ROPS commentary-Addressing our fatal blind spot: Applying evidence-based solutions to reduce the most frequent cause of death on U.S. farms.

Tractor overturns are the most prominent contributing factor to death on U.S. farms and have been for decades. While public health researchers hypothesized years ago that overturn fatalities would largely disappear as older tractors were replaced by newer ones, this has not happened. In the meantime, farmers continue to die in these easily preventable and tragic events. Not only are tractor rollover protective structures (ROPS) 99% effective in preventing death in the event of an overturn, a national program exists to connect farmers with ROPS. While this program has been popular with farmers, and the cost-effectiveness of providing farmers with technical support and cost-sharing rebates has been demonstrated, many states lack access to ROPS rebates, even those states with the highest number of overturn fatalities. Given the evidence, it is difficult to reconcile the lack of policy or public investment in a solution that decisively addresses the most pernicious contributor to death in the agricultural industry. In this commentary, we highlight the science behind this proven solution to tractor overturns and the essential role that the media and implementation science can play in encouraging policy-makers to save lives.

The news about rollover protective structures: Findings from an analysis of news from Iowa, Nebraska, Kansas, and Missouri.

INTRODUCTION: Rollover protective structures (ROPS) can prevent fatal tractor overturns, a leading cause of death among farmers. This content analysis aims to understand how this life-saving strategy appears in news about farm safety. METHODS: As part of a larger study of farm safety news coverage from four agricultural states, we conducted a content analysis of articles that mentioned ROPS. RESULTS: Few (10%) articles about farm safety explicitly mentioned ROPS. When ROPS were mentioned, they were described in terms of their potential to save lives or prevent injury. CONCLUSION: Despite proven success, ROPS-and programs to make ROPS more widely available to farmers-are all but absent from news coverage in key agricultural states. This represents a missed opportunity not only to motivate farmers to install ROPS, but also to demonstrate to policymakers the importance of establishing and maintaining funding to prevent the most frequent cause of death on farms. Farmers face barriers to installing life-saving equipment. Without an increase in ROPS utilization and improved access to prevention programs, farmers, especially low-income farmers, will remain at disproportionate risk for death and injury.

Therapist Alliance-Building Behaviors, Alliance, and Outcomes in Cognitive Behavioral Treatment for Youth Anxiety Disorders.

OBJECTIVE: The alliance influences outcomes in CBT for youth anxiety disorders. Thus, knowledge about how therapists can enhance the alliance is needed. METHOD: Seventy-three youth with anxiety diagnoses (M age = 11.5 years, SD = 2.2; range 8 to 15 years; 47.9% boys; 90.4% white-European) participated in 10-session cognitive behavioral therapy in community clinics. Therapist alliance-building behaviors in session 2 was reliably coded with the observer-rated Adolescent Alliance-Building Behavior Scale (Revised) (AABS(R)). Alliance was measured as youth- and therapist-rated alliance, and youth-therapist alliance discrepancy in session 3. Outcomes were diagnostic recovery and anxiety symptom reduction at post-treatment and one-year follow-up, and treatment dropout. We examined the direct effects of alliance-building on alliance, alliance on outcomes, and alliance-building on outcomes in multilevel mediation models, and between- versus within-therapist variance across these effects. RESULTS: The alliance-building behaviors collaborate, present treatment model, and explore motivation positively predicted alliance, whereas actively structuring the session (i.e., dominating) negatively predicted alliance. The alliance-building behaviors attend to experience, collaborate, explore motivation, praise, and support positively predicted outcomes. The alliance-building behaviors present treatment model, express positive expectations, explore cognitions, and support negatively predicted outcomes. The effect of collaborate on symptom reduction was mediated by youth-therapist alliance discrepancy. There was almost zero between-therapist variance in alliance-building, and considerable within-therapist variance. CONCLUSION: Therapist alliance-building behaviors were directly (positively and negatively) associated with alliance and/or outcomes, with only one effect mediated by alliance. Alliance-building behaviors varied far more within therapists (i.e., across clients) than between therapists.

An exploration of rollover protective structures (ROPS) rebate program media coverage: strategies for implementation and sustainment.

