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.

Medically Attended Suicidality in Youth Who Live on Farms.

Suicides are increasing in U.S. youth, particularly in rural areas. The influence of farming, however, is unclear, as suicide rates are higher in individual adult farm workers, but lower in farming-reliant counties. Early recognition of suicidality (suicidal ideation, intent, or attempt) is a key element of prevention, but there are no prior studies comparing suicidality in farm vs. non-farm youth. The purpose of this study was to examine associations between farm/rural residence and suicidality. Medical records were reused from an existing cohort of child and adolescent patients under surveillance for agricultural injuries in a Wisconsin healthcare system. The sample included 2,010 youth who lived on farms and 51,900 youth who did not live on farms (57% rural). The outcome was medically attended suicidality in 2017-2022 per a composite of diagnoses for suicidal ideation, attempt, or intentional self-harm that presented to ambulatory, emergency, or inpatient care settings. Suicidality was observed in 0.8% of farm, 1.8% of non-farm rural, and 1.6% of non-farm non-rural youth. After covariate adjustment, farm youth had significantly lower odds of suicidality (adjusted odds ratio [aOR] [95% confidence interval; CI] = 0.55 [0.33, 0.91], P = .019), while non-farm rural youth had significantly greater odds of suicidality (aOR [CI] = 1.21 [1.05, 1.40], P = .007), relative to non-farm non-rural youth. Children and adolescents who live on farms are about half as likely to (medically) present for suicidality as compared to their non-farm counterparts, both rural and non-rural. Future research should identify causal suicide protection factors in farm youth.

The Potential of AI and ChatGPT in Improving Agricultural Injury and Illness Surveillance Programming and Dissemination.

Generative Artificial Intelligence (AI) provides unprecedented opportunities to improve injury surveillance systems in many ways, including the curation and publication of information related to agricultural injuries and illnesses. This editorial explores the feasibility and implication of ChatGPT integration in an international sentinel agricultural injury surveillance system, AgInjuryNews, highlighting that AI integration may enhance workflows by reducing human and financial resources and increasing outputs. In the coming years, text intensive natural language reports in AgInjuryNews and similar systems could be a rich source for data for ChatGPT or other more customized and fine-tuned LLMs. By harnessing the capabilities of AI and NLP, teams could potentially streamline the process of data analysis, report generation, and public dissemination, ultimately contributing to improved agricultural injury prevention efforts, well beyond any manually driven efforts.

Race, Rurality, and Suicidality in Children and Adolescents.

INTRODUCTION: Suicide is among the leading causes of death in U.S. youth. Rural residency is a risk factor, but suicide variability by race/ethnicity is more nuanced. Early detection of suicidal ideation and intent are key components of prevention, but to the authors' knowledge, few prior studies have examined how rurality and race interact on youth suicidality. This study examined suicidality between White non-Hispanic versus non-White or Hispanic youth, as well as those who lived in rural versus non-rural areas. METHODS: Cross-sectional analyses were conducted using data from youth age 5-17 years who had complete capture of their medical care in a Wisconsin healthcare system. Suicidality was extracted from medical records by screening for diagnoses indicative of suicidal attempt or ideation between 2017 and 2022. Race/ethnicity and rural residence were extracted from administrative records. Analyses were done in 2023. RESULTS: The sample included 27,392 rural and 20,370 non-rural youth, with suicidality observed in 2% of participants. There was a significant interaction between rural residence and race/ethnicity (p=0.015). Non-White or Hispanic youth in rural areas had the highest risk of suicidality at 75 (CI: 57, 97) per 10,000. Non-White or Hispanic youth in non-rural areas had the lowest risk of suicidality at 38 (CI: 28, 52) per 10,000. CONCLUSIONS: Racial/ethnic minority youth who lived in rural areas were more likely to experience suicidality as compared to their non-rural counterparts. Larger prospective studies are needed to identify causal elements of the rural environment that may hasten racial disparities in youth suicidality.

Needs assessment survey for enhancing United States child agricultural injury prevention capacity: Brief report.

