CHILDHOOD AGRICULTURAL INJURY PREVENTION INITIATIVE

Progress and Proposed Future Activities - July 1999

The National Institute for Occupational Safety and Health (NIOSH) of the Centers for Disease Control and Prevention (CDC) is seeking public comments on the progress and proposed future activities for the Childhood Agricultural Injury Prevention Initiative implemented by NIOSH in October 1996 ( Click Here to view the Federal Register announcement). A summary of the progress and proposed future activities for this initiative are provided in this document.

Background

The problem of children being injured while living, working, or visiting agricultural work environments (primarily farms), has been recognized for several decades. The most recent data suggest about 100 youths under the age of 20 die on farms each year (Rivara 1997) and greater than 100,000 farm-related injuries occur to the same age group (National Committee for Childhood Agricultural Injury Prevention [NCCAIP] 1996). Many individuals and groups have advocated for the prevention of agricultural injuries inflicted upon youths, and media attention has been generated on the issue, but until recently a national coordinated effort to address the problem has not existed. There have been a number of efforts which have led to a new national initiative to prevent childhood agricultural injuries that is being spearheaded by the National Institute for Occupational Safety and Health. These are described below.

A direct outgrowth of NIOSH's overall agricultural initiative funded by Congress in 1990 under Public Law 101-517 was the Surgeon General's Conference on Agricultural Safety and Health held in Des Moines, Iowa, in April 1991. During this conference, a session entitled Intervention: Safe Behaviors Among Adults and Children highlighted the risks faced by people, both young and adult, involved with production agriculture.

In April 1992, a Childhood Agricultural Injury Prevention symposium was held in Marshfield, Wisconsin. The symposium was sponsored by the National Farm Medicine Center, a component of the Marshfield Medical Research and Education Foundation, which sought to develop consensus on relevant research, education, policy, and other interventions aimed at the reduction of agricultural injuries among children. Individuals with expertise in different disciplines, including farming, joined together to review state-of-the-art knowledge about the issues and to offer recommendations for action. A multifaceted approach was used to help assure that both scientific and humanistic issues were addressed Lee and Gunderson 1992).

From 120 participants at the first meeting, a core of 42 individuals formed the National Committee for Childhood Agricultural Injury Prevention (NCCAIP). The Committee had broad stakeholder representation, including researchers, farmers, agricultural groups, safety and health professionals, and government officials. Over a 16-month period, members of the committee reviewed relevant information from previous reports, developed new recommendations based on current injury data along with other scientific evidence, and refined and prioritized recommendations to be acted upon by relevant individuals and agencies.

In April 1996, NCCAIP published a National Action Plan to promote the health and safety of children exposed to agricultural hazards (NCCAIP 1996). The National Action Plan recommends leadership, surveillance, research, education, and public policy. The plan specifically recommended that NIOSH serve as the lead federal agency in preventing childhood agricultural injury. Due in large part to the efforts by NCCAIP to raise awareness and concern about childhood agricultural injury issues, in October 1996, NIOSH began implementation of a National Childhood Agricultural Injury Initiative. To date, NIOSH has undertaken a number of activities to address the recommendations in the National Action Plan.

The NIOSH Childhood Agricultural Injury Prevention Initiative builds on previous NIOSH research and objectives as well as recommended action steps in the NCCAIP National Action Plan. After a draft implementation plan was developed by NIOSH, input was sought from representatives of diverse stakeholder groups. NIOSH convened a meeting in February 1997which was attended by 23 individuals representing farm families, a farmworker organization, an insurance agency, an equipment manufacturer, safety advocates and educators, researchers, and key federal agencies to provide their opinions on NIOSH's plans for implementing the Initiative. This meeting allowed NIOSH to obtain diverse perspectives and expertise from individuals who commented on the draft plan. Based on the input received at the meeting, revisions were made to the proposed implementation plan. This current request for public review and comment is part of the NIOSH commitment to continue seeking valuable stakeholder input as the Initiative proceeds.

NIOSH is in the third year of the Initiative, which includes both intramural and extramural components. Several activities have been conducted thus far through the Initiative: the exploration of surveillance methods, the establishment of the National Children's Center for Rural and Agricultural Health and Safety, the funding of childhood agricultural health and safety research grants, and the establishment of a Federal Task Force to assess Federal efforts in the area of childhood agricultural injury. Activities in subsequent years will be determined based on an assessment of progress and continuing needs and written comments and oral input from stakeholders at the September 22, 1999 public meeting.

The purpose of the NIOSH Childhood Agricultural Injury Prevention Initiative is to develop a better understanding of injury circumstances and identify effective prevention strategies for all children exposed to agriculture production hazards, not just those who are doing what is traditionally considered work, but also those who are exposed to agricultural production hazards in their living environments or when they accompany their parents to work. The populations of principal interest are children of farm families, youths who work on farms, and children of migrant and seasonal farm workers.

NIOSH goals for the Initiative are to fill critical data needs, establish an infrastructure which facilitates the use of data to develop and improve upon prevention efforts, encourage the use of effective prevention strategies by the private and public sectors, and increase the involvement of the private sector in both prevention and research efforts. Progress will be provided for both the intramural and extramural components of the Initiative.

Progress to Date

Intramural Program

National Childhood Agricultural Injury Prevention Town Meeting

Rationale: Sufficient funding and cooperation from the public and private sectors are objectives of the National Action Plan. The town meeting provided an opportunity to publicize the National Action Plan, garner private sector support, and clarify NIOSH's goals for the initiative.

Progress: On April 22, 1997, a town meeting was held in Marshfield, Wisconsin, to publicly announce a new federal initiative aimed at protecting the health and safety of young people on farms. Representative David Obey (WI), and Dr. Barbara Lee, NCCAIP chairperson, addressed an audience of more than 100 people about the National Action Plan and the need for such an initiative. The town meeting-style event was intended to solicit suggestions and participation by the farming community for designing and carrying out this national safety and health effort. Eighteen different farmers or farm family members provided testimony about how dangerous working on a farm can be. The event was covered on 40 television stations in the Marshfield area and in other farming communities across the U.S. through a video news release produced for the town meeting. The video news release included messages by Secretary of Health and Human Services, Donna Shalala, and NIOSH Director, Dr. Linda Rosenstock, on the importance of working with our partners in the farming community to protect young people on farms from agriculture-related injury and death. The initiative was also reported widely across the U.S. through an Associated Press newspaper article and radio coverage.

Surveillance of Childhood Agricultural Injuries

Rationale: The NCCAIP National Action Plan calls for the establishment and maintenance of a comprehensive national database of childhood agricultural injuries. Routine collection and analysis of data on childhood agricultural injuries are needed to understand the magnitude and scope of the problem and to assess progress over time.

Background: The NIOSH program on the surveillance of childhood agricultural injuries is an internal activity with the goal of providing national and regional surveillance information about children injured on farms. This effort is intended to meet the NCCAIP recommendation for the establishment of a national surveillance program for childhood agricultural injuries. The surveillance program is being conducted as an intramural NIOSH effort because it is more cost-effective compared to surveillance conducted through an extramural program.

