Injury, Musculoskeletal Symptoms, and Stress as a Function of Aging in Agricultural Operators in the Central United States.

BACKGROUND: Studies show conflicting evidence on the association of age and occupational injury in agriculture, and few studies have addressed the effect of age on work-related chronic conditions or preventive practices among farmers. METHODS: We examined the probability of injury, work-related stress, musculoskeletal symptoms (MSS), and preventive practices for MSS as a function of aging using surveillance data of 7,711 farm and ranch operators in the central United States. FINDINGS: Segmented regression analyses of men (85% of sample) indicated that the probability of all four outcomes increased up to a certain age and then decreased; the changepoints in years of age being 59.6 for injury, 55.4 for work-related stress, 59.6 for MSS, and 67.9 for MSS preventive practices. Female operators had an increasing trend for stress up to age 29.7, while they showed no changepoints across their age spectrum in the proportion of injury, MSS, and prevention techniques. CONCLUSION/APPLICATION TO PRACTICE: These findings emphasize the need for preventive efforts particularly among younger and middle-aged farmers and ranchers, and the need to modify work duties to match work abilities at older ages.

County-level analysis on occupation and ecological determinants of child abuse and neglect rates employing elastic net regression.

BACKGROUND: Occupation is a known determinant of worker physical and behavioral health risk, yet most previous studies have focused on unemployment, underemployment, and job satisfaction to understand child maltreatment risk. OBJECTIVE: This county-level study (n = 278) investigated the association between occupation and child maltreatment rates and community well-being in California, Colorado, Minnesota, Oregon, and New Mexico. PARTICIPANTS AND SETTING: States were selected due to having comparable, publicly available county-level data on substantiated child abuse and neglect rates within a five-year span between 2015 and 2020. METHODS: Using US Census Bureau American Community Survey data, we collected percentages of the employed population among 13 occupations. Five additional community health indicators came from the County Health Rankings and Roadmaps. Elastic net linear regression was used for variable selection and because of explanatory variables' interrelationships. Linear regression was used to model individual industries positively associated with child abuse rates. RESULTS: The elastic net model selected ten important variables in explaining child maltreatment rates. Important occupational sectors were agriculture, forestry, fishing (AFF), manufacturing, wholesale, retail, finance, and education. Important community indicators included housing, injury deaths, and poor mental health days. Only AFF and retail showed greater child abuse rates with increasing percentages of the workforce in these occupations in unadjusted models (AFF: ß = 0.03 SE = 0.01, p = 0.02; Retail: ß = 0.09 SE = 0.04, p = 0.02). CONCLUSIONS: Our findings suggest group-level effects of counties with a larger AFF and retail presence experiencing higher child maltreatment rates. Given that numerous prior studies of county economies note the strong associations of certain employment types with cultural attitudes, educational opportunities, regional biases, and other unmeasured variables, future studies should incorporate individual level data in a multilevel framework.

Agricultural Injuries: Risk Factors and Severity by Affected Body Part among US (Midwest) Farmers.

OBJECTIVES: Statistics from the United States Bureau of Labor Statistics indicate that agriculture consistently ranks as the most hazardous industry in the US. To identify specific targets for prevention, we investigated injury risk factor profiles separately for each injured body site. We also characterized the severity of agricultural injuries by injured body site using the type of medical care and lost work time due to injury. METHODS: We used the Central States Center for Agricultural Safety and Health (CS-CASH) surveillance data for 2018 to perform descriptive statistics and regression modeling. RESULTS: We found that 12% (513/4351) of the participants experienced one or more injuries in the previous 12 months. Compared to female operators, male operators had 3.53 (95% CI: 1.17-10.68) times higher odds of back injury. Operators in livestock production had 2.77 times (95% CI:1.12-6.82), 2.28 times (95% CI:1.25-4.14), and 1.69 times (95% CI:1.10-2.59) higher odds of injury to the chest/trunk, finger, and leg/knee/hip, respectively, compared to operators in crop or mixed production. After adjusting for age and gender, operators who worked full time (vs. part-time) on the farm/ranch had 2.11 times (95% CI:1.03-4.34) higher odds of back injury. Arm/shoulder and leg/knee/hip injuries were more frequent in older age groups. CONCLUSIONS: Prevention measures should be tailored considering specifically livestock producers with emphasis on trainings on proper livestock handling, such as being gentle, establishing routine, keeping distance, and avoiding sudden and loud noise when handling animals. Applying these techniques avoid startling the animals and reduce the risk of injuries.

