prevention of agricultural injuries: an evaluation of an education-based intervention

Prevention of Agricultural Injuries: Prevention of Agricultural Injuries: An Evaluation of an Education-An Evaluation of an Education-

based Interventionbased Intervention

LM Hagel, W Pickett, P Pahwa, L Day,

RJ Brison, B Marlenga, T Crowe,

P Snodgrass, K Ulmer, JA Dosman

ObjectiveObjective

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

InterventionAgricultural Health and Safety Network

Features of the program• community-based• co-directed by members of the population

at risk• well funded• sustained program over 19 years

FARM SAFETY ISSUE

No. of Times Issue Addressed

1988 to 2006(all network

years)

1999 to 2006(most recent

8 years)

N N

Tractor safety 22 16

Farm machinery safety 36 19

Non-machinery hazards 14 7

Burden of farm injury 16 11

Personal and farm protection 16 6

Special populations at risk 8 6

Total Interventions 112 65

MethodsMethods

Design: Cross-sectional surveyDesign: Cross-sectional survey

SettingSetting

Southern Saskatchewan Rural Municipalities

Saskatchewan, Canada

Sampling

Multi stage

• Rural Municipal (RM) level

• Farm level

• Individual level

Data Collection

Instrument

• standardized mail questionnaire

• key informant on each farm

• January to April, 2007

Data Collection

Impact and Outcome Measures

• safety practices, farm hazards – farm level

• injury history– individual level

Data Collection

Exposure Measure

• years of membership

• 3 levels of exposure– None– 1 to 7 years of membership– 8 or more years

Statistical Analyses

Descriptive – demographic and operational

characteristics

Analytic– regression analyses

• adjusted RR (95% CI) • account for clustering, binomial regression

Results

Participants

50 Rural Municipalities

2,392 Farms

AHSN > 8 yrsn = 664 farms

AHSN < 8 yrsn = 1034 farms

AHSN 0 yrsn = 688 farms

Years in AHSN Significance

Factor High Low None

(%) (%) (%)

Grain production 86 90 87 *

Brown soil zone 12 31 21 *

University educated 14 15 22 *

Vulnerable populations: children young workers >65 year olds

543937

473834

524137

*NSNS

Demographic Comparisons

Years in AHSN Adjusted RR

High Low None None vs. High

(%) (%) (%) RR (95% CI)

ROPS absent 16 12 16 0.95 (0.69 - 1.30)

Shields absent on combines 13 9 8 0.64 (0.41 - 1.01)

Shields absent on augers 20 16 15 0.83 (0.59 - 1.17)

Ladder cages absent 79 79 80 1.05 (0.98 - 1.13)

No water hazard barriers 50 43 47 1.13 (0.96 - 1.33)

Physical Safety Hazards

Years in AHSN Adjusted RR

Children younger than7 years of age

High Low None None vs. High

(%) (%) (%) RR (95% CI)

Present in worksite 38 37 43 1.01 (0.84 - 1.21)

Ride in cabbed tractor 13 13 12 0.86 (0.53 - 1.41)

Assigned small farm jobs 14 13 13 0.96 (0.61 – 1.50)

Present during farm work 28 29 30 0.99 (0.76 - 1.28)

Hazardous Practices Children

Years in AHSN Adjusted RR

Young workers13 to 18 years old

High Low None None vs. High

(%) (%) (%) RR (95% CI)

Operate tractor > 20hp 32 30 30 0.95 (0.68 - 1.32)

Operate tractor w/out ROPS 12 12 11 1.15 (0.53 – 2.49)

Operate equip > 20 yrs 16 20 20 1.14 (0.65 – 2.01)

Work at heights 8 7 8 0.70 (0.70 - 1.81)

Work with large animals 18 19 18 0.82 (0.48 – 1.43)

Hazardous PractisesYoung Workers

Years in AHSN Adjusted RR

Young workers13 to 18 years old

High Low None None vs. High

(%) (%) (%) RR (95% CI)

Wear protective equipment 33 34 29 0.91 (0.65 - 1.27)

Trained before equip use 60 64 67 1.09 (0.89 - 1.39)

Trained with large animals 50 47 56 1.07 (0.82 - 1.41)

Supervised operating equip 40 46 43 1.10 (0.81 - 1.51)

Supervised w large animals 42 47 48 1.04 (0.77 - 1.40)

Training and Supervision Young Workers

Years in AHSN Adjusted RR

High Low None None vs. High

(%) (%) (%) RR (95% CI)

Farm injuries 2006 9 9 7 0.99 (0.74 - 1.32)

By location of treatment

Hospital or emergency 3 3 2 1.00 (0.99 - 1. 01)

Non-hospital setting 6 6 5 1.00 (0.98 - 1.01)

Injuries

Limitations

• Non-compliance with intervention

• Not possible to evaluate safety consciousness among non-participants

• unable to control for effect of exposure to other interventions

Strengths

• large and longstanding intervention

• large study population:– 5 492 people, 2 386 farms

• robust evaluation:– “hard” outcome measures

Conclusion 1

• After 19 years, the educational interventions were not associated with observable differences in farm safety practices, physical farm hazards or farm-related injury outcomes

Conclusion 2There is a need for the agricultural sector to extend its injury prevention initiatives to the full public health model. Education alone is insufficient.

Education

Engineering Enforcement

Publication:Hagel LM, Pickett W, Pahwa P, Day L, Brison RJ, Marlenga BL, Crowe T,

Snodgrass P, Ulmer K and Dosman JA. Prevention of agricultural injuries: An evaluation of an educational intervention. Injury Prevention 2008; 14(5)