A cross-sectional study assessing concordance with advance care directives in a rural health district.

OBJECTIVE: To measure compliance with Advance Care Directives (ACDs) for decedents in a rural setting. DESIGN: Observational, cross-sectional medical records audit comparing requests in ACDs with actual outcomes. SETTING: Rural Australian coastal district. PARTICIPANTS: People who had an ACD, died during the study period (30 May 2020 to 15 December 2021) and participated in a local research project. MAIN OUTCOME MEASURE(S): Compliance was measured by comparing stated requests in the ACD with outcomes recorded in medical records. This included the place of death and a list of 'unacceptable interventions'. RESULTS: Sixty-eight people met the inclusion criteria (age range of 46-92 [mean 67 years; median 74 years]; 42 [62%] male). The main cause of death was cancer (n = 48; 71%). Preferred place of death was not stated in 16 ACDs. Compliance with documented preferred place of death was 63% (33/52): 48% (16/33) when the preferred place of death was home; 78% (7/9) when sub-acute was preferred; and 100% (10/10) when hospital was preferred. Compliance was 100% with 'unacceptable interventions'. CONCLUSION: These results demonstrate strong compliance with rural patients' requests in ACDs, particularly 'unacceptable interventions'. Home was the most common preferred place of death, but the compliance measure (48%) was the lowest in this study. This requires further exploration.

Farm-related injury deaths in Australia (2001-20).

OBJECTIVE: To describe the agents, pattern and trends of unintentional farm fatalities in Australia (2001-2020). METHODS: Review of study of National Coronial Information System data. DESIGN: Descriptive. SETTING: Australia (2001-2020). PARTICIPANTS: All cases involving fatal work and non-work injury events on a farm. MAIN OUTCOME MEASURES: Patterns and agents of injury events, with trends for all-cause deaths based on rates per 10 000 farms and work-related incidents (per 100 000 workers and 1 000 000 h worked). RESULTS: There were 1584 unintentional farm fatalities (annual mean 79). Two-thirds of cases were work-related (68%). Major agents of injury were farm vehicles (39%) and machinery (26%). Persons aged over 55 years were involved in 58% of all work-related incidents and were significantly more likely to die than younger cohorts when assessed against hours worked. Death rates involving all on-farm fatal incidents (both work and non-work) per 10 000 farms (p = 0.015) and work-related rates per 100 000 workers (p = 0.015) reduced over the period, with both demonstrating a fluctuating rate. There was no change in the work-related rates when assessed against hours worked (p = 0.276). CONCLUSION: Over the period, the annualised number of deaths fell by approximately 24% (98-75), with agents of injury remaining similar. General trends suggest a reduction in the overall death rates for work and non-work incidents. However, trends were less apparent when the reduction of farms (~19%), workers (~7%) and hours worked (no change), were accounted for. Targeted approaches are required to stimulate improvements in these preventable incidents.

Comparison of severe on-farm injuries to older and younger persons in New South Wales (2012-2016).

OBJECTIVES: To assess and compare rates of severe on-farm injury for older (> 50 years) and younger (15-49 years) cohorts, on NSW farms. DESIGN: Descriptive retrospective epidemiological study of the New South Wales Trauma Registry (Institute of Trauma and Injury Management - ITIM) for persons injured on a farm. SETTING: New South Wales, Australia. PARTICIPANTS: Cases involving persons (≥15 years), with data on the NSW Trauma Registry (2012-16). MAIN OUTCOME MEASURES: Comparison of injury rates and severity between younger (15-49 years) and older (50+ years) cohorts over the 2012-16 period based on Injury Severity Scores (ISS). RESULTS: Older males are injured at a rate that is roughly 18% higher than younger males and 13% higher than the overall injury rate. Older individuals also have significantly longer hospital stays post-injury (P = 0.01), with this being most pronounced for older men (P < 0.01). There was no statistically significant difference in ISS demonstrated between the age cohorts (P = 0.64), except for younger women having higher median ISS than their older female counterparts (P = 0.02). CONCLUSION: Overall, the general trends displayed support the contention that older males are more likely to incur a severe on-farm injury than their younger counterparts. This provides support for a preventative focus targeting older farmers in NSW.

Protecting the future: Fatal incidents on Australian farms involving children (2001-2019).

