InputsActivitiesOutputsIn
Goal 2: Priority Populations at Risk—Reduce injuries, illnesses, and fatalities in subgroups of the working population determined to be at high risk or under-
5
Review of Research on High-Priority Populations at Risk
“Priority populations at risk”, “populations at risk”, and “special populations”
are descriptors used by National Institute for Occupational Safety and Health (NIOSH) in referring to selected groups of people with various degrees of involve- ment in agriculture, forestry, and fishing (AFF) activities. The definition includes those “underserved by traditional occupational health approaches” and at high risk of illness or injury. In the agricultural sector, the AFF Program presented infor- mation on research among selected populations while for the forestry and fishing sectors all workers were viewed as special populations.
STRATEGIC GOALS AND OBJECTIVES
Goal 2: Priority Populations at Risk—Reduce injuries, illnesses, and fatalities
The program listed goals for populations identified as meriting special attention:
• Child labor: Protection of children living and working on farms, under- standing the exposure. Reduce injuries, illnesses, and fatalities among children working on farms.
• Minority populations: Reduce injuries, illnesses, and fatalities among mi- grant and minority farm workers.
• Logging: Reduce injuries, illnesses, and fatalities among logging workers.
• Fishing: Reduce injuries, illnesses, and fatalities among commercial fishermen.
The NIOSH research priority-setting process in relation to AFF populations at risk was based on perceived needs, consultation with experts, and charges given to the agency.
As defined by NIOSH, populations at risk include children, minority groups, logging workers, and fishery workers. Child labor is a complicated issue because children living in a farm environment are involved in various farming activities often viewed as chores rather than work by parents. Minorities are classified by race and ethnicity, and studies included Hispanic and Latino, Navajo, and black farmers and farm workers. Many of the studies of Hispanics and Latinos have centered on hired orchard workers. Loggers and fishermen have received less attention in the AFF Program than agriculture, consequently high-risk populations in those sectors have not been well described. Other age, gender, racial, and ethnic minority groups were not included as populations at risk in the agricultural sector. Intramural ac- tivities related to populations at risk in all sectors have focused on surveillance to fill in data gaps peculiar to AFF, such as gaps in data from the Department of Labor, Bureau of Labor Statistics (DOL/BLS). The extramural activities have been region- ally appropriate and include a wide range of agricultural settings and populations that integrate the social context in which illnesses and injuries occur. In forestry and fishing, there was some extramural funding provided on a regional basis.
The high-priority research topics defined in the National Occupational Re- search Agenda (NORA) have been modified recently to adopt an approach based on industry sectors and to establish sector-specific research goals and objectives.
This emphasis promotes research-to-practice through sector-based partnerships.
“Special populations at risk” were aligned with work environment and workforce categories and share priority status to a lesser degree with emerging technologies, indoor environment, mixed exposures, and work organization. It is not apparent how the priorities based on industry sectors might be used to differentiate issues associated with, for example, child labor in the context of a small family fishing operation or a small family farm operation. Although the setting is different, some
of the concerns about children working in family-run operations—such as youth operating machinery and children playing at or visiting the workplace—are similar.
To establish an approach based on industry sectors and to develop sector-specific research goals and objectives may be disadvantageous in relation to an approach that requires the integration of social context and the interconnectedness of all AFF activities and populations at risk.
Given that there was no clear definition of populations at risk in its review of NIOSH’s AFF activities, the committee used the NIOSH AFF classifications of populations at risk.
LOGIC SUBMODEL
Information received from the NIOSH AFF Program (NIOSH, 2006a) related to inputs, activities, outputs, intermediate outcomes, and end outcomes in research on priority populations at risk is summarized in the priority populations at risk research logic submodel (Figure 5-1).
INPUTS Child Labor
In 1996, NIOSH was charged with reducing injuries and illnesses in child workers. As a result, it assigned 75 percent of available funds ($5 million dollars) to extramural research and 25 percent to intramural activities, which consisted primarily of surveillance.