BACKGROUND: Media advocacy plays an important role in public health initiatives, as it can provide vital information to target populations, policy makers, or other relevant stakeholders. Unfortunately, little is currently known about the use of media advocacy to promote occupational safety and health programs. This study explores media coverage related to the Rollover Protection Structure (ROPS) Rebate Programs, which were designed to encourage the use of rollover protection on agricultural tractors, thus reducing the risk of tractor overturn fatalities. The Program's portrayal in the media, as well as the role that the media has played in implementing and sustaining these Programs. METHODS: Media articles pertaining to any of the state-based or National ROPS Rebate Programs and published between November 1, 2006 and October 31, 2018 were included for review. Discourse analysis was used to understand the messages portrayed by the media and how those messages shaped the outcomes of the ROPS Rebate Programs. RESULTS: During the study period, 212 unique articles were published about the ROPS Rebate Programs. While these articles all portrayed the ROPS Rebate Programs in a largely positive light, they were used at different stages, from pre-implementation through sustainment of the ROPS Rebate Programs, and to different extents. CONCLUSIONS: Media articles have played an important role in implementing and sustaining the ROPS Rebate Programs. Based on the results of this study, more robust and continuous media coverage are important for the longevity and success of public health programs.

Accelerometers: Assessing their potential for measuring personal flotation device use on commercial fishing vessels.

BACKGROUND: Falls overboard are the most common cause of fatalities in commercial fishing. As a result, interventions aimed at increasing and measuring the use of personal flotation devices (PFDs) are a high priority. The focus of this study was to explore the use of accelerometers as a means for objectively measuring PFD use on lobster fishing vessels. METHODS: For participating vessels, researchers attached an accelerometer to a PFD worn by a crewmember and another to the vessel's wheelhouse. GoPro videos were also employed to record crewmember activities so these could be synchronized with accelerometer outputs. Accelerometer outputs included two distinct measures, the proportional integration mode (PIM) and zero crossing mode (ZCM). Data were fitted to various equations to identify the best method for predicting PFD use. RESULTS: Seven lobster fishing vessels participated in the trial. Data indicated that accelerometers could predict PFD use with a fairly high degree of accuracy. In particular, a logistic equation incorporating PIM values from the PFD and the absolute value of the difference between the PFD PIM readings and the PIM readings from the stationary accelerometer demonstrated the highest degree of accuracy, with correct classifications for 73.3% to 77.6% of the 10-second data intervals. Accuracy was highest when crew members were moving versus stationary. The predictive value of ZCM was comparatively limited. CONCLUSIONS: PIM accelerometer readings can be used to measure PFD use with a considerably high degree of accuracy, especially for sternmen who are moving regularly and have the highest risk for falling overboard.

Rollover Protective Structures, Worker Safety, and Cost-Effectiveness: New York, 2011-2017.

OBJECTIVES: To measure cost-effectiveness of an intervention to increase retrofitting of rollover protective structures (ROPS) on tractors. METHODS: Tractor overturns are the leading cause of farm fatalities. ROPS prevent these deaths. This study updates a 2011 cost-effectiveness assessment of a New York State intervention to increase use of ROPS. We subtracted intervention cost from the cost of injuries averted, then divided this figure by the number of averted injuries. We used related probabilities and costs of fatalities and injuries from published literature to calculate the program's cost-effectiveness. RESULTS: The total cost of the injuries averted from 2007 to 2017 was $6 018 742 versus a total program cost of $1 776 608. The one-time retrofit costs will continue to prevent injuries as long as the tractors are used, generating additional (projected) future savings of $12 136 512, $15 781 027, and $18 924 818 if retrofitted tractors remain in operation 15, 20, or 25 years after their retrofit. CONCLUSIONS: Social marketing was cost-effective for reducing injuries from tractor overturns. Public Health Implications. These results indicate that the intervention model is effective from both a public health and economic standpoint and should be expanded into other states.

An overview and impact assessment of OSHA large dairy local emphasis programs in New York and Wisconsin.

