Occupational injury and illness among migrant and seasonal farmworkers in New York State and Pennsylvania, 1997-1999: pilot study of a new surveillance method

Enhancing detection of labor violations in the agricultural sector: A multilevel generalized linear regression model of H-2A violation counts

Agricultural workers are essential to the supply chain for our daily food, and yet, many face harmful work conditions, including garnished wages, and other labor violations. Workers on H-2A visas are particularly vulnerable due to the precarity of their immigration status being tied to their employer. Although worksite inspections are one mechanism to detect such violations, many labor violations affecting agricultural workers go undetected due to limited inspection resources. In this study, we identify multiple state and industry level factors that correlate with H-2A violations identified by the U.S. Department of Labor's Wage and Hour Division using a multilevel zero-inflated negative binomial model. We find that three state-level factors (average farm acreage size, the number of agricultural establishments with less than 20 employees, and higher poverty rates) are correlated with H-2A violations. These findings offer valuable insights into where H-2A violations are being detected at the state and industry levels.

Occupational Hazards and Health and Safety Risks for Latino Tree Trimmers in the Pine Forest Industry

A pilot project was conducted to evaluate the working conditions and work-related body pain among Latino immigrant tree trimmers (n = 57) in the commercial pine forest service industry. Participants were interviewed about personal and work characteristics, job-related occupational hazards, and body pain. A structured questionnaire and a body pain diagram were used as measures for evaluating associations between personal and work characteristics and body pain. The most common health complaints were physical exhaustion (80.7 percent) and headache (33.9 percent). The reported percent of work-related body pain was 54.4 percent. Statistically significant associations were identified between experiencing body pain in knees, working more than two years, and working more than six hours per day (p < .05) as a tree trimmer. Thorough clinical evaluations are needed to confirm these findings. Future research including a larger sample size and more in-depth evaluations are needed to better evaluate worker tasks, musculoskeletal risk factors, and safety climate issues among this highly vulnerable occupational group.

Differences among Thai Agricultural Workers' Health, Working Conditions, and Pesticide Use by Farm Type

More than 11 million Thai people (38%) work in agriculture, but since most are in the informal sector, government enforcement and support are very limited. As a result, working conditions on Thai farms vary greatly, putting the health of many agricultural workers at risk. A cross-sectional study in three Thai provinces collected information on the work activities and conditions of 424 farmers representing five farm types: rice, vegetable, flower, rice/vegetable, and flower/vegetable. The agricultural workers were mainly women (60%); their average age was 53 but ranged from 18 to 87 years. More than 64% worked more than 5 days/week. Seventy-four percent of them had only primary school education. A number of the health and hazardous working conditions surveyed were significantly different by farm type. Rice farmers were found to have the highest prevalence of allergies, nasal congestion, wheezing, and acute symptoms after pesticide use, while flower farmers had the lowest prevalence of these health outcomes. Rice farmers reported the highest prevalence of hazardous working conditions including high noise levels, working on slippery surfaces, sitting or standing on a vibrating machine, spills of chemicals/pesticides, and sharp injuries. The lowest prevalence of these working conditions (except noise) was reported by flower farmers. Vegetable farmers reported the highest prevalence knee problems, while rice farmers had the lowest prevalence. Among these farmers, more than 27 different types of pesticides were reported in use during the past year, with the majority reporting use once a month. The flower/vegetable farming group reported the highest frequency of good exposure prevention practices during pesticide use. They were the most likely to report using cotton or rubber gloves or a disposable paper masks during insecticide spraying. Those farmers who only grew vegetables had the lowest frequency of good exposure prevention practices, including use of personal protective equipment. The economic cost of work-related injuries and illnesses among informal sector agricultural workers in Thailand is unknown and in need of study. Gaps in the regulations covering pesticide sales allow farmers to purchase pesticides without adequate training in their safe use. Training targeted to farm type regarding safe pesticide use and the prevention of accidents and musculoskeletal disorders is needed. Studies of chronic health effects among Thai farmers are needed, with special emphasis on respiratory, metabolic disease and cancer.