OBJECTIVES: To assess the demographic and causal factors, plus trends in rates of fatal farm incidents involving children (<15 years) in Australia over the 2001-2019 period. DESIGN: A descriptive retrospective epidemiological study of the National Coronial Information System. SETTING: Australia. PARTICIPANTS: Cases involving children (<15 years), where incidents have occurred on a farm (1 January 2001-31 December 2019). RESULTS: There has been essentially no change in the fatality rate for farm-related child injury deaths across Australia in the 2001-2019 period (-0.009/year). Men and children aged 0-4 years were significantly more likely to be involved in these incidents. Most cases were recreational in nature (81%), with seven agents (water bodies, quads [all-terrain vehicles], tractors, utes, cars, motorbikes and horses), accounting for 75% of cases. Water bodies were responsible for over 31% of deaths. CONCLUSION: The lack of progress addressing child farm injury mortality requires urgent attention. The overall rates and pattern of injury-related deaths have stagnated, necessitating new and innovative approaches to address the issue. The emerging National Injury Prevention Plan might provide scope to improve the focus on and implementation of evidence-based approaches.

Patterns of emergency department use in rural and metropolitan New South Wales from 2012 to 2018.

OBJECTIVE: To explore the patterns of and investigate the factors associated with rises in emergency department presentations in rural and metropolitan New South Wales from 2012 to 2018. DESIGN: A retrospective descriptive study of de-identified data from the New South Wales Emergency Department Data Collection. SETTING: New South Wales, Australia. PARTICIPANTS: All individuals presenting to 99 New South Wales emergency departments, which continuously reported to the Emergency Department Data Collection between 2012 and 2018. A total of 2 166 449 presentations recorded throughout New South Wales in 2012 (rural 786 278; metropolitan 1 380 171) and 2 477 192 in 2018 (rural 861 761; metropolitan 1 615 431). MAIN OUTCOME MEASURES: Total emergency department presentations, plus Poisson regression modelled annual changes in emergency department presentations over the period 2012-2018. RESULTS: Growth in emergency department presentations outpaced population growth in both rural and metropolitan New South Wales between 2012 and 2018. The patterns of age-standardised rates of presentations were broadly similar between rural and metropolitan areas, with highest rates observed in the youngest (0-4 years) and oldest (85+ years) cohorts. The rural sample also displayed a distinct third peak in ages 15-39 years, and rates were higher across all age groups. Rural New South Wales displayed disproportionately higher emergency department presentations in the two most deprived socio-economic status quintiles. While rural New South Wales displayed significant reductions in triage category 5 (non-urgent cases) over time, the relative proportion remained approximately double that of metropolitan sites. CONCLUSIONS: There are differences between rural and metropolitan emergency department presentations relating to demographic factors, triage levels, acuity and admissions. Detailed local investigations are required to determine specific contextual issues that impact on emergency department demand.

Comparison of cancer incidence in Australian farm residents 45 years and over, compared to rural non-farm and urban residents - a data linkage study.

BACKGROUND: It is not known if the incidence of common cancers in Australian farm residents is different to rural non-farm or urban residents. METHODS: Data from farm, rural non-farm and urban participants of the 45 and Up Study cohort in New South Wales, Australia, were linked with state cancer registry data for the years 2006-2009. Directly standardised rate ratios for cancer incidence were compared for all-cancer, prostate, breast, colorectal cancer, melanoma and non-Hodgkin Lymphoma (NHL). Proportional hazards regression was used to generate incidence hazard ratios for each cancer type adjusted for relevant confounders. RESULTS: Farm women had a significantly lower all-cancer hazard ratio than rural non-farm women (1.14, 1.01-1.29). However, the lower all-cancer risk observed in farm men, was not significant when compared to rural non-farm and urban counterparts. The all-cancer adjusted hazard ratio for combined rural non-farm and urban groups compared to farm referents, was significant for men (1.08,1.01-1.17) and women (1.13, 1.04-1.23). Confidence intervals did not exclude unity for differences in risk for prostate, breast, colorectal or lung cancers, NHL or melanoma. Whilst non-significant, farm residents had considerably lower risk of lung cancer than other residents after controlling for smoking and other factors. CONCLUSIONS: All-cancer risk was significantly lower in farm residents compared to combined rural non-farm and urban groups. Farm women had a significantly lower all-cancer adjusted hazard ratio than rural non-farm women. These differences appeared to be mainly due to lower lung cancer incidence in farm residents.

Farm safety-Time to act.