Estrogen-DNA Adducts and Breast Cancer Risk in Premenopausal Asian Women.

The incidence of breast cancer among premenopausal women has been increasing rapidly in recent decades in East Asia. This case-control study investigated whether estrogen-DNA adducts were associated with breast cancer risk in Taiwan. The control group (n = 146) comprised healthy female volunteers and women with non-proliferative breast disease. The case group (n = 221) comprised women either with proliferative benign breast disease or breast cancer. The ratios of estrogen-DNA adducts to their respective metabolites and conjugates in plasma were analyzed using ultraperformance LC/MS-MS. The SNPs of CYP1A1, CYP1B1, and COMT were genotyped. Logistic regression model was used to compare the estrogen-DNA adduct ratios between the two groups. The estrogen-DNA adduct ratio in the case group was significantly higher than that in the control group (median ratio: 58.52 vs. 29.36, P = 0.004). A multiple logistic regression model demonstrated that a unit increase in the natural log of the estrogen-DNA adduct ratio in premenopausal women was a significant predictor of breast cancer risk, with an estimated hazard ratio of 1.718 (1.444-2.046, P < 0.001). However, the CYP1A1, CYP1B1, and COMT SNPs were not associated with the estrogen-DNA adduct ratios. In conclusion, plasma estrogen-DNA adduct ratio was associated with the presence of breast cancer or proliferating benign breast disease in premenopausal women in Taiwan. PREVENTION RELEVANCE: This study provides evidence that endogenous estrogen-induced genotoxicity may contribute to the carcinogenesis of breast cancer in premenopausal Asian women. This work could have important preventive implication for the emerging disease in East Asia.

The NIOSH Agricultural Centers' YouTube Channel: Time Series Modeling of Viewership of Agricultural Health and Safety Videos.

We sought to understand the mechanism underlying the growth trajectory in the United States Agricultural Safety and Health Centers YouTube channel. We also explored the benefits and limitations of using YouTube analytics to evaluate the impacts of public health interventions involving YouTube. Time series analysis of total views, total watch hours, average duration of watch time, and number of subscribers were assessed to determine the monthly patterns of non-seasonal and seasonal components in the data from 2013 to 2020. Health, safety, and animal handling video views were summarized descriptively across time and season. Lastly, time series regressions were used to determine the type of video that best predicted growth in the channel viewership metrics. The time series were not random but could be explained by autoregressive and moving average correlation structures. Health videos were the strongest predictors of future growth but were not the most watched type of video. Strong seasonality components indicated that videos were most watched during periods of high agricultural activity, but less so during the winter months. Generally, growth in YouTube viewership metrics was explained by past month viewership predicting future viewership. Outreach and media content may produce spikes of increased interest, but in order to sustainably grow the channel over time, Ag Centers and other agricultural stakeholders should continue to focus on the value of particular content to potential viewers, how and when content is released, and strategic promotion of the channel and its videos.

Occupational stress among farm and ranch operators in the midwestern United States.