After the NIOSH meeting on implementing the Childhood Agricultural Injury Prevention Initiative (February 1997), the recommendation was made to convene a meeting of researchers knowledgeable in the field of agriculture injury surveillance to obtain more detailed information specific to conducting surveillance activities for this unique group. NIOSH held this meeting in the Fall of 1997. Comments were received from Dr. Paul Gunderson, National Farm Medicine Center; Dr. Susan Gerberich, University of Minnesota; Dr. Michael Shulman, North Carolina State University; and Dr. Robert McKnight, University of Kentucky. Written comments were also provided by Dr. Lorann Stallones, Colorado State University; Dr. Fredrick Rivara, University of Washington; and Dr. Dennis Murphy, Pennsylvania State University. Based on the information provided by this group, it was clear that no specific surveillance effort would adequately cover all populations of interest included in this initiative: youth farm workers, the children of farm workers and farm operators, children of migrant and seasonal farm workers, and children visiting farming operations. As a result, NIOSH decided to pursue several different methods of obtaining population-specific childhood agricultural injury data, to assess how each system works, and to examine the possibility of utilizing a combination of surveillance methods to obtain representative data sources for these injuries.

Progress: To date, NIOSH has entered into interagency agreements with the Consumer Product Safety Commission (CPSC) to conduct follow-back interviews with youths injured on farms through the National Electronic Injury Surveillance System (NEISS); the U. S. Department of Labor (DOL) to incorporate questions on injuries to young farm workers into the National Agricultural Workers' Survey (NAWS); and the U.S. Department of Agriculture (USDA), National Agricultural Statistics Service (NASS) to conduct a survey of 50,000 farms to determine the frequency of injury to youths living, working, or visiting farms. In addition to conducting these three surveys, NIOSH evaluated the usefulness of the USDOL, Bureau of Labor Statistics (BLS), Census of Fatal Occupational Injuries (CFOI) surveillance system for identifying occupational farm-related deaths occurring to youths less than 20 years of age and evaluated the CPSC's NEISS for identifying occupational farm-related injuries occurring to youths less than 20 years of age.

In October 1998, NIOSH initiated a telephone follow-back survey interviews of youths, or their parents, for farm-related injuries identified through the National Electronic Injury Surveillance System (NEISS). The NEISS is an injury surveillance system based on a random sample of hospital emergency departments across the U.S. For this NIOSH survey, 65 hospital emergency departments are in the sample. Cases include both work-related and non-work-related injuries. Any nonfatal injury was considered an in-scope case if it occurred on a farm, involved a farm tractor, or was selected as a probable nonfatal farm injury based on the emergency department narrative about the injury. Telephone interviews were conducted to obtain additional information about the injury event. It is estimated that NIOSH will receive approximately 300 interviews covering the time period, June 1, 1998, through September 30, 1999. Preliminary results from these surveys should be available in January 2000, with detailed results available in the spring of 2000.

Youth farm workers and the children of farm workers are being examined through the DOL National Farm Worker Survey (NAWS). This involves personal interviews with approximately 4,000 farm workers across the U.S. over a 1-year period. Farm workers less than 20 years of age are asked directly about any farm-related injuries, both work or nonwork in origin, that they had in the past calendar year. Details about the injuries are collected for all positive responses. For the children of farm workers, all interviewed farm workers are asked about injuries that occurred to their children on a farm, both work and nonwork in origin. Details about the injuries are collected from the parent. Demographic information about farm worker households is collected as a standard part of the NAWS survey. The NAWS nonfatal injury survey was initiated in October 1998 and is scheduled for completion by September 1999. Preliminary results of the survey should be available in January 2000, with detailed results being available by the spring of 2000.

Injuries to the children of farm operators and children visiting farms are being examined through a special farm operator survey conducted for NIOSH by the U.S. Department of Agriculture, National Agricultural Statistics Service (NASS). The NASS survey is based on a telephone interview of 50,000 farm operations selected at random across the U.S. Farm operators were asked questions on both work-related and non-work-related injuries that occurred to youths less than 20 years of age on their farm in the calendar year 1998. Details about all injuries are collected for all positive responses. In addition to nonfatal injury events occurring on the farm, demographic data about the farm household and youths employed on the farm are collected. Finally, an estimate of the number of youths visiting the farm in the past calendar year is collected. The NASS survey was initiated in January 1999 and was completed in early March. Preliminary results of the survey should be available by October 1999, with detailed results released by January 2000.

Occupational fatal injury surveillance for youths on farming operations does not require additional surveillance efforts by NIOSH. NIOSH assumes that adequate work-related fatality surveillance is provided by the present Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries (CFOI) surveillance system. NIOSH has recently completed an agreement with BLS to gain full access to the CFOI, which will allow NIOSH to more accurately define age group- and state-specific surveillance data related to young workers who died on farms. For general youth fatality information for farms, NIOSH is also collecting death certificates from all Vital Statistics reporting agencies that meet the following criteria: the victim was less than 20 years of age; the cause of death was external as defined by an International Classification of Disease, 9th revision, E-Code (E-800 through E-999); and the death occurred on a farm as defined by the location variable on the death certificate. While this collection of death certificates will include both occupational and nonoccupational fatalities, these data will be used only to define the general fatality and nonoccupational fatality issues faced by youths on farms.

Coordinating a Federal Response to the NCCAIP Recommendations

Rationale: A number of recommended action steps in the NCCAIP National Action Plan require or are appropriate for response from federal agencies. The recommended action steps are not limited to the responsibilities of NIOSH but crosscut with mandates and jurisdictions of other federal agencies.

Background: NIOSH organized and led a Federal Agency Task Force toward facilitating a coordinated and informed public response to preventing childhood agricultural injuries. The task force includes representatives of key federal agencies that can potentially impact research and prevention of childhood agricultural injuries. These agencies include the National Center for Injury Prevention and Control, the Maternal Child Health Bureau, the Office of Rural Health Policy, and agencies within the Departments of Agriculture, Labor, Education, and Transportation. The Federal Agency Task Force will review and consider recommended steps in the National Action Plan and forthcoming research findings and consensus-based standards. NIOSH will take the lead in documenting the scientific basis for regulatory and programmatic recommendations identified by NCCAIP and the Federal Agency Task Force through the development and dissemination of NIOSH comments, health communication, policy, and criteria documents.

