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In the United States, diabetes is the seventh leading cause of death and continues to rise in prevalence, with type 2 diabetes accounting for 90–95% of all cases. Rates of diabetes in Kentucky, and, in particular, the Appalachian region, are among the highest in the nation and are increasing faster than the national average. Despite this disproportionate burden, barriers to clinical appointment attendance have not been fully explored in this population. This article examines the association among perceived barriers to clinical attendance, glycemic control, and diabetes self-care as part of an ongoing study. We used a 25-item checklist developed using the Chronic Care Model to assess participants’ barriers to clinic attendance. Glycemic control was assessed via A1C measurement. Diabetes self-care was assessed using the Summary of Diabetes Self-Care Activities measure. At the time of analysis, 123 of the 356 participants (34.6%) did not report any barriers to clinic attendance. For the remainder, the major reported barriers included forgetting appointments, inability to afford medicines or other treatment, and placing faith above medical care. The average A1C was 7.7%, and the average diabetes self-care summary score was 17.1 out of 35 points (with higher values indicating better self-care). Missing clinic appointments is associated with lower health outcomes, especially in vulnerable populations. This study can help educate clinic staff on perceived barriers to type 2 diabetes management among people with diabetes in Appalachia.

Background Exposure to tobacco product marketing increases tobacco use among young adults, especially those from vulnerable communities (VCs). Purpose This study examined real-time tobacco marketing exposure among young adults from vulnerable and non-vulnerable communities using Ecological Momentary Assessment (EMA). Methods This study used EMA data to assess context (e.g., location and activity) of tobacco marketing exposure using four text-messaging surveys per day over 2 weeks. Young adult non-current tobacco users living in Washington, D.C. (n = 146; ages 18–24) recorded 5,285 surveys, including 20 participants (13.2%) from VCs with high proportions of lower income and racial/ethnic minorities, and high smoking rates. Unadjusted and adjusted multilevel logistic regressions were used to assess the associations between exposure to any and flavored tobacco marketing, VC residence, and real-time context. Results Fifty-nine participants (40.4%) reported at least one tobacco marketing exposure and recorded 94 exposure moments. In adjusted models, odds of exposure were higher among VC residents (AOR = 2.6, 95% CI = 1.2–5.4), in the presence of anyone using tobacco versus no use (AOR = 4.0, 95% CI = 2.4–6.7), at store/retail (AOR = 17.0, 95% CI = 6.4–44.8), or outside/in transit (AOR = 4.1, 95% CI = 2.1–7.8) versus at home. VC residence (AOR = 7.2, 95% CI = 2.3–22.2) was the strongest predictor of flavored tobacco marketing exposure among all covariates examined. Conclusions Young adults are predominantly exposed to tobacco marketing in their daily lives through retail advertisements. Young adults from VCs are at increased risks of seeing any tobacco and especially flavored tobacco marketing. Policies that curtail tobacco retailer density and advertisement displays may reduce overall and differential tobacco marketing exposure.

BackgroundAudits of tobacco retail stores can identify marketing patterns as newer tobacco products are introduced in the US. Our study examined store and neighborhood correlates of availability of nicotine pouches and disposable e-cigarettes in four US sites.MethodsWe conducted standardized store audits of n=242 tobacco retailers in 2021 in different states: New Jersey, Kentucky, North Carolina, and New York. Store audits focused on availability of nicotine pouches and disposable e-cigarettes. We geocoded stores linking them with census tract demographics. We conducted unadjusted and adjusted Poisson regression of availability of each product with correlates of the proportion of Non-Hispanic White residents, households under poverty, proximity to schools, site, and store type.ResultsNicotine pouches and disposable e-cigarettes were each available in around half the stores, but availability differed across sites. In adjusted analyses, nicotine pouches were less likely to be available in each store type vs. chain convenience and more likely in stores in census tracts with more non-Hispanic White residents. In contrast, disposable e-cigarettes were more likely to be available in tobacco store/vape shops than convenience stores and less likely in non-specialty store types like groceries.ConclusionsThe availability of newer tobacco products like nicotine pouches and disposable e-cigarettes were widely available in stores across sites, but retail marketing patterns appear to differ. As these product types become subject to increased regulation as they go through the FDA pre-market authorization process, understanding changes in their retail environment is critical to inform potential policies regulating their sale and marketing.

Introduction: The prevalence of cardiovascular disease (CVD) and type 2 diabetes (T2DM) in Appalachian communities is among the highest in the nation. Health literacy, one’s ability to understand and use information to make health-related decisions, influences self-care practices which, in turn, shape chronic disease prevalence and outcomes. Hypothesis: Higher levels of health literacy are associated with optimal self-care practices among rural Appalachian adults with T2DM. Methods: Adults (N=356) diagnosed with T2DM were recruited from community sites across six rural Appalachian counties in Kentucky. Health literacy was measured using the New Vital Sign (NVS), with scores ranging 0-6. T2DM self-care was assessed using the Summary of Diabetes Self-Care Activities (SDSCA), with scores ranging 0-35. Linear mixed-effects models with random effects to account for clustering at the community level and household within site were fit to examine the association between level of health literacy and self-care practices. Results: The majority of the sample identified as female (65%), with a mean age of 64.2 years (SD: 10.6). The mean and median health literacy scores were 4.0 (SD: 2.0) and 5, respectively, indicating moderate health literacy. T2DM self-care scores ranged from 4-33 (Median= 17, Mean=17.1, SD: 6.3), indicating room for improvement concerning frequency of self-care practices. Specifically, average rates of self-care practices per week included following a generally healthy diet 3 days (SD: 2), exercising for 30 minutes 2 days (SD: 2), measuring blood sugar level 4 days (SD: 3), and practicing foot care 5 days (SD: 1). Health literacy was not associated with self-care practices when controlling for age, sex and financial status. Conclusions: Contrary to our hypothesis, results do not suggest a direct association between health literacy and T2DM self-care practices among Appalachian adults. Future studies should explore other personal or socio-cultural factors that may influence T2DM self-care among vulnerable populations experiencing numerous risk factors of cardiometabolic disease.

