Attitudes, Beliefs, and Perceptions Associated with Mask Wearing within Four Racial and Ethnic Groups Early in the COVID-19 Pandemic

BACKGROUND

While previous studies have identified a range of factors associated with mask wearing in the US, little is known about drivers of mask-wearing among racial and ethnic minority groups. This analysis assessed whether factors positively associated with wearing a mask early in the pandemic differed between participants grouped by race/ethnicity (Hispanic, non-Hispanic Black, non-Hispanic Asian, and non-Hispanic White).

METHOD

Data were obtained from a US internet panel survey of 3217 respondents during May-November 2020 (weighted by race/ethnicity, age, gender, and education to the US national population). Within each of the four available racial/ethnic groups, crude and adjusted odds ratios (COR and AOR) were calculated using logistic regression to assess factors positively associated with wearing a mask. Adjusted models were controlled for age, gender, education, county COVID-19 case count, presence of a state-issued mask mandate, and interview month.

RESULTS

The following variables were most strongly positively associated with mask wearing (p<0.05) in each racial/ethnic group: Hispanic-seeing others wearing masks (AOR: 6.7), importance of wearing a mask combined with social distancing (AOR: 3.0); non-Hispanic Black-belief that wearing a mask would protect others from coronavirus (AOR: 5.1), reporting hearing that one should wear a mask (AOR: 3.6); non-Hispanic Asian-belief that people important to them believe they should wear a mask (COR: 5.1, not statistically significant); and non-Hispanic White-seeing others wearing masks (AOR: 3.1), importance of wearing a mask (AOR: 2.3).

CONCLUSION

Public health efforts to encourage mask wearing should consider the diversity of behavioral influences within different population groups.

Perceptions toward Ebola vaccination and correlates of vaccine uptake among high-risk community members in North Kivu, Democratic Republic of the Congo

The tenth Ebola Virus Disease (EVD) outbreak (2018-2020, North Kivu, Ituri, South Kivu) in the Democratic Republic of the Congo (DRC) was the second-largest EVD outbreak in history. During this outbreak, Ebola vaccination was an integral part of the EVD response. We evaluated community perceptions toward Ebola vaccination and identified correlates of Ebola vaccine uptake among high-risk community members in North Kivu, DRC. In March 2021, a cross-sectional survey among adults was implemented in three health zones. We employed a sampling approach mimicking ring vaccination, targeting EVD survivors, their household members, and their neighbors. Outbreak experiences and perceptions toward the Ebola vaccine were assessed, and modified Poisson regression was used to identify correlates of Ebola vaccine uptake among those offered vaccination. Among the 631 individuals surveyed, most (90.2%) reported a high perceived risk of EVD and 71.6% believed that the vaccine could reduce EVD severity; however, 63.7% believed the vaccine had serious side effects. Among the 474 individuals who had been offered vaccination, 397 (83.8%) received the vaccine, 180 (45.3%) of those vaccinated received the vaccine after two or more offers. Correlates positively associated with vaccine uptake included having heard positive information about the vaccine (RR 1.30, 95% CI 1.06-1.60), the belief that the vaccine could prevent EVD (RR 1.23, 95% CI 1.09-1.39), and reporting that religion influenced all decisions (RR 1.13, 95% CI 1.02-1.25). Ebola vaccine uptake was high in this population, although mixed attitudes and vaccine delays were common. Communicating positive vaccine information, emphasizing the efficacy of the Ebola vaccine, and engaging religious leaders to promote vaccination may aid in increasing Ebola vaccine uptake during future outbreaks.

Ebola vaccine uptake and attitudes among healthcare workers in North Kivu, Democratic Republic of the Congo, 2021

Introduction

During the 2018-2020 Ebola virus disease (EVD) outbreak in the eastern part of the Democratic Republic of the Congo (DRC), prevention and control measures, such as Ebola vaccination were challenging by community mistrust. We aimed to understand perceptions regarding Ebola vaccination and identify determinants of Ebola vaccine uptake among HCWs.

