Certified Safe Farm Implementation in North Carolina: Hazards, Safety Improvements, and Economic Incentives.

OBJECTIVES: Certified Safe Farm (CSF) is a multimodal intervention composed of four components: safety, health, education, and economic incentive. North Carolina has conducted the largest implementation of CSF outside of the Midwestern United States where it was developed. This paper describes the Efficacy dimension of the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework for the implementation of CSF in North Carolina during 2009-2012 on 113 farms in a three-county, highly productive and diverse agricultural area. METHODS: Using descriptive statistics, analysis of variance, correlational analyses, and logistic regression, quantitative data were examined from on-farm safety reviews, as well as primary operators' use of cost-share funds as an economic incentive (34% participation) to make identified safety and health improvements on the farm. RESULTS: Overall farm safety review scores were generally high (96% passing rate). Category scores revealed hazards in seven key categories: Chemical Storage; Tractors; Machine Shop, Repair Area; Gravity Flow, Auger, and Forage Wagons; Portable Augers; Dairy and Beef Structures; and Swine and Poultry Structures. The cost-share economic incentive component was utilized in addressing hazards in five of these categories, as well as in nine others. The average per farm cost-share reimbursement was $3,276, with a median of $1,615. In total, an investment of $255,307 (farmer investment plus incentive) was made in safety and health improvements on farms (n = 38). Correlation and logistic regression analyses revealed no significant relationships among scores, cost-share investments, and selected farm demographics. CONCLUSION: Findings suggest the 50% cost-share for safety and health improvements is a promising economic incentive model for CSF implementation.

Adapting Certified Safe Farm to North Carolina Agriculture: An Implementation Study.

Certified Safe Farm (CSF) is a multimodal safety and health program developed and assessed through multiple controlled intervention studies in Iowa. Although developed with the intent to be broadly applicable to agriculture, CSF has not been widely implemented outside the midwestern United States. This article describes the CSF implementation process in North Carolina (NC), as piloted on a large-scale in three agriculturally diverse and productive counties of NC, and reports its effectiveness using the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. Implementation involved (1) capacity building through safety and health training, (2) adaptation of components of Iowa's CSF model to NC agriculture, (3) marketing and recruitment, and (4) formative evaluation, including an online survey and focus group discussion. From 2009 to 2012, 113 farms participated in at least one component of the CSF intervention, representing a NC farm participation rate of 3.1% in the study area. A major adaptation of NC implementation was the utilization of NC Cooperative Extension as the local driver of implementation in contrast to local AgriSafe clinics in Iowa. The most innovative adaptation to CSF components was the development of a defined economic incentive in the form of a cost-share program. The RE-AIM framework was found to be useful and relevant to the field of agricultural health and safety translational research. This study provides effectiveness measures and implementation alternatives useful for those considering implementing CSF. It informs current efforts to move CSF from research to practice through the National Sustainable Model CSF Program initiative.

Assessing the effectiveness of the Pesticides and Farmworker Health Toolkit: a curriculum for enhancing farmworkers' understanding of pesticide safety concepts.

Among agricultural workers, migrant and seasonal farmworkers have been recognized as a special risk population because these laborers encounter cultural challenges and linguistic barriers while attempting to maintain their safety and health within their working environments. The crop-specific Pesticides and Farmworker Health Toolkit (Toolkit) is a pesticide safety and health curriculum designed to communicate to farmworkers pesticide hazards commonly found in their working environments and to address Worker Protection Standard (WPS) pesticide training criteria for agricultural workers. The goal of this preliminary study was to test evaluation items for measuring knowledge increases among farmworkers and to assess the effectiveness of the Toolkit in improving farmworkers' knowledge of key WPS and risk communication concepts when the Toolkit lesson was delivered by trained trainers in the field. After receiving training on the curriculum, four participating trainers provided lessons using the Toolkit as part of their regular training responsibilities and orally administered a pre- and post-lesson evaluation instrument to 20 farmworker volunteers who were generally representative of the national farmworker population. Farmworker knowledge of pesticide safety messages significantly (P<.05) increased after participation in the lesson. Further, items with visual alternatives were found to be most useful in discriminating between more and less knowledgeable farmworkers. The pilot study suggests that the Pesticides and Farmworker Health Toolkit is an effective, research-based pesticide safety and health intervention for the at-risk farmworker population and identifies a testing format appropriate for evaluating the Toolkit and other similar interventions for farmworkers in the field.

Engaging Latino farmworkers in the development of symbols to improve pesticide safety and health education and risk communication.

The working and living environments of farmworkers put them and their families at risk for pesticide exposure and, consequently, immediate and long-term health effects. In this study, visual materials for a pesticide toxicology safety and health curriculum were constructed by engaging farmworkers in various stages of symbol development. Twenty-seven farmworkers in two states participated in this descriptive case study through focused small group discussions and interviews. Our findings support the importance of vivid and realistic symbols, the effectiveness of a traffic-light symbol in communicating technical information to farmworkers, and the need to engage low-literacy end-users in the production of educational materials. This work informs the development of curricula for other vulnerable populations pertaining to a variety of health-related topics, as well as discussions surrounding regulatory proposals to revise the United States Worker Protection Standard.

Assessing exposure to crystalline silica from farm work: a population-based study in the Southeastern United States.

PURPOSE: Farm workers are exposed to crystalline silica, but there are no established questionnaires to assess silica dust exposure from farm work in epidemiologic studies. This study examines aspects of farm work that were used to estimate potential silica dust exposure in a population-based study conducted in the southeastern United States. METHODS: We collected work and farming histories through in-person interviews with 620 participants in a population-based case-control study of systemic lupus erythematosus. A dust-exposure matrix was used to develop a telephone interview for 69 participants with potential medium- or high-level exposure, including questions on tasks, frequency, and farm location. Soil systems maps were used to infer soil type (sandy/other). Exposure indices were constructed based on tasks, frequency, and soil type. RESULTS: Thirty-six percent of study participants worked on a farm, but only 52 (8%) were classified in the high (n=16) or medium (n=36) exposure groups based on responses to follow-up interview questions. Exposure indices based on open-ended job descriptions in initial interviews correctly categorized 52% of participants who answered prompted questions on relevant dusty tasks in follow-up interviews. CONCLUSIONS: Specific questions on dusty tasks and frequency are needed to accurately assess silica exposure from farm work.

Exposure to respirable crystalline silica in eastern North Carolina farm workers.

Occupational exposure to crystalline silica has been linked to silicosis, some forms of cancer, and certain autoimmune diseases. Little information exists on exposure levels of respirable silica in the agricultural industry. This study assessed respirable silica exposure of farm workers in eastern North Carolina. Sandy soils in this region have been shown to contain high levels of respirable silica. Personal breathing zone samples (n = 37) were collected from 27 workers at seven farms during various agricultural activities. The highest respirable silica concentrations were measured during sweet potato transplanting (3.91 +/- 2.07 mg/m3). Respirable silica exposure was observed to be associated with agricultural activity, soil moisture, relative humidity, and wind speed. Most of the variation in exposure (79%) was explained by agricultural activity and soil moisture. The observed percentage of silica levels (mean 34.7%) were almost twice as high as was reported in studies of California agriculture. This may be due to the loamy sand and sandy loam soil types in the regions in this study. In agriculture, respirable silica exposure is highly variable, but the potential for exposures above the threshold limit value of 0.05 mg/m3 exists during particular agricultural activities.