Background Opioid use has risen dramatically in recent years, and its illegal use puts first responders at risk when intervening in overdoses. Synthetic opioids, like fentanyl with a potency 50 to 100 times greater than morphine, pose a great risk and accidental exposure via ingestion, inhalation, mucosal, or percutaneous routes, can potentially lead to fatal outcomes. Anecdotal media accounts in early 2017 of accidental occupational opioid exposure among first responders generated a national concern. Methods To identify first responders' recollections, beliefs, and concerns about possible occupational exposure to opioids and other drugs, researchers in Kentucky, Virginia, Mississippi, and Georgia administered an emailed, anonymous convenience sample survey. Results A total of 5955 surveys were analyzed with 15% of respondents reporting they believed they had been exposed to opioids, and of those, less than 1% reported experiencing health effects from perceived exposure. Over half (51%) of respondents reported being “very or somewhat concerned” about developing health effects from exposure to opioids. Half of respondents reported being unaware of Centers for Disease Control and Prevention (CDC)/National Institutes for Occupational Safety and Health (NIOSH) guidelines for preventing occupational‐related opioid exposures. Conclusions Only a small fraction of first responders believed they had experienced symptoms related to opioid exposure in overdose response calls, but half were concerned about potential exposures and half were unaware of the educational guidance on prevention available. The high level of concern regarding potential exposure warrants the need for the development and or enhancement of targeted educational training interventions and further dissemination of pre‐existing training interventions to ensure first responders have the knowledge and understanding of occupational opioid exposures and minimize stress associated with the potential rare exposures.

K-12 school staff from Indiana, Kentucky and Ohio were asked about their use of disinfectants to mitigate the spread of COVID-19 in schools. Survey participants (n = 1,555) reported frequent use of disinfectants, often using unknown products, and were provided little to no training on safe and effective use. Participant concerns included student involvement in disinfection, inadequate ventilation, surface contact time, and potential health effects.

Background: Despite disproportionate rates of diabetes among Appalachian residents, barriers to attending clinical appointments have not been fully explored. We examined the association between barriers to clinic attendance, A1c, and self-care. Methods: We report baseline cross-sectional data from an ongoing study of participants in six counties in rural Appalachia Kentucky. Barriers to clinic attendance were measured using a 25-item checklist adapted from the Chronic Care Model and self-care was measured using a summary score from Toobert’s Diabetes Self-Care Activities. Linear regression models were fit with varying levels of adjustment. Results: Most study participants (N=356) where White (n=349), women (n=230), and had health insurance (n=349). Average A1c was 7.7% (SD=1.7%). No barriers were reported by 37.4% of participants. In fully adjusted models, not being worried about diabetes was significantly associated with diabetes self-care. Inaccessible transportation and co-payment, and the belief that God (but not them) will help their diabetes were significantly associated with A1c (Table 1). Conclusions: Both logistical and cognitive barriers obstruct clinic attendance in this sample. Additional aspects or barriers to clinical attendance could be cognitive or emotional, such as social support and cultural norms. Future research should develop interventions for these logistical and cognitive barriers. Disclosure B. L. Smalls: None. M. Lacy: None. L. Hieronymus: None. P. Westgate: None. M. Azam: None. S. C. Westneat: None. N. Schoenberg: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK112136)

Introduction Flavored tobacco products (FTPs) are disproportionately used among young people and racial/ethnic minority populations. However, few studies have examined the retail distribution of such product marketing beyond menthol cigarettes. This study created geographic-based predictions about marketing of FTPs (overall, cigarettes, cigars, e-cigarettes, and smokeless) in stores across Washington, DC neighborhoods. We examined neighborhood-level demographic correlates of the amount of FTP and non-FTP marketing. Methods We conducted photographic audits of interior and exterior tobacco marketing in 96 Washington, DC tobacco retailers visited by 149 young adult respondents between 2018–2019. We created a geographic predictive surface of overall and product-specific tobacco marketing and then estimated the average predicted amount of marketing at the census-tract level using zonal statistics. Using linear regression, we examined neighborhood demographic correlates (race/ethnicity, family poverty, and youth population under 18) of FTP and non-FTP marketing. Results The predicted amount of non-FTP ads/displays were evenly distributed with no neighborhood variability (Range 8.46–8.46). FTP marketing overall was geographically concentrated with greater range across neighborhoods (Range 6.27–16.77). Greater FTP marketing overall and flavored cigar marketing was available in neighborhoods with higher percentages of Black residents. Flavored cigar marketing was less available in neighborhoods with more Hispanic residents, but there was greater flavored smokeless tobacco marketing. Nonflavored marketing overall and by product did not vary across neighborhoods. Conclusions This study provides evidence of disproportionate distribution of FTP marketing in Black neighborhoods, especially for flavored cigars, at the point-of-sale. Policies that restrict the sale of FTPs may enhance health equity. Implications Tobacco marketing has frequently been shown to be more prevalent in neighborhoods with lower household income and more Black residents. Using geographic-based predictions, we find that greater flavored tobacco marketing in these neighborhoods, not decreased marketing for nonflavored tobacco, is driving this disparity. Targeting Black neighborhoods with increased marketing of flavored tobacco products, which has been found to be more appealing, easier to use, and harder to quit is a social justice issue.

Background Adult smoking prevalence in Central Appalachia is the highest in the United States, yet few epidemiologic studies describe the smoking behaviors of this population. Using a community-based approach, the Mountain Air Project (MAP) recruited the largest adult cohort from Central Appalachia, allowing us to examine prevalence and patterns of smoking behavior. Methods A cross-sectional epidemiologic study of 972 participants aged 21 years and older was undertaken 2015–2017, with a response rate of 82%. Prevalence ratios and 95% confidence intervals for current smoking (compared to nonsmokers) were computed for the entire cohort then stratified by multiple characteristics, including respiratory health. Adjusted prevalence ratios for current smoking versus not smoking were also computed. Results MAP participants reported current smoking prevalence (33%) more than double the national adult smoking prevalence. Current smoking among participants with a reported diagnosis of chronic obstructive pulmonary disease and emphysema was 51.5 and 53.3%, respectively. Compared to participants age 65 years and older, those age 45 years or younger reported double the prevalence of smoking (PR: 2.04, 95% CI: 1.51–2.74). Adjusted analyses identified younger age, lower education, unmet financial need, and depression to be significantly associated with current smoking. Conclusions Despite declining rates of smoking across the United States, smoking remains a persistent challenge in Central Appalachia, which continues to face marked disparities in education funding and tobacco control policies that have benefitted much of the rest of the nation. Compared with national data, our cohort demonstrated higher rates of smoking among younger populations and reported a greater intensity of cigarette use.