ISSUES ADDRESSED: Agriculture is recognised as a highly dangerous sector worldwide; hence, the use of evidence-based solutions to address injury-related incidents is critical to prevention. The main of this article was to determine the potential for prevention by use of existing controls based on deaths data from 2001-2016. METHODS: This study assesses data from the National Coroner's Information System for the period 2001-2016 in regard to unintentional farm injury deaths in Australia (n = 1271). The six leading causes of death (tractors, quads [ATVs], water/dams, farm utilities [pickups], motorcycles and horses: n = 644) are reviewed against existing evidence-based practice recommendations to ascertain the potential capacity to prevent and/or ameliorate the severity of the fatal incidents. Projections of economic costs associated with these incidents in the past five years (2012-2016) are outlined. RESULTS: Of the cases involving the six leading agents (n = 644), 36% (n = 235) have the potential to be prevented with the use of designated evidence-based controls. Meanwhile, the costs attributed to deaths involving the six leading agents in the 2012-2016 period, exceeded $313 million. CONCLUSIONS: Farm injury incidents and their related economic costs can be reduced by enhanced adoption of the existing evidence-based controls. SO WHAT: Farm safety efforts in Australia require reinvigoration and funding to focus on evidence-based controls supported by enforcement to attain maximum impact.

Rural-urban variation in injury-related hospitalisation, health outcomes and treatment cost in New South Wales.

OBJECTIVE: To compare differences in injury characteristics, health outcomes and treatment costs between urban and rural residents who were hospitalised following an injury. DESIGN: A retrospective examination of injury-linked hospitalisation and mortality data in New South Wales from 1 January 2010 to 30 June 2014. PARTICIPANTS: Urban (496 325) and rural (213 139) residents who were hospitalised following an injury. MAIN OUTCOME MEASURES: Demographic and injury characteristics, injury severity, hospital length of stay, 28-day hospital readmission, 90-day mortality and treatment cost. RESULTS: Rural residents had an increased likelihood of being hospitalised for injuries from motorcycles, vehicles, animate causes, venomous animals or plants and assault compared to urban residents. Rural residents were less likely to be readmitted to hospital within 28 days and had a lower length of stay and age-adjusted length of stay than urban residents. Injury-related hospitalisations for urban and rural residents cost $4.4 billion and $1.7 billion, respectively. Annually, acute injury treatment ($1.1 billion), rehabilitation ($130 million) and subacute non-acute patient care ($57 million) cost $1.3 billion ($990 million for urban and $384 million for rural residents) in New South Wales. Fall-related injuries and transport incidents were the costliest injury mechanisms for both urban and rural residents. CONCLUSIONS: Injuries contribute substantially to hospitalised morbidity and its cost. The development and implementation of injury prevention strategies targeting the most common injuries for urban and rural residents will go some way towards reducing hospitalised injury and its cost.

Stage of diagnosis of prostate, breast and colorectal cancer in farm residents compared with other rural and urban residents in New South Wales.

OBJECTIVE: To determine if stage at diagnosis of prostate, breast and colorectal cancers differs between farm, rural non-farm and urban residents. DESIGN: Data linkage of baseline survey information from a large cohort study, with state cancer registry records from 2006 to 2009. SETTING: New South Wales, Australia. PARTICIPANTS: New South Wales residents enrolled in the 45 and Up Study cohort. MAIN OUTCOME MEASURES: Adjusted odds ratio of non-localised cancer stage was modelled using binary logistic regression, controlling for commonly known cancer risk factors. RESULTS: Overall differences in the odds ratios for later stage prostate, breast and colorectal cancer diagnosis in farm men and women compared with rural non-farm and urban counterparts were not statistically significant, although farm men had twice the odds of either group of being diagnosed at later stage colorectal cancer. The odds of later stage prostate cancer for farm and urban men were similar, but rural non-farm men were significantly less likely than urban men to be diagnosed at later stage. Higher household income was associated with later stage breast and prostate cancer; and private health insurance with extras was negatively associated with later stage prostate cancer. CONCLUSIONS: Differences in stage of cancer diagnosis, particularly between farm and rural non-farm men, remain unexplained but were not statistically significant. Farm men may be at higher risk of later stage colorectal cancer diagnosis, which if confirmed has implications for research on possible reasons, and for the delivery of appropriate cancer diagnostic services in rural areas.

Farmers' knowledge of Q fever and prevention approaches in New South Wales.