The dissemination of childhood agricultural safety and health information and resources through organizations that farmers trust enhances implementation and the Socio-Ecological Model can help identify these organizations. However, to become effective partners in improving agricultural health and safety, organizations need to build capacity in child agricultural safety and health, thus, more information is needed about these organizations' current practices, needs, and capacity for leadership, policy makers, and knowledge mobilization. An online survey was administered to organization leaders with an interest in child agricultural injury prevention, chosen through agricultural health and safety organization membership lists. Invitations to participate in the online survey were mailed to 95 organization leaders with three weekly reminders, resulting in participation from 50 organization leaders (53% response rate). Respondents indicated a high level of awareness of child agricultural injuries, yet few were actively engaged in injury prevention. When asked about "needs" for building capacity in injury prevention, over half (56%) identified a need for more promotion and dissemination of safety resources and strategies, including ATV safety, no extra riders on equipment, and keeping young children out of the worksite. The only topic that more than half of the organizations (54%) identified as "needing more information" was childhood agricultural injury surveillance. This assessment yielded valuable details for identifying opportunities, priorities, and topics for future collaborations and capacity building. Findings help inform national and international planning committees' work, such as the next iteration of a US National Action Plan for Childhood Agricultural Injury Prevention, scheduled for release in 2024.

COVID-19 vaccine coverage disparities in rural and farm children.

BACKGROUND: The risks of severe outcomes associated with SARS-CoV-2 (COVID-19) are elevated in unvaccinated individuals. It remains crucial to understand patterns of COVID-19 vaccination, particularly in younger and remote populations where coverage often lags. This study examined disparities in COVID-19 vaccine coverage in farm children and adolescents. METHODS: A cross-sectional analysis was conducted in patients of the Marshfield Clinic Health System (MCHS) in Wisconsin. The sample included children/adolescents age 5-17 years who were eligible for COVID-19 vaccine initiation for ≥ 90 days (as of September 30, 2022), stratified by those who lived vs did not live on a farm. Outcomes included COVID-19 vaccine initiation, series completion, and booster receipt. Multivariable regression was used to examine associations between COVID-19 vaccination and farm, as well as rural and non-rural, residence. RESULTS: There were 47,104 individuals (5% farm residents) in the sample. Overall, 33% of participants initiated and 31% completed the COVID-19 vaccine series. After adjustment, farm residence was associated with significantly lower odds of COVID-19 vaccine initiation (aOR [95% CI] = 0.68 [0.61, 0.75], p < 0.001), series completion (aOR = 0.67 [0.60, 0.75], p < 0.001), and booster receipt (aOR = 0.73 [0.61, 0.88], p = 0.001). Secondary analyses found COVID-19 vaccine coverage was lowest in young children who lived on dairy farms. CONCLUSIONS: COVID-19 vaccine coverage is low in north-central Wisconsin children and adolescents. Those who live on farms have significantly lower likelihood of COVID-19 vaccine initiation, series completion, and booster receipt compared to non-farm counterparts. Farm families are an underserved group and require more effective public health interventions designed to prevent COVID-19.

Agricultural youth injuries: An updated review of cases from U.S. news media reports, 2016-2021.

Introduction: Fatal and non-fatal youth (ages 0-17) injuries in U.S. agriculture continue to be a significant public health concern. Despite sustained work and attention from federally supported research programming, we continue to observe an unacceptably high number of life-altering and life-ending traumatic injuries to youth in agricultural environments. Likewise, there is still a gap in stringent systematic agricultural injury and/or illness surveillance at the federal level. This paper will provide an updated review of child agricultural injuries from U.S. news media reports, expanding upon this author team's initial 2018 report. Methods: Data collection from 2016 to 2021 occurred as part of the AgInjuryNews initiative, and data were coded according to the Farm and Agricultural Injury Classification (FAIC) system and the Occupational Injury and Illness Classification System (OIICS). The AgInjuryNews system primarily contains news media reports. Categorical variables were analyzed and compared using a chi-square test. In addition, the Jonckheere-Terpstra test for trend was used to test the yearly change in the number of youth injuries. Results: We observed a general decrease in agricultural injuries compared to the original 2015-2017 dataset. Younger children (<5 years-old) and males were more often injured and more fatally injured than older children and females, respectively. Males and older victims were more likely to suffer an occupational-related injury compared to females and younger victims, respectively. Vehicles remained a major source of injuries, with tractors comprising 28%, and ATVs/UTVs comprising 26% of all injuries. Roadway incidents involving tractors and UTVs were less often fatal compared to non-roadway incidents, while ATVs were more fatal on roadways. Discussion: This updated review shows childhood agricultural injuries and fatalities continue to be a major public health concern within the US. It is unclear if the trend downward in injuries is due to reporting, data capture methods, or a true decrease in injuries. These data continue to be of interest to stakeholders in academia, public health, government, and private industry-user groups who regularly and consistently seek this type of information, often from multiple data sources, including as registered users on AgInjuryNews.org. These data identify emerging issues within the industry and further inform national and international planning committees' work.

