Hired crop worker injury risks on farms in the United States during three different periods between 2002 and 2015.

BACKGROUND: Hired crop workers have high incidence of work-related injuries, but little has been documented about potential risks at the national level. METHODS: Data were obtained from a national probability sample of hired crop workers in the United States (U.S.) during 2002-2004 (period I), 2008-2010 (period II), and 2014-2015 (period III). Multivariable logistic regression models of work-related injury were constructed using an occupational exposure adjustment for weeks worked in the previous year. RESULTS: Hired crop workers reporting that their employer did not provide clean drinking water and disposable cups every day were estimated to be at greater odds of injury during all three periods. Having at least some English-speaking ability was associated with increased odds of injury in two periods, while owning a dwelling in the U.S. showed greater injury risk during period II but was associated with lower risk during period III. Other items significantly associated with injury during at least one of the study periods in the final multivariable logistic models included being a direct-hire, a migrant worker, U.S.-born, receiving public aid, and having a health condition. CONCLUSIONS: Hired crop workers are an extremely marginalized population of workers in the U.S. Innovative intervention methods must extend beyond traditional occupational models to focus on the overall health of hired crop workers, including increasing healthcare access, ending agricultural exceptionalism to provide equal regulatory protections afforded to workers in other industries, and adequate enforcement of existing regulations. These findings contribute to the understanding of correlates related to increased work-related injury among hired crop workers, and have implications in fields of prevention, intervention, and policy.

Robot-related fatalities at work in the United States, 1992-2017.

BACKGROUND: Industrial robots became more commonplace in the US workplace during the mid- to latter part of the twentieth century. Recent scientific advances have led to the development of new types of robots, resulting in rapidly changing work environments. Information on occupational robot-related fatalities is currently limited for this developing field. METHODS: Robot fatalities were identified by a keyword search in restricted-access research files from the Census of Fatal Occupational Injuries (CFOI) surveillance system of the Bureau of Labor Statistics from the years 1992-2017. RESULTS: There were 41 robot-related fatalities identified by the keyword search during the 26-year period of this study, 85% of which were males, with the most cases (29%) occurring within the age group 35-44 years. Fatalities occurred primarily with large employers that were geographically clustered, with the Midwest accounting for 46% of the total. Most of the cases involved stationary robots (83%) and robots striking the decedents while operating under their own power (78%). Many of these striking incidents occurred while maintenance was being performed on a robot. CONCLUSIONS: The changing nature of robotics in the workplace suggests that emerging technologies may introduce new hazards in the workplace. Emerging technologies have led to an increase in the number of robots in the workplace and to increased human exposure to robotic machinery. These patterns demonstrate that public health professionals will likely face significant challenges to keep pace with developments in robotics to ensure the safety and health of workers across the country.

Surveillance of acute nonfatal occupational inhalation injuries treated in US hospital emergency departments, 2014-2017.

BACKGROUND: Acute nonfatal occupational inhalation injuries are caused by exposures to airborne toxicants and contaminants in the workplace. A 1990s study found that US emergency department (ED)-based inhalation injury rates were higher than those seen in the United Kingdom and Canada. This study examines 4 years of hospital ED data to estimate current rates of occupational inhalation injuries. METHODS: Data from the National Electronic Injury Surveillance System Occupational Supplement were used to identify nonfatal occupational inhalation injuries treated in US hospital EDs from 2014 to 2017. A workplace inhalation injury was defined as any worker treated in an ED as a result of inhaling a harmful substance at work. RESULTS: From 2014 to 2017, there were an estimated 2.2 occupational inhalation injuries per 10,000 full-time equivalents (FTE) (95% confidence interval [CI]: 1.6-2.8) treated in EDs, a rate nearly four times that found in Bureau of Labor Statistics data. Although men incurred 60% (95% CI: 56%-64%) of the injuries, the overall injury rates for men and women were similar at 2.3 (95% CI: 1.7-2.9) and 2.1 (95% CI: 1.4-2.7) per 10,000 FTE, respectively. By age group, workers less than 25 years of age were at greater risk of injury at 4.1 injuries per 10,000 FTE (95% CI: 2.8-5.3). CONCLUSIONS: These results illustrate the burden of nonfatal occupational inhalation injuries, providing an understanding of how injuries are distributed based on demographics. While inhalation injury rates have declined over the last two decades, additional research is needed to determine whether interventions have reduced risk, or if the availability of alternate sources of medical treatment is a factor.

