Demographic and health characteristics associated with fish and n-3 fatty acid supplement intake during pregnancy: results from pregnancy cohorts in the ECHO programme.

OBJECTIVE: n-3 fatty acid consumption during pregnancy is recommended for optimal pregnancy outcomes and offspring health. We examined characteristics associated with self-reported fish or n-3 supplement intake. DESIGN: Pooled pregnancy cohort studies. SETTING: Cohorts participating in the Environmental influences on Child Health Outcomes (ECHO) consortium with births from 1999 to 2020. PARTICIPANTS: A total of 10 800 pregnant women in twenty-three cohorts with food frequency data on fish consumption; 12 646 from thirty-five cohorts with information on supplement use. RESULTS: Overall, 24·6 % reported consuming fish never or less than once per month, 40·1 % less than once a week, 22·1 % 1-2 times per week and 13·2 % more than twice per week. The relative risk (RR) of ever (v. never) consuming fish was higher in participants who were older (1·14, 95 % CI 1·10, 1·18 for 35-40 v. <29 years), were other than non-Hispanic White (1·13, 95 % CI 1·08, 1·18 for non-Hispanic Black; 1·05, 95 % CI 1·01, 1·10 for non-Hispanic Asian; 1·06, 95 % CI 1·02, 1·10 for Hispanic) or used tobacco (1·04, 95 % CI 1·01, 1·08). The RR was lower in those with overweight v. healthy weight (0·97, 95 % CI 0·95, 1·0). Only 16·2 % reported n-3 supplement use, which was more common among individuals with a higher age and education, a lower BMI, and fish consumption (RR 1·5, 95 % CI 1·23, 1·82 for twice-weekly v. never). CONCLUSIONS: One-quarter of participants in this large nationwide dataset rarely or never consumed fish during pregnancy, and n-3 supplement use was uncommon, even among those who did not consume fish.

Patterns of farm exposure are associated with reduced incidence of atopic dermatitis in early life.

BACKGROUND: Farm exposures may reduce the risk of atopic dermatitis (AD) in children, but this is controversial and US data are limited. OBJECTIVE: This study was conducted to identify patterns of farm exposure in Wisconsin family farms that modify AD incidence and prevalence in early childhood. METHODS: Environmental exposures, health history, and clinical outcomes were prospectively recorded for 111 farm families and 129 non-farm families enrolled in the Wisconsin Infant Study Cohort birth cohort study. Exposures from the prenatal and early postnatal (2-month) visits were evaluated together with parental report of AD diagnosis by a health care provider through age 24 months. Latent class analysis was performed with prenatal and early postnatal farm-exposure variables to assign farm children to 3 classes. RESULTS: Overall, children of farm families had reduced AD incidence (P = .03). Within farm families, exposures including poultry (3% vs 28%; P = .003), pig (4% vs 25%; P = .04), feed grain (13% vs 34%; P = .02), and number of animal species were inversely associated with AD incidence. Among the latent class groups, children in families with diverse or more intense farm exposures (classes A and B) had reduced AD incidence, whereas low-exposure (class C) infants had AD incidence similar to that in nonfarm children. CONCLUSIONS: Infants in Wisconsin farm families had reduced AD incidence, and patterns of farm exposures further defined AD risk. These findings suggest that exposure to diverse farm animals, feed, and bedding during the prenatal period and in early infancy reduce the risk of early-onset AD, a phenotype associated with multiple other atopic diseases.

Determinants of human papillomavirus vaccine attitudes: an interview of Wisconsin parents.

