Respiratory Disease in Agricultural Workers: Mortality and Morbidity Statistics

ABSTRACT

To quantify the respiratory disease burden among agricultural workers, we examined the 1988–1998 National Center for Health Statistics (NCHS) “Multiple Cause of Death Data” and the 1988–1994 Third National Health and Nutrition Examination Survey data (NHANES III). Proportionate mortality ratios (PMRs) were determined for 11 respiratory conditions among 6 agricultural groups: crop farm workers, livestock farm workers, farm managers, landscape and horticultural workers, forestry workers, and fishery workers. Prevalence ratios (PRs) were determined for 12 respiratory conditions among 3 agricultural groups: farm workers, farm managers, and other agricultural workers. Disease categories groups were based on the 9th International Classification of Diseases and the agricultural groups on the NCHS or NHANES III industry and occupation codes, respectively. Crop farm workers and livestock farm workers had significantly elevated mortality for several respiratory conditions, with mortality for hypersensitivity pneumonitis being 10 and 50 times higher than expected. Landscape and horticultural workers had significantly elevated mortality for abscess of the lung and mediastinum and chronic airways obstruction. Forestry workers had significantly elevated mortality for pulmonary tuberculosis, chronic airways obstruction, and pneumonia. Prevalence of wheeze was elevated for female farm workers, shortness of breath was elevated for farm workers who had ever smoked, and hay fever was elevated for black, non-Hispanic farm workers. Prevalence of asthma was elevated for other agricultural workers who had ever smoked. Farm workers had a PR of 173 for obstructive respiratory abnormality. Continued improvement in occupational health surveillance systems for agriculture is essential to help guide prevention efforts for respiratory disease.     

Agricultural Leaders’ Influence on the Safety Culture of Workers

ABSTRACT

Most US farmers are small, independent owner-operators, many of whom are exempt from safety regulation and enforcement, as well as age restrictions relative to family members performing hazardous tasks. These smaller farms account for a disproportionate share of the total fatality and injury statistics from farming incidents, contributing to an agriculture-industry death rate that is seven times greater than all occupations combined. In contrast, large agricultural enterprises that employ larger numbers of non-family workers are more regulated and more highly incentivized by economic, supply chain, and societal factors to implement cultures of safety, and are more readily influenced by agricultural opinion leaders, agribusinesses, farm organizations, and agricultural media. These agricultural influencer institutions must find ways to play more significant roles in changing the culture on operations that use only family labor. They will find willing partners in safety organizations such as the Agricultural Safety and Health Council of America (ASHCA), Agricultural Extension, and other health and safety advocates, including the National Institute for Occupational Safety and Health (NIOSH)-funded agricultural research centers. The overall workplace injury statistics for agriculture remain alarming; however, with leadership from the larger farm operations, and help from ASHCA, academia, the healthcare community, and others, the current culture of workplace safety and health in agriculture can be impacted in positive ways.     

The impact of agricultural injury on farm owners and workers in Alabama and Mississippi

BACKGROUND: Few studies have assessed the consequences of agricultural injury and none have done so comparing Caucasian and African-American farm owners and workers. METHODS: 1244 farmers were enrolled and prospectively observed between 1994-1996 for farming-related injuries. Injured farmers provided information on the consequences of injuries. RESULTS: One-hundred and thirty-one subjects reported a total of 140 injuries. The majority of injuries were classified as minor or moderate and required medical attention. African-American farm workers tended to have more severe injuries. Nearly all injured subjects experienced acute residual effects (e.g., pain when moving), while persistent effects occurred in about half of the injured subjects, the latter being more common among African-American workers. Lost work was a frequent nonmedical effect of the injury. African-American workers tended to be more likely to lose work and/or be hurt financially. CONCLUSIONS: The impact of agricultural injury is nontrivial, particularly for African-American farm workers. The provision of better medical care facilities for African-American farm workers may be a positive approach for reducing the impact of agricultural injuries in this population.     

Food, nutrition, and agriculture: a liaison for world development

In spite of larger worldwide food harvests in recent years, the number of people in underdeveloped countries without enough food to eat is increasing. Those most likely to suffer from undernutrition are the traditionally vulnerable groups, especially the rural poor. In many underdeveloped countries, the average farm size is smaller, the number of landless farm workers is larger, and the number of rural poor families without land on which to grow food or money to buy it for home consumption is greater than ever before. Undernutrition is often viewed as a family health problem only. Thus, education in nutrition is generally directed toward home economists, health workers, and primary school teachers. Since unavailability of food is usually the most limiting factor in improving nutritional status of the poor, all agencies dealing with the food chain from production to consumption should be involved. An educational partnership between health, nutrition, and agriculture may be the most important alliance that could be brought into being to ensure enough food for the nutritional well-being of the world's population. This article presents the rationale for education in nutrition in the preparation of agriculturalists and reviews some of the past efforts and present activities of national and international organizations to meld nutrition into agricultural world development programs.     

