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PAPERS AND PROCEEDINGS
of the
SURGEON GENERAL’S CONFERENCE ON

AGRICULTURAL SAFETY AND HEALTH

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Edited by:

Melvin L. Myers, M.P.A.
Robert F. Herrick, Sc.D.
Stephen A. Olenchock, Ph.D.
John R. Myers, M.S.F.
John E. Parker, M.D.
David L. Hard, Ph.D.
Katherine Wilson, M.P.H.

 

Public Law 101-517

April 30 - May 3, 1991
Des Moines, lowa

Convened by

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
Centers for Disease Control
National Institute for Occupational Safety and Health

September 1992
DISCLAIMER

Sponsorship of this Conference and these Papers and Proceedings by the National
Institute for Occupational Safety and Health (NIOSH) does not constitute
endorsement of the views expressed or recommendations for use of any commercial
product, commodity, or service mentioned. The opinions and conclusions expressed
in the papers and abstracts are those of the authors and not necessarily those of
NIOSH.

Recommendations are not to be considered as final statements of NIOSH policy or
of any agency or individual who was involved. They are intended to be used in
advancing the knowledge needed for improving worker safety and health.

This document is in the Public Domain and may be freely copied or reprinted. Copies of
this and other NIOSH documents are available from:

Publication Dissemination, DSDTT
National Institute for Occupational Safety and Health
4676 Columbia Parkway
Cincinnati, Ohio 45226
FAX (513) 533-8573

U.S. Department of Commerce
National Technical Information Services
Springfield, VA 22161
NTIS PB 93-114890/$77.00 or A/06

Superintendent of Documents
U.S. Government Printing Office
Washington, DC 20402
GPO 017-033-00463-3
DHHS (NIOSH) PUBLICATION NUMBER 92-105

For information on other occupational safety and health problems, call:
1-800-35-NIOSH

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National Farm Safety Week, 1991

By the President of the United States of America

A Proclamation

The men and women who work in America’s agricultural sector make a vital contribution to our Nation’s
well-being. By providing consumers with a variety of high-quality food and fiber at reasonable costs, they
help to keep our work force strong and healthy and, in so doing, help to maintain the Nation's economic
productivity and competitiveness. Because we count on farmers and ranchers for so much, both as individuals
and as a Nation, it is fitting that we observe National Farm Safety Week—a concerted public awareness
campaign aimed at promoting their health and safety. .

Over the years much has been done to improve the safety of agricultural production. Advances in science and
technology and increased attention to avoiding safety risks have made farms and ranches safer places to
work. Moreover, dedicated professionals and volunteers have been working together to promote health and
safety in rural communities. These efforts are reflected by a welcome downturn in farm accident rates.

Unfortunately, however, while important strides have been made in reducing the risks of farming and
ranching, agricultural production remains one of our most hazardous industries, with an accident death rate
that is more than four times the average of all industries. More must be done to reduce the toll of farm-related
accidents.

Most accidents on the Nation's farms and ranches can be prevented by sensible measures that involve little
extra time, effort, or expense. For example, farmers and ranchers can reduce their risk of serious injury and
illness by following manufacturers’ instructions on the use of chemicals and machinery and by utilizing
protective apparel and safety equipment when the job calls for it. Children should be kept away from
ne machinery, and all family members and employees should be trained in safety procedures and first
aid.

For generations, the men and women who work on our Nation's farms and ranches have endured long hours
of tough, physical labor. However, they have continually met the challenges of their vocation with determina-
tion and pride—and with unparalleled success. During National Farm Safety Week, let us resolve to make
excellence in health and safety another one of America’s great farming traditions.

NOW, THEREFORE, I, GEORGE BUSH, President of the United States of America, by virtue of the authority
vested in me by the Constitution and laws of the United States, do hereby proclaim the week of September 15
through September 21, 1991, as National Farm Safety Week. I urge all who live and work on our Nation's
farms and ranches to make the preservation of personal health and safety an integral part of their daily
activities. | also urge them to protect their children, not only by instruction in safety habits, but also by setting
an example of carefulness and by avoiding needless risks. I also call upon organizations that serve
agricultural producers to strengthen their support for rural health and safety programs, and I encourage all
Americans to observe this week with appropriate activities as we express our appreciation for the many
contributions that men and women in agriculture make to our Nation.

IN WITNESS WHEREOCF, I have hereunto set my hand this fifteenth day of April, in the year of our Lord
nineteen hundred and ninety-one, and of the Independence of the United States of America the two hundred
and fifteenth.

PSST ET a a en A

 

iff
Surgeon General's Conference on Agricultural Safety and Health
FarMSare 2000 © A National Coalition for Local Action

Convened by the National Institute for Occupational Safety and Health
April 30 - May 3, 1991, Des Moines, lowa

PREFACE

In 1990, the Congress established a national initiative in agricultural safety and health
under Public Law 101-517. The Congress directed that this initiative, when sustained over
a period of time, would result in a significant and measurable impact on... health effects
among rural Americans.

As part of that initiative, the Congress appropriated funds for the National Institute for
Occupational Safety and Health (NIOSH) to convene a Surgeon General’s Conference
on Agricultural Safety and Health. This Conference was held in 1991 and was chaired
by Assistant Surgeon General J. Donald Millar, the Director of NIOSH. The purpose of
this Conference was to raise consciousness, build coalitions, disseminate information, and
encourage action to prevent injury and disease in agriculture. The Conference fulfilled
this purpose and established a vision for improving the total quality of health and safety
for agricultural workers and their families in America:

» Raise Consciousness. The Congress found that agricultural workers and their families
experienced excessive rates of injuries, many kinds of cancers and lung diseases, and
various health effects from exposures to agricultural chemicals. Their findings indicated
significant disparities in the quality of health among agricultural workers and their
families and a national need to improve the quality of their health. The Surgeon
General’s Conference reinforced this need, and the evidence was broadened into
musculoskeletal problems, noise-induced hearing loss, dermatological conditions, stress,
and infectious diseases. Furthermore, participants at the Conference emphasized the
need to improve the health of agricultural workers and their families.

» Build Coalitions. The Surgeon General’s Conference raised the consciousness of many
officials in the fields of agriculture, education, labor, and public health at the national,
state, and local levels. The need for a concerted effort was recognized by the par-
ticipants. Over 500 people participated from 41 states and the Commonwealth of Puerto

Rico as well as from other countries. As a result, a growing network of the participants
are reaching out among themselves and to others to offer and to receive help.

> Disseminate Information. The most visible manifestation of information dissemination
is these Proceedings and Papers: Surgeon General’s Conference on Agricultural Safety and
Health of that Conference, which will be distributed to participants and key prevention
leaders at the national, state, and local levels across the nation.

> Encourage Action. The action that was overwhelmingly encouraged was to improve the
health and safety of agricultural workers and their families. Moreover, the word,
PREVENTION, came through loud and clear—over and over—at the Conference. This
action, the improvement of agricultural safety and health through prevention, was
identified with three views: as an action for the 1990’s, with national leadership, and
through people at the local level.

Surgeon General’s Conference on Agricultural Safety and Health - 1991 V
Preface

With the recognition of a need for improvement, the Congress, through its national
initiative at NIOSH, launched a program for improving the health and safety of agricul-
tural workers and their families. This program was comprised of:

» A Survey. The Congress directed NIOSH to undertake a Farm Family Health and
Hazard Survey to develop more complete information on the circumstances of agricul-
tural injury and disease problems. Based upon this information, informed priority-setting
for prevention can be implemented and a baseline for measuring improvement can be
established.

> Research. To insure that preventive actions are taken based upon scientific findings,
including the etiology of the injuries and diseases, the Congress also directed NIOSH to
conduct research both intramurally and through university-based Centers for Agricultural
Health and Safety.

» Intervention. To actively promote and implement the research findings, the Congress
directed NIOSH to establish a national Agricultural Health Promotion System in
collaboration with county extension agents. The Congress also directed NIOSH to devise
an early detection strategy to reduce the number of cancer deaths among farmers
through Cancer Control Demonstration Projects for Farmers. In addition, funds were
provided for the training of professionals in agricultural safety and health.

> Surveillance. To monitor results, the Congress directed NIOSH to establish an
Agricultural Health Nurse Program in which rural hospitals would provide ongoing
responsive (focused at intervention) surveillance to identify agriculture-related disease
and injury problems through the support of nurses at rural hospitals.

In 1991, the Secretary of Health and Human Services issued a report, Healthy People
2000, which included national goals and objectives for improving the health of
Americans. Three overarching goals emerged from this effort, each of which apply to
agricultural workers and their families. These goals are: increase the span of healthy life
for Americans, reduce health disparities among Americans, and achieve access to
preventive health services for all Americans. Emerging from the purpose established by
the Congress for a national initiative for agricultural safety and health from the goals of
Healthy People 2000, and from the Surgeon General’s Conference on Agricultural Safety
and Health is a national vision for the 1990’s for implementing the initiative:

To continuously and measurably improve the safety and health of every working man and

woman in American agriculture through the prevention of Leading Work-Related Diseases
and Injuries consistent with the goals and objectives of ‘Healthy People 2000.’ 0

ure © Gat

Antonia C. Novello, M.D.
Surgeon General

vi Papers and Proceedings
Surgeon General's Conference on Agricultural Safety and Heaith
FarmSare 2000 » A National Coalition for Local Action

Convened by the National Institute for Occupational Safety and Health
April 30 - May 3, 1991, Des Moines, lowa

FOREWORD

The Surgeon General’s Conference on Agricultural Safety and Health was convened by
the National Institute for Occupational Safety and Health (NIOSH) in 1991. NIOSH
was created in 1970 as a result of the passage of the Occupational Safety and Health
Act. NIOSH is the national public health organization responsible for the occupational
safety and health of all of the nation’s workers. Moreover, NIOSH is a component of
the Centers for Disease Control (CDC), The Nation’s Prevention Agency.

