Changing Health Practices Through Research to Practice Collaboration: The Farm Dinner Theater Experience.

Production agriculture ranks as one of the most hazardous occupations in the United States, with older producers suffering 3.5 times the fatalities compared with their younger counterparts. Previous interventions have not significantly improved the health or work behaviors of farmers. Through careful collaboration among academics and Cooperative Extension agents, we developed, tested, and expanded a unique educational experience, Farm Dinner Theater (FDT), for farmers aged 45 years and more and their families across three states (n = 8 communities, 573 participants). More than 50% of the participants made health or safety changes following the theater. Communities requested more theater events, noting the realism and applicability of the content and the engaging atmosphere for discussion. Participants remarked that the theater should be used across all age-groups. The FDT project created a community of "champions" that synergized the initial research project and fostered expansion and sustainability of the intervention. Process evaluation guided refinement of the theater intervention and built trust, respect, and further cooperative work among all collaborators. Members of the FDT partnership have received national recognition and funding to upscale the concept. The number of FDTs has expanded under local leadership. A toolkit that resulted from the project is available to the public and is constantly updated as more adopters contribute insight and scripts. This article describes the collaborative theater concept and demonstrates how sustained translation from research to practice can be accomplished through continued community engagement, collaboration, and outreach.

Poor sleep quality is associated with obesity and depression in farmers.

BACKGROUND: Farmers' work schedules can result in inconsistent sleep patterns which negatively impact health. PURPOSE: To explore the relationships between sleep, obesity, and depression in working, older farmers and their spouses. Covariates included body mass index (BMI), age, and gender. METHODS: Sleep quality, BMI, and depression were assessed in farmers (n = 1,394) 50 years and older. Bivariate associations among all covariates (i.e., age, gender, BMI, sleep) and dependent variable (i.e., depression) were analyzed using Pearson's correlation. Multivariable associations of the Center for Epidemiologic Studies Depression Scale (CESD). BMI with other study variables were assessed using linear regression. RESULTS: BMI was positively associated with sleep apnea symptoms (p ≤ 0.0001) and CESD scores (p = 0.0006). Participants with difficulty falling asleep were more likely to have poor sleep quality (p ≤ 0.0001) and higher CESD scores (p ≤ 0.0001). Poor sleep quality was associated with higher CESD scores (p ≤ 0.0001). Increased age, female gender, higher BMI, sleep apnea symptoms, and poorer sleep quality were all predictive of higher depressive symptoms. DISCUSSION: Farmers have unique lifestyles that increase the risk of poor sleep. Screening for sleep pattern disruption and understanding its impact could result in lower rates of depression and obesity in this group of high-risk individuals.

Postoperative Symptom Distress of Laparoscopic Cholecystectomy Ambulatory Surgery Patients.

PURPOSE: The purposes of this study were to (1) identify symptoms that cause postoperative distress in ambulatory surgery patients; (2) identify symptom management techniques that effectively reduce distress of laparoscopic cholecystectomy (LC) postoperative symptoms at home after ambulatory surgery; and (3) identify facilitators and barriers to self-management of postoperative symptoms. DESIGN: A qualitative descriptive study. METHODS: Two focus groups of ambulatory surgery patients who had experienced a laparoscopic cholecystectomy procedure and their caregivers were queried to elicit understanding of postoperative symptoms and symptom management techniques. FINDINGS: Themes identified included distressing symptoms and consequences of surgery, symptom management, and self-management facilitators and barriers. Pain was a major symptom after surgery and impacted mobility and sleep. Participants in our study wanted realistic information about symptoms and more specific information on symptom management. Caregivers were important to the success of symptom management but experienced their own stress. CONCLUSIONS: Perianesthesia nurses should focus not only on the immediate recovery, but also prepare patients and their caregivers for the more prolonged issues of recovery at home.

Active coping, personal satisfaction, and attachment to land in older African-American farmers.

Elevated suicide mortality rates have been reported for farmers and for the elderly. Very little literature exists that looks at the health of older minority farmers. This mixed-method study describes older African-American farmers (N = 156) in the contexts of active coping, personal satisfaction from farm work, and attachment to their farmland to provide insight into the psychosocial dimensions of their mental health. Findings show that the farmers have positive perspectives on work and farm future, and strong attachment to the land. Differences were noted by gender. Nurses can use these findings to frame culturally appropriate strategies for aging farmers to maximize positive outcomes.

