Intervention - Safe Behaviors Among Adults and Children

Indeed, this led to some real questions
about health and safety. Geller found out
that one out of every five had had an inju-
ry the previous year. Many of them trea-
ted it at home. Many of them said, "well,
you know, it is too far to go, the medical
facilities are elsewhere, there is no health
insurance." So, for however serious it was
people who should have seen physicians
that did not get that kind of help.

Geller found that there was a significantly
higher proportion of injuries among those
who were most financially stressed. This is
where we begin to make the connection
between stress and behavior, i.e. injury.
Those who had over 40 percent debt-to-
asset ratio, which many of you know is a
real bad thing to have-you are on the
edge, going over-had over 60 percent of
the accidents. That was true across age.

The younger you were, also, the more
likely you were to have accidents, and
when he asked these two questions that
bear directly on our considerations here,
he found very interesting results. He
asked:

Is it necessary, under current economic
conditions, to cut comers on safety to
save money?

Of those who reported they had had an
injury the previous year, 30 per cent of
them said, "Yes, it is necessary to cut cor-
ners." Of those who had had no accident,
only 20 percent said yes.

Then he asked, "Have you found it difficult
to concentrate on farm work this past
year?" Of those who had had an accident,
two-thirds of them said, "Yes, I have found
it difficult to concentrate."

426

We now find people who are concentrating
far less on what they are doing. They have
become much more distracted, much more
thinking about the conversation with the,
for example, banker tomorrow. Often
what sets them off is a small thing.

Many of more I have interviewed have
said to me, "You know, I went out behind
the barn...," "I got a message from my
banker...," or, "The feed dealer called me a
liar," and then they would add, "And I took
the gun and I. . .`I These were the conver-
sations I had after they had said, "I'll walk
you to the car." Then they would say, "I've
never told my wife this, but..." and then I
would get the rest of the story.

We are seeing increased pressures on
many farm families. Leslie Whitener of
USDA on this program knows well the
data that indicate the increased numbers
of people with off-farm jobs. What was
found in another study in North Dakota is
fascinating with regard to the topic of
increased stress from multiple jobs.

People who had identified themselves in
one study as underemployed, were inter-
vieweed to find out how underemployed
they were. What the researchers found
out was the respondents were not at all
underemployed. They were, in fact,
under-compensated. Their incomes did
not cover their expenses, but they were
filled to the brim with jobs, pieces of jobs,
part-time jobs, plus a farm. With both
parents under such stress, the kids were
under pressure also.

A friend of mine refers to this as a recipe
for psychopathology. Another one of my
friends simply says, "It's crazy making."
Their commutes of the respondents were
increasing distances from home with spous-
es often going opposite directions. They

Papers and Proceedings


were tired more often. They were cutting
out a lot of social activity.

You who are medical professionals in this
group know well-much better than I-the
statistics that point out that at least 75
percent of all illnesses are stress-related.
Immune systems seem to get weaker the
higher the stress level.

Depression is known by another name-as
"anger turned inward." Many of these
folks could not figure out whom to be
angry with, "and they turned it all in on
themselves. Should we be surprised at
high farmer suicide rates?"

I think it quite.remarkable that with some-
thing like 650,000 farm families losing their
farms in the 1980's that some people con-
tinue to insist that they were simply bad
managers or speculators. Is it possible that
so many got so stupid simultaneously? It
seems to me that it is not really individual
causation when numbers this extraordinary
exit.

I not long ago spoke to a pastor in a rural
community in which the bank had failed in
about 1982 or 1983. He said to me, "Oh,
you've got to know this, I am presently
visiting nine terminally ill cancer patients
in our community." That community prob-
ably does not have 200 people in it. You
have to wonder about the relationship
between such illness and the severe stress.

THE RURAL COMMUNITY

The second context concerns the issue of
the rural community. All you have to
remember in my next illustration is "70
percent of the population of this country."
I am going to use the same percentage. In
1890, 70 percent was rural; by 1960, 70
percent was considered urban; by 1988, 70

A Rural Sociologist's Perspective, May 2, 1991

percent of the population of the U.S. was
said to live within 100 miles of our coast-
lines the great emptying of America.

As a friend said the other day, "we are in
the process of proving that the
Homestead Act was a huge mistake." Ru-
ral communities are in crisis-that is no
surprise to anyone. Many are declining. I
think it must be rather hard to speak about
the concerns of health and safety issues to
folks who are living in increasingly declin-
ing, dysfunctional, despairing communities.

Poverty has been referred to earlier. Pov-
erty is the cause of lots of things. How
many of you saw the NBC story on tuber-
culosis last night? Did any of you say to
yourself, "Wait a minute, in which century
am I living?" "Increasing amounts of tu-
berculosis in this country related to what?"
the announcer asked.

Poverty, became the answer. Migrant
farmworkers are among those who are very
much involved. And then there is the
cholera epidemic in South America.
Which century is this?

The poverty figures have increased and
many of you know them well. There are
also data available that speak to the in-
creasing disparity in rural communities
between those who have and those who
have not.

One of the agencies in Washington put out
the differences in food stamp usage in
rural communities from 1980 to 1987.
While the Northeast, including New York
State, was showing a decline, some Mid-
west states showed 47 percent, 31 percent,
and 35 percent increases in food stamp us-
age.

Surgeon General's Conference on Agricultural Safety and Health - 1991

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Intervention - Safe Behaviors Among Adults and Children

I know people I interviewed whose kids
were almost starving who would not on a
bet ask for food stamps. So, we can as-
sume that even with numbers showing
increased use that they are being under
utilized.

There has been, as you well know, institu-
tional decline. When I thought I was
about as depressed as I could possibly be
about what is happening to rural America,
I made the mistake of watching Tom
Brokaw's expose on Sunday night and
discovered that the Mafia-give us a break
out here-the Mafia, which controls the
garbage routes in New York and New
Jersey, have decided to dump it in rural
America, and they have been found to
drive their trucks and dump illegally in
places as far away as Nebraska. Grand-
mothers in the hills of Eastern Kentucky
are sitting and writing license plates and
watching trucks owned by the Mafia. I do
not think they know that this could be dan-
gerous dump waste.

We had reference yesterday to the fact
that Californians are eyeing the water in
the Snake River. The point is, communi-
ties are increasingly in conflict,

Farmers who were encouraged and who
thought it was a wise idea to trade more
acreage for fewer neighbors are finding
that they are not now as much better off as
they thought they might be.

It is thought that fewer medical personnel
are now needed since there are fewer
people out there, yet many cannot afford
to pay for the ones who are there. Many
drive a greater distance to facilities. If you
are very lucky, there are volunteer emer-
gency medical technician who might rescue
you from your farm accident-if you are
lucky.

428

Rural mental health is in a shambles in
many places. Rural mental health workers
whose caseloads mount are inundated. I
talk with pastors who tell me, "Judy, I am
the only one in this huge territory that has
any semblance of mental health training at
all and one little old course in clinical
pastoral education does not constitute
being prepared to do serious psychiatry,
but where can we send them?" What can
we do?

Furthermore, at a time when we need
more highly trained professionals in rural
areas, they are less likely to come and to
stay. Many of them are unwilling to sub-
ject their families to living so far away
from some of the amenities.

Frankly, I am absolutely convinced that
rural economic development will not take
place without medical facilities being in
place. I know of situations in South Dako-
ta, where firm was ready to start up and
discovered their they could not get liability
insurance because the hospital had closed
the previous year. Think of it. You see,
the big pieces are beginning to come to-
gether.

