIC LABORATORY

By Gary D. Osweiler, D.KM., M.S., Ph.D.
  Iowa State University, Ames, Iowa

Food and companion animals are often exposed more directly to environmental chemicals
than are humans, and may serve as sentinels of potential health effects in humans. Recently,
the National Academy of Sciences has recognized and reinforced this idea. Prompt investigation
of animal losses or illnesses may determine that a poisoning has occurred and allow preventive
measures before they become widespread in humans or the environment. In some circumstanc-
es, animals studied at questionable locations, such as hazardous waste sites or industrial
locations, may provide early clues well before human problems become apparent. Toxic effects
of chemicals may alter functions of cells, cause morphologic changes, or act on individual
cellular components important to the immune system. Veterinary diagnostic laboratories are an
important link in the assessment of potential human problems of toxicosis, immune dysfunction
and carcinogenesis by their ability to evaluate immune function in exposed animals, as well as
correlate the morphologic effects and concentration of chemicals that result from exposure to
pollutants in the environment of both animals and man. The Iowa State University Veterinary
Diagnostic Laboratory has evaluated numerous potential human problems by monitoring key
effects in animals at risk. Some of these problems include lead poisoning, organophosphate
toxicosis, dioxin hazards in wood preservatives, water quality, aflatoxicosis, and therapeutic
drugs. Details and significance of these activities relative to human health will be discussed.

522

Papers and Proceedings


Poster Abstracts, May 2, 1991

IOWA FARM FAMILY HEALTH AND HAZARD SURVEILLANCE
             PROJECT

By William J. PopendorJ; Ph.D.
University of Iowa, Iowa City, Iowa

Agriculture is now recognized as the most hazardous workplace in America. Yet agriculture
lags behind general industry in the application of the traditional preventive phases of recogni-
tion, evaluation and control of health (and safety) hazards. The dilemma of agriculture as both
an industry and a way of life contributes not only to this lag but also influences the design and
approach of a successful health survey of an agricultural population. The aims and approach of
the National Institute for Occupational Safety and Health [NIOSH] funded Iowa Farm Family
Health and Hazard Surveillance Project are:

1. To determine the retrospective distribution of farming practices, medical symptoms, and
traumatic injuries from a randomly selected cohort of farming families using a mailed survey
questionnaire to a population-based, random cohort on about 500 farms.
2. To record temporal exposure to environmental and biomechanical/ergonomic factors likely to
contribute to work-related illness or injuries by on-farm observations of a sub-cohort of these
farming families.

3. To measure the levels of exposure to a small number of selected low-frequency, high-hazard
agents or processes likely to contribute to work-related illness using traditional quantitative
industrial hygiene assessment techniques.

Data collected in this survey will provide the basis for future investigative agricultural health
and safety efforts in several directions. The health status data will comprise the first systematic,
representative view of the health of American farmers and farm families. Hazard data will
provide not only a statistical distribution of risk factors within this population, it will also contain
a basis upon which to estimate the time or frequency of being "at-risk," yielding new insight into
interpreting accident, injury and fatality data collected in these and other studies. Additionally,
these data will be used to develop specific recommendations for modifications of tools,
machinery, work methods and buildings which will reduce work-related injuries among this
segment of the population.

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IOWA STATE UNIVERSIp/: RESEARCH AND INFORMATION
         FOR SAFE77 AND HEALTH

  By August Ralston
Iowa State University, Ames, Iowa

Illustrated are the research undertaken and information and services provided by the
Cooperative Extension Service (CES) at Iowa State University in the area of agricultural safety
and health. The structure of the CES including 4-H, and how farm families and workers and
safety and health professionals can access information from the CES are explained. Re-
search/information topics covered are clothing contamination by chemicals, application of
chemicals, household use of pesticides, rollover protective structures, quality of water supply,
carbon monoxide spillage from heating equipment, air quality and respiratory illness, design of
confinement buildings, machinery design, and tractor stability.

AGRICULTURAL HEALTH PROMOTION SYSTEMS:
  OBJECTIVES AND PROGRAMS IN IOWA

  By August Ralston
Iowa State University, Ames, Iowa

Illustrated are the objectives and plan of action under the Agricultural Health Promotion
Systems (AHPS) cooperative agreement between NIOSH and Iowa State University. Efforts to
enhance the capability of professional extension staff as interveners for occupational safety and
health, to build a network among public health agencies, volunteer groups, and cooperative
extension, to cooperate with the Center for Agricultural Research, Education, and Disease and
Injury Prevention at the University of Iowa, and to improve the formal occupational safety and
health college curriculum are explained. Examples are provided of the likely impact of the
AHPS cooperative effort on educational programs and intervention techniques and networks
that are aimed at reducing the occupational hazards and exposures faced by farm families and
workers.

524

Papers and Proceedings


Poster Abstracts, May 2, 1991

RURAL YOUTH DISABILITY PROJECT

   By Angie Reynolds, R D.H., B.S.
Iowa Department of Public Health, Des Moines, Iowa

Health and safety are major problems in agriculture. When a farm injury results in a child
affected by a disability, the rural community is impacted socially and economically. Farm
injuries and the resulting disabilities consequently become a major public health problem. The
Rural Youth Disability Prevention Project focuses on increasing community awareness and
ownership of the farm-child injury problem. This is a necessary focus for any effective and on-
going community-based prevention strategy. The project is owned, operated, and directed by the
community with technical assistance provided by the Office of Disability Prevention and the
University of Iowa Hospital and Clinics. These community prevention projects have been
implemented by the Disability Prevention Program. Each project is operated locally and focuses
on unique disability risk factors. The project sites are located in Marshaltown, Spencer, and
Harlan. These communities were selected due to their affiliation with the Iowa Agricultural
Health and Safety Service Project (IA-HASSP). The IA-HASSP project also serves to focus
community awareness, ownership, and cooperative efforts in reducing farm-related health and
safety hazards. The goal of this project is to demonstrate that disabilities of rural youth can be
reduced through concerted community-wide efforts. Three major activities conducted include:

o Community survey of existing safety knowledge, attitudes, behavior and near-miss injuries.
o Farm family hazard analysis ("Walkabouts").
o Community Involvement Injury Control Workshop.

Special emphasis is placed on the development of effective community prevention strategies
which involve organizing broad community rnfluence and support. To accomplish this, the
project will promote active collaboration between multiple disciplines, agencies, and businesses
in the projects.

Surgeon General's Conference on Agricultural Safety and Health - 1991

525



Making Connections

CLEAN AIR FILTER FOR TRACTORS

By Mike Schmik, Eugene Ahrenholtz
      Defiance, Iowa

Workers exposed to chemical fumes inside their cabs are reported to have headaches, nausea,
and sickness as a result of these fumes. It seems the tractor cab filtration systems are not
designed to filter chemical fumes. The authors researched and developed a design for an air
filter that reduces chemical fumes and particulate matter in the tractor cab. They suggest this
filter should be added to gloves, goggles and other protective equipment used when applying
pesticides and herbicides, The clean air filter has a three-stage design. Stage one is a paper
media that removes dust. Stage two is an activated carbon that adsorbs organic vapors. Stage
three is a final filter which prevents carbon dust infiltration. The filter is patent-pending, but as
yet untested by a large research company, Many farmers in Iowa are already using the product
regardless of lack of testing, and say it does significantly reduce the chemical fume leakage into
the tractor cab. The authors would like to work with a research company to test the product.

526

Papers and Proceedings


Poster Abstracts, May 2, 1991

IOWA'S BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM

    By Susan Schoon, RD., L.D.
Iowa Department of Public Health, Des Moines, Iowa

The Iowa Department of Public Health (IDPH) has identified cardiovascular disease as the
number one health problem in Iowa. Data from death certificates and other sources show the
annualized 198486 mortality rate from ischemic heart disease is 253 per 100,000 population as
compared to the national rate of 217 per 100,000 population. How do Iowans rate with their
lifestyle behaviors ? The Behavioral Risk Factor Surveillance System (BRFSS) is providing some
answers. Data Collection--The goal of the BRFSS is to provide data to identity health promo-
tion and disease prevention priorities for the public and private sectors of Iowa. Specific
objectives are to determine the state-specific prevalence of personal health behaviors related to
the leading causes of premature death and to advance the understanding that health-related
behaviors are critical indices of health. Interview Process--The telephone interview process uses
a modified random digit dialing and random selection of adults over 18 from the household.
One hundred fifty interviews are conducted each month, totaling 1,800 interviews a year. There
are currently 47 states using the 77 core questions developed at the Centers for Disease Control.
1989 Behavioral Health Risks of Iowans:

Cholesterol - 57.6 percent reported having their cholesterol checked at least once.
Hypertension - 15.8 percent had been told by a doctor or health professional they have high
blood pressure.

Exercise - 28.1 percent reported more than 20 minutes, 3 times a week of leisure-time
physical activity.
Binge or acute drinking - 16.6 percent of the respondents reported having 5 or more drinks
on an occasion, one or more times in the past month.
Seat belt use - 76.2 percent of those surveyed reported using a seat belt always or nearly
always.

Overweight - 25.3 percent based on body mass index.
Smoking - 22.7 percent reported they now smoke.

Surgeon General's Conference on Agricultural Safety and Health - 1991

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Making Connections

OVERTURNING PERCEPTIONS OF TRACTOR OVERTURN
             HAZARDS

By Charles V: Schwab, Ph.D.
Iowa State University, Ames, Iowa

Tractor-related fatalities in Iowa account for approximately 41 percent of the total fatalities
recorded during 1988 through 1990. The National Safety Council identifies tractors as a major
agent for death of agricultural workers. Overturns, runovers, and power-take-offs (PTOs) are a
few specific examples of different dangers associated with tractor operations. Elevation of
agricultural workers' awareness for tractor overturn hazards is accomplished by an interactive
display. A table-top terrain and remote-controlled tractor operated by 4-H youth graphically
illustrate the overturn hazards. Improper and proper responses to situations when a tractor
wheel slips off the road are performed. Demonstrations of safe ascension of tractors on sloped
ground is shown. The success and effectiveness of this educational and intervention display
results from several factors. The high level of interaction is one factor. Participants view a
dynamic model of a real life situation, while a narrative explains the significant details. The
presenter disarms the audience because the 4-H youth do not represent authoritative figures
stating guidelines, common procedures, and regulations. The display "Drive Head over Wheels" is
an effective and popular display that promotes tractor safety and elevates the level of awareness
for tractor overturn hazards.

528

Papers and Proceedings


Poster Abstracts, May 2, 1991

PESTICIDE RESIDUES IN A MIDWESTERN FARMER'S COVERALLS

By Janis F. Stone, Ph.D., H. Michael Stahr, Ph.D.
    Iowa State University, Ames, Iowa

Careful use and management of clothing can assist in minimizing exposure to
crop chemicals and contribute to the farm worker's health and safety. This
research concerns protective cotton coveralls actually worn during corn and
soybean production. An Iowa farm family cooperated in this case study and
provided used coveralls that had been worn for four crop seasons and laundered after every
wearing during application of many thousands of pounds of eight different pesticides. Samples
were cut from the lower leg, thigh, crotch, shoulders, sleeves, pockets, collar and waistband of
the coveralls, both front and back, totaling 40. Each was separately extracted using ethyl acetate
with 5 minutes of shaking and 16 hours standing. The solvent was analyzed for Treflane by
electron capture GLC. After the EC analysis, samples were concentrated and analyzed for
organophosphorus pesticides. All samples were quantified by two replicate systems. Standards
were run after every five sample injections. Every fifth sample was amended with a mixture of
the six pesticides anticipated to be present (because the owner had reported using them).
Quantitative analyses for these were made; 90-100 percent recovery was obtained of the added
pesticides. The pesticide deposition per square centimeter (cm2) of fabric for each sample was
separately calculated based on the cm2 size of the extracted sample. The farmer was reported to
be in good health, but his coveralls contained unexpected levels of five pesticides. Residues of
pesticides used only in the first season that the coveralls were worn remained in them at the
time they were retired, despite laundering after every wearing. Garment areas (pockets,
waistband) frequently touched by hands seemed to have higher contamination levels. Measur-
able amounts of Treflane, Lorsbane and Counter were found in all samples of the coveralls, but
no Lasso/Atrazine was detected. This could be explained by the laner's known solubility in
water. A few samples contained Thimete and Dyfonate, although they had been used only in
the first and second crop seasons, respectively. Residues released in the first extraction of lower
leg samples ranged from 0.2 ng/cm2 of Dyfonate and 0.5 ng/cm2 of Thimete to 4.9 ng/cm2 of
Treflane and 7.3 ng/cm' of Lorsbane. Sleeve cuffs showed 14.0 ng/cm2. Treflane, 91.9 ng/cm2
Lorsban, and 10.5 ng/cm2. Counter. A second extraction from se1ecte.d samples from the lower
leg, abdomen, shoulders, chest pocket, sleeve and cuff proved that pesticides had not been
exhausted from the fabric by the first extraction. Dyfonate and Thimet appeared in a few
samples with the second extraction that had not appeared with the first extraction. Two samples
selected for a third extraction produced about 30 percent additional pesticide. Although original
contamination levels were unknown, this study shows the difficulty of removal of pesticides from
a textile matrix and suggests that work based on a single extraction may underestimate the
amount of pesticide present. It also underscores the importance of dosimeter materials in
affecting results of exposure studies. The residues per cm2 seem small, but the total garment
load must be considered. The health risk associated with chemicals so firmly bound in cloth is
uncertain, especially when other clothing layers are worn beneath. L.aundering after every
wearing does not seem to completely clean pesticides from clothes in real-life minimum
exposure situations of corn and soybean farming, but many studies have previously indicated
that laundering greatly reduces pesticide residues. The persistence of Thimet and Dyfonate(s)
which were used four and three years before this analysis, respectively, was unexpected. Cotton
coveralls offer several advantages over disposables that are expensive, cannot be decontaminat-
ed, contribute to hazardous-waste problems, and are often too hot for comfort. This work
suggests that it may be wise to replace cotton coveralls each crop season to prevent residue
buildup.

Surgeon General's Conference on Agricultural Safety and Health - 1991

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Making Connections

ASSESSMENT OF BIOAEROSOL EXPOSURES IN GRAIN AND
         DRY VEGETABLE HANDLERS

By Peter S. Thorne, M.S., Ph.D., Sue Ellen Hosch, Janet L. Watt, David A. Schwarh i
            University of Iowa, Iowa City, Iowa

Workers exposed to grain and dry vegetable dust are reported to experience airway inflam-
mation and progressive airflow obstruction. A population-based, longitudinal study was
undertaken to determine the association of specific workplace exposures with pulmonary
changes in grain handlers. A unique component of this study is the quantification of airborne
levels of fungi, total bacteria, gram negative bacteria and thermophilic organisms. In addition,
total and respirable dust, endotoxin levels, and other environmental parameters will be assessed
for approximately 400 workers on three occasions over 5 years. At the outset, a survey was sent
to 669 operating grain facilities in eastern Iowa. Completed surveys were received from 80
percent which illustrated the high degree of cooperation from these mixed grain, corn and
soybean facilities. The mean number of production employees was 7.7 (range: 1 to 800) and
employees numbered five or less in 71 percent of these sites. In the first two quarters of the
study, exposure assessments and respiratory health evaluations were performed on 185 workers
at 50 sites. Levels of indoor airborne fungi averated 600 CFU/m3 for postal workers, who serve
as our control population, while grain facilities averaged in excess of 20,000 CFU/m3. Airborne
bacteria were generally twofold higher than fungi with 23 percent of the grain sites exceeding 1 x
105 CFU/m3. Thermophilic microbes averaged 200 CFU/m3 in postal stations but were 10 to 40
times higher at grain sites, and gram negative bacteria at grain sites averaged 4000 CFU/m3.
For all types of microbes, levels appear to be highest at mixed grain facilities. Microbial counts
were split approximately evenly between respirable and non-respirable sizes. These data
indicate that microbial exposure levels cover a broad range. Moreover, the range of exposure
levels will enhance our ability to test our hypothesis thesis that pulmonary function deficits are
exposure dependent. (Funded by the Veterans Administration Merit Review and NIEHS
ES00202).

530

Papers and Proceedings


Poster Abstracts, May 2, 1991

DEVELOPMENT OF AN INHALATION TOXICOLOGICAL MODEL
           FOR FARMER'S LUNG

By Peter S. Thome, AU., Ph.D., Susan D. Kdtizewski
     University of Iowa, Iowa City, Iowa

Farmers inhale a complex mixture of xenobiotics that includes respiratory irritants, microbial
toxins, nuisance dust and a multitude of aeroallergens derived from plants, animals, arthropods,
and microbes. Farmer's Lung is an extrinsic allergic alveolitis characterized by lymphocytic and
granulomatous interstitial lesions. It is most often associated with exposure to the thermophilic
spore-forming bacterium, Faeni rectiviqda (M. faeni), found in moldy hay. In order to study the
pulmonary immunologic processes associated with the early stages of this disease, we undertook
to develop murine and guinea pig models of Farmer's Lung using inhalation exposure. Large
quantities of pure A4 faeni were grown in tryptic soy broth at 5O"C, then washed and concentrat-
ed. Aerosols of a homogenate of this M. faeni preparation were generated into exposure
chambers using a PIIT#l nebulizer. This procedure allowed generation of atmospheres
containing up to 8 mg/m3 pure M faeni. Two exposure systems allowed inhalation challenge to
either mice or guinea pigs with responses determined from histopathology, immunochemistry
and pulmonary function evaluations. In one such study, mice inhaled MI faeni aerosols (5.7 +
1.7 mg/m3) for 30 min, once each week. Three groups of 10 mice received either 4 or 8
exposures or were sham exposed, and each group consisted of 5 animals fed a standard diet and
5 fed a diet containing a stimulant of delayed hypersensitivity responses (vitamin A). Histopath-
ological examination of the mouse lungs demonstrated marked perivascular and peribronchiolar
histiocytosis, localized acute inflammatory cells, fibrosis, and giant cells in granulomatous lesions
in the mice fed the vit. A-supplemented diet and exposed on 4 occasions. Other treatments
resulted in mice with less severe responses. Inhalation exposures of guinea pigs in plethysmo-
graphy will incorporate measurement of bronchoconstriction, airway hyperreactivity and
immunochemistry into the model. This appears to be the first animal model to demonstrate
Farmer's Lung solely by the inhalation route of exposure.

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Making Connections

FARM FAMILY REHABILITATION MANAGEMENT PROGRAM
           (FARM)

    By Therese M. Willkomm, M.S.
Iowa Easter Seal (FaRM) Program, Des Moines, Iowa

There are more than 45,000 Iowa farm families who have been affected by permanent
disabling accidents, injuries, or illnesses. Until recently, many farm families were forced to
prematurely discontinue this rural way of life or attempt to farm with a disability that often
resulted in secondary injuries. In 1986, the Iowa Easter Seal Farm Family Rehabilitation
Management (FaRM) Program was developed to address the needs of this "at risk" population.
The FaRM Program provides onsite rural rehabilitation services to farm families affected by
disabilities. These services promote return to farming, the community, and increased indepen-
dence by both the disabled individual and family members through adaptive equipment,
modifications to the farm and home, secondary injury prevention education, and community
support services. The success of this program has been recognized nationwide as an innovative
and grassroots service delivery program. In November of 1990, President Bush signed the Farm
Bill which included an amendment to establish programs in other states that will assist farmers
with disabilities based on the successful Iowa FaRM Program. The Iowa Easter Seal FaRM
Program relies heavily on its cooperative agreements, coalitions, contracts, and networking with
the following organizations: The Farm Bureau, Pork Producers, Cattleman's Association, and
other community organizations to assist in identifying individuals with disabilities and providing
assistive technology services; Iowa State University Agricultural Engineering Program to assist in
designing agricultural work site adaptations; the University of Iowa Ag-Medicine Program and
the Iowa Program for Assistive Technology to assist in injury-prevention activities, statewide
awareness, and direct service delivery; State Vocational Rehabilitation, rehabilitation hospitals,
and The Department of Public Health to assist in referrals and funding of services. In addition,
the FaRM Program utilizes: a statewide ingenuity network comprised of volunteers who assist in
obtaining, designing, and fabricating rural assistive technologies; a peer technology support
network comprised of individuals with disabilities who share their experiences with individuals
who are newly disabled; and an on-site Mobile Rural Assistive Technology Unit.

532

Papers and Proceedings


Poster Abstracts, May 2, 1991

EDUCATING IO WA FARMERS ABOUT PESTICIDE SAFETY AND
             HEALTH RISKS

63, Wendy K wintersteen, Ph.D.
Iowa State University, Ames, Iowa

Minimizing the health risk inherent in pesticide application is a major goal of the Pesticide
Applicator Training (PAT) program. In the past three years, more than 40,000 Iowa farmers
attended a 4-hour training session on the health and safety concerns associated with pesticides.
Although pesticides are toxic, the health risk they pose can be significantly reduced by practices
that limit exposure. The Iowa State Cooperative Extension Service PAT program seeks to
reduce harmful health effects by alerting farmers to the exact toxic nature of pesticides, and
strate ies to minimize
read t fl e pesticide labe P esticide exposure. When handling pesticides, farmers are cautioned to
          and wear the suggested protective clothing. Neoprene or nitrile gloves,
goggles or face shields, rubber aprons of coated T&ek disposable suits. are items that can
dramatically decrease pesticide exposure and limit harmful health effects. Farmers are also
taught to re-enter sprayed fields only after a safe interval and methods to reduce pesticide drift
on themselves and their neighbors. Pesticide poisoning symptoms and exposure routes receive
considerable attention as well. Recognizing pesticide poisoning symptoms for each class of
pesticides, and responding with the proper first aid and medical treatment is essential farm
safety knowledge. Program evaluations have been very favorable and participants have adopted
safer pesticide-handling practices as a result of attending the program. A post-training survey of
1,040 applicators asked respondents if they would change their farming practices as a result of
attending the training program. The response choices were: likely, not: likely, or not sure. As a
result of attending the training sessions, 91 percent said they would check pesticide labels for
signal words indicating product toxicity. Also, 87 percent thought they would increase their use
of protective equipment, such as gloves, goggles, and coveralls.

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Making Connections

THE AGRICULTURAL SAFETY AND HEALTH PROMOTION
     PROGRAM FOR OLDER KANSANS   1

   By Marvin Hachmeister
Kansas State University, Manhattan, Kansas

The Agricultural Safety and Health Promotion Program for Older Kansans was launched this
year in an effort to communicate safety information to farmers who may not have been reached
successfully in the past. To this end, we are taking a slightly different approach in our outreach
than that of previous safety programs. Since farmers' past attendance at seminars and meetings
focused specifically on safety has been disappointing, we are attempting to communicate our
safety message by taking advantage of already existing community forums. In each of Kansas'
105 counties, we are recruiting and training a team of volunteers who will make brief, 7-to-lo-
minute presentations on various safety topics to community gatherings such as Extension
meetings, Farm Bureau meetings, seed and fertilizer sale days, church events, and meetings of
local service organizations. Each team of volunteers is backed up by a support team consisting
of the county Extension agents, the county Farm Bureau safety chairperson, and the county
health director or local representative of the Area Agency on Aging. The volunteers will base
their presentations on a series of 4-page tabloids dealing with the following seven topics:

o Tractor Safety.

o Pesticide application and farm chemical handling.
o Farm machinery (other than tractors).
o Farm vehicles (trucks, wagons, ATVs, etc.).
o Livestock safety.
o Health issues.
o Farmstead safety (electrical hazards, grain bins, manure pits).
Volunteers will be provided with lesson plans containing suggestions for conducting the

presentations, although volunteers are encouraged to be original and to use their personal
knowledge and experience in formulating their own approach to their audience. Volunteers will
distribute the tabloids at each of the meetings at which they make presentations. To further
broaden our audience, the project will include production of a series of eight videotapes, one on
each of the above topics, plus an additional video dealing with the aging process and how it
relates to farm work. The project also involves incorporating units on safety into college
agricultural courses and holding an annual Agricultural Engineering Safety Design Contest for
college students.

534

Papers and Proceedings


Poster Abstracts, May 2, 1991

R/SK OF EXPOSURE TO CRYPTOSPORlDlUM AMONG
        FARMERS IN WISCONSIN

By Eugene J. Lengerich, KM.D., D. Addiss, D. Juranek
    Centers for Disease Control, Atlanta, Georgia
               J. Mam
   Marshfield Medical Research Foundation, Wisconsin
           B. Ungar

Uniformed Services University of the Health Sciences, Bethesda, Maryland

Cryptosporidium infection is an important cause of diarrhea in humans and domestic animals;
no effective therapy is known. Because the livelihood of farmers often requires contact with
potentially infected animals, farmers may be at greater risk for Cryptosporidium exposure and
disease than non-farmers. We used an enzyme-linked immunosorbent assay to determine the
serologic status of current farmers, ex-farmers, and persons who never farmed in a cohort of 116
Wisconsin men. Of 75 men who reported to be currently farming, 33. (41.3 percent) were
seropositive for Cryptospon'dium, compared with 8 (19.5 percent) of 4 1 ex-farmers and never--
farmers (odds ratio = 2.9, 95 percent confidence interval 1.1-7.9). After leaving the occupation
of farming, ex-farmers experienced a decrease in seropositivity (p = 0.06). These findings
suggest that current farmers are at greater risk of Cryptospon'dium infection than are ex-farmers
and persons who never farmed. Additional work is needed to define high-risk farming activities
and determine modes of transmission in the farm setting so that farmers can take effective
measures to prevent this potentially serious disease.

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Making Connections

NON-HODGKIN'S LYMPHOMA ASSOCIATED WITH THE
    AGRICULTURAL USE OF HERBICIDES

By Dennis D. Weisenburger, MD., S. Zahm, M War-4 l? Babbitt, F. Holmes

C. Boysen, R Rebel, R Saal, J. Vaught, X Cantor, A. Blair
University of Nebraska, Omaha, University of Kansas, Kansas City
    National Cancer Institute, Bethesda, Maryland

Recent epidemiologic case-control studies in Kansas and Nebraska have s,hown that agricul-
tural herbicide use, particularly that of 2,4-D, is associated with an increased risk of non-
Hodgkin's lymphoma (NHL). To better characterize this risk with regard to' histologic type, we
combined the results of the two studies (370 male cases, 1,671 controls) using the Working
Formulation histologic classification. Among men, the use of herbicides was associated with a
50 percent increased risk of NHL (OR= 1.5; 95 percent Cl= 1.1,2.1), and the use of 2,4-D was
associated with a two-fold increased risk (OR=1.9; 95 percent CI= 1.3,2.8). Exposure to 2,4-D
more than 20 days/year increased the risk more than four-fold (OR=4.5; 95 percent CI= 1.1,18.-
3). Interestingly, increased risks were seen for all ten major histologic types of NHL (categories
AJ) in the Working Formulation. The highest risks associated with exposure occurred in
intermediate-grade NHL (categories D-G). The use of herbicides was associated with a 70
percent increased risk of intermediate-grade NHL (OR= 1.7; 95 percent CI== 1.2,2.6), and the
use of 2,4-D was associated with a more than two-fold increased risk (OR=2.4; 95 percent
CI= 1.53.9). Exposure to 2,4-D more than 20 days/year increased the risk of intermediate-
grade NHL by more than eight-fold (OR=8.3; 95 percent CI= 1.7,38.7). Within intermediate-
grade NHL, follicular large cell NHL (category D) was the highest risk type with a nearly seven-
fold increased risk associated with the use of herbicides (OR=6.7; 95 percent Cl= 1.4,44.1) and a
ten-fold risk associated with the use of 2,4-D (OR= 10.0; 95 percent CI= l-9,69.8). We conclude
that agricultural herbicide use is associated with an increased risk for all ma.jor types of NHL,
and for follicular large cell NHL in particular.

536

Papers and Proceedings


Poster Abstracts, May 2, 1991

TRACTOR SAFETY CLASSES FOR YOUTH

       By Geraldine Smith
Huron County Health Department, Bad Axe, Michigan

"Farming Safely in the Thumb" is a program serving Huron, Sanilac, and Tuscola Counties of
Michigan. It is funded by a grant from the Michigan Department of Labor, Safety Education
and Training Division. One of the major events of this program has been the Safe Tractor
Operation classes for youth ages 10 years and older in each of the three counties. The 4-H
Tractor Operation Program was established in 1970 as a means for youth to receive an
exemption from the tractor driving restrictions of the Hazardous Occupations Order. For many
years, the training needed by youth to receive this exemption was handled through Vo-Ag
programs of local high schools. As a result of the discontinuation of or change in these
programs and the concerns of liability, most youth in the "Upper Thumb" of Michigan had no
way of earning a "certificate of training." This training has been demonstrated to be very
successful in reducing injuries among those youth completing the program. The Safe Tractor
Operation classes meet all of the requirements for providing youth 14-15 years of age with the
training needed to earn this certificate. At the same time, these classes provide safety education
to younger youth when they are beginning to learn to drive tractors. The classes are co-
sponsored by "Farming Safely in the Thumb," the county 4-H Council and the county Farm
Bureau. They run 7 weeks, meeting 1 night a week for 2 hours. The. classes are strictly
classroom instruction (there is no practical tractor driving) and are divided by ages (lo-12 years
and 13 or older). Each youth has a manual, and the instructors make use of slide/tape
presentations (available through the Cooperative Extension Service, Michigan State University),
safety videos and outside speakers. Every youth receives a 4-H Certificate of Participation and
a Tractor Safety T-shirt. The students 14 and 15 years old who wish to earn a "certificate of
training" must pass both a written test and a practical driving test. Over 1,000 youth participat-
ed in the classes this winter.

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Making Connections

GREEN ISLE PROJECT: MY HEALTH FOR BETTER

LIVING

  By Linda J. Hachfeld, M.P.H., RD.
Wellness Center of Minnesota, Mankato, Minnesota

Rarely are there programs that outlive the grants that have given birth to them. Fewer still
leave their imprint by serving as a model for a state public health sector. The. My Health for
Better Living Project influenced a rural community and two townships of 1,600 to re-examine
their lifestyle to make changes in their eating patterns and exercise habits. The project
incorporated the effort of 4-H members, community leaders, parents, schools, and county health
professionais to improve the health and well-being of the families in the rural area surrounding
and including the Green Isle community in western Minnesota. This project included the
development of a health promotion education model that fostered community participation.
The specific purpose of the project was to fill a need as expressed by the citizens of the Green
Isle rural community and evidenced by the number of overweight children, undernourished
elderly, medical complications, and chronic disease cases. Due to the worsening rural economic
crisis, rural families were manifesting poor health habits which exacerbated their underlying
health concerns. This project is unique because it was spearheaded by concerned youth and
their parents. A Health Advisory Committee assisted in translating the ideas into action. The
results have been positive. Designed for 1 year, the program has lasted 3! The cost of the
programs was done on less than $8,500 and has involved more than 1,200 hours of volunteer
time. Many people have admittedly taken the time to make changes in their eating and exercise
habits, positive changes influenced by programs initiated by the Sundown Busy Bees 4-H Club.
The programs address several age groups and continue to occur because they either have been
integrated into existing establishments or have become self-sustaining. This project has received
recognition from the Governor of Minnesota and the U.S. Secretary of Hea1t.h and Human
Services.

538

Papers and Proceedings


Poster Abstracts, May 2, 1991

TEEN STRESS, DEPRESSION, AND SUICIDE

       By Diane Norland
Sioux Trails Mental Health Center, New Ulm, Minnesota

According to University of Minnesota researchers, teen stress, depression, and suicide are
occurring at high levels. These findings help dispel the notion that childhood is an unbroken,
happy, carefree time. To address these issues, Sibley County, Minnesota, set up a Teen Stress
Committee to develop an education and intervention program for school personnel, young
people, parents, and interested community members. The committee used a program Tackling
Tough Stuff developed by Joyce Walker, a University of Minnesota Youth Development
Specialist. The Teen Stress Committee carried out two trainings of Sibley County school
personnel which educated the participants about the prevalence of stress, depression, and suicide
among young people. The participants also learned about signs and symptoms. Most important-
ly, they learned how to help. Selected teachers were recruited and trained in the use of the
Tackling Tough Stuff curriculum to be used in their classrooms. A Student Assistance Team was
recruited and trained in each school to deal with referrals from other school personnel and
students. A play about teen depression, suicide and possible responses was performed for the
community to raise their awareness about the issues. Several types of parenting workshops have
been held twice a year on parenting challenges. Finally, a workshop featuring resources was
held for all area professionals, such as school personnel, health professionals, social services, law
enforcement, and clergy.

Surgeon General's Conference on Agricultural Safety and Health - 1991

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Making Connections

ROCK COUNTRY WALKS AROUND THE WORLD IN 30 DAYS

      By Gloria Tollefson
Rock County Health Service, Luverne, Minnesota
          Lin Blaskovich
Minnesota Department of Health, Minneapolis, Minnesota

Rock Healthy is a community-based health promotion coalition whose mission is to reduce
the risk factors of chronic disease through proper nutrition and fitness. The coalition is made
up of representatives from food retailers, businesses, county agencies, schools, producer groups,
commodity groups, consumers, and the local hospital and medical clinic. The coalition planned
and implemented a county-wide program, Rock County Walks Around the World in 30 Days.  The
goals of the program were to: (1) increase awareness of the relationship between exercise and
heart health; (2) promote walking as a heart healthy exercise; (3) increase awareness of the
available walkmg sites and trails in Rock County; (4) provide the opportunity for residents to
engage in a walking program; and (5) to sign up 1,000 participants. Participants were recruited
from the community-at-large, work sites, schools, community groups, and churches. Participants
were given a sample walking program, weekly log cards, and exercise tip sheets. Each week
walkers turned in their log cards. Miles were added up each week and tracked on a map of the
world that was on display at the downtown newspaper office. Rock County has a population of
10,442; its major industry is agriculture and related to businesses. Almost 18 percent (n= 1,772,
805 men and 967 women) of the population participated in the Walking Campaign-walking a
total of 43,942 miles. The rural community of Hardwick, population 150, had 50 percent of its
residents participate. All the school districts in the county (elementary, junior and senior high)
participated for a total of 1,069 school-age children. Rock Healthy Coalition has put together a
campaign overview and a media guide (sample ads, stories, etc.) that can be used by other
communities.

540

Papers and Proceedings


NETWORKING

Poster Abstracts, May 2, 1991

THE NEBRASKA SAFEW PROGRAM

   By Rollin D. Schneider
University of Nebraska, Lincoln, Nebraska

There are many organizations, groups, and private citizens who are willing to help in
delivering a message. Nebraskans are willing to help, if given the opportunity. For the last 30
years, I have been able to use a number of people to tell the safety and health story across the
state of Nebraska and some other states within the United States. Foreign countries are not
excluded. Altogether, I have over 1,000 people helping me tell the safety and health story. This
includes upwards of 375 State Patrol Personnel, Sheriffs Departments, EMTs, County Extension
Agents, Vocational Agriculture Instructors, Farm Organizations, etc. This figure is greatly
expanded when you consider there are approximately 21,000 Emergency Medical Technicians
who carry the story to the local level. After all, it is to their benefit if they can teach about an
accident potential in a positive manner rather than having to pick up an injured person. Each
state has this cadre of people to work with. It is just a matter of getting the people to under-
stand what is needed and then giving them the facilities or information to work with. There is a
segment of the "You scratch my back and I'll scratch yours." If I expect people to help me, they
may also want my help at some time. Overall, I use 50 or more organizations or groups to help
with the safety and health story. This practice has proven to be very beneficial. Some people I
talked to point out they cannot get cooperation. The first question I ask them is, "Did you ask
for help?" The answer is usually "No. They did not help someone else I know so they probably
will not help me." My reply is, "They are going to either say yes or no.  You don't know which it
will be until you ask."

Surgeon General's Conference on Agricultural Safety and Health - 1991

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Making Connections

GRAIN SORGHUM DUST EXTRACT CHALLENGE CAUSES
NEUTROPHIL MIGRATION TO THE PERIPHERAL BLOOD, THE
UPPER RESPIRATORY TRACT AND THE LOWER RESPIRATORY TRACT

By Susanna G. Von Essen, M.D., D.P. O'Neill, R.A. Robbins, S.I. Bennard
         University of Nebraska, Omaha, Nebraska

Inhalation of grain dust is known to cause acute bronchitis symptoms, nasal irritation, and
peripheral blood neutrophilia. We proposed that challenge with grain sorghum dust extract
(GSDE) causes neutrophils to migrate to both the upper respiratory tract (URT) and lower
respiratory tract (LRT). To test this hypothesis, 8 normal non-smoking, non-allergic volunteers
were challenged with 24 ml of grain sorghum dust extract delivered to the URT and LRT as an
aerosol generated by a Pulmoaid nebulizer. Assessment of the URT and LRT for signs of
inflammation was done using nasal lavage (NL) and bronchoscopy with bronchoalveolar lavage.
NL performed at baseline and +24 hours was done by instilling 3.5 ml. aliquots of saline which
were immediately, forcibly expelled. There were more PMNs at +24 hours than at baseline
(.29 t . 09 vs . 2 . 33 +_ 1. 40 x 10, p < .l). BAL was performed at + 24 hours by instilling 5,
20 ml aliquots of saline followed by gentle aspiration. The returns from the first aliquot were
processed as the "bronchial" sample and the remaining BAL fluid was pooled as the "alveolar"
sample. There was significantly more PMNs in the "bronchial" and "alveolar" compared to
normal controls ("bronchial": 40 2 4 vs. 10 k 1 percent, p < 0.05; "alveolar": 46 + 7 vs. 1 -+ 4
percent, p c 0.05). Although GSDE can attract neutrophils by a variety of mechanisms, an
alternative, not mutually exclusive, hypothesis is that neutrophils are stimulated to randomly
migrate (chemokinesis). To test this hypothesis, blood neutrophils are collected from the GSDE
challenged volunteers at baseline and +7 hours. Neutrophil chemotaxis to GSDE was done with
these PMNs using a modified blindwell chamber technique and significantly more PMNs
migrated towards GSDE 7 hours after aerosol challenge with GSDE than a.t baseline (126 +- 7
vs. 164 k 7 cells/bps, p < .OS). These experiments demonstrated that there is a PMN influx into
the URT and LRT. This may be explained, at least in part, by increased chemokinesis of the
exposed patients' PMNs.

542

Papers and Proceedings


Poster Abstracts, May 2, 1991

MANAGEMENT PROCEDURES TO ENSURE HORSE
FARM SAFETY AND TO REDUCE LIABILITY COSTS AND
          RISK TO OWNERS

     By Zane R Helsel, Ph.D.
Rutgers Cooperative Extension, New Brunswick, New Jersey

Liability costs are a prohibitive factor to horse farm owners and riding instructors to the
extent of making it financially unfeasible to remain in business. The objective of this extension
educational program was to increase the awareness of horse farm owners and riding instructors
of proper farm management and riding techniques that not only ensure personal safety and well-
being, but also reduce insurance premiums and risk of lawsuit from liability claims. The
program was designed to provide horse farm owners with a model horse farm to assist in
meeting standards for farm safety techniques that will serve as evidence they are making a
conscious effort to provide a safe atmosphere for themselves, clients, and horses. The model
farm and safety techniques are described on videotape and in a series of fact sheets. The
agenda for the videotape included: 1) general barn, surrounding acreage and pasture safety; 2)
demonstration of what constitutes an "attractive nuisance"; 3) proper storage and care of
equipment and outbuildings; and 4) examples of posted signs and considerations for liability
coverage. Topics of fact sheets included: 1) safe management techniques while approaching,
handling, leading, typing, saddling, and bridling; 2) proper riding safety while mounting,
dismounting, and astride; 3) preventive measures for fire safety and what to do in the event of
fire; and 4) considerations for liability coverage and examples of hold-harmless agreements.
Success of the program was determined by increased awareness of the need for horse farm
owners to take a proactive role in reducing farm and instructor liability and demonstrated
improved farm safety management practices and riding techniques by horse farm owners in New
Jersey. Overall program success will be identified by reduced farm liabihty premiums and the
number of horse farm and riding accidents.

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Making Connections

A RESPIRATORY AWARENESS PROGRAM FOR NEW YORK
              FARMERS

By Marylee B. Hill, B.S., RN., John J. May, MD.

New York Center for Agricultural Medicine and Health, Cooperstown, New York

To Workers in agriculture are at risk for a variety of occupational respiratory diseases (ORD).
address this problem, we designed an outreach program aimed at heightening the awareness
of New York farmers regarding ORD. We elicited information regarding occupational dust
exposures as well as respirator use from 431 farmers prior to routine spirometric evaluation at
10 agricultural exhibits. One hundred eighty-one farmers (42 percent) reported using respirators
prior to participation in the program. However, further questioning revealed that 118 of these
(65 percent) were using handkerchiefs and single-strap masks. Following an explanation of the
screening results, a brief review of the risks of ORD, the benefits of dust avoidance, and
instruction on the proper use of approved respirators, each participant was given a list of
respirator suppliers. Effectiveness of this interventional approach was determined by 6 week
follow-up with postcards (55 percent response rate) and with telephone interviews of a 10
percent sub-sample of the non-responders. Follow-up of those not previously reporting use of
protection showed current respirator use in 60 percent of the postcard responders and 50
percent of the sample of non-responders for a total weighted average of 54.6 percent improved
compliance following the program. There was a prevalence (36 percent) of abnormal spiromet-
ric results in those not converting. This prevalence was not significantly different from the 34
percent prevalence found in those converting. Therefore, we concluded that abnormal results
were not a predictor of behavioral change. We conclude that this approach is effective in
improving respirator compliance among farmers and that this improvement is independent of
their spirometric results.

544

Papers and Proceedings


Poster Abstracts, May 2, 1991

FATAL FARM ACCIDENTS IN NEW YORK: CONSEQUENCES
         AND ECONOMIC IMPACT

By Timothy WI KeLwy, Ph.D.