The Organization of Working Time: Developing an Understanding and Action Plan to Promote Workers' Health in a Seasonal Work Context: L'organisation temporelle du travail: la comprendre pour développer des actions favorisant la santé des travailleuses en contexte de travail saisonnier

Despite the health problems associated with irregular schedules and long working hours, few studies have focused on the temporal dimension of work in seasonal working contexts. Through the monitoring of sixteen seasonal workers in the crab-processing industry over a two-year period, this study aimed to better understand their working reality and to provide a detailed picture of the temporal dimension of seasonal work as experienced by these workers. Observations of the work activity, interviews, and analysis of official documents were carried out. The findings reveal that the organization of working time and working conditions are very restrictive. These constraints are linked not only to the work environment and management but also to various public policies and ministerial directives. Methodological elements essential for the study of the organization of working time have been identified and could contribute to a better understanding of temporal constraints experienced by seasonal workers. Résumé Malgré les problèmes de santé associés aux horaires non standards et aux longues heures de travail, peu d'études se sont attardées à dégager un portrait de la dimension temporelle du travail en contexte de travail saisonnier. Par le suivi de 16 travailleuses saisonnières de l'industrie de la transformation du crabe pendant deux années, cette étude visait à mieux comprendre leur réalité de travail et à dresser un portrait détaillé de la dimension temporelle du travail saisonnier tel que vécu par ces travailleuses. Des observations du travail, des entretiens et l'analyse de documents ont été réalisés. Les résultats révèlent une organisation temporelle et des conditions de travail fort contraignantes pour ces travailleuses liées, entre autres, à l'environnement et à la gestion du travail, mais également à diverses politiques publiques et consignes ministérielles. Des éléments méthodologiques essentiels pour l'étude des temps de travail ont également été identifiés et contribueront à mieux cerner les contraintes temporelles des situations de travail vécues par les travailleuses saisonnières.

A Descriptive Study of Body Pain and Work-Related Musculoskeletal Disorders Among Latino Farmworkers Working on Sweet Potato Farms in Eastern North Carolina

Agricultural work is a physically demanding occupation. The purpose of this project was to describe the prevalence of work-related musculoskeletal disorders (WMSDs) and self-reported pain among Latino farmworkers who work extensively hand harvesting sweet potatoes. Data were obtained from a cross-sectional survey of farmworkers (N = 120) in eastern North Carolina. Univariate and bivariate analyses were used to describe personal, work characteristics, and self-reported pain associated with musculoskeletal injuries. Overall, 79% of farmworkers reported any type of pain or discomfort. The highest reported areas of pain were in the back (66%) and shoulder areas (31%). Younger participants experienced more shoulder pain (P = .04) than older workers, and working more than 5 years as a farmworker was significantly associated with back pain (P = .01). Interventions aimed at administrative and engineering controls for reducing risk factors that contribute to WMSDs are warranted.

Hired crop worker injuries on farms in the United States: A comparison of two survey periods from the National Agricultural Workers Survey

BACKGROUND

Hired crop workers in the United States are at high risk of occupational injury. Targeted surveillance is important for effective occupational safety efforts.

METHODS

The National Agricultural Workers Survey was utilized to collect injury data during the years 1999, 2002-2004 (period I) and 2008-2010 (period II).

RESULTS

The overall injury rate declined between the two periods from 4.3 to 2.9/100 per full-time week-based equivalents (FTEWB ). Injury rates remained high during both periods for those with greater than 20 years farm experience (3.6 and 3.8/100 FTEWB ) and pesticide handling work (4.9 and 5.0/100 FTEWB ). Overexertion, contact with objects and equipment, and falls from height were common during both periods. Older workers comprised a greater proportion of injury cases in period II.

CONCLUSION

Overexertion that leads to sprains/strains, dangerous ladder use, and pesticide use should be targeted as important risk exposures on the farm.

Industry-Related Injuries in the United States From 1998 to 2011: Characteristics, Trends, and Associated Health Care Costs

OBJECTIVE

To describe the trends, correlates, and healthcare costs associated with industry-related injuries across the United States between 1998 and 2011.

METHODS

A retrospective, cross-sectional analysis of hospital discharges was conducted using the National Inpatient Sample. We used the International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify accidents occurring in industrial settings. Joinpoint regression modeling was used to analyze trends.

RESULTS

Most of the 357,716 inpatient hospitalizations were admissions from the emergency department (55%). Fractures were the most prevalent injuries (48.1%), whereas the lower and upper extremities were the most common injury sites (51.7%). The mean per admission cost of direct medical care was $12,849, with an overall downward trend in injuries during the study period.

CONCLUSIONS

A comprehensive trend analysis of industry-related injuries is valuable to policymakers in formulating targeted strategies and allocating resources to address disparities at various levels.