Hired crop worker injuries on farms in the United States: A comparison of two survey periods from the National Agricultural Workers Survey.

BACKGROUND: Hired crop workers in the United States are at high risk of occupational injury. Targeted surveillance is important for effective occupational safety efforts. METHODS: The National Agricultural Workers Survey was utilized to collect injury data during the years 1999, 2002-2004 (period I) and 2008-2010 (period II). RESULTS: The overall injury rate declined between the two periods from 4.3 to 2.9/100 per full-time week-based equivalents (FTEWB ). Injury rates remained high during both periods for those with greater than 20 years farm experience (3.6 and 3.8/100 FTEWB ) and pesticide handling work (4.9 and 5.0/100 FTEWB ). Overexertion, contact with objects and equipment, and falls from height were common during both periods. Older workers comprised a greater proportion of injury cases in period II. CONCLUSION: Overexertion that leads to sprains/strains, dangerous ladder use, and pesticide use should be targeted as important risk exposures on the farm.

2009 Pandemic influenza A H1N1 in Alaska: temporal and geographic characteristics of spread and increased risk of hospitalization among Alaska Native and Asian/Pacific Islander people.

Alaska Native people have suffered disproportionately from previous influenza pandemics. We evaluated 3 separate syndromic data sources to determine temporal and geographic patterns of spread of 2009 pandemic influenza A H1N1 (pH1N1) in Alaska, and reviewed records from persons hospitalized with pH1N1 disease in 3 areas in Alaska to characterize clinical and epidemiologic features of disease in Alaskans. A wave of pH1N1 disease swept through Alaska beginning in most areas in August or early September. In rural regions, where Alaska Native people comprise a substantial proportion of the population, disease occurred earlier than in other regions. Alaska Native people and Asian/Pacific Islanders (A/PI) were 2-4 times more likely to be hospitalized than whites. Alaska Native people and other minorities remain at high risk for early and substantial morbidity from pandemic influenza episodes. These findings should be integrated into plans for distribution and use of vaccine and antiviral agents.

Impact of hysterectomy and bilateral oophorectomy prevalence on rates of cervical, uterine, and ovarian cancer among American Indian and Alaska Native women, 1999-2004.

OBJECTIVE: To present more accurate incidence rates of cervical, uterine, and ovarian cancer by geographic region in American Indian/Alaska Native (AI/AN) women. METHODS: The authors used data from central cancer registries linked to Indian Health Service (IHS) patient registration database, the Behavioral Risk Factor Surveillance System, IHS National Data Warehouse, and the National Hospital Discharge Survey. Cancer incidence rates were adjusted for hysterectomy and oophorectomy prevalence and presented by region for non-Hispanic White (NHW) and AI/AN women. RESULTS: AI/AN women had a higher prevalence of hysterectomy (23.1%) compared with NHW women (20.9%). Correcting cancer rates for population-at-risk significantly increased the cancer incidence rates among AI/AN women: 43% for cervical cancer, 67% for uterine cancer, and 37% for ovarian cancer. Risk-correction led to increased differences in cervical cancer incidence between AI/AN and NHW women in certain regions. CONCLUSIONS: Current reporting of cervical, uterine, and ovarian cancer underestimates the incidence in women at risk and can affect the measure of cancer disparities. Improved cancer surveillance using methodology to correct for population-at-risk may better inform disease control priorities for AI/AN populations.

Injuries to hired crop workers in the United States: a descriptive analysis of a national probability survey.