Methods

In March 2021, we conducted a cross-sectional survey among 438 HCWs from 100 randomly selected health facilities in three health zones (Butembo, Beni, Mabalako) affected by the 10th EVD outbreak in North Kivu, DRC. HCWs were eligible if they were ≥ 18 years and were working in a health facility during the outbreak. We used survey logistic regression to assess correlates of first-offer uptake (i.e., having received the vaccine the first time it was offered vs. after subsequent offers).

Results

Of the 438 HCWs enrolled in the study, 420 (95.8%) reported that they were eligible and offered an Ebola vaccine. Among those offered vaccination, self-reported uptake of the Ebola vaccine was 99.0% (95% confidence interval (CI) [98.5-99.4]), but first-offer uptake was 70.2% (95% CI [67.1, 73.5]). Nearly all HCWs (94.3%; 95% CI [92.7-95.5]) perceived themselves to be at risk of contracting EVD. The most common concern was that the vaccine would cause side effects (65.7%; 95% CI [61.4-69.7]). In the multivariable analysis, mistrust of the vaccine source or how the vaccine was produced decreased the odds of first-time uptake.

Discussion

Overall uptake of the Ebola vaccine was high among HCWs, but uptake at the first offer was substantially lower, which was associated with mistrust of the vaccine source. Future Ebola vaccination efforts should plan to make repeated vaccination offers to HCWs and address their underlying mistrust in the vaccines, which can, in turn, improve community uptake.

How to improve outbreak response: a case study of integrated outbreak analytics from Ebola in Eastern Democratic Republic of the Congo

The emerging field of outbreak analytics calls attention to the need for data from multiple sources to inform evidence-based decision making in managing infectious diseases outbreaks. To date, these approaches have not systematically integrated evidence from social and behavioural sciences. During the 2018–2020 Ebola outbreak in Eastern Democratic Republic of the Congo, an innovative solution to systematic and timely generation of integrated and actionable social science evidence emerged in the form of the Cellulle d’Analyse en Sciences Sociales (Social Sciences Analytics Cell) (CASS), a social science analytical cell. CASS worked closely with data scientists and epidemiologists operating under the Epidemiological Cell to produce integrated outbreak analytics (IOA), where quantitative epidemiological analyses were complemented by behavioural field studies and social science analyses to help better explain and understand drivers and barriers to outbreak dynamics. The primary activity of the CASS was to conduct operational social science analyses that were useful to decision makers. This included ensuring that research questions were relevant, driven by epidemiological data from the field, that research could be conducted rapidly (ie, often within days), that findings were regularly and systematically presented to partners and that recommendations were co-developed with response actors. The implementation of the recommendations based on CASS analytics was also monitored over time, to measure their impact on response operations. This practice paper presents the CASS logic model, developed through a field-based externally led consultation, and documents key factors contributing to the usefulness and adaption of CASS and IOA to guide replication for future outbreaks.

New Mixed Methods Approach for Monitoring Community Perceptions of Ebola and Response Efforts in the Democratic Republic of the Congo

The Red Cross community feedback system enabled rapid collection and analysis of extensive verbal feedback during an Ebola outbreak in eastern DRC. Using this information, Ebola response leaders adapted strategies to address community concerns. In an epidemic, community feedback is critical to ensure that response strategies are accepted and appropriate.

Background:

Efforts to contain the spread of Ebola in the eastern Democratic Republic of the Congo (DRC) during the 2018–2020 epidemic faced challenges in gaining community trust and participation. This affected implementation of community alerts, early isolation, contact tracing, vaccination, and safe and dignified burials. To quickly understand community perspectives and improve community engagement, collaborators from the DRC Red Cross, the International Federation of the Red Cross, and the U.S. Centers for Disease Control and Prevention explored a new method of collecting, coding, and quickly analyzing community feedback.

Methods:

Over 800 DRC Red Cross local volunteers recorded unstructured, free-text questions and comments from community members during community Ebola awareness activities. Comments were coded and analyzed using a text-coding system developed by the collaborators. Coded comments were then aggregated and qualitatively grouped into major themes, and time trends were examined.