BACKGROUND: This study used surveillance data from 2018 and 2020 to test the stability of work-related strain symptoms (high stress, sleep deprivation, exhaustion) with demographic factors, work characteristics, and musculoskeletal symptoms among farm and ranch operators in seven midwestern states of the United States. METHODS: Cross-sectional surveys were conducted among farm and ranch operators in 2018 (n = 4423) and 2020 (n = 3492). Operators were asked whether, in the past 12 months, they experienced extended work periods that resulted in high stress levels, sleep deprivation, exhaustion/fatigue, or other work-related strain symptoms. Covariates included personal and demographic factors, work characteristics, number of injuries, work-related health conditions, and exposures on the operation. Summary statistics were tabulated for explanatory and outcome variables. The classification (decision) tree approach was used to assess what variables would best separate operators with and without reported strain symptoms, based on a set of explanatory variables. Regularized regression was used to generate effect estimates between the work strain variables and explanatory variables. RESULTS: High stress level, sleep deprivation, and exhaustion were reported more frequently in 2018 than 2020. The classification tree reproduced the 2018 model using 2020 data with approximately 80% accuracy. The mean number of reported MSD symptoms increased slightly from 1.23 in 2018 to 1.41 in 2020. Older age, more time spent in farm work, higher gross farm income (GFI), and MSD symptoms in six body regions (ankles/feet, knees, lower back, neck, shoulders, wrists/hands) were associated with all three work strain symptoms. CONCLUSIONS: Musculoskeletal pain and discomfort was a strong predictor for stress, sleep deprivation, and exhaustion among farmers and ranchers. This finding indicates that reducing MSD pain and discomfort is beneficial for both physical and mental health.

Assessing Nonresponse Bias in Farm Injury Surveillance Data.

HIGHLIGHTS: Despite a response rate of about 18%, there was scant evidence of nonresponse bias. Farm and ranch characteristics of operations responding to a mailed survey were similar to those not responding. Responders were significantly more likely to be married but only slightly older and more educated than nonresponders. Earlier survey responders reported more injuries and greater severity when injured compared to later responders. ABSTRACT: Nonresponse bias in a survey can result in misleading estimates of agricultural injuries and can misdirect prevention efforts aimed at reducing the burden of injuries on farmers. Responders (n = 2,977) and nonresponders (n = 13,849) were compared based on demographics and agricultural production characteristics to identify underrepresented subgroups. Injury characteristics were compared between early (n = 1,667) and late (n = 1,309) responders. Methods accounted for correlated data, sample size inflation of p-values, and assessment of meaningful differences. Few differences were identified between responders and nonresponders. Responders differed from nonresponders by state of residence, and responders were more likely to be married. Other characteristics (age, gender, education, farm size, crops grown, animals raised) were similar across groups. Early responders reported more injuries and more often sought medical care for an injury than late responders. The differences identified between responders and nonresponders were minimal and not likely to create bias. Differential reporting of injury and injury severity between early and late responders is worthy of further investigation.

Understanding the Impact of Seeing Gun Violence and Hearing Gunshots in Public Places: Findings From the Youth Firearm Risk and Safety Study.

There is a current public health emphasis on finding strategies for reducing the risks associated with children's gun violence exposure. This article examines the impact of seeing and hearing gun violence on youth of different ages and living in urban and nonurban areas. Participants were 630 youth, aged 2 to 17. Youth, ages 10 to 17, completed a self-report survey, and caregivers of young children, ages 2 to 9, completed the survey as a proxy for that child. Participants resided in Boston, MA; Philadelphia, PA; and rural areas of eastern TN. Participants were recruited through a variety of techniques including pediatric clinics, housing authorities, youth-serving agencies, festivals, word of mouth, and local e-mail lists for classified advertisements. Data were collected between October 2017 and April 2018 and analyzed in 2019. In total, 41% of youth in this study reported ever seeing or hearing gun violence; 32% had such an experience in the past year. Among exposed youth, 50% took protective action to keep themselves safe, and 58% reported being very or extremely afraid, sad, or upset as a result of the indirect gun violence. More youth living in urban compared with nonurban areas took some protective action. Females and younger children had increased odds of experiencing high fear as a result of the violence. Current gun violence prevention has typically targeted adolescents; however, current findings suggest the need to focus on younger children as well, including the distress resulting from indirect exposure to gun violence.

Assessing Connections in an Agricultural Community Using Social Network Analysis.