BACKGROUND: Little empirical data are available examining the injury experience of hired crop workers in the United States (US). This study analyzed work-related injury data collected on these workers from a national survey. METHODS: Data were collected through the National Agricultural Workers Survey (NAWS) for the federal fiscal years 1999, 2002, 2003, and 2004. These data provided descriptive injury characteristics and rate estimates from a sample of 13,604 crop farm workers. RESULTS: The injury rate was 4.3 injuries per 100 week-based full-time equivalents (FTE(WB) ). The majority of the injuries occurred to male (84%) and Mexican born (72%) workers. Shuttle migrants had the highest injury rate at 7.2 injuries/100 FTE(WB) . Workers reporting one or more health conditions and workers reporting one or more musculoskeletal complaints had higher injury. The most common injury events were overexertion from lifting (20%), being struck by hand held objects (13%), and falls to a lower level (10%). Injuries due to falls to a lower level accounted for the highest average number of restricted workdays (45 days). CONCLUSIONS: The use of hand tools, falls, and lifting overexertion injuries were identified as significant causes of injury among hired crop workers. Increased injury risk was also seen for crop workers with existing health or musculoskeletal complaints. These results are useful for targeting injury prevention efforts and future research needs for this unique worker population. Am. J. Ind. Med. 54:734-747, 2011. © 2011 Wiley-Liss, Inc.

A National Overview of Youth andInjury Trends on U.S. Farms, 2001-2014.

HIGHLIGHTS The total number of injuries to all youth on farms consistently declined during the 14-year period from 2001 to 2014. Injuries to household farm youth, after initial declines, increased in 2012 and 2014. Although progress in farm youth safety has been made, farms continue to be hazardous places for youth. ABSTRACT. The National Institute for Occupational Safety and Health (NIOSH) conducted injury surveillance for youth on U.S. farms for two decades to measure childhood injury burden, track injury trends, and monitor hazardous injury exposures. The Childhood Agricultural Injury Survey (CAIS), a regionally stratified telephone survey, collected injury and demographic data for all youth less than 20 years of age on U.S. farms. Results from the 2014 survey are provided. Trend analyses for all survey years were conducted using a Poisson regression model with generalized estimating equations. Rate ratios with corresponding 95% confidence intervals were calculated from the model. In 2014, there were an estimated 11,942 youth farm injuries. Of these, 63% occurred to household youth. Youth between the ages of 10 and 15 incurred the most injuries, and 34% of the injuries were work-related. The total number of injuries to all youth on farms consistently declined during the 14-year period from 2001 to 2014, with annual injury rates ranging from 13.5 to 5.7 per 1,000 farms. The injury rates for household youth decreased through 2009 but increased slightly in 2012 and 2014. Farms continue to be hazardous environments for youth. Although there has been a significant decrease in the overall numbers and rates of youth farm injuries over the past decades, researchers should continue to monitor areas that remain a concern. One area that is specifically troublesome is the increase in injury rates observed for household youth in 2014.

Injuries and fatalities to U.S. farmers and farm workers 55 years and older.

BACKGROUND: Previous studies have shown that older farmers and farm workers have been identified at high risk for farm fatalities, most notably involving tractor overturns. Older farmers also incur more severe non-fatal injuries. METHODS: Data from two national surveillance systems are presented to describe fatal and non-fatal injuries occurring to older farmers 55+ years of age. Tractor-related fatality investigations for older farmers are examined for characteristics of the tractors not available in the injury surveillance systems. RESULTS: Older farmers and farm workers averaged 26,573 lost-time injuries annually in 2001 and 2004, with an injury rate of 4.5 injuries/100 workers/year compared to an overall farming injury rate of 4.8 injuries/100 workers/year. Fatality data show that older farmers accounted for over half of all farming deaths between 1992 and 2004 (3,671 of 7,064 deaths), and had a fatality rate of 45.8 deaths/100,000 workers/year compared to the overall farming fatality rate of 25.4 deaths/100,000 workers/year. Most common mechanisms of fatal injury to older farmers were "tractors" (46%), "trucks" (7%), and "animals" (5%). CONCLUSIONS: Although older farmers and farm workers are at lower risk of overall injury compared to their younger counterparts, injuries to farmers 55 years and older tend to be much more severe. To effectively minimize the risk faced by older farmers, prevention programs must encourage safe work behaviors and practices and the implementation/installation of appropriate safety devices and equipment.

National Estimates of Youth and Injuries on U.S. Farms, 2012.

The National Institute for Occupational Safety and Health (NIOSH), in order to provide injury surveillance for youth on farms in the U.S., partnered with the USDA to conduct the Childhood Agricultural Injury Survey (CAIS). CAIS data for all farm youth less than 20 years of age have been collected intermittently since 1998. CAIS data from 2012 indicated that an estimated 25.9 million youth lived on, worked on, or visited U.S. farms. These youth experienced almost 14,000 injuries while on the farm. The majority of these injuries occurred to males (7,290) and youth between the ages of 10 and 15 years (5,766). Approximately 20% (2,739) of the injuries were related to work being done on the farm. Youth living on the farm incurred 56% (7,784) of the injuries. An additional 5,771 injuries occurred to hired and visiting youth. Although youth injuries on farms have declined, the numbers are still unacceptably high. Additional research and detailed assessments of subsets of the youth population would help to better direct safety intervention programs and focus future research activities.