The use of certified physician assistants (PA) has increased throughout the US health care system. The purpose of this study was to objectively evaluate physicians' perceptions of PAs' mastery of specific skills. It is important to understand stakeholders' perceptions of PAs' capabilities to support future changes in policies for better utilization of PAs in our health care system.From 2014 to 2015, randomly chosen "active" physicians listed with the Kentucky Board of Medical Licensure were surveyed about their perceptions of competencies of certified PAs. Six competency domains (medical knowledge, interpersonal and communication skills, patient care, professionalism, practice-based learning, and improvement and systems-based practice) were rated using a Likert scale. Each competency-derived skill-based question was ranked by the number of physicians giving the highest scores on the Likert scale (a score of 4 or 5) and by effect size. Cronbach's alpha for the survey was calculated.An overwhelming majority of the physicians perceived certified PAs to be competent (n ≥ 161, ≥ 60%) for specific skills. The survey had internal consistency with Cronbach's alpha ranging from 0.75 to 0.87 for competency domains. Effect size ranged from 0.44 to 0.98 for scores given by physicians with, versus without, experience with PAs.For the first time, there is objective evidence of physicians' perceptions of PAs' mastery of specific competency-derived PA skill sets. This study will help guide effective utilization of PAs throughout the health care system and future PA education.

OBJECTIVE The purpose of this study was to assess for any associations between individual and social factors and late-stage melanoma in Kentucky from 1995 to 2013. METHODS The study combines three datasets: individual-level data from the Kentucky Cancer Registry, census tract-level data from the US Census, and county-level physician licensure data from the Kentucky Department for Public Health. The study population is described by all cases, early stage, and late stage. Logistic regression was used to evaluate the unadjusted associations between each covariate and early-stage and late-stage disease groups. All of the significant variables were assessed for interaction effect, and the significant interaction terms were used in the final model. Multiple logistic regression provided the final model of late-stage disease. RESULTS In this study population, a dramatic increase in melanoma incidence is seen from 1995 to 2013 with a threefold increase in the number of cases per year. Of the 10,109 cases reported, 13.6% have late-stage disease, with a mean age for all cases at 56.9 years and the majority being men. Late-stage cases are more commonly uninsured or insured with Medicaid or Medicare compared with cases with early-stage lesions. Having a spouse or partner is clearly protective from being diagnosed as having late-stage melanoma, whereas being uninsured or having Medicaid increases the odds of late-stage melanoma. CONCLUSIONS The incidence of melanoma is increasing dramatically. With no screening recommendation for the general population from the US Preventive Task Force, clinicians should focus on those at increased risk of late-stage melanoma: unmarried men who are uninsured or receiving Medicaid.

Children residing on farms with livestock may be at an increased risk for work-related injuries, compared to children who work on other commodity farms. This study characterizes children's work tasks on Kentucky farms and assesses whether children who work on beef cattle farms are at an increased risk for farm work injuries. The results of a cohort study of children aged 5-18 years (N=999 at baseline) working on family farms in Kentucky, followed for two consecutive years after an initial enumeration five years previously, found that 70% of the children were involved in animal-related chores. Across all age groups, children on beef cattle farms devoted a greater number of hours per week to farm work, compared to children living on other commodity farms, especially during the school year. For all children in the study, working more than 180 days per year, performing farm work independently, and working on a beef cattle farm (compared to other commodity farm), increased the risk of a farm work injury. However, none of these associations were statistically significant. For male children only, the performance of work tasks independently was significantly associated with a 2.4-fold increased risk (OR = 2.41; 95% CI: 1.15-5.06; P=0.02) for a farm work injury, after controlling for days of working, age, period of data collection, and commodity type of the farm. Language: en

Occupational illnesses are inadequately reported for agriculture, an industry dominated by a vulnerable Hispanic population and high fatal and nonfatal injury rates. Work-related illnesses can contribute to missed work, caused by a combination of personal and work factors, with costs to the individual, employer, and society. To better understand agricultural occupational illnesses, 225 Hispanic horse workers were interviewed via community-based convenience sampling. Descriptive statistics, bivariate analyses, and log binomial regression modeling were used to: (1) describe the prevalence of missed work due to work-related illnesses among Hispanic horse workers, (2) examine work-related and personal factors associated with missed work, and (3) identify health symptoms and work-related characteristics potentially associated with missed work. Key findings reveal that having at least one child (PR = 1.71, 95% CI = 1.03, 2.84), having poor self-reported general health (PR = 0.72, 95% CI = 0.48, 1.08), experiencing stress during a typical workday (PR = 2.58, 95% CI = 1.25, 5.32), or spending less time with horses (PR = 1.87, 95% CI = 1.15, 3.05) are significant predictors of missing work. Interventions can be designed to identify workers most susceptible to missing work and provide resources to reduce absenteeism. Future research should examine work-related illness in agricultural horse production, including personal and work-related factors, in order to diminish occupational health disparities among these workers, who are more likely to be employed in hazardous agricultural work. Keywords: Agriculture, Health disparities, Horse workers, Missed work, Occupational illness, Worker absenteeism.

The aim of this study was to understand the educational status and plans of Kentucky's RN workforce in advancing nursing educational levels.The Institute of Medicine called for 80% of nurses to hold a minimum of a BSN by 2020. Nurse leaders from practice, academe, and the community need evidence to guide the development of effective strategies.An electronic survey was administered to Kentucky's RNs. This descriptive analysis was based on 1363 usable responses.Only 40% of Kentucky's RNs held at least a BSN. Another 17% were enrolled in a nursing degree program; half of those enrolled were pursuing a BSN. Of those not enrolled in a degree program, 61.5% reported no plans to return to school. The top barriers were lack of perceived benefit, financial concerns, family obligations, and planned retirement. The top motivating factor was career advancement.The gap between the current reality and the goal is wide. Nurse leaders will need to develop creative strategies that strengthen motivating factors and reduce barriers to accelerate movement toward increasing BSN rates.

This study with three Appalachian county agricultural education programs examined the feasibility, effectiveness, and impact of integrating a cost-effective rollover protective structure (CROPS) project into high school agricultural mechanics classes. The project aimed to (1) reduce the exposure to tractor overturn hazards in three rural counties through the installation of CROPS on seven tractors within the Cumberland Plateau in the east region; (2) increase awareness in the targeted rural communities of cost-effective ROPS designs developed by the National Institution for Occupational Safety and Health (NIOSH) to encourage ROPS installations that decrease the costs of a retrofit; (3) test the feasibility of integration of CROPS construction and installations procedures into the required agricultural mechanics classes in these agricultural education programs; and (4) explore barriers to the implementation of this project in high school agricultural education programs. Eighty-two rural students and three agricultural educators participated in assembly and installation instruction. Data included hazard exposure demographic data, knowledge and awareness of CROPS plans, and pre-post knowledge of construction and assessment of final CROPS installation. Findings demonstrated the feasibility and utility of a CROPS education program in a professionally supervised secondary educational setting. The project promoted farm safety and awareness of availability and interest in the NIOSH Cost-effective ROPS plans. Seven CROPS were constructed and installed. New curriculum and knowledge measures also resulted from the work. Lessons learned and recommendations for a phase 2 implementation and further research are included.