While I applaud the notion of volun-
teerism, I am really opposed to allowing
rural America to have "volunteers" and ur-
ban America to have real physicians and
nurses. I am kind of picky about that, and
I am operating under the notion that
"equitable access to services" is a phrase
that few politicians, if they were smart,
would vote against; and the rest of us in
the community need to rise up and say,
"That's what's needed here."

I am not talking about a doctor in every
community. I am realistic, but, folks, we
cannot have rural health care in communi-
ties without trained personnel.

Papers and Proceedings


A Rural Sociologist's Perspective, May 2, 1991

I with to comment on one other aspect of
the quality of life in rural communities.
There was a meeting fairly recently where
Iowa and Mirmesota Agricultural Leaders
of Tomorrow-the Kellogg Leadership
Program--were in attendance. A leading
agricultural economist from the University
of Minnesota told the group of what he de-
scribed as an efficient farming operation of
the future.

I share this because I want you to wonder
whether this is the kind of community in
which you want to live. The suggestion
was that a truly efficient farmer would, of
course, have a lot of land because he
would have large and expensive equipment
over which to run it. The only way to
make the equipment pay would be to run
it 24 hours a day. All of our agricultural
safety people are about to have an instant
coronary.) That is not clever. It is not
healthy. So, what was he saying?

He stated that you were not supposed to
run it yourself, but you were supposed to
hire people who would run it during the
needed time, and when you had finished
with them, you should fire them, ". . . and
then they can go back on the public wel-
fare system."

I do not accept that definition of efficiency
in agriculture, and I do not think-and
maybe you do not either-that it is possible
to have healthy and wholesome and safe
producers and workers that in such a com-
munity or in communities that are sick, de-
clining and despairing. I think that is a
very important issue.

GLOBALIZING AGRICULTURAL
PRODUCTION AND CONSUMPTION

If YOU have not read Wendell Berry's es-
say, "Does Community Have a Value?" in

his book, Home Economics. I strongly rec-
ommend it to you, especially as we think
about the rural families and communities
in a era in which the globalization of our
food production system seems to be en-
couraged.

Policy makers in our world are bringing
about the globalization of our food system.
I point out to you that there is neither an
invisible .hand nor a mythical or mystical
force that is dictating this; that it is, in fact,
becoming a matter of public policy. It has
been decided at the highest levels that this
will happen.

I raise with you some questions about this
because I think it is important in the con-
text of the issue of which we are speaking.
The consequences of this policy, however
unintended, may not have yet been thor-
oughly discussed. The current operational
definition of this globalization can be
found in the General Agreement on
Trades and Tariffs (GATT), and in the
North American Free Trade Agreement
(NAFTA). The destruction of locally
regionally self-sufficient food systems in
favor of a globalized system is being pre-
sented through these two treaties.

If we are to function globally, do we not
then have to broaden our concern to in-
clude the banana packers in Central
America who breathe chemical fumes all
day in the packing plants; to the families
of migrants whom I have seen living in
the colonias on our border?

If these public policies come into being,
how will they change the context in which
American farmers, rural residents, and
rural communities look at their quality of

Surgeon General's Conference on Agricultural Safety and Health - 1991               429


Intervention - Safe Behaviors Among Adults and Children

life? Will the "harmonization" of
regulations that is in the GATT mean a
reduction in health and safety standards?
Some are asking. I am not sure.

If we are to function globally, do we not
then have to broaden our concern to in-
clude the banana packers in Central Amer-
ica who breathe chemical fumes all day in
the packing plants; to the families of
migrants whom I have seen living in the
colon.& on our border? This latter group
is often U.S. citizens whose water comes
from chemical barrels that are now used
for rain catching. I saw that just a year
ago, so it is still a contemporary situation.

Do we need to include the minority
women and poor white women of North
Carolina and other states who work in
poultry plants ? They go into the plant
company healthy persons and within
months some have developed urinary tract
infections (from being not allowed to use
the bathroom as often as needed), or they
have developed repetitive motion syn-
drome (carpal tunnel) so badly that they
are unable to lift their own children. As
someone has said, "they come in healthy
and they are dumped back on the public
system crippled." Do we have to include
them?

What about the cane workers who are
imported with promises and hopes from
the Caribbean (Jamaica) to work in the
cane fields of south Florida. Many find
recruiting promises go unkept.

Or the campesinos all across Latin
America who work for three dollars a day
or less. Our Missouri Agricultural Leaders
of Tomorrow (Kellogg group) just returned
from a trip to Brazil and Argentina, and
my understanding is that the major thing
they have had to cope with, since getting

430

home, is the despair about the obvious ad-
vantages Latin America has for producing
the things we think of ourselves as so effi-
cient at producing. Some of the outstan-
ding young farmers say, "Hey, I might as
well quit now." They may work through
that, but how can American farmers com-
pete with laborers who will work for three
bucks a day. American farmers tend not
to like to live so little. That is an issue of
agricultural health and safety in every
sense of the term.

We could go on. What about the Japanese
farmers who are raising rice in the high
mountain terraces are not very excited
about our rice producers moving into their
markets? (I raise beef and soybeans and
of course I would love to get them to buy
more farm products from the U.S.) How-
ever, if we force our rice into their mar-
kets, the economically more marginal pro-
ducers in Japan (namely those growing
rice in those mountain terraces) will likely
not be able to raise rice as cheaply as
some of our producers and they will go out
of business.

What will then happen to the terraces that
have conserved both water and soil for
hundreds of years ? Will they give way
leading to soil loss and water quality loss?
Now we are talking about a different issue,
but one that clearly must be part of the
discussion of the health and safety of agri-
cultural producers and communities.

Well, as you can see, if we really decide as
a matter of public policy to globalize the
food system, can you and I then be com-
fortable with only focusing on agricultural
health and safety at the national level?

The front page this week of Feedstuffs
magazine talks about the opening of North
America to "free trade." I am troubled by

Papers and Proceedings


A Rural Sociologist's Perspective, May 2, 1991

the statement here that the Administration
refuses, as the Congress has asked, to look
at labor and environmental concerns in-
volved in such trading arrangements. The
Administration has indicated that these
issues will not be discussed; they will not
allow them to be discussed in the context
of free trade negotiations. I suggest to you
that this should be a cause of alarm for us.

We who are part of the community of
faith, we who contribute millions of mis-

sion dollars to improve the lines of the
poor, the exploited and the despairing of
the world, we believe that we have an
important stake in this enlarging issue of
the health and safety of agricultural pro-
ducers, workers and processors around the
world. We are indeed your allies as all of
us seek to improve the conditions of farm
and rural families and communities here
and abroad.0

Surgeon General's Conference on Agricultural Safety and Health - 1991

437


Surgeon General's Conference on Agricultural SatWy and Health
f%idAFE 2000 8 A National Coalition for Local Action
Convened by the National institute Ibr Occupational Safety and Heatth
April 30 - May 3, 1991, Des Moines, Iowa

YOUNG FARMERS' PERSPECTIVE

Wayne Sprick

Executive Director

National Young Farmer Educational Association

Dr. Walter J. Armbruster: Wayne Sprick is the Executive Director of the National Young Farmer
Educational Association. He will present his perspective from the viewpoint of Young Farmers.
Mr. Sorick:

It is a pleasure for me to come before you
and present the perspective of the National
Young Farmer Educational Association
and the young farmers we represent. This
has been an informative session and con-
ference. I am pleased to be part of it.

Before getting into my comments and
reactions, let me take an opportunity to
provide some background on myself and
the organization I represent.