Progress: Two meetings of the Federal Task Force have been held to date (November 1997 and April 1998). Thirty-one members representing various federal agencies who have an interest in childhood/youth safety and health comprise the group. The Federal Task Force has been used as a vehicle for communication between NIOSH and relevant federal organizations. NIOSH has used the Federal Task Force as a means of raising familiarity among Federal Task Force members with NCCAIP recommendations, activities undertaken through the NIOSH initiative, and new research findings from the initiative. The Federal Task Force systematically reviewed NCCAIP recommendations and considered potential roles for each member organization. Potential contributions of member organizations ranged from roles in improving data collection and fostering needed research to assisting in future efforts to implement proven prevention strategies. Similarly, the Federal Task Force provides a means for other federal organizations to provide input to NIOSH on the initiative. Federal Task Force members were requested to provide input on potential future activities as part of this public review meeting.

A number of Federal Task Force organizations have undertaken activities independently or in collaboration with NIOSH that are responsive to NCCAIP recommendations. For example, the National Cancer Institute has several projects to develop resources that would enhance research on childhood cancer, including cancers that may result from exposures associated with agricultural production. The Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, will include issues related to childhood agricultural injuries in the development of guidelines by an expert panel for injury prevention by school programs. The Wage and Hour Division, Employment Standards Administration, Department of Labor, undertook a targeted enforcement campaign, Operation Salad Bowl, to increase enforcement of child labor laws in the agricultural industry.

Two subgroups of the Federal Task Force have been formed. The Surveillance Data Needs Subgroup includes members of organizations involved in data collection. This subgroup will address inconsistencies and deficiencies in definitions, coding systems, methods, and data presentation in childhood agricultural injury surveillance. This subgroup will also provide specific input to NIOSH on surveillance efforts undertaken or recommended by NIOSH. The second, a Regulatory Subgroup, will include organizations with regulatory responsibilities. This subgroup will review NCCAIP recommendations about regulation for the purposes of clarifying jurisdictional issues, determining the feasibility of specific recommendations within current regulatory structures, and determining steps which need to be taken for specific recommendations to be considered, with specific attention to areas in which NIOSH review of scientific data would be useful.

It is envisioned that the Federal Task Force will serve as a vehicle for ensuring that new findings are shared with Federal Task Force members in a timely fashion so that the member organizations have current scientific information to consider in the implementation of their programs. New research findings, based on analysis of data from the National Electronic Injury Surveillance System, were shared with Federal Task Force members in the summer of 1998. In the event they might receive calls from the press or public, Federal Task Force members from statistical agencies were provided with a pre-publication copy of a NIOSH article published in September 1998 in the CDC Morbidity and Mortality Weekly Report demonstrating that youths working in agricultural production and services industries were at equal or higher risk of injuries than their older counterparts. Other Federal Task Force members were provided with copies of the article once published.

Convene a Workshop to Strategize Involving the Private Sector

Rationale: Sufficient funding and cooperation from the public and private sectors are objectives of the NCCAIP National Action Plan. Public and private sectors are encouraged to become partners in efforts to plan, implement, and evaluate childhood agricultural injury prevention initiatives.

Background: Representatives from agribusiness, private foundations, and community-based organizations were invited to a workshop to strategize how the NIOSH Childhood Agricultural Injury Prevention Initiative can be transitioned from being centered in the public sector to being centered in the private sector. Stakeholder groups which were invited to participate in this workshop included large corporate farm organizations, trade associations, private foundations such as the W.H. Kellogg Foundation and the Robert Wood Johnson Foundation, unions, equipment manufacturers, health care associations, educational associations, child safety advocates, youth group organizations, and religious organizations. The goal of the workshop was to focus on (1) identifying perceived needs of private sector groups to move forward with funding and/or implementing prevention activities, (2) how the public sector can best meet these needs, and (3) what are the continuing roles for the public and private sectors in maintaining the Initiative.

Progress: A contract was awarded to the Purdue University (William Field) for convening a workshop involving private industry representatives in the fall of 1998. The Childhood Agricultural Injury Prevention Strategy Workshop: A Private Sector Perspective was an outcome of this process. It was designed to incorporate private sector involvement in childhood agricultural injury prevention strategies and to document previous and ongoing private sector childhood agricultural injury prevention efforts. NIOSH contacted more than 250 groups representing the following industrial areas: agricultural chemical manufacturers, agricultural cooperatives, insurance companies, private consultants and legal professionals, farm media, safety equipment manufacturers, feed and grain suppliers, utilities, commodity groups, farm structure providers, suppliers of farm services, medical professionals and lending institutions. As a result of these contacts, forty-three individuals attended and participated in the workshop.

Workshop participants identified corporate image, name recognition, media attention, and increased leverage in future litigation as important justification for involvement in injury prevention programs. Reasons for supporting specific activities included consistency with corporate mission, enhanced public relations, and the potential for successful outcomes. Budget restraints and a perceived lack of benefits to the organization were identified as primary reasons why requests for support were rejected. Internal barriers for organizational support of injury prevention programs were budget limitations, the potential for creating a liability risk, and the lack of support from management.

Workshop participants indicated the private sector should be recognized and acknowledged by planners of agricultural childhood injury prevention efforts. Participants felt the private sector commitment to injury prevention is a reflection of concern for families that use their products and services. Participants believed the problem is a community problem which will require a broad-based collaborative effort involving all stakeholders and that additional regulations are not needed. A final report summarizing the workshop is available through the National Technical Information Service (NTIS 1999).

Supplement Ongoing NIOSH-Supported Research and Prevention Projects to More Comprehensively Address Agricultural Youths

Rationale: With minimal additional funding, current efforts supported by NIOSH would be able to help meet objectives outlined in the NCCAIP National Action Plan. Supplementing ongoing efforts takes advantage of existing protocols or research populations which are cost- and time-effective.

NIOSH Vocational Education Module Development

Rationale: Provision of vocational training for adolescents and ensuring that educators understand issues relevant to children and adolescents exposed to agricultural hazards are stated objectives in the NCCAIP National Action Plan.

Background: The current NIOSH efforts to develop occupational safety and health educational modules for use by secondary school teachers of vocational educational programs were augmented to develop modules on safety and health topics specific to agricultural vocational programs. A series of student learning activities was prepared for each module. Proposed curriculum modules to be developed were (1) Safety and Health in Agriculture, (2) Safety and Health in Horticulture, and (3) Pesticides and Agricultural Chemicals. These curriculum modules were to be composed of a teacher outline, student lesson plan, case study, crossword puzzle quiz, references and resources for additional study, safety checklist, and regulation information. An electrical safety module, which was developed for another vocational sector, was made available for vocational agriculture, with an evaluation planned for the fall of 1999.

Progress: The curriculum modules on Pesticides and Agricultural Chemicals and Agricultural Safety and Health are completed. The module on Horticulture Safety and Health should be completed in the fall of 1999.

Ergonomic and Workload Hazards to Children and Adolescents in Agricultural Work Settings

Rationale: The NCCAIP National Action Plan calls for studies of work-induced health hazards, such as cumulative trauma, on children and adolescents participating in agricultural work. The OH Farm Family Health and Hazard Survey (FFHHS) data can help identify a feasible sample of farms on which to conduct assessments.