Farm Dinner Theater: Testing an innovative health and safety intervention among older farmers and their families.

PURPOSE: The effectiveness of a novel intervention for increasing health and safety behaviors of older farmers was tested. Blending didactic and readers' theater techniques, Farm Dinner Theater (FDT) engages farmers in discussions of health and safety in a nonthreatening social atmosphere supportive of potential changes. METHODS: Through community collaborations, farmers 45 years and older were recruited in 8 communities for the FDT. For each site, 3 scripts were prepared highlighting health and safety issues especially relevant for older farmers. The brief plays were performed in a dinner theater format, with group discussion following each play. Printed educational packets (EPs) addressing the same topics were mailed to comparison groups of participants in 9 communities. In telephone interviews conducted 2 weeks and 2 months later, 870 participants (553 FDT and 317 EP) reported health and safety-related changes they had made in their farm operations. FINDINGS: FDT participants were more likely than EP participants to report having made any changes and reported making more changes on both the 2-week and 2-month follow-up assessments. This outcome occurred when analyzing all farms and when considering only farms with at least 1 participant who spent 10 or more hours per week farming. CONCLUSIONS: FDT is a fun, relaxing intervention; it is acceptable to farming communities; and it is more effective in producing health and safety-related changes than the common approach of providing printed materials. FDT not only had a greater impact than EP, but it has the potential to reach larger audiences due to its greater appeal.

Exercise among commercial truck drivers.

This study examines the exercise habits and perceived barriers to exercise of a convenience sample of 300 commercial truck drivers. Participants reported minimal amounts of exercise, with nearly 20% not exercising in the past week. A high prevalence of obesity was found in this sample: 93.3% of study participants had a body mass index (BMI) of 25 or higher. Drivers with BMIs of greater than 30 were significantly more likely to rate the exercise environment as terrible/bad. Drivers who had at least one health condition engaged in significantly less aerobic exercise, used fewer strengthening exercises, did not exercise for 30 minutes continuously, and had a higher BMI. Drivers who spent most of their off-duty time in their truck while their partner drove were also significantly more likely to not exercise regularly. Most drivers cited lack of time and place as the primary barriers to exercising. This study adds to the limited knowledge about exercise behaviors among commercial truck drivers.

Obesity and Work-Related Injuries Among Farmers in Kentucky, Tennessee, and West Virginia.

BACKGROUND: Obesity is a recognized risk factor for work-related injuries (WRI). Despite the inherent safety hazards associated with farm work, research on obesity among farmers is limited giving little guidance to occupational health providers on obesity as a risk factor in farm WRI. This study evaluated the association between obesity and farm WRI. METHODS: Cross-sectional data were collected from farmers (n = 100) in Kentucky, Tennessee, and West Virginia. Data included a survey (demographic data, farm factors, health indicators, occurrences of work-related injuries consistent with the definition of Occupational Safety and Health Administration [OSHA] recordable injuries) and direct anthropometric measures (height, weight, and waist circumference). Logistic regression was used to model any work-related injury, injuries consistent with the definition of OSHA recordables (herein called OSHA-recordable injuries), and recurrent injuries occurring during farm work performance on body mass index (BMI) and waist circumference. FINDINGS: Twenty-five percent of the participants reported any injuries, and 18% reported OSHA-recordable injuries. Farmers with a BMI ≥30 kg/m2 had 3 times the risk for OSHA-recordable injuries and 5 times the risk for recurrent injuries. No significant relationship was identified between waist circumference and farm WRI. CONCLUSION: This study provides evidence that increased BMI is a safety risk for farmers. Prospective studies with a larger sample are needed. Occupational health nurses and providers should educate farmers on the potential safety risk of obesity and implement weight management programs addressing obesity in farmers.

Risk for Depressive Symptoms and Suicide Among U.S. Primary Farmers and Family Members: A Systematic Literature Review.