My background is in agricultural
education. Prior to that, I was born and
raised on a dairy farm in Missouri, Frank-
lin County, the town of Washington. This
is located about 50 miles west of St. Louis
on the Missouri River. I went to school at
the University of Missouri, Columbia,
where I received a degree in agricultural
science, in dairy science. At the time of
my graduation, the job that I was looking
for was not available. I chose to pick up
the courses that were needed to be certi-
fied as an instructor of agricultural educa-
tion.

Upon receiving that certification, I went to
work in 1968 and taught for 19 years in
two school systems in East Central Missou-
ri. During that time I worked with second-
ary students, as well as adults, in agricul-
tural education. This was through the
Young Farmer Program, as well as general
adult education. I also had the opportuni-

432

ty to teach part-time in a nearby communi-
ty college.

During that time, I had the opportunity to
buy a neighboring farm to my home place.
Everybody involved in agricultural educa-
tion has to put to practice what they
preach. So, in addition to teaching, I
owned and operated 120-acre general
farm.

I have been involved with the National
Young Farmer Educational Association
since January 1987, during which time I
relocated my family from East Central
Missouri to Alexandria, Virginia. It was a
culture shock, to move from 120 acre farm
to a half-acre lot. We have adjusted quite
well and the family is enjoying it.

Many of you are familiar with other voca-
tional student organizations. There are
three in agriculture. The Post-secondary
Agricultural Student Organization (PAS),
the National Young Farmer Educational
Association, and the National FFA organi-
zation. In addition to these three in agri-
culture, you are probably familiar with the
Distributive Educational Clubs of America,
the Vocational Industrial Clubs of
America, FHA, HERO. There are ten
that are recognized as vocational student
organizations by the United States Depart-
ment of Education.

Papers and Proceedings


We provide opportunities relating to award
recognition, leadership, and communica-
tion skills development for those students
that are enrolled in agricultural education.
The FFA addresses those needs of the
secondary students. The PAS addresses
the needs of those who are enrolled in the
community junior college system generally
in technical programs. We serve those
needs of adults as they are enrolled in
agricultural education.

2. To develop or to assist in developing re-
sources that otherwise may not be avail-
able.

Eighty percent of our membership is be-
tween the ages of 20 and 40. The term
"young" is a relative term. If you would
come to our Institute in Mobile, Alabama,
in December and survey the group, you
will certainly feel that way. I remember
the very first Institute that I attended. I
walked away from it and said, "Good grief,
these are young farmers?" After doing
some checking and research on it, I real-
ized quickly that few people involved in
production agriculture have the opportuni-
ty and resources of both time and finances
to travel and to leave the farm for an ex-
tended period of time.

One of the programs that I am going to
share with you was sponsored by Navistar
International Transportation Corporation.
One of the ways we were able to get those
resources was that we could provide them
with a program that was national in scope
and related to our goals and objectives.
These are to develop and to assist in de-
veloping leadership and communications
skills, to provide identity and unity to the
group-

It also helped to promote the National
Young Farmer Educational Association as
a vital part of the instructional program in
agricultural education. One of the more
important opportunities, as it relates to our
purpose; is to improve the rural community
as a place to live relating to health services
and rural/urban relations.

Those people who do are the older seg-
ment of the farm population. Those peo-
ple who are required to stay home because
of their tie to the business and the high
requirement for family labor are the youn-
ger people. Also, the secondary reason is
that our Institute is held the end of No-
vember and the first part of December.
This coincides with the deer season in
many states. Life is a matter of priorities.

How is this done? We are a member of
the family of agricultural education. Our
programs are administered and conducted
by, on the local level, that instructor of
agricultural education. Yesterday Bob
Graham, representing the National Voca-
tional Agricultural Teachers' Association,
gave you a perspective on that group.

me purposes of our organization are:

The primary emphasis that you picked up
from that presentation was that they work
with the secondary teacher. That second-
ary agricultural instructor many times is
the advisor to the Young Farmer Associa-
tion.

1. To assist young farmers to remain es-
tablished in farming, ranching and    Agricultural safety has been a priority in
                    all of our lives, mine as well, from an early
agribusiness. This goes beyond
production agriculture. You will note I  age. I am not going to go into any of the

said agribusiness.           things that I did as a child and young adult
                   growing up on a dairy farm because at this

Young Farmers' Perspective, May 2, 1991

Surgeon General's Conference on Agricultural Safety and Health - 1991

433


Intervention - Safe Behaviors Among Adults and Children

point it is unimportant. The perspective
that the people in production agriculture,
the farmers, have is that they are risk-tak-
ers. A high level of risk-taking exists in all
things that they do. This relates to safety
as well.

My life was impacted when I was a ninth--
grader. A classmate of mine, Ken Kruse,
was killed as a result of a farming accident.
My life was also impacted when my broth-
er sustained eye damage. He was working
in a construction job between his freshman
and sophomore years in college and sus-
tained permanent eye damage. My life
was also affected when my nephew lost an
eye as the result of an object being thrown
by a lawnmower that his father was using.
And the list goes on. I too have sustained
injury as a result of working in production
agriculture.

The setting in the agricultural shop of the
high school at which I taught was also an
area where safety was important.

As we look at the opportunity for interven-
tion as it relates to the reduction of injury
and death from farm accidents, we need to
reflect on some of the presentations that
were made. We just heard a presentation
on the relationship between knowledge
and education versus faulty habits and
attitudes as it relates to the occurrence of
farm accidents. I said that farmers, as well
as all the rest of us, have the knowledge
and know the difference between right and
wrong.

I have a 13-year-old son who is just start-
ing to leave home and to go on his own to
skiing trips and other activities with organi-
zations, including our church group. When
he leaves on these trips, I tell him, "Jon, I
do not need to tell you what to do and
what not to do. You know what is right

434

and what is wrong. What I need to tell
you is that when you are faced with a situ-
ation, you take the time to stop and think,
`Is this right or is this wrong?' Weigh the
circumstances and make the decision."

I used that same example when I was teac-
hing agriculture. I would take my students
to Columbia, Missouri, for the state judg-
ing contest and the state convention. I
said, "If you do not know the difference
between right and wrong, I have been a
failure." In the case with Jonathan as a
parent, or with my students I have been a
failure as a teacher. What I am asking you
to do is to stop and think and weigh the
risks.

People involved in production agriculture
are risk-takers. We assume risk when we
plant the crop. What are the risks? We
are not guaranteed what the weather con-
ditions are going to be. We are assuming
risk. We are not guaranteed what the
price is going to be. We are assuming risk.
We do the same kinds of things as it re-
lates to safety. That kind of feeling comes
through in all that we do.

At the same time, we in education provide
programs and information that should help
that person in production agriculture shift
those risks. What do we have as it relates
to price protection? The futures markets
can be used as a hedge to shift that risk
from the farmer to someone else. As it
relates to weather, there are crop insur-
ance programs that are available.

What ccut we do as it relates to safety?
How can we help that person in
production agriculture shift that risk or,
better yet, eliminate that risk and be acci-
dent free?

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Young Farmers' Perspective, May 2, 1991

Another important factor is awareness.
We in the National Young Farmer Educa-
tional Association just completed a safety
program called Board, EM II. This is a
program that is conducted in cooperation
with the FFA chapters across the country.
We work closely with the FFA chapters,
which provides for a good situation. The
FFA chapters and those younger people
are looking for opportunities to conduct
community-service types of projects.