Results:

Communities reported a lack of information about the outbreak and the response, as well as concerns about the Ebola vaccination program and health care quality. Some doubted that Ebola was real. The response used the feedback to revise some community engagement approaches. For example, 2 procedural changes that were followed by drops in negative community responses were: using transparent body bags, which allayed fears that bodies or organs were being stolen, and widening the eligibility criteria for Ebola vaccination, which addressed concerns that selectively vaccinating individuals within Ebola-affected communities was unfair.

Discussion:

This system is unique in that unstructured feedback collected by local volunteers in the course of their work was rapidly coded, analyzed, and given to health authorities for use in making course corrections throughout the response. It provides a platform for local voices to be heard throughout an emergency response and provides a mechanism for assessing the effects of program adjustments on community sentiments.

Influences of Community Interventions on Zika Prevention Behaviors of Pregnant Women, Puerto Rico, July 2016-June 20171

We assessed how community education efforts influenced pregnant women’s Zika prevention behaviors during the 2016 Centers for Disease Control and Prevention–Puerto Rico Department of Health Zika virus response. Efforts included Zika virus training, distribution of Zika prevention kits, a mass media campaign, and free home mosquito spraying. We used telephone interview data from pregnant women participating in Puerto Rico’s Women, Infants, and Children Program to test associations between program participation and Zika prevention behaviors. Behavior percentages ranged from 4% (wearing long-sleeved shirt) to 90% (removing standing water). Appropriate mosquito repellent use (28%) and condom use (44%) were common. Receiving a Zika prevention kit was significantly associated with larvicide application (odds ratio [OR] 8.0) and bed net use (OR 3.1), suggesting the kit's importance for lesser-known behaviors. Offer of free residential spraying was associated with spraying home for mosquitoes (OR 13.1), indicating that women supported home spraying when barriers were removed.

Respiratory fit testing for farmworkers in the Black Dirt region of Hudson Valley, New York

Respiratory protection in agriculture has lagged behind other industries. Migrant farmworkers often work in dusty environments yet do not receive appropriate, fitted respiratory protection. During May and June of 2013, researchers pilot-tested a respiratory protection program adapted to fit the unique needs of migrant and seasonal farmworkers. It was implemented in Spanish, with literacy support, at convenient times and locations. Additionally, staff was known to workers, and a farmworker medical center provided medical follow-up. Fifty-six farmworkers participated (68%; 82 invited). Of the participants, 88% were male; 20% reported using respiratory protection. One worker had been fit tested previously; 57% reported being exposed to pesticides. All but six farmworkers passed the medical clearance (91%). The mask most commonly fit to the American-born population was a good fit for only 41% of Latino farmworkers. The fact that two thirds of invited farmworkers participated in the clearance and over half completed mask fitting indicates that the modified protocol meets farmworker needs. A wide range of mask types should be made available for Latino farmworkers.

A comparison of health, health behavior, and access between farm and nonfarm populations in rural New York state

BACKGROUND

Recent technological and demographic changes in US agriculture raise questions about whether the previously observed benefits of the agricultural lifestyle persist.

METHODS

In 2009, researchers conducted a household survey of 9,612 adults (aged 20+) in a rural region of Upstate New York. Data on health status, health behaviors, and health care access among farmers and rural nonfarm residents were compared.

RESULTS

After adjustment for age, gender, education, and having a regular health care provider, male farmers had elevated prevalence of asthma (OR: 1.82, 95% CI: 1.05-3.16) and untreated chronic obstructive pulmonary disease (COPD) (OR: 3.17, 95% CI: 1.12-9.01). Farmers had significantly lower hypercholesterolemia (OR: 0.70, 95% CI: 0.50-0.99), but not lower prevalence of heart disease or stroke. Farmers had lower rates of smoking (OR: 0.60, 95% CI: 0.40-0.89) and higher rates of hard physical labor (OR: 2.61, 95% CI: 1.83-3.72) than nonfarmers, but they had notably worse health behavior prevalence relative to various types of screening, vaccinations, and having a regular medical care provider (OR: 0.53, 95% CI: 0.39-0.71).