BACKGROUND: Farming has been exempted from most labor regulations and shielded from regulatory scrutiny by the Occupational Safety and Health Administration (OSHA). Yet, agriculture and dairy in particular, has relatively high injury and fatality rates. METHODS: A recent shift in OSHA's approach to agricultural worker safety and health includes two dairy-focused Local Emphasis Programs (LEPs), one launched in Wisconsin in 2011 and the other in New York in 2014. We examine data from LEP-related, OSHA consultations and inspections as well as non-governmental audit programs, and review farmer perceptions about the LEP. RESULTS: Inspections conducted by OSHA and private consultation programs highlight the presence and variety of hazards on dairy farms in Wisconsin and New York. CONCLUSION: The LEPs helped raise dairy producers' awareness of inherent hazards and methods to correct them. Farmers cited the LEP as beneficial, identifying it as a catalyst to reduce hazards on their farms.

Adapting the T0-T4 implementation science model to occupational health and safety in agriculture, forestry, and fishing: A scoping review.

BACKGROUND: Despite much research to develop life-saving innovations for the agriculture, forestry, and fishing workforce, these populations continue to face the highest fatal and non-fatal injury rates in the United States, as many of these solutions are not fully adopted. METHODS: A scoping review was conducted to provide an overview of research to practice efforts in this field. The language used to describe these initiatives, the utility of the NIH T0-T4 model, and the progress along the research to practice continuum were examined. RESULTS: Fourteen eligible references demonstrated that progress in implementation science is lacking and that there is little consistency in how researchers apply the T0-T4 model; thus, a new model is presented. CONCLUSIONS: Researchers in this field face several challenges when moving from research to practice. While some challenges are addressed with the proposed model, additional resources and infrastructure to support such initiatives are necessary.

Counseling on lifestyle habits in the United States and Sweden: a report comparing primary care health professionals' perspectives on lifestyle counseling in terms of scope, importance and competence.

BACKGROUND: The role of primary care professionals in lifestyle counseling for smoking, alcohol consumption, physical activity, and diet is receiving attention at the national level in many countries. The U. S. and Sweden are two countries currently establishing priorities in these areas. A previously existing international research collaboration provides a unique opportunity to study this issue. METHODS: Data from a national survey in Sweden and a study in rural Upstate New York were compared to contrast the perspectives, attitudes, and practice of primary care professionals in the two countries. Answers to four key questions on counseling for tobacco use, alcohol consumption, physical activity, and eating habits were compared. RESULTS: The response rates were 71% (n=180) and 89% (n=86) in the Sweden and the U.S. respectively. U.S. professionals rated counseling "very important" significantly more frequently than Swedish professionals for tobacco (99% versus 92%, p<.0001), physical activity (90% versus 79%, p=.04), and eating habits (86% versus 69%, p=.003). U.S. professionals also reported giving "very much" counseling more frequently for these same three endpoints than did the Swedish professionals (tobacco 81% versus 38%, p<.0001, physical activity 64% versus 31%, p<.0001, eating 59% versus 34%, p=.0001). Swedish professionals also rated their level of expertise in providing counseling significantly lower than did their U.S. counterparts for all four endpoints. A higher percentage of U.S. professionals expressed a desire to increase levels of counseling "very much", but only significantly so for eating habits (42% versus 28%, p=.037). CONCLUSIONS: The study demonstrates large differences between the extent that Swedish and American primary care professionals report being engaged in counseling on lifestyle issues, how important they perceive counseling to be, and what expertise they possess in this regard. Explanations might be found in inter-professional attitudes, the organization of healthcare, including the method of reimbursement, traditions of preventive healthcare, and cultural differences between the two countries. Further studies are needed to explore these questions, with the aim of facilitating improved lifestyle counseling in primary care.

Examining the Facets of Burden from Agricultural Injury: Policy Implications.

Agriculture is one of the most dangerous industries in the United States. Loss of life, injury, and illness estimates in the agriculture industry only measure a fraction of the total burden to society. The purpose of this review was to conduct a comprehensive scan of the peer-reviewed literature to catalog research that explores the burden of agricultural injury to synthesize what is currently known. In total, 116 full-text papers meeting eligibility criteria were reviewed. Publications documenting agricultural injury burden were scanned and observations were categorized using a priori themes previously identified by occupational safety and health researchers. Results from this review indicate the true burden of agricultural injury is more expansive and complex than previous narratives on injury burden would imply. Future research should consider policies that encourage the collection of more expansive injury burden data, as well as methods to incorporate them into standard injury surveillance efforts.

Tractors, Trees, and Rollover Protective Structures: A Cause for Concern.