They have the means and work diligently
in providing the legwork to get the infor-
mation out. At the same time, those peo-
ple out there in production agriculture, the
young farmers as well as the not-so-young
farmers, benefit from the reduction in
accidents and the reduction losses result-
ing from these programs.

The Volatile Fuel Safety Program involved
several areas. One of them was to reduce
the accidents that result from mishandling
and improper handling of volatile fuels,
primarily gasolines. One of the reasons
that this area was identified and initiated
in the mid 1980's was that people were
keeping tractors longer because of the
economic situation. They were also keep-
ing the tractors in a poorer condition and a
lower level of repair and maintenance.

The other thing is that these tractors were
manufactured in the early 1970's, the
1960's, and the 1950's. We even found
some that were manufactured in the late
1940's. The specifications under which
they were built were for the product that
was being used and manufactured at that
time. Now they are being operated on
gasolines that are manufactured primarily
for our cars of today, with the different
octanes and volatility levels.

Tractors are being used for heavier opera-
tions than they were manufactured for.
This causes a higher level of heat.

L

The FFA chapters and those younger
people are looking for opportunities to
conduct community-service types of pro-
jects.   I

The Board EM Program emphasized three
major areas: instruction, awareness, and
the opportunity to update and check equip-
ment to keep it in proper operating condi-
tion.

The awareness aspect of the program was
addressed through decals placed on fuel
tanks and the storage tanks, as well as the
tractor, itself. This called attention to the
idea that when you work with these fuels,
you, as the farmer, know the difference
between the proper way and improper way
of fueling this tractor. It is up to you to
take the initiative to exercise the proper
practice and to follow through.

This program was sponsored by Navistar
International Transportation Corp. Their
primary interest was to reduce their risk
and exposure relating to these kinds of
injuries. As we were seven months into
the period, incidence and injuries was
reduced considerably.

The Young Farmer Educational Associa-
tion presently is looking at other areas and
thrusts for safety programs, Among other
things, this conference is providing me with
names of resource people that I will be
contacting in the future to help us identify
thrusts and available information and re-
sources.

Surgeon General's Conference on Agricultural Safety and Health - 1991

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lntetventlon - Safe Behaviors Among Adults and Children

I mentioned that the opportunity and the
purpose that we have in addressing the
awareness aspect of safety is important.
The decals that were placed on the ma-
chines were printed and distributed in
English and Spanish, as well as French for
the Canadian provinces.

I would like to react to some of the things
that have been presented. One of the
purposes for my being represented at this
conference is, What can we as a vocational
student organization bring to the table?
What can we do to help in reducing the
incidence of accidents and death?

I heard the statement made yesterday that
there needs to be a bridge built between
the professionals and the farmers. I see
this as being very important. I mentioned
that farmers are risk-takers. We have
heard, also, that farmers are people who
listen to farmers.

They tend to stay within their own groups
and to rely on their same kind for informa-
tion. This is an opportunity for us. We
need to direct our attention to how behav-
ioral changes can come about and be part
of the solution.

Most effective learning occurs when there
is activity involved. Learning by doing is
one of the lines of the FFA motto. We
need to provide the opportunity for posi-
tive reinforcement. People involved in
production agriculture are students, regard-
less of their age. They need to have the
same opportunities for positive reinfor-
cement as our high-school or elementary
students.

We at this conference are not going to be
made effective simply by what we have
heard. We need to take it with us. We
need to involve the people back at home.

436

Teaching values and behavior to our kids
at a very young age is important. This is
where we develop the habits like to use
the seat belts.

When our first-born, Jonathan, came home
from the hospital in 1978, he was in an
infant seat utilizing the seat belt. Irene
and I decided that this was going to be a
priority. Now Joel, who is our S-year-old,
gets in the car and we drive just a short
distance; he wants to be buckled. These
are the kinds of habits we need to work
with in production agriculture as well.

We have heard throughout this conference
that children are a very at-risk population.
We need to address that risk.

I will be here during the remainder of this
conference. If there is not the opportunity
during one of these sessions to ask ques-
tions, I would be more than glad to visit
with you on an informal basis.

In closing, I would like to point out that
when addressing the opportunity for im-
provement and the reduction of farm acci-
dents, it is important that we know the
people with whom we are dealing. I have
a very serious concern about the low num-
bers of people involved in production agri-
culture attending this conference. I can
understand the reason for it when we con-
sider the date of this conference.

On the positive side, however, we are
having an excellent opportunity to gain the
perspective of the Surgeon General as it
relates to agricultural safety. Now it is up
to us to take this information and to see
that it gets to the place where it can be
effective. Thank you very much.0

Papers and Proceedings


Suqpon Qmwal'8 Conhmnce on Agricultural Satbiy end Heat&
F&W&FE 2000 o A Nat/one/ Coal/t/on hr Local Act/on
Conmad by iho Nattonal lnrtlfm ibr Ckcupedond Sahv end Health
Aprlr 30 - May 3, 1991, 088 Molner, Iowa

FARM FAMILY BEHAVIOR PERSPECTIVE

    By Robert Aherin, Ph.D.
      Unhrerslty of llltnols
Professor, Department of Agricultural Engineering

My presentation will focus on farm family
behavior and the issues surrounding effec-
tive safety and health behavioral change
among adults and children. I will com-
ment on some of the issues that I heard
today and yesterday during this conference
that relate to behavioral change. I will
also review some additional issues for con-
sideration in looking at behavioral change
concepts in dealing with the very complex
safety and health issues that face produc-
tion agriculture in this country.

ten awareness and knowledge of farm
safety among farm populations. Some of
the methodologies discussed included
group presentations; using the media effec-
tively; exhibits; demonstration activities;
and learning through interaction. Further-
more, the importance of networking among
organizations for the purpose of sharing
expertise and resources to address farm
safety and health issues was addressed.

THE 4-H PROGRAM

My research activities have focused on    Before I continue with my primary topic, I
analyzing and predicting various safe work  was asked to describe the 4-H program in
behaviors among farm populations through  this country for the benefit of those who
the application of social behavioral psycho-  may not be familiar with 4-H. As a mem-
logical models. I have conducted studies   ber of the Cooperative Extension Service
involving dairy farmers, pesticide applica-   staff at a land grant university, I work
tors, and child safety behaviors on farms.   closely with 4-H.

There has been a lot of discussion at this
conference concerning the uniqueness of
agriculture as it relates to occupational
injury and illness problems. This has in-
cluded the variety of occupational hazards
that farm workers have to deal with; the
variations of economic status among farm-
ers and farm workers; the diversity of work
activities on farms; the periods of high
physical and emotional stress; the extreme
environmental conditions that farmers
often work under; and their limited access
to emergency care.

The 4-H program is another major mecha-
nism of reaching youth, particularly with
agricultural safety and health information
that some of you may not have traditional-
ly been involved with.

It is part of the Cooperative Extension
System and the United States Department
of Agriculture. 4-H combines the coopera-
tive efforts of youth; volunteer leaders;
state land-grant universities; Federal, state,
and local governments; and the U.S. De-
partment of Agriculture.

Yesterday we had the opportunity to hear,
in this session, a number of very good
presentations on ways and means to heigh-

The mission of the Cooperative Extension
System in conducting 4-H programs is to
assist youth in acquiring knowledge, devel-

Surgeon General's Conference on Agricultural Safety and Health - 1991

437


Intervention - Safe Behaviors Among Adults and Children

oping life skills, and forming attitudes that
will enable them to become self-directing,
productive, and contributing members of
society. 4-H's goal is to create a learning
environment for youth that is stimulating
to the development of life skills in three
areas:

b First, competency and knowledge.

b Second, coping and dealing with stress

in their daily living.

b Finally, being contributing individuals of

society by learning the importance of
helping others.