In 1990, the Congress expressed concern that agricultural workers and their families
experience a disproportionate share of injuries and diseases associated with numerous
chemical, biological, and physical hazards. For example, agricultural workers have the
second highest occupational fatality rate. They run a significantly higher risk of dying of
certain types of cancer than persons in other occupations. The Congress also observed
that inhalation of organic dusts from plant, soil, and animal sources, and from chemical
and other substances, results in occupational health risks to agricultural workers.

The Congress, recognizing that agricultural workers continue to suffer high levels of
injury and illness, directed NIOSH to lead a comprehensive national program and
undertake a series of initiatives in surveillance, research, and intervention to prevent
occupational injuries and diseases in agriculture. The Congress believed that NIOSH
was in a unique position to lead a comprehensive national effort to prevent injury and
disease in agriculture. The NIOSH initiative is intended to provide a balanced approach
to substantially reduce the incidence of fatal and nonfatal traumatic injury, chronic
injury, and occupational diseases among the 3.4 million agricultural workers in the
United States. NIOSH expanded its research program to address the safety and health
of workers in agriculture and awarded cooperative agreements to enhance the Institute’s
existing program in the areas of surveillance, research, and intervention.

The Congress also directed that NIOSH convene a Surgeon General’s Conference on
Agricultural Safety and Health. Held in 1991, its purpose was to raise consciousness,
build coalitions, disseminate information, and encourage action to prevent injury and
disease in rural areas. Several solutions for preventing diseases and injuries were
presented and discussed at this Conference. The following is a summary of the Con-
ference through the words of its participants, followed by a statement of the problem
that emerged from the Conference, and a vision for the future of agricultural safety and
health in America as well as a special mention of a particular, fully preventable agricul-

tural injury—"an occupational obscenity"—which was repeatedly emphasized at the
Conference.

CONFERENCE SUMMARY
The general design of the Conference was to, first in plenary session, address its purpose,

then provide direction through keynote speeches and questions, and pose some as- —
sumptions about the future of both the agricultural workforce and workplace. The titles

Surgeon General’s Conference on Agricultural Safety and Health - 1991 Vii
Foreword

of the sessions and titles in this document corresponding to this part of the Conference
are: The Potential for a National Coalition, Looking Ahead to the Next Century, Questions
to Guide the National Agenda, Medical Intervention Problems and Opportunities, and Issues
That Affect the National Agenda.

The Conference included five concurrent sessions dealing with the issues of surveillance,
research, and intervention. The proceedings from these sessions are addressed in this
document in the chapters entitled Surveillance~Agriculture-Related Diseases, Injuries, and
Hazards, Research-Chemical and Biological Hazards, Research-Mechanical and Physical
Hazards, Intervention-Worker Protection from Environmental Hazards, Intervention-Safe
Behaviors among Adults and Children. Within each of these sessions, presentations of
factual information were made, and discussions ensued from the perspectives of a range
of interested parties.

Returning to plenary sessions, the chair of each concurrent session reported the results
of deliberations in their session. In addition, a report was made on the issues raised at
another conference held concurrently on migrant and seasonal labor. These reports are
presented in the chapter entitled Elements of a National Agenda. The closing plenary
session provided an opportunity for concluding remarks from a variety of participants
who ranged from governmental to those representing farm organizations to a victim.
These remarks are documented herein in the chapter entitled Actions for the Future.

The Conference included a poster and video tape session with 102 posters presented.
The abstracts of the posters and titles of the video tapes are presented in the chapter
entitled Making Connections.

Six unifying principles emerged from the Conference as operational concepts for the
future. They are found in the words of 72 speakers at the Conference—these themes
offer a verbal tour through these Papers and Proceedings:

> CONTINUOUS IMPROVEMENT THROUGH PREVENTION. The Congress has directed
that a national initiative, of which this Conference was a part, be launched so that when
sustained over a period of time, would result in a significant and measurable impact on. . .
health effects among rural Americans. Augmenting this direction for continuous improve-
ment, the Surgeon General’s Conference consistently and in multiple ways demonstrated
the need to prevent problems in order to improve the safety and health of agricultural
workers and their families.

Senator Tom Harkin of Iowa asserted, ". .. we need to make "Prevention First" our
motto for health care in the 90’s.". Dr. Thomas Dean of the National Rural Health
Association challenged the Conference, "... to go forth in these deliberations with a

sense of urgency and with an understanding that every day lives are lost because families
are being devastated and futures are being ruined because of our failure in the past to
build these coalitions."

Vili Papers and Proceedings
Foreword

Speaking to a paradigm for prevention, Dr. William Popendorf from The University of
Iowa said, ".. . we face yet another challenge; how to translate them (parameters of
health effects) into "agricultural hygiene," the industrial hygiene paradigm of “anticipa-
tion, recognition, evaluation, and control learned in general industry .. . " Jeffrey
Human of the Office of Rural Health Policy encouraged the Conference to, "...
confront conventional approaches and make new choices with limited funds, choices that
help solve rural health problems."

Willis Eken of the Minnesota Farmers’ Union contended, " . . . that it is something of a
sham if the most effective tool for safer environmental protection regarding machinery is
a law suit." Joseph Kinney of the National Safe Workplace Institute urged the Con-
ference, ".. . to begin to get realistic about how you would like to see these issues ad-
dressed." Merlin Plagge of the Iowa Farm Bureau observed about OSHA standards that,
" _, knowing they exist has encouraged farmers to work for safer farmsteads."

>» RECOGNIZE THE NEEDS OF THE POPULATION AT RISK. Fundamental to prevention
is recognizing the needs of agricultural workers and their families, a population at
disproportionately high risk of work-related disease and injury.

Dr. Myron Johnsrud of the U.S. Extension Service asserted, "A national strategy could
rest on the belief that the most effective preventive efforts will emerge from a process
that emphasizes identifying and characterizing problem areas and populations at risk."
Relatedly, Dr. James Merchant of the Institute of Agricultural Medicine and Oc-
cupational Health at The University of Iowa reported, “Agricultural production is now
changing dynamically, resulting in a substantial increase in farmers with non-farm jobs,
greater involvement of women and seasonal workers, and involvement of children and
recreational farmers in agricultural operations.”

Dr. Leslie Whitener of the Economic Research Service at the U.S. Department of
Agriculture defined this population: "The largest component (46 percent) of the
agricultural work force in 1987 was made up of the 3.6 million people who did unpaid
farmwork .. . the hired component of the agricultural work force will continue to grow
in importance as hired workers increasingly replace family workers on farms and as the
number of large, labor-intensive commercial farms continues to increase."

Christopher Atchison of the Iowa Department of Public Health noted, "Because farming
has traditionally been a family business, that it is not just the professional farmer, it is
the farm family that is at risk for injury."

Cheryl Tevis from Successful Farming Magazine observed, ".. . that about half of farm
women work outside the home." Todd Frazier from NIOSH expressed his viewpoint,
"Because I am from a public health background and have always been interested in the
population at risk, these demographics spell out to me a very serious challenge that we
are facing when we look at projects that address the problems of farm families in
generally rural areas.”

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

Speaking of the migrant labor portion of the population, Roberta Ryder of the National
Migrant Resource Program asked, "Is it really acceptable that such a large portion of our
population be relegated to the edge for the duration of their lives?" Dr. Russell Currier
from the Iowa Department of Public Health recognized two patterns of disease among
agricultural workers, "Migrant farm workers experiencing human-host illnesses, often
episodic and exacerbated by substandard living and employment conditions. All other
farm workers experiencing sporadic, isolated illness that is most frequently zoonotic,
vector-borne, or environmentally acquired in nature."

>» SURVEILLANCE TO MEASURE IMPROVEMENTS. Part of prevention is the study of
trends so as to measure progress. Surveillance is the means of doing so. Through
surveillance, we can systematically and continually collect, analyze, and interpret data
related to health and safety and direct prevention programs so as to control and, when
possible, eliminate the occurrence of diseases and injuries.

With reference to John Donne’s 16th century poem, Dr. William Halperin from NIOSH
spoke to the role of surveillance as a guide to preventive action, "Surveillance in modern
times is the equivalent of the tolling of the bells with the added commitment to inves-
tigation of the causation of morbidity and mortality and dissemination of data and
analysis with the goal of prevention." Dr. John May from the New York Center for
Agricultural Medicine and Health speaking to the use of sentinel events in surveillance
relayed that, "... intervention should affect other workers by either addressing the
hazardous exposure, by screening similarly exposed workers, or by insuring that at least
adequate protection is provided to similarly exposed workers."

About surveillance and priorities, Dr. Dennis Murphy from Penn State University
contended, "If we are going to let data guide us, we have to get to some specific
categories to have some guidance.” Dr. Henry Anderson from the Wisconsin
Department of Health and Social Services reported, "We need to move away from the
broad view to some specific, high-priority activities."

Regarding the role of the "helping" professions, Rodney Gilmore from the North Dakota
State Department of Public Health related, "We learned that in order to keep a good
surveillance system going, you must keep direct and frequent contact with the medical
facilities and with the providers who are giving you the information." Dr. Eugene Freund
from NIOSH suggested, "Inasmuch as the nurses, through their interactions with
providers, can do case surveillance, they can help with the recognition of problems that
may not be identified in the community."