New York Center for Agricultural Medicine & Health, Cooperstown, New York

Farming is often identified as one of the nation's most hazardous occupations. The National
Safety Council estimates that 1,300 people die each year in agricultural accidents. Despite the
high fatality rate, there has been only anecdotal evidence about the consequences of fatal farm
accidents on farms, farm families, and local communities. Existing analyses considering the
impact of farm accidents have primarily been case studies which concentrated on non-fatal
accidents. Studies focused on fatal accidents have generally only considered the causes of
accidents and to whom they occur. Using information from a previous newspaper clipping and
death certificate-based study of fatal farm accidents, 87 families who had a member die in a
farm accident in New York between 1985 and 1987 were identified. Fifty-two (60 percent) of
these farm families were successfully interviewed by telephone. Income foregone by the
accidents was estimated from the responses, using discounted future earnings and weighing by
age-based and sex- specific survival probabilities. The discount rate was 5, and was combined
with a productivity increase of 2 percent per annum. The net discount rate was thus 3 percent.
All calculations were in 1987 dollars. Income foregone included on-farm and off-farm income
and the value of household work. Fatal farm accidents cost New York an estimated $1.3 million
a year in lost income. The average present value of lifetime expected income foregone included
$447,157 per male owner, $472,607 per hired worker, $268,918 per female owner, and $514,754
per child killed. The accidents had other costs as well; 67 percent of the families had quit
farming entirely, and 44 percent of the families had moved and were no longer living on those
farms. The relatively high displacement from agriculture and from homes shows that fatal farm
accidents do not just mean the tragic loss of life. These accidents also often have tragic
implications for the families' livelihoods and lifestyle. On the other hand, these family tragedies
clearly do not overshadow other difficulties in agriculture. With at least 1,000 farms in New
York quitting operation every year during this time period, fatal farm accidents were not a
major source of farm family displacement. Furthermore, the total value of the income foregone
by accidental deaths to farm operators was only equivalent to 1.2 percent of the returns from
farming to farm operators in New York, and only 0.48 percent when both on-and off-farm
income of farm households in New York is considered. Fatal farm accidents are major
tragedies for the affected families, but such accidents' foregone income impacts and displace-
ment are relatively small from a societal perspective.

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Making Connections

NORTH CAROLINA AGRICULTURE: DO WE POSSESS
THE RIGHT TOOLS FOR HUMAN ILLNESS IN SWlNE
AND POULTRY OPERATIONS AND INJURIES
     FROM AGRICULTURE MACHINES?

   By Robert L. McLymore, M.S.
University of North Carolina, Raleigh, North Carolina

The Agricultural Health Promotion Systems program in North Carolina is addressing the high
rate of injury and illness of the agricultural worker. In North Carolina, according to the North
Carolina Department of Labor, those involved in agricultural occupations had an occupational
rate of 8.3 /lOO,OOO in 1987, compared to the overall incident rate of 7.3. North Carolina State
Data Center statistics indicate that of the 48 farm-related fatalities reported in 1988, one-third
involved agricultural machinery. Curriculum materials are being developed during the first year
for the College of Agriculture and Life Sciences that will educate students about "Human
Illnesses resulting from Swine and Poultry Confinement Facilities, " and `IAgricultural Machinery
Hazards." These materials will be presented in the 1991 Fall Semester for both associate aqd
baccalaureate courses at NCSU. In addition, courses at the past Carolina University School of
Medicine will benefit from the developed materials. In the second year, eight County Extension
Service programs will pilot the developed materials prior to statewide dissemination. The
development of a Lay Advisors' Program in the third year of the project will lay the foundations
for an ongoing program that will continue to address the health and safety of the agriculture
workers. The relationship which exists between East Carolina University School of Medicine,
local Extension Services Offices, state and local Health Departments and the agricultural
community will become stronger, Through these interactions, a decrease in work-related injuries
and illnesses and the promotion of health in agricultural workers and their families should occur
in North Carolina.

546

Papers and Proceedings


Poster Abstracts, May 2, 1991

FARM OPERATOR INJURY AND HEALTH STATUS

    By Michael D. Schulman, Ph.D.
North Carolina State University, Raleigh, North Carolina

Panel data from random sample surveys of North Carolina farm operators provide data about
injury and health status. Among farm operators who stayed in farming during both survey waves
(N-95), 10 percent said they or a member of their family hid been injured on the farm seriously
enough to miss a day's work, a day of school, or to require a visit to a doctor. Farmers with 200
or more days of on-farm work, those with no off-farm work, those under 45 years of age, and
those with high gross farm incomes had the highest injury rates. Seventeen percent of continu-
ing farm operators fell into the poor health category on an index composed of 10 questions
about common health problems. Eighteen percent of continuing farm operators reported having
a chronic health problem that sometimes interfered with their work. Seven percent of continu-
ing farm operators reported they lacked health insurance. Among farm operators who exited
farming (N-198), 7 percent cited health as the most important reason they left farming and 11
percent said they were disabled. Approximately 27 percent of ex-farmers fell into the poor
category on the health index and 13 percent lacked health insurance. The results point to the
need to consider both the short-term and long-term effects of agricultural hazards on the health
status of farmers and ex-farmers.

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Making Connections

THE USE OF PROCESS HAZARD ANALYSIS FOR PREVENTION
    OF INJURIES FROM ANHYDROUS AMMONIA

By Amy A. Beady, B.S.
  Cincinnati, Ohio

In order to prevent occupational illness and injury, it is desirable to anticipate potential
hazards and to proactively implement appropriate preventive measures. One possible tool for
doing this is Process Hazard Analysis (PHA). Researchers from the National Institute for
Occupational Safety and Health (NIOSH) have applied a form of PHA called Hazard and
Operability (HAZOP) analysis to analyze the use of anhydrous ammonia by farmers. Due to
the extensive use of anhydrous ammonia, it is particularly important that the equipment,
hardware, and procedures be both safe and highly tolerant to potential misuse. The HAZOP
analysis involves: a systematic evaluation of the potential failure points that can occur with the
equipment and procedures used in anhydrous ammonia storage, transfer, and application; the
identification of addible and hazardous accident scenarios; and the identification of practical
solutions or of research needs. Specific examples of these findings are given. In the future, we
plan to use Process Hazard Analysis in the handling of acutely hazardous pesticides and working
with power equipment. Results from these studies will be disseminated and their effectiveness
assessed.

548

Papers and Proceedings


Poster Abstracts, May 2, 1991

IGE ANTIBODIES TO SWINE ANTIGENS IN THE SERA OF
         PORK PROCESSORS

By Toni A. Bledsoe, M.S., M.T. (A.S.C.P.), Daniel M. Lewis, Steven W Lenhart
NIOSH, Division of Respiratory Disease Studies, Morgantown, West Virginia
             Sheny L. Baron

NIOSH, Division of Surveillance, Hazard Evaluations and Field Studies, Cincinnati, Ohio

As part of an investigation of respiratory illness among workers at a pork processing facility,
we obtained serum samples from 37 workers and bulk samples of substances to which the
workers were exposed. The serum samples were analyzed for total IgE content by a commercial
radioimmunoassay (PRIST), and for specific IgE antibodies by the radioallergosorbent test
(RAST) using extracts of swine urine, serum, blood, and dander coupled to cyanogen bromide-
activated cellulose beads. A sample was considered positive if the binding to the antigen-coated
beads was at least twice the binding to human serum albumin-coated beads. By this criteria, IgE
antibodies to one or more antigens was detected in 28 (75.7 percent) of the sera tested. All 28
sera reacted with the whole blood extract, while 16 reacted with the dander, 10 with the urine,
and 8 with the serum. No correlation between the total IgE content and specific IgE antibodies
was observed. By questionnaire, 25 of the subjects were symptomatic for respiratory disease; 14
of these subjects had abnormal serial peak flow measurements. The antibody data was analyzed
with respect to the symptoms and peak flow finding, and revealed that 9 of 14 (64 percent)
symptomatic with abnormal peak flow measurements had IgE antibodies while 10 of 11 (91
percent) of symptomatic with normal peak flow measurement had IgE antibodies. These results
demonstrate that pork processing workers develop IgE antibodies to swine antigens, and that
antibody activity may correlate with symptoms but not impaired pulmonary function.

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Making Connections

DEVELOPMENT OF AN IMMUNOASSAY METHOD FOR THE
DETECTION OF ALACHLOR IN AGRICULTURAL WORKERS'
URINE: CORRELATION WITH A GAS CHROMATOGRAPHIC
       (CC) CHEMICAL METHOD

By Raymond E. Biagini, Ph.D.
NIOSH, Cincinnati, Ohio

u

A NIOSH field study of commercial pesticide applicators was conducted to characterize their
exposure to alachlor, a major component of Lasso, which is a commonly used pre-emergent
herbicide. To assess exposure and estimate uptake of alachlor, worker urine samples were
analyzed using two different techniques for alachlor or its metabolites. The first was a published
gas chromatographic method for analysis of urinary alachlor metabolites. We also developed an
enzyme-linked immunosorbent assay (ELISA) method. The ELISA method is based on the use
of antibodies directed against alachlor. The antibodies are also tagged with an enzyme whose
reaction products are colored; adding the substrate of the enzyme to the reaction mixture yields
varying intensities of color which are related to alachlor concentration. Preliminary results
indicate a high correlation between the two methods. Immunochemical technology appears to
be a viable alternative to traditional wet chemical and instrumental methods of analyses for
assessing exposures in agricultural environments. Benefits of this technology include simpler
sample preparation, reduced cost and analysis time, and the potential for onsite field measure-
ments. A detailed description of the ELISA method and the results of the analyses for the field
study samples will be presented.

  THE USE OF CONTlNlJOlJS EXPOSURE MONITORING
COMBINED WITH VIDEO TASK ANALYSIS TO CHARACTERIZE
AND PREVENT OCCUPATIONAL HAZARDS IN AGRICULTURE

By James A. Gideon, Ph.D., Mike Gressel, Leroy Mickelsen, MS.
           NIOSH, Cincinnati, Ohio

NIOSH researchers have developed a powerful new technique that combines two separate
tools for analyzing occupational hazards: videotaping and "real-time" continuous exposure
monitoring. The level of hazard exposure can then be superimposed onto the videotape in the
form of a moving bar. This permits a simultaneous inspection of individual tasks that are
performed during a workday and of the exposures associated with each task. The result is a
much clearer understanding of the sources of exposures and the ability to formulate a much
more specific intervention strategy. This technique applies to chemical, physical, ergonomic, and
any other hazards for which the level of hazard can be continuously monitored. A videotape of
industrial processes demonstrating this technique will be available.

550

Papers and Proceedings



Poster Abstracts, May 2, 1991

THE OHIO STATE UNIVERSIW NIOSH AGRICULTURAL
HEALTH AND SAFETY PROMOTlON PROGRAM

  By Timothy J. Lawrence
Ohio State University, Columbus, Ohio

Surveys conducted in the state of Ohio in 1982 and again in 1990 indicate the rate of farm
accidents remains very high. The 1982 survey showed that nearly one-third (30.2 percent) of all
farms surveyed (n = 918) experienced a farm-related accident during the 3-year period from 1980
to 1982. The 1990 survey revealed that 15 percent of all farms surveyed (n=574) experienced at
least one farm accident during 1989. These data demonstrate that farming in Ohio follows the
national trend as being one of the most hazardous occupational pursuits. In an effort to reduce
the rate of farm accidents, the Ohio State University is participating in a NIOSH Agricultural
Health and Safety Promotion Program. The goal of the project is to improve the health and
safety record of the Ohio farming community through a comprehensive educational program.
Carefully selected faculty members from the departments of Agricultural Engineering, Family
Resources, and Preventive Medicine will work with the Cooperative Extension Service to
accomplish this objective. The long-term goal of this program will be to establish an up-to-date
information source and a network of individuals to teach farm health, safety, and rescue. The
first phase of the program is to assess the Extension agricultural safety and health training,
education and informational program needs. This will be accomplished through surveys,
accessing additional farm accident data, personal knowledge of the professional faculty and a
review of available literature. Current Extension literature will be reviewed and updated. New
comprehensive teaching modules will be developed in areas of specific concern in the state of
Ohio. These modules will cover such areas as tractor, implement and pesticide safety, and will
be targeted to satisfy the needs of vocational education teachers. Working with the Ohio Fire
Academy, the program will establish a continuing "Train the Trainer" program for Fire and
E.M.S. personnel on farm accident rescue. The Department of Agricultural Engineering will
develop a "capstone" course for all students to increase their overall understanding of health and
safety issues. This program will develop a solid basis for improving the state of Ohio's agricul-
tural health and safety environment on a continuous basis for years to come. This poster
session will focus on the current Ohio agricultural health and safety issues, the methods the
Ohio State University will employ to mitigate the problem, and the expected long-term effect of
the NIOSH program in Ohio.

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Making Connections

CHEMICAL HAZARDS TO THE NEUROBEHAVIORAL HEALTH
        OF AGRICULTURAL WORKERS

By John M. Russo, Ph.D.
NIOSH, Cincinnati, Ohio

An estimated 3.2 million agricultural workers in the United States may be at risk of multiple
exposures to known or suspected neurotoxic chemicals (e.g., pesticides, fumigants, solvents,
metals and gases). These chemicals can produce immediate, delayed or chronic impairments of
behavior and neurologic function, including sensory, cognitive and motor abilities. Neuroanato-
mic or neurochemical damage may accompany behavioral deficits, but often such damage is
undetectable before the onset of functional impairment. Current knowledge of the impact of
neurotoxicants on agricultural workers is largely derived from controlled laboratory and field
studies intended to assess the acute effects of single compounds or compound classes (e.g.,
organophosphate pesticides). Few studies address the neurobehavioral health of agricultural
workers after repeated exposures to multiple chemicals. This presentation describes advances in
selected neurobehavioral test methods, proposes a strategy for application in field studies, and
suggests a research agenda for the surveillance and assessment of neurobehavioral health among
agricultural workers.

552

Papers and Proceedings


Poster Abstracts, May 2, 1991

EXPOSURE OF COMMERCIAL PESTICIDE APPLICATORS TO
        THE HERBICIDE ALACHLOR   r-l

By Wayne T. Sander-son, R. Biagini, G. Henningsen, B. MacKenzie, V. Ringenbetg
             NIOSH, Cincinnati, Ohio

(2-chloro-2',6'-diethyl-N-[methoxymethyl] acetanilide), one of the most common pre-emergent
herbicides used on corn and soybean crops, is considered to be carcinogenic in rodents.
However, exposure and health information on humans is lacking. A study of commercial
pesticide applicators, who apply a variety of herbicides and insecticides to agricultural cropland,
was conducted to characterize their exposure and estimate internal dose to alachlor. Surveys
were conducted at 5 application companies in Illinois and 7 in Ohio. A total of 20 applicators, 7
hauler/mixers, and 18 controls participated in the study. Participants in the study wore air
samplers to measure inhalation exposure and clothing patches to estimate skin deposition.
Hand and glove washes, and surface wipe samples were collected to evaluate hand exposures to
alachlor. To estimate the absorbed dose of alachlor, urine samples were collected at the
beginning and end of the shift, and the morning after the exposure survey. Inhalation exposures
ranged from 0.28 to 6.4 ,ug/m3 with a mean of 2.1 pg/m3. The deposition of alachlor on the skin
ranged from 0.03 to 4.0 pg/cm2 with a mean of 0.63 pg/cm2. The legs generally received more
deposition of alachlor than any other part of the body. Hand wash and glove rinse samples
indicated that the hands were also an area of heavy alachlor exposure; post-shift hand wash
samples and rinses of the inside of the gloves ranged from 0.11 to 281 pg. The concentrations
of alachlor metabolites in the urine ranged from < 1 to 25 ppm with a mean of 5.9 ppm. Those
workers with higher inhalation and hand exposures tended to have greater concentrations of
urinary metabolites. Alachlor exposures were found to be higher for this group of commercial
pesticide applicators than have previously been reported for other applicators and mixers.
Individual work practices had a direct impact on the variability of exposure and dose concentra-
tions. Practical steps can be taken to reduce exposure and internal noise, such as proper use of
pesticide resistant gloves and aprons.

Surgeon General's Conference on Agricultural Safety and Health - 1991

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Making Connections

A FARM FAMILY AND HAZARD SURVEILLANCE PROGRAM
     FOR CASH GRAIN FARMERS IN OH/O

By J.R. Wilkins III, Ph.D., T.L. Bean, Ph.D.
Ohio State University, Columbus, Ohio

A multiple-phase, population-based health and hazard study of Ohio cash grain farmers and
eligible family members is described. The project was designed as a five-year collaborative
effort between Ohio State University, CDC/NIOSH, and the State of Ohio. In Phase 1 of the
project period, which is now underway, a stratified random sample of 6,480 cash grain farms will
be selected from a comprehensive statewide roster, with stratification by size of farm (in acres).
A mixed-mode survey (i.e., a self-administered, mailed questionnaire, with telephone follow-up
of mail non-respondents) will then be conducted to obtain relevant health and hazard data. The
content of the questionnaire and its design will be modeled to a great extent after NCHS'
National Health Interview Survey, a national health survey of the civilian non-institutionalized
population of the United States. In Phase 2, a subsample of eligible Phase 1 respondents whose
farms are located in the 20-county central Ohio area will be invited to participate in a program
of nurse-conducted, in-home physical examinations and on-farm hazard assessments. Procedures
employed for collection of the Phase 2 health data will be modeled after NCHS `s Third
National Health and Nutrition Examination Survey (NEANES III). To the extent possible, the
collection of the Phase 2 hazard data will be modeled after NIOSH's National Occupational
Exposure Survey. With respect to the collection of the Phase 2 health data, attempts will be
made to recruit 624 farm families. For each eligible and participating household member, the
following procedures will be performed by a specially trained public health nurse according to a
standardized protocol: spirometry, audiometry, and measurement of height, weight and blood
pressure. With respect to the (concurrent) collection of Phase 2 hazard data from the same
subsample of farms, a specially trained, two-person Hazard Technician team will conduct on-
farm hazard assessments to obtain (qualitative and quantitative) information on work-related
risk factors. In Phase 3, a sample of farm operators will be asked to participate in a program of
personal exposure monitoring, with a focus on noise and airborne exposure to dust and selected
pesticides. One data collection effort in Phase 3 will involve attempts to collect pesticide
exposure data from all residents in the participating domiciles by monitoring levels of selected
urinary metabolites. In addition to the urinary metabolite analyses, airborne levels of exposure
experienced by the operator/applicator will be monitored by air sampling pumps as in Phase 2,
and, in addition, by application of passive dosimetry techniques.

554

Papers and Proceedings


Poster Abstracts, May 2, 1991

NOISE AND HEARING LOSS IN THE AGRICULTURAL SETTING

By Christa L. Themann, MA, Donald Henderson, Ph.D.
         NIOSH, Cincinnati, Ohio

Nearly 10 percent of the 3.6 million United States farmers and an unknown portion of the
additional 11.8 million farm family members, part-time farmers, and hired workers are exposed
to average daily noise levels in excess of 85 dB(A), the level at which industrial workers are
mandated by OSHA to be protected by a hearing conservation program. Numerous studies
have documented a high incidence of hearing loss among farm workers, a finding generally
attributed to these high noise levels. Although it is fairly apparent that farmers are at risk for
and often develop noise-induced hearing loss, there is little information on actual exposure
levels. Most investigations have focused on noise levels produced by tractors; there is virtually
no information on levels produced by other farm equipment, livestock or processes. There is
also little information on changes in sound levels over time as equipment ages or is modified by
the farmer. A more basic problem is adequate characterization of noise exposure in this setting.
The OSHA dosage calculations and damage-risk criteria for industry do not take into account
farmers' highly seasonal exposure patterns, which are typified by 12-15 hour exposures during
peak seasons, preventing adequate recovery prior to re-exposure. Noise-induced hearing loss
results from the gradual destruction of sensory hair cells within the cochlea. It is a subtle
process which eludes notice until sufficient cells have been damaged so as to produce a decrease
in auditory sensitivity. Once damaged, however, the hair cells cannot be repaired or replaced,
even through medical intervention. Therefore, the key is prevention through education as to the
hazards of noise and the protective measures which may guard against it. Farmers want health
and safety information made available to them, and initial hearing conservation efforts in this
population have been well received. This presentation will summarize the available literature on
noise-exposure levels in the agricultural setting, their apparent effects on the hearing of farmers,
research questions which need to be addressed, and how the Farm Family Health and Hazard
Survey and other projects through NIOSH's Agricultural Initiative are beginning to address
these problems.

Surgeon General's Conference on Agricultural Safety and Health - 1991

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Making Connections

REDUCING STRESS, ACCIDENTS AND DEATHS IN
      OKLAHOMA AGRlClJLTURE

      By Pat Lewis
Oklahoma State University, Stillwater, Oklahoma

The safety specialist at Oklahoma State University has cooperated with several departments
and agencies to promote farm safety in Oklahoma. In 1988, the vital statistics section of the
Oklahoma Department of Health furnished nameless agriculture death certificates to the safety
specialist to establish new safety educational programs. At that time, suicides proved the
leading cause of preventable deaths among the agriculture sector in Oklahoma. The Governor
appointed a task force of eight agencies to collectively look into suicide and stress-related
problems in rural areas. Various public hearings were held throughout the state enabling
farmers/agriculture-related businesses to inform the task force of their concerns/problems. One
of the major problems among farmers was the stress they contended with daily. This also may
account for various accidents on a farm. An AG-LINK Coalition was formed in 1985 to offer
direct communication to farmers in a crisis situation. The crisis may include severe depression,
loneliness, family problems, financial, health, or suicidel. AG-LINK is accessible 24 hours a day,
and all calls are returned within 15 minutes. Crisis intervention has saved the lives of 234
farmers and 5 lending institute officers. In 1989, the AG-LINK averaged 1,035 phone calls per
month. The OSU family life specialist has developed several publications, in-service training
and workshops pertaining to stress in the rural areas. His cooperation and assistance with the
AGLINK Coalition has been an asset. An Oklahoma Injury Prevention Advisory Board,
appointed by the Commissioner of Health, is working with several agencies to determine safety
programs in Oklahoma to reduce any type of accidents. The OSU safety specialist is a member
of this board and represents the farm and rural safety expertise. In 1989, it was determined by
the safety specialist and the Director of Epidemiology that farm pond drowning was the leading
cause of preventable deaths in Oklahoma. Farm Bureau and Oklahoma 4-H are working
together to implement an ATV safety program for 4-H and Youth. The OSU safety specialist is
a member of the National 4-H ATV Safety Committee which is sponsored by American Honda
Corporation.

556

Papers and Proceedings


Poster Abstracts, May 2, 1991

COMPILING, CORRELATING AND COMBATING
AGRICULTURAL ACCIDENTS IN TENNESSEE

    By Joel Lown, M.U.E.
University of Tennessee, Knoxville, Tennessee

Agriculture brings industry to the homestead and powerful tools to the untrained - often a
deadly mix. Accidents are typically outside of the realm of conventional industrial monitoring,
and so widespread that cooperative effort is necessary even to detect and report them.
Gathering appropriate accident data allows careful correlation of parameters that can reveal
trends and critical areas of focus. Finally, a unique coalition must be drawn together to provide
integrated safety programs for a particular state or region.

Surgeon General's Conference on Agricultural Safety and Health - 1991

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Making Connections

OBTAINING RELlABLE DATA ON FATAL INJURIES
  INVOLVING VIRGINIA FARM WORKERS

By Glen H. Hetzel, Ph.D.
Virginia Tech, Blacksburg, Virginia

National farm accident and fatality data show that children are at high risk when working on
farms. Death certificate data from the Virginia Bureau of Vital Statistics do not show this to be
true for the state. Data from 1980-1989 for farm accident victims were reviewed. The analysis
showed patterns by age, activity, county and other factors. More than 60 percent of the fatalities
involved tractors or machinery. Grouping of deaths by counties did not show the incidences to
be consistently high in those counties having the highest agricultural activity. During the lo-year
period, only one child under age 14 was reported to have died from a farming accident. This is
a significant difference from the situation in many other states. Risk factors associated with the
farm-related fatalities were identified. Risk factors are being used to identify areas needing
emphasis on current agricultural health and safety programs. The data were also compared with
farm-related fatal injury data obtained from the Chief Medical Examiner's Office of the
Commonwealth of Virginia. Significant differences were observed in the number of fatalities,
place death occurred and when the death occurred. More consistent definitions and better use
of E-Codes are needed to increase the reliability of data from agricultural accidents. Reliable
data are needed prior to developing effective preventive counter measures.

558

Papers and Proceedings


Poster Abstracts, May 2, 1991

SURVEILLANCE TO SOLUTION

    By WB. Symons, Ph.D.
Washington State HAPS, Pullman, Washington

This health promotion system provides the advantage of linking health and safety data with
applied research and farm worker training. It is the first time that elements within and outside
our university converge upon identified worker hazards from different directions. By concentrat-
ing efforts toward known in-state worker hazards, program credibility and speed of program
reaction to identified hazards increases. Farm worker populations are being trained that have
not been previously reached. Timely workplace-related training that is hands on in nature will
reduce worker exposure to job site hazards. The educational effort is strongly supported by
small-scale research efforts and a surveillance system. The applied research effort is currently
focusing upon reducing the level of pesticide exposure to orchard workers through the adoption
of smart sprayers that reduce off-target sprayer applications. The surveillance system consists of
a data gathering operation that attempts to corroborate information from various sources within
the state of Washington. Its sole purpose is to identify where other efforts within the project
should be directed. This applies to both applied research and farm worker training.

Surgeon General's Conference on Agricultural Safety and Health - 1991

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Making Connections

ANALYSIS OF BEDDING AND RAFTER DUST FROM NORTH
        CAROLINA CHICKEN COOPS

By Paul D. Siegel, Ph.D., Stephanie J. Conway, Anne DXlessandri
        Stephen A. Olenchock, Ph.D.
         NIOSH, Morgantown, West Virginia
             Steven W Lenhatt

NIOSH, Cincinnati, Ohio

Respiratory problems documented among poultry farmers include airway irritation, cough,
chest tightness and phlegm. In the present study, bedding and rafter dust from 16 different
chicken coops were examined. The bedding ranged in age from 2 weeks to 3 years old. Each
bedding and dust was examined for bacteria (total, gram negative and thermophilic), fungi,
endotoxin, histamine and ammonia. The presence of chicken sera, sera albumin, IgG and egg
albumin were also documented. The rafter dust was aerosolized, the respirable fraction
collected and evaluated for endotoxin, histamine, and ammonia. Only ammonia correlated with
the age of the bedding (up to 1.5 years old r-0.9488). The 2-week-old bedding contained an
unusually high amount of endotoxin (13570 EU/mg). In the other beddings, rafter and
respirable dusts endotoxin levels ranged from 15.2 to 814 EU/mg, 50.9 to 865.2 EU/mg, and 0.1
to 512.8 EU/mg, respectively. Histamine was found in all samples tested ranging from 0.33 to
6.6 ng/mg bedding or dust. Chicken coop bedding and dust contains a variety of substances and
organisms that may present a potential respiratory risk to farmers.

560

Papers and Proceedings


Poster Abstracts, May 2, 1991

MUSCULOSKETAL INJURIES IN AGRICULTURE-AN
      ERGONOMICS PERSPECTIVE

By Thomas G. Bobick, John R Myers, Roger C. Jensen, John E. Parker, M.D.
          NIOSH, Morgantown, West Virginia

The National Institute for Occupational Safety and Health has begun a major research
initiative addressing mortality and morbidity in the agricultural workforce. Review of data from
the Supplementary Data System (SDS), maintained by the Bureau of Labor Statistics, indicates
that upper extremity sprains and strains, including back injuries, account for more than 30
percent of the agriculture-related workers' compensation claims. SDS data were examined for
1985 from 25 states that provided records. A total of 9, 970 sprain/strain injury claims were
filed. Of these, 3,138 (31.5 percent) occurred in landscaping/horticultural services and horticul-
tural specialties. Also, 2,268 (22.7 percent) sprain/strain injuries occurred in the production of
fruits, nuts, vegetables and melons. Typical work activities from these two agricultural sectors
will be observed and recorded on videotape for study using a motion measurement system to
identify biomechanical stresses in this workforce. The ultimate goal of this study is to identify
potential intervention strategies (work place modifications or development of specialized
mechanical-assist devices) to reduce musculoskeletal injuries in these agricultural industry
sectors.

Surgeon General's Conference on Agricultural Safety and Health - 1991

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Making Connections

ENDOTOXIN IN COTTON DUST: A RESPIRATORY HAZARD
WITH IMPLICATIONS FOR WORKER HEALTH IN BOTH
     AGRICULTURE AND MANUFACTURING

By kobeti M. Castellan, M.D., M.P.H., Stephen A. Olenchock, Ph.D.
     Kathleen B. Rinsley, Richard D. Kennedy
  NIOSH, Division of Respiratory Disease Studies, Morgantown

The Public Health Service's Year 2000 Objectives for the Nation call for the elimination of
exposures that cause byssinosis ("brown lung disease"), an occupational lung disorder which
affects cotton workers. Recent research on the etiology of byssinosis has contributed substan-
tially to the body of knowledge necessary to achieve this goal. Although byssinosis is usually
considered in the context of the textile manufacturing industry, results of this recent research
have implications for both agricultural worker health and agricultural practices which may
prevent downstream risk in manufacturing. Recent experimental evidence has clearly demon-
strated that the acute airway response of humans exposed to cotton dust is associated with
airborne endotoxin concentration. Cotton is contaminated by endotoxin-containing gram-
negative bacteria while in the field before harvest. Local cotton growing conditions appear to
substantially affect the level of colonization by gram-negative bacteria, resulting in wide variation
in the potency of cotton dust with respect to endotoxin. A survey of commercial cotton gins has
revealed substantial regional differences in endotoxin contamination of airborne cotton dust. In
addition to regional effects, year-to-year variability within the same growing location has been
observed in the level of endotoxin contamination of experimentally-generated cardroom dust.
Subsequent environmental sampling of cardroom work areas in selected commercial cotton
textile mills has shown that area of growth differences are also reflected in yarn manufacturing
processes. Airborne endotoxin concentrations in work areas of both agriculture and manufactur-
ing range widely, from relatively low levels to levels which may represent a substantial respirato-
ry hazard. Byssinosis prevention may be enhanced by appropriately applying knowledge of how
to limit the natural tendency for gram-negative bacteria to colonize cotton. Therefore, defining
the factors which influence the level of gram-negative bacterial contamination of cotton is a
prime objective of ongoing research. Furthermore, because of the relationship between
endotoxin exposure and byssinosis, a pilot surveillance system to monitor endotoxin in cotton is
currently under development.

562

Papers and Proceedings


Poster Abstracts, May 2, 1991

AN ANIMAL MODEL TO PREDICT THE PULMONARY
RESPONSE TO INHALATION OF AGRICULTURAL DUSTS

By Vincent Castranova, Ph.D., D.G. Frazec K Robinson, U Jones
NIOSH, Division of Respiratory Disease Studies, Morgantown, West Virginia

Agricultural dusts are associated with many farm operations such as grain unloading, hay
handling, chicken or pig confinement, etc. Such dusts are often contaminated with bacteria,
fungi and molds as well as endotoxins, mycotoxins and spores associated with these microbes.
Several farm operations are known to generate high levels of dust and have been reported to
cause adverse physical reactions in farm workers. Symptoms often include fever, headache,
malaise and respiratory difficulty. The present report describes an animal model which
characterizes the pulmonary responses to inhalation of selected agricultural dusts. Bulk samples
collected at the farm site can be placed in a container and dust aerosols of respirable size
generated by acoustical energy. Guinea pigs can be exposed to these aerosols and their
pulmonary responses, such as airway constriction and inflammation, can be monitored as a
function of exposure dose and time. This animal model may have the capability to predict the
potential biological reactivity of various agricultural materials. In addition, this system could be
used to determine the agent(s) associated with agricultural dust which causes disease and to
determine the mechanisms by which disease develops.

ROLLOVER PROTECTION STRUCTURE (ROPS) FOR FARM
TRACTORS: THE STAGE IS SET FOR LOCAL ACTION

By John R Ether-ton, M.E.A., Z. J. Parker, M.D.

NIOSH, Division of Safety Research, Morgantown, West Virginia
               K Maines
  West Virginia University, Morgantown, West Virginia

Between 1980 and 1985, nearly 800 people were killed in the United States in farm tractor
rollovers. Current data show that farm tractor rollover fatalities have been a factor in 17
percent of all deaths to workers in the Agriculture, Forestry, and Fishing Industry. A 30 percent
reduction in the fatality rate for this industry is a Year 2000 goal for the nation. To address this
problem of farm tractor rollovers, a workshop was held to develop strategies for research and
safety promotion in preventing fatalities to farm tractor operators. A widely recognized
engineering intervention to prevent rollover fatalities is the use of rollover protective structures
(ROPS) and seat belts on all tractors. Proposed strategies fell into two categories: (1) retrofitt-
ing tractors built between 1970 and 1985, for which ROPS have already been designed; and (2)
retrofitting tractors built before 1970, for most of which there are no ROPS designs. Workshop
attendees felt that local action groups should begin educational campaigns to encourage owners
of tractors built since 1970 to have lifesaving ROPS and seat belts installed.

Surgeon General's Conference on Agricultural Safety and Health - 1991               563


Making Connections

ASSESSMENT OF INHALED AGRICULTURAL DUST HAZARD
  AND MECHANISMS OF DISEASE USING AN ANIMAL
INHALATION MODEL IN COMBINATION WITH STUDIES OF
          ISOLATED AIRWAYS

By Jej@y S. Fedan, Ph.D.

NIOSH, Division of Respiratory Disease Studies, Morgantown, West Virginia

It is becoming increasingly clear that inhalation of some agricultural dusts in the workplace
may cause pulmonary obstruction. We have been conducting biological experiments designed to
both assess the potential hazard of agricultural dusts and to determine the mechanism(s) of the
pulmonary response. This has been accomplished through the use of a computer-operated dust
generation and animal inhalation exposure system (designed by David G. Frazer), which
provides dust-exposed animals from which airways are then removed for additional study of the
mechanisms of inhaled dust toxicity. Studies on isolated airways involve the isolated perfused
guinea pig trachea. The perfused trachea is used because it contains respiratory smooth muscle,
which is involved in narrowing of the airways in response to inhaled substances, and other cell
types such as epithelium, which lines the airways and is known to be a target of the toxic effects
of some agents. The isolated trachea also permits a detailed evaluation of the mechanisms of
effect of suspected etiologic agents under carefully controlled laboratory conditions. We are
able to ascertain the effect(s) of inhaled substances on respiratory smooth muscle and epitheli-
urn. The protocol used to examine dust effect(s) is to apply the bronchoconstricting drug,
methacholine, to the fluid surrounding the trachea in order to establish the dose-response
relationship for the diameter decrease caused by contraction of the smooth muscle. The
methacholine easily reaches the muscle, which is situated on the outer surface of the trachea.
These results are compared with the dose-response relationship obtained after the trachea is
challenged with methacholine perfused through the lumen. The muscle contracts to luminal
methacholine only after the drug has crossed the epithelium. The epithelium is a diffusion
barrier and a metabolic site, and also releases modulatory factors which affect the responsive-
ness of the muscle. We have examined the effects of respirable cotton and barn dusts. A six-
hour exposure to cotton dust caused pulmonary obstruction, the degree and duration of which
depended on the level of dust in the air. The perfused trachea preparation revealed that a
complex set of changes had occurred in the release of modulatory factors from the epithelium,
which altered in a dust level- and post-exposure, time-dependent manner responsiveness of the
muscle. Inhaled barn dust did not affect pulmonary function or tracheal reactivity. The use of
these laboratory methods will continue to assist in the identification of inhaled dust hazards and
disease mechanisms.

564

Papers and Proceedings


Poster Abstracts, May 2, 1991

BUILDING STATE-BASED AGRICULTURE SAFETY AND
HEALTH INFRASTRUCTURES: A MODEL AGRICULTURE
  HEALTH PROMOTIONS SYSTEM PROGRAM

By David L. Hat-4 Ph.D., John Myers, Nancy Stout, Tim Pizatella
NIOSH, Division of Safety Research, Morgantown, West Virginia

Based on data from the National Traumatic Occupational Fatalities (NTOF) database
maintained by the National Institute for Occupational Safety and Health (NIOSH), Agriculture,
Forestry, and Fishing is one of the most hazardous industrial divisions in the U.S. While only 2
percent of the U.S. workers are employed in this sector, it has the fourth highest injury fatality
rate (20.4 deaths/lO?,cOO workers) in the U.S. Farming as an occupation has the second highest
rate of work-related ln~ury deaths (21.4/100,000 workers). In addition, during 1988 the
agriculture industry ranked third among the 10 industrial sectors for occupational injury rates
(10.4 injuries/100 workers). Because of the hazardous nature of agricultural employment, the
NIOSH, Division of Safety Research (DSR), h as instituted an intervention program with the
goal of reducing the incidence of fatal and nonfatal traumatic injury, chronic injury, and
occupational diseases among the 3.4 million agricultural workers in the U.S. This program, the
Agricultural Health Promotion Systems (AHPS), is administered through cooperative agree-
ments to Land-Grant Universities and the Cooperative Extension Service within the States.
Through the AHPS, the land-grant universities will disseminate information and conduct
programs to prevent illness and injury among agricultural workers and their families. Currently,
15 states are conducting programs in this area for FY 1991, with eight more states to be added
by FY 1992. Examples of some of the emphasis areas include, but are not limited to, youth
training, bilingual work-site safety packets for farm workers, and programs targeted to older
farmers. Also included are programs in forestry, logging and fishing.

Surgeon General's Conference on Agricultural Safety and Health - 1991

565


Making Connections

By David L. Hard Ph.D., Patricia Cutlip, Nancy Stout, Lynn Jenkins
      Suzanne Kikner, Rosemary Cianfrocco
  NIOSH, Division of Safety Research, Morgantown, West Virginia

This analysis describes fatal occupational injuries involving irrigation operations or mecha-
nisms in the United States. Cases were identified by examining data from the National
Traumatic Occupational Fatality (NTOF) database, which is maintained by the Division of
Safety Research (DSR), National Institute for Occupational Safety and Health (NIOSH).
NTOF includes data from death certificates, obtained from all 50 States, New York City and the
District of Columbia, that indicated the decedent was 16 years or older, died from an external
(injury) cause and was injured at work. A key-word search of injury descriptions and cause of
death narratives from NTOF identified cases described as involving "irrigation." This analysis
includes cases from 1980 to 1989, although data for 1987-89 are incomplete. From 1980 through
1989, 60 workers died in the U.S. from work-related injuries involving irrigation. Twenty-two
percent of these deaths occurred in California and 12 percent were in Texas. Most fatalities
were among men (97 percent). More deaths occurred to Whites (65 percent) than to Hispanics
(30 percent), Blacks (3 percent), or other races (2 percent), although Hispanics may be over-
represented relative to their proportion of the labor force. Workers between the ages of 20 and
34 accounted for 43 percent of the deaths. Farmers (32 percent) and farmworkers (37 percent)
were the most frequent occupations of the victims. Seventy percent of the fatalities were in the
Agriculture, Forestry and Fishing Industry. From 1980 through 1986, the leading causes of
death involving irrigation operations or mechanisms were electrocution (67 percent), drown-
ing/suffocation (11 percent), and machines (9 percent). The ability to identify specific occupa-
tional fatalities are possible through computer keyword searches of injury descriptions and
cause-of-death narratives from the NTOF data base.

566

Papers and Proceedings


Poster Abstracts, May 2, 1991

AGRICULTURAL LUNG DISEASE: A NATIONAL PROGRAM

By Gregory Kullman, M.S., Richard D. Kennedy, Michael Lyman, William G. Jones
     Stephen A. Olenchock Ph.D., Gregory R Wagner, M.D.
  NIOSH, Division of Respiratory Disease Studies, Morgantown, West Virginia

Occupational exposures to dust of agricultural origin are known to cause respiratory illness
among farm workers. Several pulmonary responses have been described in different agricultural
settings. The National Institute for Occupational Safety and Health (NIOSH), Division of
Respiratory Disease Studies (DRDS), in Morgantown, West Virginia is involved in a nation-
wide agricultural program, emphasizing the study of respiratory illness among farm workers, as a
foundation for preventing occupational lung disease through the development and dissemination
of appropriate prevention strategies. Surveillance, research, and intervention are key elements
of this research program. Our program involves many separate projects that are part of an
integrated, multi-disciplined approach to the study of agricultural respiratory disease involving
clinical evaluations, environmental exposure assessments, laboratory research evaluating
biological disease mechanisms, microbiological characterizations of agricultural materials, animal
exposure studies and epidemiological surveillance. NIOSH scientists at DRDS have been
actively involved in the study of respiratory illness in a variety of agricultural settings including
Dairy Farming (Silo Unloading and Bedding Chopping), Cotton Processing, Recycling, Mush-
room Farming, Poultry Growing, Grain Harvesting and Storage, and others. NIOSH scientists
are interested in learning about instances of respiratory illness among farm workers and have a
Respiratory Disease Health Hazard Evaluation Program available, at no cost as a resource for
farm workers. To request assistance or to provide information on the occurrence of respiratory
illness among agricultural workers, call (304) 291-4203.