A proportionate mortality analysis of California agricultural workers, 1978-1979

There are few published reports of epidemiologic studies of the risks of agricultural work. Members of this occupational group have been of special concern because of their exposure to pesticides, some of which are mutagens and animal carcinogens. A previous proportionate mortality study of California agricultural workers was based on deaths recorded among white males of this occupational group during 1959-1961. We have conducted a proportionate mortality analysis of all deaths recorded during 1978-1979 among California farm workers and farm owner/managers. In general, the findings of our study are consistent with those of the previous study. For farm workers, we found proportionate mortality ratios (PMRs) which were consistently elevated for all race and sex categories (in which there were 6 or more decedents) for deaths due to motor vehicle accidents, all respiratory disease, and all infective and parasitic diseases. The PMRs for the former three causes of death were also found to be elevated across several race and sex categories for farm owner/managers. We also found a significant and consistent deficit of deaths among farm workers and farm owner/managers due to arteriosclerotic heart disease. The proportionate cancer mortality ratios (PCMRs) for cancer of the stomach and cancer of other lymphatic tissue were elevated, although not necessarily statistically significantly, for several race and sex categories among farm workers and farm owner/managers. The PCMR for cancer of the cervix was statistically significant for white female farmworkers.     

Increased risk of agricultural injury among African-American farm workers from Alabama and Mississippi

Research on the epidemiology of agriculture-related injuries has largely ignored African-Americans and farm workers. This cohort study is the first to estimate injury rates and to evaluate prospectively risk factors for agriculture-related injuries and compare them among African-American and Caucasian farmers and African-American farm workers. A total of 1,246 subjects (685 Caucasian owners, 321 African-American owners, and 240 African-American workers) from Alabama and Mississippi were selected from Agricultural Statistics Services databases and other sources and were enrolled between January 1994 and June 1996. Baseline data included detailed demographic, farm and farming, and behavioral information. From January 1994 to April 1998, subjects were contacted biannually to ascertain the occurrence of an agriculture-related injury. Injury rates were 2.9 times (95% confidence interval (CI): 2.0, 4.3) higher for African-American farm workers compared with Caucasian and African-American owners. Part-time farming (relative risk (RR) = 2.0, 95% CI: 1.3, 2.5), prior agricultural injury (RR = 1.5, 95% CI: 1.0, 2.1), and farm machinery in fair/poor condition (RR = 1.8, 95% CI: 1.2, 2.7) were also independently associated with injury rates. The results demonstrate the increased frequency of agricultural injury among farm workers and identify a number of possible ways of reducing them.     

Effects of pesticide applications on respiratory health of Ethiopian farm workers

The effects of pesticide use on the respiratory health of agricultural farm workers were studied in 203 farm workers and 131 controls. The farm workers were sprayers, supervisors, technicians, and pest assessors. Pulmonary function was found to be remarkably poor among the non-smoker supervisors, followed by the non-smoker sprayers, as compared with that of the non-smoker controls. The means (SD) of FVC and FEV1 for supervisors and sprayers were 2.88 (0.41), 3.05(0.50) and 2.74(0.38), 2.89(0.54), respectively, p < 0.05. The non-smoker technicians had the most respiratory symptoms, with wheezing and breathlessness being the most frequent (35.7% in 14 technicians). Farm workers with various job experiences are subject to reduction of pulmonary function and frequent complaints of respiratory symptoms that could possibly lead to chronic respiratory health problems.     

Cancer mortality in a cohort of male agricultural workers from northern Italy

Cancer mortality in a cohort of 36,579 Italian male agricultural workers (Province of Forlì, 1969-1993) was compared with that of the rest of male population using the ratio of age-standardized (Europe) mortality rates (ASR) with the 95% confidence interval (CI). The cohort yielded 707,496.3 person-years with 3684 cancer deaths. Total ASR ratio was 0.85 (95% CI = 0.81-0.90). A significant excess mortality was observed only for gastric cancer (1.25; 1.13-1.39). Reduction in total cancer mortality was restricted to farm owners (0.83; 0.79-0.88), whereas excess gastric cancer mortality involved both farm owners (1.23; 1.11-1.37) and farm workers (1.32; 1.10-1.58). ASR ratio for gastric cancer decreased from 1.58 (1.34-1.86) in 1969-1976 to 0.97 (0.80-1.19) in 1985-1993. In conclusion, the only positive finding in this cohort of male agricultural workers was a generalized but declining excess mortality from gastric cancer.     