>» RESEARCH TO FIND ROOT CAUSES. A principle that emerged at the Conference was
to base actions on facts. Research is a way of finding the facts, and through research, we
work to understand the causes of work-related diseases, injuries, and hazards; detect
their vulnerabilities to prevention; and discover, assess, and improve measures to reduce
them. Dr. Lorann Stallones from Colorado State University reported, "National policy
guidance is needed in order to provide focus for targeting proper areas of research and
to define the scope of research to be performed within priority areas."

x Papers and Proceedings
Foreword

Regarding high technology, Dr. Ronald Eckoff of the Iowa Department of Public Health
introduced two speakers saying that they, ". . . will reveal changes in the agricultural
work place as it is affected by new and different crops and by biotechnology." Dr. Daniel
Kugler from the Office of Agricultural Materials at the U.S. Department of Agriculture
noted, "... that agriculture, indeed, is a very high-tech business." Dr. Jane Rissler from
the National Wildlife Federation challenged the Conference with, "I hope that this
presentation will provoke a wide-ranging consideration and evaluation of the potential
impacts of biotechnology on farm worker health." Regarding noise-induced hearing loss,
Dr. Matthew Marvel from the Oneonta Health Center observed that, "We also might
find some high-technology solutions like using sound cancellation."

 

The occupational problems faced by farmers were seen to be numerous, significant, and
preventable. Dr. Susanna Von Essen from the University of Nebraska summarized the
problems with lung diseases on the farm, "The presence of inflammation is a common
theme in these disorders." Other problems were addressed by Dr. Linda Rosenstock
from the University of Washington when she maintained that, "On the basis of this study
and the accumulating evidence in the medical literature, we feel that even episodes of
acute organophosphate poisoning can cause permanent neurologic dysfunction."

Dr. Aaron Blair from the National Cancer Institute observed, "A critical role for
suppression of immune responsiveness by pesticides has been demonstrated for infectious
disease and maybe for other diseases."

The injury problem was addressed by Dr. Sverker Hogliind from the Swedish Farmers
Safety and Preventive Health Association who explained that, "Machine design may be
related to hazards of two kinds. One is accidents causing acute injuries. The other is
chronic injuries or illnesses because of long-term, unfavorable effects on the body during
work operations.” Murray Madsen from Deere and Company observed that, “Sometimes
equipment is in mint condition; other times it is not, or modified, or built from scratch in
a local shop." Dr. Thomas Bean from Ohio State University reported that, "In either
case, the majority of studies indicated that farm equipment was the single factor most
associated with on-farm injury." John Crowley from the Equipment Manufacturers
Institute urged that, "Behavioral research is needed to guide engineers on how equip-
ment can be designed for safer operation and maintenance."

Dr. Susan Gerberich from the University of Minnesota maintained that, "A major barrier
to progress in the prevention of agricultural injuries has not only been a lack of
knowledge about the magnitude of the problem but also a lack of knowledge about
specific causes or risk factors due to the lack of analytical studies." Penn Peters of the
US. Forest Service stated that, "A high-priority'research area is in the injuries that result
from a felled tree having hit another tree, which includes hangup fell, broken limbs or
tops, and butt rebound."

Regarding the hazards of overhead electrical lines, Robert McLymore from North
Carolina State University remarked, "That moment of carelessness may end up with that
piece of equipment getting in contact with that line. We know how electricity kills."
Governor Robert Ray, Chairman of the National Advisory Committee on Rural Health

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

Policy, observed that, "the suicide rate for farmers is now 30 to 40 percent above the
national non-farm rate."

Dr. David Cochran of the Occupational Safety and Health Administration recounted a
conversation, "She was telling me that the top occupational category suffering from
tendinitis in the state of Washington is farmworkers." Regarding greenhouse workers,
Dr. John Coumbis of the Agency for Toxic Substance and Disease Registry related that,
" _. you find some of the reports of back pain in roughly a third of the work force, pain
in multiple joints in 19 percent, pain of the upper extremities in 11 percent of the
workers, lower extremities in 8 percent, and neck pain in 2 percent."

» RESPECT PEOPLE WHILE CONTROLLING THE PROBLEMS. Another principle that
emerged overwhelmingly at the conference was respect for people, and also consistent
with our Conference theme of A National Coalition for Local Action, our intervention
must be based upon such respect.

Speaking to this theme through a video message, Secretary Louis Sullivan of Health and
Human Services stated, "The key to making those strategies effective—the critical, vital
factor that will determine our success in lowering the risks of agricultural work—is local
initiatives and efforts." Assistant Surgeon General William Roper declared, "As the
theme of this meeting, National Coalition for Local Action, clearly portends, the foun-
dation of our public health system, as it functions in agriculture and other sectors, must
be the local public health agency."

Dr. James Dosman from the University of Saskatchewan recommended, ". . . the estab-
lishment of health and safety committees at the local level, organized by target pop-
ulations, for the purpose of identifying issues, facilitating programming, and achieving
results." Referring to agricultural workers, Ellen Widess’ Children’s Advocacy Institute
contended, "Unless we also deal with those economic realities of their lives and their
limited choices, we will fail in our efforts to improve health and safety.”

Regarding networking and community involvement, Dr. Dean Stueland from the -
National Farm Medicine Center related, "We need to close the loop between what is
happening on the farm and what is happening in medicine so that people understand
each other." Wayne Sprick of the National Young Farmer Educational Association said,
"The FFA chapters and those younger people are looking for opportunities to conduct
community-service types of projects." Robert Graham with the National Vocational
Agriculture Teachers’ Association commented, "We encourage students to sit down and
do a community review by interviewing resource people with organizations, such as the
community health organizations, the district representatives of OSHA and NIOSH, the
Farm Bureaus, and National Grange Affiliates." Valerie Wilk from the Farmworker
Justice Fund reported, "In a number of the workshops there were very concrete examples
of groups who had worked in coalition, either within their community or statewide, on
particular health and safety issues: workers’ compensation or field sanitation."

xii Papers and Proceedings
Foreword

Gene Graham with the W.K. Kellogg Foundation challenged the Conference, "... (how
can we) develop meaningful opportunities for enfranchisement, access to the institutions
of society, and the much needed occupational safety and health interventions for migrant
and seasonal workers?" Craig Merrilees with the Consumer Pesticide Project contended,
"Health and safety improvements come only when people are organized and when they
are able to control their own destiny.” Thomas Seymour from the Occupational Safety
and Health Administration observed, "In the OSHA history of writing rules, regulations
and enforcement, we have found that the people who are interested in trying to correct
these problems need to be on board and in support of the process."

Regarding the issue of training, Cynthia Douglass from the Occupational Safety and
Health Administration conveyed, "The answer lies in education, training, and increasing
awareness of those hazards and how they can be reduced." Malanie Zavala from the
University of California-Davis pointed out that, "... a lot of these people come here
without an excellent education, and this is going to make a difference as to what they
can understand in terms of reading—not so much in terms of spoken language, I think,
but in terms of things that they are going to have to read.”

On children and women, Marilyn Adams of Farm Safety for "Just Kids" proposed, "My
experience with the youth tells me that they are our best bridge to the farm family. If
you take this one step further and train farm women in tractor safety, chemical safety,
rescue, and the other aspects of farming along with the youth, Dad and Grandpa will not
have a chance after we start rocking the boat and making waves." Surgeon General
Antonia Novello declared, "As a woman, I totally agree with the philosophy of Marilyn
Adams’ group, Farm Safety for "Just Kids," who say that the one person on a farm who
can play the most pivotal role in educating farmers and farm children about the dangers
of working on a farm is the woman." Nineteen-year-old Mark Timm from the National
FFA Organization related, "Not only does America need its young, but young people
need your help, support, guidance, and leadership." Dr. Walter Armbruster of the Farm
Foundation observed, "We also know that reaching adults through youth is a very
effective channel for modifying adult behavior."

» UNDERSTAND "THE SYSTEM" IN ORDER TO CONTROL THE PROBLEMS. A general
principle that emerged was to develop win-win situations by understanding the system,
recognizing people as part of the system, and intervening early in that system in its
design.

Dr. Rice Leach, Chief of Staff to the Surgeon General, in speaking to a ‘win-win’
strategy conveyed it succinctly, "_ T submit that the purpose of this endeavor or our
mission is to prepare the next generation to live in harmony with nature." Judith
Heffernan of the University of Missouri-Columbia remarked, “There is a social
movement afoot that looks at environmental and food safety and a whole host of issues
that are... put together, and so pesticide usage and water quality—and you know the
litany—we have heard much of it here.” Dr. Robert Pinger from Ball State University
reported, "Integrated Pest Management is the use of the safest and most appropriate

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

combination of methods (physical, chemical, and biological) to control vector popu-
lations."

Dr. Kelley Donham from the University of lowa reported, "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
conservation perspective.” Larry Belmont from the Idaho Panhandle Health District 1
stated, "Our next best alternative is to develop new solutions or new systems of service to
cover those areas.”

Recognizing human behavior as an important part of the system, Dr. Robert Aherin
from the University of Illinois propounded, “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." Assistant
Surgeon General Michael McGinnis offered an avenue for prevention by noting that,

" _. the prominent role of behavior in health threats is not novel or unique, some of the
lessons that can be gleaned from other public health areas may be germane to the kinds
of approaches that we seek to establish for agricultural health and safety." In contrast,
Dr. Pamela Elkind from Eastern Washington University contended, "This assumption,
simply stated, is that to make agriculture safe for the farm families and workers, it is
necessary to motivate them to protect themselves from health and safety hazards .. . I
shall attempt to demonstrate to you that these assumptions lack validity."