Injury and fatality events that are caused by tree work and tractor-related activities contribute to the already elevated rates of work-related injuries in the agriculture and logging sectors. This brief report highlights the circumstances surrounding these events, as well as a number of surveillance sources that identify the extent to which they contribute to the injury burden in these hazardous industries. These data sources include fatality investigations, agricultural injury news reports, consumer product injury data captured from emergency rooms and near-miss reporting data captured from individuals participating in the National Rollover Protective Structure Rebate Program (NRRP). Several recommendations for further research and interventional efforts are outlined, with particular consideration of the manner in which rollbars have been involved in falling object incidents.

A Case Study on the Practical Use of Low-Fidelity Modeling to Mitigate the Spread of COVID-19 Amongst the Underserved Farmworker Community.

In March of 2020, with the full magnitude of the COVID-19 pandemic yet to be seen, Costa and Martin released a report through the Economic Policy Institute noting that "To prevent infections and the spread of COVID-19 on farms, farm employers should be planning and implementing safety measures to protect their employees" (Costa D, Martin P, Coronavirus and farmworkers: farm employment, safety issues, and the H-2A guestworker program, Economic Policy Institute, https://www.epi.org/publication/coronavirus-and-farmworkers-h-2a/, 2020). The report goes on to provide multiple observations recognizing the seasonal nature of farm work, effects increased unemployment may have on the workforce, industry dependence on H-2A visa farm workers, impact school closings would have on worker availability, and includes recommendations for safety equipment, social distancing, as well as worker housing and transportation. This paper focuses on the worker housing component of those recommendations and describes an effort to rapidly develop and deploy a computationally efficient, web-based, low-fidelity mathematical model of COVID-19 spread in dormitory style housing to support education and mitigation strategies for the historically underserved farmworker community.

The direct and indirect effects of a global pandemic on US fishers and seafood workers.

The United States' fishing and seafood industries experienced major shifts in consumer demand and social-distancing restrictions starting in March 2020, when the early stages of the COVID-19 pandemic were unfolding. However, the specific effects on fishers and seafood processors are less well known. Fishermen and seafood workers are potentially at risk during a pandemic given existing tight working quarters, seasonal work, and long hours. To address these concerns, and given a lack of data on the sector, we reviewed news articles, scientific articles, and white papers to assess the various effects of COVID-19 on US seafood workers. Here, we show that most COVID-19 cases among seafood workers occurred during summer 2020 and during the beginning of 2021. These cases were documented across coastal areas, with Alaska experiencing the largest number of cases and outbreaks. Seafood workers were about twice as likely to contract COVID-19 as workers in other parts of the overall US food system. We also documented a number of indirect effects of the pandemic. New social-distancing restrictions and policies limited crew size, resulting in longer hours and more physical taxation. Because of changes in demand and the closure of some processing plants because of COVID-19 outbreaks, economic consequences of the pandemic were a primary concern for fishers and seafood workers, and safety measures allowed for seafood price variation and losses throughout the pandemic. We also highlight a number of inequities in COVID-19 responses within the seafood sector, both along racial and gender lines. All of these conditions point to the diverse direct and indirect effects of the COVID-19 pandemic on fishers and seafood workers. We hope this work sets the foundation for future work on the seafood sector in relation to the COVID-19 pandemic, improving the overall workplace, and collecting systematic social and economic data on workers.

The Impact of COVID-19 on Northeast and Appalachian Loggers.

OBJECTIVE: The Northeast Center for Occupational Health and Safety conducted a survey in December 2020 to understand the impact of the coronavirus disease 2019 (COVID-19) and the Androscoggin Mill explosion among loggers in six states: Maine, New Hampshire, Vermont, New York, Pennsylvania, and West Virginia. METHODS: Logger mailing addresses were aggregated with the assistance of state logging organizations. A paper survey, including a self-addressed return envelope was mailed to the loggers in December 2020. RESULTS: The mailed survey had a response rate of 13.3% and captured data on 484 loggers. The majority knew someone (including themselves) who tested positive for COVID-19 (71.9%). Less than half (43%) received employer training about COVID-19 prevention measures, though 73% received some form of COVID-19 personal protective equipment from their employers. The health department, Centers for Disease Control and Prevention (CDC), and health care providers were the most trusted sources of health information. Nearly half acknowledged significant change in their home lives and work responsibilities due to the pandemic. The explosion of the Androscoggin Mill affected the business of 80% of Maine loggers, and 18% of loggers that resided outside Maine. CONCLUSION: The lessons learned can be used to enhance trust in public health institutions and future public health response to this unique occupational group.