Surgeon General's Conference on Agricultural Safety and Health - 1991

567


Making Connections

ORGANIC DUST EXPOSURE FROM COMPOST HANDLING
            OPERATIONS

By Gregory J. Kullman, KG. Jones, S.A. Olenchock, Ph.D., WG. Sorenson
     R Marcelo-Baciu, E.L. Petsonk, J.E. Parker, M.D.
   NIOSH, Division of Respiratory Disease Studies, Morgantown, West Virginia

Environmental measurements were made during hand loading of compost in a small scale
recycling project. The compost consisted of chopped leaves and branches stored outdoors
during a spring and summer of record rainfall. Exposures to organic dust from this material
resulted in the hospitalization of one individual experiencing severe respiratory illness.
Measurements included inspirable and respirable dust, particle size distribution, endotoxins,
spore counts and viable microorganisms. Visible clouds of fine particulate were easily generated
during handling activities; impactor measurement of this aerosol indicated a mass median
aerodynamic diameter of approximately 3 micrometers. Worse case dust concentrations of
inspirable and respirable particulate were 150 and 83 milligrams per cubic meter (mg/m')
respectively; however, routine dust exposures from compost handling were below 1 mg/m3 for all
size fractions. Microscopic examination (both light and SEM) of these dusts indicated a
predominance of spores. Airborne spore counts, made directly from cellulose ester filters
cleared with acetone, ranged from 106 to 109 spores/m3. Mesophilic fungi and bacteria,
collected using the AGI 30 impinger with distilled water, ranged from 105 to 108 colonies/m3.
Airborne thermophilic bacterial concentrations were lower, 103 to 104 colonies/m3. Spore
counts made from filter samples collected downstream from the impinger showed high spore
penetration, with break-through weighted toward smaller diameter spores, c 3 p/m. Endotoxin
concentrations from inspirable, thoracic and respirable dust samples ranged from 636 to 16,300
endotoxin units/m3. Levels of contaminants found here are consistent with those associated with
respiratory illness in other agricultural settings.

568

Papers and Proceedings


Poster Abstracts, May 2, 1991

HYPERSENSITIVITY PNEUMONITIS (HP) IN RATS CAUSED BY
Aspergillus Umbrosus AND Thermoactinomyces Vulgaris

By A. Manninen, IX Vallyathan, S. Olenchock, Ph.D., D. Lewis, W: Sorenson
          NIOSH, Morgantown, West Virginia
                   E. Terho
           University of Turku, Turku, Finland
            R Husman, M. Kotimas
        Institute of Occupational Health, Kuopio, Finland

HP is an allergic lung disease in the terminal bronchioles, interstitium and alveoli resulting from
repeated exposure to inhaled organic dusts. Thermophilic actinomycetes and fungal spores have
been implicated as causes of HP in man. To evaluate the inflammatory potential of the two
microorganisms, we exposed rats (Sprague-Dawley, VAF) to extracts of Aspergillus umbrosus
(AU) and Thermoactinomyces vulgaris (TV) six times by intratracheal injection. We made a
pathologic evaluation of the changes in the lungs and in the cellular influx in bronchoalveolar
lavage fluids (BALF) f p
            o ex osed and control animals. Initial installations of AU and TV caused
an intense inflammatory reaction in and around respiratory bronchioles and blood vessels. The
celldar infiltrate (Cl) predominantly was lymphocytes, but the number of macrophages was also
increased. Lymphatoid granulomas were seen as well as thickening of alveolar walls with type II
cell hyperplasia. The number of the total cells in BALF increased dramatically, two-and-one-
half to fivefold, compared to the controls. Differential estimates of CI showed 71 percent
lymphocytes and 27 percent macrophages. Eight and 28 days after the final exposure, the lung
appeared normal. These results indicate that these agents can cause an intense pulmonary
inflammation, and that the inflammation subsides rapidly when the exposure ends, leaving no
apparent permanent pulmonary injury.

Surgeon General's Conference on Agricultural Safety and Health - 1991

569


Making Connections

HYPERSENSITIVITY PNEUMONITIS ANTIGENS ACTIVATE
    ALVEOLAR MACROPHAGES IN VITRO

   By Janusz Milanowski
    NIOSH, Morgantown
  and the Clinic of Lung Diseases
University School of Medicine Lublin, Poland

The gaseous phase cultures of alveolar macrophages (AMs) of guinea pigs were exposed to
the saline extracts of the dust-borne bacteria Micropolyspora faeni (syn. Faenia rectivirgda) and
Erwinia herbicola (syn. Enterobacter agglomerans) which have been added at the concentration of
1 pug/ml to culture medium with or without complement. The effects of exposure on superoxide
anion ("2-) production by AMs were assessed by the lucigenin-dependent chemiluminescence
method. Both extracts caused significant (p < 0.01) increase in "2- generation by AMs, as
assessed by the 161-254 percent enhancement of chemiluminescence release comparing to
control values. The presence of complement augmented the production "02-, which reached a
peak at 3 hours after initial exposure. The possible significance of the generation of oxygen
radicals in pathogenesis of the diseases due to exposure to agricultural dusts loaded with
bacterial antigens is discussed.

570

Papers and Proceedings


Poster Abstracts, May 2, 1991

RESPIRATORY DISEASE MORTALITY IN AGRICULTURAL
             WORKERS

By Karl J. Muqrave, D. VIM., M.P.H., R Althouse, RM. Castellan
       NIOSH, Morgantown, West Virginia

Agricultural workers have been shown to be at increased risk of developing respiratory
diseases (RDs). Most mortality studies of agricultural workers to date have considered only
crude mortality using underlying cause of death and may underestimate the public health
importance of contributing causes of death. Furthermore, crude mortality data is a poor
measure of premature mortality in the working-age population. Decedents noted as having
worked in an agricultural industry were selected from national multiple cause of death data
tapes for 14 states that had industry and occupation information for each of the years 1985-1987.
To estimate the relative public health importance of specific RDs for these decedents, crude
"cause of death" ratios (deaths due to a specified RD/total deaths from all RDs), years of
working life lost (15-64 years) and years of potential life lost (age 15-life expectancy) were
estimated for deaths where specific RDs were mentioned either as an underlying or contributing
cause of death. Of the 81,317 decedents, 11,046 (14 percent) had a RD listed as an underlying
cause of death while an additional 8,948 (11 percent) had a RD listed as a contributing cause.
Of all RDs, respiratory neoplasms contributed most to the total years of working life lost (38
percent or 7,000 years), while pneumonia and influenza contributed the most to the total years
of potential life lost (33 percent or 81,340 years). Calculations of premature mortality are useful
in determining the relative public health importance of specific RDs on the working-age
population in agriculture. Use of multiple causes of death data allows for an analysis of the
maximum diagnostic information listed on death certificates.

Surgeon General's Conference on Agricultural Safety and Health - 1991

577


Making Connections

MICROBIAL CONTAMlNATlON AND IMMUNOLOGIC
     REACTIVITY OF STORED OATS

By Stephen A. Olenchock, Ph.D., Ph.D., U?G. Sorenson, John E. Parker, M.D.
          NIOSH, Morgantown, West Virginia
              James J: Maq Jr.

Marshfield Medical Foundation, Marshfield, Wisconsin

Bulk samples of oats were obtained from Alabama where a cluster of cases of organic dust
toxic syndrome occurred in workers who shoveled approximately 800 bushels of oats from a
poorly ventilated storage bin. Airborne dusts were obtained from the samples by acoustical
vibration in a laboratory dust generator. Microbial contamination of the airborne dusts, as
measured by standard dilution plating techniques, revealed 1.4 x 105 colony forming units per
cubic meter of air (CFU/m3) of total viable bacteria, 1.5 x 103 CFU/m3 of yam-negative
bacteria, 1.8 x 105 CFU/m3 of thermophilic bacteria, and 8.3 x 104 CFU/m of fungi. The most
common fungi isolated from the dust included Altemaria, Aspergillus, Cladosporium, Penicilliurn,
and Scopulatiopsis species. Analysis of the generated airborne dust for gram-negative bacterial
endotoxins resulted in the detection of 325.71 Endotoxin Units per milligram of dust (EU/mg).
The endotoxin contamination of the bulk oats was 122.66 EU/mg. An extract of the bulk
sample consumed human serum complement in vitro in a dose-dependent fashion, indicating the
inflammatory potential of the material. Sera from the exposed workers were examined for
antibodies against the extract, against antigens from the predominant fungi, and against standard
antigens associated with hypersensitivity pneumonitis. Evidence of exposure (specific antibod-
ies) was determined, although symptomatic and asymptomatic workers could not be differentiat-
ed. Stored oats provided a source of respiratory exposure to microbial antigens and to immuno-
reactive materials.

572

Papers and Proceedings


Poster Abstracts, May 2, 1991

  DEATHS WITH FARMERS LUNG DISEASE AND DAIRY
FARMING PRODUCTION: A CORRELATION USING NATIONAL
CENTER FOR HEALTH STATISTICS MULTIPLE CAUSE OF
             DEATH TAPES

By John E. Parker, M.D., D.M. Mannino, M. C. Townsend
      NIOSH, Morgantown, West Virginia

Farmer's Lung Disease (FLD) is a form of hypersensitivity pneumonitis (HP) prevalent in
agricultural workers. We hypothesize that extensive prolonged work in closed spaces exposes
the dairy farm worker to various sensitizing agents associated with HP and FLD more than
other types of farm workers. This report looks at data available from the National Center for
Health Statistics (NCHS) multiple cause of death data tapes from 1979 through 1986 concerning
deaths with FLD. During this time period, 73 death certificates listed FLD as being present.
Data from these death certificates were correlated with farming data from the 1982 agricultural
survey and the 1986 Statistical Abstract of the United States, by state, using Spearman correla-
tions.

TABLE OF CORRELATIONS
     Variables by State
  Whole Milk Sold    0.53*
  Dairy Farms      0.54*
  Farms with Cows    0.54*
  Farmers         0.35*
  Deaths          0.11*
         P < 0.05 - *

In this ecological study, deaths with FLD were more related to dairy farming than farming in
general, supporting our hypothesis. The NCHS multiple cause of death data tapes have thus
provided a new way to evaluate the demographics of an occupational pulmonary disease, and
help generate a hypothesis as to its occupational origin.

Surgeon General's Conference on Agricultural Safety and Health - 1991

573


Making Connections

HYPERSENSITIVITY PNEUMONITIS (HP) OR ORGANIC DUST
TOXIC SYNDROME (ODTS)?: THE CLINICAL DILEMMA IN
        ORGANIC DUST EXPOSURES

By Edward L. Petsonk, M.D., G. Kullman, W. Jones, S. Olenchoclq Ph.D., W Sorenson
             .I Parker, M.D.
         NIOSH, Morgantown, West Virginia
                 S. Weber
      West Virginia University, Morgantown, West Virginia

Twelve hours after shovelling composed wood chips and leaves, a healthy 52-year-old male
presented to the emergency room with fever (T 38.8"C), myalgia, and marked dyspnea.
Inspiratory crackles, hypoxemia (room air arterial PO2 53mm Hg), and bilateral patchy pulmo-
nary infiltrates were seen. Systemic steroids were given, and he improved over 3 days. No
antibodies were found to 10 common HP antigens. Using respiratory protection, we repeated
the exposure setting and made extensive environmental measurements. General area samples
for respirable particulate were < 1 mg/m3. Peak exposures were > 80 mg/m3. Mass median
aerodynamic diameter of the aerosol was approximately 3 micrometers. Microscopic analysis of
the dust indicated a predominance of spores, with counts ranging from 106 to 109 spores/m3.
Airborne endotoxin concentrations ranged from 244 to 16,300 endotoxin units/m3, levels
previously associated with illness in similar settings. Cultures of air samples yielded high levels
of mesophilic fungi and lower levels of thermophilic bacteria. Serum from the patient showed
precipitation with extracts of bulk samples of the compost material. Inhalation of dust from
contaminated organic materials may result in acute respiratory tract illness. Possible mecha-
nisms include toxic and cellular reactions from microbial and other organic products or
immunologic responses after prior sensitization to an antigen. Differentiation is based on
clinical and epidemiologic clues. Our data suggest that, in a clinical setting even with extensive
environmental measurements, separation of ODTS and HP may not be possible.

574

Papers and Proceedings


Poster Abstracts, May 2, 1991

By KG. Sorenson, Ph.D., l&E Shen, D.M. Lewiq SA. Olenchock, Ph.D.
NIOSH, Division of Respiratory Disease Studies, Morgantown, West Virginia 3'

MICROBIOLOGICAL ANALYSES AND INFLAMMATORY
EFFECTS OF SETTLED DUSTS FROM RICE AND HAY

Fourteen samples of settled dust from two factories processing rice and wheat straw near
Shanghai, China, were examined by dilution plating for total bacteria, gram-negative bacteria,
thermophilic actinomycetes and fungi. They were also examined for aflatoxin, endotoxin and
potential to stimulate production of human interleukin lB (IL-lB) and to consume complement.
The concentrations of total microorganisms were consistently greater than 107 CFU/g and
ranged from 107 to 109 CFU/g. In general, the level of microbial contamination was greater in
the hay dust samples than in the rice dust samples, with bacteria being the most numerous
microorganisms observed followed by molds, thermophilic actinomycetes and yeasts. The
predominant fungi were species of Asversillus, Cladosporium, Penicillium, Trichosporon, and
Cryptococcus. No significant levels of aflatoxin were observed and the isolate of A. flavum
examined lack significant aflatoxigenic potential. The levels of microorganisms in these samples,
the types of organisms found, and the inflammatory mediators such as endotoxin suggest that
workers exposed to these dusts may be at risk for respiratory illness.

Surgeon General's Conference on Agricultural Safety and Health - 1991

575



Making Connections

IMPROVED METHODOLOGY TO VALIDATE ENDOTOXIN
LEVELS IN INHIBITORY AGRICULTURAL SAMPLES

By Michael P. W'hitmer, Ebon Research Systems, Stephen A. Olenchock, Ph.D.
          Daniel M. Lewis, Judith C. Mull
  NIOSH, Division of Respiratory Disease Studies, Morgantown, West Virginia

Endotoxins are lipopolysaccharide-protein complexes that are integral parts of the outer
membrane of gram-negative bacteria. They are ubiquitous in the agricultural environment, both
in bulk material and airborne dusts. Because endotoxins can exert profound effects on humans
after exposure, it is important to quantify their presence in agricultural workplaces. However,
certain agricultural materials cause inhibition or enhancement of endotoxin analyses. In this
study, an improved methodology was used to validate the endotoxin levels and overcome
inhibition due to agricultural samples. Settled dusts and litters from chicken houses were
extracted in water by standard technique. Endotoxin analyses were performed on 31 samples in
duplicate using the kinetic Limulus amebocyte lysate assay. Product inhibition was found in 27
of the 31 samples (87 percent), which indicates that lower than actual levels of endotoxins may
be reported erroneously. Through the use of a new methodology that includes serial dilution
followed by spiking with known concentrations of endotoxin standards, comparisons between
values in spiked and unspiked dilutions by a computer-enhanced kinetic plate reader are
generated. With these data, the proper levels of endotoxin in the samples were determined.
This improved capability should have a positive impact on future studies of endotoxins in
agricultural materials.

576

Papers and Proceedings


Poster Abstracts, May 2, 1991

  EFFECTS OF AIRBORNE CONTAMINANTS IN SWINE
CONTAMINANTS IN SWINE CONFlNEMENT BUILDINGS ON
ACUTE CHANGES IN LUNG FUNCTION IN SWINE FARMERS

By Chen Zhou, M.D., M.P.H., R Mueller, E.M. Barber
        College of Engineering
             C. Rhodes

Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Canada
              S.A. Olenchock, Ph.D.
          By NIOSH, Morgantown, West Virginia

Dust, endotoxin, ammonia and carbon dioxide were measured in 25 swine confinement
buildings and lung function tests were conducted before work and every 2 hours subsequently on
52 swine farmers working in the buildings. Swine farmers had 8.7 -C 6.8 swine farming years
and 4.3 + 2.3 work-hours per day. Values for forced vital capacity (FVC), forced expiratory
volume in one second (FEVl) and maximum mid-expiratory flow rate (MMFR) in these farmers
were significantly lower after 2, 4, 6 and 8 hours of work than at baseline (p < 0.05). Average
shift changes during the day were: -3.98 + 6.18 percent for FVC, -6.07 + 6.14 percent for FEVl,
-2.06 t .42 percent for FEVlFVC and -12.14 + 11.17 percent for MMFR. Male swine farmers
had significantly greater shift changes than did female swine farmers (p 1 co-"S). Swine farmers
with acute cough, acute chest tightness and chronic cough symptoms had greater shift changes in
FEVl than those without these symptoms (p < 0.05). Multiple regression analysis showed that
endotoxin, total dust, number of swine per farm, swine farming years, grain farming years and
mask wearing were associated with the shift changes in FEVl in non-smoking swine farmers.
We conclude that swine farming is associated with acute reductions in lung function which are
related to exposures to airborne contaminants in confinement buildings. (Supported by Health
and Welfare Canada and the Saskatchewan Lung Association).

Surgeon General's Conference on Agricultural Safety and Health - 1991

577


Making Connections

THE NIOSH AGRICULTURAL HEALTH PROMOTION SYSTEM
         PROGRAM IN WISCONSIN

By L.J. Chapman, Ph.D., R T. Schuler, Ph.D., CA. Sqolaas
    University of Wisconsin, Madison, Wisconsin

Wisconsin's program now has three primary goals: 1) Training for extension agents that
improves the quality and timeliness of information they have on hand in county offices; 2)
Epidemiologic Surveillance to increase understanding of health and hazards; and 3) Injury
Control Intervention via an inspection and consultation program. The extension agent training
is delivered through continuing and professional education sessions and is supplemented by a
comprehensive resource guide in each county office. Each office also has an electronic mail
information service linking agents with each other and with experts. These new features are
intended to improve the technical content of informational exchanges between agents and their
clients. The training improvements are being evaluated with a baseline and follow-up survey of
agents that asks about their current activities, individual perceptions and needs in the farm
health and safety area. Surveillance data will be collected from farmers on occupational injuries
and illnesses in collaboration with the Wisconsin Agricultural Statistics Service. Surveillance
projects are planned for traumatic injuries, chronic musculoskeletal disorders, and diseases
associated with adverse agricultural chemical exposures. The surveys will be administered to a
representative probability of Wisconsin farmers and will pay special attention to quantifying
exposures to machinery and equipment and other injury, ergonomic and chemical hazards.
Research in other injury control fields indicates that conventional safety training may be of
limited or questionable effectiveness for improving subsequent injury and illness experience. We
are planning a farm safety inspection and consultation intervention program that will focus
attention on easily remedied, yet common and important farm hazards. The on-site intervention
will collect inspection data on hazards and then inform and persuade individual farm operators
to make lowcost, one-time changes that will permanently improve safety and health. We will
test the effectiveness of the inspection and consultation program in reducing hazards with
follow-up inspections and investigate the influence of material incentives. As incentives, the
pilot will include insurance refunds for documented reductions in risk. Wisconsin extension
agents have also developed and successfully conducted brief safety inspections using volunteers
and youth in two counties.

578                                    Papers and Proceedings


Poster Abstracts, May 2, 1991

AN ANALYSIS OF SUICIDE AMONG FARMERS IN FIVE NORTH
        CENTRAL STATES, 1980-1988

    By Paul D. Gunderson, Ph.D.
National Farm Medicine Center, Marshfield, Wisconsin

The farm media has repeatedly carried stories about individuals who, given the plight of the
farm economy, commit suicide. Unfortunately, these anecdotes are not placed within an original
schema which might detail the degree of risk experienced by farmers as a whole. Accordingly,
five states (Minnesota, Montana, North Dakota, South Dakota and Wisconsin) were chosen for
this analysis. Since suicide is typically a rare event, the years chosen for surveillance began in
1980 and ended in 1988. All deaths that occurred within the surveillance period constituted the
universe, now 101,000 events per anum; subsequently, only those cases in which the cause of
death was classified on the death certificate as "suicide" or "undetermined" and which met
specific residence and occupational criteria were retained. Four populations were "at risk" for
suicide: farmers, farm women, farm workers, and children and adolescents. The rate of suicide
among farmers varied by state from 41 to 61 events per 100,000 farmers at risk. The rates for
farm workers and farm women were much lower, 3-5 and l-2 events per 100,000 respectively.
Most farmers, farm workers, and children and adolescents who committed suicide were male
and white. A farmer at risk of suicide was typically 63 years of age; a farm woman, 47 years of
age; a farm worker, 37 years of age; and an adolescent's median age of death resulting from
suicide was 18 years. Wisconsin and Montana reported proportionately more deaths of farmers
due to suicide; Minnesota, North and South Dakota, fewer deaths. Most victims chose firearms
or poisoning by gas as the suicide method. While women, children and adolescents who
reside/work on farms are at low risk, farmers are one-and-one-half to two times more likely to
commit suicide than their white male counterparts, suggesting need for targeted interventions.

Surgeon General's Conference on Agricultural Safety and Health - 1991

579


Making Connections

FARM INJURY SURVEILLANCE

By David L. Nordstrom, M.S., M.P.H., Peter M. Layde, M.D., Dean Stueland, M.D.
   National Farm Medicine Center, Marshfield Medical Research Foundation
                Marshfield, Wisconsin

The Surgeon General's Year 2000 Objectives for the Nation include a target of 8 cases per 100
full-time farm workers of work-related injuries resulting in medical treatment, lost time from
work, or restricted work activity. There may be major obstacles to monitoring our progress
toward that goal. Although farming is among the most hazardous of all occupations, the
methods used for traditional occupational health and safety surveillance are of little use in the
surveillance of farm injuries. Many national data sources, such as the Bureau of Labor Statistics
and Occupational Safety and Health Administration, have virtually no data on farm operations
employing fewer than eleven workers; fewer than four percent of the farm operations in the
United States qualify for inclusion in those databases. Similarly, virtually none of the state-
based Worker's Compensation programs covers family farming operations or includes data from
small farms in their records, Because of the importance of farm injuries and the paucity of
available data, it is necessary to develop special methods to monitor the occurrence of farm
injuries. At this table we will discuss various methods that have been successfully used for farm
injury surveillance, including telephone surveys and health care provider-based surveillance
systems. We will also discuss other relevant approaches, including mortality surveillance through
death certificates and newspaper clipping services. The uniqueness of agriculture, with literally
millions of work sites each with an average of only a few workers, poses unique methodologic
challenges for occupational injury surveillance. With care, adequate farm injury surveillance
systems can be developed. Such systems will be necessary to monitor the high rate of injuries in
agriculture and to evaluate the effectiveness of interventions designed to reduce the hazards of
farming.

580

Papers and Proceedings


Poster Abstracts, May 2, 1991

ORGANIC DUST TOXIC SYNDROME: CLINICAL AND
LABORATORY EVALUATION OF A CLUSTER OF CASES

By John E. Parker, M.D., RM. CartelIan, S.A. Olenchock, Ph.D., WIG. Sorenson
          NIOSH, Morgantown, West Virginia
                  J.J. Marx

Marshfield Medical Research Foundation

Eleven male workers, aged 15-60 years, moved 800 bushels of oats from a poorly ventilated
storage bin in Alabama. The oats were reported to contain pockets of white, powdery dust.
Work conditions were described as extremely dusty, and all workers wore single-strap, disposable
masks while inside the bin. The workers shoveled the oats for 8 hours in groups of two or three
for shifts of 20 to 30 minutes. Two workers remained outside the storage bin and developed no
symptoms. Within 4 to 12 hours, all nine who worked inside the bin became ill with fever/chills,
chest discomfort, and weakness/fatigue. Eight reported shortness of breath, six had non-
productive cough, five complained of myalgias, and four developed headache. Six sought
physician attention within the first 2 days of symptoms. Reported abnormal physical signs
included: temperature greater than 38.0% in two, crackles in two, and wheeze in one. Chest
radiographs were normal by B-reader review in all six. Symptoms resolved in all affected
workers in 2 to 12 days (median 4). Samples of bulk oats and sera from 10 workers were
collected. Airborne dust generated in the laboratory from the bulk oats contained 39.5 mg/m3
of respirable dust and the following concentrations of viable organisms (cfu/m3): 1.4x105 total
bacteria, 1.~~103 gram negative bacteria, 1.8x105 thermophilic actinomycetes and 8.3x104 fungi
(12 species). Endotoxin content in the airborne dust was 325.7 endotoxin units/mg. Serologic
testing for antibodies to an aqueous extract of the bulk oats, to nine standard hypersensitivity
pneumonitis antigens, and to aqueous extracts of the fungal isolates failed to separate ill from
asymptomatic workers. Despite the initial clinical diagnosis of farmer's lung disease, the
clustering of illness experienced by these workers is typical of organic dust toxic syndrome
related to inhalation of high concentrations of organic dust contaminated with microbial
organisms and their products.

Surgeon General's Conference on Agricultural Safety and Health - 1991

581


Surgeon General's Conference on Agricultural Safety and Health
FARMSAFE 2000 o A National Coalition for Local Action
Convened by the National Institute for Occupational Safety and Health
April 30 - May 3, 1991, Des Moines, Iowa

FFA POSTERS

Seven outstanding FFA chapters were selected to present posters at the Surgeon
General's Conference on Agricultural Safety and Health in 1991, and another seven from
different states were selected to present posters at the Center for Agricultural Disease
and Injury Research, Education, and Prevention Regional Conference in Iowa City in
1992. These selections were made from among winners of the FFA National Chapter
Safety Award Program, and they recognize an ongoing activity that addresses community
approaches to preventing agriculture-related diseases and injuries. Chapters were
selected for geographic balance, addressing farm safety and health issues, completion of
a community assessment, and selecting unique prevention targets within the community.
Poster abstracts of these 14 national winners are presented on the following pages:

1990 FFA Chapter Winners
Paramount High, Alabama
Southwestern-Hanover, Indiana
Stockton, Missouri
Amanda-Clearcreek, Ohio
Ysleta, Texas
Park View Senior, Virginia
Elma, Washington

1991 FFA Chapter Winners
Platte Valley, Colorado
Lake Placid, Florida
Newton County, Georgia
Cascade, Iowa
Verdigre, Nebraska
Rolette, North Dakota
New Auburn, Wisconsin

Figure 1. States Represented by National FFA Chapter Safety Award Program Winners.

582                                    Papers and Proceedings


FFA Poster Abstracts, May 2, 1991

MAKING OUR HOME, SCHOOL AND COMMUNITY SAFER PLACES
             TO LIVE AND WORK

  By Jimmy Moore, Safety Program Chairperson
       Henry Miles, Sr., Advisor   D
Paramount High FFA Chapter, Paramount High School, Boligee, Alabama

The Chapter serves seven communities-rural and towns; 27 community leaders-principals,
Board of Education members, Superintendent of Education, a probate judge, county commis-
sioners, mayors, town councils, and others-were polled for their opinion of safety needs.
Meetings were held in each community to capture the public's view as well. Additionally, the
CHEM WASTE facility, which is the largest hazardous waste storage site in the United States,
is located 20 miles from the community. The Chapter planned safety programs to meet the
needs of all families whether or not they live on a farm, which included a hazardous waste
seminar. (No emergency preparedness plan was in effect a few years ago when an emergency
spill occurred 1 mile from the school.) Programs were delivered each month. Publicity included
newspapers, radio and TV. Evaluation of the success of each activity was completed after each
activity.

Activities Completed (and community groups included):

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.

14.
15.

Well Water Testing (County Health Department FFA members).
Electrical Safety Checks (FFA Members).
School Bus Safety Week Poster Contest (Elementary and High School students).
Radon Testing (FFA members Radon Hotline).
Monthly Fire Drills (Paramount High students) (896).
Monthly Tornado Drills (Paramount High students) (896).
Fuel Safety Decals (Paramount High students (700), Volunteer Fire Department.
Fire Extinguisher Demonstration (FFA members Paramount faculty).
Pesticide Safety (County Extension Agent).
National Fire Prevention Week (Fire Protection Association).
Propane Gas Leaks (Thermogas County FFA Alumni).
School Traffic Control (County Highway Department School Administration).
National Farm Safety Week (County Extension Agent, Local Agricultural Equipment
Dealer).

How to Saddle a Horse (FFA members, FFA Alumni, 4-H Club, Boy Scouts, Cub scouts).
Hazardous Waste Disaster Seminar (Chemical Waste Management Inc., FFA Alumni, Higl
School students).

Surgeon General's Conference on Agricultural Safety and Health - 1991               583


Making Connections

SAFETY THROUGH EDUCATION

By Tracy Mefford, Safety Program Chaiperson
      Ken Salkeld, Advisor

Southwestern-Hanover FFA Chapter, Southwestern High School, Hanover, Indiana

Each year, a random survey of perceived safety and community needs is
conducted. A number of "standard" safety programs are conducted annually. The
Chapter requested information and materials on selected safety problems from agencies and
organizations. Materials were reviewed for appropriateness, and new materials wer designed
when necessary. The Chapter delivered educational messages on selected safety topics through
presentations to large school groups, civic groups, and via door-to-door to ensure that the
information was within everyone's reach. Events were publicized through newspaper, radio, wall
calendars, and posters. Evaluation was limited, but it was noteworthy to mention that there were
no flowing grain or suffocation fatalities, fatal fires, nor serious machinery injuries since 1984.

Activities Completed (and community groups included):

1.
2.
3.
4.
5.
6.
7.

8.
9.

10.

Fire Safety Campaign (None).
Home Safety and Farm Machinery (None).
Safety Awareness Fingerprinting (Jefferson Co. Sheriff Dept.).
Farm Safety Coloring pages (None).
"Stick-A-Tractor" (None).
FFA Wall Calendars (None).
Emergency Maps of Schools (SW Administration and Maintenance Staff and local Fire
Departments).

Hazardous Grain Handling (Purdue Coop Extension).
Emergency Medical Treatment: Children's booklets (Publisher, SW Elementary School and
Teachers).

Halloween Trick or Treat Safety Bags (None).

584                                  Papers and Proceedings


FFA Poster Abstracts, May 2, 1991

IN THE SCHEME OF LIFE THEY SAY, `YOU LIVE AND LEARN. 7-L

WITH SAFETY WE 5ELfEllE THAT YOU LEARN

  By Damien Lucius, Safety Program Chairperson
     John Rummel, Don Rains, Advisors
Stockton FFA Chapter, Stockton R-l Schools, Stockton,

AND LIVE

Missouri

The Chapter used data from several surveys to plan programs: 1) of area high school students'
drinking and driving habits 2) of chapter members' perceived need for electrical and machinery
safety programs in the community and 3) of elementary teachers for elementary students' safety
needs. Some community groups came to the Chapter with safety projects. The Chapter
continued to implement selected programs and develop new ones to meet the needs identified in
the surveys. It focused on a philosophy that safe children become safe adults. Publicity included
using newspapers, radio, television, posters, and the school bulletin. An evaluation showed that
the objectives were met.

Activities Completed (and community groups included):

1.
2.

Substance abuse awareness program (FHA/HERO, FBLA, Student Council).
Re-floor Caplinger Mill Bridge (Bridge Preservation Society, Senior Citizen Club, Stockton
City Council).

3.  Ambulance program (Ambulance Board).
4.  Chainsaw safety (Stihl Corporation).
5.  Fire prevention (Springfield Fire Department).
6.  Electrical safety display (Missouri State Fair).
7.  Brand'em safety (All Community).
8.  Bulletin boards on safety (John Deere).
9.  Halloween safety (Safety Council).
10.  Electrical safety (Stockton Elementary).
11.  Fire safety (Stockton FFA).
12.  Underground cable safety (Missouri Telephone).
13.  Combine safety (John Deere).
14.  Tractor safety (John Deere).
15.  Bypass starting (John Deere).
16.  Safety on the farm (John Deere).
17.  Fire extinguisher use (Stockton High School).
18.  Environmental safety (Department Natural Resources).
19.  Pesticide safety (ASCS).
20.  Hunter and gun safety (Missouri Department of Conservation).
21.  Boat and water safety (Missouri Water Patrol).

Surgeon General's Conference on Agricultural Safety and Health - 1991                585


Making Connections

PERSONAL SAFEW IN YOUR LIFE

      By Gary Brumjield, Safety Program Chairperson
            Charles E. Miller, Advisor
Amanda-Clearcreek FFA Chapter, Amanda-Clearcreek High School, Amanda, Ohio

The safety committee received input on community needs for safety programming from squad
chiefs and fire chiefs from Clearcreek and Amanda Townships and a representative from the
Sheriffs department. Others interested in safety issues were identified from local emergency
services and listings of government agencies. The community is made up of villages and rural
areas. A general meeting of all people and agencies with interest in safety areas was held to
plan activities. The chapter involved as many members of the community as possible. The
primary focus of the year was injury prevention. Publicity included newspaper articles, radio and
TV, posters, pamphlet distribution, displays, demonstrations, and speeches.

Activities Completed(and community groups included):

1.


2.

3.


4.

5.

6.

7.

8.

9.

10.


11.

12.



13.

Fire Extinguisher Safety Program
(Clearcreek EMS, AC FFA, Nation Fire Prevent, Humes Extinguisher Service).
Farm Safety Week (SKY MED, Clearcreek Fire/EMS, Amanda Fire/EMS,
Coop Extension Service, AC FFA and Young Farmers).
Farm Safety for"Just Kids"

(Farm Safety for Kids program, AC FFA Children's Hospital, Clearcreek EMS).
Hazardous Farm Chemicals for Joint Fire District (Hazard Committee Sheriffs
Department
All County Fire Districts, Coop Extension Service, AC FFA).
Chemical Safety for Farmers

(Monsanto Company Hazard Committee, AC FFA and Young Farmers).
Fire Safety Week

(Clearcreek EMS, Humes Extinguisher Service, AC FFA).
Equipment Safety Program

(John Deere-Lifer, Clearcreek EMS/Fire, Amanda EMS/Fire, AC FFA and Young
Farmers).
Farm Accidents Seminar for Squads
(Children's Hospital, AC FFA, Lifer-John Deere, Lancaster-Fairfield Hospital).
911 - System Operation

[Sheriffs Department, Clearcreek Fire/EMS, Amanda Fire/EMS, AC FFA).
"Code-4" Car
(Amanda Fire/EMS, Sheriffs Department, State Highway Patrol, Student Council).
Poster Contest (Farm Safety for "Just Kids," Clearcreek EMS, AC FFA and Young Farm-
ers).

Health Screening - Blood Pressure, Cholesterol
(Lancaster-Fairfield Hospital, Amanda EMS, Clearcreek EMS, AC FFA and Young
Farmers).

Bloodmobile (Lancaster-Fairfield Hospital, Red Cross, AC FFA).

586                                 Papers and Proceedings


FFA Poster Abstracts, May 2, 1991

STRESSING SAFER CAMPUS, HOME, AND COMMUNITY
         THROUGH EDUCATION

By John Barragan, Safety Program Chaiqerson
  Dr. Steve Forsythe, John Hughes, Advisors
Ysleta FFA Chapter, Ysleta High School, El Paso, Texas

The advisors and the safety committee assessed local and national trends and their impact on
El Paso. (Example: because of proximity to Mexico, rabies is a safety concern to domestic
animals.) More than 100 community members were surveyed and participated in neighborhood
polls to determine community needs as they relate to safety. Results of the community survey
were tabulated and analyzed. Chapter officers and the safety committee Young Farmers, FFA
Alumni, and the agricultural advisory committee to help determine priorities. Monthly safety
programs were scheduled. Local and state resource people were contacted as speakers. FFA
members met with outside groups to outline cooperative efforts in safety projects. Materials for
programs were obtained. Media including TV, radio, and newspapers were contacted to inform
them about activities planned throughout the year and to gain their support.

Activities Completed (and community groups included):

1.  ATV/3-Wheeler Seminars (Yseta Young Farmers).
2.  Rabies Control Field Seminars (Alumni, Humane Society, Local Veterinarians).
3.  "Brand Urn" Campaign (El Paso Equipment Dealers).
4.  Pecan Pesticide Safety Awareness (Young Farmers, Extension Service).
5.  Adoption of Machinery for Safety Features (El Paso Equipment Dealers).
6.  Gun Safety Workshop (D.P.S., Student Council).
7.  Agricultural Products/Hazards Inservice (T.D.A., El Paso Food and Fiber Council).
8.  Water Quality Testing (Lead) (YISD Administrative Council, City Council).
9.  Fire Extinguisher-Fire Safety Inservice

10.
11.
12.
13.

(Ft. Bliss Firefighters Association, Industrial Technology Club).
Cardio-Pulmonary Resuscitation Workshop (Young Farmers and Alumni).
Planned Public Relations Campaign (Local media, local press club, Young Farmers).
Color Coding/Eye Protection Updating (Standard Paint Company Alumni).
Educational Programming (El Paso County Health Association).

Surgeon General's Conference on Agricultural Safety and Health - 1991               587


Making Connections

COMMUNI7Y SAFE7Y TAKING THE LEAD IN SOUTH HILL   A

     By George Bashewille, Safety Program Chairperson
         E.C. Conner, R.A. Thomas, Advkors
Park View Senior FFA Chapter, Park View Senior High School, South Hill, Virginia

The chapter safety committee met with school officials, school club representatives, and
community organization representatives to coordinate a community safety plan. Newspapers,
radio, and surveys were used to poll the general public for their concerns. After data were
collected, a list of suggested activities was developed and taken to chapter members. FFA
members and some community members met to decide which projects would be completed
during the year. Activities were scheduled monthly and tied into seasonal events when possible.
Publicity included newspaper, radio PSA's, exhibits, posters, and school intercom announce-
ments.

Activities Completed (and community groups included) were a:

1.
32:
:*
6:
7.
a.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.

Repairs and inspection of children's Playgrounds (None).
Fire extinguisher inspection (South Hill Volunteer Fire Department).
Farm safety exhibit (None).
Shop safety test (None).
Color coding of shop (None).
Boating and water safety display (South Hill Chamber of Commerce).
Hunter education courses(South Hill American Legion).
Served as pilot school senate drug program (None).
Ford/New Holland tractor safety program (None).
Sports A Field Day (Mecklenburg 4-H).
Tie One On ribbon program (SADD Chapter).
Chainsaw safety course (South Hill Ruriton Club).
Vials of life (Signet Bank).
Electrical wiring program (PV Young Farmers).
Restricted use pesticide recertification (Virginia Coop Extension Service).
Distribution of Pesticide Container test kits (Conner Claims Service).
Formation of Jr. Town Council (South Hill Chamber of Commerce).
Home safety hazard hunt survey (Friends of R.T. Arnold Library).
Lawnmower safety program (Mecklenburg Chapter American Red Cross).
After-prom party (SADD Chapter).
Boating safety course (Virginia Game Commissions).
Public service announcements on seatbelts (None).
Fire safety course (Mecklenburg Department of Forestry).
CPR classes(Southside Rescue Squad).

588                                   Papers and Proceedings


FFA Poster Abstracts, May 2, 1991

A.L.I.V.E. (AWARE LEADE~;M'&UNG VITAL EDUCATION) 0

  By Dan Pearson, Safety Program Chairperson
Mike Hickman, Christi N. Renz, Tim Schneider, Advisors
Elma FFA Chapter, Elma High School, Elma, Washington

The community was defined as that area served by the Elma School District, which included
two towns and three unincorporated communities. Needs assessment meetings were held with
the chiefs of Police, city councils, American Red Cross, Seattle Parks and Recreation, Seattle
Canoeing Club, and other community groups and service organizations in each of the five areas
to be served. The primary safety problems found were traffic safety related to drinking and
driving and low seatbelt use. In addition, no boating safety course existed in the Eastern Grays
Harbor community. The chapter analyzed each phase of the program for effectiveness and
improvement and worked together with other community groups to avoid duplication of efforts.
FFA members were involved as frequently as possible, especially during activities conducted in
the schools. Publicity efforts included newspapers, presentations and television.

Activities Completed (and community groups included) were a:

1.

2.

3.
4.

5.

6.

7.

8.
9.

10.

11.

Boating Safety - Instruction of Classes (Washington Parks and Recreation Commission,
Seattle Park and Recreation, Seattle Canoeing Club, Summit Lake Community).
Elementary Presentation

(Washington Parks and Recreation Commission, and Elementary School).
FFA Members Recreational Outing (Wynathchee Lake State Park).
Holiday Awareness Program - Assembly and Information Distribution (Elma D.A.R.E.
program, S.A.D.D., Washington State Traffic Commission, Elma Police Dept., Whiteside
Funeral Home, High School ASB).

FFA Meeting Featuring Safety - Hunting Safety, Job Site Safety
(Washington Department of Wildlife, Morton Thiokol International, Ventron Division).
Elementary Safety Week - Mr. Egg and Seatbelt Safety - Fire Prevention Safety
(Washington Traffic Safety Commission, Elementary School, Elrna Fire Department,
Aberdeen Fire Department, Featuring EDDE the Robot, Elementary School).
Personal Emergency Safety and Inspection of Ambulance
(Elma Fire Department, Aberdeen Fire Department, Elementary School).
Electrical Safety (Grays Harter PUD - Elementary School).
Bicycle Rodeo (Elma Police Department, Washington State Patrol,
Washington Traffic Safety Commission, Burger Elementary School).
Safety Poster Contest (Elma Police Department, Washington State Patrol,
Washington Traffic Safety Commission, Burger Elementary School).
State Safety (Washington State Traffic Safety Commission).

Surgeon General's Conference on Agricultural Safety and Health - 1991               589


Making Connections

AGRICULTURE CHEMICAL SAFE7Y

   By Stason Ikenouye, Safety Program Chairperson
       Jack Smith, John Stahley, Advisors
Platte Valley FFA Chapter, Platte Valley High School, Kersey, Colorado

We performed a safety program on March 26, 1991. In order to perform a mock chemical
spill, we contacted several organizations. They consisted of the school board, the Kersey and
Greeley fire departments, the state patrol, Kersey police, health department, the mayor of
Kersey, town council, Platte Valley Elementary, and High School, Centennial Ag, HA2 MAT
Team, EPA, Administration, two newspapers, radio, TV (news). We attended a Fire Depart-
ment meeting, town council meeting, board of education meeting, and we held a meeting which
consisted of the head of personnel, of every organization we listed above. The mock chemical
spill began with a truck driver who was encountered by a heart attack, he lost control and the
truck unfortunately went out of control and tipped over in the high school parking lot. Letting
the chemical inside the tanker spread onto the parking lot contaminating, and injuring people
trying to get into their cars. The first person that discovered the spill was our principal, Ms.
Swain. The next person contacted was the Kersey police, followed by Mr. Hanson, administra-
tor, Kersey Fire Department, EMT, Sheriff Department, Greeley Fire Department, and finally
the State Patrol.