Animal production is a dangerous industry and increasingly reliant on a Latino workforce. Within animal production, little is known about the risks or the occupational hazards of working on farms involved in various aspects of thoroughbred horse breeding. Extant research suggests that horse workers are at risk of musculoskeletal and respiratory symptoms, kicks, and other injuries. However, limited known research has examined the experiences of the industry’s workers, including immigrant workers, despite their prominence and increased vulnerability. Using data collected from thoroughbred farm representatives via a phone-administered survey, a 2-hour face-to-face semi-structured interview, and farm injury logs, this article identifies and describes types of injuries experienced by workers (N = 284) and their surrounding circumstances. Results indicate that general injuries and musculoskeletal strains, sprains, and tears account for a majority of injuries among workers on thoroughbred farms. Upper limbs and extremities are most frequently injured, while direct contact with the horse accounted for over half of all injuries. No differences in the diagnoses or distribution of injury were found by ethnicity; however, Latinos were more often struck by or trampled by a horse while non-Latinos were more often injured by an insect or plant. Implications and opportunities for future research are discussed.

Elevated suicide mortality rates have been reported for farmers and for the elderly. Very little literature exists that looks at the health of older minority farmers. This mixed-method study describes older African-American farmers (N = 156) in the contexts of active coping, personal satisfaction from farm work, and attachment to their farmland to provide insight into the psychosocial dimensions of their mental health. Findings show that the farmers have positive perspectives on work and farm future, and strong attachment to the land. Differences were noted by gender. Nurses can use these findings to frame culturally appropriate strategies for aging farmers to maximize positive outcomes.

While working on farms with livestock increases the risk of injury among farm workers in comparison to other commodity farms, few studies have examined the role offarm management practices in association with the risk of cattle-related injury. We examined the farm management practices of Kentucky beef cattle farms in association with self-reported rates of cattle-related injuries among workers. We conducted a mail survey of a random sample of 2,500 members of the Kentucky Cattlemen's Association. Results from 1,149 farm operators who were currently raising beef cattle and provided complete survey response are reported. During the busy season, the principal operator worked 20 hours per week on the beef operation, and among all farm employees, the beef operation required 35 hours per week (median cumulative hours). There were 157 farms that reported a cattle-related injury in the past year among the principal operator or a family member, yielding an annual cattle-related injury rate of 13.7 beef cattle farms per 100 reporting at least one cattle-related injury. The majority of these injuries were associated with transporting cattle, using cattle-related equipment (head gates, chutes, etc.), and performing medical or herd health tasks on the animal. A multivariable logistic regression analysis of cattle-related injuries indicated that the risk of injury increased with increasing herd size, increasing hours devoted to the cattle operation per week by all workers, and the number of different medical tasks or treatments performed on cattle without the presence of a veterinarian. Farms that performed 9 to 13 tasks/treatments without a veterinarian had a two-fold increased risk of a cattle-related injury (OR = 1.98; 95% Cl: 1.08-3.62) in comparison to farms that performed 0 to 4 tasks without a veterinarian. In adjusted analyses, the use of an ATV or Gator for cattle herding was associated with a significantly reduced risk of cattle-related injury (OR = 0.51; 95% CI: 0.30-0.86) in comparison to other herding methods. This study indicates that a substantial proportion of cattle-related injuries are associated with work activities related to handling practices and cattle restraining equipment.

This study investigated the prevalence of self-reported musculoskeletal discomfort (MSD) and work-related factors associated with elevated MSD among Latino thoroughbred farm workers. Participants (N = 225) were recruited using a community-based purposive sampling approach to participate in in-person interviews. Of these workers, 85% experienced MSD. MSD was divided into tertiles; the upper tertile was defined as elevated. Multivariable Poisson regression revealed associations between any elevated MSD and longer tenure on horse farms, longer work hours, and poor safety climate. Elevated neck/back MSD was associated with longer tenure, longer work hours, and poor safety climate. Elevated upper extremity MSD was associated with age and poor safety climate. Elevated lower extremity MSD was associated with longer tenure, longer work hours, and being female. Musculoskeletal discomfort is common among these workers. Improving safety climate and minimizing long work hours is recommended.

This study describes chores when farmers were either fatally or seriously injured and required emergency medical treatment as a result of overturns of tractors with or without rollover protective structures (ROPS). Data from the 2002 Kentucky Farm Tractor Overturn Survey were used for this study. The data were collected by a telephone survey of a population-based random sample of 6063 (7.98%) of Kentucky’s 76,017 farm operators as listed in the Kentucky Agricultural Statistics Service database. Of farm operators interviewed, 551 (9.1%) reported 603 overturns and 5512 (90.9%) reported no overturns in the history of their farm, covering a period from 1925 to February 2002. Only the latest overturn was considered to improve recall accuracy. In addition, since the 1925 to 1959 time period had only 49 (8.1%) of the overturns reported, (14 farmers did not provide the year of most recent overturn); only data from the 1960 to 2002 period (approximately 41 years) were used. After making these adjustments, incidents evaluated included 25 cases (one fatal and four serious nonfatal injuries) that involved ROPS-equipped tractor overturns and 88 cases (24 fatal and 64 serious nonfatal injuries) that involved non-ROPS tractor overturns. Chores at highest risk for tractor overturns were identified for which educational and ROPS retrofit interventions could be emphasized. The highest frequency of overturn-related fatalities and nonfatal injuries were associated with hay harvesting, rotary mowing, and on-farm travel chores. These three chores represented 68.2% of fatal events and 50.0% of permanent and 56.6% of temporary disability overturn incidents. Tragically, in countries such as India and China with emerging mechanization, a large majority of tractors are produced without ROPS that can be expected to result in the same overturn-related epidemic of deaths experienced in highly mechanized countries, despite evidence of the protection provided by ROPS.

Introduction Why do generations of farmers tolerate the high-risk work of agricultural work and resist safe farm practices? This study presents an analysis inspired by empirical data from studies conducted from 1993 to 2012 on the differing effects of farm safety interventions between participants who live or work on farms and those who don't, when both were learning to be farm safety advocates. Both groups show statistically significant gains in knowledge and behavioral change proxy measures. However, non-farm participants' gains consistently outstripped their live/work farm counterparts. Method Drawing on socio-cultural perspectives, a grounded theory qualitative analysis focused on identifying useful constructs to understand the farmers' resistance to adopt safety practices. Findings Understanding apprenticeships of observation and its relation to experiential learning over time can expose sources of deeply anchored beliefs and how they operate insidiously to promote familiar, albeit unsafe farming practices. The challenge for intervention-prevention programs becomes how to disrupt what has been learned during these apprenticeships of observation and to address what has been obscured during this powerful socialization process. Practical applications Implications focus on the design and implementation of farm safety prevention and education programs. First, farm safety advocates and prevention researchers need to attend to demographics and explicitly explore the prior experiences and background of safety program participants. Second, farm youth in particular need to explore, explicitly, their own apprenticeships of observations, preferably through the use of new social media and or digital forms of expression, resulting in a story repair process. Third, careful study of the organization of work and farm experiences and practices need to provide the foundations for intervention programs. Finally, it is crucial that farm safety programs understand apprenticeships of observation are generational and ongoing over time, and interventions prevention programs need to be ‘in it’ for the long haul.