Background: The purpose of this project is to estimate the magnitude of ergonomic/workload hazards to children performing agricultural work. The project will seek (1) to identify unique features of farm work that increase the risk of injury to children and adolescents and (2) to develop recommendations in the form of educational materials for controlling or eliminating this risk. NIOSH will collaborate with the Ohio State University to use information to identify farms where children may be employed in agricultural work. Farms where large numbers of children are recruited for seasonal tasks such as baling hay or detasseling corn will be targeted. NIOSH researchers will apply job analysis techniques and other ergonomic exposure methods to agricultural tasks commonly performed by children. The end product of this work will be a series of educational documents describing specific ergonomic concerns associated with common agricultural tasks, as well as suggestions for adapting or modifying these tasks to eliminate potential hazards.

Progress: The problem of non-traumatic work-related musculoskeletal disorders (NTWRMDSs) in children working in agriculture has been approached from three directions. First, it is planned to identify jobs performed by children on farms and then assess the risk of injury to children performing those jobs by comparing the required physical and cognitive demands to the known capacity of children of various ages. To identify potentially hazardous jobs performed by children on farms, an extensive search of agriculturally related ergonomics literature was conducted and six focus groups with farm children and parents were held to discuss jobs and risk of injury. Based on the findings, a comprehensive list of jobs performed by children on farms was developed, and the jobs with the greatest suspected risk were identified. The next step is to conduct a comprehensive ergonomic assessment of each of the suspected jobs and estimate whether a significant risk would exist for children at certain age levels. This approach is directly related to efforts to assist the National Children's Center for Rural and Agricultural Health and Safety in their project to develop the North American Guidelines for Children Working in Agriculture.

The second approach is focused on the problem ofdetermining the prevalence and severity of farm-related NTWRMSDs. Since there is no formal mechanism for identifying and tracking non-traumatic work-related musculoskeletal disorders (NTWRMDSs), a contract was awarded to Dr. Pamela Kidd at the University of Kentucky to develop a surveillance tool for collecting information about NTWRMSDs for farm children and parents seeking medical attention at school and local health clinics, doctors' offices, and hospitals. The contract includes a pilot study of the surveillance tool in two counties in KY to determine whether it would be practical for implementation in a larger region of the United States. Based on the findings, plans are to develop a series of recommendations for reducing the risk of injury to children working on farms.

A final component is to develop a Farm Stressor Inventory for adult farmers supervising children or adolescents which attempts to look at the organizational aspects of work. A contract was awarded to Professor John Carlson, University of Idaho, Moscow, with consultation from Professor Pam Elkind, Eastern Washington University. NIOSH has provided the Ohio State University Farm Stressor Inventory (FSI), Colorado State University children's work and injury survey, the University of Kentucky farm children's chores instrument, and other candidate survey items. Subsequent investigation may identify additional items as well. In collaboration with NIOSH, the contractor will produce a single, smoothly integrated survey instrument, suitable for self-administration via regular mail. A list of owner-operators of family farms with a diversity of enterprises and with sufficient size to require the assistance of family members or to hire part-time workers will be developed. Inclusion of sufficient farm and ranching regional diversity to adequately represent both enterprise and regional diversity is desired. The target population for this instrument is farm owner-operators with children or adolescents under age 18 working on the farm. Any children working on the farm must be family members. Consistent with the U.S. Department of Labor, Child Labor regulations applicable to agriculture, adolescents above age 14, who are unrelated to the farm owner-operator, may be hired as part-time workers.

Feasibility Study of Tractor CD-ROM

Rationale: Efforts to conduct evaluations of the effectiveness of educational training materials and approaches for influencing agricultural safety and health behaviors among children and adolescents are recommended in the National Action Plan.

Background: The Kayles Difficult Decision training module was a previous NIOSH project which developed a realistic scenario about a teenage youth who is faced with making decisions about operating a tractor and the consequences associated with the different options or decisions one could make. This was originally in a pencil-and-paper version. Through the initiative, NIOSH funded the development of a CD-ROM version to evaluate the effectiveness of this approach to educating farmers and their families about safety decisions which can have a significant impact on their lives.

Progress: Completion of the CD-ROM version of Kayles Difficult Decision was accomplished in the fall of 1997. The feasibility study will evaluate the effectiveness of the CD-ROM and involve focus groups of vocational teachers. Suggested changes will dictate the improvement of the Kayles CD-ROM. The utility of the CD-ROM version and comparison with the paper-and-pencil version will be assessed in vocational classrooms. The feasibility study is ongoing.

Surveillance of Migrant Farm Workers Using Community Health Aides and Surveys

Rationale: Migrant and seasonal farm workers are an understudied farmworker population. They are a particularly difficult population to address in standard injury surveillance methodologies. This feasibility project should provide guidance on how to encompass children of migrant and seasonal workers in efforts to conduct national surveillance of childhood agricultural injuries.

Background: It is very difficult to obtain information on migrant farm workers, but the limited information that is available indicates they are at high risk for nonfatal injury. This effort is being viewed as a demonstration project to explore the feasibility/utility of using camp health aides to obtain basic surveillance and risk factor information on migrant workers. Camp health aides will be enlisted through the Health Resources and Services Administration. Funds were provided to an existing NIOSH project entitled Surveillance of Migrant Farm Workers Using Community Health Aides and Surveys to expand the survey population to include youth.

Progress: The original interview was conducted in migrant communities in Homestead, Florida, by lay health advisors of adult residents (which included a household census of residents who did farm work). Few adults admitted that children or adolescent residents of their households were involved in farm labor. Therefore, the original goal of using community-based surveys of seasonal and migrant adults, conducted by lay health workers, was shown to be infeasible when a census of residents detected almost no adolescents who admitted to employment as farm workers. To further complicate the ability to conduct in-person interviews with the target population, DOL surveys indicate that most adolescents doing migrant and seasonal farm work in this country are young males from Mexico who travel to the U.S. and back unaccompanied by adults and who would probably not be detected through community- or school-based surveys. This population would be very difficult to enumerate without going directly to the workplace since they are otherwise undefined for any other administrative purpose (there are issues of parental consent and issues of illegal-resident status).

Since funding for this project was already in place with the group who train lay-health workers (Midwest Migrant Health), an alternative strategy was devised for research that would fulfill the goal of collecting self-reported injury information among a subset of the adolescent farm worker population. The plan was to conduct surveys among students in schools heavily populated by migrant adolescents in the Lower Rio Grande Valley, Texas. Focus groups and a pilot study were conducted and a survey was planned for the fall of 1998. However, the pilot survey found that the questionnaire and self-administered format did not work well in junior-high-school-aged adolescents and the sampling frame of high schools in the targeted area was not a representative sample of the target population. The original question regarding the feasibility of conducting interviews through lay health advisors to characterize injuries among adolescent farm workers has been answered -- it is not feasible at this point. During 1999, the survey of adolescent workers will be conducted (with a revised instrument) specific to seasonal and migrant adolescents in the Lower Rio Grande Valley. The present survey will collect information specific to high school students in the Lower Rio Grande Valley but will not be representative of all high schools in the area. The entire migrant student body of two or three selected high schools will be targeted.

