1. Prevention of Agricultural Injuries: An Evaluation of an Education-based Intervention LM Hagel, W Pickett, P Pahwa, L Day, RJ Brison, B Marlenga, T Crowe, P Snodgrass, K Ulmer, JA Dosman

2. Objective To evaluate the effectiveness of an agricultural health and safety program in reducing risks for injury.

3. Intervention Agricultural Health and Safety Network Features of the program community-based co-directed by members of the population at risk well funded sustained program over 19 years

4. FARM SAFETY ISSUE No. of Times Issue Addressed 1988 to 2006 (all network years) 1999 to 2006 (most recent 8 years) NN Tractor safety2216 Farm machinery safety3619 Non-machinery hazards147 Burden of farm injury1611 Personal and farm protection166 Special populations at risk86 Total Interventions11265

7. Methods

8. Design: Cross-sectional survey

9. Setting Southern Saskatchewan Rural Municipalities Saskatchewan, Canada

10. Sampling Multi stage Rural Municipal (RM) level Farm level Individual level

11. Data Collection Instrument standardized mail questionnaire key informant on each farm January to April, 2007

12. Data Collection Impact and Outcome Measures safety practices, farm hazards –farm level injury history –individual level

13. Data Collection Exposure Measure years of membership 3 levels of exposure –None –1 to 7 years of membership –8 or more years

14. Statistical Analyses Descriptive –demographic and operational characteristics Analytic –regression analyses adjusted RR (95% CI) account for clustering, binomial regression

15. Results

16. Participants 50 Rural Municipalities 2,392 Farms AHSN > 8 yrs n = 664 farms AHSN < 8 yrs n = 1034 farms AHSN 0 yrs n = 688 farms

17. § adjusted for number of family members; age of the owner/operator; main family residence; education of owner/operator. † unable to calculate due to small numbers ‡ adjusted for number of family members; age of the owner/operator; main family residence. § adjusted for number of family members; age of the owner/operator; main family residence; education of the owner operator and number of tractors, combines, augers, grain bins and water hazards as appropriate. Years in AHSNSignificance FactorHighLowNone (%) Grain production869087* Brown soil zone123121* University educated141522* Vulnerable populations: children young workers >65 year olds 54 39 37 47 38 34 52 41 37 * NS Demographic Comparisons

18. § adjusted for number of family members; age of the owner/operator; main family residence; education of owner/operator. † unable to calculate due to small numbers ‡ adjusted for number of family members; age of the owner/operator; main family residence. § adjusted for number of family members; age of the owner/operator; main family residence; education of the owner operator and number of tractors, combines, augers, grain bins and water hazards as appropriate. Years in AHSNAdjusted RR HighLowNoneNone vs. High (%) RR(95% CI) ROPS absent1612160.95(0.69 - 1.30) Shields absent on combines13980.64(0.41 - 1.01) Shields absent on augers2016150.83(0.59 - 1.17) Ladder cages absent79 801.05(0.98 - 1.13) No water hazard barriers5043471.13(0.96 - 1.33) Physical Safety Hazards

19. Years in AHSNAdjusted RR Children younger than 7 years of age HighLowNoneNone vs. High (%) RR(95% CI) Present in worksite3837431.01(0.84 - 1.21) Ride in cabbed tractor13 120.86(0.53 - 1.41) Assigned small farm jobs1413 0.96(0.61 – 1.50) Present during farm work2829300.99(0.76 - 1.28) Hazardous Practices Children

20. Years in AHSNAdjusted RR Young workers 13 to 18 years old HighLowNoneNone vs. High (%) RR(95% CI) Operate tractor > 20hp3230 0.95(0.68 - 1.32) Operate tractor w/out ROPS12 111.15(0.53 – 2.49) Operate equip > 20 yrs1620 1.14(0.65 – 2.01) Work at heights8780.70(0.70 - 1.81) Work with large animals1819180.82(0.48 – 1.43) Hazardous Practises Young Workers

21. Years in AHSNAdjusted RR Young workers 13 to 18 years old HighLowNoneNone vs. High (%) RR(95% CI) Wear protective equipment3334290.91(0.65 - 1.27) Trained before equip use6064671.09(0.89 - 1.39) Trained with large animals5047561.07(0.82 - 1.41) Supervised operating equip4046431.10(0.81 - 1.51) Supervised w large animals4247481.04(0.77 - 1.40) Training and Supervision Young Workers

22. Years in AHSNAdjusted RR HighLowNoneNone vs. High (%) RR(95% CI) Farm injuries 20069970.99(0.74 - 1.32) By location of treatment Hospital or emergency3321.00(0.99 - 1. 01) Non-hospital setting6651.00(0.98 - 1.01) Injuries

23. Limitations Non-compliance with intervention Not possible to evaluate safety consciousness among non-participants unable to control for effect of exposure to other interventions

24. Strengths large and longstanding intervention large study population: –5 492 people, 2 386 farms robust evaluation: –“hard” outcome measures

25. Conclusion 1 After 19 years, the educational interventions were not associated with observable differences in farm safety practices, physical farm hazards or farm- related injury outcomes

26. Conclusion 2 There is a need for the agricultural sector to extend its injury prevention initiatives to the full public health model. Education alone is insufficient. Education EngineeringEnforcement

27. Publication: Hagel LM, Pickett W, Pahwa P, Day L, Brison RJ, Marlenga BL, Crowe T, Snodgrass P, Ulmer K and Dosman JA. Prevention of agricultural injuries: An evaluation of an educational intervention. Injury Prevention 2008; 14(5)