OBJECTIVE: To identify what New South Wales (NSW) farmers know about Q fever to inform preventive approaches. DESIGN: Thematic analysis of qualitative data gathered through semi-structured individual interviews, focus groups and a community meeting. SETTING: Rural communities in NSW, Australia. PARTICIPANTS: A total of 25 farmers participated in individual interviews (n = 4) or three focus groups, each with seven participants (n = 21). A further 27 persons, were involved in a community meeting. MAIN OUTCOME MEASURES: Themes derived from the interviews, focus groups and community meeting. RESULTS: Knowledge variations regarding Q fever risk and transmission highlight a need for improved risk communication. Vaccination was viewed as the preferred prevention approach; barriers were raised including time, costs, access to screening/vaccination and General Practitioner (GP) knowledge about Q fever. Local vaccination initiatives were supported. CONCLUSIONS: Strengthening existing GP knowledge and services leading to expanded provision of screening/vaccination could improve the coverage of Q fever vaccine in endemic NSW farming and rural communities.

Mount Isa statement on quad bike safety.

CONTEXT: Quad bikes are the leading cause of death in Australian agriculture, with half of these deaths resulting from rollovers. Between 2001 and 2012, there were more than 160 such deaths in Australia, representing a significant burden. ISSUES: There is a diversity of public opinions offered about quad bike safety. The Are You Remotely Interested … in Prevention; Building a Culture of Safety conference held in Mount Isa, Queensland, in August 2012 brought together subject matter experts from across Australia to discuss a range of issues relevant to rural Australia (including quad bikes). During this conference, the Mount Isa Statement for Quad Bike Safety was produced. The intent of the Statement was to draw on existing evidence to highlight solutions and provide a direction for future efforts to reduce the burden of death and injury related to quad bike use. The conference provided an opportunity for those with an interest in quad bike safety to come together in one location, discuss the issues and develop a common direction (the Statement). The Statement is presented in three sections: a statement of the facts that were available at the time of development; a set of recommendations; and what needs to happen next. LESSONS LEARNED: We believe to the best of our knowledge this is the first time where many potential solutions for keeping people safe while operating quad bikes in agriculture have been explored in a public forum. There are some immediate solutions that people can undertake to keep themselves and those in their care safe when using a quad bike: initially selecting safer vehicles to use; fitting quad bikes with crush protection devices; not carrying passengers or overloading the quads; and wearing helmets.

A Summary of Fatal Injury Surveillance Methods in Australian Agriculture and Their Impact on Safety Policies and Practices.

Agriculture is one of the most important and also hazardous industries in Australia. Having a sound knowledge and understanding of the circumstance of injury events is critical to developing evidence-based intervention programs. This paper aims to provide a brief historical snapshot of the development of data systems underpinning the assessment of fatal farm injury in Australia and how it has impacted on safety policy and practice. The first Australian studies used coronial information to explore agricultural fatalities, these studies reviewed paper-based records (in-situ) and collected the information for analysis and reporting. This task was laborious and costly. When the National Coronial Information System (NCIS) was established in 2000, this allowed access to coronial records online. Information provided about the deceased includes demographics, contextual details on the nature of the fatality and autopsy, toxicology, and police reports, as-well-as the coroner's finding. Information from the NCIS, along with media reports, have been used to develop the farm fatality database. This information has been used to inform the safety goals and targets for farm commodity groups, identify key risks, provide long-term benchmark indicators and underpin the development of prevention materials and training resources. Without accurate, timely, concise and relevant data about injury occurring on farms, there is no evidence to drive policy and practice or to evaluate programs of work. As such, the continued utilization and extension of the NCIS data will prove crucial to further reducing the burden of preventable fatal injuries on Australian farms.

Quad bike related injury in Victoria, Australia.