Medical repatriation of migrant farm workers in Ontario: a descriptive analysis

BACKGROUND

Approximately 40 000 migrant farm workers are employed annually in Canada through temporary foreign worker programs. Workers experiencing health conditions that prevent ongoing work are normally repatriated to their home country, which raises concerns about human rights and health equity. In this study, we present data on the reasons for medical repatriation of migrant farm workers in Ontario.

METHODS

In this retrospective descriptive study, we examined medical repatriation data from Foreign Agricultural Resource Management Services, a non-profit corporation managing the contracts of more than 15 000 migrant farm workers in Ontario annually. We extracted repatriation and demographic data for workers from 2001-2011. Physician volunteers used a validated system to code the reported reasons for medical repatriation. We conducted descriptive analyses of the dominant reasons for repatriation and rates of repatriation.

RESULTS

During 2001-2011, 787 repatriations occurred among 170 315 migrant farm workers arriving in Ontario (4.62 repatriations per 1000 workers). More than two-thirds of repatriated workers were aged 30-49 years. Migrant farm workers were most frequently repatriated for medical or surgical reasons (41.3%) and external injuries including poisoning (25.5%).

INTERPRETATION

This study provides quantitative health data related to a unique and vulnerable occupational group. Our findings reinforce existing knowledge regarding occupational hazards and health conditions among migrant farm workers. Medical repatriation of migrant farm workers merits further examination as a global health equity concern.

Injury Patterns Among Illegal Migrants from Africa in Israel

In recent years Israel has become a destination for many migrants from Africa that illegally cross the Egyptian-Israeli border. The objective of this paper is to describe the epidemiological characteristics of injuries among illegal migrants in Israel. The study was carried out retrospectively using data from 19 trauma centers that participated in the Israel National Trauma Registry between 1 January 2006 and 31 December 2011. Illegal migrants from Africa were compared to the local population. Migrants were injured more often than the local population from intentional injuries (57.11 %). Migrants were also less likely than the local population (58.38 %) to sustain a minor injury (i.e., injury severity ≤8). The study also shows the hospitalization cost as a result of injuries among migrants from Africa. Preventive measures among illegal migrants from Africa should prioritize intentional injuries and industrial site injuries.

Migrant and seasonal crop worker injury and illness across the northeast

BACKGROUND

Northeast farmworkers are a small, widely dispersed, and isolated population. Little is known about their occupational injury and illness risk.

METHODS

Researchers conducted chart reviews in migrant health centers across the Northeast, and calculated incidence-density for agricultural morbidity based on a new method for estimating total worker hours at risk, and adjusting for cases seen at other sources of care.

RESULTS

An estimated annual average of 1,260 cases translated to an incidence of 30.27 per 10,000 worker weeks, (12.7 per 100 FTEs). Straining/spraining events (56% cases) was the most common occurrence (16.8 per 10,000 worker weeks), and lifting (21.5% cases) was the leading contributing factor. Incidence by crop category ranged from 12.95 (ground crop) to 29.69 (bush crop) per 10,000 weeks. Only 2.8% filed for Workers' Compensation.

CONCLUSION

The predominance of straining/spraining events affecting the back, and their association with lifting suggests that Northeastern farmworker occupational health programs should focus on ergonomics, and specifically on safe lifting.

Self care and health-seeking behavior of migrant farmworkers

There are an estimated three million migrant and seasonal farmworkers (MSFW) in the United States. In addition to the inherent dangers of farm work, numerous factors place MSFW at even greater risk for work-related injuries. Little is known about how MSFW care for work-related injuries, and how the decision to seek professional care is made. A prospective survey using face-to-face structured interviews was used to explore the type and frequency of occupational injuries as well as self-care and health-care seeking practices of MSFW. Musculoskeletal injuries were the most commonly reported injuries, followed by injuries of the skin and chemical exposure. Self care with over-the-counter remedies was the predominant method of dealing with injuries, and, with the exception of chemical exposure, was found to be for the most part, appropriate. The reported use of alternative medicine or herbal remedies was low. Future research efforts should focus on ergonomic modifications and farmworker education to reduce or prevent musculoskeletal injuries. The number of reported chemical exposures and inappropriate treatment draw attention to the need for continued efforts for both primary prevention of exposure and optimal treatment once exposure occurs.