BACKGROUND: Parental attitudes play a key role in their decisions to vaccinate adolescents against the human papillomavirus (HPV). Little is known, however, about the formative experiences that shape parents' attitudes about the HPV vaccine. METHODS: We conducted semi-structured interviews with 25 parents of 11-17 year old adolescents in Wisconsin who changed their HPV vaccine attitudes (per prior surveys) over one year. A modified grounded theory approach was then used to generate primary themes of attitudinal determinants. RESULTS: Participants were predominately mothers. We identified three major themes that shaped parents' HPV attitudes: (1) the perceived likelihood of the HPV vaccine preventing cancer, (2) agency in adolescence and gauging their adolescent child's intent for sexual activity, (3) the credibility of HPV vaccine information sources. General messaging around cancer prevention did not always supersede some parents' concerns about the vaccine's perceived link to sexual activity. Parents often viewed their adolescent child's feelings about the HPV vaccine as a gauge of their (child's) intent for sexual activity. Interviewees felt a sense of responsibility to educate themselves about the HPV vaccine using multiple sources and particularly looked to their medical provider to filter conflicting information. CONCLUSIONS: More family-specific (vs. disease-prevention) messaging and recommendations may be needed in the clinical environment to sway some parents' negative attitudes about the HPV vaccine. Future research should explore additional strategies to improve HPV vaccine attitudes, such as situating the vaccine in the context of a monogamous lifestyle that many parents wish to impart to their children.

Parent perspectives on the benefits and risks of child-livestock interactions.

Growing up on a farm or ranch often involves interactions with livestock that present both potential risks and benefits to children. While these "child-livestock interactions" contribute to the burden of agriculturally related injuries to youth in the United States, they may also result in improved immunological health and other benefits. Agricultural upbringings are also widely perceived to improve physical, cognitive, and skill development of children, contributing to a combination of potential benefits and risks known as the "farm kid paradox." Although previous studies show the health impacts of child-livestock interactions, less is known about the ways in which farm and ranch parents perceive the benefits and risks of these interactions, and how and why they choose to raise children around livestock. Our research addresses this gap by analyzing data from semi-structured interviews with 30 parents of children between the ages of 10-18 who produce beef cattle in Kansas. This research is part of a larger anthropological study of the benefits and risks of child-livestock interactions involving parents on beef and dairy operations in multiple states, along with agricultural safety and health professionals. The results offer insights into the experiences, practices, and perspectives of parents, outlining agricultural ways of life in which safety and relations to risk are shaped by patterns of production, family dynamics, values and habits, and other social and cultural dimensions. These insights deepen our understanding of parents' perceptions of both benefits and risks of agricultural childhoods.

Regional surveillance of medically-attended farm-related injuries in children and adolescents.

Purpose: Due to numerous environmental hazards such as heavy machinery and large livestock, youth who live and work on farms are at high risk of injury, disability, and death. This study described a regional surveillance system for monitoring farm-related injuries in children and adolescents. As the risk of farm-related injuries are not exclusive to farm residents, trends in farm-related injuries over the previous 5 years were reported and compared between children/adolescents who did and did not live on farms in north-central Wisconsin. Methods: A retrospective cohort of child and adolescent patients of the Marshfield Clinic Health System was assembled. Incident farm-related injuries, including from agricultural work or other activities in a farm environment, were extracted from medical records from 2017 through 2021. Generalized linear models were created to compare age- and sex-adjusted farm-related injury rates by year. Results: There were 4,730 (5%) in-farm and 93,420 (95%) out-farm children and adolescents in the cohort. There were 65 incident farm-related injury cases in the in-farm group and 412 in the out-farm group. The annual incidence rate of farm-related injuries was higher in the in-farm group, but changes during the 5-year timeframe were not significant in either group. In the in-farm group, rates ranged from a high of 61.8 [95% confidence interval (CI): 38.3, 94.5] incident farm-related injuries per 10,000 children/adolescents in 2017 to a low of 28.2 (13.5, 51.9) injuries per 10,000 children/adolescents in 2018. In the out-farm group, rates ranged from 10.7 (8.3, 13.6) to 16.8 (13.7, 20.5) incident farm-related injuries per 10,000 children/adolescents per year between 2017 and 2021. The in-farm group had a higher proportion of injured males and heavy machinery injuries, while the out-farm group had more all-terrain vehicle injuries and pesticide poisonings. Conclusion: Farm residency remains hazardous for children and adolescents, as injury rates were three times higher in the in-farm group and remained stable over 5 years. All-terrain vehicle injuries were high in both groups, and should be a priority in rural safety interventions. With additional adaptations to other states, this surveillance model could be scaled across other healthcare systems.