Do Cialdini's "Principles of Influence" Motivate Safe Practices on Farms?

On farms, power take-off (PTO) drivelines pose serious risks in terms of both fatal and non-fatal injuries. PTO shielding can prevent such injuries; however, is often underutilized by the farm population. This study aims assesses seven influence campaigns and their ability to change attitudes toward PTO shielding in order to encourage sustainable behavior change. Seven strategies based on common principles of influence (liking, social proof, authority, consistency, reciprocity, and scarcity) were implemented in seven agricultural counties in upstate New York. Pre- and post- tests focused on shielding behaviors and attitudes, as well as the presence of the influence strategies, were used to assess changes resulting from these interventions. Little change in the presence of influence strategies was noted from baseline to follow-up. Additionally, there were no significant changes in behavior or attitude toward PTO shielding in the same time period, indicating the failure of the interventions to create change. The findings of this study support the challenges identified in past efforts to increase the use of PTO shields on farms and highlight the need for more intensive, focused interventions. Future studies can use these lessons to develop more robust interventions for improved outcomes.

A Scoping Review of Safety and Health Interventions in the High-Risk Dairy Industry: Gaps in Evidence Point to Future Directions in Research.

The occupational injury rate of the dairy industry (6.6 per 100 full-time workers) is twice that of the national average across all industries (3.3 per 100 full-time workers). While dairy farms are becoming larger in size and fewer in number, this rate has not changed. A scoping review was conducted to identify published reports of occupational safety interventions in the dairy industry. An additional criterion was that the study included an evaluation of the intervention. Out of 22 articles that met the first criterion (discussion of interventions specific to the dairy industry), 19 met the second of having an evaluative component. These 19 articles corresponded to 16 unique studies, because 4 articles corresponded to the same study. Of the 16 unique studies, only 3 had a comparison of treatment vs. control effects, and none measured the impact of the intervention on injuries and fatalities. Of the 16 interventions, 6 were focused on training or informational campaigns in which the evaluations primarily measured knowledge acquisition. Additionally, none of these studies had a sufficient sample size to compare injury rates as an outcome. Our study demonstrates that the literature lacks any rigorous evaluation of whether dairy safety interventions are making an impact on injury prevention. Given this, it is not possible to determine how work-related injuries and deaths can be prevented in the dairy industry. Recommendations for future research include incorporating rigorous evaluation into research designs and attempting to develop low-cost, unobtrusive methods for collecting data on intermediate and final outcomes.

The social marketing of safety behaviors: a quasi-randomized controlled trial of tractor retrofitting incentives.

OBJECTIVES: We assessed the effect of social marketing incentives on dispositions toward retrofitting and retrofitting behavior among farmers whose tractors lacked rollover protective structures. METHODS: From 2006 to 2007, we conducted a quasi-randomized controlled trial with 391 farm owners in New York and Pennsylvania surveyed before and after exposure to 1 of 3 tractor retrofitting incentive combinations. These combinations were offered in 3 trial regions; region 1 received rebates; region 2 received rebates, messages, and promotion and was considered the social marketing region; and region 3 received messages and promotion. A fourth region served as a control. RESULTS: The social marketing region generated the greatest increases in readiness to retrofit, intentions to retrofit, and message recall. In addition, postintervention stage of change, intentions, attitudes, subjective norms, and perceived behavioral control levels were higher among farmers who had retrofitted tractors. CONCLUSIONS: Our results showed that a social marketing approach (financial incentives, tailored messages, and promotion) had the greatest influence on message recall, readiness to retrofit tractors, and intentions to retrofit tractors and that behavioral measures were fairly good predictors of tractor retrofitting behaviors.

Cost Analysis of a PTO Driveline Shielding Program: Are Effective Programs Cost-Effective?