4-H programs are also internationally in-
volved. In addition to the United States, it
is carried out in 82 other countries in the
world. Our country was and is a model for
4-H programs throughout the world.

In the United States, there are currently
about five million youths involved in 4-H
programs. Only 13.7 percent, or about
700,000 of the five million youths involved
in 4-H, live on farms. Approximately 38
percent of 4-H members live in towns
under 10,000. About 20 percent of 4-H
members live in cities larger than 50,000.

Girls make up about 53 percent of the
members. Sixty-six percent of 4-H mem-
bers are between 9 and 11 years of age; 23
percent are between 12 to 14; and 10 per-
cent of the members are between 15 to 19
years.

The 4-H program is operated primarily
through volunteer leaders. There are staff
located at the county or local level, and
state staff that help facilitate programs
throughout each state.

438

A national staff coordinates programs at
the national level. But, primarily, 4-H
nationwide is made up of over 519,000 4-H
adult leaders and 125,000 junior and team
leaders.

4-H volunteers on the average donate
about 220 hours per year preparing club
meetings and teaching youth. Thus, for
each hour a salaried staff person spends in
4-H, a volunteer spends about 12 hours of
time with 4-H members.

Safety is taught through specific projects
on safety topics and as part of other pro-
jects. Members also have an opportunity
to be involved in community safety activi-
ties. Thus, 4-H is a major organization
that has deep roots in rural areas that can
serve as a significant communication link
on farm safety issues.

USE OF EDUCATIONAL MEANS

Now, to go back to my primary topic. I
think it would be good to look at some of
the issues or statements that have been
made by several of the speakers in the last
couple of days that relate to using various
educational means to change safety behav-
iors. I would like to discuss the need to
evaluate the effectiveness of educational
efforts to influence safe work procedures
and relatively new methodologies by which
this can be accomplished.

For example, on Tuesday, Dr. McGinnis,
when speaking on the topic of disseminat-
ing safety and health information through
educational means, stated that "education
alone is not enough." The physical envi-
ronment must be changed.

Further, he stated that there needs to be a
balance between health promotion and
health protection. We need to know the

Papers and Proceedings


facts. We need to build coalitions to do
this job. "Knowledge and attitude change
may not be sufficient" was another state-
ment that he made.

Dr. Sullivan, Secretary of Health and Hu-
man Services, stated that more extensive
educational programs can be effective in
reducing occupational injuries and illnesses
in agriculture. I would say, yes; but there
are some qualifications, and I will discuss
those here in a minute.

Dr. William Roper, the Director of CDC,
made some statements that we must be
able to measure progress with our inter-
vention programs. We must deliver suc-
cessful programs.

Finally, Dr. Myron Johnsrud, Director of
USDA Cooperative Extension Service,
asked a couple of very good questions. He
asked, "Why are educational warnings
going unheeded?" Additionally, he asked,
"What intervention programs are needed
to be effective?"

I have worked as an agricultural safety
professional for over 17 years involving
positions at the University of Minnesota
and now at the University of Illinois. A
very significant portion of my program
involved developing and implementing
safety education programs for farm work-
ers and farm family members.

Normally the success of these programs
was measured by how many people were
contacted and how many programs were
offered. It was assumed that those
exposed to farm safety information through
Some type of educational program would
become aware of the risk, would learn how
to minimize or avoid the risk, and then
would take action.

Farm Family Behavior Perspective, May 1, 1991

As I grew in my professional career, some
of my concerns were, How do we know if
our safety educational efforts are effective?
Are we really changing the person's behav-
ior with educational programs? How can
we do a better job of that? These con-
cerns inspired me to explore these issues.

Mr. Graham stated that there were four
steps needed to be effective in our pro-
gramming efforts. These include identify
needs, develop objectives, take action, and
evaluate the results. I basically agree with
these four points. The problem is that we
have not been very' good at achieving
them.

Identifying Needs and Evaluating
Results

Let us focus on identifying needs and eval-
uating results. Some of the measures typi-
cally used to accomplish these would in-
clude looking at injury and illness data to
learn where some of the problems are in
order to direct some of our efforts.

Once educational intervention programs
are implemented, we evaluate to see if
there has been any change in the injury or
illness data over time. There are some
significant limitations in using injury data
to evaluate safety intervention programs in
agriculture.

Such data can provide us with a lot of
information on what some of the
contributing factors are to agricultural
injuries and illnesses. But utilizing injury
and illness data for evaluation purposes is
basically a long-term measure.

Normally, it takes five to ten years for
most farm safety issues to see if there has
been any significant impact. This is be-
cause there are so many factors such as

Surgeon General's Conference on Agricultural Safety and Health - 1991               439


Intervention - Safe Behaviors Among Adults and Children

sociological, environmental, and economic
that can influence injury and illness rates.

For a variety of reasons, educational pro-
grams have been the primary intervention
means to reduce injury risk in production
agriculture. This is due to the limitations
that have faced other general intervention
efforts.

Furthermore, injury data is a very poor
measure in small geographical locations.
This is because during the short term there
are very few cases to evaluate. The injury
rate in a given area may drop by 10 or 15
percent from one year to the next just
because of natural fluctuations.

There are significantly fewer laws and
regulations that are directed at the safe
work activities of farm workers compared
to workers of most other industries. Fed-
eral and state regulations have been limit-
ed for a variety of reasons. Some of these
include

o  The lack of a concentrated work
force-farms are generally small opera-
tions in most areas of the country that
employ few people at one location.
This makes it difficult and costly to
effectively enforce safety regulations.

o Unorganized work force-most workers
in agriculture are not organized. Labor
unions in other industries have been a
major factor in the promotion of safe
work places through work contracts and
through support for state and federal
regulations for their members.

o Independent nature of farm opera-
tors-most farmers do not like to be told
what to do. They tend to want only
minimal outside intervention into their
livelihood. Thus, most farm organiza-

440

tions have not favored laws and regula-
tions directed at farming operations.

Probably the most effective means of inju-
ry control is the providing of automatic
protection of workers from agents of inju-
ry. This is basically accomplished through
the design of equipment and processes to
eliminate or reduce the potential for injury
by users. While the manufacturers of farm
equipment, structures, and processes have
made major advancements in safety design
these improvements are rarely passed on
to existing equipment or processes.

Most industries have guidelines and re-
quirements for retrofitting older equipment
to bring it in line with current safety tech-
nology. This is generally not practiced in
agriculture at this time. Farmers often see
little economic incentive to retrofit older
equipment.

Thus, these are some of the basic reasons
why the agricultural industry has tradition-
ally relied so heavily on safety educational
measures to reduce injury exposure. While
in the future it is envisioned that a greater
utilization of other injury control measures
might be used in agriculture, education will
continue to play a major role. It is imper-
ative for this reason that more effective
means to utilize educational intervention
efforts to influence safe behaviors of farm
workers be sought.

Many of the safety and health intervention
programs of the past have been developed
on the basis of what we "think" will work
rather that what we "know" will have the
greatest impact. I believe that there are
new theories and models for evaluating
social behaviors that can be helpful in
delineating the intervention need in agri-
cultural safety and health.

Papers and Proceedings


These models potentially could define
safety and health issues to the point of
providing direction for the development
and use of educational measures. Addi-
tionally, these analyses could identify the
limitations educational measures may have
in effecting positive safety change for some
issues.

