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Journal of Agromedicine Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wagr20

Assessment of Personal Protective Equipment Use Among Farmers in Eastern North Carolina: A Crosssectional Study a

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Gregory D. Kearney , Xiaohui Xu , Jo Anne G. Balanay , Daniel L. Allen & Ann P. Rafferty a

Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA b

Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, Florida, USA c

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Environmental Health Sciences Program, Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, North Carolina, USA Published online: 30 Jan 2015.

To cite this article: Gregory D. Kearney, Xiaohui Xu, Jo Anne G. Balanay, Daniel L. Allen & Ann P. Rafferty (2015) Assessment of Personal Protective Equipment Use Among Farmers in Eastern North Carolina: A Cross-sectional Study, Journal of Agromedicine, 20:1, 43-54, DOI: 10.1080/1059924X.2014.976730 To link to this article: http://dx.doi.org/10.1080/1059924X.2014.976730

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Journal of Agromedicine, 20:43–54, 2015 Copyright © Taylor & Francis Group, LLC ISSN: 1059-924X print/1545-0813 online DOI: 10.1080/1059924X.2014.976730

Assessment of Personal Protective Equipment Use Among Farmers in Eastern North Carolina: A Cross-sectional Study Gregory D. Kearney,1 Xiaohui Xu,2 Jo Anne G. Balanay,3 Daniel L. Allen,1 and Ann P. Rafferty1

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1 Department

of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA 2 Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, Florida, USA 3 Environmental Health Sciences Program, Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, North Carolina, USA

ABSTRACT. Agriculture consistently ranks among the top hazardous occupations, accounting for a significant number of injuries and fatalities in the workplace. Eastern North Carolina has a significant number of small, independent, family-run, owned, and operated farms. However, little is known about perception, behavior, training, accessibility, or purchasing personal protective equipment (PPE) for safety among farmers in the region. In this study, telephone interviews were conducted among participating farmers between March and June 2012 (N = 129). Univariate and bivariate analyses were conducted to examine associations between PPE behavior and workplace hazards, health-related concerns, and wearing and purchasing PPE. Findings indicated that personal behavior of wearing hearing protection devices (HPDs) and protection from the sun among farmers was low. However, a relatively high percentage of farmers reported wearing PPE when working with agricultural chemicals. Most farmers received training from agricultural extension offices. The findings indicate that, in general, farmers are well aware of the risks associated with occupational hazards and recognize concern for health and safety protection in the workplace. Transitioning these concerns into preventative action remains a challenge and priority for the agricultural health professional.

KEYWORDS. Agriculture, injuries, occupational health, personal protective equipment

Agriculture is one of the most hazardous occupations, accounting for a large number of workforce injuries, chronic illnesses, and deaths.1 In 2010, the US Department of Labor reported that farmers and ranchers experienced a worker fatality rate of 41.4 (per 100,000 fulltime equivalents [FTE]) compared with 3.5

(per 100,000 FTE) all-worker fatal injury rate for other occupations.2 This estimate does not account for nonfatal injuries, illnesses, or chronic diseases, nor the accompanying personal pain and suffering, years of potential life loss, or economic burden to the existing health care system. Significant reduction of acute and

Address correspondence to: Gregory D. Kearney, Department of Public Health, Brody School of Medicine, East Carolina University, 600 Moye Boulevard, MS 660, Lakeside Annex #8, Greenville, NC 27834, USA (E-mail: [email protected]). Color versions of one or more figures in the article can be found online at www.tandfonline.com/wagr. 43

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PPE USE AMONG FARMERS IN EASTERN NC