Musculoskeletal disorders in labor-intensive agriculture

This paper gives an overview of the extent of musculoskeletal disorders (MSDs) in agriculture, and a historical perspective on how ergonomics has been used to reduce the health effects of labor-intensive agriculture. A summary of exposure to MSD physical risk factors within various classes of crops, along with various administrative and engineering controls for abating MSDs in agriculture is given. These controls range from programmed rest breaks to mechanized or partially-mechanized operations. Worker-based approaches such as prone carts and platforms, and load transfer devices hold promise in combating the prevalent stooped work in agriculture. Including the worker as an integral contributor to all aspects of developing and implementing an intervention, and considering the psychosocial and socio-cultural aspects of the work environment are crucial elements of effective interventions for reducing MSDs. Despite the advent progress in new technologies in agricultural practices, reliance on labor, especially in fresh market fruits and vegetables, will always be a major cornerstone of agriculture for at least the foreseen future. It is encouraging to see the increased interest among health and safety professionals, epidemiologists, engineers, social scientists, and ergonomists throughout the world who are committed to the plight of reducing MSDs and other health problems among agricultural workers.

Costs by industry and diagnosis among musculoskeletal claims in a state workers compensation system: 1999-2004

BACKGROUND

Musculoskeletal disorders (MSDs) are a tremendous burden on industry in the United States. However, there is limited understanding of the unique issues relating to specific industry sectors, specifically the frequency and costs of different MSDs.

METHODS

Claim data from 1999 to 2004 from the Ohio Bureau of Workers' Compensation were analyzed as a function of industry sector (NAICS industry-sector categories) and anatomical region (ICD-9 codes).

RESULTS

Almost 50% of the claims were lumbar spine (26.9%) or hand/wrist (21.7%). The majority of claims were from manufacturing (25.1%) and service (32.8%) industries. The industries with the highest average costs per claim were transportation, warehouse, and utilities and construction. Across industries, the highest costs per claim were consistently for the lumbar spine, shoulder, and cervical spine body regions.

CONCLUSION

This study provides insight into the severity (i.e., medical and indemnity costs) of MSDs across multiple industries, providing data for prioritizing of resources for research and interventions.

Surveillance of occupational health disparities: challenges and opportunities

Increasingly, the occupational health community is turning its attention to the effects of work on previously underserved populations, and researchers have identified many examples of disparities in occupational health outcomes. However, the occupational health status of some underserved worker populations is not described due to limitations in existing surveillance systems. As such, the occupational health community has identified the need to enhance and improve occupational health surveillance to describe the nature and extent of disparities in occupational illnesses and injuries (including fatalities), identify priorities for research and intervention, and evaluate trends. This report summarizes the data sources and methods discussed at an April 2008 workshop organized by NIOSH on the topic of improving surveillance for occupational health disparities. We discuss the capability of existing occupational health surveillance systems to document occupational health disparities and to provide surveillance data on minority and other underserved communities. Use of administrative data, secondary data analysis, and the development of targeted surveillance systems for occupational health surveillance are also discussed. Identifying and reducing occupational health disparities is one of NIOSH's priority areas under the National Occupational Research Agenda (NORA).

Occupational injury and treatment patterns of migrant and seasonal farmworkers

Migrant and seasonal farmworkers are thought to be at increased risk for occupational injury and illness. Past surveillance efforts that employed medical chart review may not be representative of all farmworkers, since the proportion of farmworkers using migrant health centers (MHCs) and area hospital emergency rooms (ERs) was unknown. The purpose of the current study was to determine the proportion of workers using MHCs versus other sources of occupational health care, and to use these data to correct previous occupational injury and illness rate estimates. Researchers conducted a survey of migrant and seasonal farmworkers in two sites: the Finger Lakes Region of New York and the apple, broccoli, and blueberry regions of Maine. Researchers also conducted MHC and ER medical chart reviews in these regions for comparison purposes. Proportions of occupational morbidity by treatment location were calculated from the survey, and a correction factor was computed to adjust chart review morbidity estimates for Maine and New York State. Among 1103 subjects, 56 work-related injuries were reported: 30 (53.6%) were treated at a MHC, 8 (14.3%) at an ER, 9 (16.1%) at some other location (e.g., home, relative, chiropractor), and 9 (16.1%) were untreated. Mechanisms of injuries treated at MHCs versus all other sources did not differ significantly. The survey-based multiplier (1.87) was applied to previous statewide MHC chart review injury counts from Maine and New York. The corrected injury rates were 7.9 per 100 full-time equivalents (FTE) per year in Maine, and 11.7 per 100 FTE in New York. A chart-review based surveillance system, combined with a correction factor, may provide an effective method of estimating occupational illness and injury rates in this population.