Thirty percent of America's 2.2 million farms are operated by individuals older than 65 years. This study examined how older farmers define health and determined whether demographic characteristics, farm work, and physical and mental health status predict health definition. Data were collected via telephone and mailed surveys during the baseline wave of data collection in a longitudinal study of family farmers residing in two southern states ( n = 1,288). Nearly 42% defined health as the “ability to work” compared to a physical health-related definition. Predictors of defining health as the ability to work included being White, performing more farm tasks in the past week, taking prescription medications daily, and having minimal health-related limitations to farm work. Health behaviors are centered on the individual's perception of health. Understanding the defining attributes of health can support better approaches to health care and health promotion, particularly among rural subcultures such as farmers, whose identity is rooted in their work.

Tractors are used in pond culture of catfish for a variety of mobile tasks, including placing aerators into ponds, mowing, spreading feed into ponds, and transporting equipment (e.g., seining reels), as well as for the stationary task of using the tractor's power-take-offs to operate aerators in the ponds. The mobile tasks place the tractor operator at risk of injury in the event of an overturn, and rollover protective structures (ROPS) are a proven intervention to mitigate injury in a tractor overturn. A 2008 survey was conducted among 96 participants in Mississippi (USA) to determine the hours of tractor use for these tasks. This article reports on exposures to tractor-related tasks conducted on catfish farms as identified in this survey. Annual exposure to potential tractor overturns was calculated based on the hours of mobile operation. The overall annual exposure to potential tractor overturns on the catfish farms participating in the survey was 7322 h per farm and 837 h per tractor on these...

BACKGROUND: Agriculture is hazardous and increasingly dependent on Latino workers, a vulnerable population. However, little research has studied how work organization influences Latino farmworker health. METHODS: Using a work organization framework, this cross-sectional study describes and compares the work organization and occupational health characteristics of a sample of Latino crop (n = 49) and horse production (n = 54) workers in Kentucky. RESULTS: Crop workers experienced more physical demands, work-related and environmental stressors, and musculoskeletal and ill-health symptoms. Significantly more crop workers indicated work-related illness or missed work due to work-related illness/injury, though one-fourth of both groups reported work-related injury in the past year. A majority of both groups cited exposure to toxic chemicals, a minority of whom received training on their use. CONCLUSION: Further surveillance is needed to understand the rate and precursors of illness/injury in these populations, as is research on the relationship between supervisory practices, psychosocial stressors, and occupational health. Am. J. Ind. Med. © 2012 Wiley Periodicals, Inc. Language: en

Primary smoking during pregnancy places a woman at greater risk for preterm delivery, preterm premature rupture of membranes, and delivering a low birth weight (LBW) or small for gestational age (SGA) infant [1]. Although there is less evidence regarding the effect of secondhand smoke on perinatal morbidity; increase risk for decreased birthweight, smaller head circumference, stillbirth and preterm birth have been consistently reported [2-5]. Secondhand smoke is defined as smoke inhaled by an individual that is not actively engaged in smoking but who is exposed to ambient tobacco smoke [6]. SHS consists of two components: sidestream smoke and mainstream smoke. Sidestream smoke refers to the smoke emitted from tobacco products, while mainstream smoke refers to the smoke exhaled by smokers. SHS contains approximately 4,000 chemicals, is responsible for nearly 3,000 cases of lung cancer deaths among nonsmokers each year, and affects more than 22 million US children annually [7]. Biomarker validation is recommended to confirm smoking and SHS due to a high deception rate for self-report status caused by the social pressures attributed to smoking during pregnancy [8]. Whether a women smokes during pregnancy or is exposed to SHS, biomarkers of exposure can be detected in both the mother and infant [9-11]. Nicotine in maternal hair is a valid biomarker strongly associated with prenatal reports of SHS exposure [12]. Research examining the association between prenatal smoking, SHS exposure and number of household smokers is limited. The purpose the study is to examine the relationship between maternal and infant hair nicotine levels and number of household smokers in women who smoke and who are exposed to SHS during pregnancy. The study aims propose to: 1) examine the difference in maternal hair nicotine in smoking and SHS-exposed women in homes with one, or two or more additional smoker(s) in the home; 2) to examine the difference in infant hair nicotine in smoking and SHS-exposed women in homes with one, or two or more additional household smokers; and 3) describe the relationship between hair nicotine levels and preterm birth in homes with multiple smokers.

From 1982 to 2007, Kentucky had 459 deaths related to all-terrain vehicles (ATVs), fifth highest among US states. By 2012, Kentucky ranked fourth highest, with 578 ATV-related deaths. Following the sentinel event of an ATV-related traumatic brain injury to an unhelmeted high school student, the authors developed a 19-item survey that collected data regarding rural Kentucky high school students' years of ATV driving, second-rider frequency, typical duration of riding events, estimated weekly number of riding events, and frequency of helmet use. Of the 159 students involved, males scored significantly higher on each of these items, except frequency of any ATV driving and frequency of helmet use, which showed no gender differences. Overall, 9.3% of students reported always wearing a helmet when driving and/or riding; 61.2% reported never wearing a helmet; 132 (83.0%) reported that they either drove ATVs or rode as a second rider, and 72 of these (57.1%) reported having had an ATV incident, 33 (45.8%) of which resulted in an injury. Twenty-one of these were serious injuries, including concussions; unconsciousness; fractures to skull, nose, collarbones, arms, ribs, and legs; elbow and hip dislocations; lacerations to head, eyes, arms, legs, and back; and multiple contusions and sprains. Findings have implications for the design of responsibility to protect (R2P) interventions that will reduce exposure and prevent ATV injury and fatality. A method that leverages the relevance of a sentinel event as a community public-health surveillance opportunity is described. Study surveillance data showed higher exposure to ATV hazards than previously reported.