Prevalence of Borrelia burgdorferi in small mammals in New York state.

Intensive small mammal trapping was conducted in 12 counties in New York state during 1998-2000 to investigate the prevalence and site specificity of the Lyme disease spirochete, Borrelia burgdorferi in, and presence of the blacklegged tick, Ixodes scapularis Say on, the wild mice Peromyscus leucopus Rafinesque and Peromyscus maniculatus Wagner and other small mammal species. Previously captured mice (1992-1997) from throughout New York state also were recruited into the study, providing a total of 3,664 Peromyscus from 107 sites in 31 counties. Infection with B. burgdorferi was determined by polymerase chain reaction testing of ear tissue, and rates were determined by species, counties, and regions of the state. B. burgdorferi was detected in 10 small mammal species captured during 1998-2000. Peromyscus captured from Dutchess County in the lower Hudson Valley had the highest infection rate of 21%. The next highest infection rates were in counties within the Capital District: Albany (18%), Rensselaer (17%), and Columbia (13%). From 4,792 small animals examined, we recovered 2,073 ticks representing six species from 414 individuals of 12 mammal species, including 1,839 I. scapularis collected from 315 Peromyscus trapped in five counties. I. scapularis were most often collected from animals trapped in Albany, Rensselear, and Dutchess counties. We used protein electrophoresis of salivary amylase to distinguish between P. leucopus and P. maniculatus species. I. scapularis burdens were 5.7 ticks per P. leucopus and 14.3 ticks per P. maniculatus.

Small-area variations in conviction rates for DWI: the significance of contextual variables in a Southwestern state.

Average annual conviction rates (1990-2000) of people arrested for driving under the influence of alcohol in each of New Mexico's 33 counties are described. Conviction rates vary from 58 to 95%. Rates are correlated with political conservatism, being higher where a higher proportion of voters voted for the republican presidential candidates, and with measures of crowding in the courts. Conviction rates are higher in rural than urban areas and are correlated with a low prevalence of alcohol-related problems in the population. The variance in conviction rates is higher in rural than urban areas, and higher where measures of court crowding are low. The results suggest that political culture and the efficiency of court functioning are each independently associated with conviction rates for DWI and may also be associated in a reciprocal fashion with both low DWI arrest rates and alcohol-involved crash rates.

Nonfatal all-terrain vehicle-related injuries to youths living on farms in the United States, 2001.

CONTEXT: Use of all-terrain vehicles (ATVs) in agriculture appears to be growing. PURPOSE: To provide estimates of ATV ownership and exposure on US farms and an overview of injuries to youths as a result of ATV use on the farm in 2001. METHODS: Analysis of the National Institute for Occupational Safety and Health and US Department of Agriculture 2001 Childhood Agricultural Injury Survey. These data, collected via telephone surveys, provide information on nonfatal injuries that occurred to youths younger than 20 years living on US farms during 2001. The injuries included both occupational and nonoccupational incidents. FINDINGS: Of an estimated 1.1 million youths living on farms, 36% had operated an ATV in 2001. Youths younger than 16 years were more likely to have operated an ATV than a tractor on these farms. An estimated 2,246 nonfatal ATV-related injuries occurred to youths younger than 20 years on US farms during 2001. The majority of these ATV injuries (1,668, 74%) occurred to youths identified as members of the household. Males accounted for 1,145 (69%) of the ATV injuries to household youths. The majority of the injuries were to youths aged 10-15 years (1,170, 70%). Most ATV injuries were the result of recreational activities (970, 58%). In addition, many of these injury events involved youths riding without helmets and using ATVs that were larger than the recommended size for their age.

Household youth on minority operated farms in the United States, 2000: exposures to and injuries from work, horses, ATVs and tractors.