ACTIVITIES Child Labor
The major issues in relation to child labor identified by NIOSH and stakehold- ers were traumatic and cumulative injuries related to farming activities. Those activities included living on, working on, and visiting a farm. Efforts were focused on childhood injury prevention, surveillance of fatal injuries, and childhood agri- cultural musculoskeletal disorders (MSDs). In consultation with experts, NIOSH did a thorough qualitative review of the hazardous orders (HOs) for youth working in agriculture and made recommendations for changing 8 of the 11 HOs.
Surveys were conducted over a number of years that were focused on identi- fied problems or populations, such as the migrant and seasonal farm workers, selected farm operations, and racial minority farm operators. One follow-up study was conducted when injuries occurred on a farm using a national representative
FIGURE 5-1Priority populations at risk research logic submodel. CAIS = Child Agricultural Injury Survey, CES = Cooperative Extension Service, ESA = Employment Standards Administration, FACE = Fatality Assessment and Control Evaluation, FOPS = falling object protective structure, ROPS = rollover protective structure.
Inputs Activities Outputs IntermediateOutcomes End Outcomes 1.Childlabor vSurveillance vHazardousorders(HOs) vResearch vPartnershipsandextramural activities 2.Minoritypopulations vVarieddegreesofresearchand outreachactivities vHispanic/LatinoandAfrican- Americanfarmers vPanelsonhiredfarmworkers vCollaborationsandpartnerships withotheragenciesincluding CES vFarmoperators vInformationsharing 3.Logging vHelicopter-relateddeaths vNationalloggingstandards vROPSandFOPS vFACE vMechanicalharvesting 4.Fishing vAlaskaFieldStation vSurveillance vFatalityreduction vPartnerships vUncleardefinitionsofpopulationsatriskusedbydifferentagenciesvLackofchildlaborlaws vPoorsurveillanceandrelianceonoutsidesourcesofdatavPoorunderstandingofthescopeandcostofAFFstudies vIndecisionsregardinglong-termsupportofdifferentprojectsvRegulatoryenvironment External Factors
1.Childlabor vPublicationsincludedinCAIS vMeetingsandconferences vTestimonytoESA vDepartmentofLaboruseof HOs vSafeareasforchildren 2.Minoritypopulations vHiredfarmworkersurvey vPartnershipsfordissemination ofsurveyresults vPeer-reviewpublications vOutreachpublications 3.Logging vPeer-reviewpublications vConferencesandpublic testimonies 4.Fishing vPeer-reviewpublications vFishingvesselsafety conferencesandworkshops vDeclineinthefatalityrate vLobsterfisheries vDecksafety vFull-timeequivalents 1.Childlabor vChildhoodinjuryand prevention vUseofdata/informationfor otherprograms,suchasFarm Safety4JustKidsandthe NationalSafeKidsCampaign vCitationof10oftheHOs vUseof4HOsforregulatory action 2.Migrant vPositivetestimonialsfrom pesticidetraining 3.Logging vWorkshops vParticipationininter-agency preventionprograms vTrainingofMexicanMDs throughFACE vExpansionofFACEtodifferent states vTrainingonaccident investigation 4.Fishing vPreseasondocksideinspection vMarinesafetytraining vTechnicalassistanceforfishery management 1.Generalandwork-related decreaseinnumberofinjured youths 2.Declineoffatalitiesand occupationalinjuryandillness associatedwithlogging 3.Impressivereductionoffatalities incommercialfishing
Planninginputs: 1.Childlabor 2.Minoritypopulations 3.Logging 4.Fishing ProductionInputs: 1.Budget 2.Staff 3.Facilities 4.Managementstructure 5.Extramuralentities 6.Partners
sample of emergency department records. Important data were collected in the surveys. However, comparison of results across the surveys has been hampered by differences in data collection procedures, in definitions of target populations, and in denominators. MSD studies were more comprehensive and included plans for dissemination of information and for community involvement.
