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.

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.

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.

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.

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.

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.

Stakeholders Team up for Action in New York Dairy (STAND): A Collaborative Action-Planning Workshop to Combat Toxic Stress among New York Dairy Farmers.

Objectives: Mental health challenges on farms, especially dairies, are increasing. A Future Search workshop was held in December 2018 to develop collaborative strategies for addressing this issue. This brief report outlines the methods used at this workshop and its outcomes.Methods: Participants from eight sectors related to producer wellbeing were invited to participate in the 3-day workshop. This included: male and female farmers, health, mental health, government, agricultural, and dairy-specific organizations, and processors. Together, the group worked through activities dealing with the past, present, and future. These activities led to the development of common ground missions and action steps to achieve these goals.Results: The workshop participants developed goals and action steps to create change in nine areas: peer support and social networks; environment; healthcare; business planning; regulations; milk pricing; marketing and consumer education; education, research and technology; and workforce.Conclusions: Much was achieved during the 3-day workshop. Additional follow-up with participants will ensure that momentum toward shared goals continues.

Corrigendum to "Fall Risk Reduction Program Paired with a Transportation Program in an Underserved, Urban Minority Community: A Qualitative Evaluation".

[This corrects the article DOI: 10.1155/2019/2719290.].

Key factors for successful implementation of the National Rollover Protection Structure Rebate Program: A correlation analysis using the consolidated framework for implementation research.

Objectives On US farms, tractor overturns are the leading cause of death; however, these fatalities are preventable with the use of a rollover protection structure (ROPS). A ROPS rebate program was established in New York in 2006 to address these fatalities. Due to its success, the program expanded to six additional states before being implemented as the National ROPS Rebate Program (NRRP) in 2017. The aim of this study was to evaluate the success of the NRRP implementation using short- and long-term ROPS outcome measures and identify which components of the consolidated framework for implementation research (CFIR) correlate with these outcomes. Methods Stakeholders involved in the NRRP implementation were surveyed at four time points, beginning at the time of the NRRP launch and then every six months. These surveys measured 14 relevant CFIR constructs. Correlations between CFIR survey items (representing constructs) and three outcome measures (intakes, funding progress, and retrofits) were used to identify CFIR survey items that are predictive of the outcomes. Results Eight CFIR survey items were highly correlated (rho ≥0.50) with at least one of the three outcome measures. These eight CFIR survey items included four constructs: access to knowledge and information, leadership engagement, engaging (in fundraising and funding requests), and reflecting and evaluating. Conclusions The results of this study provide important guidance for continuing the implementation of the NRRP. Similarly, these findings can inform the evaluation of other similarly structured implementation efforts and the application of CFIR in a variety of settings.

Creation of the Person-Centered Wellness Home in Older Adults.

BACKGROUND AND OBJECTIVES: Extending the Patient-Centered Medical Home (PCMH) model into the community may address the poor linkage between medical clinics and underserved communities. Our first of three objectives was to determine if peer leaders and wellness coaches can be the relationship center of wellness care. We evaluated the Self-management Resource Center Small Group Programs (SMRCSGP), plus wellness coaching, as a booster intervention in older adults with chronic diseases. Second, we evaluated the role of personal health records (PHR) prototype as the linkage between the clinic and community. Using input from these two objectives, we lay the groundwork for the Person-centered Wellness Home (PCWH). RESEARCH DESIGN AND METHODS: Participants enrolled from five South Bronx New York City Housing Authority communities. We conducted a pragmatic, randomized controlled trial using two arms (n = 121): (1) SMRCSGP and (2) SMRCSGP plus wellness coaching initiated as a booster after SMRCSGP completion. Adjusted individual growth models compared the slope differences for outcomes. We conducted a social networking analysis on the ties between wellness coaches and participants. PCMH-certified physicians completed in-depth interviews on the PHR prototype. An adaptation from the consensus-workshop model summarized the priority PCWH items. RESULTS: There was an improvement in self-reported physical functioning (2.0 T-score units higher, p = .03) by the wellness coaching group, but the groups did not differ on physical activity. From the social networking analysis, connections were stable over time with wellness-coaches and participants. The Consensus Conference identified eight major components of the PCWH. DISCUSSION AND IMPLICATIONS: Wellness coaching post-SMRCSGP was a booster to physical function, an upstream outcome for physical activity. During the Consensus-Conference, community-based prevention marketing and personal navigators for connecting to a PCMH emerged as novel components. This supports future work in training community health workers as peer leaders to provide evidence-based programs and other PCWH components.

Marketing Farm Safety: Using Principles of Influence to Increase PTO Shielding.

OBJECTIVES: Despite much work to reduce the frequency and severity of agricultural injuries, these events still occur. Power take-off entanglements are one example of agricultural events that can lead to death or permanent disability. This manuscript considers the use of marketing techniques to reduce agricultural injuries. Specifically, the "principles of influence" (liking, social proof, authority, consistency, reciprocity, and scarcity) are explored as methods of promoting power take-off shielding among New York farmers. METHODS: Focus group discussions were held with farmers and agricultural service providers in seven agricultural counties in New York. Participants were provided with background information about power take-off injuries, as well as information on one principle of influence. Facilitators then guided the groups through a brainstorming discussion to formulate intervention strategies. RESULTS: Thirty-nine individuals participated in the discussions. Participants provided feedback on individuals and organizations that could serve as influencers, potential incentives for participants, and beliefs about what would not work in their community. CONCLUSION: Overall, participants were enthusiastic about using principles of influence to promote power take-off shielding. These methods appear to be promising for improving safety on farms, and have the potential to save both time and money compared to other intervention strategies.