Horse breeding farms are hazardous. Yet, little is known about the injuries of Latino horse workers. This study assesses Latino horse workers’ injury prevalence, describes their injuries, and analyzes differences between injuries receiving medical versus those receiving first aid care. Data were gathered from 225 Latino thoroughbred workers via a community-based purposive sampling strategy. Questions included injury experiences in the past year and details about each person’s two most severe injuries. Univariate and bivariate analyses were conducted. Nearly half of workers experienced an injury in the past year, often involving a horse. Bruises and sprains/strains were most common, as were injuries to upper/lower appendages. Head/face injuries more often resulted in medical care. The injury burden in this Latino worker population is high. Personal protective equipment (PPE) and training is advised due to the high prevalence of horse-related injuries. Future research should investigate aspects of the work environment that may influence injury risk.

Kentucky FFA students inspected 153 farm tractors for safety features that prevent operator injuries during tractor overturns, highway collisions, runovers, and power take-off (PTO) entanglements. Tractor mean age was 23.6 years (SD = 20.9). Rollover protective structures (ROPS) were present on 50.66% of tractors, but only 33.33% of these had functional seatbelts. Loose and damaged seats were found on 30.46% of tractors. In 38.99% of cases, tractor rear-wheel fenders exposed operators to moving tractor tires, and 48.67% of tractors had dangerously worn or damaged tires. Tractors with a narrow front-end stance comprised 16.11% of the total. Only 53.06% of the tractors had starters with secure hard cover by-pass starting shields that fully covered the starter terminals, and 37.37% had fully exposed terminals with no cover. PTO master shields with all parts present and undamaged were present on only 29.27% of the tractors, and in 39.02% of cases the entire shield was missing. Only 44.67% of the tractors had properly mounted and fully functional mounting and dismounting access steps and handholds. SMV emblems were missing on 53.64% of tractors and in the proper place and condition in only 25.83% of cases. Tractors with properly mounted and fully functional head and tail lights comprised 40.94% of the sample, and tractors with no functional lights comprised 24.16%. Properly mounted, clean, and functional rearview mirrors were present on only 19.87% of the tractors, and 69.54% had no rearview mirrors. The project increased farming and non-farming students' awareness of tractor safety issues, provided empirical data about the safety status of a sample of tractors that frequently travel public highways in four rural Kentucky farming counties, and promoted dialog about these issues with adult farmers and other community members with whom the students interacted.

INTRODUCTION: Early studies of injuries associated with overturns indicate that more fatalities occurred when a tractor overturned beyond 90 degrees (continuous roll) relative to the impact plane. Recently, the principle of preventing continuous rolls has re-emerged for the protection of riding lawnmower operators. METHOD: Related to tractors, a population-based study was conducted that compared the severity of fatal and nonfatal injuries between a 90 degrees and continuous roll for tractors equipped with rollover protective structures (ROPS) and not equipped with a ROPS (non- ROPS). In 2002, the Kentucky Farm Tractor Overturn Survey was administered to an 8% random sample (6,063) of Kentucky farm operators. The farmers responded to questions that differentiated between the types of overturns and operator injury outcomes for ROPS-equipped and non-ROPS tractors during overturn events. Overturn characteristics were collected that included 90 degrees to the side, beyond 90 degrees to the side, and to the rear for both ROPS-equipped and non-ROPS tractors. RESULTS: Of the 541 overturns reported in this study, 535 (99%) of the respondents reported the most recent overturn characteristics of the tractor: 92 (17%) were ROPS-equipped and 443 (83%) were non-ROPS. For side overturns, 67% of the rolls occurred with ROPS-equipped tractors, and 54% occurred with non-ROPS tractors. The percentages of deaths related to rolls to the side for ROPS-equipped and non-ROPS tractors were, respectively, 1.6% and 3.7%. There was one (2%) deaths related to 90 degrees rolls for ROPS-equipped tractors, whereas for continuous rolls there were 6.4% fatalities related to side overturns, 13% resulted in non-fatal injuries with an average of 1 day of hospitalization for ROPS-equipped tractors, and 39% resulted in non-fatal injuries with an average of 18 days of hospitalization for non-ROPS tractors. The results from this study indicated that a ROPS was more effective at stopping an overturn at 90 degrees than no ROPS, with an associated reduction in the severity of injury in the event of a tractor overturn. Language: en

Aquaculture involves the production of plant and animal products that are cultured in water. The principal freshwater fishes raised in the U.S. are catfish (raised mainly in ponds) and trout (raised mostly in concrete raceways), and the principal crustaceans grown are shrimp, crayfish, oysters, and clams. Tractors are used on aquaculture farms mostly in pond culture. Ponds present overturn hazards because of the slopes of levees, slippery conditions, and nighttime driving. Protection is afforded to the tractor operator when a rollover protective structure (ROPS) is attached to the tractor. The purpose of this study was to analyze and describe the prevalence of ROPS-equipped tractors on farms engaged in aquaculture in the U.S. The analysis concluded that 78% of tractors used in aquaculture were equipped with a ROPS, in contrast with the prevalence of ROPS at 49% for all of agriculture. Moreover, 91% of the tractors in the South used for aquaculture were equipped with a ROPS. The national sample for aquaculture included 75 farms and 137 tractors, which is small, but nonetheless, several hypotheses can be generated as a result of this descriptive study.

Previous estimates of operator death from farm tractor overturn events range from 0.03 to 0.68. This study provided population-based estimates of the denominator of total farm tractor overturns and the frequency of six classes of overturn injury outcomes for tractors with and without rollover protective structures (ROPS). A 40-item telephone survey collected information from a random sample of 6,063 (8.0%) Kentucky farms about each farm’s most recent overturn. A total of 551 (9.1%) farms reported overturns, and 5,512 (90.1%) reported no overturns. Injury outcomes for 443 overturns of non-ROPS tractors and 89 ROPS tractors were distributed as follows: no or minor injury (non-ROPS: 70.43%; ROPS: 82.02%), outpatient treatment (non-ROPS: 21.90%; ROPS: 9.00%), hospital admission (non-ROPS: 15.35%; ROPS: 3.37%), temporary disability (non-ROPS: 13.54%; ROPS: 14.61%), permanent disability (non-ROPS: 3.16%; ROPS: 0.00%), and death (non-ROPS: 5.42%; ROPS: 1.12%). (Percents total to more than 100 because some operators treated as outpatients were subsequently hospitalized, disabled, or died.) The observed 0.054 probability of death from overturn of non-ROPS tractors in this sample was corrected for the proportion of farms that went out of business prior to the survey and thus were excluded from the sampling frame. The adjusted 0.08 probability of death from overturn of a non-ROPS tractor is five times smaller than the NIOSH estimate of 0.40. The discrepancy lies in the much larger denominator of all non-fatal and fatal overturns than assumed previously.