A majority of the activities conducted in the extramural programs and partner- ships were investigator-initiated research project grants (R01 grants) and included support for conferences and interactions with extramural partners. The R01 com- ponent was strong and involved different centers, such as the National Children’s Center for Rural and Agricultural Health and Safety (NCCRAHS), a center that conducts research on children’s agricultural injury prevention. Research in the center has produced measurable results in the form of qualitative and quantitative outcomes. The materials produced from the childhood agricultural initiative have been referenced and used in outreach activities. Conferences were useful for sharing experiences and ideas among the different centers and extramural participants.
Minority Populations
Under the assumption that different minority farmworker groups face different hazards, the AFF Program has studied American Indians, Hispanic and Latino hired laborers and orchard workers, and minority farm operators, including Hispanics and African Americans. Cultural factors and conceptions of health and disease in minority group workers have been proposed as affecting the underreporting of various conditions. Further, different agricultural activities have been associated with different hazards. For example, the variety of jobs that orchard workers per- form at different times of the year, the long working hours involved in these jobs, and the strenuous working conditions (such as carrying heavy containers up and down ladders) are some of the possible causes cited for high rates of illness and injury. In addition, changes in agricultural practices among certain populations may also lead to changes in the hazards in a specific population. An example of this is the move among Navajo from subsistence farming to cattle ranching. These types of changes require monitoring and quick response to reduce the risks among the worker populations involved.
In 1995, NIOSH convened a panel of experts on hired farm workers. Three years later, the panel issued its report and made recommendations for surveillance.
Several high-priority subjects were identified, including MSDs, pesticide-related conditions, traumatic injuries, respiratory conditions, dermatitis, infectious dis- eases, cancer, eye conditions, and mental health. In 1998, an Occupational Health Supplement was developed to be included in the National Agricultural Workers Survey (NAWS) in collaboration with government organizations including DOL,
the U.S. Environmental Protection Agency, the U.S. Food and Drug Administration, the National Cancer Institute, the Health Resources and Services Administration (HRSA), and the Occupational Safety and Health Administration (OSHA); and with researchers from community organizations, universities, industry, advocacy groups and extension. The questionnaire was translated into Spanish, pilot tested, and revised. The survey results indicated that hired farm workers and migrant workers were younger than other workers. The results also indicated low English literacy, which has implications for health because of the inability to understand job-related instructions in English. The current survey focuses on mental health and psychological factors, but the continuation of this survey is uncertain because of funding issues.
As part of the AFF Program, the U.S. Department of Agriculture (USDA) con- ducted a Minority Farm Operators Occupational Health Survey in 2000. Several other organizations took part at different stages during the project, including academic institutions and research organizations. The response rate was low, and additional sampling was required; at that point, the method was changed, and data were collected using face-to-face interviews. The prevalence of various health and related conditions, including hearing loss, access to medical care, and mental health symptoms were estimated. This work highlights the importance of adapting methods to meet the needs of special populations in order to obtain health- and injury-related data for occupational health.
Several extramural studies have been conducted in conjunction with the Co- operative Extension Service (CES) assigned to the Navajo Nation to assess Navajo occupational safety and health needs. Projects included cattle handling and safety equipment, development of a training video, a loan program to purchase safety equipment, and development of an education program related to flash flooding.
These projects were conducted with cultural sensitivity of the target population using stakeholder involvement and provided an important example of how to use CES, extramural researchers, and AFF Program staff to conduct needs assessment to develop educational and hazard reduction interventions.
Participatory research has been used in several other extramural studies funded by the AFF Program in several states involving Hispanic and Latino workers. Use of a participatory approach has resulted in improved success with interventions in relation to pesticide exposures and ergonomics.
Logging
Logging is historically one of the most hazardous industries in the United States. Logging fatality and injury rates have slowly declined since the mid-1950s;
injury rates are twice the rate of all U.S. workers. In 1994, NIOSH published re-
search indicating the differences in logging-related fatality rates across the country;
the highest fatality rate was associated with manual harvesting of saw timber, for which there was no logging safety standard.