Heritable vaginal bacteria influence immune tolerance and relate to early-life markers of allergic sensitization in infancy.

Maternal asthma status, prenatal exposures, and infant gut microbiota perturbation are associated with heightened risk of atopy and asthma risk in childhood, observations hypothetically linked by intergenerational microbial transmission. Using maternal vaginal (n = 184) and paired infant stool (n = 172) samples, we identify four compositionally and functionally distinct Lactobacillus-dominated vaginal microbiota clusters (VCs) that relate to prenatal maternal health and exposures and infant serum immunoglobulin E (IgE) status at 1 year. Variance in bacteria shared between mother and infant pairs relate to VCs, maternal allergy/asthma status, and infant IgE levels. Heritable bacterial gene pathways associated with infant IgE include fatty acid synthesis and histamine and tryptophan degradation. In vitro, vertically transmitted Lactobacillus jensenii strains induce immunosuppressive phenotypes on human antigen-presenting cells. Murine supplementation with L. jensenii reduces lung eosinophils, neutrophilic expansion, and the proportion of interleukin-4 (IL-4)+ CD4+ T cells. Thus, bacterial and atopy heritability are intimately linked, suggesting a microbial component of intergenerational disease transmission.

Broadening Our Understanding of Farm Children's Risk Exposure by Considering Their Parents' Farming Background.

While farm safety researchers have seldom considered the association between farm parents' background and their children's safety, researchers who have compared first- and multi-generation farmers have found differences that may shape safety outcomes. We draw on the farm safety and family farm bodies of literature and a survey of 203 United States farm parents to assess the role of farming background in farm children risk exposure. Exploratory in nature, the bivariate analysis revealed no statistically significant differences between first- and multi-generation farmers in children injury, agricultural safety perceptions, knowledge, and practices but revealed differences in key demographic characteristics and parenting styles. A range of factors likely explain these findings with meso- and macro-level factors likely impacting farm parents' ability to adopt safety practices. In contrast to the emphasis on knowledge and behaviors, we call for the integration of lived realities in farm safety research and to do so in a way that connects realities and choices to larger contexts. We also call on the need to expand the toolkit of interventions to address meso- and macro-level factors. A shift towards addressing social and economic conditions in agriculture could reduce farm children's injuries while supporting the sustainability of farm labor systems.

Childhood Agricultural Injury Prevention Among Organic Farmer Mothers.

Purpose: Rates of organic farms and women organic farmers are increasing. Yet, this recent surge brings new and uncertain challenges for injury epidemiology. Since many in the population are of child-bearing age, and child agricultural injury is a significant threat, of particular relevance are the knowledge, attitudes, and beliefs towards risk of child injury.Methods: A paper, self-administered 11-question questionnaire was distributed at four events geared towards early career women organic farmers. The questionnaire generated data around select demographics, attitudes towards farm safety, and sources of safety knowledge.Findings & Discussion: The questionnaire had a 45% response rate. As expected, most respondents were new to farming (1-3 years' experience as a primary owner/operator), and 47% reported having a child under the age of 18 years work on the farm. While respondents recognized farms were generally unsafe for children, they reported their own farm as safe for children. Preferred sources of safety knowledge were those with user-generated content from other farmers.Conclusion: Interventions with new women organic farmers in the Midwest are likely to be most effective by incorporating social media, networking with area farmers' groups, and addressing the optimism bias. Information not explicitly marketed as safety information may gain traction. A more complete analysis of risk, incidence, and prevalence of this niche population is important.

Farmers' Mental Health: Perceptions from a Farm Show.