In 2002, the Kentucky Farm Tractor Overturn Survey was administered, in which 6,063 randomly selected farm operators responded to questions that addressed the presence and use of seatbelts in the event of a tractor overturn. Data were analyzed to determine the proportion of seatbelt presence and use on tractors that overturned differentiated by whether they were equipped or not equipped with a rollover protective structure (ROPS). In 537 overturns reported for which the ROPS status was known, 92 involved ROPS-equipped tractors, of which 60 had a functioning seatbelt, and 19 operators of these tractors used the seatbelt that was present during the overturn. However, of the 445 overturns of non-ROPS tractors, eight had a functioning seatbelt, and three of these operators wore the seatbelt. Two of the three operators that wore seatbelts on non-ROPS tractors suffered a permanent disability. In contrast, of the 19 operators who wore a seatbelt on ROPS-equipped tractors, 18 experienced no or minor injuries, and one required outpatient care. Seatbelts are known to save lives but are a secondary safety device to ROPS, for ROPS alone saves lives and is a necessary pre-condition for seatbelt presence and use.

Objective: To evaluate the cost effectiveness of a 4.5 year education campaign that promoted farmers' adoption of rollover protective structures (ROPS) to prevent tractor overturn injuries. Design: Randomized controlled trial, decision analysis, and cost effectiveness analysis. Setting: One treatment county and one control county in the State of Kentucky. Intervention: A campaign by a local tractor and equipment dealership to encourage farmers to purchase and install ROPS and seatbelt retrofit kits for older tractors. Main outcome measures: Number of injuries averted and cost per injury averted. Results: The dealership's 4.5 year intervention was shown to potentially reduce both fatal (0.26) and non-fatal (1.50) injuries by 2.6% in its county over the intervention period using a 20 year analytic horizon. When extrapolated statewide, 6.7 lives would be saved and 39 non-fatal injuries would be averted over the combined 24.5 year combined intervention period and analytic horizon. The intervention for this period was cost effective with a "savings" of $35 713 per injury (fatal plus non-fatal) averted at a 4% discount rate. Conclusions: Tractor manufacturer promotions can influence their dealerships to promote ROPS retrofits by their customers. A manufacturer backed dealer ROPS retrofit campaign was cost effective in reducing overturn related injuries.

The number of nurses across the United States with expertise in agricultural health nursing is unknown, yet as many as 8,000 are needed. This article describes agricultural health content in nursing programs in the southeastern United States. Agriculture is primarily family based but ranks among the top three most hazardous industries in America. Nurses in the southeastern United States serve more than 541,000 farm families, more than a quarter of the nation's agricultural population. A 15-item survey was mailed to 185 nursing schools located within 13 southeastern states. Information was requested about undergraduate and graduate curricula that included information about agricultural health and safety. Surveys were returned from 113 programs (61.1%). Schools with larger percentages of rural students were more likely to include mention of agricultural health; however, scant attention was given to any rurally focused content. In 27.4% of the schools, no mention of agricultural health issues was made, and 54.0% of nursing faculty who completed the survey were not aware of the need for nurses with agricultural health expertise. Results suggested that, when agricultural health topics were presented in class, student interest in the topic increased. Given the occupational hazards faced in agriculture and the region's economic dependence on agriculture, increased attention should be focused on agricultural health content within nursing programs.

This article describes workplace violence issues experienced by long-haul female truckers in the US. Females comprise between six and ten per cent of long-haul truckers, and their numbers are growing. Data for this study were collected via a self-administered survey using a convenience sample of 51 female long-haul truck drivers at a major truck show. Forty-two per cent of women reported at least one type of workplace violence while working as a long-haul trucker. Sixty-seven per cent had feared for their personal safety while working during the previous year. Measures women take to ensure their safety at work included carrying a weapon, taking a self-defense class, and cautionary tactics regarding where they stopped to refuel and rest. Because women experience workplace violence differently than do men, different interventions need to be developed to ensure a healthy workforce.

A community educational campaign implemented in two Kentucky counties was effective in influencing farmers to retrofit their tractors with rollover protective structures (ROPS) to protect tractor operators from injury in the event of an overturn. This article reports on the cost-effectiveness of this program in the two counties when compared to no program in a control county. A decision analysis indicated that it would be effective at averting 0.27 fatal and 1.53 nonfatal injuries over a 20-year period, and when this analysis was extended statewide, 7.0 fatal and 40 nonfatal injuries would be averted in Kentucky. Over the 20-year period, the cost-per-injury averted was calculated to be $172,657 at a 4% annual discount rate. This cost compared favorably with a national cost of $489,373 per injury averted despite the additional program cost in Kentucky. The principle reason for the increased cost-effectiveness of the Kentucky program was the three-fold higher propensity for tractors to overturn in Kentucky. The cost-per-injury averted in one of the two counties was $112,535. This lower cost was attributed principally to incentive awards financed locally for farmers to retrofit their tractors with ROPS.

Many injury prevention interventions require changes in human behavior to reduce self-risk or risk to others. Promising injury prevention interventions may be discarded if they lack power to create a significant difference in outcomes when judging their ability to "move a person from nonaction or negative action to positive action (safety)." The transtheoretical model of change (TMC) allows greater sensitivity in detecting along the change process where an intervention may be effective. The stages of change consist of precontemplation, contemplation, preparation, action, maintenance, and termination. Change is not viewed as an "all or none phenomenon."Use of the TMC was examined using a quasiexperimental, cross-over design involving high school agriculture students enrolled in 21 schools in Kentucky (n=9), Iowa (n=7), and Mississippi (n=5). A series of physical and narrative simulations (safety training exercises) were developed with a focus on preventing amputation, spinal cord injury, hypersensitivity pneumonitis, and noise-induced hearing loss. Contemplation and action, as part of the TMC, were measured using a 10-item, Likert-type, stages of change (SOC) instrument comprised of two subscales (reliability coefficients were.88 and.81, respectively). The final sample consisted of 790 students (373 treatment and 417 control).There was a significant group effect for both contemplation, F(1,732)=197.4; p.0001, and action, F(1,730)=106.1; p.0001. A convenience sample of 29 of the participating students was selected for follow-up farm visits 1 year postparticipation. Of these students, 25 (86%) had made safety behavior changes in their farm work.The use of the TMC model can provide researchers with greater precision in examining intervention effectiveness in promoting change.