chronic injury and even death may be avoided by the use of proper personal protective equipment (PPE).3 Although Occupational Safety and Health (OSHA) regulations require employers with 11 or more employees to provide PPE to their employees,4 Schenker et al.1 and Carruth et al.5 identified that workers in smaller agricultural operations were less likely to comply with these safety protection standards. Primary reasons cited by farmers for not wearing PPE include being uncomfortable, inconvenient, inaccessible to purchase, and/or interference to hear machinery.3 In a cross-sectional study among farmers in California (N = 1,947), Schenker et al.6 evaluated the association between PPE use and common agricultural workplace exposure hazards, including organic and inorganic dust exposure, ultraviolet radiation from the sun, pesticide exposure when mixing, loading, or applying chemicals, and loud, excessive noise associated with farm machinery.6,7 In general, results of the study found that self-reported behavior of protection from the sun (i.e., sunscreen, protective clothing) and use of hearing protection devices (HPDs) when working around excessive noise among farmers was low. PPE worn most often included the use of chemical gloves (74%), protective clothing (61%), and face shields (57%) when working with pesticides.6 The study area for this project included 29 geographically connected counties in eastern North Carolina (ENC-29). The region encompasses approximately 8,300 farms8 and is primarily characterized as rural and economically disadvantaged, with high unemployment and high percentage of families living below the federal poverty level.9,10 ENC-29 suffers from the highest age-adjusted mortality rates of most major chronic health conditions in the state, including heart disease, stroke, and diabetes.11,12 The ENC-29 area has a high concentration of small, family-run farms and includes the largest sweet potato and flue-cured tobacco producing counties in the United States. Other principal crops and livestock produced in the region include soybeans, cotton, peanuts, corn, hogs, poultry soybeans, vegetables, and/or fruits.8,13

With such a large concentration of familyrun farms and poor economic and adverse health conditions in the region, there is a limited amount of information related to farmers and their use of PPE. The primary objective of this project was to describe and assess behavior of wearing PPE among farmers in the ENC-29 region. Exposure hazards in this assessment included those previously identified by Schenker et al.,6 including ultraviolet radiation from the sun, loud noise, and agricultural chemicals. Other components evaluated as part of this assessment included farmers’ perceived occupational health–related concerns, training, purchasing, and factors that influence decision-making for wearing PPE. The results of this project offer county agricultural extension agents and outreach workers insight for developing educational intervention programs aimed at improving health for farmers in the ENC-29 region.

METHODS Participants Participants for this project were selected from a publicly available database provided by the North Carolina Department of Agriculture and Consumer Services (NC DACS). This database was used primarily because it was readily available and contained contact information for over 43,000 NC licensed, private pesticide applicators (which are primarily farmers). Using the sort function in Microsoft Excel (2010), the names and contact information of 5,655 licensed, private pesticide applicators in the ENC-29 county region were extracted. From the list, 4,817 or 85% of the names had complete telephone contact information. Eligible participants from the list were randomly selected and contacted by telephone. The inclusion criteria for participants in the study included being 18 years or older, residing within the ENC29 county region (or area), and actively working in agriculture. The study was targeted primarily at owners and/or operators of the farm. Job positions were used as a way to categorize primary job duties and included the following: farm

Kearney et al.

laborer (primarily responsible for chores), farm operator (primarily operates equipment), farm manager (does not operate equipment, but oversees farm duties), farmer (includes operating equipment and performs other farm duties), or other (agricultural duties not mentioned). All participants provided oral consent prior to any data collection. This project was approved by ECU Institutional Review Board (approval no. UMCIRB 11-001099).

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Procedures This was a cross-sectional study, using telephone interviews conducted by trained assessors between March 12 and June 12, 2012, by the East Carolina University (ECU) Center for Survey Research. Survey data were collected, recorded, and processed using Cardiff TeleForm Data Capture software. The survey included 45 questions related to categories of self-reported sociodemographics, farm characteristics, workplace exposures, behavior, perceived health-related concerns, training, purchasing, and influential factors for wearing PPE. The survey questions were developed primarily from two earlier studies that assessed the use of PPE among farmers in California and the Midwest.6,14 The questions pertaining to behavior and health-related concerns concentrated on major occupational hazards and exposures to farmers, including excessive loud noise, ultraviolet radiation from the sun, mixing, loading and/or applying agricultural chemicals, and use of respiratory protection and protective clothing.