Introduction: Current economic and environmental conditions have increased awareness of farmers' mental health. Agribusiness professionals may be important key informants to assist agricultural safety and health professionals in understanding the mental health experience of farmers and inform their potential role in mental health promotion. The objectives of this study were to explore agribusiness personnel's perceptions of their farmer clients' mental health and their perceived role in mental health promotion.Methods: Fifteen brief interviews of agribusiness personnel were conducted across 3 days in July 2018 at Farm Technology Days in Wood County, Wisconsin.Results & Discussion: Many interviewees commented on the mental health status of farmers in Wisconsin, stating farmers are "stressed" and "depressed". However, agribusiness personnel were hesitant about their organization's role in mental health promotion. Several respondents cited lack of training and confidence as barriers to addressing mental health with their clients. Others were optimistic about their organization's role in mental health promotion; however, participation would be mostly passive, stating mental health is a difficult topic to broach with some individuals.Conclusion: To engage agribusiness in mental health promotion, efforts to reduce the stigma of mental health disorders and increase agribusiness representatives' confidence and skills in talking about mental health will be necessary.

Respiratory health, allergies, and the farm environment: design, methods and enrollment in the observational Wisconsin Infant Study Cohort (WISC): a research proposal.

Epidemiologic and cross-sectional studies suggest that early life farming and animal exposures are associated with major health benefits, influencing immune development and modifying the subsequent risk of allergic diseases, including asthma. The Wisconsin Infant Study Cohort (WISC) study was established in central Wisconsin to test the hypothesis that early life animal farm exposures are associated with distinct innate immune cell maturation trajectories, decreased allergen sensitization and reduced respiratory viral illness burden during the first 2 years of life. Beginning in 2013, a total of 240 families have been enrolled, 16,522 biospecimens have been collected, and 4098 questionnaires have been administered and entered into a secure database. Study endpoints include nasal respiratory virus identification and respiratory illness burden score, allergic sensitization, expression of allergic disease, and anti-viral immune response maturation and profiles. The WISC study prospective design, broad biospecimen collections, and unique US rural community will provide insights into the role of environmental exposures on early life immune maturation profiles associated with protection from allergic sensitization and significant respiratory viral disease burden. The WISC study findings will ultimately inform development of new strategies to promote resistance to severe respiratory viral illnesses and design primary prevention approaches for allergic diseases for all infants.

"When This Breaks Down, It's Black Gold": Race and Gender in Agricultural Health and Safety.

Farmers are growing older, and fewer new agriculturists are rising to take their place. Concurrently, women and minorities are entering agriculture at an increasing rate. These rates are particularly curious viewed in light of the racialized and gendered nature of agriculture. Slavery and agriculture share strong historical roots, with many male slaves performing agricultural labor. So then, why would African American women choose to engage in agriculture in any form? Participant observation and in-depth interviews with a group of African American women urban farmers in the southeastern United States were asked this question. Interviews with seven such women revealed their perception of self-sustainable small-scale agriculture as a departure from, not return to, slavery. The women drew metaphors between the Earth and femininity, believing their work to be uniquely feminine. Production of food for consumption and trade provides a source for community and healthy food amid urban poverty and the plight of food deserts. These data encourage agricultural health and safety professionals and researchers to tackle the health-promoting nature of such work, with the entrée of anthropology and other social sciences into the field. In many ways, these women portrayed small-scale food cultivation as an important component of, rather than a threat to, health and safety. Indeed, they viewed such labor as wholly health promoting. Their strong social connections provide a potential means for community-led dissemination of any relevant health and safety information.

Socio-environmental risk factors for medically-attended agricultural injuries in Wisconsin dairy farmers.