Agricultural Pesticide Exposure and Neurobehavioral Impairment in Farm Children

Rationale: Conducting physical assessments of children and adolescents who have been exposed to agricultural chemicals is a recommended action step in the NCCAIP National Action Plan. Accumulating information about the tasks conducted by youths and about parental attitudes and behaviors is important for developing guidelines on age- or developmentally appropriate activities for children and effective educational messages. These activities are recommended in the NCCAIP National Action Plan.

Background: Farm family children will be included in a study to validate a previously observed relationship between pesticide use and neurobehavioral symptoms reported by adult farmers. The Ohio Farm Family Health and Hazard Survey (OH FFHHS) will be supplemented to address agricultural pesticide exposure and neurobehavioral impairment in farm children. From 1992-1996, the OH FFHHS demonstrated a significant relationship between pesticide use and neurobehavioral symptoms based on the self-reports of adult farmers. To further validate this relationship, NIOSH and the Ohio State University School of Public Health are collaborating on a major project to measure pesticide bioburdens and neurobehavioral functioning in the adult members of 100 Ohio farm families. With minimal additional cost, the present project was expanded to include the child members of these farm families which would allow important research questions to be examined, including the potential for children to be more susceptible than adults to certain pesticide effects.

Progress: To date, dust samples have been collected from the children's homes, neurobehavioral tests have been performed on the children, and urine samples have been collected from the children for pesticide analysis. Data analysis is in progress.

Parental Attitudes and Behaviors About Children and Farm work

Background: The purpose of this project is to supplement the existing Colorado Farm Family Health and Hazard Survey (COFFHHS) to pilot data collection on parental attitudes and behaviors about children and farmwork, injury histories of the youths, and information on youths' work and tasks. The FY96 COFFHHS cooperative agreement submission included a range of tasks required by the original FFHHS announcement, as well as some promising opportunities suggested from early survey results. However, FY96 funding was available for original/core FFHSS activities only.

Based on early survey results, the CO FFHHS proposed a survey of farms with children to assess job tasks performed by children of all ages on the farm, parental attitudes and behaviors related to high-risk activities of children on farms, and work-related injury patterns of children on these farms.

Progress: This qualitative study was performed to investigate the perceptions of safety, behavior, and hazards of children working on farms. Thirty-six adolescents, ages 14-18, were interviewed in four focus groups. All participants were living in eastern Colorado and were members of the Future Farmers of America (FFA). They were asked questions regarding work they do on the farm, how they learned to perform the work, and what safety rules they do and do not follow. Themes which emerged included Age Started Chores, Safety Behavior, Attitude Toward Injury, and Attitude Toward Prevention. These themes provide information about learning safety information, why injuries occur, the inevitability of injury, injuries sustained during farmwork and play, and attitudes of participants regarding injuries and injury prevention. The results indicate that these adolescents have been and are at risk of injury on the farm while working, playing, and playing in the context of work. They recognize the importance of safety rules but bend or break those rules based on a personal assessment of the task. They take more risks while playing than while working, but playing often occurs in the context of work and involves some of the same equipment or machinery (i.e., All-Terrain Vehicles). Finally, many of the students reported modeling the unsafe practices of parents, grandparents, and other authority figures as opposed to performing chores the way those individuals taught them. (Darragh et al., 1998).

Professional Training Component

Rationale: One of the objectives of the National Action Plan is to ensure that rural safety and health professionals understand the issues relevant to children and adolescents exposed to agricultural hazards.

Background: One of the NCCAIP recommendations is to provide health professionals with an understanding of agricultural occupational safety and health issues. This can be accomplished by encouraging the inclusion of childhood agricultural safety issues and agricultural operating procedures within agricultural safety and health courses offered at colleges and universities, and by providing short courses and other types of in-service training opportunities.

Progress: In FY99, NIOSH plans to fund one of its Education and Research Centers (ERCs) to develop a short course on childhood agricultural safety and health hazards for training professionals. In addition, the National Children's Center for Rural and Agricultural Health and Safety (NCCRAHS) has twice conducted a summer seminar on agricultural hazards for safety and health professionals since the establishment of the Center.

Extramural Program

Establish a National Information Resource Center for the Prevention of Childhood Agricultural Injury

Rationale: The national initiative to promote childhood agricultural injury prevention will result in substantial amounts of new information which is of importance to researchers, program planners, farmers, and youths. It is imperative that this and existing information be readily accessible to multiple stakeholders, that this information be utilized in health education campaigns and the development of recommended standards, and that linkages be facilitated between the public and private sectors and researchers and persons who can enact change through prevention efforts.

Background: The National Children's Center for Rural and Agricultural Health and Safety (NCCRAHS) was funded in September of 1997 at Marshfield, Wisconsin, as a cooperative agreement. It is dually funded by both NIOSH and the Maternal and Child Health Bureau (MCBH), with MCHB funding rural and health issues and NIOSH funding agriculture and injury issues.

The overall mission of the National Children's Center for Rural and Agricultural Health and Safety is to enhance the health and safety of all children exposed to hazards associated with agricultural work and rural environments. Eight objectives specific to the NIOSH Childhood Agricultural Injury Prevention Initiative have been put forth, along with numerous activities across these objectives to implement the Center program. These objectives are to: (1) establish and maintain a National Center for disseminating research findings and information shown to be effective in preventing childhood agricultural injuries, (2) establish and maintain a repository of information and data through contacts with organizations and individuals active in relevant research, education, and interventions, (3) facilitate awareness and utilization of the National Children's Center through public relations activities and technical assistance that reaches all geographic regions, a diversity of agricultural enterprises and unique, as well as traditional populations affected by childhood agricultural injuries, (4) coordinate and collaborate with established and ongoing health communication efforts such as the National Safety Council's "Farm Safety and Health Week" and the media events of Farm Safety 4 Just Kids and the National SAFE KIDS campaign, (5) organize and manage multi-perspective work groups which use consensus-development processes to arrive at recommended standards/guidelines for (a) agricultural youth work and the protection of bystander children and (b) standards for data collection and program evaluation, (6) collaborate and facilitate the involvement of researchers, educators, agribusiness, major organizations, and others in both the private and public sector who can enact change through prevention activities, (7) provide formal and informal training to health and safety professionals by enhancing existing systems and by offering options for regional, specialized training, and (8) evaluate the process and impact of the newly established National Center for Childhood Agricultural Injury Prevention and recommend its continuation, alteration, or cessation based on evaluation results.