OBJECTIVE: To enumerate and describe fatal and hospital-treated injury associated with quad bike use in Victoria. DESIGN: Retrospective descriptive analysis of coronial records and hospital-treated injury data (2002-03 to 2010-11). MAIN OUTCOME MEASURES: Number of quad bike-related fatalities, hospital admissions, emergency department (ED) presentations, and results of a trend and severity analysis (International Classification of Disease-based Injury Severity Score; ICISS). RESULTS: There were 19 fatalities, 766 hospital admissions and 816 ED presentations. The peak age group for fatalities and admissions was 15-29 years (26.3% and 27.9%, respectively), with children 0-14 years being the most common group presenting to EDs (32.2%). Males were strongly overrepresented (84.2% of fatalities, 73.8% of admissions and 71.2% of ED presentations). Intracranial injury (26.3%), fractures (15.8%) and traumatic asphyxiation (15.8%) were the most common injuries among fatal cases. Fractures accounted for half all admissions. Twenty-eight per cent of admissions were classified as "serious" (ICISS, ≤ 0.941) and, over the 9-year study period, the frequency of admissions increased significantly by an estimated 41.4% (95% CI, 9.6%-78.9%). This was significant for males (53.2%; 95% CI, 11.5%-104.4%) and people aged 15-29 years (163.1%; 95% CI, 75.2%-253.7%). CONCLUSION: Quad bikes are imposing a significant injury burden in Victoria. Fatalities are frequent, while the number of admissions, often serious, increased over the study period. Children were involved across all levels of severity. A range of prevention approaches, such as mandatory fitting of crush protection devices to protect riders in the event of a roll over, are required.

Safe play areas on farms in New South Wales.

OBJECTIVE: To assess the prevalence and security of fenced house yards on NSW farms and rural properties with a view to providing information to increase the development of safe play areas on farms. DESIGN: A cross-sectional stratified study using computer-assisted telephone interviewing. SETTING: Interviews were conducted in the four rural Area Health Services throughout February to December 2008. PARTICIPANTS: Randomly selected sample of 1117 adults living on a farm or rural property in the study areas. MAIN OUTCOME MEASURES: Self-reported issues involving fenced house yards or safe play areas for children. RESULTS: Overall, 79.8% of farm respondents reported that they had a fenced house yard or safe play area. For those respondents with a fenced house yard, 66.6% reported that it was secure enough to prevent /make it difficult for a young child to wander away unsupervised. Based on these figures, it is estimated that only 53.1% of all farms or rural properties have a secure fenced house yard or safe play area. There were statistically significant variations between geographic locations, with the North Coast (37.7%) being lower. CONCLUSIONS: This study illustrates a need across rural NSW to further promote, install or upgrade secure fenced house yards or safe play areas. While all geographic regions of the state could improve provision to protect children, there may also be some that are in need of more intensive intervention programs to enhance compliance. Such a proposition may also be relevant on a national level.

Fatal Animal Related Incidents on Australian Farms - a 20-Year Review.

Objectives To assess demographic and causal factors of fatal farm incidents involving animals in Australia. Methods Descriptive study of the National Coronial Information System for persons fatally injured by an animal on an Australian farm over the 2001-20 period. Data were analysed in relation to age, sex, state where incident occurred, work-relatedness and causal agents. Results There has been little change in the mean number of animal-related injury deaths across Australia in the 2001-20 period (mean 6.5), however this is a 35% reduction on an earlier 1989-92 assessment (mean 10). The majority of incidents (81%) involved horses (n = 75) and cattle (n = 31). Males were involved in 86 (66%) cases, with 54 female cases. People aged 60 years and over accounted for 46% of the cases, with more than half occurring during work. Of the decedents, 85% fell from or were struck by an animal at the time of the incident, with 40% resulting in a head injury. Conclusion While annualized case numbers have decreased slightly, the leading agents remain consistent with previous studies. The lack of genuine progress in addressing fatalities related to horses and cattle, along with the representation of older persons in the cohort, require attention drawing on the Hierarchy of Controls.

A Narrative Review of Fatigue in Agriculture and Its Impact on Injury and Fatality in Australia.

OBJECTIVES: To identify current knowledge about the role of fatigue in occupational injury in the agricultural sector and briefly assess potential intervention approaches. METHODS: Narrative review of peer reviewed literature (in English) from 2010 to 2022 focusing on fatigue in agricultural and other sectors. Data were extracted from Medline, Scopus, and Google Scholar. RESULTS: The initial search revealed 6,031 papers, of these 33 met the inclusion criteria. The literature unanimously agreed that fatigue contributes to occupational injury in agriculture and related industries. However, there was a scarcity of literature specific to Australia or agriculture. This limits the ability to draw conclusions about the true relationship between fatigue and injury. CONCLUSION: While fatigue is likely a major contributor to occupational injury in Australian agriculture, the limited literature impedes the ability to draw conclusions and extrapolate interventions used by other industries that are practical and feasible, to agriculture. Future studies should establish the nature of the problem in Australian agriculture and consult with members of the sector to establish the best interventions to ameliorate the problem, then implement and robustly evaluate intervention studies.

A descriptive review of quad-related deaths in Australia (2011-20).