Regarding design, Dr. David Pratt of the New York Center for Agricultural Medicine
and Health reported, “Intervention strategies are most effective when they are applied
early in the process." Dr. Gary Erisman, a private farmer, declared, "... design is the
most critical stage for the prevention of hazards and hazardous products." Ray
Crammond, consulting engineer, said of design, "I think the biggest problem is people
who ignore the human input." Rollin Schnieder from the University of Nebraska stated,
"You have to realize that a lot of the equipment that we have in agriculture is not totally
designed." Professor Stephan Konz from Kansas State University maintained, “Designing
out the problem is the best approach because it is a permanent solution." Dr. Richard
Fenske from the University of Washington said," ... there are many opportunities, if we
are creative, to reduce the hazard before we ever have to worry about personal protec-
tive equipment." Dale Baker from J.I. Case Company challenged the Conference, "Is
anyone going to invest the time and effort to develop new designs unless there is, in fact,
a demand?"

THE PROBLEM: DISEASE AND INJURY
To help establish priorities for the field of occupational safety and health, NIOSH in

1983 developed a list of 10 Leading Work-Related Diseases and Injuries and proposed
national strategies to prevent each of them. NIOSH invited leading experts to improve

xiv Papers and Proceedings
Foreword

and elaborate on these strategies at two national symposia held in 1985 and 1986.’ The
‘nitial list was based upon three criteria: the scope of the problem, the severity of the
problem in the individual case, and the vulnerability of the problem to prevention. More
recently, infectious diseases have also emerged as a significant problem in occupational
safety and health.’

The problem is disease and injury, our common enemy. We have seen how this enemy
attacks American agricultural workers and their families. Recognized at this Conference
were a number of The Leading Work-Related Diseases and Injuries:

1. Occupational Lung Diseases - farmers’ lung, asthma, hog lung, silo fillers’ disease, etc.

2. Musculoskeletal Injuries - milkers’ knee, tractor drivers’ syndrome, tendinitis, repetitive
motion trauma, etc.

3. Occupational Cancers - skin, bladder, and brain cancer, leukemia, etc.

>

Severe Occupational Traumatic Injuries - machine-related fatalities, electrocutions,
suffocations, suicides, amputations, eye injuries, etc.

5. Occupational Cardiovascular Diseases — heat stroke.

6. Disorders of Reproduction - miscarriages, infertility, etc.

7. Neurotoxic Disorders - dementia, neurologic dysfunction, etc.
8. Noise-Induced Hearing Loss

9. Dermatological Conditions - burns, lacerations, dermatitis, etc.
10.

Psychological Disorders - depression, stress, etc.

11. Infectious Diseases - zoonosis, tuberculosis, etc.
A VISION FOR THE FUTURE

In 1990, the Congress directed NIOSH to lead a comprehensive national program to

prevent occupational injuries and diseases in agriculture. NIOSH gains its authority for
responding to this direction from the Occupational Safety and Health Act of 1970, which

 

1 Proposed National Strategies for the Prevention of Leading Work-Related Diseases and Injuries. Part
1 in 1986 and Part 2 in 1988, Published by the Association of Schools of Public Health under a Cooperative
Agreement with the National Institute for Occupational Safety and Health.

2 For an example related to agricultural workers see: Centers for Disease Control. "Prevention and
Control of Tuberculosis in Migrant Farm Workers: Recommendations of the Advisory Council for the
Elimination of Tuberculosis," MMWR 1992;41 (No. RR-10).

Surgeon General’s Conference on Agricultural Safety and Health - 1991 XV
Foreword

established the national goal "to assure so far as possible every working man and woman
in the Nation safe and healthful working conditions and to preserve our human resour-
ces."

NIOSH is charged in the Act to undertake scientific activities that will enable the goal to
be won. In response to this charge, NIOSH identifies those populations at highest risk,
defines risk factors that guide our efforts to reduce those risks, and provides information
to whomever has the ability to act in preventing the problem.

The Surgeon General’s Conference of 1991 has established a national commitment to the
continuous improvement of safety and health among agricultural workers and their
families. It is a "Total Quality" commitment! As a result of the Conference, the Surgeon
General has identified a VISION for a national program for agricultural safety and health
in America:

To continuously and measurably improve the safety and health of every working
man and woman in American agriculture through the prevention of Leading
Work-Related Diseases and Injuries consistent with the goals and objectives of
‘Healthy People 2000.’

In 1991, the U.S. Public Health Service published a report, Healthy People 2000:
National Health Promotion and Disease Prevention Objectives. This document is a
statement of national opportunities. This report is not intended as a statement of
Federal standards and requirements, but as a product of a national effort that involved
over 10,000 people. The Surgeon General addressed three overarching goals from this
report in the Preface. These goals are buttressed by specific and substantive objectives,
which are aimed at guiding decisions about programs, resource allocations, and profes-
sional and personal commitments.

The objectives enumerated in Healthy People 2000 deal with Health Status, Risk Reduc-
tion, Services and Protection, and Surveillance. The Health Status Objectives address
the problem of disease and injury, the Risk Reduction Objectives address the control of
the causes of the disease and injury problem. The Services and Protection Objectives
relate to the processes that require improvement so that risk can be reduced. The
Surveillance Objectives address the process of diagnosing and reporting information
about health status, risk reduction, and services and protection so as to better guide and
focus our intervention to control disease and injury.

With the vision of the future in mind, FarmSafe 2000 is a program commitment to

Healthy People 2000. Consistent with this commitment, we have listed, as illustrative
examples, 11 Health Status Objectives for the year 2000 that correspond with the

xvi Papers and Proceedings
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problem, the 10 Leading Work-Related Diseases and Injuries plus infectious diseases.’
Each objective represents a significant improvement in health status over an existing
baseline by the year 2000.

1. Occupational Lung Diseases - Reduce asthma morbidity, as measured by a reduction in
asthma hospitalizations to no more than 160 per 100,000 people (11.1).

2, Musculoskeletal Injuries - Reduce cumulative trauma disorders to an incidence of no
more than 60 cases per 100,000 full-time workers (10.3).

3. Occupational Cancers - Reverse the rise in cancer deaths to achieve a rate of no more
than 130 per 100,000 people (16.1).

4. Severe Occupational Traumatic Injuries - Reduce work-related injuries resulting in-
medical treatment, lost time from work, or restricted work activity to no more than 6
cases per 100 full-time agricultural workers (10.2c).

5. Occupational Cardiovascular Diseases - Reduce stroke deaths to no more than 20 per
100,000 people (15.1).

6. Disorders of Reproduction - Reduce the prevalence of infertility to no more than 6.5
percent (5.3).

7. Neurotoxic Disorders - Reduce nonfatal poisoning to no more than 88 emergency
department treatments per 100,000 people (9.8).

8. Noise-Induced Hearing Loss - Reduce significant hearing impairment to a prevalence of
no more than 82 per 1,000 people (17.6).

9. Dermatological Conditions - Reduce occupational skin disorders or diseases to an
incidence of no more than 55 per 100,000 full-time workers (10.4).

10. Psychological Disorders - Reduce suicides to no more than 10.5 per 100,000 people
(6.1).

11. Infectious Diseases - Reduce tuberculosis to an incidence of no more than 3.5 cases
per 100,000 people (20.4).

Another Health Status Objective, which would be classified under Severe Occupational
Traumatic Injuries, is to reduce deaths from work-related injuries to no more than 4 per
100,000 full-time agricultural workers. There was an annual average of 6 deaths per
100,000 for the period, 1983 to 1987. The next issue that I will discuss relates directly to
this objective.

 

3 Each Objective is parenthetically followed by an identifying number. This number uniquely
identifies each Objective within the document: U.S. Department of Health and Human Services, Public
Health Service. Healthy People 2000: National Health Promotion and Disease Prevention
Objectives. 1990; DHHS Publication No. (PHS) 91-50212, Washington, DC: Government Printing Office.

Surgeon General’s Conference on Agricultural Safety and Health - 1991 xvii
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AN "OCCUPATIONAL OBSCENITY"

One final issue that was raised at the Conference cannot go without special mention.
Amidst expressions of anguish and pleas for reason, there was an overwhelming interest
in a particular issue, namely the need to reduce the risk of fatalities related to tractor
roll-overs.

Deaths from tractor roll-overs are the leading cause of traumatic fatalities on the farm.
There is no acceptable excuse for the persistence of this problem as deaths from tractor
roll-overs are fully preventable. The problem justifies the term, “occupational obscenity."
Twenty-seven speakers at the Conference addressed this problem. Categorized by the six
principles that emerged as unifying concepts at the Conference, here is what they said:

>» CONTINUOUS IMPROVEMENT THROUGH PREVENTION.

A good example of the need for such a model is the prevention of tractor roll-over deaths through
the application of roll-over protective structures (ROPS) on both new and older tractors. The
epidemiological evidence for the very significant risk posed by tractors without ROPS is clear...
The data available from Sweden, which mandated such a program, makes it equally clear that
ROPS can prevent almost all tractor roll-over deaths. An important question for this conference
is whether an American intervention model can be developed that can produce a significant
reduction of tractor roll-over deaths and injuries. A second question, with much broader
ramifications, is, "If we cannot develop a U.S. model for a proven intervention on the single most
important cause of agricultural mortality, how can we succeed in addressing less dramatic yet still

important causes of agricultural diseases and injuries?" — Dr. James A. Merchant
Director, Institute of Agricultural Medicine and Occupational Health
The University of lowa

In Sweden in 1959 the law was put forward concerning safety frames (ROPS) in new tractors. It
was also decided that employed agricultural workers were not allowed to work in tractors lacking
such frames. Self-employed farmers and family members for many years were excluded from this
law and could use old tractors without frames in farm work. A new tractor, of course, had this
device. In 1983 the law was extended to include family farmers. It was later decided that even old
tractors had to have frames if they were to be used in agricultural work. The effect on fatalities
due to tractor turn-over since the year of legislation was striking. It is obvious that this action from
the authorities, unpopular as it might have been, has had quite a significant effect in preventing
severe accidents. — Dr. Sverker Hogliind

Director, Swedish Farmers Safety and Preventive Health Association
Stockholm, Sweden

> RECOGNIZE THE NEEDS OF THE POPULATION AT RISK.