Much of safety educational efforts of the
past focused on changing attitudes with the
belief that attitude change would result in
behavioral change. As Dr. Elkind pointed
out in her presentation at this conference,
studies conducted in the late 60's and 70's
found little or no correlation with this
hypothesis.

It has been learned in recent times that
attitude measures do not correspond with
behavioral criterions. The early attitudinal
studies would evaluate a very general be-
havioral statement. An example of this
would be when evaluating the potential
purchase of a roll-over protective structure
(ROPS) on a tractor a subject might be
asked to evaluate a statement such as,
"Roll-over protective structures are ."

Behavioral psychologists have learned that
many of the low correlations of attitude
measures with the actual behavior are
because the statement is directed toward
the object of the behavior rather than the
behavior itself. Thus, if researchers are
interested in predicting behaviors through
an attitudinal measure, the attitudinal
measure must be directed toward that
specific behavior, not the object of that
behavior.

A more appropriate evaluative statement
for predicting ROPS purchasing behavior
would be to ask farmers their attitude
toward buying roll-over protective
structures. The attitude question would

Farm Family Behavior Perspective, May 1, 1991

look as follows: "My buying a roll-over
protective structure in the next two years
for one of my non-ROPS equipped tractors
is . n

The attitudinal question must match the
corresponding behavioral criterion in terms
of 1) action, 2) target, 3) context, and
4) time. In the previous example the ac-
tion was "my buying," the target was
"ROPS for one of my (the subject) non-
ROPS equipped tractors," the context was
"general," and time was "within the next
two years."

In summary, there may be a substantial
difference between people's attitudes to-
ward objects (in this example, ROPS) and
people's attitudes toward behaviors associ-
ated with objects (in this example, buying
ROPS). To predict behavior, this distinc-
tion is crucial.

One of the prominent social psychological
models for behavior prediction and analy-
sis is the Theory of Reasoned Action that
was developed by Fishbein and Ajzen.lz
This theoretical model took the question
of behavioral prediction many steps further
than models previous to it by adding vari-
ous concepts to the analysis of social be-
haviors. Figure 1 illustrates the various
components of the model.

The ultimate goal of this theory is to un-
derstand human behavior, not just predict
it. This theory has proven that intention is
strongly correlated to one's behavior and
behavioral intentions are formed by two
basic determinants, one personal in nature
and the other reflecting social influence.

The theory of reasoned action predicts a
behavior (box number 1 in Figure 1) by
asking individuals whether they intend to

Surgeon General's Conference on Agricultural Safety and Health - 1991                441


Intervention - Safe Behaviors Among Adults and Children

perform a specific behavior (box number
2). This "intention," in turn, is determined
by two components: attitude and subjec-
tive norm (boxes 3 and 4 respectively).

The attitude component, as expected,
analyzes a person's attitude toward the
behavior, while the subjective norm com-
ponent analyzes the amount of pressure a
person feels from significant others to per-
form the behavior. Both of these compo-
nents are predicted by qualitatively dif-
ferent beliefs (boxes 5 and 6 respectively).

Within populations for specific behaviors,
some will be more affected by their atti-
tudes while others will be more affected by
social influences. Furthermore, others will
be equally influenced by both attitudes and
social influences. Through the statistical
analysis of the model one can learn what
portions of the population are affected by
the various determinants of the behavior
being evaluated.

By comparing the beliefs of intenders to
non-intenders, the researcher can see what  I have tested this model in a study con-
beliefs need to be changed in order to    ducted among a population of Wisconsin

change the behavior of the unsafe farmers.  dairy farmers and Illinois pesticide applica-
                   tors. The nredictive ability of the model

An advantage of this model is that it pro-
vides very specific recommendations on

showed poktive results in both of these
studies. However, this theory needs to be
further tested on farm populations.

how to change specific behaviors, based on
the farmers involved with those behaviors.

I ntent ion

to perform --LC Behavior

behavior

1

                                 2
    6              4
Normat i ve    1   Subjective '
bel iefs and           norm
mot ivat ion --)- cancer n i ng
to corrply        behav i or

Figure 1: The Theory of Reasoned Action.

442

Papers and Proceedings


I believe the Theory of Reasoned Action
and other behavioral models that have
been developed from it can be significant
tools in identifying the attitudinal and
social beliefs that, need to be modified in
order to change behavior. This level of
analysis can provide strong insights into
whether the behavior being evaluated can
be significantly affected by educational
interventions or if other types of interven-
tions will be necessary, such as economic
incentives or design changes in equipment
or processes.

An example of an issue that might benefit
from Theory of Reasoned Action type of
analysis would be the installing of ROPS
on tractors. Tractor roll-overs are a major
factor in farm work- related deaths.

It is well known that if a tractor has a
ROPS it almost eliminates the death po-
tential in a tractor roll-over incident. But
only about 30 percent of the farm tractors
in the United States have a ROPS. Thus,
at issue is what it would take to persuade
farm tractor owners to install a ROPS on
non-ROPS tractors.

There have been significant educational
programs to promote the purchase of
ROPS among farm tractor owners. But
there has been no significant increase in
the retrofitting of ROPS on non-ROPS
equipped tractors.

If an analysis was conducted among US
farm tractor operators utilizing the Theory
of Reasoned Action, one could learn what
intervention initiatives would be necessary
to effect a significant change in this behav-
ior.

For example, it could be learned how
much if anything farmers would be willing
to spend for a ROPS, their general percep-

Farm Family Behavior Perspective, May 1, 1991

tion of the need for ROPS on their trac-
tors, tractor use problems that they may
encounter with ROPS, and so on. This
type of information would provide focus
for initiatives to deal with this issue rather
than using the traditional "shotgun" ap-
proach of trying anything and seeing if it
works.

Additionally, an analysis of this nature can
be conducted once intervention has oc-
curred to determine if any behavioral
change has developed. Thus, it has poten-
tial to serve as an excellent evaluation
measure.

In conclusion, given the current restraints
that safety and health professionals in
agriculture must work under it is impera-
tive that we identify and utilize interven-
tion measures that are capable of self-
motivating farmers and farm workers to
adopt safe work practices. We must strive
to improve our ability to accomplish this.

There has been practically no systematic
evaluation of the effectiveness of agricul-
tural safety and health education, legisla-
tion, or engineering intervention efforts to
prevent or control agricultural injuries in
this country. It is essential that agricultur-
al safety and health professionals from all
disciplines undertake scientific evaluations
of their efforts to effectively reduce the
risk of agricultural injuries and illnesses for
the farm populations that they serve.

As previously stated, several practical and
cultural considerations suggest education-
oriented intervention approaches will con-
tinue to be an important option for the
prevention and control of agricultural
injuries and illnesses. But I am very con-
cerned by the thousands of dollars and
hours that are spent on agricultural safety
educational programs without seriously

Surgeon General's Conference on Agricultural Safety and Health - 1991               443


lntetventlon - Safe Behavlors Among Adults and Children

evaluating the potential effect that such
efforts will have on the issues being ad-
dressed.

The recently developed theories of social
psychological behavioral analysis and pre-
diction show promise for providing re-
searchers and educators with a more com-
prehensive understanding of safety and
~tJtlt;related behaviors among farm popu-
      .

Agricultural safety and health professionals
need to become more familiar with recent

concepts of applied behavioral analysis. A
limited number of research programs
should be supported that apply social psy-
chological behavioral analysis to selected
agricultural safety and health issues of
national importance. One of the primary
purposes of these studies would be to
further validate the utilization of these
types of analysis for addressing agricultural
safety issues.