Progress: Major objectives have been met for the first year of operation and include the following: (1) the establishment and convening of a Steering Committee for the Center (two meetings have been held to date in February and October 1998), (2) publication of an information sheet about the National Center and creation of an Internet site, (3) establishment of a dedicated 800 number for the National Center which can be used for process and impact evaluation measures, (4) hiring a full complement of staff, (5) convening a consensus-development group for youth work guidelines (four meetings have been held to date in March, August, September, and December 1998), (6) entering into contractual/collaborative arrangements with five childhood agricultural injury prevention groups, (7) presenting at and convening meetings of professional groups relating to childhood agricultural injury prevention (National Institute for Farm Safety, National Safety Council, and 4^th International Symposium on Rural Health and Safety in a Changing World), and (8) conducting professional training in the summers of 1998 and 1999 for injury professionals (summer seminar for rural youth injury prevention). During the first six months of NCCRAHS operation, 276 requests for assistance regarding issues associated with childhood agricultural injury prevention were received and displays or resource materials on childhood agricultural injury prevention were placed at 18 regional, national, or international conferences.

Childhood Agricultural Safety and Health Research Grants

Rationale: The NCCAIP National Action Plan includes objectives calling for research into the costs, risk factors, and consequences of childhood involvement in agricultural work and for rigorous evaluations of commonly used educational and training programs. Research is needed to facilitate the appropriate prioritization of childhood agricultural safety and health activities and to inform the development and implementation of appropriate and effective prevention efforts.

Background: In the Spring of 1997, NIOSH announced the availability of funds for research into risk factors, positive and negative outcomes of youth work, intervention strategies, and evaluation of commonly used educational or training program(s). Data on risk factors unique to children are needed for the development of age- and developmentally appropriate guidelines for work and protection of nonworking children. Research assessing outcomes of children's involvement in agriculture is needed to address health hazards which may have implications for youths' future health and to understand the magnitude and scope of the injury problem to allow the appropriate prioritization of prevention efforts. Data on positive as well as negative outcomes of youths' involvement in agriculture are needed to develop a balanced response to protecting children. Intervention research is needed to direct prevention efforts to those programs which have been proven to be most effective. Finally, rigorous evaluations of commonly available and used education or training programs are needed. It is critical that intervention efforts which are undertaken on a widespread basis have demonstrated success in reducing risk for injury.

Projects were sought that would conduct research on etiology, outcomes, and intervention strategies and would rigorously evaluate the effectiveness of commonly used educational materials and methods in preventing childhood agricultural injuries and illnesses. Findings from these projects were intended to advance the scientific base of knowledge needed to maximize the safety and health of children exposed to agricultural production hazards. In September 1997, NIOSH provided funding for 16 grants falling within the specified research areas -- 8 of them for a 3-year cycle and another eight for one year to more fully develop their proposals. These later eight would have to re-compete when a new RFA was released in fiscal year 1998.

A second NIOSH grants solicitation was announced in the spring of 1998. Projects were sought to conduct research on risk factors for agricultural injuries associated with child development, social and economic consequences associated with youth workers, and the design and/or evaluation of strategies to prevent childhood agricultural injuries. Findings from these projects are intended to advance the scientific base of knowledge needed to maximize the safety and health of children exposed to agricultural production hazards. Abstracts for each of the grants funded through Childhood Agricultural Injury Initiative is available upon request through the NIOSH docket office. You may contact the NIOSH docket office by mail at NIOSH Docket Office, Education and Information Division, 4676 Columbia Parkway, M/S C-34, Cincinnati, Ohio, 45226 or by e-mail to niocindocket@cdc.gov.

Fund an intervention evaluation cooperative agreement Community-Based Health and Safety Interventions for Adolescents Working in Agriculture: Evaluation of a National Initiative

Rationale: A stated objective in the NCCAIP National Action Plan is to conduct systematic evaluation to ensure that educational materials and methods targeted toward childhood agricultural safety and health have demonstrated positive results. Results from this study will have significant implications for future agricultural safety interventions and corporate sponsorship of national safety and health initiatives.

Background: This specific project was originally submitted to NIOSH under the fiscal year 1996 Community Partners in Healthy Farming (CPHF) cooperative agreement announcement and was approved but not funded. The project was funded through this initiative. The goal of this proposed study is to conduct a comprehensive, systematic evaluation of the pilot phase of a community-based agricultural safety and health intervention for adolescents that is scheduled for implementation in 4,000 sites across the U.S. by 1998. The evaluation study will use a randomized, case-control methodology for evaluation. The community-based intervention which will be evaluated is the National Future Farmers of America (FFA) "Partners for a Safer Community" program that will be funded primarily by prominent agricultural businesses. Specific objectives for the study are to (1) assess the impact of an education and training intervention on the knowledge, attitudes, and practices of adolescent farm workers, (2) describe the agricultural injury experience among adolescent workers in agriculture, (3) determine the impact of an education and training intervention for building leadership skills of youths through community-based initiatives, (4) determine the impact of an education and training intervention on building community partnerships with potential for sustainability, (5) collaborate with a prominent, not-for-profit, youth-oriented organization in conducting a process and impact evaluation, (6) recommend continuation, refinement, alteration, or cessation of a national education and training intervention targeted for rural and agricultural youth, (7) recommend a practical model for evaluation of community-based occupational safety intervention programs for youthful workers, and (8) disseminate results of a comprehensive, systematic evaluation project to funding agencies, program evaluators, and the agricultural community.

Progress: Ten states with the highest number of farms, based on the 1990 Census of Agriculture were identified, and 123 FFA chapters with more than 3,000 students and 90 FFA advisors across the ten states were enlisted, along with 270 community leaders, to participate in the evaluation study. The chapters were randomly assigned to one of three groups: Group A -- standard, Group B -- enhanced, or Group C -- control. Chapters and state training teams were notified of the FFA chapter assignments. State FFA Partners for a Safer Community training was to be implemented during the spring or summer of 1998 with chapters assigned a standard of enhanced intervention status. Local FFA chapters implemented the FFA Partners for Safer Community project during the 1998-99 school year. Data regarding knowledge, attitude, and behavioral intentions related to rural health, and safety and health leadership skills were collected through written surveys before the first training of the local FFA chapter in September 1998. The survey was repeated in May 1999, and will be administered again in May 2000. Students in grades 9-11 who participate in the FFA Partners for a Safer Community program will be surveyed.

Partially Fund Research Grant Occupational Injury in Hispanic Farm worker Populations

Rationale: Migrant and seasonal farm workers are an understudied farmworker population. They are a particularly difficult population to address in standard injury surveillance methodologies.

Background: The predominant ethnic group of migrant and seasonal workers is Hispanic, and in California this group constitutes approximately 90 percent of migrant and seasonal farm workers. This prospective cohort study of occupational injury among migrant Hispanic farm workers will evaluate risk factors for injury for use in targeting and designing injury reduction programs in this high-risk population. The purpose of this grant is to conduct a prospective cohort study of occupational injury among migrant Hispanic farmworker families through a harvest season. The sample will comprise approximately 500 families including 1,000 adults and 1,000 children. The study is unique in two important respects. First, it addresses specific hypotheses regarding remediable risk factors for injury that have not been evaluated in other populations. These include organophosphate pesticide exposure (as indicated by erythrocyte acetylcholinesterase levels), piece-work versus hourly pay, language appropriate safety training, and the role of multiple employment. Second, the study focuses on migrant farmworker families-a large, yet understudied at-risk group. These data will be useful for targeting and designing injury reduction programs in this high-risk population.