CONCLUSIONS

The farm population is becoming more like the rural nonfarm population with regard to health outcomes and lifestyle, yet it remains notably poorer with regard to prevention. Targeted outreach is needed to increase prevention within the agricultural community.

Evaluation of a community-based participatory farmworker eye health intervention in the "black dirt" region of New York state

BACKGROUND

Eye irritation is a constant hazard for migrant and seasonal farmworkers, but there are few studies of the problem or how to address it. Researchers evaluated the effect of a community-based participatory eye health intervention on farmworker eye symptoms in the Hudson Valley, NY.

METHODS

A randomized pre-post intervention with 2, 4-week follow-up periods was implemented with a sample of 97 farmworkers. Five eye symptoms were measured, along with utilization of protective eyewear and eye drops.

RESULTS

Leading baseline eye symptoms were redness (49%), blurred vision (43%), itching (43%), and eye pain (29%). Significant reductions in eye pain (P = 0.009), and non-significant reductions in redness were observed for the intervention group while controls experienced increases in both.

CONCLUSIONS

The intervention was effective in significantly reducing eye pain, and to a lesser extent, redness. Future eyewear promotion programs should offer a range of eye wear, tailor offerings to local climate and tasks, evaluate eyewear durability, and include eye drops.

Community Views and Public Health Priority Setting

Objectives. New York, like many other states, provides county-level health statistics for use in local priority settings but does not provide any data on public views about priority health issues. This study assessed whether health department priorities are notably different from community concerns about health, and how both groups’ priorities compare with local health statistics. Method. Data from a 2009 rural survey on community health concerns were compared to priorities named by the seven area county health departments, and to local health indicator data. Results. Health care/insurance cost (60%), obesity (53%), and prescription cost (41%) were leading community concerns, regardless of age, education, sex, or Internet in the home. Six of seven county health departments selected access to quality health care (which includes health care/insurance cost) as a leading public health priority, but only three identified obesity. The following leading local health issues were suggested by health indicators: Physical activity and nutrition, Smoking, and Unintentional injury. Conclusions. Health departments diverged from community priorities, from health indicator data, and from one another in choosing priorities. Adding a question about community health priorities to existing state telephone surveys on health behavior and lifestyle would provide an important tool to local health departments.

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.

A correction factor for estimating statewide agricultural injuries from ambulance reports

PURPOSE

Agriculture ranks as one of the most hazardous industries in the nation. Agricultural injury surveillance is critical to identifying and reducing major injury hazards. Currently, there is no comprehensive system of identifying and characterizing fatal and serious non-fatal agricultural injuries. Researchers sought to calculate a multiplier for estimating the number of agricultural injury cases based on the number of times the farm box indicator was checked on the ambulance report.

METHODS

Farm injuries from 2007 that used ambulance transport were ascertained for 10 New York counties using two methods: (1) ambulance reports including hand-entered free text; and (2) community surveillance. The resulting multiplier that was developed from contrasting these two methods was then applied to the statewide Emergency Medical Services database to estimate the total number of agricultural injuries for New York state.

RESULTS

There were 25,735 unique ambulance runs due to injuries in the 10 counties in 2007. Among these, the farm box was checked a total of 90 times. Of these 90, 63 (70%) were determined to be agricultural. Among injury runs where the farm box was not checked, an additional 59 cases were identified from the free text. Among these 122 cases (63 + 59), four were duplicates. Twenty-four additional unique cases were identified from the community surveillance for a total of 142. This yielded a multiplier of 142/90 = 1.578 for estimating all agricultural injuries from the farm box indicator. Sensitivity and specificity of the ambulance report method were 53.4% and 99.9%, respectively.