Agricultural safety and health issues are
some of the most complex of any industry.
We must continue to strive to identify
means that are effective in addressing
these issues so as to preserve the valuable
human resources who are involved in pro-
duction agricu1ture.U

REFERENCES

1. Ajzen, I, Fishbein, M. (1990). Understanding Attitudes and Predicting Social Behavior. Englewood Cliffs,
New Jersey: Prentice-Hall.

2. Fishbein, M., Ajzen, I. (1975). Belief; Attihtdes, Intention, and Behavior. Massachusetts: Addison-
Wesley.

444

Papers and Proceedings


Sumeon Qmwal's Conhwnce on AgricuHurel SaMy and Health
FARMSAE 2000 o A Nathmal Coalnlon kr Local Action
Conwmd by the National lnsdtuh for Occupational SaMy and Heatih
April 30 - May 3, 1991, De8 Moines, Iowa

SURVEILLANCE - AGRICULTURE-RELATED
DISEASES, INJURIES, AND HAZARDS

    By Henry A. Andmon, M.D.
Chlef, Section of Environmental Epidemiology
Wlsconsln Department of Health and Social Services

Dr. Richard A. Lemen: Our first speaker will sum up the sesslon on Surveillance
Related Diseases, Injuries, and Hazards.                  -Agriculture-
                   Our speaker, Dr. Henry Anderson, is the Chief of the

Section of Environmental Epidemiology with the Division of Health In Madison, Wisconsin.
Dr. Anderson has a medical degree from the Unlverslty of Wisconsin and received his bachelor's
degree from Stanford University. Dr. Anderson:

Over the past several days, we have experi-
enced some stimulating discussions and
presentations. What stands out are the
vivid images that have been evoked.

We are all now familiar with the theme of
the movie Field of Dreams; we have heard
all about "belltollers." We can clearly say
that this conference, among all conferenc-
es, has definitely overcome the "vision
thing."

THE TIME HAS COME FOR ACTION

Our session was to address surveillance of
agriculture-related diseases, injuries, and
hazards. I think we confirmed that the
time has come for action; that there is a
crisis of disease, injury, death, and disabili-
ty on farms and in farm families.

We need to move away from the broad
view to some specific, high-priority activi-
ties.

Our challenge is, "Why can't we prevent
these events from happening in the first
place? Why haven't we, and why can't
we?" What is critical to accomplishing the

goals is that a coalition is forming, and it is
forming around the common interest of
concern and support for the prevention of
agricultural injury and disease.

SURVEILLANCE IS ESSENTIAL TO
PREVENTION

As you might expect from our group, we
feel surveillance is essential to prevention.
We discussed that the role of surveillance
and prevention has four main goals.

b The first is the ability to recognize and
identify problems. We have certainly done
that through existing programs. We have
heard this week about the many problems
that do exist.

. The second activity of surveillance and
prevention is defining the scope of the
problem. In many instances, we are in the
process of trying to do that, but we also
need the second step to continue that.

b The third is to target interventions.
Right now we are in the process, for many
diseases and injuries, of trying to target
where we can get the most bang for our
buck.

Surgeon General's Conference on Agricultural Safety and Health - 1991

445


Elements of a National Agenda

b The fourth role is in evaluating the effi-
cacy of interventions.

For many conditions we are at different
surveillance stages in this scheme. For one
condition that we have heard much about,
that of farm fatalities due to tractor roll-
over, we have identified the problem, we
largely know the scope of the problem, and
we know what needs to be done to target
interventions.

We also have heard this week that we have
not been very successful. Surveillance in-
formation is continually telling us that our
programs are not as effective as we would
like and that we need to bring our coali-
tion together to control these problems.

We discussed a number of issues: hearing
loss, skin cancer, acute pesticide poisoning,
and respiratory illness. All of these are
problems that need to be addressed, and
surveillance can assist us.

TASKS CAN BE ACCOMPLISHED BY A
COALITION

We also discussed defining the coalition.
We all have a fuzzy, warm feeling about a
coalition, but we really need to begin to
define what it is and who it is. We need
to involve government at all levels-that is,
the Federal government, state govern-
ments, local governments, and county
governments.

There is a critical need to have industry
involved. They are key actors and players
to help us intervene.

Communities also need to be involved.
Both the academic community and the
community of the voluntary organizations
that represent individuals need to be in-
volved.

We also heard of a need for grass roots
effort. We need to have individuals in-
volved. The individual farm family must
be committed to this activity and partici-
pate.

The coalition needs to identify a set of
conditions and hazards for surveillance.
We need to move away from the broad
view to some specific, high-priority activi-
ties.

THE NEED FOR PRIORITIES

Our session participants determined that
an initial task of the coalition must be to
establish surveillance priorities and to
provide support to build the infrastructure
necessary to carry out the surveillance
programs.

b Therefore, first we are proposing that
within 60 days the Surgeon General make
every effort to identify resources for a
workshop of coalition members and that
agricultural disease and injury experts
come together to identify conditions for
surveillance.

p Second, after that group has come to-
gether to identify candidate conditions,
that within 180 days the Surgeon General
make every effort to identify resources for
a workshop, which will take up the candi-
date conditions involving all levels of the
coalition. We have, over the past several
days, identified and spoken of a number of
candidate conditions in our group, includ-
ing farm fatalities and the more serious
injuries.

Of course, we talked about roll-overs, but
also we have to be concerned about ampu-
tations and loss of eyes. Skin cancer, re-
petitive trauma, hearing loss, and especial-

446                                    Papers and Proceedings


Surveillance - Agriculture-Related Diseases, Injuries, and Hazards, May 3, 1991

ly respiratory conditions, also, must be
considered as candidates.

CANDIDATE SURVEILLANCE
PROGRAMS

We also discussed various types of surveil-
lance programs. Once these candidate
conditions are identified, we must begin to
move forward for the establishment of
surveillance. A situation such as the need
for continued coding of death certificates
for industry and occupation, as well as that
portion of the death certificate that indi-
cates whether the fatality is work-related
or not, is one candidate surveillance system
that could be easily implemented.

We also need to begin additional surveil-
lance at the local level by health and safety
practitioners. Another example would be
in-depth case investigations of individual
fatalities or individual diseases by health
and safety experts.

Lastly, and parallel with this activity, we
recommend that the Surgeon General and
the coalition, together, need to move for-
ward to identify resources for the further
development and support of the infrastruc-
ture that is necessary to carry out this
mandate.

In conclusion, our group did feel that we
have a vision, but we do not feel that it is
visionary but rather that it is practical.
Prevention can be accomplished, if we are
all committed to achieving the goals. We
feel that this conference is the first step in
getting a coalition formed and allowing us
to begin to make that commitment to
move beyond all of the activity that is
currently ongoing and to make additional
strides for the prevention of disease and
injury.0

Surgeon General's Conference on Agricultural Safety and Health - 1991

447


Steve Olenchock, the rapporteur in our
group, and I worked for several hours last
night to summarize the kinds of messages
that came through over the past two days
in our group. We felt we could best sum-
marize those ideas in about three different
topics.

. Number one, there was a special spirit
that transcended throughout the session
that can best be described by a combina-
tion of urgency, enthusiasm, and commit-
ment.

b What I want to talk about second is spe-
cific facts that were mentioned in regard to
particular agents of disease and the gaps in
the knowledge that were identified.

b The third topic I want to discuss is the
need for a coalition to address the issues.