Developing a Model Policy on Youth Employment in Agriculture

The goal of this project was to develop a model policy that agricultural employers could adopt specific to youth employment, including age-appropriate assignments, training needs for adolescent workers, ideal supervision, and mentoring by adult workers. Methods included discussions at a national conference of agricultural employers, a survey of employers’ perspectives on young workers, forming a task force to draft a model policy, and finalizing the policy document. The process resulted in a template that can be used by agricultural employers for immediate adoption, or to be customized and adapted for their unique company. Given new trends in agriculture to use certification systems, safety audits, and voluntary safety standards in addition to the regulatory process, there is value in having a voluntary “best practice” model policy that can be adopted in settings where safeguarding young farm workers is a priority.     

Understanding the ergonomic risk for musculoskeletal disorders in the United States agricultural sector

INTRODUCTION: Farming is a very large industry in the United States. Understanding the risks for injuries and more specifically musculoskeletal disorders in this industry poses a challenge for health officials. METHODS: A review was conducted of the existing peer-reviewed publications prior to December 2006 about injuries and musculoskeletal disorders for farmers and farm workers. The aim was to review existing knowledge concerning: (1) the prevalence, types, and causes of farm-related injuries, paying particular attention to musculoskeletal disorders and the special populations within the agricultural sector, and (2) interventions that have been developed to reduce risk factors associated with farm-related injuries. RESULTS: Farmers and farm workers experience high rates of low back, shoulder, and upper extremity disorders. Musculoskeletal disorders may disproportionately affect farm youth and migrant workers due to the types of farm tasks performed. There is an urgent need for improved and validated interventions to reduce exposures and to improve the health of farmers and farm workers. DISCUSSION: Future farm-related musculoskeletal disorder research should emphasize: (1) better identification of exposures for special populations, (2) development of interventions for diverse farm populations, and (3) identification of additional exposures for musculoskeletal disorders. Inadequate understanding of musculoskeletal disorders in farming impedes efforts to prevent this common and important type of occupational injuries on farms.     

Knowledge,attitudes and practices (KAP) among agricultural extension workers concerning the reduction of the adverse impact of pesticides in agricultural areas in Tanzania

BACKGROUND: Extension workers are educated locally to enable them to train farmers in using improved local farming methods and imported technology, such as pesticides, to increase crop production. However, the extension workers are not adequately trained in health aspects of pesticides and hence are unable to provide adequate services to farmers with regard to safe use of pesticides. OBJECTIVE: The present study assessed the knowledge, attitudes and practices of agricultural extension workers with respect to health effects of pesticides in order to develop strategies for the control of pesticide exposure and prevention of pesticide poisoning in Tanzania. METHODS: A survey of Tanzanian agricultural extensionists was undertaken in 1991-1994 using a standardized questionnaire in face-to-face interviews. Extensionists who were district agricultural officers, assistant agricultural officers, agricultural assistants, and field assistants, working in the coffee and cotton growing areas (N = 61) within a radius of 15 km of farm, estate or village under farm worker study (reported elsewhere) were included in the survey. RESULTS: The majority of extensionists knew that pesticides could enter the human body but only a quarter perceived pesticides as a major problem in the community they served. The majority showed awareness of potential health hazards of the different pesticides used in their service areas, but they did not recognize what pesticides were responsible for poisoning. A high proportion was familiar with first aid procedures in case of pesticide poisoning; however, many procedures described were not appropriate for pesticide poisoning. CONCLUSIONS: The survey indicated that training of agricultural workers in health aspects of pesticide exposure is an important task for adequate provision of service to farmers with regard to safe use of pesticides in Tanzania. Nevertheless, the appropriate role of extensionists in reducing the health impact of pesticides would be to advocate pesticides of low toxicity or non-chemical pest control.     

Soft tissue sarcomas in agriculture and forestry workers.

The National Cancer Register maintained by the Office of Population Censuses and Surveys (OPCS) was used to investigate the relative risks of soft tissue sarcomas among farmers, agricultural workers, and related occupational groups. The relative risk for the group as a whole was 1.15 (95% confidence limits 0.83-1.59). One of the four subgroups (which comprises farmers, farm managers, and market gardeners) experienced a relative risk of 1.7 which just achieves significance at the 5% level (95% confidence limits 1.00-2.88). The risks in the other three subgroups were respectively 1.0 (agricultural workers, 003), 0.7 (gardeners and groundsmen, 005), and 1.0 (foresters and woodmen, 006). No attempt has been made in this study to determine exposure to phenoxy herbicides in cases or controls. The significance of these findings is discussed.     

Economic and Health Needs of Wisconsin Migrant Farm Workers

Migrant farm workers play an essential role in the planting and harvesting of crops in our agricultural production system. In the United States today, about 6 percent of the paid farm labor force "follow the crops" across the nation. This article reports on the economic and health care needs of migrant farm workers who travel from the border areas of Texas to Wisconsin each year. Surveys conducted in 1978 and 1989 show that this population remains in serious need of health care and access to financial assistance programs. During the 11-year interval between surveys, little change occurred in the health care status or use patterns of Wisconsin migrant workers, although housing and sanitary conditions in the work environment improved somewhat due to the passage of new federal regulations. This article discusses the problems and barriers that migrants continue to face and offers recommendations for government action.     