Activities Completed were a:

1.
2.
3.
4.
5.
6.
7.
;:
10.
11.
12.
13.
14.
15.
16.

Hazardous Chemical Spill Safety Simulation.
Hunters Safety Course.
Safety Tests.
Safety Films.
Safe Operation and use of Machinery.
Safety Review of Shop Equipment.
Arc Welding Safety.
Oxy Acetylene Welding Safety.
Power Tool Safety.
Engine Safety.
Electrical Safety.
Tractor Bypass Starting Safety.
Tractor PTO Safety.
Lawnmower Blade Safety.
Riding Lawnmower Safety.
Tractor Rollover Safety.

590                                   Papers and Proceedings


FFA Poster Abstracts, June 29, 1992

SAF. FOR EVERYONE IN `91

By David J. Summers, Safety Program Chairperson-1991
Stephanie Moore, Safety Program Chairperson-l 992
       Dale McQuillen, Advisor

Lake Placid Senior FFA Chapter, Lake Placid High School, Lake Placid, Florida

Our programs provide safety awareness from pre-school to adults with families and homes,
and even in their jobs. We believe our program will make the community more aware of safety
and make it a common, everyday practice. Our group focused a great deal on younger children.
We tried to aid in their protection by issuing identification stickers and tags, and providing
home safety material on young children to their parents. All students in our high school are
required to take and pass the Red Cross CPR course and test. This training will last a lifetime
and possibly save a life. We have told tractor operators in the community of the dangers of
tractors and gave ideas on safety around them. The department has taught students proper
safety of various shop tools and lawn equipment. Animal handling has been taught in classes in
effort to prevent injury to handler or the handler. Chemical safety is also an issue pursued by
the department and each ag student is taught safety around chemicals. The Lake Placid Senior
FFA Chapter of the National FFA, hopes that their involvement and assistance with the
community and its safety will make Highlands County a safer and healthier place in which to
live and work. By conducting our various and many programs in safety, we hope that our
community will always remember to keep safety in mind and be safe.

Activities Completed (and community groups included) were a:

1.
2.
3.

z-
6:
7.
8.
9.
10.

Identification Stickers (County Elementary School Staff).
Chemical Safety (Extension Service).
Tractor Safety Program (National Sticker Program, local tractor owners, passed out safe-
packets.
Small Gas Powered Engine Equipment (Extension Service, Local and State).
Seat Belt Safety (Florida Highway Patrol, High School).
Animal Safety (4-H and FFA Members of Highlands County).
CPR Training (LPHS Staff).
Home Safety (State Extension Staff, Local Business).
Home Safety Demonstration (Extension Staff, LPHS Staff).
Electrical Safety (Florida Power, Lake Country Elementary).

Surgeon General's Conference on Agricultural Safety and Health - 1991

597


Making Connections

HUNTER SAFETY AND AGRICULTURAL WORK-SITE SAFETY r-l

By Kerry Courchaine, Safety Program Chairperson-l 991
  Keith Mitchum, Safety Program Chairperson-l 992
    Scott M. Carey, Bruce Thomas, Advisors
Newton County FFA Chapter, Newton County High School, Covington, Georgia

For the past three years our chapter has placed emphasis on safety for our members and the
community. Our FFA officer team identified the chapter and community needs. This year we
planned to diversify our safety program and expand it. Our first major area was hunter safety
program. As a part of our hunter safety program we invited a local game warden to our school.
Mr. Roy Morris presented a program on hunter safety. We also began an education program in
the school concerning requirements for obtaining a hunting license. Our second major area of
emphasis this year was agriculture safety on the farm. From our community survey and the
local farm bureau, we found some problems in Newton County. We began our program during
National FFA Week by declaring one day as Safety Day. During Safety Day, Ms. Beck Tyles
from the Georgia Farm Bureau presented a program on agriculture safety on the farm.
Students were educated on hazards on the farm and how to correct them. Each student was
given literature on hazards and ways to prevent them. The next step of our program was to put
in action the information learned by the student. Our chapter prepared a safety tour of two
farms and an agricultural business. On this tour, we utilized a safety packet produced by
Progressive Farmer. The packet contained safety material, stickers, evaluation and tagging
devices. At each location we explained our purpose to the owners and students marked and
tagged hazards. At the agriculture business, students were shown up to date safety devices on
agricultural equipment. One of the farms was a former FFA member. Upon completion follow-
up survey's were completed. Our chapter also viewed safety films on various topics during FFA
Safety Week. To remind community members to keep safety on their minds at all times, the
chapter constructed two signs. These signs were placed on the roadways entering Newton
County. The theme on the sign was Prevent Accidents, Act Safely. Chapter members erected
the signs so citizens of Newton County would be reminded of safety.

Activities Completed (and community groups included) were a:

1.
2.
3.
4.
5.
6.

7.

8.
9.

Hunter Safety Program (School).
Community Survey.
Safety Awareness Day (High School).
SMV Sign Distribution (Farm Bureau).
Safety Vest Sale (Farm Bureau).
Livestock Chute Demonstration
(Local Farmers).

Hunting Licence Certification (Georgia
Department of Natural Resources).
Classroom Safety Pretest.
Classroom Safety Post Test.

10.  Greenhouse Chemical Safety Program

11  (Georgia Department of Agriculture).
12:  Safety Film Farr.
  Georgia Farm Bureau Safety Program
  (Farm Bureau).
13 .  Safety Tour: 1) Ballard Farms, 2) Marks
  Dairy, 3) Hay's Truck and Tractor (Local
  Farmers).
14.  Follow-up Survey (Progressive Farmer).
15.  Construction of Safety Sign Upon
  Entering Newton County (Farm Bureau,
  State FFA Camp).

592                                   Papers and Proceedings


FFA Poster Abstracts, June 29, 1992

SAFEp/ AWARENESS IN THE COMMUNITY

By Michael Hawkins, Safety Program Chairperson
       Milt Lucksteact, Jr., Advisor
Cascade FFA Chapter, Cascade High School, Cascade, Iowa

At the end of each year our safety committee and FFA members evaluate the past years
program. The evaluation is used to help determine the needs of the safety program for coming
years. After our safety committee is selected, they sit down and decide which activities will best
promote safety in the Cascade area. FFA members always look for new ideas to improve
existing safety programs. This year we were able to add lots of media coverage, an elementary
program, and cooperated with Mercy Health Center to improve safety awareness. Once the
safety committee has met they split up duties among FFA members, to contact necessary
people. For example, the elementary safety program was coordinated through Marilyn Adams
and the Cascade Elementary staff. FFA members contacted these people and set up the time
and place to conduct the meeting. Other FFA members met together to put a program
together. Our safety program begins each year by examining the previous years evaluation.
Plans are made for the coming year. Keeping in mind short and long term goals. At the end of
the year another evaluation takes place. Continuity and organization are keys to keeping "Safety
Awareness in Our Community" a priority program.

Activities Completed (and community groups included) were a:

1.
2.
3.
4.
5.
6.
7.

Health and Safety Walkabout (Mercy Health Center).
Safety Messages on Silo Bags (Community Members).
Safety Meeting (Cascade Elementary Farm Safety for "Just Kids").
5th Grade Safety Poster Contest (4 Elementaries).
300 Safety Stickers Handout Out and Applied (Community Members).
Tractor Safety Driving Contest (Alumni Members).
Water Safety (Board of Supervisors, Health Board, Extension Service, County High
Schools).

8.  Chainsaw Safety Demonstration (Dave Stevens, Chainsaw Dealer).
9.  Public Service Announcements (KDTH Radio Station).
10. Hunter Safety Classes (Twin Rivers Pheasants Forever, High School Administration).
11.  Trapshoot Safety Demonstration (Community Members).
12.  Safety Films (High School Administration).
13.  Membership (Farm Safety for "Just Kids", Iowa Farm Safety Council).
14.  Shop Safety (High School Administration).
15.  TV Interviews (KDUB, Channel 40).
16.  National Farm Safety (Area Business, Local Paper).

Surgeon General's Conference on Agricultural Safety and Health - 1991

593


Making Connections

SAFETY SPRAYER TUNE-UP

   By James A. Pavlik, Safety Program Chairperson
     Gary L. Hansen, Kevin Randa, Advisors
Verdigre FFA Chapter, Verdigre Public School, Verdigre, Nebraska

During one of our FFA meetings, the chapter came up with suggestions for possible safety
projects. The safety committee and chairman, James Pavlik, looked into the projects and a list
was posted for all members to view and consider for possible ideas. At a FFA meeting, the
chapter discussed and voted on the activities to be conducted for the year. The Sprayer Tune-
Up Kit was not the chapters first choice for our main safety activity. We first contacted our
local EMT Unit to put on a safety demonstration and film with the help of jaws-of-life. They
couldn't do the demonstration until spring. A safety specialist was consulted about presenting a
PTO demonstration on safety and care that should be used around this type of equipment.
Local EMT's were also to take part in this demonstration, however, due to conflict in dates this
project was not completed. We then came in contact with the sprayer project and being mainly
a rural area, we felt this project would be a very needed subject area for our community. The
response was great in helping us and very positive. The people felt the training they received at
the CO-OP's Sprayer Tune-Up day held February 18th was beneficial. The CO-OP also held a
sprayer calibration demonstration for chapter members.

Activities Completed (and community groups included) were a:

1.
2.

3.
i`
6:
7.
8.
9.
10.
11.

Sprayer Tune-Up Week Kit (Verdigre CO-OP, ZOBJ Hall, Verdigre Elevator).
Cement put in pipes of BOAC fence project (Verdigre School Board, Town Board,
Verdigre School Insurance).

Film "Can You Get Out" (School Nurse, Fire Marshall).
Safety Articles (Safety Committee).
Safety Films (Ag Ed Class, Safety Committee).
Ag Shop Evaluation (School, FFA, Ag Ed Classes).
Emergency information ad in local paper (Safety Committee).
Safety Goggles (School, FFA).
Articles on Bulletin Board (FFA, School).
Safety Application (FFA).
School Bus Stop Signs (School Bus Drivers, Supervisor, FFA).

594                                    Papers and Proceedings


FFA Poster Abstracts, June 29, 1992

KEEP HARM OFF THE FARM

By Chad J. Heit, Safety Program Chairperson-1991
Jason Heinz, Safety Program Chairperson-l 992
      Cliff Orgaarc$ Advisor

Rolette FFA Chapter, Rolette Public School, Rolette, North Dakota

Our goal is to prepare each member to be a safe and well informed member of the communi-
ty. We carry out a variety of activities and involve several members of the community and
alumni to increase the interest level and impact upon the members. Also, since Rolette is a
fairly small community, we make every attempt to cooperate with other organizations for our
mutual benefit. For instance, by working with the Ambulance Squad, we helped them qualify for
a $1,500 grant. We live in a rural area that relies almost exclusively on production agriculture
for its income. Almost all students live and/or work on a farm and use farm equipment.
During 1990, at least three farmers in our community had farm related injuries. Fortunately
they are all recovering, but it made us aware of the importance of continued training in safe
practices and emergency first aid. Even though no formal survey was developed, we feel we met
the needs of our community by carrying out the activities that we did.

Activities Completed (and community groups included) were a:

1.  Tractor Safety Course to Eighth Grade Students (Rolette Insurance Agency).
2.  Ambulance Demonstration (Rolette Emergency Medical Services Personnel).
3.  Machinery Safety Video Presentation (County EMS Personnel).
4.  Community-Wide Farm Safety Program (Rolette EMS, Johnson Oil, Rolette Bank, A of G
Church, City Medical Officer).

5.  Weight Room Renovation (School Board Athletic Department).
6.  Gun Safety Demonstration (FFA Chapter).
7.  Sponsorship of Post-Prom Party (All Rolette Businesses).

Surgeon General's Conference on Agricultural Safety and Health - 1991

595


Making Connections

     SURVIVING WITH SAFETY

By Amy Tucker, Safety Program Chairperson-l 991
  Charlotte Kreier, Safe@ Program Chairperson-l 992
       Brenda J. Scheil, Advisor
New Auburn FFA Chapter, New Auburn Hlgh School, New Auburn, Wisconsin

We are concerned with our present generation and future generations so we concentrate on
including safety topics which would be significant to lives of all ages. We also realize that
among our varied age groups we must also meet the needs of a diversified population and we
believe we do this through our safety program and safety campaign efforts. When we selected
major safety topics we included; National Farm Safety, School Bus Safety Promotion, Tractor
Safety Certification, Bicycle Safety, School Shop Safety and Poison Prevention. By adding
additional safety topics through the year our safety program maintains diversity and safety then
becomes an on-going and continual concern. Our new emphasis this year was "Outdoor Power
Equipment" and we also painted our playground equipment on our school grounds. If we were
to table our safety program and make no effort to promote safety...dangerous situations would
be an even greater threat to our community. We believe that as time progresses our safety
program becomes even more preventative. We want to prevent dangerous situations and
accidents before they happen. By carrying out our preventative programs we are building
positive safety records and this is a continual goal which will hopefully become a long-term
record. It is our long-range goal within our long-range plan to have a program set up for each
level in the pre-school, grade school and high school in addition to safety programs geared to
our adults within our community. By building our base program of safety we will eventually be
able to present programs of safety to all community organizations on a rotating basis in order
that once a year each community group would hear at least one different safety topic from us.
This would build stronger ties within our community and FFA would always remind each person
of safe attitudes and actions. "Surviving with Safety" does not happen without dedication.

Activities Completed (and community groups included) were a:

1.
::
4.
6:
7.
8.
9.
10.
11.
12.
13.
14.

15.

Tractor Safety Program and Contest (Extension Office, Neighboring Chapter).
National Farm Safety (Local Businesses).
School Announcements (School Staff and Administration).
Bicycle Safety Education Program (Fifth Grade Class).
Paint Playground Equipment (School Personnel).
Gas Weed Eater Safety (FFA Members).
Lawnmower Safety (Northstar Implement).
Fall Harvest Safety Presentation (FFA Alumni).
Seatbelt Safety (Department of Transportation).
Eye Safety Emphasis (FFA Members, Faculty Members).
Laminate Posters (FFA Members).
FFA Safety Booth (FFA Members, Lion's Club, FFA Alumni).
"Mr. Yuc" Poison Prevention Program (Luther Hospital, Elementary School).
Safety Preparation for Maintenance Personnel (Simplicity Lawnmower Company, FFA
Members).

View Safety Films, Videos and Filmstrips (FFA Members, Organization from which they
were obtained).

596                                   Papers and Proceedings


Surgeon Qeneml's Contimnce on Agicuttural Sakty and Health
FAJWSAFE 2000 o A National Coalition for Local Act/on
Convened by the Natlonal Institute for Occupational Sahty and Health
April 30 - May 3, 1991, Des Moines, Iowa

VIDEO TAPE PRESENTERS

TITLE                     SOURCE

Idaho
. .." ,..,...,-,. 4.,1.," ,IY..,...y . . . . . 1 ,,-, "" .,.. ^ ..,-. Y..l ,..,... "..^.." ,,.,..,.. ""." .-..A.. ^ ..A... Y..l..,"I".l .,.. ^.-1*.A.A." -,...e., ",.w.".II..-."."a..IY." . . -.-I.-^..I.-~YI"..I..~I..

Farm and Ranch Equipment Safety

Idaho Cooperative Extension
Agricultural Communication Center
10 Agricultural Science Building
Moscow, ID 83843-4196
(208) 885-6436 or FAX
(208) 885-6654

Illinois
,.........,..,..,...........,,......,..,.........,.......... " ,......," . . . . . L . . . . . . . . . . . . . . ., . . . . . ..." . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1........... .., . . . . . . . . . . . . . A. . . . . . ..C .L...... . . . . . . 1.... . . . . . ..." . . . . . .

Safe Country

County Companies
Insurance
Community Education
P.O. Box 2020
Bloomington, IL 61702
(309) 557-2836 or FAX
(309) 829-9430

0

Iowa
. . . . . . . . . . . . . . . . . - . . . . . . . . . . I. . . . . . . . . . . . . . . . ,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I.. . . . . .

Agriculture at Risk

Audiovisual Center
University of Iowa
C215 Seashore Hall
Iowa City, IA 52242
1 (800) 369-IOWA or FAX
(319) 335-2507

Surgeon General's Conference on Agricultural Safety and Health - 1991               597


Making Connections

Farm Safety for Kids

Farm Safety for "Just Kids"
P.O. Box 458
130 East First
Earlham, IA 50072
(515) 758-2827 or FAX
(515) 758-2517

   Rural Health Series Tape     Jacqueline Snider
                      Information Resource Center
# 1 Agricultural Traumas         University of Iowa
                    124 AMRF-Oakdale Campus
#2 Pesticide Toxicology         Iowa City, IA 52242
                  (319) 335-4427 or FAX
#3 Agricultural Respiratory Disease and  (319) 335-4225
Skin Diseases of Agricultural Workers

#4 Zoonotic Diseases #1

#5 Zoonotic Diseases #2

Nebraska
. . . . . . .._.......... I ,...~~~,..~..~~~_~~..~~~~~...~~.,,~.....,.....,,.............. 1 . . . .._................................................." . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Farm Machinery Accidents

Lincoln Medical Education
Foundation
4600 Valley Road
Lincoln, NE 6851 O-4844
(402) 483-4581 or FAX
(402) 483-4184

#l Auger Rescue

#2 PTO

#3 Crushing Injury

Rollin Schnieder
Cooperative Extension
Institute of Agriculture and Natural
Resources
221 West Chase Hall
University of Nebraska-Lincoln
Lincoln, NE 68583-0771
(402) 472-2824 or FAX
(402) 472-6338

598                                Papers and Proceedings


Video Tape Presenters, May 2, 1991

New York

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..-............................................................................................................................... _ . . . . . . . . . . . . . . . . . ..Y.....................

      FARMSAFE Series

#l Agricultural Injuries and Children

#3 Recognizing Workplace First
Response to Farm Injuries and
Reporting a Farm Accident

New York Center for
Agricultural
Medicine and Health
One Atwell Road
Cooperstown, NY 13326
(607) 547-6023 or FAX
(607) 547-6087

#4 Personal Protective Equipment

#5 Tractor Overturns

#6 Electrocution Hazards

#7 Job Safety Analysis and Risk Taking
  Demonstration

#8 Safety on the Farm, But off the Job

#9 Respiratory Hazards on the Farm

#l 0  Power Take off Injuries

#l 1  Farm Family Stress

#12  Economic impact of Farm Injuries

Vermont
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ............... _ ........................... .I ........ .......... ^ ..............._._.,.

It Can't Happen to Me

UVM Extension Service L4
Office of Information
Morrill Hall, UVM
Burlingtbn, VT 05405
(802) 656-3024 or FAX
(802) 656-8642

Surgeon General's Conference on Agricultural Safety and Health - 1991               599


Making Connections

Wisconsin
. . . .._...........,_._....... 1 .,......,,.....,...,........ _ . . . . . . . . . I ..Y............... _ . . . . . . . . . . . . . . . . 1............................... _ ..,.-........ I -........-..,.....-............-.........,............. 1

Grant County Farm injury Statistics

Linda Adrian
Grant County Nurses Office
111 S. Jefferson Street
Lancaster, WI 53813
(608) 723-6416 or FAX
(608) 723-2377

How to Have an Accident

Cooperative Extension Media
Collection
Bureau of AV Instruction
1327 University Ave.
Madison, WI 53715-2491
(608) 262-1644 or FAX
(608) 262-7568

600                                  Papers and Proceedings



Surgeon General's Conference on Agricultural Sakty and Health
FARM&E 2000 o A National Coalition for Local Action
Convened by the National lnstkte tbr Occupational Safety and Health
April 30 - May 3, 7997, Des Moines, Iowa

NATIONAL PARTICIPANTS

Figure 1. The 41 States That Were Represented by Participants at the Conference.

ALABAMA
. . ., . . . . . . . . . . . . . . . . . . . . . . . n

Mr. Henry Miles, Sr.
FFA Advisor
Paramount High School
P. 0. Box 188
Boligee, AL 35443

Mr. Jimmy Moore
FFA Safety Chairperson
Paramount High School
P. 0, Box 188
Boligee, AL 35443

Mr. Charles 6. Ogburn
Extension Agricultural Engineer
Alabama Cooperative Extension
Service, Auburn University
Room 218, Agricultural Engineering
Building
Auburn, AL 36849

ALASKA

. . . . . . . . . . ..r.................... . . . .

Mr. Richard Kennedy   *

Statistician
NIOSH, CDC
3601 C. Street, Suite 250
Anchorage, AK 99503

Mr. Robert Seay
County Extension Agent
Cooperative Extension Service
1204 SW 14th Street
Bentonville, AK 72712

Surgeon General's Conference on Agricultural Safety and Health - 1991

ARIZONA

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,

Mr. Lance Fluegel
Safety Coordinator
Arizona Cooperative Extension
222A Forbes Building
Tucson, AZ 85721

ARKANSAS
..n.r ..,,,^...............,.... . ..,.. . . ..^.._ . . . . . . Y

Mr. Jim Wohlleb
Assistant Director
Arkansas Area Health
1123 South University
Little Rock, AR 72205

601


National Participants

CALIFORNIA
. . . . . . . . . . . . . . ., . . . . . .." . .I. . . . . . . . . . t-l

Dr. Carol Conroy
Occuoational

Epidemiologist
California Occupational Health Program
2151 Berkeley Way, Annex 11
Berkeley, CA 94704

Dr. David F. Goldsmith
University of California, Davis
Division of Occupational and
Environmental Medicine
ITEH
Davis, CA 95616

Mr. Gene F. Graham
Assistant Program Director
W.K. Kellogg Foundation
1111 N. Dartmouth Ave, Apt 205
Clairemont, CA 91711

Mr. James Grieshop
Specialist, Applied Behavioral Sciences
University of California
Department of Applied Behavioral
Sciences
Davis, CA 95616

Mr. Kevin Kokrda
Engineering Admininistrative Manager
Kubota Tractor Corporation
550 W. Artesia Boulevard
Compton, CA 90220-7020

Mr. Neil Maizlish
Epidemiologist
California Occupational Health Program
2251 Berkeley Way, Annex 11
Berkeley, CA 94704

Mr. Craig Merrilees
Special Projects Director
National Toxics Campaign and
Consumer Pesticide broi,ct
425 Mississippi Street
San Francisco, CA 94107

Dr. James M. Meyers
Agricultural Health Specialist
University of California, Berkeley
322 Warren Hall
Berkeley, CA 94720
5701642-8375
570/ 6425815 - FAX

Dr. John Miles
University of California, Davis
Agricultural Engineering Department
Davis, CA 95616

Mr. Dalton Paxman
University of California, Berkeley
322 Warren Hall
Berkeley, CA 94720

Dr. Marc Schenker
University of California, Davis
Agricultural Health and Safety Center
Davis, CA 95616

Dr. Wrlliam E. Steinke
Extension Agricultural Engineer
Aaricultural Enaineerina Extension
Uiiiversity of Glifornia-
Davis, CA 95616

Mr. Don Villarejo
Executive Director
California Institute for Rural Studies
P.O. Box 2143
Davis, CA 95617

Mr. Robert Wagner
Director, Agricultural Safety
Zenith Insurance Company
226 Airport Parkway
San Jose, CA 95110

Ms. Ellen G. Widess
Director of Health and Safety Policy
Children's Advocacy Institute
Suite 340
1160 Battery Stret, Suite 340
San Francisco, CA 94111

Ms. Melanie Zavala
Farm Worker Safety Coordinator
University of California, Davis
IPM Education and Publications
Davis, CA 956168620

COLORADO
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..,..,..,....

Mr. Paul D. Ayers  cl
Colorado State
Department of Agricultural and
Chemical Engineering
Ft. Collins, CO 80523

Ms. Lela K. Criswell
Epidemiology
Colorado State University
Department of Environmental Health
Ft. Collins. CO 80523

Mr. Bill Daniels
Regional Representative
Public Health Service Region 8
1961 Stout Street
Denver, CO 80227

Dr. Lorann Stallones
Associate Professor
Department of Environmental Health
Colorado State
Fort Collins, CO 80523

DISTRICT OF COLUMBIA
..Y.. LI^Y...Y.~."^..~.Y,".~.-.-",~"-..~..~..*~.-.-*~

Ms. Judith Bowers
Head. Public Affairs
Communication, Information, and
Technology Unit
3331 South Building
Washington, DC 20250-0900

Ms. Carmen Calhoun
Assistant to the Director
National Association of Wheat Growers
Foundation
415 Second Street, N.E.
Washington, DC 20002

Dr. David J. Cochran
Industrial Engineer
175 Nebraska Hall
Lincoln, NE 68588-0518

Ms. Cynthia Douglass
401 M. Street, SW
OS-1 20
Washington, DC 20460

Mr. Tom Harkin
U.S. Senator

State of Iowa University
SH531 Hart Senate Office Building
Washington, DC 20510-1502

Dr. Myron D. Johnsrud
Administrator, Extension Service
USDA
Room 338 A, Administration Building
Washington, DC 20250-0900

Dr. Daniel E. Kugler
Director, Office of Agricultural Materials
USDA
14th and Independence Avenue, SW,
Aerospace Center 342
Washington, DC 202502200

Mr. Stephen Mallinger
Deputy Director of Technical Support
OSHA, US Department of Labor
200 Constitution Avenue, NW
Room N3653

Washington, DC 20210

Dr. J. Michael McGinnis
Deputy Assistant Secretary for Health
DHHS
330 C Street, SW, Room 2132
Washington, DC 20201

Mr. Joseph M. Miller
Bureau df Census
Aoriculture Division
426 lverson Building
Washington, DC 20715

Papers and Proceedings


Participants

Dr. Antonia C. Novello
Surgeon General
USPHS
The Hubert Humphrey Building
Room 710G
200 Independence, SW
Washington, DC 20201

Ms. Joann On
National Aerial Agricultural Association
1005 E Street, SE
Washington, DC 20003

Mr. Vernon Orr
President
National Agricultural Aviation
Association
1005 E Street, SE
Washington, DC 20003

Mr. Bradley K. Rein
USDA Extension Service
Agricultural Programs
Room 3346, S. Building
Washington, DC 20250-0900

Dr. Jane Rissler
Biotechnology Specialist
National Wildlife Federation
14W 16th Street, NW
Washington, DC 20036

Mr. Randall Rutta
Director of Governmental Affairs
National Easter Seal Society
1350 NY Avenue, NW, Suite 415
Washington, DC 20005

Mr. Thomas Seymour
Deputy Director of Safety
OSHA, US Department of Labor
200 Constitution Avenue, NW
Room N3605
Washington, DC 20210

Dr. Louis W. Sullivan
Secretary of Health and Human
Services
200 Independence Avenue, SW
Room 615F
Washington, DC 20201

Dr. Leslie Whitener
Leader, Agricultural Labor Section
USDA
1301 New York Avenue, NW
Washington, DC 20005

Ms. Valerie A, Wilk
Health Specialist
Farm Worker Justice Fund, Inc.
2001 S. Street, NW, Suite 210
Washington, DC 20009

FLORIDA
YYI.......I.-~-W..I-I-

Mr. Arturo Lopez
Executive Director
Coalition of florida
Farmworker
pp;t;bn;
Homestead, FL

GEORGIA

\

Ms. Diane Allen
NIOSH, CDC
Room 3066, MS D-26  I,f
Atlanta, GA 30333

Ms. Jennifer L Ballew
NIOSH, CDC
Room 3417, MS D-32
Atlanta, GA 30333

Ms. Kimberly L Barth
NIOSH. CDC
Room &43, MS D-26
Atlanta, GA 36333

Mr. Paul Burlack
Public Health Advisor
CDC
Koger Center, 1045, MS F-36
Atlanta, GA 30333

Ms. Glenda Cowart
Cffice of the Director
CDC
Room 2011, MS D-15
Atlanta, GA 36333

Ms. Ann Cronin
NIOSH, CDC
Room 3124, MS D-36
Atlanta, GA 30333

Ms. Brooke Dixon
Director, Georgia Migrant Health and
Agricultural Surveillance Program
Georgia Division of Public Health
1190 Winding Branch Circle
Dunwoody, GA 30336

Ms. Betty Dryden
NIOSH, CDC
Room 3067, MS D-26
Atlanta, GA 30333

Mr. Brian Dugan
NIOSH, CDC
Room 3423, MS D-32
Atlanta, GA 39333

Dr. Richard L Ehrenberg
NIOSH, CDC
Room 3047, MS D-26
Atlanta, GA 30333

Dr. Roy M. Fleming
Associate Director for Grants
NIOSH, CDC
Room 3057, MS D-313
Atlanta, GA 313333

Mr. William Gimson
Deputy Director
Office-of Program Support, CDC
Financial Management Office
Buckhead, 200;MS E-12
Atlanta, GA 30333

Ms. Mary Griffin
NIOSH. CDC
Room 3112, MS D-36
Atlanta, GA 30333

Mr. Tim Groza
NIOSH, CDC
Room 3040 MS D-29
Atlanta, GA 36333

Ms. Denise Johnson
Public Health Advisor
CDC
1600 Clifton Road, NE
Atlanta. GA 30333

Ms. Joyce A. Johnson
NIOSH. CDC
Room 3040, MS D-29
Atlanta, GA 30333

Mr. Ted Katz
NIOSH, CDC
Room 3116, MS D-36
Atlanta, GA 30333

Ms. Evelyn Lemelin
Program Analyst
NIOSH, CDC
Room 3040, MS D-29
Atlanta, GA 30333

Dr. Richard A. Lemen
Deputy Director
NIOSH, CDC
Room 3007, MS D-36
Atlanta, GA 36333

Dr. Eugene J. Lengerich
Epidemiologist
CDC, CCDPHP
Chamblee, 1019, MS F-13
Atlanta, GA 30333

Mrs. Joan P. Millar
3243 Wake Robbin Trail, NE
Atlanta, GA 30341

Surgeon General's Conference on Agricultural Safety and Health - 1991

603


National Pattlclpants

Dr. J. Donald Mlllar
Director
NIOSH, CDC
Room 3007, MS D-36
Atlanta, GA 30333

Ms. Barbara Morrison
Program Analyst
NIOSH. CDC
Room 3040, MS D-29
Atlanta, GA 30333

Mrs. Annette B. Myers
1293 Berkley Road
Avondale Estates, GA 30002-1517

Mr. Melvin L. Myers
Special Assistant to the Director
NIOSH, CDC
Room 3041, MS D-26
Atlanta, GA 30333

Ms. Barbara Nelson
Program Analyst
NIOSH, CDC
Room 3040, MS D-29
Atlanta, GA 30333

Mr. Claude F. Pickelsimer, Jr.
Director, FM0
CDC
Buckhead, 200, MS E-12
Atlanta, GA 30333

Dr. Patricia H. Price
Medical Cfficer
ATSDR
Executive Park, MS E-33
Atlanta, GA 30333

Dr. William L. Roper
Director, CDC
Room 2000, MS D-14
Atlanta. GA 30333

Mr. Sven J. Rundman, Ill
OSHA, U.S. Department of Labor
1375 Peachtree Street, NE
Room 587

Atlanta, GA 30367

Mr. Stan Salisbury
Regional Program Consultant
Public Health Service Region IV
101 Marietta Tower
Atlanta, GA 30323

Ms. Ann Smith
Program Analyst
NIOSH, CDC
Room 3040, MS D-29
Atlanta, GA 30333

Mr. Larry W. Sparka
NIOSH. CDC
Roo& j104, MS D-35
Atlanta, GA 30333

Ms. Gwendolyn L Strickland
Senior Attorney
CDC, Office of the General Counsel
Room 4017, MS C-05
Atlanta, GA 30333

Ms. Newell B. Tozzer
Program Analyst
NIOSH, CDC
Room 3040, MS D29
Atlanta, GA 30333

Mr. Bobby. L. Tyson
Extension-Engineer
Universitv of GA
Athens, GA 30602

Ms. Barbara Wedding
NIOSH, CDC -
Room 3053. MS D-30
Atlanta, GA' 30333

Ms. Katherine Wilson
Center for Chronic Disease Prevention
and Health Promotion
CDC
Koger Center, 4102, MS K-46
Atlanta, GA 30333

Ms. Rebecca B. Wolf
Program Analyst
CDC, OPPE
Room 2050, MS D-23
Atlanta, GA 30333

IDAHO
. . . . . _ . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . . . . . . . . . . . . .

Mr. Larry Belmont
Director, Idaho
Panhandle
Health District 1
2195 lronwood Court
Coeur d'Alene, ID 63614

Dr. Jim Berry
Director, Production Research
Rogers NK Seed Company
6338 Highway 20-26
Nampa, ID 83687

Mr. Tom Karskey
Extension Farm Safety Specialist
University of Idaho
Agricultural Engineering Department
Moscow, ID 83843

Mr. Ryan Kurhmiohrl
osti
U.S. Deoartmrnt of Labor
Ee yoh Lakeharbor Lane
Boise, ID 83703

ILLINOIS
,____L.__rev"...."

Mr. Kevin
Adolphaon
Commercial Loae
Control Coordinator
Country Companies
1705 Towanda Avenue
Bloomlngton, IL 61702-2100

Dr. Robert Aherln
Professor, Department of Agricultural
Engineering
University of Illinois
1304 West Pennsylvania Avenue
Urbana, IL 61601

Dr. Walter J. Armbruster
Associate Managing Director
Farm Foundation
1211 W. 22nd Street, R216
Oak Brook, IL 60521-2197

Mr. L. Dale Baker
Product Safety Engineer
JI Case Company
7 South 600 County Line Road
Hinsdale, IL 60521

Mr. Emmett Barker
President
Equipment Manufacturers Institute
10 South Riverside Plaza
Suite 1220
Chicago, IL 60606-3710

Ms. Page L. Bellinger
Manager of Product Safety and
Engineering Standards
Deere and Company
John Deere Road
Moline, IL 61265

Mr. James F. Bennett
Farm and Industrial Equipment
Manufacturer's Institute
lo South Riverside Plaza, Suite 1220
Chicago, IL 606Q6-3710

Mr. Stanley Bozdech
Assistant Manager of Engineering
Dekalb Plant Genetics
3100 Sycamore Road
Dekalb, IL 60115

604

Papers and Proceedings


Participants

Mr. Jack W. Burke
Program Manager
Agricultural Safety
Natlonal Safety Council
444 North Mlchlgan Avenue
Chlcago, IL 60611

Dr. Wade P. Clarke
Director, Government Affairs
Deere and Company
John Deere Road
Moline, IL 61265

Mr. John H. Crowley
Director Safety Programs
Equipment Manufacturers Institute
10 South Riverside Plaza, Suite 1220
Chicago, IL 60606-3710

Ms. Belinda Dehart
Illinois Department of Public Health
Center for Rural Health
535 W. Jefferson
Springfield, IL 62761

Mr. Richard De Pauw
Product Safety Coordinator
John Deere Harvester Works PDD
1800 158th Street
East Moline, IL 61244

Dr. Gary Erisman
Private Farmer
P.O. Box 278
Stanford, IL 61774

Ms. Elizabeth Esseks
Graduate Student
University of lllnois
Department of Health and Safety
Studies
121 Huff Hall, 1206 S. Fourth Street
Champaign, IL 61820

Ms. Theresa Foes
Director of Health Education
Rock Island County Health Department
2122 25th Avenue
Rock Island, IL 61207

Mr. Joseph A. Kinney
Executive Director
National Safe Workplace Institute
122 S. Michigan Avenue, Suite 1450
Chicago, IL 60603

Mr. Mark Landmark
Director of Safety
American Farm Bureau Federation
225ToughyAvenue
Park Ridge, IL 60068

Mr. Terry L Loughrin
Produot Englnerrlng Manager
Walterschrld, Inc.
16 W 030 83rd Street
Burr Ridge, IL 80521

Mr. Murray D. Madsen
Product Safety Engineer for Agriculture
Equipment
Deere and Company
Product Safety and Engineering
Standards
Mollne, IL 61265

Ms. Judy Marshall
Writer
Deere and Company
John Deere Road
Moline, IL 61265

Mr. Shane Miller
Route 1, Box 228
Tolono, IL 61880

Ms. Leslie Nickels
Project Director
University of Illinois
815 W. Van Buren, Suite 214
Chicago, IL 60607

Mr. Keith Pfundstein
Owner
KPS Technology
3714 44th Street
Rock Island, IL 61201

Ms. Marsha Purcell
Director of Program Development
American Farm Bureau Federation
225 Touhy Avenue
Park Ridge, IL 60068

Ms. Barbara I. Riordan
Childhood Injury Prevention Consultant
Illinois Dept of Public Health
2009 Glenview Road
Rockford, IL 61107

Mr. Dave Schmerse
Project Manager, Product Safety
Deere and Company
John Deere Road
Moline, IL 61265

Mr. Doug Sommer
District Coordinator of Community
Education
Country Companies
Box 2020
Bloomington, IL 61701

Mr. Mike Tumbleeon
Unlversltv of llllnois
VoternaG Medlclne Basic Solence
BuildInn. Room 3217
2001 S,iJnooln Avenue
Urbana, IL 61801

Mr. Jamra Westaby
University of Illlnols
Department of Agricultural Engineering
1304 W. Pennsylvania Avenue
Urbana, IL 61801

Mr. James L Willlams
Associate Director
Community Education
Country Companles
1701 Towanda Avenue
P.O. Box 2020
Bloomington, IL 61701

Mr. Ted 0. Yanecek
Legislative Counsel
Deere and Company
John Deere Road
Moline. IL 61265

Mr. Tracy Mefford
FFA President
Southwestern-
Hanover FFA
Route 5, Box 222
Madison, IN 47250

Dr. Robert R. Pinger
Director
Public Health Entomology Laboratory
Ball State
Muncie, IN 47306

Mr. Ken Salkeld
FFA Advisor
Southwestern FFA
Route 1, Box 473 D
Lexington, IN 47138

Mr. Mark Timm
President
National FFA Organization
Route 1, Box 20AA
Fillmore, IN 46128

IOWA
.,.,^.._." ..,....,. *w....e... ,..,.. . . . . . . .