This was a group that was quite large. We
usually had over a hundred people in the
rqom, very interactive, and I think it was a
very exciting group to be with.

GROUP SPIRIT

Regarding the spirit of this group, I would
like to try to demonstrate this through a
model diagram of a nerve synapse. The
spirit that we felt contained enthusiasm,
commitment, and goal direction.

448

Surgeon General's Conkmnce on A@cultural Safety and Health
FARMSAFE 2000 o A National Coalition for Local Action
Convened by the National Institute kv Occupational Safety and Health
April 30 - May 3, 1991, Des Moines, towa

RESEARCH - CHEMICAL AND BIOLOGICAL HAZARDS

        By Kelley J. Donharn, D.EM.
Professor, Department of Preventive Medicine and Environmental Health
           University of Iowa

Dr. Richard A. Lemen: Our next speaker this morning will be talking about the findings and the
recommendations of the sessions on Research - Chemical and Biological Hazards. To do that
is Dr. Kelley J. Donham, who is a veterinarian who received his degree from Iowa State University
and his undergraduate and master's degree training from the University of Iowa. Dr. Donham:

The spirit really was something that was
sparked or initiated back in 1988 when
there was a conference here in Iowa, enti-
tled "Agricultural Occupational and Envi-
ronmental Health: Policy Strategies for
the Future." This conference resulted in A
Report to the Nation, which indicated that
there was an urgency, a feeling of urgency,
about this whole issue.

I believe since 1988 that urgency has tran-
scended into even a greater and broader
enthusiasm and commitment demonstrated
here at this conference. Clearly, the neu-
rotransmitter substance here was Dr.
Novello's enthusiastic communication to us
of her commitment to this public health
problem of agricultural safety and health.

However, in the background there is the
question about the reality of this commit-
ment in the years to come. The momen-
tum, will it continue? The fact is that the
changes, the actual reduction in injuries
                                    _ -

and illnesses that we hope to see, will take
time and will take long-term commitment.

One of the items that came out of the
group was a call for a sustainable human
resource in agriculture. This was based on
an analogy to the sustainable agriculture
movement from a natural resources con-
servation perspective.

Papers and Proceedings


Perhaps one of the aspects that has not
been thought of or put into the equation of  and a complex such as a combination of
sustainable agriculture is that we must    chronic bronchitis combined with hyper-re-

have a sustainable human resource. We   active airways disease. To sort those out,

need a sustainable human resource that is  the clinician at the community level needs
as free as possible of illnesses and injuries  help in regards to training and newer and
from an economic standpoint as well as a  more specific diagnostic tools.
humanistic standpoint.          Treatment: It is not entirely certain from

FACTS                the physician's standpoint as to what is the
                 best treatment for these agricultural respi-

Dust-Related Diseases

ratory ailments. We know that protection,
perhaps, is the best answer; but when a

Moving now from the spirit of this group
to facts, Suzanna Von Essen reviewed

clinician is faced with these problems in
his or her office, what is the best treat-
ment?

some of the major respiratory diseases
resulting from exposure to agricultural
dust: bronchitis (both acute and chronic);
occupational asthma; organic dust toxic     Fifty percent of the pesticides that are in
syndrome; mucous membrane irritation;    use show some potential for car-
hypersensitivity pneumonitis; and classical    cinogenicity.
allergies (rhinitis and asthma). These are     I
placed subjectively in order of importance,
as I interpreted from the discussion and    Children: There are auestions about chil-
from the presentation. I also noted some  dren who are exposedAt these environ-
gaps in knowledge brought out in the dis-   ments at an early age. What are the issues
cussions.                and problems involved? Are they more
                        prone to allergies ? Are they susceptible to
There were questions about the sequelae   inflammatory agents and long-term sequel-
of repeated acute exposures or acute epi-   ae? It is not known.
sodes of organic dust toxic syndrome, acute
bronchitis, or hypersensitivity pneumonitis.  Pesticides and Fumigants
What are the long-term and outcome se-
quelae? They are unknown. This is where  Aaron Blair had the topic of pesticides and
additional research is needed.       fumigants, and he outlined his presenta-
                   tions emphasizing chronic outcomes in four

There was considerable discussion in re-   areas: cancer, immunologic, neurotoxic,
gards to agents of agricultural respiratory   and reproductive. He concentrated pri-
disease. The exact agents are unknown, as  marily on the potential relationships of
are the specific mediators that result in the  pesticides to cancer, because that is where
biological conditions that are seen.       most of the research has been done.

The difficulty of differential diagnosis was  Fifty percent of the pesticides that are in
mentioned several times. It is not easy to  use show some potential for car-
differentiate between organic dust toxic   cinogenicity, based on a variety of different
syndrome and hypersensitivity pneumonitis  kinds of bioassays, and they seem to span

Surgeon General's Conference on Agricultural Safety and Health - 1991               449

Research - Chemical and Biological Hazards, May 3, 1991


Elements of a National Agenda

the classes of pesticides that are used,
including insecticides and herbicides. Even
though farmers have lower overall risks for
cancers, there are certain cancers that they
have increased risk for, including
reticuloendothelial cancers, multiple my-
eloma, lip, prostate, and soft tissue sarco-
ma among others. Perhaps, in terms of the
evidence relating pesticides to cancers,
non-Hodgkin's lymphoma seems to have
the strongest relationship.

Immunologic Concerns: Perhaps one of
the most interesting facts that was brought
up was that non-farm populations of imm-
unosuppressed individuals seem to have
similar patterns of cancer as farmers.
There are a host of neurotoxic problems
that are at least, I guess, beginning to be
associated with pesticide exposure, but
they are not really well-known at this
point. Then, certainly, there are certain
pesticides that have some effects on both
male and female reproductive outcomes.

Perhaps one of the major gaps that was
noted was the need for a well-controlled,
long-term prospective study; perhaps this is
one of the major ways to try to find out
some of these associations.

Infectious Diseases

Dr. Russell Currier had the assignment of
discussing infectious diseases. He dis-
cussed these in four different categories:
interpersonal, food-borne, vector-borne,
and other zoonoses.

In terms of interpersonal infections, he
noted that there are certain diseases that
have been rare in the past, but are very
prevalent in certain farm populations.
Tuberculosis, for example, is 300 times
more prevalent in the migrant farm popu-
lation than in the white population.

450

Polio and rubella have been noted in the
Amish population. Enteric diseases, gener-
ally speaking, are more prevalent in the
migrant and economically deprived groups.
There is a problem with a combination of
socioeconomic status and cultural situa-
tions that clearly influences the disease
pattern within this population.

There are occasional outbreaks of a whole
host of food-borne diseases within farm
family populations, because of their partic-
ular food preparation methods and use of
food from the farm. Examples include
Campylobacter, Listeria,, Salmonella, and
trichina.

Perhaps one of the most interesting facts
that was brought up was that non-farm
populations of immunosuppressed individ-
uals seem to have similar patterns of
cancer as farmers.

Vector-borne diseases still crop up as occa-
sional problems, ea plague, Rocky Moun-
tain spotted fever, equine encephalitis,
California encephalitis, and even malaria
in certain areas.

Zoonoses, in particular tetanus, were not-
ed. We still do have tetanus, and the fact
is that the immunization status of our
population is not as complete as we would
hope it to be.

Bovine tuberculosis has shown up again
from other species besides cattle. Llamas
and buffalo are species that can harbor the
infection and reintroduce it to the cattle
population, which may in turn expose the
farm population. Then, finally, rabies is
still a problem and will be a problem for
many years to come.

Papers and Proceedings