The Agricultural Disability Awareness and Risk Education Project (AgDARE) is a research–based curriculum of agricultural safety instruction based on Prochaska and DiClemente’s Transtheroetical Model of Change. The program uses eight reality–based psychomotor and narrative modules to teach safe farm work behaviors. In addition to in–class pencil and paper assessments on safety attitudes and behavior intention, farm visits were made to assess the longer term influence of AgDARE. Visits were made between 11 and 20 months (mean = 14.24 months) after completion of the classroom instruction to 29 students who worked on farms and completed at least one–half of the AgDARE instruction. All but one of the visited students exhibited safe work behaviors addressed by the AgDARE instruction. In addition, 76% of the visited students had moade positive changes in their farm work behavior since participating in AgDARE. Changes extended beyond the instruction that students received in class to include other aspects of farm work and other family members. The use of farm visits to evaluate students’ safety behaviors was tempered by the challenge of contacting students and obstacles associated with observing work in an environment where little is routine or regular.

Background: Perceived control has been suggested as a modifiable factor associated with health-related quality of life (HRQOL). However, the relationship between perceived control and HRQOL has not been evaluated in patients with heart failure (HF). The purpose of this study was to determine whether perceived control independently predicts HRQOL in HF patients. Methods: A total of 423 HF patients were included. Hierarchical linear regression was performed to determine the independent association of perceived control to HRQOL after controlling for covariates. Results: Higher levels of perceived control were associated with better HRQOL in univariate analysis. However, this relationship was strongly attenuated after controlling for relevant demographic, clinical, and psychological factors; the variance in HRQOL explained by the addition of perceived control to this model was small (1.4%). Conclusions: We found only a weak relationship between perceived control and HRQOL when considered in the presence of demographic, clinical, and psychological factors.

Back ground: Agricultural work re mains one of the most haz ard ous occupations interms of in jury and ill nesses. It is not well known, how ever, to what ex tent phy si cians whocarefor farm ers are aware of these risks, or if they per form ad di tional medical sur veil lance or coun sel ing spe cif i cally for their farm ing pa tients. Methods: At a se ries of re cent medical con fer ences, 209 phy si cians completed ques tion naires con cern ing farm health issues and per sonal medical practice be hav iors. Results: Given a se ries of diseases knownto be associated with farming and asked to compare prev a lence rates be tweentheir farm ing patients and their other work ing pa tients, the re spon dents rated only skin diseases as be ing more prev a lent among farm ers. Risk per cep tion increased with per sonal farm experience and num ber of farm ing pa tientsseen. Con clu sions: Some primary care phy si cians, particularly those with a lim ited knowl edge of farm ing as an occupation, may un d...

Objective—Develop and test a farm health and injury prevention educational intervention for high school agriculture students. Setting—Twenty one high schools in Kentucky, Iowa, and Mississippi. Methods—A quasiexperimental crossover design was used to test the eVectiveness of two sets of instructional materials designed through participatory action research with agriculture teachers and students. Narrative simulations based on farm work stories and simulations of farm work while students pretended to have a disability were completed in 14 schools (n = 373) over the academic year. Students in seven control schools (n = 417) received no intervention but completed, in the same time frame as students in the treatment schools, demographic surveys and premeasures and post-measures of farm safety attitudes and intent to change safety behaviors. One year after the intervention,29 students from the treatment group received farm visits to measure their farm safety behaviors. Results—Students engaged in hazardous work on farms. Thirty two were involved in tractor overturns and 11 had received injuries from rotating power take-oV mechanisms. One fourth reported hearing problems, and 21% had respiratory symptoms after working in dusty farm surroundings. Students who completed at least two physical and two narrative simulations of the Agricultural Disability Awareness and Risk Education (AgDARE) curriculum showed statistically significant positive changes in farm safety attitude and intent to change behaviors. Conclusions—Adolescents engage in farm work that places them at risk for injury and illness. The AgDARE curriculum may be an eVective and eYcient method of teaching farm safety in high school agriculture classes. (Injury Prevention 2001;7(Suppl I):i59‐63)

Despite women's involvement in agricultural production, the work role of women residing in farm households has not been thoroughly examined. Data collected in 1994-1995 as part of the NIOSH-sponsored Farm Family Health and Hazard Surveillance Project were used to address task issues and health status of farm women in Kentucky. In 1996, the farm woman component of the Kentucky study was replicated in five counties in west Texas, allowing an examination of farm women in two large agricultural states. The Kentucky study employed a two-stage cluster design; the Texas study was based on a systematic quota sample of farms. Both studies selected a sample of women aged 18 years and older living in farm households. A total of 992 women in Kentucky (response rate = 85%) and 665 women in Texas completed a structured 30-min telephone interview on work roles, health status, injuries, and demographics. The results indicated that although 46.4% of the Kentucky respondents and 46.3% of the Texas respondents characterized themselves as farm homemakers, they regularly engaged in farmwork. Reported tasks included work with animals, tobacco-related chores, field irrigation, farm equipment operation, and farm management. Further, women who characterized themselves as homemakers reported rates of farm injuries that were comparable with women who classified themselves in other roles such as full agricultural partners. Role definition may influence the woman's perception of risk on the farm, preclude participation in farm safety programs, and prevent an accurate occupational medical history. This two-state descriptive study highlights the hidden work role of the farm woman -- a role that remains invisible to the farm woman herself -- and emphasizes the important occupational exposures that farm women encounter.

Background Agricultural tractor overturns without rollover protective structures are the leading cause of farm fatalities in the United States. To our knowledge, no studies have incorporated the spatial scan statistic in identifying high-risk areas for tractor overturns. The aim of this study was to determine whether tractor overturns cluster in certain parts of Kentucky and identify factors associated with tractor overturns. Methods A spatial statistical analysis using Kulldorff's spatial scan statistic was performed to identify county clusters at greatest risk for tractor overturns. A regression analysis was then performed to identify factors associated with tractor overturns. Results The spatial analysis revealed a cluster of higher than expected tractor overturns in four counties in northern Kentucky (RR = 2.55) and 10 counties in eastern Kentucky (RR = 1.97). Higher rates of tractor overturns were associated with steeper average percent slope of pasture land by county (p = 0.0002) and a greater percent of total tractors with less than 40 horsepower by county (p

Background Despite an effective tetanus vaccine, tetanus continues to claim lives worldwide. The very young and the elderly are at highest risk for the disease. Farmers are at high risk for injury, the leading factor associated with tetanus. Methods As part of a larger study of older members of farm households in the southern United States, 595 participants provided data on health, injuries, work, socioeconomic status, and healthcare. Results 69% reported receiving a tetanus booster in the past ten years, 24% had not, and 7% did not know. Females were less likely to be currently immunized. There was no association between immunization status and age, income, or race. There were associations between farm tasks, farm work-related injury, and immunization. Conclusions Older farmers are at risk for tetanus by virtue of their age and work environment. Health care providers should explore strategies to improve immunization status among this work group.