Agricultural workers experience higher rates of injury and illness than other occupational groups. NIOSH-supported agricultural centers in the U.S. are funded to reduce injury and illness but require effective partnerships with other agricultural organizations to achieve this goal. Our purpose was to understand the structure of agricultural organization connections within six states in the western U.S., including how different types of organizations connect to one another, and specifically where the High Plains Intermountain Center for Agricultural Health and Safety (HICAHS) is positioned in the agricultural organization network. An electronic survey was distributed to contacts within organizations that had a previous history with HICAHS leadership and advisory board members. The survey asked respondents about their position in the organization, years with the organization and frequency of contact in the past year. A social network analysis was undertaken to assess the connections between agricultural organizations using measures of centrality (density, closeness, betweenness), cliques, clusters, and brokers. A two-tier structure was identified with a core group of 21 organizations and a peripheral group of 30 organizations. Influence was centered in the core group as evidenced by high centrality scores with minimal bridging between organizations. HICAHS was on the periphery, but on the cusp of being in the core. Agricultural producers, agricultural extension and insurance companies were central in the network. Centers are in a unique position to promote collaboration with stakeholders. The social network analysis identified missing connections that need further development in order to address agricultural safety and health.

Gun Violence Exposure and Posttraumatic Symptoms Among Children and Youth.

Although statistics on youth homicide and injury from gun violence are available, little research has focused on how gun violence overlaps with other victimizations or on the psychological impact of gun violence on children. Pilot survey data were collected on the experiences of 630 U.S. children (age range: 2-17 years) from Boston, Philadelphia, and rural areas of eastern Tennessee. Youth aged 10-17 years completed a self-report survey on a wide range of gun violence exposures, and parents of younger children (aged 2-9 years) completed the survey as a proxy for that child. Direct gun violence exposure, witnessing gun violence, and hearing gunshots were all significantly associated with other forms of victimization, rs = .10-.38, p < .001. The findings suggest that youth who experience direct gun violence are often exposed to multiple violent contexts. For older youth (ages 10-17 years) polyvictimization was most strongly associated with posttraumatic symptoms, ß = .35, p < .001, although witnessing gun violence still uniquely predicted a higher level of symptoms, ß = .18, p < .01. For younger children (ages 2-9 years), hearing and witnessing gun violence were both related to posttraumatic symptoms, ß = .15, p < .01 for both, even after controlling for polyvictimization. Mental health professionals and trauma-informed services should be mindful that the traumatic impact of gun violence for children may not necessarily be attached to direct victimization experiences but may also result from simply seeing or hearing it in their neighborhoods.

Perceived health, medical, and psychiatric conditions in individual and dual-use of marijuana and nonprescription opioids.

OBJECTIVE: Marijuana and nonprescription opioids remain the two most commonly used illicit substances in the United States. They have commonalities, yet the use of both at the same time may have a greater impact on psychological and health outcomes. Research is needed to determine whether dual-use is associated with more negative outcomes than individual substance use. METHOD: We used the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC) Wave 1 (W1; N = 43,093), Wave 2 (W2; N = 34,653), and the more recent NESARC-III (N3; N = 36,171) to compare nonuse with use of marijuana, nonprescription opioids, or both. We examined perceived health, pain interference, pain-related medical conditions, psychiatric conditions, and suicidality. RESULTS: Individual use and dual-use were more common in N3 than in W1. W1 dual-use and nonprescription opioid-only use predicted worse outcomes for most variables prospectively and cross-sectionally, including pain interference and poorer general health. Associations between marijuana-only use and outcomes were not as strong; however, marijuana was associated with depression and suicidal ideation. CONCLUSION: Nonprescription opioid use is concerning with dual-use predicting poorer perceived health and pain interference with work 3 years later along with strong relationships to suicidality and psychiatric conditions. Marijuana and nonprescription opioid dual-use is a possible treatment target. Substance interventions may be enhanced by addressing alternative pain care; chronic conditions; and/or psychiatric comorbidity. Differences in outcomes between substance use and nonuse were smaller recently in N3, particularly for marijuana use only. This may be due to increased access decreasing differences between those using and not using these drugs. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Comparisons of Cocaine-Only, Opioid-Only, and Users of Both Substances in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