Several logging-related activities have been conducted by NIOSH, includ- ing support of OSHA’s adoption of a national standard for the logging industry, coordination of a statewide injury and helicopter-fatality intervention in Alaska, targeting logging fatalities in Fatality Assessment and Control Evaluation (FACE) investigations, and evaluation of mechanical logging methods.
In 1989, OSHA proposed a new standard in logging, which was largely based on standards developed in the 1976 NIOSH document titled “Criteria for a Recom- mended Standard: Logging from Felling a First Haul.” From 1989 to 1990, NIOSH continued to offer comments to OSHA, provided data from the National Traumatic Occupational Fatality (NTOF) Surveillance System of the AFF Program, and made several important recommendations related to safety equipment, snakebite protec- tion, work organization and communications, and safe felling techniques. These efforts culminated in the adoption of standards by OSHA in 1994, which included many of the recommendations made by the AFF Program.
Helicopter logging emerged in the late 1980s as a form of transportation mainly because of restrictions on road-building in Alaska’s national forests. Investigations conducted by NIOSH staff showed that improper operation and maintenance were the main problems associated with the crashes. In 1993, a prevention matrix was developed by the Alaska Interagency Working Group for the Prevention of Occu- pational Injuries, which included representatives from the Federal Aviation Ad- ministration, the National Transportation Safety Board, the U.S. Coast Guard, the USDA Forest Service, OSHA, the Alaska Department of Labor, the Alaska Depart- ment of Social Services, and the AFF Program to identify risk factors for helicopter crashes. The result was a reduction in helicopter crashes: only one helicopter crash has occurred since 1993. Clearly the active involvement of other organizations in cooperation with NIOSH provides an example of successful partnering resulting in direct benefits for loggers in Alaska.
The programs in logging have focused on acute traumatic injuries and have not addressed other hazard and illnesses that might be related to logging. There has been a lack of work on the cultural and social issues that influence work-related illnesses and injuries among loggers.
Fishing
In 1990, the AFF Program goal was to reduce the number and rate of commer- cial fishing fatalities by 50 percent by 2005. In 1991-1992, data sharing agreements with the U.S. Coast Guard (USCG) and Alaska state troopers were established and
a comprehensive surveillance system for occupational fatalities, the Alaska Occu- pational Injury Surveillance System (AOISS), were established. High-risk groups and types of gear were identified as deserving of attention for interventions. An interagency effort was created that included the participation of many organizations.
Many intervention programs have been implemented since then, and assistance has been offered on prevention of vessel-related fatalities, nonfatal work-related inju- ries, and fatalities due to loss of vessels. The program provides a model for build- ing collaborative working relationships with other agencies to provide surveillance data from which to design intervention programs. However, the work focused on traumatic injuries and neglected other health hazards associated with fishing.
OUTPUTS Child Labor
Numerous peer-reviewed publications were part of the Childhood Agricul- tural Injury Survey (CAIS), as were presentations in scientific conferences and professional meetings and NIOSH internal documents that were published and disseminated through a variety of media outlets. The overall citation index of the peer-reviewed papers is high. Although a vast number of publications are avail- able through the NIOSH Web site, documents are not cataloged, and searches are cumbersome and time consuming.
In 2004, the AFF Program provided testimony on child labor regulations to the Employment Standards Administration (ESA). The DOL used NIOSH recommen- dations regarding the HOs covering youths of all ages and farms of all types. The AFF Program HO report was presented to the International Labour Organization (ILO). No evidence was provided on the impact of the presentations. NCCRAHS documents were used to design safe areas for children on farms. Although the idea for safe play areas was well received, the impact of the program is unknown because there is no information available on how many safe areas for children have been built on the farms as a result of the study. Three prominent outcomes are highlighted in the NIOSH evidence package (NIOSH, 2006a). One is a paper showing that motor vehicles and intentional causes of death are major issues for youths living on farms (Goldencamp et al., 2004). Another is a conference report that influenced the AFF Program in 2002, in reference to childhood agricultural injury prevention and modifications that were made in NORA priorities (Lee et al., 2002). The third is a 1996 report on children in agriculture (National Committee for Childhood Agricultural Injury Prevention, 1996). It is not clear why those items were highlighted, inasmuch as no policy change or intervention program develop- ment is cited or connected to them. No comparative study is offered to show that motor vehicle issues, for example, are different for youths not living on farms.