CONCLUSIONS

This method provides a cost-effective way to estimate the total number of agricultural injuries for the state. However, it would not eliminate the more labor intensive methods that are required to identify of the actual individual case records. Incorporating an independent source of case ascertainment (community surveillance) increased the multiplier by 17%.

Community collaborations for farmworker health in New York and Maine: process analysis of two successful interventions

We conducted a process evaluation of 2 successful farmworker community-based participatory research intervention development projects (in Maine and New York State). Participant surveys measured satisfaction with the program process. We used qualitative methods to analyze free-text responses. Respondents indicated high satisfaction levels overall. The main concern was long-distance project coordination. Community-based participatory research programs in which (1) the work team defines the target health issue, (2) agricultural employers are meaningfully included, and (3) interventions are carried through to completion, warrant further study.

Growth of the Spanish-speaking workforce in the Northeast dairy industry

The Spanish-speaking proportion of the Northeast dairy industry workforce is believed to be increasing. This study quantifies the extent of this increase over time in New York, Pennsylvania, and Vermont, and compares demographics between English- and Spanish-speaking workers. A total of 293 farms were followed for 21 months via telephone. The proportion of the Spanish-speaking dairy workforce was measured. Differences in demographic characteristics were assessed. The proportion of Spanish-speaking workers increased linearly for both large and small farms. The rate of increase was much greater on large farms. Linear models predicted that 53.2% of the large and 18.1% of the small farm workforce would be Spanish speaking within 5 years. Spanish-speaking workers worked significantly longer weeks than their English-speaking counterparts. The Occupational Safety and Health Administration (OSHA) monitoring cutoff for number of employees is currently 10. Consequently, the increase in the proportion of Spanish-speaking workers in dairy, who have been shown to work more hours per week, is likely to result in fewer workers per farm. This could have implications for farms currently under OSHA regulations based on having 10 or more workers, because farms with workers working longer hours per week will employ fewer workers overall. In addition, according to section 330 of the Public Health Service Act, these workers do not currently meet the migrant farmworker definition that would qualify them to receive primary health services from federally funded migrant health centers. New legislation is needed to formally qualify this growing indigent population to receive healthcare via channels that are currently available to migrant and seasonal farmworkers.

Spanish-Speaking Dairy Workers in New York, Pennsylvania, and Vermont

A New York Center for Agricultural Medicine and Health (NYCAMH) study surveyed 294 dairy farms in New York, Pennsylvania, and Vermont. The study utilized a quarterly telephone survey to assess the proportion of Spanish-speaking workers on these farms, and also to contrast the hazard level of work tasks and prevalence of lost work time between Spanish- and English-speaking workers. The total workforce followed in the study was comprised of 14.4 percent Spanish-speaking workers, with larger farms having a higher proportion than smaller farms (19.9% versus 4.6%, respectively). Of the 294 farms, 22.5 percent had at least one Spanish-speaking worker, which differed, greatly between larger and smaller farms (51.5% versus 7.3%). Spanish workers were significantly younger, worked significantly longer hours and had significantly fewer years of employment than their English-speaking counterparts. Work hour differences were more pronounced on the larger farms. Lost work time, due to on-farm injuries, did not differ between the Hispanic workers and the non-Hispanic workers. After correcting for both age and length of farm employment, Spanish-speaking workers were far less likely to perform managerial functions than their English-speaking counterparts (OR = . 22 p < .01).

Electromyographic assessment of apple bucket intervention designed to reduce back strain