BACKGROUND: Cocaine and opioid co-use is a notable public health concern, but little is known about correlates of this behavior. Most prior findings come from treatment samples and concern cocaine and heroin. Findings from a nationally representative sample involving primarily prescription opioid misuse would expand knowledge. METHODS: Past-12-month cocaine and/or opioid users in Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) formed the sample (N = 839). Cocaine-only, opioid-only, and cocaine/opioid co-users were compared regarding sociodemographics, other substance involvement, psychiatric, and medical conditions/events. RESULTS: Opioid-only users were the largest group (n = 622), followed by cocaine-only (n = 144) and co-users (n = 73). The vast majority of opioid misuse was of prescription opioids (1.4% with past-12-month use of heroin). Notably, co-users did not differ from single drug users in frequency of use of either drug. Co-users did not have significantly greater incidence of any psychiatric conditions, medial conditions, or events. In preliminary analyses, co-users were more likely than either single use group to report several classes of other drug use. However, for most comparisons, opioid use did not add substantial risk beyond cocaine use. Differences on multiple sociodemographic variables suggested opioid-only users were at lowest risk of negative outcomes. These results may relate to a finding that opioid-only users were less likely to have sought treatment. CONCLUSIONS/IMPORTANCE: This sample of past-12-month cocaine and/or opioid users had greater involvement with other substances, more psychiatric and medical conditions compared to the general population. Co-users had greater involvement with other substances than opioid-only users in particular.

Environmental exposure to manganese in air: Associations with tremor and motor function.

BACKGROUND: Manganese (Mn) inhalation has been associated with neuropsychological and neurological sequelae in exposed workers. Few environmental epidemiologic studies have examined the potentially neurotoxic effects of Mn exposure in ambient air on motor function and hand tremor in adult community residents. Mn exposed residents were recruited in two Ohio towns: Marietta, a town near a ferro-manganese smelter, and East Liverpool, a town adjacent to a facility processing, crushing, screening, and packaging Mn products. METHODS: Chronic (≥ 10 years) exposure to ambient air Mn in adult residents and effects on neuropsychological and neurological outcomes were investigated. Participants from Marietta (n=100) and East Liverpool (n=86) were combined for analyses. AERMOD dispersion modeling of fixed-site outdoor air monitoring data estimated Mn inhalation over a ten year period. Adult Mn-exposed residents' psychomotor ability was assessed using Finger Tapping, Hand Dynamometer, Grooved Pegboard, and the Computerized Adaptive Testing System (CATSYS) Tremor system. Bayesian structural equation modeling was used to assess associations between air-Mn and motor function and tremor. RESULTS: Air-Mn exposure was significantly correlated in bivariate analyses with the tremor test (CATSYS) for intensity, center frequency and harmonic index. The Bayesian path analysis model showed associations of air-Mn with the CATSYS non-dominant center frequency and harmonic index; while the Bayesian structural equation model revealed associations between air-Mn and lower Finger Tapping scores. Household income was significantly associated with motor dysfunction but not with tremor. CONCLUSION: Tremor and motor function were associated with higher exposure to airborne Mn.

Assessing the connection between organophosphate pesticide poisoning and mental health: A comparison of neuropsychological symptoms from clinical observations, animal models and epidemiological studies.

Psychiatry and psychology are beginning to recognize the importance of lead, mercury and heavy metals as causal partners in the development of mental disorders. Further, mental health researchers and clinicians are embracing the idea that the combined effects of genetics and environmental exposures can result in perturbations in brain neurochemistry leading to psychiatric disorders. The purpose of this review is to examine the biological foundations for the epidemiological observations previously identified by reviewing the toxicology literature and relating it to epidemiological studies addressing the role of poisoning with organophosphate pesticides (OPs) in neurobehavioral and neuropsychological disorders. The goal of this review is to raise awareness in the mental health community about the possibility that affective disorders might be the result of contributions from environmental and occupational pesticide poisoning.

Characterization of air manganese exposure estimates for residents in two Ohio towns.