BACKGROUND: Accidents are common in the agricultural industry, particularly among dairy farmers. How said farmers get hurt is well established, but far less is known about how distal, socio-environmental factors influence injuries. This study examined associations between medically-attended agricultural injuries and: (1) personal sociodemographic characteristics, and (2) farm environment features and general safety practices. METHODS: A cross-sectional survey was implemented with linked data from electronic health records on prior agricultural injuries that occurred between 01/01/2002-12/31/2015. The sample included adult dairy producers who resided in north-central Wisconsin (USA) and were medically-homed to the Marshfield Clinic Health System. Multiple logistic regression was used to analyze associations between socio-environmental characteristics and agricultural injuries. RESULTS: There were 620 dairy farmers in the analytical sample, with 50 medically-attended agricultural injuries observed during the 14-year study time period (5.7 injuries per 1000 dairy farmers per year). In the multivariable model, the odds of agricultural injury were significantly greater among farmers who have private individually-purchased health insurance (OR=4.25; 95% CI: 1.31, 13.84), do not live at their dairy operation (OR=2.91; CI: 1.27, 6.67), and do not provide safety training to their workers (OR=4.27; CI: 1.00, 18.21). CONCLUSIONS: Dairy farmers in this analysis who did not live at their dairy operation, did not provide safety training to all their workers, or had individually-purchased health insurance were more apt to get injured, but more research is needed to confirm these findings in prospectively designed studies. How these factors can be directly addressed or otherwise used to better focus farm injury prevention initiatives should also be explored.

Integrating Agricultural Injury Prevention with Rural Pediatrics: A Pilot Assessment.

BACKGROUND: Childhood agricultural injuries are an important public health problem. Pediatricians are a trusted source of expertise in children's health and safety and could serve as a sphere of influence to augment child agricultural injury prevention efforts. The purpose of this pilot study was to begin to explore the perspectives of pediatricians in a large rural health clinic about addressing child agricultural injury prevention within their practice. METHODS: Structured interviews were conducted with nine pediatricians who maintain a clinical practice of at least 2 days a week and care for newborns through adolescents. Detailed interviewer notes were reviewed and summarized. RESULTS: Rural pediatricians readily acknowledge substantial numbers of farm children in their practice. In general, these providers: (1) recognize farming environments as a safety risk and see agricultural injury prevention as an important topic to be addressed with their patients, (2) are comfortable discussing the topic, but seldom actually initiate such conversations, and (3) doubt farm parents would be receptive to integrating agricultural injury prevention into a rural pediatric practice. CONCLUSION: While rural pediatricians recognize child safety risks in farm environments, they are reluctant to actually initiate this conversation with parents. Future research should explore both pediatricians' hesitancy to discuss agricultural injury prevention and farm parents' readiness for integrating the topic into pediatric primary care visits. Such would help to assess the viability of pediatricians as a sphere of influence for augmenting child agricultural injury prevention efforts.

Sorting Through the Spheres of Influence: Using Modified Pile Sorting to Describe Who Influences Dairy Farmers' Decision-Making About Safety.

OBJECTIVES: The primary goal of this study was to describe the mutually perceived influence of bankers and insurers on their agricultural clients' decision-making regarding health and safety. METHODS: Semistructured interviews were conducted with 10 dairy farmers, 11 agricultural bankers, and 10 agricultural insurers from central Wisconsin. Three of the interview questions involved pile sorting. Pile sorting included 5-point Likert-like scales to help participants sort through 32 index cards. Each card represented an individual or group that was thought to possibly affect farmers' decision-making, both generally and about health and safety. Results (photographs of piles of cards quantified into spread sheets, fieldnotes, and interview transcripts) were analyzed with SAS and NVivo. RESULTS: All three groups expressed moderate-to-strong positive opinions about involving agricultural bankers (x2(2) = 2.8155, p = 0.2695), although bankers qualitatively expressed apprehension due to regulations on the industry. Insurance agents received more positive support, particularly from bankers but also from dairy farmers themselves, and expressed more confidence in being involved in designing and implementing a farm safety program. CONCLUSION: Agricultural bankers and insurers can influence individual farmer's decision-making about health and safety. Both are believed to be good purveyors of safety programs and knowledge, especially when leveraging financial incentives. Insurance agents are thought to be more critical in the design of safety programs. Insurers and bankers being financially tied to safety programs may prove both positive and negative, as farmers may be skeptical about the intention of the incentives, making messaging critical.