Furthermore, we cannot determine whether the results of the report on children in agriculture were used as the basis of intervention programs.
The CAIS database on youth farm injuries contains data from surveys con- ducted in 1998, 2001, and 2004. Only basic information with regard to traumatic injuries is available. Children are particularly vulnerable to risks and hazards when performing complex agricultural tasks, considering their age, sociological and de- velopmental status, and body size. These types of sociological and psychological factors, among others, are rarely considered and would be important to understand.
Thus a more integrated and interdisciplinary approach is needed when dealing with children in agriculture.
Migrants
The National Agricultural Workers Survey Occupational Health supplement is currently under review. The document summarizes results of the survey, will be shared with researchers and the ten Centers for Agricultural Disease and Injury Research, Education, and Prevention, and will be available on NIOSH and DOL Web sites. The National Center for Farmworker Health will assist in the dissemina- tion of survey results by sharing data with migrant worker health clinics, HRSA, the DOL, Migrant Health Promotion, the National Institutes of Health, and other organizations. The document may be essential for disseminating the results of the survey, but the survey was conducted in 1999, and the information will be dated when it is published. No specific date for the completion of the document and dissemination of the results was provided.
Educational materials for migrants and minority groups have been included in the National Agriculture Safety Database (NASD) for the agriculture community and for adaptation by agricultural safety specialists. The NASD contains many cataloged educational materials and resources in English and Spanish from differ- ent sources. Particularly highlighted is the inclusion in the database of a bilingual NIOSH document: Simple Solutions: Ergonomics for Farm Workers. The accessibility of this document for workers was not addressed, as many agricultural workers do not read English or Spanish. Use of the standard approaches to dissemination of information for agricultural workers is evident throughout the AFF Program and neglects social and cultural differences in terms of preferred modes of communica- tion, as well as literacy and language barriers.
Logging
Outputs related to logging include peer-reviewed publications, conferences, testimony, government publications, and NIOSH Web sites. Three workshops with proceedings were held between 1993 and 1997 to address helicopter logging
crashes. NIOSH testimony that influenced OSHA’s logging standards is cited. Three government publications on prevention of logging injury and death prevention were produced in 1976, 1994, and 1998.
NIOSH seems to have reached a plateau in relation to logging research and programs in 2002. The issues or challenges for the logging industry seem to be specific to that sector, and the industry has been responsive to proposed improve- ments. However, there are significant changes in logging procedures and practices that need to be addressed in the future.
Fishing
A number of articles have been published in a variety of media and range from scientific publications to industry trade articles. Five conferences centering on fishing vessel safety have been sponsored by the AFF Program. Seven selected outputs are highlighted by NIOSH with various levels of development, comple- tion, and impact:
Fishing Industry Safety and Health Workshop
In 1992, a conference was held to raise awareness and promote injury and disease prevention programs, and resulted in workshop proceedings. There were 77 attendees from Alaska and the West Coast.
NIOSH Current Intelligence Bulletin
A decline in the fatality rate in commercial fishermen has been noted since 1998, when the Commercial Fishing Industry Vessel Safety Act was passed. The implication is that NIOSH work in this matter has contributed to the decline in fatalities. However, the number of vessel sinkings has not decreased. The AFF Program made 11 recommendations regarding improvements in vessel stability, training, avoidance of harsh weather, falls overboard, and other issues associated with deck safety. The document has been used as a resource by six states and by federal, academic, and private organizations. Eight of the 11 recommendations were adopted by USCG.
FISH Workshop
The Second National Fishing Industry Safety and Health Workshop (FISH II) was sponsored and organized by the AFF Program in 1997; the proceedings became available in 2000. Attendance at the workshop is not given, but attendees