'Between a rock and a hard place': applied anthropology and AIDS research on a commercial farm in Zambia

Fieldwork on a commercial farm in southern Zambia, which was aimed at designing an HIV prevention program for farm workers, gradually exposed the nature of sexual liaisons between young girls, coming to work on the farm from the surrounding villages, and older migrant men workers. Before completing fieldwork, the anthropologist voiced her concern about the implications of these liaisons for the spread of STDs and HIV with the local rural community, farm management and farm workers. The immediate outcome of her intercessions was the decision by management to sack under-age workers. Although some members of the local community, including local research assistants, and some managers and workers welcomed this decision, others were angered by it. Caught between interest groups and conflicting guidelines, the anthropologist, it is argued, was in a no-win situation, 'between a rock and a hard place'. The paper proposes that the application of anthropological ethics in AIDS research needs some re-evaluation.     

FARMEDIC:

Agriculture is an industry that exposes its workers to extensive occupational health and safety risks. National statistics consistently rank agriculture as one of the most hazardous occupations employing a significant number of workers. Agricultural occupational death rates are more than four times the average of all industries, and in recent years, 1800 deaths have occurred annually due to farm and agricultural accidents. Over 25% of the nation's population lives in rural areas. The number of people classified as farmers is about 8 million; however, including the members of the farm family, farm workers and others visiting the farm, well over 25 million individuals are exposed to the hazards of production agriculture on a regular basis. All of these people are exposed to a combination of machinery, respiratory, chemical, animal, and electrical and weather hazards. When rural or farm accidents occur, the emergency responders are generally not well prepared to deal with the aspects of the accidents that are unique to rural America. Rescue workers are trained to respond to urban accidents-automobiles, fires, gunshot, but seldom to tractor, PTO entanglements, pesticide toxicities, and silo fires. Without adequate training, their efforts may either be ineffective or even sometimes add to the extent of injury. In several cases, rescue workers are injured or die because of their lack of knowledge of farm equipment, their dangers, and how to respond.     

Human rights,environmental justice,and the health of farm workers in South Africa

Despite the democratization of South Africa in 1994, which brought the agricultural sector within the ambit of legal protection, farm workers remain vulnerable to an undue burden of social and health problems. Alcohol abuse due to the DOP system, pesticide poisonings, and other occupational hazards illustrate that the likely success of efforts at redress depends on a greater awareness of the rights and justice dimensions of the health problems facing these workers. International trade policies may exacerbate inequalities that deprive them of opportunities to realize their rights at national level. A public health agenda must integrate into programs and policies to address the health of farm workers the recognition that violations of their rights underlie much of their burden of ill health.     

Effect of industrial and socioeconomic factors on morbidity levels with temporary work loss among workers and employees of specialized state farms]

Specialization of the agricultural industry at state farms brings changes into conditions of work, affects the disease incidence involving temporary incapacitation among state farm workers. The sick-rate among those of them who are engaged in dairy and vegetable-growing state farms is higher that among workers of the cattle breeding ones. A higher level complex mechanization of labour-consuming processes in cattle breeding and plant growing mitigates the influence exercised by specialization of the state farm agricultural production. The disease-incidence with temporary incapacitation is affected not only by occupational, but also by non-occupational factors.     

Prologue: agricultural occupational and environmental health: policy strategies for the future

The conference "Agricultural Occupational and Environmental Health: Policy Strategies for the Future" documented for the public record the epidemic of occupational and environmental deaths, diseases, and injuries experienced by America's farm families and agricultural workers. The conference also gave life to a process aimed at reducing those hazards. The outcome of long-range objectives of lowering death, injury, and disease rates in our agricultural population will not be known for several years. However, there was unanimous consensus that the major short-range objectives were achieved. Extensive regional and national media coverage helped meet the goal of facilitating public awareness of the issues. In addition, a prioritized policy agenda, soundly based on recent scientific information, was produced. This agenda was the product of collaboration between the scientific community, farm constituency groups, farm equipment and chemical manufacturers, and representatives from state and federal governments. Primary changes resulting from the conference include an increase in general awareness and a sense of urgency that agricultural health problems must be addressed. In addition, the conference spawned a new organization called the National Coalition for Agricultural Safety and Health (N-CASH) to help assure a vibrant continuation of conference issues. This coalition will live on to help disseminate the spirit, information, and specific policy recommendations of the conference to the public sector and private institutions. Two years of planning and work by 18 individuals occurred even before the start of the conference. During the conference, 176 individuals put in an equivalent of three and a half person years of work. However, the work is just beginning. This effort is justified if it results in one less death or serious injury in a farm family.