OBJECTIVE: To assess Australian quad-related deaths during the 2011-20 period in relation to introduction of the Consumer Goods (Quad Bikes) Safety Standard 2019. METHODS: All Australian quad-related deaths retrieved through the National Coronial Information System. RESULTS: There were 155 cases, with 116 occurring on a farm and 39 in a non-farm context. Deaths were evenly split between work (52%) and non-work activities, however, 66% of all farm incidents involved work. Rollovers were responsible for 59% of cases and occurred largely on farms (86%), whilst working (69%). Head injury (32%) and asphyxiation (29%) were primary causes of death. Helmet use was low (<5%) in the head injury cases, with 80% of the asphyxiation cases incurring no life-threatening injury other than being entrapped by the quad. CONCLUSION: Quad-related deaths are prevalent, with minimal variation in the pattern of incidents from previous Australian studies. Rollover incidents continue to be a major problem especially in a farm context. IMPLICATIONS FOR PUBLIC HEALTH: In tandem with existing efforts to enhance behavioural compliance (e.g. helmet use, no child access) and retrofitting Operator Protector Devices, these data support the introduction of the new Standard addressing vehicle stability and fitting Operator Protector Devices to limit potential for asphyxiation.

Reducing farm injury deaths through regulation.

Manufacturers will need to improve quad bike design to meet safety requirements.

Mortality patterns of Australian male farmers and farm managers.

OBJECTIVE: To compare the all-cause and specific-cause death rates of Australian male farmers and farm managers aged 25-74 years, with other Australian men. METHODS: Data were extracted from the Australian Bureau of Statistics Death Registration Collection covering the calendar years of 1999-2002. Denominator data for male farmers and farm managers were drawn from the 2001 Australian Population Census. Direct age-standardized death rates were calculated and compared with the general Australian male population. RESULTS: The 4025 male farmers or farm managers who died in this period represented 3.35% of all male deaths in the 25-74 year age range. The all-cause death rate for farmers and farm managers (730/100,000) was 33% higher than that of the Australian male population of the same age (549/100,000) (standardized mortality ratio (SMR)=1.33). Causes of death related to neoplasms (SMR=1.37), circulatory disease (SMR=1.40) and all external causes (SMR=1.37), were all statistically higher than the comparison population. Within these groupings, ischaemic heart disease (SMR=1.39), other circulatory disease (SMR=1.42), prostate cancer (SMR=2.40), lymphohaematopoietic cancer (SMR=1.80) and transport injuries (SMR=2.06), were all significantly higher. CONCLUSION: These data indicate that Australian male farmers and farm managers are a disadvantaged group in terms of health status. The elevated rates of all-cause and specific-cause mortality compared with the Australian comparison population, illustrate both the need and scope for further investigation of these issues.

Improving hearing health for farming families.

INTRODUCTION: Occupational noise injury and hearing loss are common features of agricultural workforces internationally. Farmsafe Australia has identified hearing health as one of its 4 key priority goals and targets. Currently, approximately 60-70% of Australian farmers have measurable hearing loss, compared with 27% of those in the general Australian community. This article describes the findings of a community based demonstration project to address hearing health issues conducted in the Australian state of New South Wales. This program sought to implement local demonstration projects in 3 communities to identify what works well in hearing health promotion with farmers and what could be applied more broadly throughout Australia. METHODS: Local advisory groups were established in each community to guide project development and implementation. Project implementation focused on 3 major aspects: (1) increasing awareness of priority noise injury prevention and hearing health practices; (2) improving access to hearing health services; and (3) networking services in local communities. Area-specific training was undertaken for stakeholders to maximize local information links. Service utilization data were monitored and analysed. RESULTS: There was variability among sites; however in general there was an increased awareness of hearing health issues by farming families and expanded opportunities for farmers to access screening services. Utilization rates of hearing services also increased markedly in one community. Local hearing health networks were strengthened by linkages to key stakeholders outside the health sector. Previously unidentified methods of promoting hearing health (eg using agricultural retail outlets that supply hearing protection equipment and are accepted by farmers as an information source) were identified and utilized. CONCLUSIONS: Hearing health promotion with farmers in local communities can be enhanced through utilization and strengthening of local networks. Integration of hearing health initiatives with other agencies already working with farming families will be important in developing and enhancing long-term sustainable outcomes. Continued work at a national level to assist in stimulating local action will be required to build on the potential gains in reducing noise injury in the farming community.