This study was conducted to derive receptor-specific outdoor exposure concentrations of total suspended particulate (TSP) and respirable (dae ≤ 10 µm) air manganese (air-Mn) for East Liverpool and Marietta (Ohio) in the absence of facility emissions data, but where long-term air measurements were available. Our "site-surface area emissions method" used U.S. Environmental Protection Agency's (EPA) AERMOD (AMS/EPA Regulatory Model) dispersion model and air measurement data to estimate concentrations for residential receptor sites in the two communities. Modeled concentrations were used to create ratios between receptor points and calibrated using measured data from local air monitoring stations. Estimated outdoor air-Mn concentrations were derived for individual study subjects in both towns. The mean estimated long-term air-Mn exposure levels for total suspended particulate were 0.35 µg/m³ (geometric mean [GM]) and 0.88 µg/m³ (arithmetic mean [AM]) in East Liverpool (range: 0.014-6.32 µg/m³) and 0.17 µg/m³ (GM) and 0.21 µg/m³ (AM) in Marietta (range: 0.03-1.61 µg/m³). Modeled results compared well with averaged ambient air measurements from local air monitoring stations. Exposure to respirable Mn particulate matter (PM10; PM <10 µm) was higher in Marietta residents.

Environmental exposure to manganese in air: Associations with cognitive functions.

Manganese (Mn), an essential element, can be neurotoxic in high doses. This cross-sectional study explored the cognitive function of adults residing in two towns (Marietta and East Liverpool, Ohio, USA) identified as having high levels of environmental airborne Mn from industrial sources. Air-Mn site surface emissions method modeling for total suspended particulate (TSP) ranged from 0.03 to 1.61 µg/m(3) in Marietta and 0.01-6.32 µg/m(3) in East Liverpool. A comprehensive screening test battery of cognitive function, including the domains of abstract thinking, attention/concentration, executive function and memory was administered. The mean age of the participants was 56 years (±10.8 years). Participants were mostly female (59.1) and primarily white (94.6%). Significant relationships (p<0.05) were found between Mn exposure and performance on working and visuospatial memory (e.g., Rey-O Immediate ß=-0.19, Rey-O Delayed ß=-0.16) and verbal skills (e.g., Similarities ß=-0.19). Using extensive cognitive testing and computer modeling of 10-plus years of measured air monitoring data, this study suggests that long-term environmental exposure to high levels of air-Mn, the exposure metric of this paper, may result in mild deficits of cognitive function in adult populations.

Breast health and reducing breast cancer risk: a functional medicine approach.

BACKGROUND/OBJECTIVE: A functional medicine approach to reduce breast cancer risk is preferable to early detection and treatment in maintaining breast health. Estrogens are implicated in breast cancer initiation through conversion to metabolites that react with DNA to form specific adducts associated with the development of breast cancer. The purpose of this study was to determine the ability of a defined clinical intervention, the AVERTi-Healthy Breast Program (AHBP), to reduce breast cancer risk conditions likely to develop into breast disease. METHODS: To obtain evidence that risk conditions in breast tissue can be reduced with a defined, multifaceted approach, this small clinical trial of 21 women measured indicators of breast health. A detailed clinical evaluation was conducted with all participants, including identification of physical symptoms, such as areas of tenderness upon palpation. Two laboratory assessments were conducted to determine the efficacy of the AHBP. First, 31 estrogen metabolites, estrogen conjugates, and depurinating estrogen-DNA adducts in urine samples taken before intervention were analyzed. The ratio of DNA adducts to metabolites and conjugates was calculated for each sample. Second, oxidative stress was analyzed by measuring the redox potential of glutathione and cysteine in blood plasma. All assessments were conducted before and after participation. RESULTS: The estrogen adduct ratio and redox potential were improved after 90 days on the AHBP. A significant mean reduction of 3.31 (p=0.03) was observed in the adduct ratio, along with a significant improvement in the redox potential of 3.80 (p=0.05). The significant change in the adduct ratio occurred in women whose oxidative stress profile also improved. CONCLUSION: These significant within-individual decreases suggest that the AHBP can reduce the risk for breast cancer in a relatively short time.