Even though the land is so flat, we still have a tendency to have tractor roll-overs in the eastern part
of the state... Tractor roll-overs are still a major source of fatalities in the state. | — Rodney Gilmore

Injury Control Program Manager
North Dakota State Department of Public Health

Bob Aherin said something about ROPS that really interested me. He said to identify the farmers

with high risk exposure and to identify appropriate intervention strategies . . . As a farmer, this
makes much more sense to me than suggesting that all farmers should put ROPS on all tractors.

xviii Papers and Proceedings
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We need to start somewhere and give the farmer a realistic picture of the high-risk exposure with
all tractors with end loaders or whatever the highest risk is... I heard Wes Buchele address the
issue of retrofits. By all means, guarding for the older equipment needs to be made accessible and
marketed. It is my personal feeling that dealers should not resell equipment without all protective
shields. They have a responsibility to their customers to market the proper shielding for their own
products.

— Marilyn Adams
President, Farm Safety for "Just Kids"

Farm children have been injured and killed for years. I was too young to remember a tragic tractor
roll-over accident that claimed the life of our neighbor's son. Years later I remember finding the
yellowed and brittle newspaper articles about it that my mother had saved. On looking back, I
think that that accident may have had a lot to do with the fact that my brothers were not expected
to function as hired hands at a young age... When asked, "If cost were not a consideration, would
you use roll-over protection?" 89 percent said they would; 96 percent would use safety shielding; and
50 percent would use day care. These figures may be slightly high. We all know it is good to have
good intentions. — Cheryl Tevis

Senior Farm Issue Editor
Successful Farming Magazine

We have had a great deal of discussion, in this session, about ROPS. We have all seen the slide,
many times, of the success of ROPS in Sweden. In 1985, we had a commitment by the North
American tractor manufacturers to make ROPS standard on all tractors. With a few exceptions
of tractors that are being imported into this country and those that are for orchard applications, all
tractors since that time are equipped with ROPS. By 1970, ROPS in this country became available
on virtually all major manufacturers’ product lines. There was no demand for them. Therefore,
we have a significant number of tractors in operation in the U.S. that were built in that interval
between 1970 and 1985 that are not equipped with ROPS. I would suggest, in gross terms, that
there are about a million tractors that are equipped with ROPS or that have ROPS built into the
cab. About a million tractors that are out there could have a ROPS installed on them but do not.
Another million tractors that are in use were built prior to this introduction of ROPS and here
installation of ROPS becomes a real technological issue. Now we should look at those two issues
separately,

In putting ROPS onto tractors that were built prior to 1970, there are some significant technical
issues. Will the tractor structure survive an impact with this ROPS attached? The structure was
not built for that kind of use. New frames could be designed, possibly, to accommodate the design
by sharing the load forward to the transmission housing. There is now a need to develop that new
structure. There were many applications for those old tractors where implements were attached to
the same location that we would attach this ROP structure. If you destroy that, you have destroyed
the utility of that tractor. There is also the issue of the economics of putting those ROPS on old
tractors. If there is to be a program of that nature, it is going to have to start with the development
of some pubic policy change that will create that demand. Is anyone going to invest the time and
effort to develop new designs unless there is, in fact, a demand?

The issue for tractors built in the interval between 1970 and 1985 where a ROPS can be installed
becomes an issue of how to create an environment where the public demands those ROPS. They
are available. A demand undoubtedly could bring down the cost that was mentioned earlier. Until
there is a demand, there will not be any initiative that will cause that to happen. It is the chicken
and the egg situation. If you could decrease the cost, maybe you could increase the demand. You

Surgeon General’s Conference on Agricultural Safety and Health - 1991 xix
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cannot decrease the cost, however, until there is a demand. We are now again looking at what is
a public policy issue of how you create that demand. I would say to you that my brother is aware
of the issues of ROPS and tractor overtumns. But fatal tractor overturns are a rare event (a farmer
is far more likely to be killed in a car accident than a tractor overturn). Virtually all farmers are
aware of the issue of fatal tractor overturns in the same sense that farmers (and the general public)
are aware of the issue of cigarette smoking causing cancer. —L. Dale Baker

Product Safety Engineer
JI, Case Company

>» SURVEILLANCE TO MEASURE IMPROVEMENTS.

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. — Dr. Henry A. Anderson
Chief, Section of Environmental Epidemiology
Wisconsin Department of Health and Social Services

For example, in 1958, Sweden instituted a law that any new tractor that was produced had to have
roll-over protection. In the years thereafter, surveillance data indicate a decline in roll-over
fatalities. In 1978 Sweden instituted another law that any tractor in use had to have roll-over

protection, and the problem was eradicated. — Dr. William E. Halperin
Associate Director for Surveillance

Division of Surveillance, Hazard Evaluations, and Field Studies

National Institute for Occupational Safety and Health

The Olmstead Agricultural Trauma Study provided the basis for the Regional Rural Injury Study,
currently being conducted in a five-state region: Minnesota, Wisconsin, North Dakota, South
Dakota, and Nebraska. Data collection covers a twelve-month period of time for over 4,000 rural
households, utilizing computer-assisted telephone interviews. This effort will enable the
identification of injury rates for each state and the region as well as multiple analytic substudies,
including tractor-roll-overs and animal-human injuries. The project also includes application of
the results to the development of intervention strategies, to be achieved by convening nationally
recognized experts and the regional participants in the Agricultural Injury Intervention Strategy

Workshop. — Dr. Susan Goodwin Gerberich
Division of Environmental and Occupational Health
School of Public Health, University of Minnesota, Minneapolis, Minnesota

We will look at safety risk factors, injuries, ergonomics, roll-overs, power-take-off’s, and secondary

occupations. — Todd M. Frazier
Chief, Surveillance Branch

Division of Surveillance, Hazard Evaluations, and Field Studies

National Institute for Occupational Safety and Health

They (nurses) can identify that as a problem and trigger efforts to prevent it from happening again.
Since they will be located in their own regions, they will often be able to identify all cases of a given
condition, tractor roll-overs or power take-off injuries. They can identify the scope of those
problems, use that information to target intervention efforts, and after intervention efforts, evaluate
how effective they have been... The ‘Extension service have people who know how to retrofit trac-

tors with roll-over protection, if that ts something someone wants to do. — Dr. Eugene Freund
Medical Officer, Surveillance Branch

Division of Surveillance, Hazard Evaluations, and Field Studies

National Institute for Occupational Safety and Health

XX Papers and Proceedings
Foreword

>» RESEARCH TO FIND ROOT CAUSES.

Farm equipment accounted for 40 to 60 percent of deaths and injuries in the majority of studies,
followed very closely by livestock injuries and falls. Numerous types of farm machinery have been
implicated in all studies. Since the majority of farm machinery is associated with tractors, it stands
to reason that injuries "involving" tractors were the most common type of machinery-related trauma.
Tractor over-turns, it appeared, were involved in the majority of agricultural fatalities. Many studies
indicated that youth and the elderly were most often associated as an at-risk population... The
studies varied, though, when you compared those using statistics from government agencies that
were not gathering the appropriate and associated data with youth...

The opportunity presents itself to include some homespun theory. This happens to be a theory of
mine: on family farms, older tractors and equipment are often reserved for general duty while
newer pieces of machinery are delegated to more production types of tasks. The general duty may
be more hazardous than the normal production tasks on farms. As a result, general duty is often
done by the youth or the elderly. The typical farmer, the principal operator, is using the newer
machinery to plow and till the field, etc., while the older machinery may be relegated to cutting the
fence rows or ditch banks and stationary operations that may be more hazardous than doing field-
related operations. As a result, when you combine the inexperience of youth and the diminished
capacity that comes with aging (because the elderly or youth usually do this general duty) with the
inherent danger of the equipment, you have an increased potential for trauma... Research on roll-
over protection on older tractors should continue. — Dr. Thomas L. Bean

Safety Leader, Ohio Cooperative Extension Service
Ohio State University

Dr. Bean stressed the need to install ROPS on farm tractors... "ROPS is a proven intervention
strategy. Why can we not implement it?" Is the problem the cost, the infrastructure, the regulation,
or the legal system? — Penn A. Peters

Project Leader
U.S. Forest Service

In the late 1950’s and early 1960's, extensive research and development work was done by the
industry to establish the efficacy of ROPS designs for the kinds of tractor overturns that can occur
in normal farming and road transport. Manufacturers began supplying ROPS commercially in the
late 1960’s. The experience in both the United States and Europe has proven ROPS to be an
effective safety device.

There is a need for additional research on small tractors’ ROPS. The standard "protective zone"
around the tractor operator, which controls the size of the ROPS envelope, was defined on the basis
of the ergonomic data that existed in the 1950's and 1960’s. The zone remains essentially un-
changed today. The Equipment Manufacturers Institute (EMI) sponsored a literature review of the
different protective zones used for the design of several kinds of vehicles, including aircraft,
automobiles, racing cars, farm equipment, construction equipment, and mining equipment. This
study, which was performed by Triodyne, Inc. of Skokie, Illinois, has been completed. Publication
will be through both the Society of Automotive Engineers (SAE) and the American Society of
Agricultural Engineers (ASAE) before the end of 1991. The basic conclusion of the Triodyne study
was that it did not appear, from the kinds of systems that are in place, that sufficient research had
been done that could serve as the basis for making the protective zone of a ROPS, as specified by
current standards, for smaller for small tractors. Small tractors are often used in low overhead
clearance settings—in vineyards, orchards, storage buildings, and machine sheds.