Ms. Marilyn Adams
President   Q

Farm Safety for "Just
Kids"
P.O. Box 458
Earlham, IA 50072

Surgeon General's Conference on Agricultural Safety and Health - 1991

605


National Participants

Mr. Eugene L Ahrenholtz
Vice President of Operations
Clean Air Filter Company
Route 1, Box 18
Defiance, IA 51527

Mr. Dale E. Anthony
Agricultural Injury Investigator
Iowa Department of Public Health
321 E. 12th Street, Lucas Building
Des Moines, IA 50319-0075

Mr. Christopher Atchison
Director
Iowa Department of Public Health
321 E. 12th Street, Lucas Building
Des Moines, IA 50319

Mr. Lawrence E. Barker
Director
Scott County Health Department
428 Western Avenue
Davenport, IA 52801

Ms. Marcia A. Barrett
Agricultural Occupational Health Nurse
MMSC AgriCare
3 South 4th Avenue
Marshalltown, IA 50158

Ms. Marlene Beckman
EMS Supervisor
Southeastern Community College
Route 1, Box 85
Mediopolis, IA 52637

Dr. Jack Beno
Associate Professor for Occupational
Safety and Health
Iowa State
122 Industrial ED and Tech II
Ames, IA 50011

Ms. Norma Bettis
Administrative Assistant
Iowa-Nebraska Farm Engineering
Association
1311 50th Street
Des Moines, IA 50265

Ms. Sarah Black
Rural Initiative Coordinator
Iowa Methodist Health System
1200 Pleasant Street
Des Moines, IA 50309

Ms. Nancy Boettger
Director of Education and Resource
Development
Myrtue Memorial Hospital
1213 Garfield
Harlan, IA 51537

Mr. Dennis Bradley
Registered Nurse
Meroy Health Center
Mercy Drive
Dubuque, IA 52001

Mr. Donald R. Bradley
Director. EMSLRC
University of lowa Hospitals
5367 UCP
Iowa City, IA 52242

Mr. John Bremhurst
Industrial Hygienist
U.S. Department of Labor
4361 69th
Urbandale, IA 50322

Ms. Mary J. Buchele
President
Buchele Associates, Ltd.
239 Parkridge Circle
Ames, IA 50010

Dr. Wesley F. Buchele
Professor Emeritus of Agricultural
Engineering
Buchele Associates, Ltd.
239 Parkridge Circle
Ames, IA 50010

Mr. James Cain
Energy Specialist
Iowa State Extension
EES Building, Harbor Road
Ames, IA 50011

Mr. Roger Chapman
Iowa Disability Prevention Project
Iowa Department of Public Health
460 Henry Mall
Des Moines, IA 53704

Mr. Kenneth Choquette
Iowa Department of Public Health
Lucas State Cffice Building
Des Moines, IA 50316

Ms. Peggy Clarahan
Nurse Consultant
Iowa Dept of Public Health, OHNAC
1804 Hemlock
Atlantic, IA 50022

Ms. Kathy Comito
Network Coordinator
Mercy Hospital
6th and University
Des Moines, IA 50312

Ms. Sharon Cook
Program Planner
Iowa Department of Public Health
321 E. 12th Street
Des Moines, IA 50319

Mr. Thomas Cook
Professor
University of lowa
2633 Syeindler Building
Iowa City, IA 52242

Ms. Debbi Cooper
Administrator Assistant
lowa Department of Public Health
Lucas Building
Des Moines, lA 50319

Mr. Ray H. Crammond
Consulting Engineer
Crammond Enaineerina Comoanv
217 Center Street, P.0,Box 197 e
Elgin, IA 52141

Dr. Russell Currier
Bureau Chief of Environmental
Epidemiology and Chronic Diseases
Iowa Department of Public Health
Lucas State Office Building
Des Moines, IA 50319-0075

Mr. Mark Dagoberg
President
Methodist Health Network of Iowa
1200 Pleasant Street
Des Moines, IA 50309

Mr. L. Graham Dameron
Director
Johnson County Department of Public
Health
1105 Gilbert Court
Iowa City, IA 52240

Mr. W.M. Davis
Box 421
Ottomwa, IA 52501

Dr. E. Elaine De Boef
Occupational Nurse Consultant
Iowa State Depattmeny of Public
Health, Disease Prevention
Route 1, Box 59
Pella, IA 50219

Ms. Pam Delagardelle
Director Farm Partners
Sartori Memorial Hospital
6th and College
Cedar Falls, IA 50613

Dr. Pat DeSotel
ER Supervisor
Washington County Hospital
Route 3
Washington, IA 52353

606

Papers and Proceedings


Participants

Mr. Gary DiGiuseppe
NAFB Farm Safety Chairman
KWMT Radio
Box 578
Fort Dodge, IA 50501

Dr. Kelley J. Donham
Professor
Department of Preventive Medicine and
Environmental Health
University of Iowa College of Medicine
Iowa City, IA 52242

Mr. John P. Dorrian
Mayor
City of Des Moines
400 E. 1st
Des Moines, IA 50309

Ms. Diane Dotson
Network Coordinator
Mercy Hospital Medical Center
6th and
Des Moines, IA 50314

Mr. Gary L. Downey
Assistant Vice President of Industry
Relations
Grinnell Mutual Reinsurance Company
l-80 at Highway 146
Grinnell, IA 50112

Dr. Ronald D. Eckoff
Director, Division of Family and
Community Health
Iowa Department of Public Health
Lucas Building
Des Moines, IA 50319

Ms. Elizabeth Elliott
Associate Vice Provost for Extension
Iowa State University
110 Curtiss Hall
Ames, IA 50011

Dr. L.J. Filer
Professor of Pediatrics
University of Iowa
College of Medicine
Iowa City, IA 52242

Mr. Tom Filer
Sales Manager
Des Moines Marriott
700 Grand Avenue
Des Moines, IA 50309

Ms. Charlene Finck
Machinery Editor
Farm Journal
3211 Sheridan Avenue
Des Moines, IA 50310

Mr. Raymond W. Forsythe
Director of Safety
Farm Bureau Mutual Insurance
Company
5400 University
West Des Moines, IA 50265

Mr. Dan Frieberg
Executive vice President
lowa Fertilizer and Chemical Association
900 Des Moines Street, Suite 150
Des Moines, IA 50309

Dr. Laurence Fuortes
University of lowa
Iowa City, IA 52242

Ms. Jane Gatzke
Safety Administrative Assistant
Pioneer Hi-Bred International, Inc.
4445 Corporate Drive, Box 6500
West Des Moines, IA 50265

Ms. Jane Gay
Project Coordinator
AMRF - Oakdale
University of Iowa
Iowa City, IA 52242

Dr. James Gilley
Head Professor
Agricultural Engineering Department
Iowa State University
Ames, IA 50011

Mr. Rodney Goodwin
Director of Research
National Pork Producers Council
Box 10383
Des Moines, IA 50306

Dr. Thomas H. Greiner
Associate Professor, Agricultural
Engineering Department
Iowa State University
200 C Davidson Hall
Ames, IA 500113080

Mr. Alonzo L. Griffin
OSHA, U.S. Department of Labor
210 Walnut Street
Des Moines, IA 50309

Mr. John Haan
Industrial Hygienist
Iowa Division of Labor
3804 1 lth Street
Des Moines, IA 50313

Ms. Charlotte Halverson
Rural Outwash Coordinator
Mercy Health Center
Mercy Drive
Dubuque, IA 52001

Mr. Monte Hamilton
Paramedic
Mary Greeley Medical Center
117 11th Street
Ames, IA 50010

Mr. Mark Hanna
Extension Agriculture Engineer
lowa State University
200 Davidson Hall
Ames, IA 50011

Ms. Marcia Heggen
Director
Occupational Health and Wellness -
Agricare
350 4th Avenue
Marshalltown, IA 50158

Mr. Brian Herbst
Senior Industrial Hygienist
Iowa Division of Labor
1000 East Grand
Des Moines, IA 50319

Ms. Marilyn Hibbs
Director of Communications
Time Frame Productions
3305 104th Street
Des Moines, IA 50322

Mr. Charles Hooper
Senior Industrial Hygienist
Iowa Division of Labor
1000 East Grand
Des Moines, IA 50319-0209

Ms. Sue Ellen Hosch
University of Iowa
pcg;ional Medicine Clinic
Iowa City, IA 52242

Ms. Kathy Houser
L & W Feeders
Route 1, Box 51
Watkins, IA 52354

Mr. Thomas J. llax
Environmental Coordinator
Iowa State University
204 Davidson Hall
Ames, IA 50010

Ms. Anne Jackson
Industrial Hygienist
Iowa Division of Labor
1000 E. Grand Avenue
Des Moines, IA 50319

Ms. Sheryi Jenko
President
Iowa FFA Association
BOX 400, 301 Center Avenue, S.
Mitchellville, IA 50169

Surgeon General's Conference on Agricultural Safety and Health - 1991


National Participants

Mr. Dale Johnson
Director of Publications
Iowa Farm Bureau
5400 University
West Des Moines, IA 56265

Mr. Jeff Jones
Safety Engineer
OSHA, U.S. Department of Labor
210 Walnut, Room 815
Des Moines, IA 50309

Ms. Shirley K. Jones
Coordinator SPRAINS
Iowa Department of Public Health
Lucas Building
Des Moines, IA 50319-0075

Mr. Troy Karns
The Greater Des Moines Convention
and Visitors Bureau
Tow Ruan Center
601 Locust Street, Suite 200-H
Des Moines, IA 50309

Ms. Bonnie Kay
Director of Occupational Health
American Lung Association of Iowa
1025 Ashworth Road, Suite 410
West Des Moines, IA 50265

Ms. Tracy Keninger
Rural Rehabilitation Specialist
Easter Seals Farm Program
8432 Franklin, X19
Des Moines, IA 50325

Mr. Craig T. Keough
EMS Field Consultant
Mercy Health Center
Mercy Drive
Dubuque, IA 52001

Ms. Carolyn Kern
Nursing Instructor
Iowa Methodist Medical Center
12th and Pleasant
Des Moines, IA 50309

Ms. Janet Kinney
National Board Member
Communicating for Agriculture
Route 3, Box 41
Alden, IA 50006

Mr. Michael David Kramer
University of Iowa
Department of Preventive Medicine
Iowa City, IA 52242

Mr. Burton C. Kross
Associate Director
University of Iowa
Iowa City, IA 52242

Ms. Wendy E. Kuhse
Nurse Consultant
lowa State Department of Public Health
203 Benton Street
Garnavillo, IA 52949

Ms. Barbara Lacina
Research Assistant
University of Iowa
Iowa City, IA 52242

Ms. Diane Lenning
Administrator
Humboldt County Public Health Nursing
Services
Courthouse
Dakota City, IA 50529

Mr. Charles Larson
Farm Program
Iowa Easter Seals
Box 4CrO2
Des Moines, IA 50333

Mr. C.W. Lawrence
Farm Safetv for *Just Kids"
130 E. 1st Street
Earlham, IA 50072

Ms. Carol Lehtola
Agricultural Engineer
Iowa State University
102 Davidson Hall
Ames, IA 50011

Ms. Stephanie Leonard
Industrial Hygienist
University of Iowa
124 AMRF
Iowa City, IA 52242

Ms. Linda Leverenz
Educations Specialist
University of Iowa
104 AMRF - Oakdale
Iowa City, IA 52242

Dr. Leonard A. Levy
Dean

University of Osteopathic Med and
Sci/Coll of Podiatric Med Surgery
2150 Grand Avenue
Des Moines, IA 50312

Ms. Mary Cl. Lewis
Research Assistant
University of Iowa
Department of Preventive Medicine and
Environmental Health
206 AMRF
Iowa City, IA 52319

Dr. Louise Lex
State Health Planner
Iowa Department of Public Health
Lucas Building
Des Moines, IA 50319

Ms. Shirley Long
Writer
The Write Touch
306 NW Bayberry
Ankemy, IA 60021

Ms. Barbara J. Lykins
Director Women's Activities and
Consumer Education
lowa Farm Bureau Federation
5400 Avenue
West Des Moines, IA 50265

Ms. Juleea Martindale
Grants Coordinator
Mercy Hospital Medical Center
6th and University
Des Moines, IA 503143190

Mr. Dennis McClure
Safety Coordinator
United AgriSeeds
Box 637
Marshalltown, IA 50158

Ms. Lois McDermott
Registered Nurse
Agricultural Health and Safety
Route 2, Box 165
Harlan, IA 51537

Ms. Monica McGregor
Greene County 4-H Club
Route 2, Box 105
Jefferson, IA 50129

Dr. Kris Mclntee
Nurse Consultant
lowa State Dept of Health
Disease Prevention
2625 West Fourth Street
Waterloo, IA 50701

Ms. Karen McMahon
Contributing Editor
Hogs Today Magazine
1221 Oak Park Boulevard
Cedar Falls, IA 50613

Mr. Al Meier
Commissioner
Division of Labor
loo0 E. Grand
Des Moines, IA 50319

608

Papers and Proceedings


Participants

Dr. James A Merchant
Director, Institute of Agricultural
Medicine and Occupational Health
University of Iowa
AMRF, Oakdale Campus
Iowa City, IA 52242

Mr. Vernon M. Meyer
Professor
Iowa State University
201 Davidson Hall
Ames, IA 500113080

Ms. Elizabeth Ruth Miller
Assistant Resident Scientist
Institute for Agricultural Medicine
University of Iowa
AMRF, Oakdale Campus
Iowa City, IA 52242

Ms. Malinda Miller
Field Editor
Iowa Farmer Today
P.O. Box 5279
Cedar Rapids, IA 52406

Mr. Jerry L. Miner
Safety Manager
Pioneer Hi-Bred
4445 Corporate Drive, Box 6500
West Des Moines, IA 50265

Ms. Linda Moyna
Director of Communications
Health Education
Ellsworth Municioal Hosoital
110 Rocksylvania '
Iowa Falls, IA 50126

Mr. Joseph L. Mullen
Industrial Hygienist
OSHA
1000 E. Grand
Des Moines, IA 50319

Mr. Cliff Mullenberg
OSHA
loo0 E. Grand
Des Moines, IA 50319

Mr. Don Nanneman
Occupational Health Nurse
Central Iowa Association of
Occupational Health Nurses
212 E. Clay
Osceola, IA 50213

Mr. Jens Nissen
Industrial Hygienist
Iowa Division of Labor
1000 E. Grand
Des Moines, IA 50319

Ms. Nancy A Norman
Associate Director
Rural Health Research Center
Iowa State University
1065 Elm Hall
Ames, IA 50011

Ms. Linda Cgilvie
University of lowa
Department of Preventive Medicine
AMRF, Cakdale Campus
Iowa City, IA 52242

Dr. Gayle Olson
Program Assistant
Institute of Agricultural Medicine and
Occupational Health
University of Iowa, Cakdale Campus
Winfield, IA 52242

Mr. Ted Ondracek
Senior Industrial Hygienist
Iowa Division of Labor
1OOCl E. Grand
Des Moines, IA 50319

Mr. Howard Oudman
Research Assistant
Iowa State University
925 Arizona Avenue
Ames, IA 50011

Mr. Shashi H. Pate1
Industrial Hygienist
lowa Division of Labor
1000 East Grand Avenue
Des Moines, IA 50319

Mr. Merlin Plagge
President
Iowa Farm Bureau Federation
5400 Avenue
West Des Moines, IA 50265

Dr. Wrlliam Popendorf
Professor
Institute of Agricultural Medicine
University of Iowa
134 AMRF
Iowa City, IA 52319

Mr. Jim Probasco
Industrial Hygienist
Iowa Division of Labor
1000 East Grand
Des Moines, IA 50316

Dr. August Ralston
Professor, College of Business
Iowa State
368 Carver Hall
Ames, IA 50011

Mr. Maurice Rarick
Industrial Hygienist
Iowa Division of Labor
loo0 East Grand Avenue
Des Moines, IA 50316

Mr. Robert D. Ray
Chairman, National Advisory Committee
on Rural Health Policy
Blue Cross/Blue Shield of Iowa
636 Grand Avenue
Des Moines, IA 50309

Mr. Craig Redshaw
Executive Director
American Lung Association of Iowa
1025 Ashworth Road, #410
West Des Moines, IA 50265

Mr. David Rosenau
Industrial Hygienist
Univresity of Iowa
124 AMRF
Oakdale, IA 52319

Dr. Eric Saikaly
Doctor
MacFarland Clinic
3012 Norbridge Parkway
Ames, IA 50010

Dr. Heidi Saikaly
Epidemiologist
MacFarland Clinic
3012 Norbridge Parkway
Ames, IA 50010

Mr. Steve Schaaf
Environmental Affairs Manager
Pioneer Hi-Bred International, Inc.
7301 NW 62nd Avenue
Johnston, IA 50131

Ms. Leah Schade
Safety Inspector
Iowa Division of Labor
1000 East Grand
Des Moines, IA 53019

Mr. Charles V. Schwab
Assistant Professor
Iowa State University
207 Davidson Hall
has, IA 50011

Mr. Dennis Schwitters
Iowa-Nebraska Farm
Equipment Association
1311 50th Street, P.O. Box 65840
West Des Moines, IA 50265-0840

Surgeon General's Conference on Agricultural Safety and Health - 1991

609


National Participants

Dr. Mustafa Selim
Assistant Professor
University of Iowa
137 AMRF
Iowa City, IA 52242

Ms. Carolyn Sheridan
AgriSafe
Spencer Municipal Hospital
1113 First Avenue East
Spencer, IA 51301

Ms. Ann Short
Iowa Department of Public Health
321 East 12th
Lucas Building
Des Moines, IA 50319

Mr. Daryl Siebens
Vice President
IA Farm Bureau
Route 1, Box 155
Akron, IA 51001

Ms. Carol L. Sipfle
Director of Programs
American Lung Association of Iowa
1025 Ashworth Road, Suite 140
Des Moines, IA 50265

Mr. Stephen J. Slater
Senior Industrial Hygienist
Iowa Department of Labor
1000 East Grand
Des Moines, IA 50319

Dr. Steve Soderlund
Director, Product Development and
Regulatory Affairs
Microbial Genetics. A Division of
Pioneer Hi-Bred International
4601 Westown Parkway, Suite 120
West Des Moines, IA 50265

Ms. Dorothy Sonksen
Wellness Coordinator
Burgess Memorial Hospital
1600 Diamond Avenue
Onawa, IA 51040

Mr. Art Spies
Vice President
Iowa Hospital Association
100 East Grand, Suite 100
Des Moines, IA 50309

Ms. Connie Stangl
AgriSafe
Spencer Municipal Hospital
1113 1st Avenue East
Spencer, IA 50515

Ms. Chrystal Stanley
Assistant Director
Easter Seal Farm Program
P.O. Box4002 -
Des Moines, IA 50333

Ms. Michelle Stirling
Community Health Educator
fldora Regional Medical Center
2413 Edgington Avenue
Eldora, IA 50126

Ms. Janis Stone
Extension Specialist
Iowa State University
141 Le Baron Hall
Ames, IA 50011

Ms. Cathy Stotts
Director Clinical Services
Lucas County Health Center
Route 3, P.O. Box 43A
Chariton, IA 50042

Mr. James Strohman
Executive Assistant
Iowa Attorney General's Cffice
Hoover State office Building
Des Moines. IA 50319-0114

Mr. Michael L. Swanson
Loss Control Manager
Pioneer Hi-Bred International, Inc.
6800 Pioneer Parkway Box 212
Johnston, IA 50131

Ms. Cheryl Tevis
Senior Farm Issue Editor
Successful Farming Magazine
Meredith Corporation, 1716 Locust
Des Moines, IA 50338

Ms. Connie Thompson
Director and Nurse of the Agricultural
Health and Safety Center
Myrtue Memorial Hospital
Route 2, Box 57
Harlan, IA 51528

Dr. Peter S. Thorne
Institute of Agricultural Medicine and
Occupational Health
University of Iowa
Iowa City, IA 52242-5000

Mr. Robin Ungar
Program Associate
University of Iowa
Iowa City, IA 52240

Ms. Terrie Urban
Wellness Coordinator
Montgomery County Memorial Hospital
2301 Eastern Avenue
Red Oak, IA 51566

Ms. Stephanie Vanlier
Director Grant Programs
Mercy Hospital Medical Center
Mercy Foundation
Sixth and University
Des Moines, IA 50314-3190

Ms. Susan F. Voehl
Agricultural Nurse
Nobles and Rock County Public HE
Route 2, Box 48
lake Park, IA 51347

Ms. Jennifer S. Vol
Advanced Care Coordinator
Iowa Western Community College
2700 College Road, Box 4-C
Council Bluffs, IA 51502

Mr. Mark Walker
Agriculture Health and Safety
Coordinator
St. Joseph Mercy Hospital
84 Beaumont Drive
Mason City, IA 50401

Ms. Teri Walker
PHN
Wayne County Public Health
Box 102
Corydon, IA 50060-1522

Ms. Janet Watt
Respiratory Therapist
University of Iowa
Iowa City, IA 52245

Mr. Allen Weller
Assistant Director of Safety
Farm Bureau Mutual Insurance
Company
5400 Avenue
West Des Moines, IA 50265

Ms. Sherri Wrldin
EMT-I
Madison County Ambulance
721 West Jefferson
Winterset, IA 50273

Ms. Therese Willkomm
Director
Easter Seal Farm Program
P.O. Box 4002
Des Moines, IA 50333

Dr. Wendy K. WIntersteen
Assistant Professor
Extension Entomologist
Iowa State University
109 Insectary, ISU
Ames, IA 50011

670

Papers and Proceedings


Participants

Ms. Debbie YOUnt
Wellness Coordinator
Iowa Farm Bureau Federation
5400 Avenue
West Des Moines, IA 50265

Mr. Chris Zimmerman
Physical Therapist
University of Iowa
2600 Steindler Building
Iowa City, IA 52242

Dr. Craig Zwerling
Associate Professor
Preventive Medicine and Environmental
Health
University of Iowa
124 AMRF Oakdale Campus
Iowa City, IA 52242-5000

KANSAS
. . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . n
Mr. Harold T. Bach
Safety Specialist
U.S. Department of Labor
1437 Tomahawk Lane
Olathe, KS 66062

Mr. Michael H. Bradshaw
Kansas State
Extension Service
343 Justin Hall
Manhattan, KS 66506

Mr. Chris Chitwood
Executive Assistant
AgriPro Biosciences, Inc.
6700 Antioch, Suite 100
Shawnee Mission, KS 66210

Mr. Stanley Clark
Head, Agricultural Engineering
Department
Kansas State
Seaton Hall
Manhattan, KS 66506

Ms. Kathy Collmer
Educational Materials Specialist
Agricultural Safety and Health Program,
Kansas State
Seaton Hall
Manhattan, KS 66506

Mr. Marvin H. Hachmeister
Kansas State
Extension of Agricultural Engineering
237 Seaton Hall
Manhattan, KS 66506-2917

Dr. Stephen Konz
Professor
k%&rn;;;eof Industrial Engineering,
Durland Hall
Manhattan, KS 665065101

Mr. John k Kramer
Extension Assistant, Farm Safety
Kansas State Universuty
Seaton Hall
Manhatten, KS 66506
9131532-5813

Mr. David F. Vvillsie
Director

State of Kansas University
Division of Safety and Health
512 SW 6th Street
Topeka, KS 66603

Dr. Cindy Wood
Epidemiologist
Department of Health and Environment
109 SW 9th Street, Suite 605
Topeka, KS 66812-1271

KENTUCKY
..._..,.....,..,._.I.-. ...Y..IIY.I

Dr. S.W. Horstman
Associate Professor
University of Kentucky
College of Medicine
800 Rose Street, Room MS129X
Lexington, KY 40538a84

Ms. Susan Jones
Western Kentucky
Department of Nursing
AC112A
Bowling Green, KY 42101

Dr. Robert McKnight
Assistant Professor
University of Kentucky
MS 12QX
Lexington, KY 40536-0084

Mr. Larry Piercy
Extension Safety Specialist
University of Kentucky
Agricultural Engineering Building
Room 128
Lexington, KY 40546-0276

MAINE
--.*---.

Mr. Stephen C. Shannon
Director, Occupational
Safety and Health
Maine Bureau of Health
157 Capitol Street
Augusta, ME 04333

Ms. Rhonda Webber
Planning and Research Association
Maine Bureau of Health
State House Station 11
Augusta, ME 04901

MARYLAND
U"-III-,YIW.....-..*

Dr. Aaron Blair

Chief, Occupational
Studies Section
National Cancer Institute
Executive Plaza North, Room 418
Bethesda, MD 20892

Dr. Gershon Fishbein
Publisher

Genetic Engineering Letter
8750 Georgia Avenue, Suite 124
Silver Spring, MD 20910

Mr. Jeffrey Human
Director, Office of Rural Health Policy
U.S. Public Health Service
5600 Fishers Lane
Parklawn Building, Room 14-22
Rockville, MD 20857

Dr. Rice C. Leach
Chief of Staff
Cffice of the Surgeon General
USPHS
Room 18-67
WOO Fishers Lane
Rockville, MD 20857

Mr. Mark A. Veazie
Johns Hopkins Injury Prevention Center
62-i North Broadway, Room 557
Baltimore, MD 21205

Mr. Robert Wright
Chief, Utilization Expenditures Statistics
National Center for Health Statistics
6525 Belcrest Road, Room 850
Hyattsville, MD 20782

Surgeon General's Conference on Agricultural Safety and Health - 1991

611


National Participants

MICHIGAN
. ..-. "~ . . . . . ...".. ..,.-".1......--7-..

Mr. Dan Lauwers
Assistant Program
Director
W.K. Kellogg
Foundation
400 N. Avenue
Battle Creek, MI

Ms. Geraldine Ft. Smith
Coordinator
"Farming Safely in the Thumb"
Huron Co. Health Department
1142 S. Van Dykr
Bad Axe, MI 48413

MINNESOTA

Dr. Debora Boyle
University of Minnesota
1635 W, Skillman, #2
Roseville, MN 55113

Mr. Bruce Chadwick
Market Manager
3M
St. Paul, MN

Mr. Willis Eken
Chairman
National Farmer's Union Executive
Board
St. Paul, MN

Dr. Susan Goodwing Gerberich
Director of Environmental and
Occupational Health
University of Minnesota School of Public
Health
420 Delaware Street, SE, Box 197
UMHC
Minneapolis, MN 55455

Dr. Ian A. Greaves
Professor
University of Minnesota
Box 197, 420 Delaware St.,
Minneapolis, MN 55455

SE

Ms. Stephanie Harnick
Manager, Occupational Safety and
Health
Northrup King Company
7500 Olson Memorial Highway
Golden Valley, MN 55427

Mr. Mark Horton
Environmental Affairs Office
Northrup King Company
7500 Olson Memorial Highway
Golden Valley, MN 55427

Ms. Linda Olson Keller
Consultant
Minnesota Department of Health
717 SE Delaware
Minneapolis, MN 55446

Ms. Brenda Len2
Publlo Health Nurse
Meeker, M&rod, Sibley Community
Health Service
804 11 th Street E
Glencoe, MN 55336

Ms. Catherlne Lexau
Project Coordlnator
Minnesota Department of Health/CHS
Division
717 SE Delaware
Minneapolis, MN 55446

Mr. Mark Melander
Consultant
Northrup King Company
7500 Olson Memorial Highway
Golden Valley, MN 55427

Ms. Colleen Nelson
Public Health Nurse
Quin County Community Health
Services
P.O. Box 248
Newfolden, MN 56738

Mr. John M. Shutske
Extension Safety Specialist
University of Minnesota
1390 Eckles Avenue
St. Paul, MN 55108

Mr. Ray Sinclair
Television Production Specialist
NIOSH, CDC
2728 Sheldon Street
Roseville, MN 55113

Mr. Steven Suchy
Safety Engineer
Cargill, Inc.
P.O. Box 9300
Minneapolis, MN 55446

Ms. Kelly Sullivan
Editor
Pro Act
4947 Weld Canyon Drive
Woodbury, MN 55125

Mr. Aaron K. Trippler
Vice President
Communication for Agriculture
2626 E. 82nd Street, X325
Bloomington, MN 55425

Ms. Peg Zonk
Managing Editor
Farm Industry News Magazine
7900 International Drive
Minneapolis, MN 55425

MISSISSIPPI
-v-1__

Dr. George C. Fun
Medical Doctor  a
Misslsslppl State
Medical Aawolatlon
270 YA Zoo Avenue
Clarkedale, MS 38614

Mr. Willlam Slmp@xr
3330 Liberty Street
Canton, MS 39046

,-..wM....-.*-- I
MISSOURI

Mr. David E. Baker    I
Extension Safety and
Health Speolalist
University of Mlssourl
205 Agricultural Engineering Building
Columbia, MO 65211

Mr. Frank Berry
USPHS

Regional Office - Region VII
601 E. 12th Street
Kansas City, MO 64106

Mr. Charles F. Brundage
Product Safety Engineer
De&-Allis Corporation
627 South Cottage
Independence, MO 64950

Ms. Sandy Clarkson
Administrator
Cariton County Health Department
P.O. Box 214
Keytesville, MO 65261

Ms. Claudine Frazeer
Administrator
Adam Co. Health Department

516 South Main
Kukswelle, MO 63507

Mr. Russell H. Hahn
Director of Standards
American Society of Agricultural
Engineers
2950 Niles Road
St. Joseph, MO 49085

672

Papers and Proceedings


Participants

Ms. Judy Heffernan
Executive Director of Heartland Network
for Town and Rural Ministries
University of Missourl
201 Sociology Building
Columbla, MO 65211

Dr. Gary Kukulka
Senior Staff Associate
National Rural Health Association
301 E. Armour Boulevard, Suite 420
Kansas City, MO 64111

Mr. John T. Phlllips
Regional Administrator
U.S. Department of Labor
911 Walnut Street
Kansas City, MO

Dr. W. Michael Rogers
Dlstrlct Director
US Food and Drug Administration
1009 Cherry Street
Kansas City, MO 64106

Mr. John Rummel
FFA Advisor
Stockton High School
Route 1, P.O. Box 190
Stockton, MO 65785

Dr. C. Saran
Professor
Central Missouri State
Warrensburg, MO 64093-5030

Mr. Jamie Swaggerty
FFA Safety Chairperson
Stockton High School
Route 1, P.O. Box 190
Stockton, MO 65785

Ms. Patti Van Tuinen
Assistant Director
Office of Injury Control
Missouri Department of Health
P.O. Box 570
Jefferson Chy, MO 65102

NEBRASKA
Y . . . . . 1 . . . . . . . ,.., . . . . . . . . . . . . , . . . . . . ,......

Ms. Joleen Huneke
Health Educator
Nebraska Department of Health
Health Promotion and Education
301 Centennial Mall South
Lincoln, NE 68509-5007

Ms. Melissa D. Leypoldt
Nebraska State Health Department
301 Centennial Mall South
Box 95007
Lincoln, NE 68521

Mr. Bryan Rettig
Research Analyst
Nebraska Department of Health
301 Centennial Mall S., Box 95.007
Lincoln, NE 68509

Mr. Rollln D. Schnleder
Extenslon Safety Speoiallst
University of Nebraska
222 L.W. Chase Hall
Lincoln, NE 68583Xl726

Mr. Richard Slama
Manager, Special Servloea
Lincoln-Lancaster County Health
Department
22W St. Mary's Avenue
Uncoln, NE 68502

Dr. Susanna Von Essen
Assistant Professor of Medicine
University of Nebraska Medlcal Center
600 South 42nd Street
Omaha, NE 68198-2465

Ms. Kathy Ward
Chronic Disease Dlrector
Nebraska Department of Health
301 Centennial Mall South
Uncoln, NE 68509

Dr. Dennis Weisenburger
University of Nebraska Medical Center,
Department of Pathology &
Microbiology
600 South 42nd Street
Omaha, NE 68022

NEW JERSEY
. . . . . . . . -.".r.......l . . . . -..e . . . . . . -..-

Dr. Zane R. Helsel
Chair. Deot of    V

Agricultural and
Resource Management Specialists
Rutgers University
Martin Hall. Room 111, Cook Campus,
P.O. Box 231
New Brunswick, NJ 08903

NEW YORK
...l . . . . . . . . ^ . . . . . -..ll.-.....ll . . . . ,....^.".

Ms. Angela DeVito,
MSCM

Associate Director, Divislon of
Occupational Medicine
State of New York at Stony Brook
HSCL3086
Stony Brook, NY 117948636

Mr. Donald DiBello
Director, Member Services
Farm Family Insurance Company
P.0. Box 656
Albany, NY 12201

Mr. Davis E. Hill
Executlve Dlrector
Farmedlo National Training Center
Alfred State College
Alfred, NY 14802

Dr. Matthew Manrel
AttendIng Phyalclan
Oneonta Health Center
50 Dletz Street
Oneonta, NY 13820

Dr. John J. May
Director, Bassett Farm Safety and
Health Project
New York Center for Agricultural
Medicine and Health
One Atwell Road
Cooperstown, NY 13326

Mr. John 0. Pollock
Executive Director
NYS Rural Health and
Safety Council, Inc.
334 Riley-Robb Hall, Cornell
Ithaca, NY 14853-5701

Dr. David S. Pratt
Director
New York Center for Agricultural
Medicine and Health
One Atwell Road
Cooperstown, NY 13326

NORTH
CAROLINA
......Y...^v....l..r..e. . . . . *v..- . . . . . .

Mr. James A. Fangman
Environmental and Safety Specialist
CIBA-GEIGY Corporation
P.O. Box 18300
Greensboro, NC 27419

Dr. James R. Fouts
Senior Scientific Advisor to the Director
NIEHS
A2-03, P.O. Box 12233
Research Triangle Park, NC 27709

Mr. Robert L Mclymore
Extension Safety Specialist
North Carolina State
Box 7625
Raleigh, NC 27695-7625

Surgeon General's Conference on Agricultural Safety and Health - 1991

673


National Participants

Ms. Susan A. Randolph
Occupational Health Nursing consultant
DEHNR Occupational Health Section
P.O. Box 27687
Raleigh, NC 2761 l-7687

Dr. Michael D. Schulman
North Carolina State
Department of Sociology
Box 8107
Raleigh, NC 276958107

NORTH DAKOTA
.I . . . . . . I..r....r.^.a. . . . . . . . . v.-..-.1"."1 I
Mr. Rodney A Gilmore
Injury Control Program Manager
North Dakota State Deoartment of
Health and Consolidated Labs
600 East Boulevard, 2nd Floor, Judicial
Wing
Bismark, ND 585054200

Ms. Ramona Eisenbarth, RN
Agricultural Occupational Health Nurse
Custer District Health Unit
P.O. Box 185
Mandan, ND 58562

Ms. Cheryl Hagen
Agriculture Occupational Health Nurse
Community Health Nurse
401 Third Avenue North
Fargo, ND 58102-4839

Ms. Malinda Lindstrom
Safety Coordinator
North Dakota Farm Bureau
1101 1st Avenue North
Fargo, ND 58107

Mr. George Maher
North Dakota State
Extension Service
Box 5626
Fargo, ND 58105

Ms. Joyce Sayler
Agricultural Occupational Health Nurse
Custer District Health Unit
P.O. Box 185
Mandan, ND 58554

Ms. Lillian Thomson
Ag. Occupational Health Nurse
Grand Forks Public Health
P.O. Box 1518
Grand Forks, ND 58206-1518

OHIO

Dr. Ray Aldetfer
NIOSH. CDC
Hamilton Laboratory
4676 Columbia Parkwav,
               _-
R-16
Cincinnati, OH 45226

Mr. Jonathan Bair
Student
Smithvilie High School
331 South Summit Street
Smithville, OH 44677

"^

c3

Ms. Sallie S. Bair
Registered Nurse
Wayne County Health Department
203 South Walnut Street

Wooster, OH 44691

Dr. Thomas L Bean
Safety Leader
Ohio State (Cooperative Extension)
590 Woody Hayes Drive X213
Columbus, OH 43210

Ms. Virginia Behrens
NIOSH, CDC
Taft Laboratory
4676 Columbia Parkway, R-18
Cincinnati, OH 45226

Dr. Raymond E. Biagini
NIOSH, CDC
Taft Laboratory
4676 Columbia Parkway
Cincinnati, OH 45226

Mr. Philip J. Bierbaum
Director. Division of Phvsical Sciences

and Engineering -
NIOSH, CDC
4676 Columbia Parkway
Cincinnati, OH 45251

Mr. Gary Brumfield
FFA Safety Chairperson
Amanda-Clearcreek High School
414 North School Street
Amanda, OH 43102

Dr. Geoffrey M. Calvert
Medical Epidemiologist
NIOSH, CDC
4676 Columbia Parkway, R-16
Cincinnati, OH 45226

Ms. Lorri Cameron
Epidemiologist
NIOSH, CDC
4676 Columbia Parkway, R-21
Cincinnati. OH 45226

Dr. Alexander Cohen
Deputy Director, Division of Biomedical
and Behavioral Sciences
NIOSH, CDC
4476 Columbia Parkway
Cincinnati, OH 45226

Ms. L Barbara Connally
Public Health Analyst
NIOSH, CDC
4676 Columbia Parkway, R-42
Cincinnati, OH 45226

Dr. John J. Coumbis
NIOSH, CDC
DTMD
Taft Building, Room B48, MS Cl2
Cincinnati, OH 45226

Dr. Laurence J. Doemeny
Deputy Director, Division of Physical
Science and Engineering
NIOSH, CDC
4676 Columbia Parkway
Cincinnati, OH 45226

Ms. Janet Ehiers
University of Cincinnati
Occupational Health Masters Candidate
3125 Locust Log Lane
Cincinnati, OH 45239

Dr. Lawrence J. Fine
Director, Division of Surveillance,
Hazards Evaluations, and Field Studies
NIOSH, CDC
4676 Columbia Parkway
Cincinnati, OH 45226

Dr. Marilyn A. Flngerhut
Chief, IWSB, DSHEFS
NIOSH, CM;
4676 Columbia Parkway
Cincinnati, OH 45226

Mr. Jerome P. Resch
Industrial Hygienist
NIOSH, CDC
4676 Columbia Parkway, C-15
Cincinnati, OH 45226

Mr. Todd M. Frazier
Chief. DSHEFS
NIOSH, CDC
4676 Columbia Parkway, R-17
Cincinnati, OH 45226

Dr. Eugene Freund, Jr.
Medical Officer
NIOSH, CDC
4676 Columbia Parkway, R-21
Cincinnati, OH 45226

614

Papers and Proceedings


Participants

Dr. Jiin Ger
Visiting Scientist
NIOSH, CDC
4676 Columbia Parkway
Cincinnati, OH 45226

Mr. Walter Haag
Associate Director
NIOSH, CDC
4676 Columbia Parkway
Cincinnati, OH 45226

Dr. William E. Halperin
Associate Director
NIOSH, CDC
4676 Columbia Parkway, R-41
Cincinnati. OH 45226-1998

Mr. Gerald A. Heath
Administrative Officer
NIOSH, CDC
4676 Columbia Parkway
Cincinnati, OH 45226

Dr. Robert F. Herrick
Associate Director
NIOSH, CDC
4676 Columbia Parkway
Cincinnati, OH 45226

Mr. Stephen 0. Hudock
Safety Engineer
NIOSH, CDC
4676 Columbia Parkway
Cincinnati, OH 45226

Ms. Janice M. Huy
NIOSH, CDC
4676 Columbia Parkway
Cincinnati, OH 45226

Ms. Nina Lalich
Chief, Illness Effects Section
NIOSH, CDC
4676 Columbia Parkwy, R-18
Cincinnati, OH 45226

Mr. Robert L. Larkin
Chief
NIOSH, CDC
4676 Columbia Parkway, R-3
Cincinnati, OH 45226

Mr. Tim Lawrence
Extension Associate
The Ohio State
590 Woody Hayes Drive
Columbus, OH 43002

Mr. Edward D. Leninger
Deputy Director
NIOSH, CDC
4676 Columbia Parkway
Cincinnati, OH 45248

Mr. Steven W. Lenhat-t
Industrial Hygienist
NIOSH, CDC
4676 Columbia Parkway, R-l 1
Cincinnati, OH 45226

Mr. Robert Alan Lunsford
Supervisory Research Chemist
NIOSH, CDC
4678 Columbia Parkway, R-7
Cincinnati, OH 45226

Mr. Robert Mason
Biologist
NIOSH, CDC
4676 Columbia Parkway
Cincinnati, OH 45216

Mr. Leroy Mickelsen
Chemical Engineer
NIOSH, CDC-
7956 Blairhouse Drive
Cincinnati, OH 45244

Mr. Charles Miller
FFA Advisor
Amanda-Clearcreek FFA
414 North School Street
Amanda, OH 43102

Ms. Charlene Maloney
NIOSH, CDC
Robert A. Taft Laboratories
4676 Columbia Parkway
Cincinnati, OH 45213

Ms. Vivian Morgan
NIOSH, CDC
Robert A. Taft Laboratories
4676 Columbia Parkway
Cincinnati. OH 45213

Dr. Richard W. Niemeier
Director, Divison of Standards
Development and Technology
NIOSH, CDC
4676 Columbia Parkway
Cincinnati, OH 45226

Mr. David H. Pedersen
Industrial Hygienist
NIOSH, CDC
4676 Columbia Parkway, R-19
Cincinnati, OH 45226

Ms. Judith Pflaumer
Clinical Nurse Specialist
University of Cincinnati
3747 Wood Trail
Cincinnati, OH

Mr. Judd C. Posner
NIOSH, CDC
4676 Columbia Parkway
Cincinnati, OH 45226

Dr. Thomas C. Purcell
Director, Division of Training and
Manpower Development -
NIOSH, CDC
4676 Columbia Parkway
Cincinnati, OH 45226

Dr. Peter G. Rentos
Scientist Director
NIOSH, CDC
4676 Columbia Parkway
Cincinnati, OH 45226

Dr. Carol Hogfoss Rubin
NIOSH, CDC
4676 Columbia Parkway, R-21
Cincinnati, OH 45215

Dr. John M. Russo
Research Psychologist
NIOSH, CDC
4676 Columbia Parkway, C-24
Cincinnati, OH 45226

Mr. Wayne T. Sanderson
Industrial Hygienist/Epidemiologist
NIOSH, CDC
4676 Columbia Parkway
Cincinnati. OH 45226

Dr. Russell E. Savage
Chief. Environmental Toxicoloav
NIOSH, CDC            -<

4676 Columbia Parkway
Cincinnati, OH 45226-l 998

Dr. Paul A. Schulte
Chief, Screening and Notification
Section
NIOSH, CDC
4676 Columbia Parkway, R-42
Cincinnati, OH 45226

Dr. Paul J. Seligman
Chief, Medical Section
NIOSH, CDC
4676 Columbia Parkway
Cincinnati, OH 45226

Mr. John P. Sestito
Assistant Chief, Surveillance Branch,
NIOSH, CDC
4676 Columbia Parkway, R-17
Cincinnati, OH 45226

Mr. Joseph A. Seta
Supervisory Industrial Hygienist
NIOSH, CDC
4676 Columbia Parkway
Cincinnati, OH 45226

Surgeon General's Conference on Agricultural Safety and Health - 1991

615


National Participants

Ms. Christa L. Themann
Audiologist
NIOSH, CDC
4676 Columbia Parkway, C27
Cincinnati, OH 45226

Dr. J. Ft. Wrlkins, Ill
Associate Professor
Ohio State University
Department of Preventive Medicine
Columbus, OH 43210

Mr. Ralph D. Zumwalde
Chief, Document Development Branch
NIOSH, CDC
4676 Columbia Parkway
Cincinnati, OH 45226

OKLAHOMA
,.....,_.,.....................................

Mr. Edward M. Barnes
Extension Engineer
Oklahoma State
214 AG Hall
Stillwater, OK 740780469

Mr. Ronald J. Dahlgren
Senior Broadcast Coordinator
Oklahoma State
105 Public Information Building
Stillwater, OK 74078

Dr. Willard Downs
Professor
Extension Agriculture Engineer
Oklaloma State University
214 AG Hall
Stillwater, OK 74078-0469

Ms. Kathy Howard
TV Producer/Director
Oklahoma State University
Agricultural Communications
Stillwater, OK 74079

Dr. Pat Lewis
Extension Safety Specialist
Oklahoma State University
219 AG Hall
Stillwater, OK 74078-0469

Ms. Judy Oskam
Oklahoma State University
214 AG Hall
Stillwater, OK 74074

Dr. Jerry L Purswell
Professor
University of Oklahoma
202 West Boyd
Norman. OK 73019

OREGON
. . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . - . . . . . . . . . . . .

Mr. Clifford 0. King
Controller
International Seeds, Inc.
P.O. Box 168
Halsey, OR 97348

Mr. Tomas Schwabe
Aoricultural Health Supervisor
Ok-OSHA
3867 Wolverine Street, NE
Salem, OR 97305

Dr. Myron Shenk
Interim Farm Safety Specialist
Oregon State
100 Gilmore Hall
Corvalles, OR 97331-3906

/r

PENNSYLVANIA
. . . . . . . . . . . . . . . . . . . . . . . . . ..e... I . . . . . . . . . . ..w... L-J

Ms. Karen Freiberg
Farm Journal
230 W. Washington Square
Philadelphia, PA 19105

Mr. Ronald McAllister
Probe Evaluation Supervisor
Ford New Holland
500 Diller Avenue, Box 1895
MS 636
New Holland, PA 17557

Dr. Dennis J. Murphy
Professor of Agriculture and Biology
Penn State University
Agriculture Engineering Building
Room 221
Park, PA 16802

PUERTO RICO
...I . . . . . . . . . . . . . . . . .._......~..................

Dr. Pable M. Calerio
Commonwealth of
Puerto Rico
Special Assistant to the Secretary
Department of Labor and Human
Resources
505 Munoz Rivera Avenue
San Juan, PR 00918

Lcdo. Jesus A. Caro Lug0
Sub Secretario
Estado libre Asociadodde
Deaptamento Del Trabajo
y Recursos Humanos
Edificio prudencio Riveria Martinez
Avenidea Munoz Rivera
506-Piso 21
Hato Rey, PR 00918

SOUTH CAROLINA
. . . . ,....... .-. I. .-.. a..v..^..T.w..I-.^I^

Dr. Mark A. Purschwitz
Extension Safety
Specialist
Clemson University
212 M&darns Hall
Clemson, SC 296340357
8w656-4666
=I-

SOUTH DAKOTA
,..^ . . . . . . "... -.-. .,.^ . . . . . . . . "..r.^.^r

Mr. James Ceglian
Director
Engineering Extension
South Dakota State University

I

Box 507
Brookings, SD 57007-Cr597

Dr. Thomas M. Dean
Medical Director
Tri County Health Care
P.O. Box 489, 605 1st Street
Nessington Springs, SD 57382

Dr. G. R. Durland
Extension Agricultural Engineering
South Dakota State University
Ag Eng Dept
Brooking& SD 57007

Mr. Larry Tidemann
Agricultural Program Leader
Cooperative Extension Service
South Dakota State University
Ag Hall, 152
Brookings, SD 57007

TENNESSEE
. ..~ . . . . I . . . . ..*........................

Ms. Nancy Dempsey
Assistant Professor, Department of
Nursing
Austin Peay State
P.O. Box 4658
Clarksville, TN 37044

Dr. B.D. Hale
Public Health Officer
Haywood County Health Department
950 East Main
Brownsville, TN 38012

Mr. Joel Lown
Extension Safety Specialist
Agricultural Engineering Dept
University of Tennessee
P.O. Box 1071
Knoxville, TN 37901

Papers and Proceedings


Participants

Mr. Timoth G. Prather
Assistant Professor
Agricultural Extension Service
University of Tennessee
P.O. Box 1071
Knoxville, TN 37901-1071

TEXAS
. . . . I.. . . . . . . . . I.. . . . . . . . . .

Mr. Charlie G. Coble
Professor
Texas A & M
Agricultural Engineering
Department
College Station, TX 77843

Mr. Edward Joseph Cosgrove
Area Director
U.S. Department of Labor - OSHA
1205 Texas Avenue, Suite 422
Lubbock, TX 79401

Mr. Rene Flares
FFA Safety Chairperson
8600 Alameda
El Paso, TX 79907

Mr. Max J. Howitt
Southwest Regional Production

Manager -
DeKalb Plant Genetics
3303 67th Street
Lubbock, TX 79413

Dr. David Lawver
Assistant Professor
Texas Tech
Mail Stop 2131
Lubbock, TX 79409-2131

Dr. Mary Nickolaus
Associate Director
University of Texas, School of Public
Health
P.O. Box 20186
Houston, TX T7225

Mr. Ronald Rinn
FFA Advisor
8600 Alameda
El Paso, TX 79907

Ms. E. Roberta Ryder
Executive Director
National Migrant Resource
Program, Inc.
2512 South, IH-35
Austin, TX 78704

Mr. Delmar E. Tally
Manager
Austin Chapter - AGC
P.O. Box 1508
Austin, TX 78767-l 508

Ms. Rebecca Trujillo
Migrant Farmworker Ministry
Diocese of Corous Christi Texas
P.O. Box 189

Skidmore, TX 78389

. . . . . . . . . . . . . . . . . . . ^..~ . . . . . . . . . . . . . . . . . . . . . . . . . . . r-l

UTAH

Dr. Jeff Lee
Associate Professor
University of Utah   l-l

RMEOEH, Building 512
Salt Lake City, UT 84112

VERMONT
._..........._._...._..,.......... . .

Mr. George L. Cook
University of
Vermont
Extension System
RRl,Box2280
Morrisville, VT 05861

VIRGINIA
. . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . ,

Mr. Robert Graham

Assistant Executive
Director
National Bocational Agriculture
Teacher's Association
P.O. Box 15440
Alexandria, VA 22309

Dr. Glen H. Hetzel
Agricultural Engineering Department
Virginia Tech
205 Seitz Hall
Blacksburg, VA 24061

Mr. Wayne Sprick
Executive Director
National Young Farmer Educational
Association
5632 Mt. Vernon Memorial Highway
Alexandria, VA 22309

Mr. Chad Springer
FFA Safety Chairperson
Park View High School
Route 1, Box 118
South Hill, VA 23970

Mr. Ronnie Thomas
FFA Advisor
Park View High School
Route 1, Box 118
South Hill, VA 23970

Mr. Steve J. Thomson
Assistant Professor
Virginia Polytechnic Institute
Seitz Hall, VPI and SU
Blacksburg, VA 24061-0303

Mr. Wei Zhao
Graduate Student
Virginia Tech
Seitz Hall
Blacksburg, VA 24061

WASHINGTON
..-- _ ..-. ..-..".w . . . . . . . . . . . -."..-......

Mr. Richard L Barker
Program Coordinator
Eastern Washington Area Health
Education Center
601 West First Avenue
Spokane, WA 99204

Dr. Pamela D. Elkind
Professor of Sociology
Eastern Washington University
Patterson Hall, MS-38
Cheney, WA QQOO4-2415

Dr. Richard Fenske
Associate Professor
University of Washington
Department of Environmental Health
Seattle, WA 98195

Mr. Edward King
Washington State Dept. of Labor and
Industries
Division of Safety and Health
1716 South 16th Avenue
Yakima, WA 98902

Dr. Paul Monahan
Yakima Valley Farm Worker Clinic
MCN
Box 190
Toppenish, WA 98948

Mr. Dan Pearson
FFA Safety Chairperson
Elma High School
30 Elma Monte Road
Elma, WA 98541

Ms. Christie N. Renz
FFA Advisor
Elma High School
30 Elma Monte Road
Elma, WA 98541

Surgeon General's Conference on Agricultural Safety and Health - 1991

617


National Participants

Dr. Linda Rosenstock
Surveillance, Chemical Hazards
Universitv of Washinoton Occupational
MedicinsProgram -
ZA66, 325 9th Avenue
Seattle, WA 98104

Ms. Rosemary Clanfrocco
Division of Safety Research
NIOSH, CDC
944 Chestnut Ridge Road
Morgantown, W 26505

Dr. Ali Manninen
NIOSH, CDC
944 Chestnut Ridge Road
Morgantown, WV 26505

Ms. Catherine L Connon
Occupational Health Nurse
NIOSH, CDC
944 Chestnut Ridge Road
Morgantown, WV 26505

Ms. Judith C. Mull
Medical Technologist
NIOSH, CDC
944 Chestnut Ridge Road
Morgantown, WV 26505

Mr. Joseph Costello
Statistician
NIOSH, CDC
944 Chestnut Ridge Road
Morgantown, WV 26505

Dr. Karl Musgrave
EIS Officer
NIOSH, CDC
944 Chestnut Ridge Road
Morgantown, WV 26505

Ms. Charlotte Dalton
Administrative Officer
NIOSH, CDC
944 Chestnut Ridge Road
Morgantown, WV 28505

Mr. John R. Myers
Statistician
Division of Safety Research
NIOSH, CDC
944 Chestnut Ridge Road
Morgantown, WV 26505

Dr. Jeffrey S. Fedan           Dr. Stephen A. Olenchock
Research Pharmacologist         Assistant to the Director, DRDS
NIOSH, CDC               NIOSH, CDC
944 Chestnut Ridge Road         944 Chestnut Ridge Road
Morgantown, W 26505          Morgantown, WV 26505

Dr. David L. Hard
Safety and Health Specialist
Division of Safety Research
944 Chestnut Ridge Road
Morgantown, W 26505

Ms. B. Teresa Palermo
Program Analyst
NIOSH, CDC
944 Chestnut Ridge Road
Morgantown, WV 28505

Dr. William D. Jones
NIOSH, CDC
944 Chestnut Ridge Road
Morgantown, W 26505

Mr. Gregory J. Kullman
Industrial Hygienist
NIOSH, CDC
944 Chestnut Ridge Ftoad
Morgantown, W 26505

Dr. John E. Parker
Chief, Protective Technology Branch
Division of Safety Research
NIOSH, CDC
944 Chestnut Ridge Road
Morgantown, WV 26505

Dr. Daniel M. Lewis
Immunologist
NIOSH, CDC
944 Chestnut Ridge Road
Morgantown, WV 26505

Mr. Penn A Peters
Project Leader
U.S. Forest Service
180 Canfield Street, P.O. Box 4360
Morgantown, WV 26505

Mr. Michael D. Lyman
Nurse Epidemiologist
NIOSH, CDC
944 Chestnut Ridge Road
Morgantown, WV 26505

Dr. Edward L. Petsonk
Acting Section Chief
NIOSH, CDC
944 Chestnut Ridge Road
Morgantown, WV 26505

k-ral Prog.

Dr. Pervis C. Major
Director, Activity for Professic
and Facility Dev.
NIOSH, CDC
944 Chestnut Ridge Road
Morgantown, WV 26505

Dr. Paul Siegel
Research Chemist
NIOSH, CDC
944 Chestnut Ridge Road
Morgantown, WV 26505

Dr. W. Symons
Safety Specialist
Washington State
Agricultural Engineering Department
Pullman, WA 99163

WEST VIRGINIA
. . . . . . . . . . . . . . . . . . . I. . . . . . .

Ms. Rochelle Althouse
Statistician
NIOSH, CDC
944 Chestnut Ridge Road
Morgantown, WV 26505

Mr. Shib Bajapayee
Industrial Hygienist/Engineer
NIOSH, CDC
944 Chestnut Ridge Road
Morgantown, WV 26505

Ms. Kay Basile
Staff
NIOSH, CDC
944 Chestnut Ridge Road
Morgantown, W 26505

Dr. Thomas R. Bender
Director, Division of Safety Research
NIOSH, CDC
944 Chestnut Ridge Road
Morgantown, WV 26505

Ms. Toni A. Bledsoe
Medical Technologist
NIOSH, CDC
944 Chestnut Ridge Road
Morgantown, WV 26505

Dr. Robert Castellan
Chief, Epidemiological Investigations
Branch
NIOSH, CDC
944 Chestnut Ridge Road
Morgantown, W 26505

Dr. Vincent Castranova
Chief, Biochemistry and Pathology
Sections
NIOSH, CDC
944 Chestnut Ridge Road
Morgantown, W 26505

618

Papers and Proceedings


Mr. Herman C. Sims
West Virainia Universitv
Institute ior Safety and Health Training
918 Chestnut Ridge Road, Suite 8
Morgantown, WV 26506

Dr. W. G. Sorenson
Research Mycologist
NIOSH, CDC
944 Chestnut Ridge Road
Morgantown, WV 26505

Mr. John T. Straface
Supply Management Cfficer
NIOSH. CDC
944 Chestnut Ridge Road
Morgantown, WV 26505

Dr. Gregory R. Wagner
Director, Division of Respiratory Disease
Studies
NIOSH, CDC
944 Chestnut Ridge Road
Morgantown, WV 26505

Dr. Kenneth C. Weber
Branch Chief
NIOSH, CDC
944 Chestnut Ridge Road
Morgantown, WV 26505

WISCONSIN
. ..Y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . r4
Dr. Henry A. Anderson
Chief, Environmental and  U
Chronic Disease
Epidemiology
Wisconsin Department of Health and
Social Services
Wisconsin Divison of Health
Madison, WI 53701

Mr. Avanson
Route 6, Highway 14
Middleton, Wl 53562

Dr. Larry Chapman
University of Wisconsin - Madison
Agricultural Engineering Department
460 Henry Mali
Madison, WI 53704

Ms. Nancy E. Chudy
Epidemiologist
State of Wisconsin, Injury Prevention
Unit
1 West Wilson Street, P.O. Box 309
Madison, WI 53701-0309

Dr. Paul Gunderson
Agricultural Safety Specialist
National Farm Medicine Center
1000 North Oak Avenue
Marshfield, WI 54449-5790

Mr. Lawrence Hanrahan
Epidemiologist
Department of Health and Social
Services
WFCCP
Madison, WI 53701

Ms. Judith Huber
Registered Nurse
Marshfield Medical Research
1000 North Oak Avenue
Marshfield, Wl 54449

Mr. Larry Lang
Product Safety/Environmental
Coordinator
Genl Company
143 Water Street
West Bend, WI 53095

Ms. Karen lappe
Program Manager
National Farm Medicine Center
1000 North Oak Avenue
Marshfield, Wl 544495790

Ms. Barbara Lee
Assistant Director
National Farm Medicine Center
1000 North Oak Avenue
Marshfield, WI 54449-5790

Ms. Laura McKee
Publications Specialist
National Farm Medicine Center,
Marshfield Clinic
1000 North Oak Avenue
Marshfield, WI 54449

Ms. Sandra Muesegades
Public Health Nurse
1011 North 8th Street
Sheboygan, Wl 53081

Mr. David L. Nordstrom
Epidemiologist
National Farm Medicine Center
1000 North Oak Avenue
Marshfield, WI 54449

Dr. Douglas J. Reding
National Farm Medicine Center
1000 North Oak Avenue
Marshfield, WI 54449

Ms. Tammy Schaefer
Director, Resource Center for Farmers
with Disabilities
Easter Seal Society of Wisconsin
101 Nob Hill, Suite 301
Madison, WI 53704

Mr. Steve Schlecht
President
GEMPLER'S
P.O. Box 270
Mt. Horeb. Wl 53572

Dr. Ronald T. Schuler
University of Wrsconsin
Agricultural Engineering Department
460 Henry Mall
Madison, Wl 53706

Mr. William J. Sheeley
Farm Health and Safety
Council of Wisconsin
2463 North 85th Street
Wauwatosa, WI 53226

Ms. Cheryl Skjolaas
Specialist
University of Wisconsin - Madison
460 Henry Mall
Madison, WI 53706

Ms. Stefani Sogard
Communtity Health Educator
LaCrosse County Health Department
300 North 4th
Lacrosse, WI 54601

Dr. Dean Stueland
Medical Director
National Farm Medicine Center
1000 North Oak Avenue
Marshfield, Wl 54449-5790

WYOMING
.-LLYI...II.Y-U..--.A... . . . -.

Ms. Judith E. Wormal
Safety Specialist
Cooperative Extension Service
Box 3354
Larami, WY 82071

Surgeon General's Conference on Agricultural Safety and Health - 1991

679


Surgeon General's Cmkmnce on Agricultural Safkty and Heatth
FARM&E 2000 o A National Coalition for Local Action
Convened by the National institute for Occupational Safety and Health
April 30 - May 3, 1991, Des Moines, Iowa

INTERNATIONAL PARTICIPANTS

CANADA                SWEDEN
..,.......... e ..I........ ...""......."..l- ..,. *....v ..,..,.............   . . . . . V..". . . . . l.._.,r.mm-.~~."_..~~-.-~..~.-.... . . . . . . . . -,

Dr. James A. Dosman
Director, Center for Agricultural
Medicine
University of Saskatchewan
Royal University Hospital
Saskatoon, Canada S7N OX0

Dr. Chen Zhou

University of Saskatchewan
Centre for Agricultural Medicine
Royal University Hospital
Saskatoon, SK, Canada S7N OX0

Dr. Sverker Hogliind
Director
Swedish Farmers Safety and Prevention
Health Association
S-105 33
Stockholm, Swedan

Mr. Bjarne Lembke
Doctor
Swedish Farmer's Safety and Preventive
Health Assoc.
Lantbrukshalsan, PL 326 26700
Bjuv, Swedan

SWITZERLAND
-"-.-e,-ww .*~--lml-"l*- . . . . . . . ..-_1

Dr. Thomas Ng
Medical Officer
World Health Organization
20 Appia Avenue
Geneva, Switzerland

TAIWAN

Dr. Guang-Yang Yang
Veterans General Hospital
Division of Clinical Toxicology, Dept of
Medicine

201 Sec. 2, Shih-Pai Road
Taipei, Taiwan 11217

620

Papers and Proceedings


Append&

Surgeon General's Conference on Agricultural Safety and Health
FAR&AFE 2000 o A National Coalition for Local Action
Convened bv the National Institute for Occuoatlonal Safetv and Health
April 30 - h&y 3, 1991, Des Moines, Iowa   '

ACRONYMS

2,4-D
4-H

ABC
AC
ACTION

AFC
AFT
AG-LINK
AGI
AHPS

AIDS

ALAI

ALIVE

AM
ANSI

ARHES

ASAE

ASCS

ATSDR

ATV
AU
K
B:S:N.
EL
BALF
BLS
BRFSS

2,4-dichlorophenoxyacetic acid
A program of informal education
for youth
Always Be Careful
Amanda-Clearcreek
Domestic Volunteer Service
Agency
antibody-forming cells
antibody-forming cells
a crisis hotline
Ace Glass Impinger
Agricultural Health Promotion
Systems
Acquired Immune Deficiency
Syndrome
American Lung Association of
Iowa
Aware Leaders Instilling Vital
Education
alveolar macrophage
American National Standards
Institute
Agricultural Respiratory Hazards
Education Series
American Society of Agricultural
Engineers
Agricultural Stabilization and
Conservation Service
Agency for Toxic Substances
and Disease Registry
all terrain vehicle
Aspergillus umbrosus
Bachelor of Arts
Bachelor of Science
Bachelor of Science in Nursing
a carcinogenic level
bronchoalveolar lavage
bronchoalveolar lavage fluids
Bureau of Labor Statistics
Behavioral Risk Factor
Surveillance System

EAHSPS

CAST

CATI

CDC
CDFA

::HIC

CES
CFM
CFR
CFU
CIEP
:!I.H.
&
co
:%
CPSC

CSP
CTL
DARE
dB(A)
DBBS

DBCP
DCC
DDT
DFR
DHHS

DLCO

Celsius
California Agricultural Health and
Safety Promotion System
Council on Agricultural Science
Technology
computer-assisted telephone
interview
Centers for Disease Control
California Department of Food
and Agriculture
California encephalitis
Center for Environmental Health
and Injury Control
Cooperative Extension Service
cubic feet per minute
Code of Federal Regulations
colony forming units
counterimmuno-electrophoresis
cellular infiltrate
Certified Industrial Hygienist
centimeter(s)
central nervous system
carbon monoxide
carbon dioxide
cardio-pulmonary resuscitation
Consumer Products Safety
Commission
Certified Safety Professional
cytotoxic T lymphocyte
Drugs and Resistance Education
decibels (A-weighted scale)
Division of Biomedical and
Behavioral Science
dibromochloropropane
day care center
dichlordiphenyltrichloroethane
dislodgeable foliar residue
Department of Health and
Human Services
low diffusing capacity for carbon
monoxide

Surgeon General's Conference on Agricultural Safety and Health - 1991               627


Acronyms

DNA
DOL
DOT
DPS
DPSE

DRDS

DSDTT

DSHEFS

DSR
DTH
DTMD

D.V.M.
EACH

E-Codes

EC
EDB
EEE

EEG
ELISA

EM
EM
EMI

EMS
EMT
EPA

ESA

ETC
EU
EVA
FACE

FaRM

FARS
FAX
FBLA

622

deoxyribonucleic acid
Department of Labor
Department of Transportation

Division of Physical Sciences and
Engineering
Division of Respiratory Disease
Studies
Division of Standards
Development, and Technology
Transfer
Division of Surveillance, Hazard
Evaluations, and Field Studies
Division of Safety Research
delayed-type hypersensitivity
Division of Training and
Manpower Development
Doctor of Veterinary Medicine
Essential Access to Community
Hospitals
injury and poisoning codes,
external cause
electron capture
ethylene dibromide
Eastern equine
encephalomyelitis
electroencephalogram
enzyme-linked immunosorbent
assay
electron microscopy
equipment maintenance
Equipment Manufacturers
Institute
emergency medical services
emergency medical technician
Envirommental Protection
Agency
Employment Standards
Administration
emergency transmatic cars
endotoxin units
extravehicular activity
Fatal Accident Circumstances
and Epidemiology
Farm Family Rehabilitation
Management
Fatal Accident Reporting System
faximile
Future Business Leaders of
America

FDA
FEV
FEVl

FEW FVC

FFA

FFHHS

FHA
FHA
FIFRA

FLD
FTA
FVC
FY
:ATT

:%I
GLC
GSDE
W
HAZMAT
HAZOP
HERO

HFS
HHS
HIV
HP
I-CASH

Food and Drug Administration
forced expiratory volume
forced expiratory volume in one
second
forced expiratory volume in one
second, forced vital capacity
formally, Future Farmers of
America
Farm Family Health and Hazard
Survey
Federal Housing Administration
Future Homemakers of America
Federal Insecticide, Fungicide,
and Rodenticide Act
farmers lung disease
Free Trade Agreement
forced vital capacity
fiscal year
gram(s)
General Agreement on Trade and
Tariffs
gas chromatography
ground-fault circuit interrupter
gas-liquid chromatography
grain sorghum dust extract
hydrogen sulfide
hazardous materials
hazard and operability
home economics related
organization
Human Factors Society
Health and Human Services
human immunodeficiency virus
hypersensitivity pneumonitis
Iowa Center for Agricultural
Safety and Health

IA-HASSP Iowa Agricultural Health and
     Safety Services Project
I ARC   International Agency for
       Research on Cancer
ICD     International Classification of
       Diseases
ICD-9    International Classification of
       Disease - 9th Revision
IDPH   Iowa Department of Public
       Health
IEA    International Ergonomics
       Association
IgE    reaginic antibodies
W    precipitating antibodies

Papers and Proceedings


IL
IL-1 B
IOM
IPM
IRCA

IS0

ISU
I
LEIA

LPHS
LRT
m
KfDD
M*A*S*H
M.B.A.

MFW
mg
ml
MLC
MMFR

M.P.A.
M.P.H.
M.S.
M.S.F.
MSHA

n
NACHO

NAFTA

NBC

NCASH

NCHS

NCI
NCSU
NEANES

NEC

International Harvester
Indian Health Service
interleukin 1 B
Institute of Medicine
integrated pest management
Immigration Reform and Control
Act
International Standards
Organization
International Standards Units
liter(s)
organization of the machine
manufacturers in Sweden
Lake Placid High School
lower respiratory tract
meter(s)
Master of Arts
Mothers Against Drunk Driving
mobile army surgical hospital
Master of Business
Administration
migrant farm worker
milligram(s)
milliliter(s)
mixed lymphocyte culture
maximum mid-expiratory flow
rate
Master of Public Administration
Master of Public Health
Master of Science
Master of Science in Forestry
Mine Safety and Health
Administration
number
National Association of County
Health Officials
North American Free Trade
Agreement
National Broadcasting
Corporation
National Coalition for Agricultural
Safety and Health
National Center for Health
Statistics
National Cancer Institute
North Carolina State University
National Health and Nutrition
Examination Survey
National Electric Code

NEISS

w
Fi
NHTSA

NIEHS

NIFS
NIH
NIOSH

NIPCC

NITS

NL
NOES

NOHS

NRHA

NSC
NTOF

NTP
OATS

OBGYN
OD
ODTS
OMB

OR
ORD
ORHP
OSG
OSHA

osu
PAS

PAT
pCi
PDR
PEACH

PEL

Surgeon General's Conference on Agricultural Safety and Health  1991                623

Appendix

National Electronic Injury
Surveillance System
nanogram(s)
ammonia
non-Hodgkin's lymphoma
National Highway Traffic Safety
Administration
National Institute of
Environmental Health Science
National Institute for Farm Safety
National Institutes of Health
National Institute for
Occupational Safety and Health
National Injury Prevention and
Control Committee
National Institute for Technology
and Standards
nasal lavage
National Occupational Exposure
Survey
National Occupational Hazards
Survey
National Rural Health
Association
National Safety Council
National Traumatic Occupational
Fatalities
National Toxicology Program
Olmsted Agricultural Trauma
Study
obstetrician gynecologist
over dose
organic dust toxic syndrome
Office of Management and
Budget
operating room
occupational respiratory diseases
Office of Rural Health Policy
Office of the Surgeon General
Occupational Safety and Health
Administration
Oklahoma State University
Post-secondary Agricultural
Student Organization
pesticide applicator training
picocurrier(s)
Physician's Desk Reference
Primary Care Hospitals Essential
Access to Community Hospitals
permissible exposure limit


Acronyms

Ph.D.
PHA
PHA
PHD
PHS
PMN
PMR
PPE
PRIST
PSA
PTO
PTS
PUD
PV
RAST
RD
FE
REL
RFP
R.N.
ROPS
RRIS
SADD
SAE
SAW

Sc.D.
SDS
SEM
SLCA
SLE
SMR
SMV

Doctor of Philosophy
phytohemagglutinin
process hazard analysis
Panhandle Health District
Public Health Service
polymorphoc neutrophils
proportionate mortality ratio
personal protective equipment
paper radio immunosorbent test
Public Service Announcement
power take-off
Permanent threshold shift
Public Utilities Department
Park View
radioallergosorbent test
respiratory disease
Registered Dietitian
Rural Electric Cooperative
recommended exposure limit
request for proposal
Registered Nurse
roll-over protective structure
Regional Rural Injury Study
Student Athletes Detest Drugs
Society of Automotive Engineers
Special Agricultural Worker
Program
Doctor of Science
Supplementary Data System
scanning electron microscopy
static lateral critical angle
St. Louis encephalitis
standardized mortality ratio
slow-moving-vehicle

SPRAINS

STD
STEL
Syn.
TB
TCE
TLC
TLV
TSCA
-ITS
z
KDP

URT
U.S.
USDA

USEPA

UTI
;:F
Vo-Ag
WC
WEE
WHO
WIG

YISD

Sentinel Project Researching
Agricultural Injury Notification
Systems
sexually-transmitted disease
short-term exposure limit
synonym
tuberculosis
trichloroethylene
total lung capacity
threshold limit value
Toxic Substances Control Act
temporary threshold shift
fhefmoacthomyces vulgaris
television
University of California
United Nations Development
Program
upper respiratory tract
United States
United States Department of
Agriculture
United States Environmental
Protection Agency
urinary tract infections
Veteran's Administration
virus, antigen free
vocational agriculture
workers' compensation
western equine encephalitis
World Health Organization
Women's, Infant's, and
Children's
Ysleta Incorporated School
District
micrometer(s)

624

Papers and Proceedings


Surgeon General's Conference on Agricultural Safety and Health
FARMSAFE 2000 o A National Coalition for Local Action
Convened by the National Institute for Occupational Safety and Health
April 30 - May 3, 1991, Des Moines, Iowa

METRIC SYSTEM OF WEIGHTS AND MEASURES '

INTRODUCTION

Use of metric measurement standards in the United States have been authorized by law
since 1866. In 1988, the Congress enacted legislation (Public Law 100-418) to establish
the metric system as the preferred system of weights and measures for all domestic trade
and commerce. This legislation also required the use of
metric measurement standards in all Federal activities.   Table I. Prefixes and Symbols
Recently, the President issued Executive Order 12770 on  for Decimal Multiples and
July 25, 1991 reiterated the order to implement the    Submultiples of Units.

metric system "as the preferred system of weights and
measures for United States trade and commerce." This
executive order directs all Federal agencies to
implement "metrification," to the extent economically
feasible, by September 30, 1992.

THE METRIC SYSTEM

Originally, there were only two basic reference points,
the meter and the gram. The list of reference points
has been expanded or changed to include the kilogram
(instead of the gram) for mass, the second for time, the
ampere for electric current, the degree Kelvin for
temperature, and the candela for light intensity.

The reference objects for these International Standards
Units are maintained for comparisons and checked
periodically against other international references by the
National Institute for Technology and Standards (NITS).

The mettic system entails the use of multiples or power
of ten to describe magnitudes greater or lesser than the
basic units of meter, gram, ampere, and so forth. For
example, the kilogram is 1,000 grams and the miZZigram
is l/l,OOOth of a gram. There are 100 centimeters (0.39
inches) to one meter (1.09 yards) and 1,000 meters to

Power Prefix  Symbol
of Ten
lo=    tera     T
log   gig a     G
lo*    mega     M
lo3    kilo     k
102    hecto     h
10'   deca* da

10-l    deci     d
1O-2    centi      C
lo9    milli       m
1oa    micro     I-I
10"    nano       n
lo-l2   pica
10-15   femto  `1
1 o-l8    atto       a
          *Also "deka."
Source: ConfOrence g&r&ale des
Poids et Mesures, Comtes rendus
des dances de la 1 la Conference
g&n&ale des Poids et Mesures,
Paris 1960, Gauthier-Wars, Paris,
1961, page 87; Conference
g&n&ale des Poids et Mesures,
Comtes rendus des seances de la
12e Conference g&n&ale des
Poids et Mesures, Paris 1964,
Gauthier-Villars, Paris, 1964, page
94.

`Adapted from OSHA Instruction CPL 2-2.20B CH-1, pp. 23-1 to 4.

Surgeon General's Conference on Agricultural Safety and Health - 1991

625


Metric System of Weights and Measures

one kilometer (0.62 miles). The prefixes for the multiples and submultiples applied as
multiples (power) of ten is presented in Table I.

CONVERSION EQUIVALENTS

The document to be used as a primary reference for inch-pound to metric conversions is
Pederal Standard 376A, Preferred Metric Unites for General Use by the Federal
Government, May 5, 1983. A selected number of conversion factors are presented in
Table II as examples.0

Table Ii. Prefixes and Symbols for Decimal h
Length

2.54 centimeters (cm)      =

1 inch (in)

25.4 millimeters (mm)

0.3048 meters (m)

=



=

   1 in

1 foot (ft)

1.609344 kilometers (km) =
Area

6.4516 cm*          =

645.16 mm2         =

0.0929034 m2 =

4046.873 m2         =

2.589998 km2        =

1 mile (mi)

1 in2

1 in2

lff


1 acre

1 mi2

Velocity

0.3048 meters/second (m/s) =   1 foot/
              second (ft/s)

1.6093478 km/hour (km/h) =  1 mile/
               hour (mi/h)

rltiples and Submultiples of Units.

Pressure

3.38638 kilopascals (kPa) =    1 inch of
             mercury (in Hg)

2.98898 kPa

=    1 foot of
water (ft H,O)

0.1 kPa

=    1 millibar

Volume

0.02831685 m3 =          1 ft3

28.31685 liter (I)

=

1 ft3

3.785412 I

=

1 gallon (gal)

0.1589873 m3 =

  1 barrel
(42 gal) (bbl)

1233.489 m3 =

1 acre-foot

0.002359737 m3

=  1 board foot (bd ft)

Weight (Mass)

0.45359237 kilogram (kg) =  1 pound (lb)

28.34952 grams (g)       =  1 ounce (oz)

626

Papers and Proceedings


Surgeon General's Conference on Agricultural Safety and Health
FARMSAFE 2000 . A National Coalition for Local Action
Convened by the National Institute for occupational safety and Health
April 30 - May 3, 1991, Des Moines, Iowa

THE SURGEON GENERAL'S CONFERENCES
   ON OCCUPATIONAL HEALTH '
         By Anne Mather

The recognition that work can cause disease and disability may be as old as mankind.
But the belief that government should try to prevent occupational affliction is not. The
Public Health Service (PHS) played an integral part in this shift in perception.

The year was 1925. For the past two years, newspapers, particularly The New York
World, had been carrying stories about cases of severe poisoning among chemists and
other workers.

The source of the poisoning was tetraethyl lead, a new compound used in gasoline as
an anti-knock agent. Within 17 months of its first manufacture in the United States, 139
cases of poisoning occurred; 13 people were dead.

In her autobiography, Dr. Alice Hamilton, a pioneer in industrial toxicology (she was
the first U.S. physician to devote her career to occupational safety and health), describes
the effects of this poison on the body: it is more quickZy absorbed than any of those
ordinatily used in the central nervow system, causing insomnia, excitement, twitching
muscles, hallucinations like those of delirium tremens, even maniacal attacks and
convukiions, and death.

It was a true emergency, one met by then-Surgeon General Hugh S. Cumming. On
May 5, 1925, he requested the industry to discontinue temporarily the manufacture and
distribution of tetraethyl lead. Industry complied. On May 20, Gumming called a
conference to discuss the problem. Attending were industrialists, chemists,
representatives of labor and physicians. They names an expert committee to recommend
ways to prevent poisoning from tetraethyl lead.

A case-control study of 252 persons led to a conclusion that the hazards of this form of
lead could be prevented by mechanical devices. When Surgeon General Gumming held
another conference in 1926, the first cooperative agreement on toxic substances was
reached.

The agreement included restrictions on the use and handling of tetraethyl lead. These
regulations were subsequently administered by the Office of Industrial Hygiene and
Sanitation, the predecessor of the National Institute for Occupational Safety and Health.

  `Adapted from Dateline: CDC article, Vol. 22, No. 9, October 1989, p. 12, written by Anne Mather
and edited by Mary Guinan, M.D., Ph.D., Assistant Director for Science.

Surgeon General's Conference on Agricultural Safety and Health - 1991               627


The Surgeon General's Conferences on Occupational Health

As a result, several states made lead poisoning a reportable disease. Reporting
continued until World War II.

These conferences were so successful that they became the model for another one, in
1928, on the health hazards of radium dial painting. Radium was also a new poison. It
was used to make the luminous dials on watches and clocks. The habit workers had of
pointing the tips of the brushes with their lips led to numerous fatalities.

So successful were these early conferences that a total of 9 were ultimately held-the
last in 1941 under Surgeon General Thomas Parran. They concerned methanol, carbon
tetrachloride and similar volatile chlorinated liquid hydrocarbons, carbon tetrachloride
fire extinguisher, aniline oil, carbon disulfide, benzol, and chronic mercurial poisoning in
the hatting industry, They resulted in agreements between industry including labor,
where appropriate, and PHS.

Wrote Hamilton,

It was to me both surptiing and heartening to see men of such widely separated
backgrounds and interests-manufacturers and their chemists and research workers on one
side, trade-union oficiaals, independent physicians, and toxicologists on the other--meet in
a spirit of reasonableness and a genuine desire to get at the real facts and deal practically
with the problem.1

628

Papers and Proceedings


Surgeon General's Conference on pqrioulturai Sefety and Health
FARMSAFE 2000 o A National Coalition for Local Action
Convened by the National Inrrtituto for Oooupetionel Safety end Heeith
April 30 - May 3, 1991, Des Moines, Iowa

EXCERPTS FROM DISEASES OF WORKERS '
      & Bernardino Ramazzini

DISEASES OF FARMERS

0 FARMERS', too blest by Fortune, did they but know their bliss!" This cried  the
prince of poets of old. And perhaps we may say as much of that pristine race of mortals
that used to till their ancestral acres with their own oxen, but not nowadays of our
farmers, for they have to wrestle with unending toil and the direst poverty on another
man's estate. The diseases that commonly attack the peasantry, in Italy at least, and
above all in the country on both sides of the PO, are: Pleurisy, pneumonia, asthma, colic,
erysipelas, ophthalmia, quinsy, toothache, and decay of the teeth. The exciting causes of
these maladies are in the main two, the weather and unwholesome food. While they
work in the fields they are exposed to the inclemency of the weather; they are buffeted
now by the south wind now by the north, soaked with rain and night dews, scorched by
the summer sun; however robust they may be, of however hardy a stock, they cannot
support such violent changes; now they are in a bath of sweat, now chilled through, and
besides they live on such unwholesome food that they accumulate a stock of thick
glutinous humors which bring in their train a host of troubles. For the whole mass of
humors is excited to a febrile effervescence, and thus in the vessels of the lungs into
which flows all the venous blood, thick and viscid humors readily stagnate. This is why,
as I have often noticed, whenever an epidemical constitution of lung diseases begins to
assault us, it gives the signal to attack first the country-people and completely dominated
them. Also from the same causes they very often suffer from the pains of colic and from
hypochondriasis; the latter they call `the master's disease', because this sort of affection
seems to savor somewhat of hysterical trouble; their coarse and sticky food produces in
the stomach and intestines a serious accumulation of pituitous and acid juice; hence
ensue griping pains and distension of the intestines. Their agricultural work, since it is
determined by differences of localities and the variations of the seasons, is various and of
many kinds; thus in winter and early spring they suffer from diseases of the chest, fluxes
to the eyes, and quinsy. These ailments are caused, as I have said, by their viscid and
thick blood which makes the circulation sluggish so that the blood stagnates easily and in
various parts excites inflammations; in fact, when blood is drawn from them by
venesection at this season, it is so thick that both in density and color it resembles
beeswax.

In my opinion there is no class of men whose blood undergoes such a great change and
in SO short a time as happens with these country-people; if you draw blood from them in

  `Courtesy of the New York Academy of Medicine Library. Translated from the Latin text De
Morbis Articicum of 1713 by Wilmer Cave Wright. Published under the auspices of the Library of The New
York Academy of Medicine, Hafner Publishing Company, New York, London, 1964, Chapter XXX% pp.
337-351, Chapter XL, pp. 353-357, and Chapter VI, pp. 44143.

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spring it may be thick and glutinous, but if in early summer some disease gives occasion
for venesection of those same persons, the blood looks lively and bright red. Exercise
and hard work have so powerful an effect that in so short a time the mass of humors in
transformed to a quite opposite crasis; but in the case of townspeople this is not
observed.

I have often noticed a curious thing that happens to our peasantry, especially to the
children. In March, about the equinox, children under the age of ten or thereabouts are
affected with remarkable dimness of vision; in the daytime they can see but little or
almost nothing, and as they run about the fields they wander and lose their way just like
blind people; but when night comes they can see fairly well. The affection passes off of
itself without any remedy, and about the middle of April their former keenness of vision
is entirely restored. I have often examined the eyes of these children when I had a
chance and noted that the pupil was excessively dilated. This affection is called by
doctors `mydriasis', but in discussing its cause writers are by no means in agreement, as
you may see by consulting Sennert, Riviere, and Platter. De Gorris states that this
disorder is not unlike paralysis of the pupil; and my own view is that the sun's rays in
March may cause some liquefaction in the brain and visual nerves; this so weakens the
tonus of the uvea, the tunic of the eye, that it collapses. These children spend the whole
winter in extremely warm damp stables, and when the winter breaks up, which happens
about the equinox, they sally forth from these dens and expose their bare heads to the
sun's rays; this is very liable to cause a diffusion of the humors followed by dilation of
the pupil and a consequent weakness of vision due to the admission of such intense light.
Towards the end of April, the influx of humors has been effectually dispersed by the
sun's rays, the pupil contracts and is restored to its natural tension, and so without any
remedy the eyesight is completely restored.

0 Furthermore, in summer farmers are very often attacked by acute and ardent fevers,
especially when the wrath of `raging Leo' begins to scorch them. In autumn they are
subject to dysentery, and this we may ascribe to their eating the fruits of the season and
to other errors of diet. Autumn is the regular time for them to steep hemp and flax in
the pools of the marshes. This task is generally assigned to women, who, in order to
drag out the bundles of hemp and clean them, wade up to the waist in lakes and pools;
as a result of this filthy task many of them are attacked by acute fever, which is very
quickly fatal; we may suppose that this is caused not only by constriction of the pores of
the skin and checked transpiration but also by the fact that the animal spirits are utterly
destroyed by that terrible pestilential stench which pollutes the whole neighborhood.
This above all others is the season when city folk are cautious and with good reason
about paying country visits; for then from every farm there comes a disgusting odor.
Father Kircher considers that this odor alone is the cause of the highly malignant plague
that certain cities have experienced from time to time. Schenck in his Observations,
Pedro `a Castro, Simon Paulli, and others fully demonstrate the virulent quality of the
vapors that rise from the water in which hemp has been steeped. As for the influence of
smells, whatever it may be, women who are subject to fits of hysterics know well how
powerful it is. Another thing that seriously injures the health of farmers is their careless
habit of piling dung for manuring the fields; they place these heaps in from on the

630                                   Papers and Proceedings


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cowhouses and pigsties and even their own houses, which may truly be called Augean
stables, and keep them there all through the summer, for a nosegay, and inevitably the
air is polluted by the foul effluvia that incessantly rise from them. For this reason
Hesiod disapproved of manuring the fields and desired that farmers should consider their
own health rather than the fertility of the soil.

Paolo Zacchias remarks that gardeners very often suffer from cachexy and dropsy; this
is because they have to keep watering the gardens and are obliged to spend their time on
ground so damp that their bodies cannot fail to absorb a great deal of moisture. I
remember the case of a patient of mine, a kitchen-gardener, who had become partly
paralysed; he had entirely lost the use on one of his legs, through its sensibility was not
impaired; in the other leg there was no sensation but its motility was not affected; by
taking a decoction of guaiacum and many other remedies, for several years, he finally
recovered. Hippocrates records a case which I will quote: "A man who lay ill in the
garden of Dealcis had heaviness in the head and pain in the right temple for a long time.
He caught fever from some exciting cause, and took to his bed." In his comment on this
case history, Galen flares up against Sabinus who held that the word `garden' had been
interpolated in the text of Hippocrates; as though in Galen's view this indicated the real
occasion of the disease; certainly Galen seems to have condemned the air of gardens on
account of the manure and the pernicious exhalations form trees, e.g. box, and from
similar plants. Those who live near meadows are also subject to the aforesaid diseases,
for meadows nearly always make the air unhealthy for the same reasons. Hence we find
in Zacchias under Furiscon.~Zts: Meadow and what the word sign@e,~, that an action may
lie against a neighbor who intends to convert arable land into pasture. It follows that
those who work in meadows, for instance mowing hay, suffer from serious disorders.