Background: About 84% of the agriculture, fishing, and forestry occupational sector is comprised of farmers. This sector is at high risk for suicide in the United States. Recent disasters and trade upheavals may make farmers and their families more vulnerable to depression and suicide. This review focused on the risk for depression and suicide among United States' primary farm operators and their families. Methods: A systematic search of the literature published between January 2000 and June 2019, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was conducted. Results: A total of 30 articles met full inclusion criteria. Seventeen reports emanated from the midwest. Twenty studies used a cross-sectional design, primarily assessing a convenience sample or random stratified sample from a limited geographic area. We discovered only one intervention evaluation study. Depressive symptoms were assessed as part of the studies, but it was not the major focus. A variety of instruments measured depressive symptoms, with the Centers for Disease Control Epidemiologic Studies-Depression (CES-D) Scale used more frequently than other scales. Thirteen studies focused on the relationship between pesticide/chemical exposure and depression or suicide risk. Increased stress, poor physical health, compromised financial position, and previous injury were among the leading indicators of depression. Conclusion/Application to Practice: The limited number of studies that was discovered identified the need for more robust science where the risk for depression and suicide is the primary focus of the study and for intervention studies grounded in science. Occupational health providers should be vigilant about farm exposure and be aware of factors that may influence depressive symptoms of workers who operate farm establishments.

Predictors of Job Satisfaction in Female Farmers Aged 50 and Over: Implications for Occupational Health Nurses.

BACKGROUND: Over the past three decades, the number of female farmers in the United States has increased to nearly 1 million, yet research on this occupational group is limited. Job stress arising from job dissatisfaction in other occupations is associated with both acute and chronic diseases. The purpose of this study was to examine the associations of demographic characteristics, agricultural occupational factors, and health indicators with farm-work satisfaction among female farmers. METHODS: Cross-sectional data from the Sustained Work Indicators of Older Farmers Study (2002-2006) was used to examine older female farmers (N = 332) from North Carolina and Kentucky. This secondary data analysis used farm-work questions adapted from the Kentucky Farm Health and Hazard Surveillance Project to measure demographics and occupational factors, the 20-item Center for Epidemiologic Studies-Depression Scale to measure depressive symptoms, and a single item from the National Health Interview Survey to measure self-perceived health status. FINDINGS: Controlling for demographic characteristics, work factors, and health indicators, the female farmers were more likely to report satisfaction with farm work when they had performed a greater number of agricultural tasks in the past year and if they had lower levels of depressive symptoms. CONCLUSIONS/APPLICATION TO PRACTICE: This study provides an initial basis for further research with women working in agriculture. Occupational health nurses, particularly those practicing in agricultural areas, can enhance their quality of care by having a greater understanding of the factors associated with farming and farm life that affect female farmers' overall health.

Exposure risks and tetanus immunization status in farmers ages 50 and over.

BACKGROUND: Despite an effective tetanus vaccine, tetanus continues to claim lives worldwide. The very young and the elderly are at highest risk for the disease. Farmers are at high risk for injury, the leading factor associated with tetanus. METHODS: As part of a larger study of older members of farm households in the southern United States, 595 participants provided data on health, injuries, work, socioeconomic status, and healthcare. RESULTS: 69% reported receiving a tetanus booster in the past ten years, 24% had not, and 7% did not know. Females were less likely to be currently immunized. There was no association between immunization status and age, income, or race. There were associations between farm tasks, farm work-related injury, and immunization. CONCLUSIONS: Older farmers are at risk for tetanus by virtue of their age and work environment. Health care providers should explore strategies to improve immunization status among this work group.

Suicide: An Unrecognized Epidemic Among Farmers.

Stress and depression are prevalent among farmers, and suicide has reached epidemic status. Occupational health nurses are in key positions to recognize these mental health issues and use strategies to control this epidemic.

Moving social work norms via theater for senior farmers.