Health care utilization among migrant Latino farmworkers: the case of skin disease

CONTEXT

Skin diseases are common occupational illnesses for migrant farmworkers. Farmworkers face many barriers in accessing health care resources.

PURPOSE

Framed by the Health Behavior Model, the purpose of this study was to assess health care utilization for skin disease by migrant Latino farmworkers.

METHODS

Three hundred and four migrant and seasonal Latino farmworkers in North Carolina were enrolled in a longitudinal study of skin disease and health care utilization over a single agricultural season. Self-reported and dermatologist-diagnosed skin condition data were collected at baseline and at up to 4 follow-up assessments. Medical visit rates were compared to national norms.

FINDINGS

Self-reported skin problems and diagnosed skin disease were common among farmworkers. However, only 34 health care visits were reported across the entire agricultural season, and none of the visits were for skin diseases. Nevertheless, self-treatment for skin conditions was common, including use of non-prescription preparations (63%), prescription products (9%), and home remedies (6%). General medical office visits were reported in 3.2% of the assessments, corresponding to 1.6 office visits per person year.

CONCLUSIONS

The migrant farmworker population consists largely of young men who make little use of clinic services. Skin conditions are very common among these workers, but use of medical services for these conditions is not common. Instead, farmworkers rely primarily on self-treatment. Clinic-based studies of farmworker skin conditions will not account for most injury or disease in this population and have the potential for biased estimates.

Estimating the occupational morbidity for migrant and seasonal farmworkers in New York state: a comparison of two methods

PURPOSE

Compare occupational morbidity estimates for migrant and seasonal farmworkers obtained from survey methods versus chart review methods and estimate the proportion of morbidity treated at federally recognized migrant health centers (MHCs) in a highly agricultural region of New York.

METHODS

We simultaneously conducted 1) an occupational injury and illness survey among agricultural workers, 2) MHC chart reviews, and 3) hospital emergency room (ER) chart reviews.

RESULTS

Of the 24 injuries reported by 550 survey subjects, 54.2% received treatment at MHCs, 16.7% at ERs, 16.7% at some other facility, and 12.5% were untreated. For injuries treated at MHCs or ERs, the incidence density based on survey methods was 29.3 injuries per 10,000 worker-weeks versus 27.4 by chart review. The standardized morbidity ratio for this comparison was 1.07 (95% confidence intervals = 0.65-1.77).

CONCLUSIONS

Survey data indicated that 71% of agricultural injury and illness can be captured with MHC and ER chart review. MHC and ER incidence density estimates show strong correspondence between the two methods. A chart review-based surveillance system, in conjunction with a correction factor based on periodic worker surveys, would provide a cost-effective estimate of the occupational illness and injury rate in this population.

Understanding the ergonomic risk for musculoskeletal disorders in the United States agricultural sector

INTRODUCTION

Farming is a very large industry in the United States. Understanding the risks for injuries and more specifically musculoskeletal disorders in this industry poses a challenge for health officials.

METHODS

A review was conducted of the existing peer-reviewed publications prior to December 2006 about injuries and musculoskeletal disorders for farmers and farm workers. The aim was to review existing knowledge concerning: (1) the prevalence, types, and causes of farm-related injuries, paying particular attention to musculoskeletal disorders and the special populations within the agricultural sector, and (2) interventions that have been developed to reduce risk factors associated with farm-related injuries.

RESULTS

Farmers and farm workers experience high rates of low back, shoulder, and upper extremity disorders. Musculoskeletal disorders may disproportionately affect farm youth and migrant workers due to the types of farm tasks performed. There is an urgent need for improved and validated interventions to reduce exposures and to improve the health of farmers and farm workers.

DISCUSSION

Future farm-related musculoskeletal disorder research should emphasize: (1) better identification of exposures for special populations, (2) development of interventions for diverse farm populations, and (3) identification of additional exposures for musculoskeletal disorders. Inadequate understanding of musculoskeletal disorders in farming impedes efforts to prevent this common and important type of occupational injuries on farms.