Now what can the medical profession do to protect these tillers of the soil whom we
need so much? To suggest to our farmers in Italy any precautions of a medical sort that
might safeguard them seems little short of absurd since they seldom or never consult
doctors about this and when one does make some suggestion they pay no attention. All
that I can do is to offer certain warnings as to their treatment that it would be well to
heed whenever they are brought to the city and are laid up in a hospital with any of the
maladies I have mentioned, or when they do call in a doctor, as happens now and again
when they can well afford it. My first warning, then, is that in cases of pleurisy or other
diseases of the chest you must not draw blood as freely as you would from townspeople;
for their bodies are worn out by unremitting toil, and it takes very little to bring on
collapse; moreover, their blood is almost wholly of a gelatinous consistency, and its
volatile elements have been used up; hence if an excessive amount of blood is drawn
from them their strength collapses, and they are unable to wash out the disease by
expectoration or vomiting. I am well aware that there are some who think that we ought
to resort to more drastic venesection when the blood is seen to be so thick, for this, they
say, would stimulate the circulation; but this is easily said. They should consult the
learned Bellini and see with what caution one must proceed when one tries by
venesection to remove blood from some part to which there has been an excessive flow.
This at least is certain, that the blood does not flow through its channels of its own
accord and by the force of its own gravity; it is the spirits that supply the driving force,

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aided by the action of the heart; so that if the spirits are enfeebled, instead of
stimulating the circulation of the blood you make it slow down still more.

Baillou raises this question: The bodies of servants, men and women alike, are in
other respects hard, compact, and soiled and their health is not so easily upset as that of
the gentry; why then when they are ill are they more easily upset as that of the gentry;
why then when they are ill are they more easily prostrated by purging and venesection
then are persons whose bodies are less compact and more delicate? Of the various
reasons that he offers for this, the most important is. that their bodies are so thick and
distended by hardened viscera that they do not easily yield to purgatives, nor do they
derive much benefit from phlebotomy; we may say the same of country-people.
Hippocrates too describes a certain constitution in which all the female slaves who were
attacked by quinsy died of it, whereas it was not fatal to free-born maidens. It follows
that in diagnosing diseases and applying treatment you should take into account not only
the bodily habit of the patients but also their mode of life and occupations.

Many indeed are the mistakes that to my knowledge are made in treating these
country-people, simply because on account of their robustness they are supposed to be
able to stand stronger remedies than the townsfolk. Often enough, and always with
compassion, I see poor peasants brought in to the public hospitals and handed over to
young doctors just out of the medical school; I see their strength utterly exhausted by
powerful cathartics and repeated phlebotomy, with no attention paid to the fact that they
are unaccustomed to strong remedies or that their strength is enfeebled by the fatigues
they have undergone. This is why so many of them prefer to face death in their huts
rather than take leave of this life in a hospital after their veins have been drained of
blood and their bellies emptied and exhausted by drugs. Every year when the harvest is
over in the Roman Campagna, the hospitals of Rome fill up with reapers who have
fallen sick; and it is a question which cuts off more reapers, the scythe of Death or the
surgeon's lancet.

I must say that I have often had cause to wonder how so many of these people when
attacked by acute diseases managed to recover, I do not say without the aid of any
remedy, for that would not surprise me, but on a rich and even sumptuous diet; for
however poor these farmers may be, when one of them falls sick the neighbors hasten to
bring them eggs and chickens with which they make dainty dishes, and in this way they
either manage to defy the virulence of the disease or to hasten their release from the life
of toil and trouble that they lead; so that with us it has come to be a common saying that
the peasant class when death takes them to himself pass over well nourished and with
full bellies; but the city folk perish miserable of hunger and starvation while the doctors
torture them,

But when the former begin to recover, they go back to their regular diet of garlic and
onions and devour them greedily as one would sweetmeats, and moreover they consider
them a strengthening food. I can well believe that that acrid sort of aliment may answer
the purpose of a medicament, for their stomachs and the whole blood mass tend to
sourness, especially in the autumn after the summer's work is finished, and so onions and

632                                  Papers and Proceedings


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garlic, like other anti-scorbutic remedies, will serve to dissolve that viscid substance and
to correct acidity. I know many of them who have driven off quartan fevers by a diet of
garlic and onions with strong wine in mid-winter.

Galen records the case of a rustic who was seized the colic pains and cured himself in
the following way: He tightened his belt, then devoured garlic and bread and exercised
himself by keeping at his usual work all day; by these means be got rid of the pain of
colic. "I should therefore", says Galen, "call garlic the peasant's theriac, and anyone who
forbids Thracians or Gauls, in short those who live in cold countries, to eat garlic will be
giving them harmful advice." Another remedy that our farmers use to cure colic is this;
they take the leaves of ground-pine, pound them, and with yolks of eggs make a poultice
and apply it to the abdomen.

In Hippocrates is a curious case history form which I quote: "There are certain
postures that give relief, e.g. the man whose work was plaiting and twisting twigs with his
hand; the pain was such that he took to his bed; but he seized the top of a pole that was
fixed above this head, gripped it firmly and the pain was relieved." Hippocrates does not
say in what part the pain was, and Galen in his note on the passage thinks it was in the
hand; but Valles decides that the pain was most violent and was piercing him as if with
something pointed, he placed the end of a wooden pole and pressed hard on it; for pains
of this sort are, he says, much relieved, `by strong pressure, by tossing the body about
and changing one's posture." This is just what nature teaches us when we have a
stomach-ache, namely, that we should press hard with the hand or fist on the painful
part; this prevents it from becoming distended and swelling up. That is why Hippocrates
recommended pressure with the hand when women have fits of hysterics, so that the
womb might be kept in its proper place, and I have often found this sort of remedy very
effectual, in fact much more that the whole outfit of remedies for hysterics.

I could write at much greater length on the proper treatment of these farmers, but let
me sum up: As far as we may gather from actual experience and from sound reasoning,
since they are enfeebled by constant toil and ill-nourished from an unwholesome diet, we
must not exhaust their bodies by copious and repeated blood-letting and purging; emetics
they can stand more easily, cupping with scarification in continuous fevers very often
gives wonderfully good results, whether because they have great confidence in this
remedy or perhaps because of some other factor of which we know nothing. When it is
necessary to administer some sort of antidote, let it be chosen from the class that are
volatile; this will be in conformity with nature, for they are accustomed to sweating not
only in summer but in winter too; for men who exercise constantly always sweat easily.
When they no longer have to battle with disease and are beginning to convalesce, they
should be allowed to return to their poor homes and to resume the diet to which they
are accustomed. Plato was quite right in ridiculing they physician Herodicus for wanting
to prescribe rules of diet for artisans.

It follows that in my opinion men of this class should be treated by the direct and
summary method; any other that is roundabout and calls for an outfit of various sorts

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gradually consumes the strength of these peasant folk: "Who seeks to cure, but makes it
worse."

DISEASES OF FISHERMEN

0 FmERS plough the earth and sow and thus by plenteous crops supply food to
the population, so fishermen plough the seas and rivers and by catching fish greatly
contribute to the food supply and furnish dainties for the table. For the mainland would
not suffice to feed such vast multitudes if the seas did not reinforce it with a supply of
fish. Thus when the price of grain is high, coastal cities and seaports suffer less than
inland towns and districts. We know that there are certain peoples called Ichthyophagi,
because their only food is fish, e.g. those who live near the Red Sea, who broil fish on
stones made red-hot by the sun and thus they make bread. Medicine therefore, which as
Hippocrates says comes to the aid of all men, ought to take as much care of fishermen
as of farmers whenever, as very often happens, they fall ill. Now when a doctor happens
to have some fisherman entrusted to his care, let him carefully consider that theirs is a
very toilsome and exacting calling; that the man has to endure the cruel buffets of the
winds, freezing cold in winter, and in summer scorching heat; he should consider what
kind of food he eats and how irregular is the sort of life he leads, so that, while other
workers when wearied by the day's toil go to their homes and spend the night in
comfort in their beds, restoring their strength by sleep, for fishermen the night is usually
spent in toil and sleepless. Thus the Apostles complained to our Saviour that they had
toiled the whole night and taken nothing. Pitiable therefore is the lot of these workers,
for since they very often have no other home than a small boat, when they fall ill they
are obliged to go into a hospital, where it is impossible to enter on the precise and
proper treatment for them unless the doctor knows clearly in what sort of occupation the
patient is engaged.

The clothes of fishermen are always wet through, hence they are exposed to diseases
that arise from obstruction of transpiration; such are acute fevers, chest troubles,
pleurisy, pneumonia, coughs, dyspnoea, and similar diseases. They live mainly on fish,
and of the inferior sort, since the better kinds are reserved for the tables of men or rank,
as in the story of that huge turbot about which Juvenal wrote his Fourth Satire; this diet
produces in them a cachectic habit, which ends in dropsy. There is a saying of
Hippocrates: "Food too weak to nourish has a brief life"; that means, according to the
admirable note of Valles, that if you want to prolong your life such food will not help
much. Hence Lievin Lemmens was right in saying that if you eat fish you need to eat
more bread because fish very quickly putrefies, These men spend all their time in places
that are very damp, and they are therefore subject to leg-ulcers that are difficult to cure.
However, it is well to know that the ulcers of men engaged in fishing in rivers and
marshes are very different from those that afflict sea-fishers; for fresh-water fishermen
have foul ulcers that readily degenerate into gangrene, but sea-fishers have dry rough
ulcers, as is remarked by Hippocrates, On the uTe of liquids, 7; and he prescribes
fomentation with sea-water as the treatment for this kind of ulcer. Marziano has an
excellent note on the passage. Though it would seem to the highly irrational to foment
dry rough ulcers with sea-water, which is so sharp and biting that it is an irritant and

634                                Papers and Proceedings


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increases any discharge, he says that Hippocrates was right to prescribe it, for the
fol!owing reasons: The ulcers of sea-fishers are very hard and dry, and by inducing
nntatron you can provoke suppuration; now unless ulcers suppurate you cannot heal
then, a fact which Galen also notes. But you must treat differently the ulcers of those
who carry on their fishing in rivers and marshy places; for foul ulcers of this sort
applications that are drying but not irritating will be best. As Hippocrates says: "A dry
ulcer is nearly well, but a wet ulcer is far from well." Sea-fishers suffer very much from
constriction of the bowels, in spite of the fact that they eat much more that those who
live ashore. Helmont remarks on this and says it is because the air they breathe is
saturated with saline vapors; this whets the appetite and at the same time makes the
bowels hard; also they eat more on account of the movement of the waves which
constantly renews the air; this gives a stimulus to the fermentation of the blood. Now
clusters of sea-water, though they are very effective for moving the bowels, actually
induce dryness later. There is a noteworthy passage in Hippocrates. "People are
mistaken about saline waters, from lack of experience, in that they think they relax the
bowels and promote stools, whereas they in fact seriously hinder evacuation of the
bowels and stools." Then let those who prescribe for constriction of the bowels sharp
clusters with a great deal of salt learn from this how far they are astray from the path
trodden by our inspired teacher. Therefore, for constriction of the bowels in fishermen it
is more suitable to give softening and oily clusters; they should swallow mild lenitives
and cathartics.

It is a known fact that fishermen are sometimes attacked with torpor and numbness of
the arms and feet when, among the fish in the nets, there happens to be a cramp-fish, for
the sea, like the land, has its venomous creatures, as Pliny records. This happens, not
only by direct contact but also from a venomous aura, which is transmitted to the man's
arm by the fishing-line or this spear; this is the explanation given by Dioscorides,.Pliny,
Mattioli, and others but from numerous experiments made by Stefano Lorenzim rt is now
certain that the fish can do this by bodily contact only, and that not every part of it has
this faculty but only certain sickle-shaped muscles. The stupefying powers of the cramp-
fish and the remedies to be used are fully described by Sermert.

DISEASES OF WORKERS WITH WOOD

Next to corn and fruit the most useful thing that Nature has produced for man is trees
and woods, indeed, as Pliny justly says: "At first, man's food came from trees, he made
his cave softer with leaves and dressed in bark." Later, the saw was invented, and men
began to cut trees into boards and so to make houses and a thousand other things for
the use of mankind. We may conclude that Lyon in France was formerly built entirely of
Wood, for Seneca tells us that that city was burnt down in a single night; so that the
peasants who as usual came there in the early morning had not heard of this calamity,
and when they came near and saw no city there they were thunderstruck and marvelled
what had become of Lyon. Hence Seneca, where he deplores the misfortunes of
mankind, exclaims: "For centuries a wood, and in a moment, ashes." Even today in
regions far north there are cities built entirely of wood, Moscow, for instance, where
there are huge warehouses in which stand for sale houses ready-made of whatever kind is

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needed, large, small, and medium-sized to suit the buyer's fancy, so that in a few days
one can have a house all finished on a chosen site.

The carpenter's trade, though we class such men under one head, is subdivided into
several separate callings; some make only coaches and carriages, others casks and vats,
others only ships. Some only carve with the chisel ornamental frames for mirrors and
pictures; these are to be gilded later. Generally speaking, carpentering is a toilsome
business and greatly fatigues the workers, but those who suffer most are the men who
with a saw cut up trees into boards. This kind of work is very tiring; they place the
squared tree-trunks so that they rest on two logs, and one workman stands on the trunk,
the other under it while with a large saw they cut up the trunk, guided by lines painted
on it in red. Hippocrates in Regimen 1, describes admirably their method of working:
"As when sawyers cut up timber with a saw; one pulls the other pushes, though both are
of course doing the same thing; the man who presses downwards pulls at the man above
him, otherwise the saw could not move downwards; but if they use too much force they
will make a mess of the whole job." The man who is above the trunk has to work harder
than the man underneath for he has to pull a rather heavy saw upwards, but the man
working underneath suffers severely Gom the sawdust that keeps falling into his eyes and
his mouth too; this makes his eyes red and painful afterwards, for he has to keep
blinking them nearly all the time.

Those too who work at the lathe, especially when the wood is box, olive, or turpentine
tree or the like, find their task very fatiguing; for they are obliged to put an incessant
strain on the hands and arms in order to control the chisel and with it by degrees shave
off the right amount according to the design of the work; the right foot is always at work
to keep the wood that is to be shaped turning round and round; moreover they must
keep the eyes fixed on the work, and from that rotary motion of the wood the eyes
contract some injury from the material that they handle, except sometimes from cypress
wood, for there are persons who cannot endure its pungent smell, and it gives them
headache.

For carpenters I have no precautions to suggest except this: They should be moderate
and not overwork, lest they bring diseases on themselves by being too much set on
making money, and so by refusing to give in be forced later on to take a holiday from
their business for many days. Gentle rubbing with oil will be beneficial, as it is for all
workers who are exhausted by overwork. They must also consider their eyes, and to
lessen their suffering as much as may be they should now and again stop working; and if
these are subject to pain and redness they should be bathed with mild lotings, e.g. barley-
water, violet-water, or woman's milk. But if from some other cause they are attacked by
acute diseases, the doctor should be as cautious about administering strong remedies as
in the case of other workers whose strength has been seriously exhausted by excessive
t0il.U

636

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Surgeon General's Conference on Agricultural Safety and Health
FARMSAFE 2000 o A National Coalition for Local Action
Convened by the National Institute for occupational Safety and Health
April 30 - May 3, 1991, Des Moines, Iowa

A

accident 26, 40, 49, 84, 89-92, 97, 107,
120, 127, 128, 186, 171, 176, 178, 262,
274, 292, 302-304, 308, 309, 312, 315,
318, 319,325, 328, 332, 333, 336, 338,
372, 373, 378, 381, 383, 384, 387,
39740, 403, 404, 426, 428, 434, 473,
489, 499, 501, 506, 509, 523, 541, 545,
548, 551,557,558,599,600,622
Adams, Darrell 38
Adams, Keith 399
Adams, Marilyn 12, 31, 38, 39, 45, 398,
489,492,497,509,593
adolescents 96, 176, 200, 221, 425, 497,
579
Adrian, Linda 600
advocacy 7, 9,46,47, 94, 134, 257,469,
470
Africa 131, 359
Agricultural Advisory Committee 321,
587

agricultural chemicals 45, 74-77, 80-82,
110, 119, 247, 248, 254, 310, 341, 342,
456, 502, 520
agricultural hygiene 243, 244, 251, 252,
451
Agricultural Stabilization and
Conservation Service 422
agriculture 1, 3-5, 7, 8, 11, 12, 14-17, 22,
28, 29, 32, 33, 36, 44-47, 50-61, 63, 64,
66, 73-78, 83, 84, 86, 87, 90-93, 95, 100,
101, 107-112, 114, 116-118, 120-126,
129, 130, 132-138, 141-143, 159, 161,
162, 164, 174, 176, 178, 184, 186, 189,
192, 193, 195-198, 202, 211, 213-215,
221, 222, 226, 229, 232, 237-239, 243,
246, 248, 249, 251, 254, 259, 261-266,
268, 274, 275, 277-280, 282, 291, 299,
300, 302-304, 306, 310, 313-315, 318,
321, 324, 325, 329, 333, 334, 336,
351-354, 356, 357, 359, 360, 362, 370,
372. 374. 379. 384. 387. 389. 391. 393.
395; 397; 404, 409, 41i, 421-424; 429;
432-437, 439, 440, 443-445, 448, 449,
451, 453, 457, 458, 462-464, 470,
473-475, 477-486, 493, 498-504, 508,
510-512, 517-519, 523, 525, 540, 541,
544-546, 550, 556, 557, 561-563, 565,
566, 571, 580. 582, 590, 592, 595, 597,

598, 621, 624

Aherin, Robert A. 128, 309, 437, 489,

506, 508

AIDS 3, 48, 138, 141, 394, 471, 505, 621
air filtration systems 310, 456, 526
Alabama 43, 65, 136,433, 572,581-583
Alar 258
Alaska 57, 59, 65
alcohol 23-25, 496

INDEX

allergies 336, 357, 449
Alzheimer's Association 417
ambulance 103,387,585,589,595
amebic dysentery 358
American Academy of Orthopedic
Surgeons 372
American Farm Bureau Federation 87,
189, 196, 324, 373,388,390, 396,454,
475-477, 485488, 511, 518, 532, 534,
537,556,592
American National Standards Institute
(ANSI) 315
Amish 217, 268, 276, 450
amputations 278, 446
Anderson, Henry A, 151, 156, 211, 214,
238,283,445
animal 4, 76, 80, 86, 95, 129, 133, 135,
138, 161, 162, 171, 175, 204. 207209,
211, 219, 221, 222, 225, 233;236, 243;
245-252. 254. 262. 263. 271. 272. 325.
357, 361, 363, 39i, 522, 531; 563; 564;
567,591, 630
anthrax 223
Arizona 65, 223,228, 469, 471, 474, 476,
495,499
Arkansas 65, 227, 257, 299, 303
Armbruster, Walter J. 383, 391,419, 420,

432,462

Arnold, Jim 404
arthrosis 51, 82, 85, 352
Asia 36, 359, 361
asphyxiation 243, 246, 262
asthma 51, 73, 80, 144, 204, 207, 209,
210,212, 215, 245, 271, 449, 629
Atchison, Christopher G. 3,7, 11, 26, 27,
93, 105

augers 284, 313, 323

B

babesiosis 359
back injuries   51, 278, 282, 336, 454,
561
Baker, L. Dale 84, 177, 238, 240-242,
298, 378, 457
banana 429,430
barn 4, 38, 221, 246, 286, 293 338, 378,
388, 421, 426, 459, 481, 543, 564
Bean, Thomas L.  132, 212, 274, 277,
283, 310, 315, 316, 318, 329, 343, 454,
517,554
beef 3,218,219,223,258,378,392,430
behavior 23, 26, 86, 89, 91, 92. 106,
123-125, 127, 128, 191, 223, 254, 280,
306, 309, 315, 334, 338, 339, 348, 363,
383, 391, 393, 420, 426, 436, 437, 439,
441-444, 456, 460-465, 475, 482, 494,
506, 508, 515, 525, 552
Belmont, Larry M. 412

biotechnology 67, 76, 84, 106, 134-142,
193,300
bison 222
black workers 39, 31, 52, 127, 198, 216,
264,348,358,380,318
black migrants 52
Blair, Aaron 84, 229, 238-240, 257, 263,
271, 449, 536
Bolen, Carrel 33
brain cancer 232
Brandon, Manitoba 378
Branstad, Terry E. 3, 8
Brokaw, Tom 428
bronchitis 204, 207, 208, 210, 211, 215,
245.246. 257.270.449.
Brumfield,' Gary 47i   ' 542

Buchele, Wesley F. 283, 490
building design 51
burns 254

C

Caesar, Tiberius 179
California 7, 9, 12, 14, 15, 59, 65, 82, 87,
98, 111, 115, 146, 189, 193-197, 216,
219221, 223, 226, 227, 229, 238, 333,
340, 357, 359, 360, 364, 405, 407, 409,
450. 453. 469. 476. 490. 499-504. 566.
621; 624' .
California encephalitis 359, 360,450, 621
Campbell, J.M. 204
Canada 95,129,157,158,194,277,316,
378, 412, 421,489, 509, 577
Canadian Research Institute 316
cancer  9, 23. 32. 37. 39-41. 51. 61. 68.
70-72, 76, ti, 86, 8;, 84, 183, i32, `136;
139, 141, 142, 157, 186, 187, 195, 229,
230, 232-235, 238-241, 257, 268, 271,
382, 398, 413, 427, 446, 449, 450, 479,
481, 493, 501, 514, 536, 622, 623
canister 375
carbon monoxide 181, 205, 243, 246,
282, 297, 513, 524, 621
carcinogen 13, 239
carpal tunnel syndrome 279, 280, 282,
336
Carr, W. Peter 161
Carter, President James Earl 380
cartridge 286,375
Castellan, Robert 187
cattle urine splash 219
Center of Rural Affairs 104
Centers for Disease Control 23, 35, 36,
39,41,43,67,68,70, 73, 140, 176, 178,
226-228, 363, 364, 387, 527, 535, 621
chainsaw 317, 318, 352, 354, 585, 588,
593
chemical 8, 34, 50, 56, 57, 70, 75, 77, 80,
81, 84, 119, 129, 131, 132, 134, 139,

Surgeon General's Conference on Agricultural Safety and Health - 1991                637


Index

151, 156, 157, 159, 161, 179, 181, 186,
187, 195, 196, 196, 230, 235-236 240,
241, 247, 248, 256,257, 272, 278, 282,
299, 310, 334, 336, 341, 342, 345, 346.
349, 350, 361363, 429, 430, 448, 456,
479, 480, 487, 489, 490, 493, 505, 526,
534, 550,552, 578, 583, 586, 590-592
chickens 47, 136, 205, 250,632
child labor 12, 14, 61, 64, 65, 257, 467,
490
children 4, 7-9, 11, 12, 14, 16, 25, 26,
31-33, 37, 42, 47-52, 57, 61, 64, 73-75,
79, 83.89, 90, 100, 107, 112, 113, 119,
124, 168, 169, 176, 188, 189, 200,
217-219, 221, 255, 271, 299, 333, 343,
378. 383. 387-389. 391. 398-401, 410,
415; 421; 424, 430; 436; 437, 449, 454,
458, 462, 467, 468, 473, 475, 476, 482,
485, 489, 490, 493, 497, 506, 511, 515,
538, 540, 558, 579, 584-586, 588, 591,
599,624, 630
China 99, 575
cholera 358, 427
choiinesterase 14, 499
chronic bronchitis 204, 207, 208, 210,

coronary heart disease 24,25
cost 10 11,13,49,66,77,9& 100,103,
129. 132. 196.225. 251. 259.262.300,
310,319; 332; 334; 336; 341; 345, 360,
362, 367,361, 389, 400,409, 414, 464,
483, 484, 486, 484,518,538, 545, 550,
567
cotton dust 10,73,78, 562, 564
Coumbis, John J. 179
Crammond, Ray H. 365, 372,374,457
cranberry bogs 300
crop rotation 29
crops 3, 12, 15, 16, 37, 106, 111, 114,
116, 129, 133,134, 136, 139, 140, 142,
225,229,243,256,300,325,341,345,
362,384,467,483,484,500,553,634
Crowley, John H. 308, 455
Cumming, Hugh S. 32
Currier, Russell W. 84,216,218,226-228,
268, 271, 450

211, 215, 257, 270, 449
cirrhosis 24

Clean Air Act 480
clearinghouse 95
coalition l-3, 7, 9, 17-19, 21, 22, 25, 27,
28, 30, 32-36, 43-45, 47, 48, 53-56, 59,
67. 73. 86, 87. 91. 93. 94. 97, 98, 105,
107, 123, i29;134, 141, i43, 146, 151,
157, 161, 179, 184, 169, 192, 193, 196,
197. 199. 204. 216. 229. 238. 243. 255,
261; 267; 274; 278; 285; 293; 299; 308,
317, 321, 327, 334, 340, 351, 357, 365,
372, 378, 363, 391, 393, 395-397, 405,
412. 419. 432. 437. 445-449, 451-453,
457; 462; 466; 469,470, 471-473, 475,
479, 484, 485, 469, 492, 498, 540, 556,
557, 582, 597, 621, 623, 625, 627, 629
Cochran. David 278. 283. 264, 318. 454
Cole, Lu'Jean 33
Colorado 43, 60, 65, 176, 177, 219, 359,
373, 453, 505, 582, 590
Colorado tick fever 219, 359
commercial fishing 300, see fishing
commercial hunting 300
communities 5, 9, 12, 16, 18-20, 24, 40,
45, 47, 53, 56, 87, 88, 94, 95, 98,
101-103, 123, 128, 176, 179, 186, 189,
191, 195, 217, 263, 271, 273, 295, 387,
388, 390, 396, 397, 399-401, 403, 412,
414, 420, 421, 424, 427-431, 446, 464,
474, 479-483, 489, 491, 493, 494, 509,
510, 519, 525,540, 545, 583, 589
confined space 279,311
Connecticut 65
consumer 8,76,164, 173, 192,193, 196,
225. 229. 256. 258.259.460. 481.621

contaminrnion `37, 92, 224226247,253,
348, 398, 507, 513, 524, 529, 562, 572,
575

coordination 19, 469, 477, 503

D

dairies 218, 300

dairy barns 205,246
dairy workers 219

DBCP 81, 196,229,230,237,621
DDT 229, 232, 233, 235, 237, 240, 260,
621
De Hostos, Eugenio Maria 53
Dean, Thomas 17,23, 25, 580
death 6, 11, 12, 22,23, 28, 29, 48-51, 53,
60, 64, 68, 69, 78, 79, 82, 89, 92, lo&
120, 138, 157, 163, 166, 167, 172,202,
209, 229, 232, 246, 252, 253, 278, 30%
312, 316, 321, 332, 368,386, 398, 43%
436, 443, 445, 447, 456,476, 486, 487,
489, 493, 496, 501, 509, 516, 527, 528,
545, 556, 558, 566, 571, 573, 579, 580,
627,632
deer ticks 219

Delaware 65, 178, 300
dementia 152

democracy 46, 126
dengue fever 357,360,361,458
Denmark 240,373
Department of Agriculture 7, 16, 22, 50,
61,86,95,107,112, 121, 122, 129,130,
132, 133, 174, 193, 236, 321, 333, 423,
437,511,592
Department of Health and Human
Services Z&71, 94, 120, 177, 260
Department of Labor 1, 107, 116, 120,
121,176,254,472,466,537,546,622
Department of Transportation 372, 622
depression 52, 96, 155, 156, 23% 40%
424, 425, 427, 539, 556
dermatitis 23.82, 85, 235,243,247,24g,

254, 256

dermatological conditions 52, 82, 369
dermatosis 357

diesel fumes 419

diet 23, 24, 531, 630, 632634
differential diagnosis 270, 449
disability 4, 17, 22-25, 27, 28, 30, 35-37,

39-44, 46, 4952, 57, 67-71, 73, 75-80,
83,90,92,101,138,140,141,1~, 149,
152, 156, 157, 161, 163, 176-179, 187,
168, 204, 205, 207, 211, 212, 214-216,
218, 219, 221-228, 230, 232, 233, 235,
236, 239, 241-243, 245, 249, 250, 252,
255,268,269,271,294,318,327,352,
357-364, 376, 387, 397, 398, 413,445
541, 453, 458 467, 472, 461, 464, 515,
519,525,532,627
disease 5,9, 17,22-25,27, 28,30,35-37,
39-44, 46, !G52, 57, 67-71, 73, 75-80,
83, 140, 142-144, 149, 152, 156, 161,
163, 176-179, 187, 188, 204-207, 211,
212, 214-216, 218, 219, 221228, 230,
232, 233, 235, 236, 239, 241-243, 245,
249, 260, 252, 255, 268, 269, 271, 387,
397, 398, 413, 445-451, 453, 458, 472,
481, 464, 498, 501, 509, 510, 520, 524,
527, 531, 535, 538, 540, 549, 562-564,
567, 568, 569, 571, 573, 575, 576, 581,
582, 598,621,622, 624, 627-633
Disraeli, Benjamin 86
dissemination 5, 14, 25, 68, 69, 83, 143,
165, 191,546,567
District of Columbia 55, 566
diversity 19, 75, 108, 112, 113, 119, 127,
216, 263, 264, 422, 437, 477, 500, 504,
596
Domestic Volunteer Service Act 415
Donham, Kelley J. 18, 93, 95, 99, 211,
213-215, 245, 251-253, 261, 398, 448,
457, 456,462,511,515, 521
Donne, John 67
Dorrian, John P. 2, 3
Dosman, James A. 78,84,155,157,l80,
211, 213-215
Douglass, Cynthia 472
drinking water 8, 12, 51, 77, 235, 241,
467,468
drought 245

Dunn, Donald 94

dust 10, 73, 78, 60, 146, 157-159, 181,
190, 204-215, 223, 245, 251, 256, 267,
270, 271, 278, 286, 344, 353, 401, 449,
456, 526, 530, 531, 542, 544, 554, 560,
562-564, 567, 568, 570, 572, 574, 575,
577, 58 1, 622,623

E

Easter Seals 404

Eckoff, Ronald D. 105, 107, 123, 129,
134
economics 44, 66. 122, 124, 129, 344,
381,404,429,462,484,622
economists 66422,458
education 5,6,20, 22-25, 31,36, 38, 39,
45, 47, 53, 56, 57, 60-62, 66, 67, 71, 75,
77, 87, 89,90, 94, 95,97, 113-116, 120,
124, 127, 128, 134, 147-150, 154, 159,
161, 165, 189, 191, 214,224, 255, 260
265, 270, 277, 297, 305, 327, 333, 342,
343, 351, 353, 356, 376, 377, 383, 389,
391, 392, 394396, 406, 408, 412, 415,

Papers and Proceedings


Index

428, 432-434, 438-440, 443, 460, 462-   233-241, 243-249, 251, 253, 256, 257,
465, 469, 471, 473-476, 482, 485, 487,   261-263, 267. 269272. 279. 282. 29%
               297, 310, 340, 341, 343-349, 353, 359,
                   36Q,~,435,440,449,450,466,475,
                   490, 49% 507, 514, 517, 521-523, 52%
                   531,533,535,536,550,553-555,559,
                    562, 563, 564, 567-570, 572, 574, 576,
                     623,624

489, 493, 497, 499, 502, 503, 505, 509,
510, 512. 517. 518. 520. 524. 532. 537-
539; 551, 555, 578, 58i-584, 587-590,
592,596-598, 621
Eken, Willis R. 479
electrical wiring 285, 455, 588
electrocutions 69
elevator 37, 40, 157, 594
Elkind, Pamela D. 123, 128, 264, 441
Emergency Medical Services 6,101,103,
372,399,595,622
EMS 6,372,387-389,586,595,622
encephalomyelitis 359, 622
enforcement 10, 89, 166, 257, 263, 324,
326,353,390, 468,473,474,477,539
engine exhausts 233, 240
engineer 46, 92, 137, 138, 278, 299,321,
323, 340, 365-368, 370, 372, 375, 378,
453, 457
engineering 25, 45, 88-92, 134-141, 147,
149, 161, 170, 179, 210, 263, 294, 297,
306, 310, 312, 318, 333-335, 340342,
344, 349, 355, 365, 366, 368, 372, 374,
378, 437, 443, 455, 459, 487, 532, 534,
551, 563, 577,622
England 64, 71, 142, 215, 233, 239, 373
entanglement 301, 304, 305
envenomization 357
environment 6, 8, 18, 25, 32, 53. 70, 71,
86,89, 92, 123, 127, 128, 130, 134, 174
181, 197, 204-206. 208. 210. 211. 213.
214, 219, 226-228; 240: 244: 251: 252:
271, 272, 278, 281, 286, 302, 305, 309,
310, 327, 328. 334. 341, 349. 353-356.
358, 361, 379; 381;391;407;412, 414;
418, 422, 438, 454, 457-460, 462, 479,
492, 497, 503, 522, 551, 576
EPA 12, 45, 62, 76, 134, 196, 197, 229,
238, 247, 248, 255, 341, 342, 345, 346,
350, 483, 514, 590, 622
epidemiologists 9, 71, 148, 170, 216,
225, 501
epidemiology 22, 45, 67-69, 71-73, 76,
155, 161, 168, 177, 195, 206, 211, 214,
216, 220, 225, 226, 239, 325, 327, 363,
364,445,500,556,622
Erisman, Gary 321, 322, 327, 333, 373,
374, 376, 377. 360. 457
Etherton, John .R. 373
etiology 69, 70, 268, 562
Europe 67, 163,283, 311
evaluation 20, 67, 68, 71, 81-83, 137,
143, 151, 164, 170, 171, 177, 178, 184,
189, 212, 214, 215, 230, 231, 236, 239,
241, 243, 244, 247, 251, 256, 258, 310,
315, 326, 328, 331 I 332, 344-346, 394,
416, 439, 443, 451, 452, 497, 499, 504,
508, 510, 515, 523, 544, 548, 564, 567,
569, 581, 583-585, 592-594
exposure 14, 29, 51, 52, 70, 73, 74, 77,
80, 81, 85, 92, 120, 137, 140, 144, 152,
155-158, 165, 168, 169, 173-175, 180,
186, 188, 194, 196, 199-201, 204-215,
217, 219, 222, 223, 225, 226, 229, 230,

extension agents 90, 94, 99, 534, 541,
578

F

fails 4,274,278,282, 302,303,317,338,
366,400,410,467,632
Farm Bureau, see American Farm Bureau
Federation

farm family 4-6, 52,61, 74, 75, 124, 127,
186, 187, 190, 218, 223, 229, 302, 303,
378, 383, 38% 387, 388, 400, 402,437,
439, 446, 450-452, 457, 470, 486,
488-490, 512, 515, 523, 525, 529, 532,
545, 554, 555, 599, 622
Farm Foundation 93, 462
farm machinery 5,34, 51, 52,56, 73, 74,
76, 79, 80, 82, 83, 169, 274-276, 303,
30% 308, 315, 316, 323, 467, 487, 506,
515,534,584,598
farm machinery manufacturers 34
farm safety 7, 31, 37, 39, 45, 56, 64, 66,
87,89, 90, 107, 108, 118120, 124,125,
128, 143, 202, 304, 383, 385, 387391,
395, 397403, 437-439, 475-477, 479,
482, 484486, 489, 491-493, 497, 508,
509, 518, 519, 533, 543, 556, 578, 582-
584,586,588,593,595, 596, 598,623
Farm Safety for "Just Kids" 56, 90, 399,
475, 489, 593, 598
farm workers 5, 7-9, 15, 31, 33, 34, 43,
52364, 72,75,82,90,98, 107, 115, 119,
136-138, 140, 216226, 229, 330, 353,
356, 359, 360, 407, 437, 439, 440, 443,
500, 501, 50% 508, 511, 521, 555, 558,
563, 565, 567, 573, 579, 580

farmers 3,7-13, 16, 18,21-23,29,31,33,
34,35, 37, 39, 40, 42-44, 49, 51, 52, 56,
59-61, 63-66, 69, 70, 72-74, 79, 80, 82,
83, 85,89-91,94,96,99, 100, 104, 107,
109, 111, 112, 119, 120, 125-128, 138,
140, 145, 147, 148, 150, 151, 157, 159,
166, 188, 191, 193, 194, 196-198, 202,
204-215, 218, 219. 222-224. 229. 232.
233, 235, 238, 239, 243-245, 249; 251;
252, 256-259, 263, 267, 271-273, 276,
277, 280, 283, 288, 289, 291, 293-298,
312, 314, 315, 317-321, 323, 325, 326,
329-331, 340-342, 345347, 349, 351-
357, 361, 367, 375, 379, 381, 384-386,
390-393, 397-399, 402-404, 407, 421,
422, 424, 425, 428, 430, 432-437, 440-
443, 450, 453, 455-458, 460, 463, 464,
472, 474476, 479482, 484-491, 496,
501, 503, 505, 508, 511, 512, 515, 519,
521, 523, 526, 531-535, 544, 547, 548,
554-556, 560, 565, 566, 573, 577-579,
586-588, 592, 595,622,629-634

Farmers Educational and Cooperative
Union of America, see National Farmers
Union

farmer's lung 148, 205, 211, 212, 397,
3!38,531,537,5Sl
Farmers Union, see National Farmers
Union
farming 4,5,8, 13,22,31,33,35,38,49,
50, 73-78, 79, 82, 83, 89, 90, 98, 105,
108, 109, 111, 119, 121, 124-126, 159,
161-163, 165, 168-170, 173, 169, 192,
208, 211, 214-216, 22i, 225, 235, 236,
239. 244. 251. 252. 254. 255. 259. 261,
263; 267; 268; 271; 277; 279; 280; 285;
295, 297, 300, 309, 311, 319, 325,
327332, 340, 341, 351, 359, 365, 378,
379, 383, 384, 389, 397-399, 401, 402,
404, 421, 424, 429, 433, 434, 440, 453,
457, 463, 473, 474, 479, 480, 483, 485,
487, 489, 490, 492, 494, 512, 517, 523,
529, 532, 533, 535, 537, 545, 547, 551,
558, 565, 567, 573, 577, 580
fatalities 4, 6, 24, 25, 28, 29, 31, 37, 61,
64, 71, 79, 84, 87-90, 92, 100, 152, 156,
161-164, 166, 171, 172, 177, 178, 200,
201, 222, 229, 243, 245, 253, 274, 290,
302. 303, 312, 314, 317-321, 324, 351,
353, 373, 386, 387, 389, 390, 446, 447,
454, 456, 474, 486, 487, 500, 504, 505,
516, 523, 528, 545, 546, 558, 563, 565,
566,584,623,628
fatigue 82, 151, 280, 293, 301, 309, 581
feline leukemia 224
Fenske, Richard 340, 350, 375, 457
fertilizer  110, 223, 245, 246. 248, 472,

534

fetal development 51
FFA 45, 55-57, 300, 392. 393, 399, 432,
433, 435, 436, 471, 485, 489, 491, 497,
498. 509. 518. 582-596. 622
FFA National Chapter Safety Award 582
Field of Dreams 6, 30, 34, 54, 93, 445
Field, William 61, 65, 147, 398, 402
field sanitation 10, 224, 227, 256, 257,
324,325,467-469
filarial worms 358
Filipinos 221
Finland 24, 569
fishing 33, 136, 280, 300, 362, 563,565,
566, 634, 635
floods 36
floor boards 283
florida 65, 109, 112, 115, 117, 118, 185,
211. 213. 215. 217. 224. 253. 343. 346.
350; 359-361; 363; 425,' 430; 467; 468,
582, 591
food 10, 13, 25, 32-34, 36,46, 56, 57, 59,
70. 76, 87. 88, 99. 100. 107. 112. 118,
120, 121, i29;130, 135, 136, 180, 197,
216-219, 224226, 229, 247, 252-254,
258, 271, 272, 321, 328-331, 345, 361,
371, 395, 410, 411, 422, 427-430, 450,
482, 484, 499, 510, 522, 540, 587, 621,
822,629,632,634,635
Forest Service 317, 319, 456
Forsythe, Raymond W. 376

Surgeon General's Conference on Agric$tural Safety and Health - 1991


Index

4-H 33,86, 399, 401,437, 438.465, 487,
491, 498, 499, 518, 524, 528, 537, 538.
556, 583, 588, 591, 621
Frazier, Todd M. 71, 72, 184, 188
Free Trade Agreement 119, 259, 429,
622
French, L. Ronald 161
Freund, Eugene Jr. 146,184, 186,189
Friend, Bill and Ann 398, 403
fruit 105, 117, 118, 136, 196, 635
fuel 134, 181,243,435, 583
fumes 208,243,288,398,4Ol, 419,429,

430, 526

fungal poisoning 204
Future of Public Health 3, 4, 44, 47, 67,
71, 412, 418

G

gastrointestinal illness 217, 225
Geller, Jack 425, 426
Georgia 65, 189, 255,328, 535, 582,592
Gerberich, Susan Goodwin 161, 171,
173-178
Germany 239,373
Gibson, Robert W. 161
Gilmore, Rodney 383
Graham, Gene F. 211, 215, 261, 272
Graham, Robert 391,396,433,439
grain  3, 37, 38, 40, 51, 55, 56, 59, 80,
105.  110.  111.  136.  138,  157, 158,
204-212,-214, 215, 223, 267, 262, 263,
283, 299, 313, 314, 325, 367, 368, 378,
389, 397, 399, 419, 485, 488, 530, 534,
542, 554, 563, 567, 577, 584,622,634
grain bin 40, 262, 367, 368, 419
grain funigants 51
Grange, see National Grange
Grassley, Charles E. 94
greenhouse 179182,253,348,349,375,
503,592