HIGHLIGHTS: This article describes a cost assessment of a PTO driveline shielding intervention. Considerations for effective occupational safety interventions beyond reductions in injuries or fatalities are described. The financial viability of combining various on-farm services to reduce intervention costs is discussed. ABSTRACT: PTO entanglements are a primary injury concern on U.S. farms, affecting adults and children. These events often lead to severe injury and permanent disability but can be prevented with proper use of PTO shielding. A promising strategy for increasing PTO shielding on farms has been the introduction of user-friendly shielding options by qualified safety specialists. This study looks at the cost-effectiveness of this approach. The cost-effectiveness of this PTO shielding strategy was calculated based on program-related costs, the PTO shield cost, the lifespan of PTO shields, and the number of PTO shields needed to prevent an entanglement. The cost per entanglement prevented was then calculated by dividing the total costs by the number of entanglements prevented in several cost-estimate scenarios. Costs were adjusted for inflation to 2019 dollars. Costs per entanglement prevented ranged from a low of $921,544 (assuming a 10-year PTO lifespan and using 12,487 as the number needed to treat, i.e., to prevent a PTO entanglement, referred to as the NNT) to a high of $18,583,492 (assuming a three-year PTO lifespan and 67,119 as the NNT). The cost per entanglement prevented at the median PTO lifespan of five years and median NNT of 39,802 was $6,612,244. Based on our estimates, the cost-efficacy of increasing PTO shielding using qualified safety specialists differs widely based on the shield lifespan and the number of shields needed to avoid one entanglement. However, if the cost of introducing PTO shields in on-farm visits is coupled with other on-farm services that defray these costs, then the cost-efficacy increases considerably.

Understanding Trends in PTO Shielding Using Kelman's Processes of Change.

Background: Kelman's Processes of Change suggest that individuals participate in behaviors for one of three reasons: because it is required (compliance), because the behavior allows them to maintain a particular social status (identification), or because the behavior aligns with the individuals core beliefs (internalization). This study aims to assess the utility of this model in understanding farmers' attitudes and behaviors regarding power take-off (PTO) shielding to prevent entanglements.Methods: Surveys collected data on 673 farmers' attitudes and behaviors related to PTO shielding in 14 highly agricultural counties of New York. Participants were classified based on Kelman's Processes of Change.Results: In total, 59.44% of participants could be classified into one of the three Kelman categories based on both attitude and behavior. Of these participants, 18% were classified in the compliance phase, 3% in identification, and 79% in internalization. Of participants who did not display appropriate shielding behavior, 77% still reported having internalized the importance of PTO shielding.Conclusions: Two main challenges occurred in using Kelman's Processes of Change to assess PTO shielding behaviors among farmers. First, the attitude and behaviors of participants were not always reflective of one another, and second, participants tended to have difficulties distinguishing their primary motivations for PTO shielding (compliance, identification, or internalization). Though participants can be classified based on Kelman's Processes of Change and researchers can benefit from a more in-depth understanding of motivations related to changing safety behaviors, this study indicates that there are challenges in accurately assigning individuals to their appropriate "change" classification.

Evaluating the Evolution of Social Networks: A Ten-Year Longitudinal Analysis of an Agricultural, Fishing and Forestry Occupational Health Research Center.

As part of our evaluation of the NIOSH-funded Northeast Center for Occupational Health and Safety: Agriculture, Forestry and Fishing (NEC), we present methodology, findings and the potential implications of a sequential social network analysis (SNA) conducted over ten years. Assessing the effectiveness of the center's scientific projects was our overarching evaluation goal. The evaluation design employed SNA to (a) look at changes to the center's network over time by visualizing relationships between center collaborators annually, (b) document collaborative ties and (c) identify particularly strong or weak areas of the network. Transdisciplinary social network criteria were applied to the SNA to examine the collaboration between center personnel, their partners and the industry groups they serve. SNA participants' perspectives on the utility of the SNA were also summarized to assess their interest in ongoing SNA measures. Annual installments of the SNA (2011-2020) showed an expansion of the network with a 30% increase in membership from baseline, as well as an increase in total relational ties (any type of contact). SNA measures also indicated significant increases in co-publication, cross-sector and transdisciplinary ties. Overall, SNA is an effective tool in visualizing and sustaining an occupational safety and health research and outreach network. Its utility is limited by how ties are characterized, grant cycle timeframes and how SNA metrics relate to productivity.