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.

What about the Rest of Them? Fatal Injuries Related to Production Agriculture Not Captured by the Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries (CFOI).

Surveillance of injuries in production agriculture is necessary to inform stakeholders about workplace hazards and risks in order to improve and advance injury prevention policies and practices for this dangerous industry. The most comprehensive fatal injury surveillance effort currently in the United States is the Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries (CFOI), which covers occupational fatalities in all U.S. industries, including production agriculture. However, this surveillance does not include many categories of fatalities that occur during agricultural work or on production agriculture worksites. To better capture the human cost of production agriculture, the authors of this paper call for the collection of additional data with a broader scope that supplements, not replaces, the current CFOI. This paper describes challenges in surveillance, highlights key procedural gaps, and offers recommendations for advancing national surveillance of fatal traumatic injuries associated with production agriculture.

A feasibility study of Augmented Reality Intervention for Safety Education for farm parents and children.

Agriculture is one of the most dangerous U.S. occupations with high rates of injuries and fatalities, and especially more dangerous for children, having more young worker deaths than any other industry. Thus, safety education is essential in promoting safe and healthy working habits in agriculture. Augmented reality (AR) technology has great potential to enhance the effectiveness of safety education due to its high levels of system-user interactivity and media enjoyment. This study aims to: (1) develop Augmented Reality Intervention for Safety Education (ARISE), an AR 3D simulator that presents farm accident situations with immersive media technology, (2) examine the feasibility of ARISE, and (3) evaluate the potential of ARISE as an effective agricultural safety education program for farm parents and children. To test the feasibility of ARISE, we conducted semi-structured in-depth interviews with ten parent-child dyads at an extension office located in Maryland. Participants were farmers who owned and operated a family farm(s) with their child or children ages 5-13. The interviews included asking participants questions about their perceptions of farm risks, sources of risk education, and protection methods. In the next step, participants used ARISE with researcher guidance. After using the application, participants were asked questions about their experience using ARISE and suggestions for improvement. The interviews were then transcribed and analyzed following the conventional content analysis method. Three main themes emerged-demand (e.g., perceived risk and need for education; lack of farm safety education from school), acceptability (e.g., attitude toward AR technology; perceived realism; perceived ease of use; perceived usefulness), and implementation. These findings help us understand how an immersive experience can play an impactful role in enhancing agricultural safety. The feasibility of ARISE sheds light on the potential of AR technology for an innovative safety education program.

An Overview of Agricultural Injuries in Florida from 2015-2019.

HIGHLIGHTS We identified 48 fatal and 187 non-fatal agricultural injuries in Florida from 2015-2019. Vehicles and environmental sources were the two leading injury sources. Using multiple data sources helped us understand the at-risk populations. ABSTRACT. The purpose of this study was to examine and describe fatal and non-fatal agricultural injuries documented in Florida. We used Occupational Safety and Health Administration (OSHA) data and AgInjuryNews.org (AIN) data from 2015 through 2019 to identify 48 fatal and 187 non-fatal injuries during the five-year study period, with 86% (40 fatal, 175 non-fatal) of these injuries being occupational. A total of 101 (43%) people were injured as a result of transportation incidents. Major injury sources were vehicles (46%) and environmental sources (heat, lightning, etc.) (14%). Using AIN data, we identified risks for youth under the age of 18 and for individuals age 65 and older. This study suggests the need for additional injury surveillance efforts to gather demographic information to identify at-risk populations.

Facebook Ads Manager as a Recruitment Tool for a Health and Safety Survey of Farm Mothers: Pilot Study.