Results: A prospective cohort study of injury across the 1997 harvest season among 1,174 adults and 907 children of migrant Hispanic farm worker families living in local migrant housing centers was conducted. Participants completed an initial interviewer-administered work-and-health questionnaire with periodic follow up during the harvest season. Subjects also completed pre- and post-season acetylcholinesterase tests. Participation rates in participating housing centers ranged from 82 to 95 percent. One-year reported injury rates based on initial interviews were 10.9 percent for men, 8.2 percent for women and 3.7 percent for children. The majority of adult injuries were occupational; the majority of childhood injuries were nonoccupational. Qualitative injury risk for this cohort appears comparable to that of agricultural workers in other U.S. settings.

Enhance Region-Specific Childhood Safety and Health Research, Education, and Prevention Efforts

Rationale: NIOSH Agricultural Centers conduct research, education, and prevention efforts which are encompassed in numerous NCCAIP National Action Plan objectives. Supplementation of the Centers provided a means to ensure that appropriate regional priorities for childhood safety and health were considered and addressed.

Background: The purpose of this effort was to provide 1-year supplemental funding to the eight NIOSH Agricultural Centers to enhance childhood safety and health research, education, and prevention efforts. Childhood safety and health were emphasized as a key area for NIOSH Agricultural Centers and most Centers initially proposed projects in this area. Due to Center funding levels, some of the Center projects on childhood safety and health were reduced or eliminated.

Progress: In FY97, each Center received 1-year supplemental funding to support these efforts. A summary of projects/activities undertaken by each Center are described in a document which is available upon request from the NIOSH docket office. You may contact the NIOSH docket office by mail at NIOSH Docket Office, Education and Information Division, 4676 Columbia Parkway, M/S C-34, Cincinnati, Ohio, 45226 or by e-mail to niocindocket@cdc.gov.

References

Rivara FP [1997]. Fatal and nonfatal farm injuries to children and adolescents in the United States. Pediatrics 76(4): 567-573.

National Committee for Childhood Agricultural Injury Prevention [1996]. Children and agriculture: opportunities for safety and health. Marshfield, WI.

Lee BC and Gunderson PD [1992]. Childhood agricultural injury prevention: issues and interventions from multiple perspectives. Marshfield, WI: Marshfield Clinic.

National Technical Information Service [1999]. The Childhood Agricultural Injury Prevention Strategy Workshop: A Private Sector Perspective. Final Report: A Summary of Strategies and Successes, NIOSH Contract Number 0009756278, Purdue University, NTIS Accession: PB 99-147597.

Darragh RA, Stallones, L, Sample P L, and Sweiter K [1998]. Perceptions of farm hazards and personal safety behavior among adolescent farmworkers. Journal of Agricultural Safety and Health, Special Issue No. 1, pp. 159-169.

Proposed Future Activities

The following provides a summary of proposed NIOSH plans for research and related activities for the Childhood Agricultural Injury Prevention Initiative after the initial 3-year period which has been summarized in the progress section. These activities are proposed for both the intramural and extramural components of the initiative. Comments and input are sought for each of these areas.

Intramural

Surveillance

To date, NIOSH has attempted to look at various options for collecting childhood agricultural injury data. However, all ongoing and proposed surveys in this NIOSH program do not constitute a surveillance system. While useful information will be gained through these surveys and the collection of death certificate data, these efforts will not be useful for surveillance unless some ongoing method of collecting injury data is established. Ideally, such a system would provide annual information on all populations of interest in the Childhood Agricultural Injury Prevention Initiative and be available in a timely fashion.

The surveillance of fatal injuries occurring on farms can easily be implemented by NIOSH in a continuous fashion because of the relatively small number of cases involved. From a practical standpoint, however, it is unlikely that NIOSH will be able to conduct such a national surveillance system for nonfatal injuries. The barriers to establishing such a nonfatal injury surveillance system are many: the need for each specific population to have a unique surveillance method, the cost of conducting annual surveillance of each of these populations, the availability of cooperating federal agencies (e.g., Departments of Agriculture, Department of Labor, Consumer Product Safety Commission) to provide the necessary support for specific surveys on an annual basis, and the internal resources available to NIOSH to maintain such broad surveillance efforts on an annual basis. Based on these barriers, it is more feasible for NIOSH to approach the nonfatal injury surveillance needs of this initiative using periodic surveillance. Under such an approach, NIOSH would conduct nonfatal injury surveillance on specific populations of interest on a rotating basis (e.g., survey farm worker youths and children of farm workers the first year, minority farm workers the second year, etc.).

The advantages of such an approach are that data collection becomes more cost-effective and more manageable, while still providing the population-specific data needed for assessing agricultural injuries occurring in the U.S. In addition, such an approach allows time for the analysis of a specific population survey, leading to well-thought-out changes to issues covered during the next cycle of that survey. Such a system also allows NIOSH to better coordinate survey activities with the other key federal partners needed to collect these data. The actual types of surveys that will be conducted to form this periodic surveillance system will not be determined until the ongoing NIOSH surveys have been evaluated for their effectiveness. Other methods may need to be tested to determine the best approach for collecting nonfatal injury data for specific populations of children.

The one opportunity NIOSH may have for continuous surveillance is in a modified National Electronic Injury Surveillance System (NEISS) that collects data on all traumatic injuries seen in the NEISS emergency department sample. While such a system is being considered, however, it does not exist at this time. Even if this surveillance effort does become available, it would not provide adequate coverage of all populations of children of interest in this initiative, nor would it provide adequate coverage for all the types of injuries occurring to children on farms that are of interest in the initiative. Therefore, NIOSH is proposing to continue with population-specific surveillance efforts as part of an overall childhood agricultural injury surveillance program.

Additional Surveys and Surveillance Opportunities

NIOSH and the surveillance experts who met in September 1997 identified an additional population of children which may not be adequately covered by the three surveillance methods initially funded by NIOSH. This population is children of minority farm operators. While it would be reasonable to assume that the National Agricultural Statistical Service (NASS) survey would include minority operators, NASS is concerned this special population is under represented in their present sampling frame.

To address this concern, NIOSH proposes to conduct a minority farm operator survey using the Census of Agriculture farm operator list rather than the NASS farm operator list. The Census of Agriculture list has several advantages over the NASS list. First, the Census of Agriculture list includes more small farm operations. In addition, with the Census, it is possible to identify racial demographic information of farm operators. Given these two pieces of information, it is feasible to conduct a farm operator survey specifically for minority operators. It is also feasible to conduct this survey in such a way as to obtain childhood agricultural nonfatal injury information on these operations with statistical confidence that is equal to or better than the general farm operator survey conducted by NASS for NIOSH in 1999. NASS, which took over the responsibility for the Census of Agriculture from the Bureau of Census in 1996, believes that the Census of Agriculture farm operator list should be available for this type of survey in the year 2000.