Measures Sociodemographic measures included, age, sex, educational attainment, race/ethnicity, household income, marital status, size of farm in acres (owned and/or operated), and health insurance status. Characteristics related to primary work activities included number of years farming ($50,000). Prior to calculating bivariate analysis, we collapsed the response variables of “some influence” and “strong influence,” and for health-related concerns, we combined “strongly agree” with “agree,” and “disagree” with “strongly disagree.” Statistical significance was considered of P values $100,000 Health insurance Has insurance No insurance Farm size (owned and/or operated) ≤50 acres >50 acres Work characteristics Years farming ≤20 years More than 20 years Hours/week works on farm ≤40 hours or less More than 40 hours Position on farm Farmer (operates equipment, oversees daily operations) Farm operator (operates only equipment) Farmer manager (does not operate equipment) Other agriculture-related duties Primary agricultural crop/livestock activity Grains and soybeans Cotton Tobacco Poultry or livestock Vegetables and/or fruits Specialty crops (not listed above) Physical health–related characteristics Overall physical health Excellent/very good Good Somewhat fair/poor Experienced poor physical health (past 30 days) None ≥1 day

% (n)

50 (16) 29 (36) 39 (49) 33 (41) 75 (95) 25 (32) 81 (103) 19 (24) 97 (125) 1 (1) 2 (3) 43 (54) 56 (73) 33 (31) 42(39) 25 (23) 89 (113) 11 (14) 13 (17) 87 (110)

36 (46) 64 (82) 28 (36) 72 (91) 57 (73) 7 (9) 12 (15) 14 (18) 39 (49) 20 (25) 16 (20) 14 (17) 5 (6) 7 (9)

60 (77) 34 (43) 6 (8) 89 (112) 11 (14) (Continued)

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PPE USE AMONG FARMERS IN EASTERN NC

TABLE 1. (Continued) Characteristic

% (n) working∗

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Experienced a farm-related injury that prevented Experienced an overnight stay in hospital for farm-related injury (within past 5 years) Exposures to work-related hazards∗ What percent of time were you around so much noise, you had to shout to be heard when farming? More than 10% of time What percent of time were spent outdoors in sun when farming?∗ More than 10% of time Do you mix, load, or apply agricultural chemicals? Yes How frequently did you mix load or apply agricultural chemicals?∗ Less than once per month At least once per month At least once per week At least once per day

9 (11) 5 (7)

45 (57) 97 (117) 88 (114) 18 (20) 27 (31) 40 (46) 15 (17)

Note. Some participants may not have responded to all questions; therefore, N may not total sample size (N = 129). ∗ Within the past 12 months.

had to shout to be heard. Ninety-seven percent of farmers reported spending 10% or more time working outdoors in the sun over the past year, and 88% reported mixing, loading, or applying agricultural chemicals. Forty percent of the participants reported mixing, loading, and applying agricultural chemicals at least once per week.

Use of PPE Self-reported behaviors of using PPE from exposures to loud noise, sun, and mixing, loading, or applying chemicals within the past year are summarized in Table 2. Among those farmers reporting, 12% stated wearing ear plugs and 7% wore ear muffs either always or most of the time. For sun protection, 63% of participants reporting wearing a baseball hat either always or most of the time, 57% reported wearing long pants, 56% wore sunglasses, and 27% wore a wide-brim hat always or most of the time. Only 16% of farmers reported wearing sunblock or sunscreen with SPF15 or higher. Among farmers reporting PPE when mixing, loading, or applying agricultural chemicals, 69% wore chemical protective gloves, 54% wore safety goggles/glasses, 40% wore a dust mask, 31% wore coverall/apron suit, 31% wore coverall/apron suit, and 31% wore protective footwear from chemicals.

Protective face shield (69%), cartridge respirators (69%), and canister respirators (77%) were never or rarely used within the past year.

Health Concerns From Occupational Hazards Among participants reporting health concerns from, or related to, agriculture occupational exposure hazards, 77% strongly agreed or agreed that they were concerned about getting skin cancer from sun exposure, 65% were concerned about hearing loss, and 64% were concerned with injuries from farm equipment or livestock (Table 3). Sixty percent of farmers strongly agreed or agreed that they were concerned with getting cancer from using chemicals, whereas 52% were concerned with skin problems from farm-related exposures and 27% were concerned with reproductive problems from using chemicals. As shown in Table 4, the decision to wear PPE was most strongly influenced by the following factors: desire to avoid injury (70%), followed by government warning stickers or labels (54%), family members telling them to wear PPE (38%), ease of using PPE (36%), and cost of equipment (22%). Time involved to put on PPE (20%) and personal appearance (15%) were reported as factors least likely to influence a farmer’s decision to wear PPE.