Surgeon General’s Conference on Agricultural Safety and Health - 1991 xxi
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The higher the profile of a ROPS relative to an overhead object such as a tree branch, the greater
the likelihood that a farmer will not want to equip a tractor with ROPS or, if there is one on a
tractor, to keep it in place. Clearly, there is potential safety value in making the ROPS as compact
as possible without compromising protection in the event of a tip-over. As Murray Madsen
mentioned in his presentation, one approach to addressing this situation is to make ROPS that can
be raised or lowered. They telescope or fold down for temporary use in the lowered position under
low clearance conditions. There are some companies that have such ROPS on the market today.
Industry's research capabilities concerning ROPS are limited to mechanical and structural aspects.
There is little more to be done there with the exception of the small tractor ROPS.

Accident data identify tractor roll-overs as the leading cause of machinery-related death on the
farm. Therefore, perhaps the most pressing challenge for behavioral researchers and health
professionals is to find an effective way to ensure, short of compulsory measures such as regulation,
that ROPS are installed and kept on tractors. EMI believes that behavioral research in this area
holds promise of effecting a substantial reduction in roll-over injury and fatality rates. The starting
point for such research, we submit, may be recognition that over one million of the approximately
3.6 million agricultural tractors in use today in the United States do have ROPS on them. There
are over one million farmers who chose to equip their tractors with ROPS when they purchased
them. The question should be asked how these farmers arrived at their decision to equip the
tractors with ROPS. Was it because of the Occupational Safety and Health Administration’s
(OSHA) rule? Was it because manufacturers were able to package the ROPS in a cab that was
noise-insulated and isolated from vibration of the tractor? It provided air conditioning, heating,
and stereo; i.e., it was made so attractive in other respects that the farmer was willing to pay for
the ROPS cab.

Or were there other factors? The key to getting ROPS on the over-2.5 million tractors that do not
now have them may indeed be found by examining the factors in the decisions of the approximately
one million farmers who did decide to equip their tractors with ROPS. The third essential criterion
is that a safety device must not by its presence, introduce different risks that would not exist without
it. Murray Madsen referred to a study that showed that some accidents occurred because of an
operator presence-type device.

I am reminded of a situation that existed several years ago when OSHA, with all good intent,
promulgated its ROPS rule for agriculture. As it turned out, there were some small tractors that
had backhoes mounted to the three-point hitch, with a separate seat for the operator affixed to the
backhoe frame behind the tractor. Without the ROPS there was not any problem. It was
discovered that when a ROPS was installed on a tractor with the threepoint-hitch-mounted
backhoe, a crush point between the elevating backhoe boom and the rigid ROPS structure was
created. A number of fatalities occurred because of that condition. The solution was to do away
with the three-point-hitch-mounted backhoe or redesign the ROPS or both. A combination of these
measures was implemented through various field rework programs to eliminate the hazard. When
tractor ROPS were being developed, manufacturers’ test programs included actual roll-overs of
tractors with experimental ROPS designs at different attitudes and speeds. There is a need, in

many cases, to verify that a new safety feature will be acceptable to the farmer. — John H. Crowley
Director of Safety Programs
Equipment Manufacturers Institute

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 behavioral statement. An
example of this would be when evaluating the potential purchase of ROPS on a tractor a subject

edi Papers and Proceedings
Foreword

might be asked to evaluate a statement such as, "Roll-over protective structures are 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
look as follows: "My buying a roll-over protective structure in the next two years for one of my non-
ROPS equipped tractors is ." 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 action 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 toward objects (in this
example, ROPS) and people’s attitudes toward behaviors associated with objects (in this example,
buying ROPS). To predict behavior, this distinction is crucial. 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 potential 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 behavior. For example, it could be learned how much if anything
farmers would be willing to spend for a ROPS, their general perception of the need for ROPS on
their tractors, 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" approach of trying anything and seeing if it works. — Dr. Robert Aherin
Professor, Department of Agricultural Engineering
University of Illinois

>» RESPECT PEOPLE WHILE CONTROLLING THE PROBLEMS.

Again, economic realities make choices very difficult. Take for example, ROPS protection. Most
farmers know the dangers and would willingly retrofit their tractors, but there is economic reality.

— Ellen G. Widess
Director of Health and Safety Policy, Children’s Advocacy Institute
Center for Public Interest Law

"I think I am going to invest in (it) whatever it costs," although I did hear myself saying to my
husband last night, "Honey, we have got to buy roll-over bars." That is on the agenda. But we,
with other income, can probably do that; but I know people who are borrowing money to put bread

on the table. — Judith Bortner Heffernan
Executive Director of Heartland Network for Town and Rural Ministries
University of Missouri-Columbia

I heard one presenter say that her family was going to buy the roll-over protective device for their

tractor. I encourage her to follow through on this commitment. — Dr. Rice C. Leach
Chief of Staff, Office of the Surgeon General

When we looked at the tractor roll-over problem with Marshfield, we decided that there was no

need for further research on the problem. What we decided we needed was a way to help farmers
who wanted to retrofit older tractors with roll bars or other roll-over protective devices to find those

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

"ROPS," as they are called. So we asked Marshfield to develop and publish a catalog of all
American manufacturers of "ROPS," all products they produce and what make of tractor, model
of tractor, and year of tractor they will build. Then Marshfield sent the catalog to all extension
agents in the country, SO it is available where it is needed. Producing that catalog is not the best
step we could take as a society. As we have seen in the slide on the Swedish experience, the best
step we could take would be to require "ROPS." But as an Office, it was the best we could do.

— Jeffrey Human
Director, Office of Rural Health Policy
USS. Public Heaith Service

We have also seen ROPS development and the recent development of retractable or foldable ROPS
for those essential applications where you must go into a building that is shorter — not as tall as
your tractor’s ROPS. I would also say to those of you who wonder about ROPS that since 1985
virtually every tractor produced has been sold with a ROPS on it or right at the fingertips. Since
1970, virtually every tractor could have a ROPS put on it, and some have since 1960. Consider,
for example, how to convince the owner of a 30-year-old tractor worth, at most, $1,000, to put a
$500 ROPS on it. The University of Illinois, NIOSH, and the University of Iowa are doing research
to help find some of those kinds of answers. A ROPS that provides protection and still meets the
needs of users under limbs, vines, and rafters holds promise. It is likely that this kind of roll-over
protection will produce more acceptable designs for the user. Perhaps it may not produce as much
protection as users have become accustomed to with larger or more conventional roll-over protective
structures. Is there an opportunity for validating acceptable ROPS for more compact tractors?

— Murray Madsen
Product Safety Engineer for Agricultural Equipment
Deere and Company

There are also recommendations aimed at reducing specific hazards, such as the danger of injury
or death in tractor roll-over or from moving machinery parts .. - OSHA also reviews existing
standards that apply to agriculture, such as the ROPS standard. We look at whether these
standards should be modified to reflect changing conditions in the United States, in the world, and
in the industry. We need your help, though, on reviewing and modifying these standards, if we are
to have good, common-sense safety standards. In another area, a member of our staff has been
comparing the new standard on ROPS for tractors and other vehicles, which was adopted by SAE,
to the existing OSHA standard. We have received design and test data from American tractor
manufacturers and others. We have made a preliminary conclusion that the new SAE standard
is equal to or exceeds the current OSHA standard and, therefore, is acceptable to the agency. A
final decision on this will be made shortly. Hopefully, this will make it easier for American farm

equipment manufacturers to compete in the European market. — Cynthia Douglass
Deputy Assistant Secretary of Labor
U.S. Occupational Safety and Health Administration

> UNDERSTAND "THE SYSTEM" IN ORDER TO CONTROL THE PROBLEMS.

Look no further than the agriculture-implement lobby here today. This lobby has blocked roll-over
protection in this country for 30 years with knee-jerk, protective, self-interested arguments that
continue to allow farmworkers to die in this country, out of their narrow interest. That is wrong.
The reason that it happened is not because we have not done enough scientific research to

document the problem. — Craig Merrilees
Director, Consumer Pesticide Project

XxiV Papers and Proceedings
Foreword

ROPS for tractors and tractor seat-belt use could prevent the majority of tractor-related deaths. Vir-
tually all new tractors sold in the United States have ROPS . .. Because of the relatively long life
of tractors, most agricultural tractors in use do not have ROPS in place. Nearly half of the
approximately 400 tractor-related deaths that occur each year in this nation involve roll-overs. How
do we ensure that the older tractors and machines without these modern safety features get
retrofitted with modem safety features when feasible or get taken out of use? The issue of how

such updating and retrofitting is practical presents a significant challenge . . . Although more
research and more data are needed to direct intervention, we know certain health and safety
precautions work; ROPS work. — Dr. Myron D. Johnsrud

Administrator, Extension Service
U.S. Department of Agriculture

Perhaps the best example of passive controls is ROPS. — Dr. David S. Pratt
Director, New York Center for Agricultural Medicine and Health
Cooperstown, NY

There are some issues, the ROPS issue is the most typical one, that we can approach from a
national perspective. — Dr. Dennis Murphy
Professor, Penn State University

The cominittee divided itself into working groups to develop suggestions and recommendations in
the areas of training, and also in the needs for standards like ROPS and machine guarding. In
1972, the full committee recommended its first standard. They recommended that we do a ROPS
rule for farm tractors. The first agricultural standard that OSHA issued under its normal
rule-making was the ROPS standard. We proposed that back in 1975, we finalized it in 1975, and
it became effective in October, 1976. It dealt with all farm tractors made after October, 1976, they
had to be equipped with the ROPS. The standard is based on the ASAE Standard, J11-94. The
complete text of that Standard was put into the OSHA standard.