INTRODUCTION: It is likely that youth living on minority operated farms (<3% of U.S. farms) face hazards similar to the general farm population; however, since minority youth are not well represented by general farm surveys, this information hasn't been confirmed. METHOD: Nonfatal injury and exposure data were obtained from the 2000 Minority Farm Operator Childhood Agricultural Injury Survey (M-CAIS). RESULTS: On racial minority farms, there were an estimated 28,600 household youth. Of these, about 41% worked, 26% rode a horse, 23% drove an ATV, and 23% operated a tractor. On Hispanic farms, there were an estimated 17,998 household youth. Of these, 44% worked, 30% rode a horse, 27% drove an ATV, and 25% operated a tractor. CONCLUSIONS: These results show the value of conducting a survey of minorities to identify high risk groups and target issues that may be unique to the minority farm population.

New Mexico's 1998 drive-up liquor window closure. Study I: effect on alcohol-involved crashes.

AIMS: To determine the spatial relationship between drive-up liquor window locations and alcohol-related traffic crashes for 2 years before and after New Mexico banned drive-through alcohol sales. DESIGN: Current liquor licenses, crash data, roadway information and US Census data were used in this analysis. Cross-sectional and longitudinal regression analyses were applied to the entire state, and to Albuquerque only. FINDINGS: Of all NM liquor licenses, 189 (9%) included drive-up sales, which co-occurred with on- or off-premise licenses (94%). The rate of non-pedestrian alcohol-related crashes relative to non-pedestrian total crashes showed an increasing trend prior to closure and a decreasing trend after the closure. Cross-sectional analyses in Albuquerque revealed that the percentage of alcohol-involved crashes was not related to densities of on- or off-premise outlets per kilometer of roadway, or to percentage of drive-up outlets. Statewide, the percentage of drive-up outlets was not significantly related to the percentage of alcohol-related crashes within census tracts but was associated positively with the percentage of alcohol-related crashes in surrounding census tracts. There was no statistically significant relationship between number of drive-ups and percentage of alcohol-related crashes in either longitudinal model. CONCLUSIONS: Despite the declining rate of alcohol-related crashes following closure of drive-up liquor windows, both in Albuquerque and statewide, regression models using spatial data do not demonstrate definitively an association between the decline and the closure of the drive-up liquor windows.

Influenza surveillance using electronic health records in the American Indian and Alaska Native population.

OBJECTIVE: Increasing use of electronic health records (EHRs) provides new opportunities for public health surveillance. During the 2009 influenza A (H1N1) virus pandemic, we developed a new EHR-based influenza-like illness (ILI) surveillance system designed to be resource sparing, rapidly scalable, and flexible. 4 weeks after the first pandemic case, ILI data from Indian Health Service (IHS) facilities were being analyzed. MATERIALS AND METHODS: The system defines ILI as a patient visit containing either an influenza-specific International Classification of Disease, V.9 (ICD-9) code or one or more of 24 ILI-related ICD-9 codes plus a documented temperature ≥100°F. EHR-based data are uploaded nightly. To validate results, ILI visits identified by the new system were compared to ILI visits found by medical record review, and the new system's results were compared with those of the traditional US ILI Surveillance Network. RESULTS: The system monitored ILI activity at an average of 60% of the 269 IHS electronic health databases. EHR-based surveillance detected ILI visits with a sensitivity of 96.4% and a specificity of 97.8% based on chart review (N=2375) of visits at two facilities in September 2009. At the peak of the pandemic (week 41, October 17, 2009), the median time from an ILI visit to data transmission was 6 days, with a mode of 1 day. DISCUSSION: EHR-based ILI surveillance was accurate, timely, occurred at the majority of IHS facilities nationwide, and provided useful information for decision makers. EHRs thus offer the opportunity to transform public health surveillance.

Nonfatal injuries to household youth on Native American operated farms in the U.S., 2000.