Greife, Alice L 186
Grieshop, James I. 408
grounding 285, 288
groundwater 8, 241, 507
Gunderson, Paul D. 161
gynecological problems 217

H

Halperin, William E. 67, 71, 72, 93, 142-
144, 190, 240

Hamilton, Alice 32
Hard, David L. 462, 565, 566
Harkin, Tom 35, 36, 38, 43, 55, 94, 98,
496

Hartye, James 147

Hawaii 65, 222, 225, 228
hazards 4-6, 12, 16, 28, 29, 32, 39, 47,
49, 50, 57, 66, 73, 79, 80, W-92,
123-125, 127, 128, 137, 139. 140, 145,
151, 178, 179, 186-188, 192, 194, 195,
199, 200, 202, 211, 214, 218, 227, 229,

230,238, 239,243,245-248250-252,
254, 256, 257, 259, 275, 276,278,282,
317,318,32O, 325, 331, 332,34O342,
343,345,35%356,389,398,402,437,
445, 446, 448, 453459, 461, 469,
474476, 479, 465, 468, 493, 494, 497,
500. 503, 504, 509, 512, 515, 516, 518,
519; 521-525, 528, 534, 546548, 5%
552. 555. 559.564.578.580.587,
599,621,623: 627; 628      592,

health care 5,6,9, 15, 17,31,36,37,40,
41,43,44,46,73-75,78,79,84,94,97,
98, 101-103, 161, 163, 168, 188, 189,
192. 195.216.225.262,269,270,356,
402; 413; 416-418, 429, 451, 466, 469,
471. 481. 483. 492. 494.517.580
health departments `45,46,6i, 145, 146,
149, 150, 186, 189, 273, 386,412, 416,
451, 546
health education 47, 67, 147, 260, 383,
395, 412, 415, 443, 502
health officer 43, 46
hearina damage 401
heart &ack 599
heart disease 23-25. 232, 413, 527
heat stress 10, 278,.344,.46O
heat stroke 51

Heffernan, Judith 419
herbicide 134, 142, 193, 194, 236, 239,
240,343,517,536,550,553
Herrick, Robert F. 199
Hetzel, Glen 285
Hightower, Jim 7
highway 49, 103, 166, 167, 171,275-277,
318, 328,333, 380, 383, 396, 420, 454,
583, 586, 591,623
Hill, Mary Lee 147
Hinshaw, Uoyd 403
Hispanic 48, 127,216,407-409,465,467,
468,501,504, 566
Hispanic workers 2932
histoplasmosis 221, 398
history 1, 2, 13,26, 32,44, 87, 179, 189,
202, 204, 206, 207, 209, 216, 217, 221,
244, 247, 295, 326, 372, 479, 480, 496,
631,633
Hodgkin's lymphoma 51, 80, 194, 232,
233, 235, 239, 240,450, 536,623
hog lung 100,402
Hoghind, Sverker 213,214,351,372-374,
457
Homestead Act 427
Hoover, President Herbert 366
horses 17, 225,359, 360, 378, 385, 543
hospital 8, 37, 39, 40, 49, 76,94, 95, 100,
102. 103. 164. 167. 170. 173, 178, 187,
238, 296, 373, 376; 400; 417, 428, 436,
453, 471, 495, 512, 517, 525, 540, 586,
596, 623, 631, 632,634
House Coalition on Rural Health 98
Human, Jeffrey 93, 94, 97,98, 100
hypersensitivity 80, 139, 142, 204, 205,
210. 212. 213.
    531; 229.
       569, 235.
        570, 254, 256, 267,
270, 449,         572-574, 581,
622

hypersensitivity pneumonitis 80, 204,
205, 210, 212, 213, 256, 267, 270, 449,
569, 570, 572-574, 581, 622

I

laoooca, Lee 380
ICASH 5

Idaho 412-415,418,464,597
Illinois 3, 59, 65, 96, 131, 223, 228, 305,
306, 309, 311, 321, 327, 333, 334, 437,
439,442,466,506-508,553,597
illness 5, 6, 33, 34, 37, 40-42, 71, 86,
loo, 107,139,14O, 146, 149,152,19l,
204-206, 212, 216-219, 221, 223-226,
265,266,278,308,327,334,336, 363,
398, 427, 437, 439, 440, 446, 501, 503,
504, 512, 523, 524, 548, 548, 549, 565,
567, 568, 574, 575, 578, 581
immunization 9,48,68,70,71, 189,221,
450
incentives 44, 83, 102, 224, 264, 305,
443, 456,578
India 99, 220, 497
Indiana 55, 65, 357, 360, 364, 393, 403,
421, 582, 584
infections 52, 217, 218, 221225, 227,
236, 250, 256, 376, 430, 450, 468, 50%
624
infectious diseases 52, 141, 142, 216,
224, 225, 250, 256, 271, 278, 450, 451
infertilitv 398, 468

infestation 36

inflammation 80.204.206-210,215,249,
278, 279, 283, 530, 642, 563;569
information 1, 4, 5, 6, 13, 14, 18,22, 25,
26, 29, 47, 52, 53, 68-70, 74-76, 79, 81,
89.95.1OO,112.116-118,120,137,140,
141, 143; 145, 146, 152, 157-159,
167-169. 172. 174. 180. 183. 187, 188,
190, 191, 202, 2Oi, 206, 216, 224, 230,
236, 238, 257, 268, 269, 271, 272, 277,
285, 299-304, 306, 308, 315, 316,
318-320, 327, 334, 339, 352, 353, 355,
356.370,376, 377, 384, 386,367, 38%
3%); 394, 395, 399, 402, 405-408, 410,
41 I _ 434439. 443. 446. 451, 457, 462,
469; 478, 4ii-490; 492-494; 497, 498,
502, 504, 505, 509, 510, 514, 518, 517,
520, 524, 534, 541, 544, 545, 551,
553-555, 559, 565, 567, 571, 578, 584,
589, 592,594,598,599
infrastructure 44-47, 88, 186, 188, 189,
191, 270,273,3O6, 319, 446, 447
injuries 1,3, 4-6,9, 11, 17,22, 23,27-31,
33, 34, 37, 40, 42, 44, 46, 48-51, 53, 54,
57, 60, 61, 6466, 68, 69, 72, 73, 75-80,
8284,869O,92,93,1OO, 101,103,104,
107, 112, 120, 123, 124, 128, 150, 161-
178, 187-191, 201, 202, 214, 215, 221,
227, 229, 236,243, 245, 246, 248, 250,
252, 254, 265, 266, 274, 278, 282, 284,
289, 293, 299, 300, 302-304, 306-309,
312, 315, 316, 318-321, 325, 326, 328,

640

Papers and Proceedings


Index

332-334, 336, 338, 339, 351-355, 357,
365, 369, 371, 373, 382, 383, 385389,
390. 396. 398. 426. 434. 435. 437. 439.
440; 443; 445249; 453; 454; 456; 458;
459, 462-464, 467, 468, 472-476, 478,
479, 461, 462, 464-487, 469, 493, 500,
501, 503-506, 508, 510. 511. 512. 515.
517, 523-525, 532, 53?, 546-548; 556;
558, 561, 565, 566, 569, 578, 580, 582,
584 586, 591, 595, 598, 599, 600,
621-624, 636
injUIY COntrOl 48, 46, 53, 86, 86, 90, 176,
306, 328, 333, 363, 440, 510, 525, 578,
621
insecticides 52, 85, 140, 229-233, 235,
237,243,247,363,450,481,553
Institute of Agricultural Medicine and
Agricultural Health 95
InStitUte of Medicine 3, 4, 43, 67, 71,
161, 176, 412,418, 623
inSUranCe  15, 65, 73, 74, 87, 97, 101,
173, 167, 188. 225. 295. 319. 383. 401.
413, 426, 428, 434; 463; 472; 483; 543;
547, 578,594,595,597
International Agency for Research on
Cancer (IARC) 233, 239
International Oiganization for Standards
(ISO) 310
intervention 24, 39, 40, 57, 61, 64, 68,
70, 71, 73, 75, 77, 78, 82, 83, 86-88,
W-92, 97, 144, 162, 164, 166, 169, 170,
181, 185, 186, 184191, 202, 214, 262,
265, 269, 308, 316, 318-320, 326, 353,
383, 387, 391, 393, 434, 439, 440, 443,
455, 457, 458, 460-465, 490, 494, 498,
500, 502, 509, 510, 515, 524, 528, 539,
550, 555, 556. 561. 563. 565. 567. 578
Iowa 1-7, 11,. 17, `22, i7, is, 36,~ 33,
35-39, 41, 43, 47, 48, 55, 59, 65, 67, 73,
74, 76, 79, 84, 86, 87, 93-98, 100-103,
105, 123, 124, 12.9, 130, 132, 134, 141,
143, 146, 147, 151, 157, 161, 178-180,
184, 185, 189, 192, 199, 202, 203, 204,
207, 216. 217. 219. 221223. 226-229.
238, 239; 243;254, `255, 261; 265, 267;
272, 274, 277, 278, 283, 285, 293, 296,
299, 303, 306, 308, 317, 321, 327, 328,
334, 340, 343, 351, 357, 365, 367, 371,
372, 378, 383, 391, 392, 397,  398,
400-405, 412, 417, 419, 425, 429, 432,
437, 445, 448, 453. 457. 462. 466. 471.
472, 475; 479, 481, 485-487; 489; 492;
497, 498, 507, 509-533, 582, 593, 597,
598, 621, 622, 625, 627, 629
Iowa Center for Agricultural Safety and
Health 5, 511
irrigation 31, 69, 72, 221, 223, 225, 362,
468, 566

Johnson, Jeannie 404
Johnsrud, Myron D. 86,308,377,439

M

J

Janko, Sheryl 471
Japan 99,239,329,430
Jefferson, Thomas 125
Jewell, J.R. 274

K

Kansas 59, 60, 65, 115, 221, 227, 334,
421, 472,534,536
Kellogg Foundation 20, 261, 262, 476
Kentucky 17, 65, 74, 84, 115, 176, 180,
189,426,453,454,471,476,492
Kimball, Ken 372
Kinney, Joseph A. 59
Konz, Stephan 334, 339,374, 376, 377,
379, 457

Koop, C. Everett 30,259
Kruse, Ken 434
Kugler, Daniel E. 129
Kukulka, Gary 18

L

labor 1, 7, 12, 14, 32, 33, 36, 51-53, 61,
62, 64, 65, 67, 69, 73, 82, 89, 99, 107,
108, 110-112, 114-122, 151, 157, 156,
163, 171, 176, 182,217, 254, 255, 257,
259, 260, 264,277,321, 329, 330, 339,
344, 354, 401, 407, 421, 431, 433, 440,
467, 468, 472, 473,480, 486, 490, 492,
493, 504, 537, 546, 561, 566, 580, 621,
622,627,628
lacerations 170
Lalich, Nina 186

Lancashire, Jeffrey H. 46
Langmuir, Alexander 66,71
Lasley, Paul 425
Latinos 221

Leach, Rice C. 471, 472, 479, 485, 469,
492
leadership 1, 19, 20, 22, 26, 27, 35, 36,
43,45-47,56,58,97,132,133,157,160,
264, 398, 429, 433, 480, 485, 491, 499,
511

Lemen, Richard A. 105, 445, 448, 453,
457,462,466, 471
leukemia 39,51,80, 100, 224, 232,233,
235,239,240,481
lighting 275, 276, 301, 303, 304, 310,
316,454
livestock 3, 5, 51, 59, 73, 74, 80, 107,
110, 111, 114, 216,218.219. 221.222.
225, 229, 250, 263, 274, 300, 303; 361;
363, 367, 369, 370. 392. 401. 419. 458.

483-485, 509, .534, .555, `592
livestock buildings 250
llama 222

   '

log skidders 277, 316
logging 28, 88, 277, 317-321, 325, 456,
565

Louisiana 65, 391, 396, 472
lupus 398

Luther, Terry 24
Lyme disease 219, 225, 357, 359, 361,
364, 398, 458, 509
lymphoma 39, 51, 80. 194, 232, 233,
235,239, 240, 450,536,623

McGinnis, J. Michael 22, 438
McLymore, Robert L 285,318,455,546
McNearny, Walter J. 413
machine guarding 13, 322, 323
machinery 4, 5, 34, 51, 52, 56, 73, 74,
76, 79, 80, 82, 83, 88, 107, 110, 119,
124, 161, 162, 165, 169, 170, 174, 178,
200, 201, 248, 268, 274-276, 282, 283,
299-304, 308-310, 312-316, 318, 323,
325, 351-356, 374, 386. 387, 400, 419,
454, 467, 476, 481, 482, 487, 499, 506,
508, 515,523, 524, 534, 546, 558, 578,
584, 585, 587, 590, 595, 598
Madsen, Murray 299,308,312,313,318,
455
Maine 65. 189

malaria 219,220, 224,227, 229,357-360,
450,458
malnutrition 9, 359
Manitoba 210, 214, 359, 378
manufacturers  26, 27, 34. 87, 88, 94.
225, 233, 308-312, 314, 3i5, j41, -353;
354, 356, 380, 381, 389, 392, 440, 455,
4@J 476, 477, 482, 484, 487, 519, 622.
623,628
manure 223, 243, 245, 246, 253, 262,
272, 299, 311, 361, 365, 368, 370, 534,
631

manure gas 243, 246, 253,272
marking systems 310
Martin, Lynn 7
Martin, Regina1 and Melody 39
Marvel, Matthew 85,213,293, 298,318,
455
Mary lmogene Bassett Hospital 453
Maryland  65, 144, 145. 178. 216. 535.

53i3

Mason, James 0. 43
Massachusens 65, 177,333,444
May, John J. 143, 188,453,544
mechanization 37, 114, 118, 300, 331,
391

medicalcare 8, 15, 44, 51, 165, 187,205,
220,224,388,413
Medicare 43, 101-103, 413
medicine 3-5, 9, 22, 36, 43, 47, 67,
71-73, 84, 85, 93, 95, 124, 141-143,
145-151, 157, 159, 161, 176-181, 204,
227, 238, 239, 243, 252-254, 267, 268,
272, 296, 298, 321, 328, 335. 340, 351,
363, 364, 376, 397, 398. 400. 407, 412.
418; 448, 453,457; 466; 469; 471, 495,
511, 512. 518, 532, 544-546, 551, 570,
577,579,580,599,622,623,629,634
Melton III, L Joseph 161
men 1, 32, 51, 61, 74, 75, 84, 154, 233,
239, 299, 359, 366, 399, 401, 419, 423,
467, 473, 478, 497, 535, 536, 540, 566,
628,629,632-636
mental disorders 23
Merchant, James A. 35, 43, 73, 84, 93,
95, 99, 178, 211, 212, 214, 215

Surgeon General's Conference on Agricultural Safety and Health - 1991               641


Index

Merrilees, Craig 192
Mexican Free Trade Agreement 119
Mexico 65,95, 119, 131, 220, 228, 259,
361,405,407,408,590,587
Michigan 48,65,105,115,129,253,257,
261, 262, 272, 278, 295, 298, 378, 401,
637
Migrant Head Start 466
migrant workers 31, 32, 51, 52, 75, 220,
229,255,260,379,384,458,467,490
Milham, Samuel 69
milkers' knee 376
Millar, J. Donald 13, 25, 30, 35, 36, 43,
48,5X3,55,471,472,475
Miller, Charles 471
Minnesota 59,65,96,161,162,167,168,
170, 177, 178. 189, 217, 239,400, 462,

429,439,479; 507; 538&o, 579
miscarriages 466
Mississippi 65,109
Missouri 57,65, 178,295,298,384,397,
404, 419-421, 423, 424, 430, 432, 434
582,585
Montana 65.386.412.579
Morgan, Dave 372
Mothers Acrainst Drunk Ddvina IMADD)
25, 497, ii3            -. ,

motor vehicles 25,310
multilingual 465, 466
multiple myeloma 51, 80, 232, 233, 460
Murphy, Dennis J. 127, 199, 309
musculoskrletal disorders 51. 179. 278,

468,578
Myers, John R. 561, 565
Myers, Melvin L 39
myiasis 357

N

nanotechnology 305
National Advisory Committee on Rural
Health 28,96,97, 101
National Agriculture Library 95
National Association of County
Health Officials 45
National Cancer Institute 132, 229, 230,
481,536,623
National Chapter Safety Award 392,562
National Coalition for Agricultural Safety
and Health 18, 33, 43, 93, 141, 146,
184,238.475
National Electric Code (NEC) 266
National Farmers Union 479484
National Grange 189,393
National Health Service Corps 17, 102
National Institute for Occupational
Safety and Health (NIOSH) 1, 19, 30,
35, 43, 60-63, 67, 72, 73, 75, 79, 87,
123,127,140,142,143,146,149,163,
164, 184-186, 186192, 253, 265, m,
281,282,392,393,306,308,309,317,
319, 325,348,349,389, 393,452, 471,
473-475, 477, 503, 510, 511, 521, 524,
548-555, 560-578, 581,623

National Rural Health Association 17, 18,
=,93
National Safety Council 3,60,79,84,87,
88. 100, 163. 164. 174. 176. 262. 302.
32i, 333, ti, 473,475,479,4&i 5171
528,545,623
NCASH 9,18,33,63,87, 124, 146, 164,
475,477,623
Nebraska 65, 91, 164, 162, 176 264,
218, 227, 239, 274, 277, 321, 372, 373,
376378, 403, 421, 428, 481, 487, 536,
541,542.582,694,598
needle sticks 221,269
neurologic dysfunction 155
neurotoxic disorders 52
Nevada 66.219.22tl
New Hampshire. 86,457
New Jersey 65,128,34Q 4283444,468,
NZMexico 65 228 361
New York 11,6& 72: 74,84,86,89,93,
96, 106, 141, 143, 145-149, 176-179,
189,211) 236,240,255,283,293,294,
286, 298, X33,363,373,376, 427,426
463,457,466,475,544,5% 566,5Q%
627, 629
nitrates 51, T7, 245, 272
noise 23,32,52,82,83,85,92,157,276,
293297, 301, 308, 312, 334, 336, 351,
353,370,373,374,5!%-555
noise-induced hearing loss 52, 82, 85,
293297,308,555
nonfatal injuries 11, 88, 176, 201
non-Hodgkin's lymphoma 51, 89, 194,
232,233,235,239,240,460,536,623
North Carolina 59,65,73,112,147,189,
216,226,285,43!3,455,467.548,547,
560,623
rdorth Dakota 65,86,162,170,189,2l8,
227, 359, 378, 383385, 387-396, 425,
426,579,5&i, 595
Novello, Antonia C. 2, 3, 7, 8, l7,22-24,
28,30, 36,488 93, 145,259,=, 4489
471,472,491-494
nurse 46,95, 102, 143, 146, 149, 150,
158,389,416,4?5,554, 544,624
nurseries 300, 467

0

objectives 3, 4, 22, 27, 33, 55, 71, 134,
160,308,392,393, 413,433,439,492,
494,510,520,524,527,562,580,585
occupational canoers 336
occupational lung diseases, see
respiratory diseases
Occupational Safety and Health Act 1,
62, 166, 321, 324, 346 456, 472, 481,
spational Safety and  Health
Administration (OSHA) 1, 7, 8, 14, 15,
60-64,123,127,128,143,l44,166,17l,
194, 195, 217, 224,244,257,275, 277,
262, 283, 293, 312-314, 317-326, 373,

390, 393, 462, 456, 467-469, 472478,
481,482,486,555,623,625
Offioe of Migrant Health 466
Office of Rural Health Policy 93,94,475,
623
Ohio 65, 72, 127, 128, 189, 192, 226,
253.274. 276. 304. 310. 376.
477; 648&!5-580, -582, -588 454.471.

oils 51
Oklahoma 55.65.96.495.556.823
Ofenchock, Stephen A 142, -213-215,
448.580.562.567-569.572.5744577.581
Ontario Se,ill,Xkl .~
Oregon 65,115,219,223,227,228,462
organic dust toxic syndrome 190, 204,
206, 210, 213, 449, 572, 574, 581, 623
organic farming 8
organic phosphate poisoning 15
organophosphate poisoning 14, 155,
156,241
outreach 5, 40, 97, 266, 321, 324-326,
417,466,474,476,477,503,534,544
wercurrent protection 285287

P

Panama 376

parasitic infections 52, 217
parathion 12, 195,229,232,243,375
Parker, John E. 214,228,457,458, 561,
568,572~574,581
part-time farming 486
basture 4. 17. 364. 543, 631
pediatric infectfons 217
Pennsylvania 59,66,1X& l27,136,2g2,
309
Penterman, Don 372
personnel  102. 103, 126. 145` 168.

221~223,225,305,335,344,368,386,
420.  428.  429.  468. 483.  487.  505.
517:519,539,541,551,596,595;596
pest control 29
pesticide poisoning W-16,29,151,152,
154,229,396,406,407,446,533
pesticides 7-9, 11, 12, 14-16,23, 25, 29,
31,37,~,51,52,56,75,n,81,82,85,
91,92,100,110,118,134,151-155,188,
192-194, 196, 197, 201, 202, 224233,
235-243,247,249,253,256,262,263,
268, 271, 272,368,310,340, 342, 343-
345,347, 362,375, 369,396,402,405,
467, 422, 437, 442,446,449-W, 459,
460.464.46746s 479.480.483.464,
488; 492; 497,499,501,5oi; 506; 507,
517,520,524,526,529,533,534 548,
!isRis, ~559,583,585,587,58& 5%
623
Peters, Penn A 212,215,317,320,321,
ph?whamidon 14,229
Piercy, Larry 453
Pinger, Robert R. 357, 457
Plagge, Merlin 485
pneumonia 148,252,358,571,829,634

642

Papers and Proceedings


Index

pneumonitis
572-574,581,622 . .
poisoning 9, 14-16, 29, 32, 41, 52, 70,
      80,204, 205,210,212,213,



104, 145, 151, 152, 154-156, 181, 204,
229, 241, 252, 272, 375, 398, 405, 407,
246, 256,




446,468,493,502,520,522,533,579,
       267, 270. 449. 569. 570.






622,627,628
polio 217, 450

poliomyelitis 226, 358
Pollock, John 373
pollution 44, 130, 194, 253, 402
Popendorf, William 214,215,243, 252,
253,255,256,265,272,451,523
population 6, 29, 30, 33, 46, 49, 52, 57,
65, 73-75, 78, 82, 89, 90, 101, 109, 112,
115, 124, 125, 138, 154, 162-165, 167,
168, 173-176. 180, 181. 184. 185. 189.
204, 207, 216, 217, 226, 229; 232; 233;
239, 240, 244, 251, 256-260, 264, 267,
268, 274, 276, 295, 296, 305, 327, 352,
363, 364, 382, 396, 409, 412, 413, 415,
427, 433, 436, 442, 450, 454; 460; 481,
492,494, 500.510.523.527.
540, 554, 555; 571; 596,'634  530. 532.

populations at risk 73, 91, 271
poultry 132, 138,202,205,208,214,215,
221, 223, 245.250.257.286. 430.483.
546,560,567.
poverty 9,73,101,427,629
Powassan fever 359
power take-off 190, 284,303, 323,389,
396,487,624
Pratt, David S.  18, 35, 85, 95, 210,
212-214, 298, 327, 334, 340, 351, 357,
365,372,373,378,453,457
pregnancy 14,51
Prevention 1, 4-6, 22, 24, 29, 39-41,
43-48, 50, 53, 55, 56, 67-69, 71-73, 75,
77,78,80,83,90,91,93,128,145,150,
161-164, 166, 169, 171, 176178, 186,
204, 214, 216, 263,266, 269,270, 277,
284, 300, 304, 307, 319, 325, 331-333,
356, 387, 411. 443.445. 447. 456. 486.
503, 504; 509:511,'515; 524; 525; 527;
532, 548, 555, 556, 562, 567, 582, 583,
585,586,589,596,623
produce 1, 3, 8, 15, 18, 78, 80, 94, 100,
112, 130-132, 135, 136, 139, 179-181,
193, 196,217,218, 225,228,237,247,
249, 259, 260, 300, 306, 328-331, 354,
356,411,413,489,552,555
promotion 22, 26, 61, 71, 87, 159, 186,
391,392,438,440.487.504.510.524.
527, 534,538,540,546;551;559;563;
565,578,596,621
prostate cancer 80, 232, 233
protection 412, 14, 16, 25, 53, 57, 61,
71, 83,91, 92, 123, 127, 134, 140, 144,
191, 195, 238, 244, 246, 248-251, 253,
257, 258, 260, 266, 275-277, 285-288,
295, 300, 306, 307, 310312, 314, 321,
322,340,343,344,346,348,349,353,
355, 363, 375, 379,380, 400, 434, 438,
440, 449, 455-457, 464, 467, 469, 470,
472, 481, 482, 488, 489, 493, 505, 507,

protective equipment 10, 77, 92, 147,
509,512,514,517,544, 563,574,563,


148, 244, 324,340-342, 344, 349, 350,
356,457,460,526,533,599,623
protective zone 311
587,591,622,624




proximity detectors 318
psychological disorders 52
PTO 188,303~305, 323, 352, 389,396,
400.590.594.598.624
public health i, 3-5, 17, 20, 23, 26, 30,
33,X5,40, 43-50,53, 55,61, 87-73,76,
79, 83, 84, 90, 93, 105, 107, 140, 143,
145, 146, 149, 161, 176-179, 185, 189,
191, 192, 194202, 216, 226228, 233,
238,268,298,311,333,340,357,358,
363, 383, 412-418, 422, 448, 451, 453.
457, 467, 471, 492, 510, 517, 520, 524,
525, 527, 532, 538, 554. 562. 571. 623.
627

Public Health Service 1, 17, 30, 35, 48,
71, 93, 105, 107, 178, 363, 422, 457,
471,492,562,623,627
Puerto Rico 33, 48, 55, 107, 122, 326,
405

Q

Qfever 223

Quebec 233,242

R

rabies 136, 138, 223,225, 228, 249,450,
509,587
radio 24,89,410,475,583-588,590,593,
623

Ramazzini, Bernardino 204, 210, 629
ranch workers 219,221
Ray,Robert D. 28,97,102
regulate 7, 8, 64, 76-78, 89, 217
regulation 10, 11, 13, 16, 21, 126, 134,
158,224,225,265, 312,319,343,390,
456,459,464,470
Remington, Richard D. 4, 27, 43
Renier, Colleen M. 161
repetitive trauma 51, 82, 446
reproductive failure 51
research 9, 20, 29,33, 39, 41, 57, 60-63,
67, 69, 70, 72-84, 86, 87, 90, 92, 94,
103, 107, 121-123, 125-127, 129, 130,
133-138, 141,149, 151. 152. 156. 158.
161, 164, 168, 170, 176, 177, 184187;
189,191,194, 195, 198, 199.216.225.
226, 230,233,238, 239;246,253;262;
265, 276, 282, 283, 293, 297, 298,
300-313, 315, 316, 318-320, 325, 333,
338, 340, 341, 345, 353, 357, 391, 399,
400,402,403, 422,433,437,444,448,
449, 453-456, 462-464, 467, 471, 472,
475, 480-482, 490, 498, 501-503, 508,
509, 524, 526, 529, 535, 548, 552, 555,
559, 561-563, 565-567, 576, 578, 580-
582,622,628
respiratory diseases 23, 51, 80, 84, 157,
212,449,511,544,571,623

respiratory illness 212, 398, 446, 501,
524, 549,567, 568, 575
respiratory infections 217, 256
retrofit 12, 88, 94, 191, 284, 297, 373,
440,443,563
Rhode Island 65
Riedel, Donald C. 413
right-to-know 8, 10, 16
risk 4,5, 11, 12, 15, 16,23-28,28,31,40,
51,66-69,71,73-84,89-93,99, 101, 112,
123. 127. 128. 135. 140. 141. 143. 161.
162; 164-166, 16~171;179,'184, 185;
188, 204207, 210, 216, 217, 219, 225,
226, 230, 232, 236-242, 244, 247, 249,
251, 256, 262, 263, 268271. 274, 280,
=`&=%297,305, 306, 309, 330, 340,
342, 352. 354. 355. 357, 362364. 395.
396; 399-401;422; 434-436, 439; 440;
443, 450,454,456, 458, 460, 468, 479,
481, 484, 486, 489, 490, 500-502, 506,
508,510,514, 515,522,523,525,527,
529,532,533,535,538,540,543,544,
552. 554, 555. 558. 560. 562. 571. 575.
578;579;597;599;621. '
risk-taking 127, 128, 306, 309, 434, 506
Rissler,Jane 134,142
road 7, 17, 48, 74, 80, 147, 201, 261,
276,277,303,311,320,383,384,419,
421,454,480,528,598,599
Rocky Mountain spotted fever 219, 357,
359, 381, 384, 450
roll bars 29, 94, 284
roll-over 12, 71, 78, 94, 191, 195, 276,
277,301,306,311,312,318,322,323,
353, 373, 379, 380, 383, 384, 389, 398,
400, 422, 441, 443, 446, 459, 474, 476,
487,489,494,505,524,563,590,624
Roll-over Protective Structures (ROPS)
12, 78, 88, 92, 94, 95, 202, 277, 301.
306, 311316, 318, 319, 322, 323; 325;
380. 381. 441. 443. 459. 474. 477. 489.
490;459;505;563;624'
Roper, William L. 36, 43, 56, 306, 412,
439
Rosenstock,Linda 85,151,154,155
rural 3, 5, 6, 8, 9, 12, 15, 17-20, 22, 28,
29, 32, 36, 40, 44-46, 52, 55, 57, 60,
73-75, 77-79, 83, 84, 90, 92-104, 107,
109, 112, 120123, 125, 126, 128, 133,
143, 146, 148-150, 154, 157, 159, 161,
162, 170, 174, 175, 178, 185-188, 211,
221, 223, 225, 227, 233, 236, 242, 247,
261-263, 269-271, 273, 295, 296. 298,
303, 351, 358, 365, 387-391, 395, 396,
398-402, 412-415, 417-422, 424, 427-
431, 433, 438, 475, 479-483, 485, 486,
494,502, 511, 515, 517, 518, 525, 532,
536,540,556,583,588,594, 595,598.
623,624
Rural Hospital Transition Grant Program

      .
102
Ryder, Roberta E.  255, 259, 260, 264,
267

Surgeon General's Conference on Agricultural Safety and Health - 1991               643


Index

s

safety 1-14, 17, 18, 20, 22, 23, 25-33,
35-40, 43, 45, 46, 48, 50, 53, 55-57,
59-64, 66-68, 73-79, 84, 86-95, 97, 100,
101, 103, 105-108, 118-120, 122-129,
134, 140, 141, 143, 145-147, 150. 151,
157, 159-161, 163, 164, 166, 17i-174,
176, 177. 179. 184. 187. 188. 189. 192.
193,197; 199;202;204;211;213;2%
217, 227, 229, 238, 243, 251, 253-255,
257-261, 263-265, 267, 274-278, 285,
286, 288, 291-293, 299302, 304-306,

308, 309, 311-321, 324, 327, 328, 330;
332-336.
357, 365, 338-340. 344. 351-353. 358.
     370, 372374; 376, 377; 378:
380, 383, 385, 387-405, 407, 410, 412,
419, 420, 422, 423, 426, 427, 429-441,
443-445, 447, 448, 453-457, 459. 460,
462-466, 468-482, 484-493, 497; 498;
499, 501-505. 508. 509. 511. 512. 515.
517-519, 523:525;528,'529; 533; 534;
537, 541, 543, 545, 546, 548, 551, 555-
559, 561, 563, 565-567, 578, 580, 582,
583-599, 621-623, 625, 627, 629
sanitarian 46
Scannell, Gerard 472-474, 476, 478
Schneider, Rollin D. 321, 322, 372, 402,
598

school 5,7, 24, 26,36, 39, 43, 59,95-97,
104, 105, 107, 113, 114, 149, 161, 178,
180, 201, 261, 262, 264, 295, 298, 321,
324, 340, 370, 383, 389, 393-397, 400,
406, 415, 432, 434, 436, 453, 467, 471,
492, 494, 497, 499, 511, 517, 539, 540,
546, 547, 570, 583-596, 623, 624, 632
seat bar 277,283,284
Secretary of Labor 7, 472, 473
Senior Companion Program 415, 417,
418

severeoccupationaltraumaticinjuries 51
sewage 46,225
Seymour,Thomas H. 321,350,456
shigellosis 358
Silage 17, 38, 138, 204, 205, 243, 252
silo fillers' disease 245
skin cancer 70, 232, 241, 398, 446
slips 4. 278. 282. 303. 528
sldw-mbving vehicles '310
Smith-Hughes Act 391
smoking 24, 25, 44, 46, 159, 208, 211,
215, 232, 256, 259, 262, 265, 334, 381,
382,419,495,527,542,577
Snider, Jacqueline 598
Society of Automotive Engineers (SAE)
311,477
soil 12, 37, 64, 129, 132, 181, 299, 329,
430,480,500,631
solvents 51, 197,233, 240,249, 501,552
South America 359, 427
South Carolina 65, 217
South Dakota 17, 64, 65, 162, 170,342,
385,428,471,579
Soviet Union 58, 99

soy beans 192,419
Spies, Arthur 94
spoiled hay 204, 205
spouses 4,89,427,463
SPRAINS 4, 79, 169, 170,227,510, 517,
561,624
Sprick, Wayne 391,432, 489
Sri Lanka 359
St. Louis encephalitis 221, 359,360,364,
624
Stallones, Lorann 84, 175, 176, 178,210,
213,453,457,458
standards  1, 7, 9, 11-14, 22, 25, 33, 87,
88. 99. 107, 112. 194. 224. 227. 248.
250, 257, 258, 269, 276, 308, 310, 311;
314-316, 321325, 366, 430, 451, 454,
456,471,474,481,489,497,510,529,
543, 576,621-623,625
statistics 3, 4, 44, 62, 70, 78, 82, 100,
101. 107, 120, 121. 123, 128. 161, 163.
171, 176,178;186;195, 199;200;229;
251, 254, 271, 274, 276, 302, 309, 317,
319, 336, 339, 351, 352, 372, 373, 376,
382,384,386,387,393, 394,396,424,
427, 481, 483, 484, 503, 516, 546, 556,
558, 561, 573, 578, 580,600,621,623
sterility 31, 237
steroids 258, 574
stimulants 51

stress 10, 23, 52, 89, 96, 103, 126, 132,
138, 157, 159, 188, 223, 271, 278, 281,
293, 331, 344, 365, 397, 403, 419,
422-427, 437, 438, 451, 454, 455, 458,
460,481,539,556,599
Stuckey, Bill 376
Stueiand, Dean T. 174, 178, 267, 298,
580
suffocations 311
suicide 16, 96, 99, 100, 152, 258, 427,
539,556,579
Sullivan, Louis W. 28, 101, 439
Surgeon General's Report 22,24,493
surveillance 4, 5, 45, 57, 60, 61, 67-73,
75-77, 79, 80, 84, 86, 87, 93, 99, 140,
142, 143-146, 148, 149, 151, 156-159,
161-168. 170. 171. 173-181. 184-186.
189, 190, 191; 195;199, 200; 202, 205;
222, 224-228, 244, 245, 251, 262, 265,
269, 308, 319, 320, 325, 363, 364, 385,
386, 389, 445-447, 452, 453, 455, 462,
493,498, 500,510,511, 517, 522,523,
527, 549, 552, 554, 559, 562, 567, 578,
579,580,621623
sustainability 266, 479, 480, 482, 484
Sweden 71, 78,95, 148, 176, 178, 351,
353,354, 356, 373,380,460,623
Swenson, Leland H. 479
swine confinement 204-209, 211, 214,
252,340,521, 577
synthetic organic chemicals 100

T

Tauka,Thomas 94
technical assistance 5, 8, 67, 90, 473,

474,512,525

television (TV) 24, 86, 99, 334, 380, 384,
408, 410,475,585, 569, 583, 586, 587,
589,590,593,624
tendinitis 278, 279, 282
Tennessee 65,217,226,557
Terry, Luther 24
tetanus 221, 229, 376, 450
Tevis,Cheryi 397
Texas 7-9, 16,46,65,111. 132,255.257,
260,321,453,566,582,587
Thackrah. Charles 204
Timm, Mark 55, 59, 64, 67, 73, 86, 392,
491
tobacco 2325., 59, 115, 120, 135, 136,
259
toilet hygiene 217
Toqueville, Alexis de 47
toxic fumes poisoning 398
toxic substances 10, 32, 76, 134, 179,
259,520,621, 624,627
toxic syndrome 190, 204, 206, 210, 213,
449,572,574,581,623
trachoma 358

tractor 12, 17, 29, 35, 37, 38, 40, 49, 51,
52, 65, 71, 78, 88, 89, 91, 92, 94, 97,
124. 161. 162. 169. 171. 175. 178. 190.
191; 200; 201, 261, 274-277; 279; 283;
284, 294, 297, 299-306, 310-318, 322,
323, 327, 332, 336, 341, 346, 352-356,
362, 372-377, 374381, 384, 386, 389,
398-401, 403, 419, 420, 435, 441, 443,
446, 454456, 458460, 476, 477, 487,
489490,494, 497, 505, 506, 508, 511,
515-517, 519, 524, 526, 528, 534, 537,
551, 555, 558, 563, 584, 585, 588,
590-593.595.596.599
tractor cabs 297, 310, 341, 375
tractor drivers' disease 376
training 6, 9, 13, 16, 47, 48, 61, 67, 91,
95, 103, 126, 127, 140, 147, 179, 186,
280, 305, 307, 309, 318, 320324, 334,
335, 338, 342, 344, 349, 351, 357, 366,
368, 375, 377, 388, 405-407, 417, 420,
428, 448, 449, 451, 460, 466, 469, 473,
474, 476,477, 486, 499,504, 507,512,
515, 533, 534, 537, 551, 556, 559, 565,
578,591,594,595,622,623
trauma 23, 48, 51, 69, 79, 82, 100, 161,
162. 167. 174. 176178. 188. 274.275.
278; 28ti284,'308, 318, 325; 326; 336;
385,446,454,493,504,623
True,John k 161
tuberculosis fl6)   31, 46, 52, 189,

216218, 222; 224, 226, 228, 256, 358,
427,450,469,495,624

tuna 258
Twain, Mark 36
typhoid fever 52, 358

II

ultraviolet light 233
ultraviolet radiation 51, 52
United Nations 81, 97, 100, 624

Papers and Proceedings


Urban, Thomas 33

urinary tract infections 217,430,466,624
USDA 45, 61, 63, 76, 88, 90, 108, 110,
112, 113, 116, 168, 170, 174, 175, 180,
193, 194, 197, 224, 225, 325, 330, 426,
439, 475,477,482-484, 624
Utah 65, 219, 223, 227

v

vectors 4, 219, 220, 223, 225, 357, 358,
361-363, 375, 376
Vermont 65, 115, 144, 177, 350,599
veterinary drugs 243, 249, 251, 255
vibration 82, 278, 279, 281, 282, 301,
309, 310,312,317,318,336, 353,572
Villarejo, Donald 195
vineyards 300, 311
urgin Islands 55
Virginia 65, 131, 136, 228, 275, 432, 521,
549, 558, 560, 561, 563-569, 571-577,
581, 582, 588
viruses 51, 80, 136, 137, 233, 268, 357,
359, 363, 364
Volatile Fuel Safety Program 435
volunteer 103, 174, 258, 260, 387, 404,
412, 414-417, 428, 437, 438, 498, 517,
524, 538, 583, 588, 621
Von Essen, Susanna 204,213, 215, 256,
270, 376, 449, 542

W

Washington 20, 22, 36, 39, 42, 43, 59,
60, 65, 71, 74, 84, 86, 95, 97, 98, 107,
112, 120-125, 127, 129, 133, 141, 142,
145, 151, 176, 238, 239, 253, 254, 278,
282, 320, 321, 412, 418, 427, 432, 466,
472, 479, 490, 333, 339, 340, 559, 582,
589

Washington D.C. 36, 71, 66, 95, 97, 98,
107, 120-122, 129, 145, 176, 238, 333,
418,466, 472, 479
water contamination 92, 398, 507
weather 2, 52, 119, 161, 181, 331, 434,
629
well water 236, 507, 583
West Virginia 65, 275, 521, 549, 560,
561, 563-589, 571-577, 581
white finger 279, 318
Whitener, Leslie A. 107, 121, 426
whole-body vibration 281, 309, 310
Widess, Elien G. 7, 23, 25, 95, 405
Wilk. Valerie A. 466
win-win 496
Wisconsin 29, 41, 49, 65, 86, 87, 112,
147, 162, 170, 178, 212, 213, 217, 219,
226, 283, 294, 295, 297, 442, 445, 458,

507, 535, 572, 578-580, 582, 596, 600
women 1. 31, 32. 37. 51, 61, 73-75. 83.
84, 188, 189; 192, 233, 235;279, 299,

Index

359, 399-401, 415, 419, 423, 430, 451,
463. 466-468. 473. 478. 487. 489. 490.
497; 540,579,624 630; 632; 633.
workers'compensat~on 7, 15, 61, 64, 65,
166, 171, 225, 352, 467, 469, 501, 561,
624

Wyoming 59, 65, 228, 372

Y

Young Farmer Educational
Association 432, 433, 435
young workers 4

Z

Surgeon General's Conference on Agricultural Safety and Health - 1991               645

Zavala, Melanie 211, 405
zebra 300
Zeman, Richard 38, 40
zoonoses 216, 222224, 226, 228, 359,
450,509
zoonotic viruses 233

ti U.S. GOVERNMENT PRINTING OFFICE: 1992 651-316