Even though tractors were required to have ROPS, we continue to see deaths of tractor operators
from roll-overs. We have seen seat belts cut off or cut out; seat belts were not used in several roll-
over deaths. Obviously, we have not seen the results that the Swedes have achieved with their
standardization efforts. OSHA wants to see its standard evaluated. We want to see this standard
looked at very thoroughly to see why it is not working. What can we do to modify it, to make it
work, to become more effective? We know that seat belts are considered by many farmers and
farmworkers as a hassle in hooking and unhooking, especially when you have to get off the tractor
a number of times. The new ASAE Standard, J21-9.4, is a revision of this effort. We have said
publicly that the standard is acceptable in meeting our ROPS standard that we require here. We
have done that administratively. The International Standards Organization (ISO) is also involved
in writing standards for ROPS, and the ISO Standards 5700 and 34-63 are additional new ROPS
standards. Our ROPS standard is not as stringent as theirs. In our opinion, if you have a ROPS
design that meets all the tests of the ISO Standards, that will be acceptable in meeting the OSHA
Standard as well. — Thomas H. Seymour

Fire Protection Engineer, Directorate of Safety Standards
U.S. Occupational Safety and Health Administration

Due to engineering advances in the last three decades, farm equipment manufacturers have incor-
porated more safety devices on their equipment. Integral rotary shields for power take-off shafts
and roll-over protective structures for tractors have been two major accomplishments in making
farm machinery more user-safe. Since tractor roll-overs are involved in a large portion of
agricultural fatalities, elimination of this type of incident alone would cause the death rate on

Surgeon General’s Conference on Agricultural Safety and Health - 1991 XXV
Foreword

American farms to plunge. But farmers themselves must make the commitment to run a safe
operation. When they see the dangers and lear the advantage, safety happens. In Nebraska, for
example, university safety experts have conducted 450 tractor roll-over demonstrations since 1970
to convince farmers of the dangers. About 23,000 young people were trained in tractor safety.

There have been two known fatalities in this group. The national average for a group that size

would be five deaths. — Merlin Plagge

President, lowa Farm Bureau

In conclusion, I wish to thank CAPT Melvin L. Myers for his hard work in planning and
managing both the Surgeon General's Conference on Agricultural Safety and Health and
the production of these Papers and Proceedings. I also wish to thank the rapporteurs,
CAPT Robert F. Herrick, CAPT Stephen A. Olenchock, Mr. John R. Myers,

CDR John E. Parker, and Dr. David L. Hard, who assisted with the concurrent sessions
and the editing of the papers presented at those sessions.

I wish to thank Ms. Katherine Wilson who coordinated the poster and video tape session
ind reviewed the abstracts from those posters for this publication. Many others who

nelped to make this Conference a success are named in the acknowledgements of this
document.

But most of all, it was the work of the 540 participants at this Conference who made it a
success through honest engagement with the issues and interaction with others. Their
names are listed by their respective state near the end of this document. My thanks to

all for making this Conference a splendid success in our national movement to improve
the safety and health of agricultural workers and their families.O

an

J. Donald Millar, M.D., D.T.P.H. (Lond.)
Assistant Surgeon General

Director, National Institute

for Occupational Safety and Health

xxvi Papers and Proceedings
Surgeon General’s Conference on Agricultural Safety and Health
FARMSAFE 2000 ¢ A National Coalition for Local Action
Convened by the National institute for Occupational Safety and Health

April 30 - May 3, 1991, Des Moines, lowa

Melvin L. Myers, M.P.A. - Chair
Office of the Director

NIOSH, CDC

1600 Clifton Rd, NE

Atlanta, GA 30333

Robert W. Mason, Ph.D.
Division of Standards
Development and Technology
Transfer, NIOSH, CDC

4676 Columbia Pkwy
Cincinnati, OH 45213

Stephen A. Olenchock, Ph.D.
Division of Respiratory Disease
Studies, NIOSH, CDC

944 Chestnut Ridge Rd
Morgantown, WV 26505

Katherine Wilson, M.P.H.
Division for Chronic Disease
Control and Community
Intervention, NCCDPHP, CDC
3005 Chamblee-Tucker Rd
Chamblee, GA 30341

Robert A. Wright

Office of Vital and Health
Statistics Systems, NCHS, CDC
6525 Belcrest Rd

Hyattsville, MD 20782

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

Lawrence J. Doemeny, Ph.D.
Division of Physical Sciences and
Engineering, NIOSH, CDC

5555 Ridge Ave

Cincinnati, OH 45226

Pantelis G. Rentos, Ph.D.
Division of Training and
Manpower Development
NIOSH, CDC

4676 Columbia Pkwy
Cincinnati, OH 45213

John R. Myers, M.S.F.
Division of Safety Research
NIOSH, CDC

944 Chestnut Ridge Rd
Morgantown, WV 26505

John J. Coumbis, M.D.
Oak Ridge Fellow, ATSDR
1600 Clifton Rd, NE
Atlanta, GA 30333

Stephen M. Ostroff, M.D.
Division of Bacterial and Mycotic
Diseases, NCID, CDC

1600 Clifton Rd, NE

Atlanta, GA 30333

THE PLANNING COMMITTEE

Russell E. Savage, Ph.D

Division of Biomedical and
Behavioral Science, NIOSH, CDC
4676 Columbia Pkwy

Cincinnati, OH 45213

Robert F. Herrick, Sc.D.
Division of Surveillance, Hazard
Evaluation, and Field Studies
NIOSH, CDC

5555 Ridge Ave

Cincinnati, OH 45226

Paul Burlack

Division of Injury Control
NCEHIC, CDC

2858 Woodcock Blvd
Chamblee, GA 30341

William H. Gimson

Financial Management Office
OPS, CDC

255 E Paces Ferry Rd
Atlanta, GA 30305

XXVii
The Planning Committee

— ADVISORS TO THE PLANNING COMMITTEE —

John E. Parker, M.D.
Division of Safety Research
NIOSH, CDC

944 Chestnut Ridge Rd
Morgantown, WV 26505

Bradley K. Rein, P.E.
Extension Service, USDA
Rm 3346, South

14th and Industrial Ave, SW
Washington, DC 20250

Jeffrey H. Lancashire
Office of the Director
NIOSH, CDC

1600 Clifton Rd, NE
Atlanta, GA 30333

Ann M. Cronin
Office of the Director
NIOSH, CDC

1600 Clifton Rd, NE
Atlanta, GA 30333

Xxvili

David L. Hard, Ph.D.
Division of Safety Research
NIOSH, CDC

944 Chestnut Ridge Rd
Morgantown, WV 26505

Cathy J. Wasem, RN, MN
Office of Rural Health Policy
Health Resources and Services
Administration

5600 Fishers Ln, Rm 14-22
Rockville, MD 20857

Vivian K. Morgan

Division of Standards
Development and Technology
Transfer, NIOSH, CDC

4676 Columbia Pkwy
Cincinnati, OH 45213

Stephen Mallinger

OSHA, US Department of Labor
Rm N3653

200 Constitution Ave, NW
Washington, DC 20210

Dushanka V. Kleinman, D.D.S.
Office of the Surgeon General
USPHS, Rm 710G

200 Independence Ave, SW
Washington, DC 20201

Todd M. Frazier, Sc.M.

Division of Surveillance, Hazard
Evaluation, and Field Studies
NIOSH, CDC

5555 Ridge Ave

Cincinnati, OH 45226

Papers and Proceedings
Surgeon General’s Conference on Agricultural Safety and Health
FarMSare 2000 « A National Coalition for Local Action

Convened by the National institute for Occupational Safety and Health
April 30 - May 3, 1991, Des Moines, lowa

ACKNOWLEDGEMENTS

Convening and holding the Surgeon General’s Conference on Agricultural Safety and
Health was a team effort as was preparing these Papers and Proceedings. In addition to
the planning committee and their advisors, the presenters, the panel moderators and
rapporteurs, and panel members, we wish to thank the following staff to the Surgeon
General, NIOSH staff, and editorial advisors for their diligent work for this Conference
and for their help in the preparation of this document:

For their willing and timely assistance from the Office of the Surgeon General,
Dushanka V. Kleinman, D.D.S., who served as the principle liaison within the Office,
Rice C. Leach, M.D., who maintained an open door for resolving the most pressing
problems, and for assisting the Surgeon General, Elizabeth P. Schmidt, Theresa Hyatt,
and Margaret Garikes. .

For their attention to detail and quality from NIOSH, Kimberly L. Barth for her diligent
work in assembling and preparing much of the information that proceeded the con-
ference and that is in this document including coordinating its changes,

Elizabeth H. Dryden who coordinated with commitment and diplomacy the staff and the
logistics of the conference with the contractor; Trevia K. Pereira for her early assistance
to the planning committee; Reneé L. Ross for her willing help in formatting the abstracts
and appendixes of this document; Amy A. Huston, Julie A. Wasil, and Judy L. James for
their assistance in making the many editorial changes during the progress of this
document; Ann M. Cronin, Mary B. Griffin, Richie D. Dickerson, Kay Basile,

Terry L. Stewart, Terri L. Sims, Kami L. Townsend, and Lunette K. Utter, who helped
with the logistics at the Conference; Janice M. Huy, Vivian K. Morgan, and

Charlene B. Maloney for their professionalism in preparing and showing the Conference
exhibit.

For their assistance as editorial advisors from NIOSH, Newell E. Tozzer,

Charlene B. Maloney, Shirley M. Carr, William E. Halperin, M.D., and

Richard A. Lemen, Ph.D. For their added assistance as editorial advisors,

Henry A. Anderson, M.D., Ph.D., Kelley J. Donham, D.V.M., Lorann Stallones, Ph.D.,

David S. Pratt, M.D., Walter J. Armbruster, Ph.D., Rice C. Leach, M.D.,
Cathy J. Wasem, RN, MN, and Valerie A. Wilk, M.S.