The authors previously developed an apple bucket that was modified by use of a hip belt to reduce muscle fatigue. The intervention of belt use was accepted by workers and shown not to interfere with productivity. However, use of this intervention did not appear to reduce muscle fatigue when measured by tests of voluntary muscle strength. The purpose of the present study was to evaluate the intervention's effect on muscle fatigue employing surface electromyographic (EMG) amplitude. Amplitude measurements on 15 muscles were taken from 10 laboratory volunteers who were carrying a full bucket of apples, once while wearing the intervention belt and once without the intervention. These measurements were taken for seven different postures (four angles of trunk flexion (0 degrees , 20 degrees , 45 degrees , 90 degrees ) and three raised-arm positions (both up, dominant up, non-dominant up)) common to apple harvest work. Participants were measured in these conditions both with the bucket carried in front and with the bucket carried to the side. Significant reductions in amplitude favouring the intervention were seen for 11 of the 15 muscles in models considering the four body flexion angles. Ten of these were of the middle and lower back. These control/intervention differences were seen with both bucket-carrying positions (front vs. side) and tended to increase with increasing flexion angle. In contrast, no significant intervention effects were observed in models considering treatment by arm-raised position. One significant main effect (upper trapezius, side bucket) showed an amplitude reduction in the treatment condition. Another main effect showing increased amplitude in the intervention condition use was observed in the dominant levator scapulae (side bucket). Thus, the use of the intervention belt reduces EMG amplitude among a number of mid- and lower-back muscles. This is suggestive of a protective effect against back strain.

Handling nonresponse in surveys: analytic corrections compared with converting nonresponders

A large health survey was combined with a simulation study to contrast the reduction in bias achieved by double sampling versus two weighting methods based on propensity scores. The survey used a census of one New York county and double sampling in six others. Propensity scores were modeled as a logistic function of demographic variables and were used in conjunction with a random uniform variate to simulate response in the census. These data were used to estimate the prevalence of chronic disease in a population whose parameters were defined as values from the census. Significant (p < 0.0001) predictors in the logistic function included multiple (vs. single) occupancy (odds ratio (OR) = 1.3), bank card ownership (OR = 2.1), gender (OR = 1.5), home ownership (OR = 1.3), head of household's age (OR = 1.4), and income >$18,000 (OR = 0.8). The model likelihood ratio chi-square was significant (p < 0.0001), with the area under the receiver operating characteristic curve = 0.59. Double-sampling estimates were marginally closer to population values than those from either weighting method. However, the variance was also greater (p < 0.01). The reduction in bias for point estimation from double sampling may be more than offset by the increased variance associated with this method.

Development and initial assessment of objective fatigue measures for apple harvest work

Previous research has shown that neck, back and shoulder musculoskeletal strain is a major occupational health problem affecting migrant orchard harvest workers. Researchers seek to measure the effect of an ergonomic modification to the apple picking bucket on muscle fatigue, however objective measures for use in the orchard are not yet available. The purpose of this study is to develop simple back, shoulder or arm strength measures, which detect statistically significant drops in strength over one workday. Candidate muscle strength measures were piloted in the laboratory, adapted for the orchard and evaluated (n=102). Data were analyzed for morning to afternoon fatigue, and for correlation between fatigue score and hours worked. In the laboratory, the timed arm hold (35.7% time reduction, 95% CI: 21.81-49.61), and the timed spinal extension (31.8% time reduction, 95% CI: 23.54-39.96) showed significant fatigue. In the orchard (n=102), only the timed arm hold showed significant (11.4%, p<.0001) fatigue. The potential effect of field conditions and subject motivation on these results needs further exploration.

Laboratory evaluation of belt usage with apple buckets

BACKGROUND

Migrant and seasonal orchard harvest workers experience musculoskeletal strain caused by carrying heavy loads and holding awkward postures. An ergonomic hip belt designed to redistribute weight from the upper back, neck, and shoulders to the hips was evaluated.

METHODS

A comparison of muscle exertion (using electromyography [EMG]) of four key back and shoulder muscles and shoulder surface pressure (using a surface pressure sensor [PS]) was made among 10 laboratory volunteers under intervention and control conditions, in two postures (standing erect [0 degrees ]) and flexed [45 degrees ]).

RESULTS

All but one measure showed a significant reduction in the flexed posture with the intervention. Two of eight measures showed a significant reduction in the erect posture. Correlations with shoulder discomfort were found for deep shoulder EMG (r=0.71, P=0.021) and shoulder surface pressure (r=0.58, P=0.082).