In 2000, there were an estimated 7,381 youth living on 9,556 U.S. farms operated by Native Americans. Most of these youth (5,454, 74%) lived on livestock operations (6,833 farms, 72%). In that year, youth living on Native American operated farms sustained an estimated 177 nonfatal injuries. The majority of all injuries to household youth (147, 83%) occurred on livestock operations. Males accounted for 112 (63%) of the injuries to household youth. Overall, household youth on Native American operated farms had an injury rate of 24.0 injuries per 1,000 household youth compared to a rate of 8.1 injuries per 1,000 household youth on all other minority-operated farms. The rate ratio for work-related injuries to household youth on Native American farms compared to other minority-operated farms was 2.1. Although female youth on these farms experienced a similar non-work injury rate of 13.8 injuries per 1,000 female household youth compared to a rate of 15.1 injuries per 1,000 male household youth, the work-related injury rate for male youth (30.2 per 1,000 male household youth) was substantially higher than the work-related injury rate for female household youth (18.3 per 1,000 female household youth). These data indicate an elevated risk of injury for youth living on farms operated by Native Americans. This result is attributed to the large percentage of livestock operations for this population and the hazards associated with this type of farming. However, further research is needed to more fully understand these results and to guide culturally appropriate interventions within this population.

Injuries to youth living on U.S. farms in 2001 with comparison to 1998.

To obtain sustained injury surveillance data for youth on farms, the National Institute for Occupational Safety and Health developed the Childhood Agricultural Injury Survey (CAIS) in collaboration with the U.S. Department of Agriculture. The first CAIS collected data for youth less than 20 years in 1998 through a regionally stratified telephone survey of 50,000 U.S. farm households; a second CAIS for 2001 was conducted using the same methodology. In 2001, there were approximately 1.2 million youth living on U.S. farms. These youth suffered an estimated 19,397 injuries (15.7/1,000 household youth). Approximately 60% (11,571) of the household youth injuries were to males. For all household youth, 10-15 year olds experienced the most injuries (49%, 9,486). In addition to providing estimates of demographics, injuries, and injury rates for household youth from the 2001 CAIS, this article provides a comparison to results from the 1998 CAIS. The number of household youth injuries on farms from 1998 to 2001 decreased by almost 30% (27,321 vs. 19,397). The results of this study show an overall decrease in the injury rate for youth living on the farm from 1998 to 2001 (18.8/1,000 household youth vs. 15.7/1,000 household youth). However, there was a considerable increase in the number of injuries to household females less than 20 years of age during this same time period. There was also an increase in the number of all terrain vehicle (ATV) and horse-related injuries. Continued surveillance is needed to assess if these are significant trends or the result of changing farm demographics.

Occupational injury mortality surveillance in the United States: an examination of census counts from two different surveillance systems, 1992-1997.

BACKGROUND: The surveillance of occupational injury mortality in the United States has evolved over the last century. Currently there are two different data sources used for the study of occupational injury mortality. Each system varies in methodology, leading to different census counts. We provide an overview and analysis of similarities and differences in these two systems. METHODS: The National Traumatic Occupational Fatalities (NTOF) surveillance system and the Census of Fatal Occupational Injuries (CFOI) were examined for civilian deaths at work in the United States from 1992 to 1997. RESULTS: There were 31,643 occupational injury mortality cases according to NTOF and 37,023 from CFOI for civilian workers 16-years and older in the United States for the 6-year period of analysis. The annual average occupational injury mortality rates were 4.5 per 100,000 full time equivalent workers from NTOF and 5.2 from CFOI. The higher capture rate by CFOI was consistent across each of the 6 years. Similar patterns for demographics, industry, and occupation, and type of incident were seen for both systems. CONCLUSIONS: While NTOF provides more years of data dating back to 1980, CFOI (established in 1992) provides a more comprehensive capture of occupational injury mortality and provides greater detail of the mortality incidents. The overall injury mortality patterns, however, appear to be similar between the systems.

Nonfatal occupational injuries from slips, trips, and falls among older workers treated in hospital emergency departments, United States 1998.

BACKGROUND: Falls are a leading cause of injury among older adults. As the workforce demographics shift to an older population, the dearth of information on occupational falls among older adults must be addressed. METHODS: A national probability sample of hospital emergency departments (EDs) (National Electronic Injury Surveillance System) was utilized to characterize falls at work. RESULTS: Older workers were found not to be at increased risk of a fall injury, but were more likely than younger workers to be hospitalized post-injury. Same-level falls were the most common type of incident among older workers. Falls from height were more prevalent among men than women. The narrative case descriptions for same-level falls to the floor primarily implicated floor contamination and tripping hazards. CONCLUSIONS: Fall prevention programs targeted to older workers must examine extrinsic sources of falls, particularly surface traction, contaminant control, and footwear.