And for her superb work as the contractor for this conference, Rosita Bachmann and to
her associates.O

Surgeon General’s Conference on Agricultural Safety and Health - 1991 XXIX
Surgeon General’s Conference on Agricultural Safety and Health
FarmSare 2000 « A National Coalition for Local Action

Convened by the National Institute for Occupational Safety and Health
April 30 - May 3, 1991, Des Moines, lowa

TABLE OF CONTENTS

ii National Farm Safety Week, 1991: A Proclamation
By the President of the United States of America

v_ Preface By Antonia C. Novello, M.D.
vii Foreword By J. Donald Millar, M.D.
xxvii The Planning Committee
xxix Acknowledgements

xxx| Table of Contents

1 Welcome from the Chair of the Conference By J. Donald Millar, M.D.
2 Welcome to Des Moines By John P. Dorrian
3 Welcome to lowa By Christopher G. Atchison, M.P.A.

THE POTENTIAL FOR A NATIONAL COALITION
Moderator: Antonia C. Novello, M.D.

 

7 Raising Safety and Health Consciousness among Farmers and Farmworkers
By Ellen G. Widess, J.D.

17 Building Coalitions for Preventing Injury and Disease in Agriculture
By Thomas M. Dean, M.D.

22 Disseminating Safety and Health Information through Education
By J. Michael McGinnis, M.D.

28 Encouraging Action in Preventing Injury and Disease in Agriculture
By Louis W. Sullivan, M.D.

30 Surgeon General Conferences: A Model for the Future
By Antonia C. Novello, M.D.

Surgeon General’s Conference on Agricultural Safety and Health - 1991 XXX
Table of Contents

L

   

35 Remarks by the Chair of the Conference By J. Donald Millar, M.D.
36 Healthy People 2000 and Agriculture By Senator Tom Harkin
43 Building Infrastructures for Prevention By William L. Roper, M.D.
48 Charge to the Conference By Antonia C. Novello, M.D.
QUESTIONS TO GUIDE THE NATIONAL AGENDA Moderator: Mark Timm

“A aeteeteieeetee elation en rettenteercententettes

   

 

Meee acer ere eee eee ee eee ee tee eee ee ee ee eee eee eee ee ee eee ee ae ee ees

55 Remarks by the National FFA President By Mark Timm

59 The Role of Public Policy in Agricultural Safety and Health
By Joseph A. Kinney, M.P.A.

67 Surveillance for Agricultural Safety and Health By William E. Halperin, M.D.
73 Research for Agricultural Safety and Health By James A. Merchant, M.D.
86 Intervention for Agricultural Safety and Health By Myron D. Johnsrud, Ph.D.

MEDICAL INTERVENTION PROBLEMS AND OPPORTUNITIES

 

93 Rural Health Policy By Jeffrey Human, M.A.

97 Medical Intervention Problems and Opportunities in Rural Areas
By Governor Robert D. Ray

ISSUES THAT AFFECT THE NATIONAL AGENDA

 

 

 

105 Introductory Remarks By Ronald D. Eckoff, M.D.
107 The Agricultural Workforce By Leslie A. Whitener, Ph.D.
123 Attitudes and Risk Behavior in Agriculture By Pamela D. Elkind, Ph.D.
129 Industrial Crops of the Future By Daniel E. Kugler, Ph.D.
134 Biotechnology and Agriculture By Jane Rissler, Ph.D.

XI Surgeon General’s Conference on Agricultural Safety and Health - 1991
Table of Contents

 

143 Surveillance: A Physician’s Viewpoint By John J. May, M.D.
151 Chemical Hazards By Linda Rosenstock, M.D.
157 Respiratory Diseases By James A. Dosman, M.D.
161 Surveillance of Injuries in Agriculture By Susan G. Gerberich, Ph.D., et. al.
179 Musculoskeletal Disorders and Hazards By John J. Coumbis, M.D.
184 A Government Perspective | By Todd M. Frazier, Sc.M.
189 A Government Perspective Il By Eugene Freund, Jr., M.D.
492 A Consumers’ Perspective By Craig Merrilees, B.A.
199 An Agricultural Safety Perspective By Dennis J. Murphy, Ph.D.

2. Research — Chemical and Biological Hazards

Moderator: Kelley J. Donham, D.V.M. Rapporteur: S tephen A. Olenchock, Ph.D.
204 Airborne Dusts By Susanna Von Essen, M.D.
216 Infectious Diseases By Russell W. Currier, D.V.M.

229 An Overview of Potential Health Hazards among Farmers from Use of Pesticides
By Aaron Blair, Ph.D.

243 Gases, Liquids, Vapors, and Drugs By William Popendorf, Ph.D.
255 The Migrant Workers’ Perspective By £. Roberta Ryder, B.A.
261 A Foundation’s Perspective By Gene F. Graham, M.S.
267 A Clinical Perspective By Dean T. Stueland, M.D.

Surgeon General's Conference on Agricultural Safety and Health - 1991 XOX il
Table of Contents

3. Research - Mechanical and Physical Hazards

Moderator: Loran S talloneS, PAD. munR@pporteur: John R. Myers, M. Sf.
274 Farm Machinery and Vehicles By Thomas L. Bean, Ph.D.
278 Musculoskeletal Hazards By David Cochran, Ph.D.
285 Electrical Power By Robert L. McLymore, M.S.
293 Noise and Stress By Matthew Marvel, M.D.
299 Technology Transfer By Murray Madsen, P.E.
308 The Manufacturers’ Perspective By John H. Crowley, M.B.A.
317 A Forestry Perspective | By Penn A. Peters, P.E.
321 A Regulatory Perspective By Thomas H. Seymour, P.E.

4. Intervention - Agricultural Workers’ Protection from Hazards

Moderator: David S. Pratt, MoD e mmm t@ppOrteur: John E. Parker, M.P.
327 Farming Methods and Systems Analysis By Gary Erisman, Ph.D.
334 Ergonomics By Stephan Konz, Ph.D.
340 Personal Protective Equipment By Richard A. Fenske, Ph.D.
351 Machine Design By Sverker Hoglind, M.D.
357 Vector Control By Robert R. Pinger, Ph.D.
365 A Consulting Engineer's Perspective By Ray H. Crammond, P.E.
372 An Extension Specialist’s Perspective By Rollin D. Schnieder, M.S.
378 An Agricultural Engineering Perspective By L. Dale Baker, P.E.

XXIV Surgeon General's Conference on Agricultural Safety and Health - 1991
Table of Contents

5. Intervention - Safe Behaviors among Adults and Children

Moderator: Walter J. Armbruster, POD. sss Rapporteur: David L. Hard, Ph.D.
383 Health Education By Rodney Gilmore, B.S., B.A.
391 Vocational Agriculture By Robert Graham, M.S.
397 The Mass Media and Agriculture By Chery! Tevis, M.A.
405 Multilingual Training By Malanie Zavala, B.S.
412 County Health Education By Larry Belmont, M.P.H.
419 A Rural Sociologist’s Perspective By Judith Bortner Heffernan, M.A.
432 Young Farmers’ Perspective . By Wayne Sprick
437 Farm Family Behavior Perspective By Robert Aherin, Ph.D.

ELEMENTS OF A NATIONAL AGENDA

Moderator: Richard A. Lemen, Ph.D.

 

445 Surveillance - Agriculture-Related Diseases, Injuries, and Hazards
By Henry A. Anderson, M.D.

448 Research - Chemical and Biological Hazards By Kelley J. Donham, D.V.M.
453 Research - Physical and Mechanical Hazards By Lorann Stallones, Ph.D.

457 Intervention - Agricultural Workers’ Protection from Hazards
By David S. Pratt, M.D.

462 Intervention - Safe Behaviors among Adults and Children
By Walter J. Armbruster, Ph.D.

466 Report on Migrant and Seasonal Farmworkers By Valerie A. Wilk, M.S.

Surgeon General’s Conference on Agricultural Safety and Health - 1991 XXXV
Table of Contents

   

A TONS OR TNE te satimamememmeanaimmmmenanl coer Pcs C oeacn Oe
471 Outstanding FFA Poster By Rice C. Leach, M.D.
472 OSHA Initiatives in Agricultural Safety and Health By Cynthia Douglass
479 Sustainable Agriculture and Safety By Willis R. Eken
485 The Farm Bureau’s Continuing Commitment By Merlin Plagge
489 A Victim's Perspective of the Conference By Marilyn Adams
492 Conference Summary By Rice C. Leach, M.D.

MAKING CONNECTIONS

Coordinator: Katherine Wilson, M.P.H. Co-coordinator: Ann M. Cronin

   

498 Poster Abstracts
582 FFA Poster Abstracts

597 Video Presenters

PARTICIPANTS
_gaanangerenng nn oatdacnaneatenamn tana ane andeticone neh nee aE Rt eae RA EASE RSS AN R A EO OEE LE EEO ER RR TE sppannessanocencencnnbinatanesianiseittin

   

601 National Participants

620 International Participants

BSB SEONG CE CEE CEU SEES SUDA RORODU OEE LEED RU OOS EEE STOOL ELBERT LET

621 Acronyms
625 Metric System of Weights and Measures
627 The Surgeon General’s Conferences on Occupational Health By Anne Mather

629 Excerpts from Diseases of Workers By Bernardino Ramazzini

HOO CONE A O OLESEN EIEIO ORE LIA IE RELEASE NAAT CEE

637 |NDEX

XOXvi Surgeon General’s Conference on Agricultural Safety and Health - 1991