PROBLEM: Senior farmers have a 2.6-fold risk of fatal injury compared to their younger counterparts. Usual educational interventions have resulted in limited success in reducing injury. METHOD: An innovative strategy, didactic readers theater, was piloted. Farmers' stories provided the foundation for the scripts. The approach incorporated adult learning strategies based on Ajzen's Theory of Planned Behavior. The intervention was marketed as a "dinner theater" to farm couples. Three short socio-novels (plays) were presented by local farmers who served as actors. Following each play participants completed a reaction form and participated in a short discussion about the play's content. One week later a phone survey was completed that tapped further reaction to the content and behavior changes. RESULTS: Thirty-three farm household individuals (including 16 couples) participated. Participants expressed favorable reaction to the intervention. Within one week post intervention, 42% had made safety changes and 67% were "thinking about/intending" to make changes. DISCUSSION: The use of real stories contributed to the success of this intervention. Farmers identified with the stories and began to think and talk about the impact that aging exerts on their health and safety. Interaction among the group identified work modifications which empowered the farmers to make positive changes in their own work behavior. SUMMARY: Educational interventions with farmers have met with limited success in reducing farm-related injuries. Moreover, few interventions have utilized the family unit. This novel program, incorporating local organizations and using limited financial resources, resulted in swift behavior changes. PRACTICAL APPLICATIONS: Total Worker Health includes not only the worker, but also the family. Interventions that include family units should be considered when possible. This format is effective, easily adapted to local issues, can be delivered using existing infrastructure, and is acceptable to the farm community. It is currently being tested on a larger scale.

Postoperative Distress of Orthopedic Ambulatory Surgery Patients.

Patients who undergo orthopedic ambulatory surgery have reported high levels of symptom distress during recovery at home. Content analysis of this qualitative descriptive study identified techniques of symptom management that effectively reduce postoperative symptom distress after orthopedic ambulatory surgery and provided insight into facilitators and barriers to postsurgery self-management. Focus groups consisted of 19 patients and caregivers recruited from a university orthopedic surgery office. The authors identified the common themes as distressing symptoms and consequences of surgery, management of symptoms, and self-management facilitators and barriers. Participants in our study noted the lack of continuity of care after discharge and wanted to know the realities of symptoms and receive more detailed information from care providers on how to self-manage symptoms. Nurses involved in the care of these patients should focus not only on short-term recovery, but on preparing patients to manage sustained recovery issues at home.

Personal protective equipment use and safety behaviors among farm adolescents: gender differences and predictors of work practices.

CONTEXT: Children on farms perform work that places them at risk for acute and chronic negative health outcomes. Despite strategies for preventing and reducing the risk of disease and injury, children's use of personal protective equipment and safely equipped farm machinery has generally remained unreported. PURPOSE: This paper reports the use of personal protective equipment, self-protective work behaviors, and selected risk exposures of children aged 14-19, who perform farm work. METHODS: Survey results of adolescent high school students (n = 593) enrolled in agriculture class in Kentucky, Iowa, and Mississippi. Students were part of the sample that participated in the Agricultural Disability Awareness and Risk Education Project. FINDINGS: Boys were at a significantly higher risk of exposure compared to girls, and boys engaged more frequently in risky behavior. Hearing and respiratory protection was used minimally and sporadically. Physical symptoms influenced use of hearing and respirator use, as did physician recommendation to use such protection. Of students who operated farm tractors, only half most frequently operated tractors with safety bars and seat belts. Sixty percent of the students reported using equipment with damaged or missing safety shields. CONCLUSIONS: In addition to the usual risks of farm work, adolescents may be at even greater risk by not using personal protective equipment or not having access to machinery that is properly equipped for maximum protection. Health care providers should incorporate advice to adolescents and their parents on risk reduction, particularly on the use of personal protective equipment.

Depression in Registered Nurses: A State of the Science.

Registered nurses suffer from depression at almost twice the rate of individuals in other professions. Major depression affects both employees and organizations. Depression is linked to increases in work absenteeism, short-term disability, and decreased productivity and presenteeism. Depression experienced by registered nurses may not be fully preventable, but realizing its presence and prevalence in the workplace is of vital importance. It is essential that we have a healthy, vibrant, and present registered nurse workforce to ensure that quality patient outcomes are achieved. This review of 36 articles assesses the current state of the science related to depression in registered nurses so that occupational health nurses can create pathways and work environments for better mental health for registered nurses.

Farm work injuries among a cohort of children in Kentucky, USA.