CONCLUSIONS

The hip belt intervention produces significant reductions in muscle activity while in a posture commonly assumed during orchard work.

Estimating farmworker population size in New York State using a minimum labor demand method

Assessment of health needs and services for hand-harvest farmworkers requires reliable population estimates. In New York State, the only publicly available source for these is the Department of Labor (DOL). However, published production data exist that may enable estimation of minimum labor demand (MLD) for hand-harvest labor. Our objective was to develop an estimation process for minimum labor demand (MLD) for hand-harvested crops in NYS and contrast the results with DOL estimates. Four crop strata (below ground, ground, bush/vine, and orchard) were identified. MLD (measured in worker-seasons) was estimated by dividing the total annual harvest hours required for each crop stratum by the total hours worked by one worker in a season for that crop stratum. The MLD estimate of the total number of worker seasons combined for all strata (14,121) was higher than that of the DOL (8,230). Harvest acreage was unavailable for 21% of the 991 county-crop combinations studied; therefore, data were imputed from other sources. Within these strata, the greatest difference was found for ground crops, where the DOL count was 28% of the size of the MLD estimate. DOL and MLD estimates were closest in orchard crops (DOL 109% of MLD). Publicly available data provide a potentially valuable source of informationfor estimation of the MLD. Use of these methods implies that the DOL may substantially underestimate the size of this population. Differences seen between the two methods were sensitive to the crop type. County-level farm surveys to verify MLD estimation factors would enhance the method's accuracy.

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.

Chronic disease risk in central New York dairy farmers: results from a large health survey 1989-1999

BACKGROUND

The agricultural workplace presents a variety of health and safety hazards; it is unknown whether farm work may be a risk factor for certain chronic diseases.

METHODS

The health survey data from a large rural population in central New York were used from two studies (1989, 1999) to assess both 1999 prevalence and 10-year incidence of self-reported diabetes, heart disease, hypercholesterolemia, and hypertension among farm (predominantly dairy) and non-farm residents. The 1999 asthma prevalence was also assessed.

RESULTS

Multiple logistic regression models for 1999 prevalence found statistically significant protective effects of farming for hypertension (OR=0.83, P=0.0105) and hypercholesterolemia (OR=0.853, P=0.0522). Non-significant results were seen for heart disease (OR=0.67, P=0.128) and diabetes (OR=0.856, P=0.1358). The model for 1999 asthma prevalence showed a significantly elevated risk for farming (OR=1.542, P=0.0004). Logistic models created for the 10-year incidence of hypertension, hypercholesterolemia, diabetes, and heart disease did not show a significant effect for farming.

CONCLUSIONS

The protective effect of farming observed for the 1999 prevalence of hypertension and hypercholesterolemia was not seen for the 10-year incidence of these diseases.

Ergonomic Analysis of New York Apple Harvest Work Using a Posture-Activities-Tools-Handling (PATH) Work Sampling Approach

Although back, neck, and shoulder strains are common among migrant and seasonal orchard workers, little data currently exist regarding the ergonomic factors contributing to this problem. We adapted Posture-Activities-Tools-Handling (PATH) instruments and methods for ergonomic job analysis of apple harvest work in three New York orchards, and used the resulting protocol to quantify hazardous activities, loads, and postures. Using a prototype developed previously, we trained twelve contract orchard observers with classroom training and supervised orchard practice. The PATH data were then collected on 14 orchard workers over four days (2,900 observations). Mean coefficients of variation ranged from a low of 0.212 (standing leg neutral) to a high of 0.603 (trunk moderate flexion). Most frequently observed activities were: picking (62.9%), placing and moving apples in the bag (8. 7%), and walking (8.1%). Weight bearing (>10 lb, >4.54 kg) was observed 78.5% of the time throughout a range of activities. Apple harvest work is comparable with other ergonomically high-risk occupations. Future research should focus on low-cost interventions that reduce load and awkward postures.