Fall Risk Reduction Program Paired with a Transportation Program in an Underserved, Urban Minority Community: A Qualitative Evaluation.

This study sought to evaluate A Matter of Balance/Volunteer Lay Leaders (AMOB/VLL) fall prevention curriculum in combination with a "door-through-door" program: Coordinated Older-Adult Senior Transportation Services (COASTS) for older adults living in an urban, underserved community. AMOB/VLL participants were offered eight 2-hour classes as part of the training program. Focus groups were conducted with older adult participants, COASTS mobility facilitators, and AMOB/VLL master trainers. A thematic analysis was conducted, and primary themes relating to curriculum content, cultural relevancy, and outcomes were examined. Older adults and facilitators felt the course was rewarding and led to improvements in mobility and confidence. Master trainers were more critical and recommended simplifying content, with tailored guidance for specific populations. They also recommended increased emphasis on balance and physical activity. Although participants and MoFas felt combining AMOB/VLL and COASTS was rewarding and improved participant mobility, master trainers and participants suggested minor modifications to increase program benefits for urban, underserved communities.

Lifejackets and Lobstermen: Giving Safety Equipment a Competitive Advantage.

Background: Falls overboard are the most frequent cause of death in the Northeast lobster fishing industry. National Institute for Occupational Safety and Health (NIOSH) surveillance indicates every victim of a fall overboard who has been found was not wearing a lifejacket. Preliminary research conducted in Maine and Massachusetts indicates lifejacket use is relatively uncommon among lobstermen due to barriers such as comfort, practicality, and social norms.Methods: This study highlights an initiative to: (1) trial various lifejacket designs with lobstermen; (2) identify the most popular designs; and (3) identify other features that could encourage use of lifejackets. In 2017, nine designs were trialed with lobstermen in Maine and Massachusetts during the winter and summer fishing seasons. Participants were recruited dockside, and lifejackets were randomly assigned. Participants completed surveys at 1 week and 4 weeks to assess positive and negative design features and to understand the importance of survival technology that can be used in conjunction with lifejackets.Results: 181 lobstermen in Maine and Massachusetts agreed to participate. Recruitment rates were 90.5%, while the survey completion rate was 88.4%. Survey results identified no clear preference for a specific lifejacket design; however, the ability to choose from many options appeared to be an important factor.Conclusion: Previous studies have indicated that lifejacket preferences are fisheries specific. In the Northeast lobster fishery, however, individual preferences varied. Our research demonstrates that a range of devices covering different buoyancies, wear type, and retrieval systems should be made more available to lobstermen.

Quality of chronic pain websites.

BACKGROUND: The Web not only can play a role in helping patients learn about their chronic pain, but can also be a source of misleading or untrue information. This study evaluates the quality of Internet information available concerning chronic pain at different sites, and determines the relation between quality and the source and character of the Websites. METHODS: A survey was conducted of patients seen at the Pain Management Center at Dartmouth-Hitchcock Medical Center (DHMC). Patients with access to the Internet identified the five most common keywords they used to look up information: pain, chronic pain, back pain, arthritis, and fibromyalgia. A focus group of pain clinicians at DHMC then chose the quality criteria to evaluate Websites. The criteria consisted of 16 items in five domains: etiology, diagnosis, goals of treatment, treatment options, and substance abuse. The first two pages of links displayed by each of three major search engines then were assessed for quality. RESULTS: A total of 240 Websites were evaluated. The mean score, the Quality Website Index (QWI), was 2.17 (SD = 3.3), (range from -16 [poorest] to +16 [best]). The overall quality of this group of Websites is rather poor, although there were several excellent sites. Websites located on the main search page had a significantly higher score than those in the sponsored section, and Websites based on standards had a significantly higher score than those that were not. CONCLUSION: Based on QWI scores, clinicians can recommend chronic pain Websites to provide their patients with accurate and pertinent information.

"I Would Go if My Arm Were Hanging off": A Qualitative Study of Healthcare-Seeking Behaviors of Small Farm Owners in Central New York State.

Compared to their rural non-farming peers, farmers are less likely to access preventive healthcare services; however, the reasons for this disparity are poorly understood. We conducted semi-structured interviews with a total of 30 farm household members in central New York. Interview topics included farming identity, perceptions of one's health, past experiences with acute and preventive healthcare, and attitudes toward seeking healthcare services. Grounded Theory analysis of the interview transcripts revealed that (1) utilizing healthcare services is felt to be in conflict with the farming identity, (2) the need to conserve time and money for farm applications poses a barrier to healthcare utilization, (3) farmers decide to seek healthcare when they believe it is necessary to ensure survival of the farm, and (4) the decision to seek healthcare is most strongly driven by the presence of intolerable symptoms, prompting from others, and the perception that treatment will yield clear benefits. Efforts to increase farmers' utilization of healthcare services must address these considerations.