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TABLE 2. Self-reported Behavior of Wearing Personal Protective Equipment (PPE) Among Farmers in Eastern NC

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Protection method

Protection from noise Ear plugs Ear muffs Protection from the sun Baseball cap Long pants Sunglasses Wide brimmed hat Long sleeved shirt Sunscreen/sunblock (SPF 15+) Gloves Protection from chemicals Chemical protective gloves Safety goggles/glasses Disposable dust/mist mask Coverall/apron/suit Protective footwear Protective face shield Cartridge respirator Canister respirator

% (n) Total∗

Never/Rarely

About Half the time

Always or most of the time

100 (57) 100 (57)

79 (45) 83 (47)

9 (5) 11 (6)

12 (7) 7 (4)

97 (116) 93 (112) 98 (117) 98 (117) 97 (116) 97 (116) 96 (115)

26 (30) 14 (17) 29 (34) 60 (70) 37 (43) 70 (81) 60 (72)

11 (13) 23 (27) 14 (16) 12 (14) 36 (44) 14 (16) 18 (22)

63 (73) 57 (68) 56 (67) 27 (33) 25 (29) 16 (19) 18 (21)

98 (112) 98 (112) 97 (110) 97 (110) 90 (103) 92 (105) 95 (108) 95 (109)

16 (18) 35 (39) 46 (50) 56 (62) 61 (63) 69 (72) 69 (74) 77 (84)

15 (17) 12 (13) 15 (16) 13 (14) 8 (8) 9 (9) 11 (12) 6 (7)

69 (77) 54 (60) 40 (44) 31 (34) 31 (32) 23 (24) 19 (21) 17 (18)

∗ Includes participants answering “yes” for the following: Hearing protection—working more than 10% of the time in conditions so loud that you have to shout to be heard (n = 57); Protection from sun—spending more than 10% of the time working outdoors (n = 117); Protection from chemicals—mixing, loading, or apply agricultural chemicals (n = 114).

TABLE 3. Health-Related Concerns Towards Exposure Hazards Among Farmers in Eastern NC (N = 129) Health concern and hazard

% (n) Strongly agree/Agree

Disagree

Strongly disagree

77 (99) 65 (84) 64 (82) 60 (77) 52 (67) 27 (35)

14 (18) 23 (29) 25 (32) 23 (30) 28 (36) 41 (53)

9 (12) 12 (16) 12 (15) 17 (22) 20 (25) 31 (40)

Skin cancer from the sun Hearing loss from farm-related activities Injuries related to farm equipment or livestock Cancer from using chemicals Skin problems from farm-related activities Reproductive problems from using chemicals

Note. Some participants may not have responded to all questions; therefore, N may not total sample size (N = 129).

Nearly three quarters (73%) of participants purchased PPE, and 70% reported receiving PPE education or training within the past 12 months (Table 5). The majority of participants reported receiving education or training from NC Cooperative Extension (61%), followed by community college (12%), NC Agrisafe (10%), vendor (7%), and the NC Agromedicine Institute (5%). In ranked order,

most participants reported that they were most likely to purchase PPE from a farm supply store (55%), followed by farm equipment supplier (27%) and hardware store (9%). The least likely places to purchase PPE were mail order and (via) the Internet (4%). When demographic, income, age groups, sex, and education variables were evaluated with PPE behavior (noise, sun, and chemical

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PPE USE AMONG FARMERS IN EASTERN NC

TABLE 4. Factors That Influence Farmers Decision Whether to Use or Not Use PPE (N = 129) Factor

% (n)

Desire to avoid injury Warning stickers or labels Family (telling you to wear it) Ease of using PPE Cost of equipment Time involved to put it on Personal appearance

No influence

Some influence

Strong influence

4 (5) 13 (17) 26 (34) 16 (21) 44 (56) 43 (55) 69 (88)

26 (33) 33 (42) 35 (45) 48 (61) 34 (44) 37 (47) 16 (21)

70 (90) 54 (69) 38 (49) 36 (46) 22 (28) 20 (26) 15 (19)

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Note. Some participants may not have responded to all questions; therefore, N may not total sample size (N = 129).

TABLE 5. Education, Training, and Purchasing PPE Among Eastern NC Farmers (N = 129) PPE-related parameter

% (n)

Purchased PPE

Assessment of personal protective equipment use among farmers in eastern North Carolina: a cross-sectional study.

Agriculture consistently ranks among the top hazardous occupations, accounting for a significant number of injuries and fatalities in the workplace. E...
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