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

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

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

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

Methods

Design: Cross-sectional survey

Setting Southern Saskatchewan Rural Municipalities Saskatchewan, Canada

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

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

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

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

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

Results

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

§ 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 * NS Demographic Comparisons

§ 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 absent ( ) Shields absent on combines ( ) Shields absent on augers ( ) Ladder cages absent ( ) No water hazard barriers ( ) Physical Safety Hazards

Years in AHSNAdjusted RR Children younger than 7 years of age HighLowNoneNone vs. High (%) RR(95% CI) Present in worksite ( ) Ride in cabbed tractor ( ) Assigned small farm jobs (0.61 – 1.50) Present during farm work ( ) Hazardous Practices Children

Years in AHSNAdjusted RR Young workers 13 to 18 years old HighLowNoneNone vs. High (%) RR(95% CI) Operate tractor > 20hp ( ) Operate tractor w/out ROPS (0.53 – 2.49) Operate equip > 20 yrs (0.65 – 2.01) Work at heights ( ) Work with large animals (0.48 – 1.43) Hazardous Practises Young Workers

Years in AHSNAdjusted RR Young workers 13 to 18 years old HighLowNoneNone vs. High (%) RR(95% CI) Wear protective equipment ( ) Trained before equip use ( ) Trained with large animals ( ) Supervised operating equip ( ) Supervised w large animals ( ) Training and Supervision Young Workers

Years in AHSNAdjusted RR HighLowNoneNone vs. High (%) RR(95% CI) Farm injuries ( ) By location of treatment Hospital or emergency ( ) Non-hospital setting ( ) Injuries

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

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

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

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

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)