Children residing on farms with livestock may be at an increased risk for work-related injuries, compared to children who work on other commodity farms. This study characterizes children's work tasks on Kentucky farms and assesses whether children who work on beef cattle farms are at an increased risk for farm work injuries. The results of a cohort study of children aged 5-18 years (N=999 at baseline) working on family farms in Kentucky, followed for two consecutive years after an initial enumeration five years previously, found that 70% of the children were involved in animal-related chores. Across all age groups, children on beef cattle farms devoted a greater number of hours per week to farm work, compared to children living on other commodity farms, especially during the school year. For all children in the study, working more than 180 days per year, performing farm work independently, and working on a beef cattle farm (compared to other commodity farm), increased the risk of a farm work injury. However, none of these associations were statistically significant. For male children only, the performance of work tasks independently was significantly associated with a 2.4-fold increased risk (OR = 2.41; 95% CI: 1.15-5.06; P=0.02) for a farm work injury, after controlling for days of working, age, period of data collection, and commodity type of the farm.

Depressive symptoms in adolescents living in rural America.

PURPOSE: The purposes of this pilot study were to examine prevalence of depressive symptoms among rural adolescents and identify related social and environmental variables. METHODS: A convenience sample of 299 14- to 18-year-old agriculture class students at 5 rural high schools in Kentucky and Iowa completed a survey that included demographic information, family farm history, experience with suicide, perception of school environment, and indicators of farm injuries and risky behaviors. Participants also completed the Center for Epidemiologic Studies Depression Scale (CES-D) as well as scales to assess the number of major life events in the last year, active coping use, and family closeness. FINDINGS: The prevalence of a high level of depressive symptoms (CES-D > or = 16) in this sample was 34%. Nine percent had seriously considered suicide in the last year. Unlike previous reports, boys reported as many depressive symptoms as girls. Although the literature reports that engaging in risky behavior is associated with depressive symptoms, the only risky behavior linked with depressive symptoms in this sample was operating a 4-wheel all-terrain vehicle. Other predictors of depressive symptoms included poor family relationships and poor active coping. CONCLUSIONS: Interventions to identify and prevent depressive symptoms in rural adolescents are needed. Boosting active coping and improving family function may also prevent the development of clinical depression in rural adolescents.

Nurses' agricultural education in the southeastern United States.

The number of nurses across the United States with expertise in agricultural health nursing is unknown, yet as many as 8,000 are needed. This article describes agricultural health content in nursing programs in the southeastern United States. Agriculture is primarily family based but ranks among the top three most hazardous industries in America. Nurses in the southeastern United States serve more than 541,000 farm families, more than a quarter of the nation's agricultural population. A 15-item survey was mailed to 185 nursing schools located within 13 southeastern states. Information was requested about undergraduate and graduate curricula that included information about agricultural health and safety. Surveys were returned from 113 programs (61.1%). Schools with larger percentages of rural students were more likely to include mention of agricultural health; however, scant attention was given to any rurally focused content. In 27.4% of the schools, no mention of agricultural health issues was made, and 54.0% of nursing faculty who completed the survey were not aware of the need for nurses with agricultural health expertise. Results suggested that, when agricultural health topics were presented in class, student interest in the topic increased. Given the occupational hazards faced in agriculture and the region's economic dependence on agriculture, increased attention should be focused on agricultural health content within nursing programs.

The risky business of production agriculture: health and safety for farm workers.

The lifestyles of employees affect their work and their health. Occupational health nurses need to know as much as possible about employees to render the best care possible. Production agriculture is a risky business performed by many employees. By understanding the risks involved, occupational health nurses can optimize the health of workers in the off farm and on farm contexts of their lives. Managers and supervisors need to realize that investment in farm health and safety can yield financial benefits in terms of decreasing lost workdays caused by injury and illness and increased morale through public recognition of the importance of agricultural production.

Health on the road: issues faced by female truck drivers.

Nearly 3 million long haul truck drivers transport goods across America. Truck driving is rated as the nation's third largest growth occupation. Between 174,000 and 290,000 drivers are women and the percentage of women in trucking is growing. A descriptive study was conducted to identify health conditions, health care access, and driving environments of female drivers. Analyses of the 284 surveys showed only 77.8% had a usual place of health care. One of five had no insurance coverage and only 35 respondents had paid sick leave. Drivers reported substantial prevalence of sinus problems, back pain, migraine headaches, and hypertension. Drivers ignored symptoms or self medicated when working. More than 40% expressed dissatisfaction with health care while "on the road." Occupational health nurses may be in positions to address the special needs of drivers through websites, trucker health clinics, or special programs delivered where truckers congregate.