Based on the availability of this new list, NIOSH proposes to work through NASS to conduct a minority farm operator survey in January of 2001. The groups to be included in this survey are farmers of African-American, Asian, and American Indian descent, and farmers of Hispanic origin. If conducted as planned, results from this survey would be available in the fall of 2001.

Other surveillance options may also become available that will allow NIOSH to provide childhood agricultural nonfatal injury information for this initiative. One promising possibility is the expansion of the CPSC NEISS to cover all traumatic injuries. At the present time, NEISS only collects information on injuries related to specific consumer products designated by CPSC and occupational injuries through an interagency agreement between NIOSH and CPSC. CPSC and other federal agencies are proposing the collection of all nonfatal injury cases identified in the participating NEISS hospitals. It is possible that such a NEISS system could be initiated in the next few years. NIOSH supports this expansion of NEISS in general because of the increased coverage of occupational injuries by such a system. In addition, such a system would provide the basis for continuous childhood agricultural nonfatal injury surveillance information.

Finally, the issue of hazard surveillance has not been addressed in this initiative. Because hazard surveillance does provide unique opportunities for preventing injuries and fatalities before they occur, NIOSH views the use of hazard surveillance as a mechanism worth pursuing in the Childhood Agricultural Injury Prevention Initiative. NIOSH will examine opportunities for incorporation of hazard surveillance components into existing nonfatal injury surveillance systems and try to take advantage of hazard surveillance information collected in existing surveys. Examples of this include farm task information already being collected in the DOL National Agricultural Worker Survey (NAWS) which may be adaptable in some form to a broad farm operator survey, and the inclusion of child agriculture safety and health issues in the new hazard surveillance activities currently being developed by NIOSH.

Federal Agency Task Force

NIOSH proposes that the Federal Task Force continue for the purposes of:

• Addressing issues related to childhood agricultural injury surveillance carried out at the federal level;
• Serving as a vehicle for routine communication among federal agencies on the initiative and related research findings and prevention effort;
• Fostering collaborative activities among relevant federal agencies, and;
• Facilitating the consideration of NCCAIP recommendations for regulatory action.

NIOSH plans to regularly communicate to Federal Task Force members new findings and new directions. Consideration will be given to the development of additional Task Force subgroups as needed during the Initiative. For example, as proven prevention strategies are identified, a subgroup to evaluate different strategies for encouraging implementation may be worthwhile. In-person meetings will be convened on an "as-needed" basis.

Professional Training Activities

Through training grants, NIOSH proposes to encourage the inclusion of childhood agricultural safety information within university agricultural safety and health courses and curricula for public health and health care providers. Once curricula are developed, collaboration with professional societies is needed to encourage widespread use. It is proposed that additional funding be provided to other NIOSH ERCs to develop such training programs addressing childhood agricultural safety and health issues.

Documenting the Scientific Basis for Regulatory and Programmatic Recommendations

Through an interagency agreement between NIOSH and the Employment Standards Administration, Department of Labor, NIOSH will provide a report to the Department of Labor assessing the adequacy of existing federal child labor regulations to protect working youths. Risks to youths working in agriculture will be included in the NIOSH report scheduled for completion in March 2000.

Additionally, NIOSH plans to conduct an independent review of the scientific basis for specific North American Guidelines for Children's Agricultural Tasks (NAGCATs), released in June 1999, that were developed through a consensus process. The need for guidelines to assign age- and developmentally appropriate tasks are based on recommendations within the farming and ranching community and from the NCCAIP National Action Plan. The NAGCATs are designed to help parents and others assign age-appropriate tasks for children ages 7-16 who live or work on farms and ranches across North America. The guidelines are based on an understanding of childhood growth and development, agricultural practices, principles of childhood injury, and agricultural and occupational safety. Voluntary use of the guidelines can help parents and others make informed decisions about appropriate tasks for youths.

The review will be undertaken to develop a NIOSH response to the guidelines, identifying specific guidelines that NIOSH believes are supported by empirical data, those contraindicated by existing data, and/or those for which additional research is needed. Areas identified as requiring additional research will be incorporated into future research efforts as part of the initiative.

Private Sector Involvement

The National Action Plan envisioned private sector foundations, corporations, and other groups as being partners with the public sector in efforts to plan, implement, fund, and evaluate activities of the Childhood Agricultural Injury Prevention Initiative. To accomplish this component, it is proposed that an external group be identified who interacts with and is known by the agribusiness private sector (such as the Farm Foundation) to arrange meetings with the various private sector industries and organizations. NIOSH proposes to work together with the agribusiness private sector to facilitate this activity. This would help establish linkages between the public and private sectors to work collaboratively on projects and evaluation activities through joint funding efforts.

Extramural Program

National Children's Center for Rural and Agricultural Health and Safety (NCCRAHS)

The NCCRAHS was funded through a cooperative agreement for a 5-year period beginning in FY97. NIOSH proposes that the Center funding be continued through this original 5-year period to address the original objectives which have been outlined in the document summarizing progress for the Childhood Agricultural Injury Prevention Initiative.

Research Activities

The following areas have been identified as gaps in current research and are proposed as priority areas for the NIOSH extramural research grants solicitation which are proposed for fiscal years 2000 and 2001:

1. Health Communication
   • Determine which health communication efforts are effective within a target population
   • Ensure the public is aware of general and specific childhood agricultural safety and health issues.
   • Design and evaluate culturally relevant/sensitive materials.
2. Engineering Interventions
   • Develop new or enhance existing engineering interventions to reduce injury hazards to youths.
3. Evaluation of Community-Based Efforts
   • Assess the impact of community-based efforts, such as cooperative child care programs and the use of community coalitions, on farm practices and agricultural injuries among children.
4. Social and Economic Costs and Consequences of Childhood Agricultural Injuries
   • Data on the social and economic consequences of injury and disease outcomes are needed to allow for the appropriate prioritization of prevention efforts.
5. Basic Research on Exposure Issues
   • Conduct assessments of the short- and long-term physical and psychological outcomes related to children's and adolescents' participation in different types of agricultural work.
   • Conduct physical assessments of children and adolescents who have been exposed to agricultural hazards such as agricultural chemicals, organic dusts, toxic gases, nitrates, volatile organic compounds, oils, and solvents.
   • Conduct studies of the impact of noise, vibration, cumulative trauma, and other work-induced health hazards on children and adolescents participating in agricultural work.
6. Evaluation of Educational Materials and Methods
   • The need continues for a strong effort to evaluate commonly used educational materials and methods to determine which ones are effective. Many of the current and past efforts of childhood agricultural injury prevention were on educational efforts. Much work needs to be done in this area of evaluation and should be a major area of emphasis.