Toxicodendron dermatitis in the UK

BACKGROUND

We present two cases of Toxicodendron dermatitis, one acquired in the United States but presenting in the United Kingdom (UK), the other a recurrent dermatitis following importation of the plant to the UK. Poison ivy, poison oak and poison sumac are native to North America and belong to the genus Toxicodendron. This group of plants is of interest to the dermatologist because they contain a mixture of potent sensitisers which cause a severe allergic contact dermatitis.

CONCLUSIONS

The dermatitis can present to the dermatologist in Europe after an individual has been in contact with the plant whilst visiting an endemic area. The plants have the potential to grow in Europe and it is therefore possible for an individual to be sensitised and subsequently to develop the rash without leaving the continent.

A descriptive study of workers' compensation claims in Washington State orchards

BACKGROUND

Previous studies have reported high rates of occupational injury and illness among workers in the tree fruit industry. However, many common and preventable risk factors and conditions in orchards have not been investigated.

AIMS

To identify and rank risk conditions leading to workers' compensation claims among orchard workers with respect to frequency, severity and cost.

METHODS

State Fund workers' compensation claims between 1996 and 2001 for orchard workers in the main tree fruit growing region of Washington were reviewed and categorized according to cause of injury. Descriptive analyses were performed to characterize claims by cause of injury.

RESULTS

Of the 13,068 claims in the dataset, 4,020 (31%) were determined to be ladder-related injuries. Ladder-related claims accounted for nearly half (48%) of all 'compensable' claims (e.g. claims involving time loss, disability or 'loss of earning power' in addition to medical expenses). Claims related to ladders were not only the most frequent but also the most expensive collectively in terms of medical aid, time loss and other costs. On a per-claim basis, ladder-related injuries were among the most severe and costly reported injuries. Other common causes of injury among claims were branches and vegetation, structure and material and ground-related injuries.

CONCLUSIONS

There is a strong and compelling need to develop interventions to reduce the number of ladder-related injuries in orchards.

Nontraditional work factors in farmworker adolescent populations: implications for health research and interventions

Agriculture has been documented to be one of the most hazardous work environments for both adults and children. Adolescents may be especially vulnerable to adverse health effects from agricultural exposures due to the rapid growth and development experienced during those years. Separating the occupational, economic, and social issues in this population is difficult. Weak regulatory protection, lack of compliance with existing regulations, and gaps in service provision characterize the working conditions of adolescent farmworkers. Although there is increasing research on the impact of work organization on mental and physical health in adult working populations, there is a scarcity of research focused on this concept in young workers--and it remains virtually unaddressed in young farmworkers. Work characteristics of the informal work sector, better delineated in international literature, should be considered when planning research or interventions in this at-risk population. Further, the population of adolescent farmworkers is diverse, and research strategies and interventions need to be targeted and tailored to the heterogeneous groups. This article addresses some of the nontraditional work factors associated with the less-than-formal work organization and environments in the farmworker adolescent population and how these factors may inform the planning of research and interventions. Specifically, mobility, cultural patterns and social networks, alternative sampling strategies, alternative delivery of health care and education, and involvement of a wide range of players in the work environment of adolescent farmworkers should all be considered when conducting research or planning programs for this population.

Occupational risk among orchard workers: a descriptive study

Orchard workers are exposed to an array of occupational health and safety hazards that result in injury, illness, and, in some cases, death. The purpose of this qualitative study was to identify and explore factors that contribute to occupational risks related to orchard work. Twenty-five Hispanic orchard workers were interviewed. They reported that the most common type of accident was falls, usually from a ladder; and the most common injuries were strains and sprains. Three broad categories of factors that contributed to the occurrence of such injuries were Knowledge, Attitudes and Behaviors; Work-Related Factors; and Factors External to Work.

An ergonomic intervention to reduce back strain among apple harvest workers in New York State

The impact of modifications to the apple picking bucket on common picking postures, self-reported comfort, ease of use, and speed of harvest were measured. Fourteen apple pickers wore an intervention hip belt, were interviewed and measured using posture-activities-tools-handling methodology. The use of hip belt did not significantly alter time spent in various postures. 78.6% of interviewed workers preferred the modified bag, 71.4% noted a difference in the back, neck, or shoulder, while 64.3% said regular use of modified bag would slow their work. Major themes in worker comments are discussed. The hip belt modification to apple harvest bag seems generally acceptable to workers, but needs further development to overcome unintended effects. Although work sampling demonstrates that the bag does not affect work practices, workers appear somewhat concerned that productivity will be negatively impacted. Further training of workers in the use and potential benefits of bag are needed.