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

BACKGROUND

Traditional worksite injury surveillance methods are often ineffective for Northeastern farms employing seasonal harvest labor. Many are small farms, exempt from mandatory injury reporting. The high proportion of foreign workers and the temporary nature of the work further discourages reporting. Therefore, an alternative migrant health center-based occupational injury and illness surveillance system was piloted during 1997-1999.

METHODS

Anonymous medical chart data from nine migrant health centers and four regional hospital emergency rooms was collected during 1997-1999.

RESULTS

There were 516 injury/illness cases over two seasons. Joint/muscle straining (31%), falling (18%), poison ivy contact (10%), and object strikes (8%) were most common injurious events. The participation rate of health care was 75%; 130 cases were reported by hospital emergency rooms; and optimal health center participation was associated with: being a farmworker-dedicated program, and including the chart reviewer in the health center's decision to participate.

CONCLUSIONS

Further development of a medical records-based surveillance system should include hospital emergency rooms and focus on identified health center performance factors.

New York State child agricultural injuries: how often is maturity a potential contributing factor?

BACKGROUND

Children living or working on New York farms face unique hazards and experience on-farm injuries related to these. The New York Community Partners for Healthy Farming (CPHF) surveillance provided a unique source of information for analyses of risk factors-particularly age-for these events.

METHODS

Agricultural injuries recorded by the state's agricultural nurse surveillance (CPHF) program over a 6-year period were analyzed. Injuries were classified by type, severity, and possible contributing factors, including whether the age of the victim was below the "job appropriate age limits" designated by the investigators using materials from the North American Guidelines for Children's Agricultural Tasks (NAGCAT).

RESULTS

Of the 164 recorded injuries to persons aged 1-18 years, 29 were fatalities, 18 were disabling, and 55% occurred while working. Leading injury types were tractor run-over (12) and overturns (11). Of those injured while working, 35% were under the "job appropriate age limits." Tasks of loading hay (square bales) (100%, 3), fieldwork with trailed implements (100%, 3), and feeding calves (100%, 2) most frequently involved very young victims. Grouped by injury source, injuries involving non-powered wagons had the highest frequency of under-age victims (82%, 9).

CONCLUSION

The frequency of problems with job appropriate ages suggests that some children on NY farms may be developmentally inappropriate for the tasks to which they are being assigned. The NAGCAT Guidelines are a needed tool for child agricultural injury prevention in New York.

Ergonomic exposures in apple harvesting: preliminary observations

BACKGROUND

Recent research on occupational injury to apple harvest workers in New York and Pennsylvania indicates that muscle strain is one of their leading problems. A descriptive study of ergonomic risks for strains of the shoulder and lower back among apple harvesters was carried out to identify opportunities for intervention.

METHODS

Based upon pilot observation in four orchards, a Posture-Activities-Tools-Handling (PATH) data collection template was designed and used to analyze the work of fifty-one workers in eight additional apple orchards.

RESULTS

Physical loading on the shoulder appears to result from three major factors: reaching to pick apples with elbows over shoulder height; downward pressure from the bucket's strap in contact with the collarbone; and strain from carrying the ladder. Strain to the back appeared to come from three circumstances: static, awkward picking postures; bending to empty the picking bucket into the bin; and supporting a full load of the apples with the lower back.

CONCLUSION

Possible intervention strategies are suggested, with emphasis on direct communication and active involvement on the part of the growers and harvesters.

Time dependent memory decay

BACKGROUND

To estimate the rate of time dependent memory decay, injury rates from three independent studies were compared.

METHODS

The studies asked subjects to recall injuries during the previous 2 months, 12 months, or 10 years.

RESULTS

The annual injury rates obtained were 108/1,000, 66/1,000, and 19/1,000, respectively. These rates are all significantly different from one another at the 0.05 level.

CONCLUSIONS

Important methodological and demographic differences between the studies, such as those involving age, injury severity, and seasonality, were ruled out as causes of these differences. Results found in the literature for other studies are compared and contrasted. These data suggest that recall periods of greater than 2 months are likely to significantly underestimate injury rates.