BACKGROUND: Social media platforms have experienced unprecedented levels of growth and usage over the past decade, with Facebook hosting 2.7 billion active users worldwide, including over 200 million users in the United States. Facebook users have been underutilized and understudied by the academic community as a resource for participant recruitment. OBJECTIVE: We performed a pilot study to explore the efficacy and cost-effectiveness of Facebook advertisements for the recruitment of an online agricultural health and safety survey. METHODS: We undertook a 1-week advertising campaign utilizing the integrated, targeted advertising platform of Facebook Ads Manager with a target-spending limit of US $294. We created and posted three advertisements depicting varying levels of agricultural safety adoption leading to a brief survey on farm demographics and safety attitudes. We targeted our advertisements toward farm mothers aged 21-50 years in the United States and determined cost-effectiveness and potential biases. No participant incentive was offered. RESULTS: We reached 40,024 users and gathered 318 advertisement clicks. Twenty-nine participants consented to the survey with 24 completions. Including personnel costs, the cost per completed survey was US $17.42. Compared to the distribution of female producers in the United States, our advertisements were unexpectedly overrepresented in the eastern United States and were underrepresented in the western United States. CONCLUSIONS: Facebook Ads Manager represents a potentially cost-effective and timely method to recruit participants for online health and safety research when targeting a specific population. However, social media recruitment mirrors traditional recruitment methods in its limitations, exhibiting geographic, response, and self-selection biases that need to be addressed.

Coding agricultural injury: Factors affecting coder agreement.

OBJECTIVES: To determine coders' agreement level for the Occupational Injury and Illness Classification System (OIICS) source of injury and injury event codes, and the Farm and Agricultural Injury Classification (FAIC) code in the AgInjuryNews.org and to determine the effects of supplemental information and follow-up discussion in final code assignments. METHODS: Two independent researchers initially coded 1304 injury cases from AgInjurynews.org using the OIICS and the FAIC coding schemes. Code agreement levels for injury source, event, and FAIC and the effect of supplemental information and follow-up discussions on final coding was assessed. RESULTS: Coders' agreement levels were almost perfect for OIICS source and event categories at the 3-digit level, with lower agreement at the 4-digit level. By using supplemental information and follow-up discussion, coders improved the coding accuracy by an average 20% for FAIC. Supplemental information and follow-up discussions had helped finalize the disagreed codes 55% of the time for OIICS source coding assignments and 40% of time for OIICS event coding assignments for most detailed 4-digit levels. Five key themes emerged regarding accurate and consistent coding of the agricultural injuries: inclusion/exclusion based on industry classification system; inconsistent/discrepant reports; incomplete/nonspecific reports; effects of supplemental information on coding; and differing interpretations of code selection rules. Practical applications: Quantifying the level of agreement for agricultural injuries will lead to a better understanding of coding discrepancies and may uncover areas for improvement to coding scheme itself. High level of initial and final agreement with FAIC and OIICS codes suggest that these coding schemes are user-friendly and amenable to widespread use.

Rural Telehealth Use during the COVID-19 Pandemic: How Long-term Infrastructure Commitment May Support Rural Health Care Systems Resilience.

Amid concerns of inadequate medical supplies and staffing anticipated from a surge in COVID-19 cases, many health care systems across the United States (U.S.) began shutting down non-essential patient services in March 2020. These sudden shifts bring up questions about the long-term effects of COVID-19 on already fragile rural health care systems and the ability of rural populations, including farmers and farm workers, to meet their health care needs. To provide alternative and safe access to health care, the Federal government relaxed telehealth regulations, which effectively removed some of the largest regulatory barriers that had limited the adoption of telehealth in the U.S. In this commentary, we draw on the example of the Marshfield Clinic Health System (MCHS), a large rural health care system in Wisconsin and provide an early assessment of how it adjusted its telehealth services during the early months of COVID-19. While the long-term effects of the pandemic on rural health care systems will not be known for some time, the example of MCHS points to the importance of on-going and sustained investments to support the resilience of health care systems and their ability to weather crises. With early evidence that MCHS patients and practitioners are interested in continuing to use telehealth post-COVID-19, we conclude our commentary by offering three recommendations to remove hurdles and improve quality of telehealth care.