Journal of Adolescent Health 54 (2014) 255e261

www.jahonline.org Original article

Involving Fathers in Teaching Youth About Farm Tractor Seatbelt SafetydA Randomized Control Study Hamida Amirali Jinnah, Ph.D. a, *, Zolinda Stoneman, Ph.D. a, and Glen Rains, Ph.D., P.E. b a b

Institute on Human Development and Disability, University of Georgia, Athens, Georgia College of Agricultural and Environmental Sciences, University of Georgia, Athens, Georgia

Article history: Received August 13, 2013; Accepted October 16, 2013 Keywords: Farm safety intervention; Injury prevention; Youth safety; Tractor seatbelts; Father involvement; Parent involvement; Randomized control evaluation

See Related Editorial p. 243

A B S T R A C T

Purpose: Farm youth continue to experience high rates of injury and deaths as a result of agricultural activities. Farm machinery, especially tractors, is the most common cause of casualties to youth. A Roll-Over Protection Structure (ROPS) along with a fastened seatbelt can prevent almost all injuries and fatalities from tractor overturns. Despite this knowledge, the use of seatbelts by farmers on ROPS tractors remains low. This study treats farm safety as a family issue and builds on the central role of parents as teachers and role models of farm safety for youth. Methods: This research study used a longitudinal, repeated-measures, randomized-control design in which youth 10e19 years of age were randomly assigned to either of two intervention groups (parent-led group and staff-led group) or the control group. Results: Fathers in the parent-led group were less likely to operate ROPS tractors without a seatbelt compared with other groups. They were more likely to have communicated with youth about the importance of wearing seatbelts on ROPS tractors. Consequently, youth in the parent-led group were less likely to operate a ROPS tractor without a seatbelt than the control group at post-test. Conclusions: This randomized control trial supports the effectiveness of a home-based, father-led farm safety intervention as a promising strategy for reducing youth as well as father-unsafe behaviors (related to tractor seatbelts) on the farm. This intervention appealed to fathers’ strong motivation to practice tractor safety for the sake of their youth. Involving fathers helped change both father as well as youth unsafe tractor-seatbelt behaviors. Ó 2014 Society for Adolescent Health and Medicine. All rights reserved.

Farm children continue to experience high rates of injuries and premature deaths as a result of agricultural activities [1,2]. Farm machinery, especially tractors, is the most common cause Conflicts of Interest: There are no potential conflicts of interest, real or perceived, for any of the authors. * Address correspondence to: Hamida Amirali Jinnah, Ph.D., Institute on Human Development and Disability, University of Georgia, 850 College Station Road, Athens, GA 30602. E-mail address: [email protected] (H.A. Jinnah).

IMPLICATIONS AND CONTRIBUTION

Fathers play an important role as teachers and role models for youth working on family farms. This randomized control trial supports the effectiveness of a home-based, father-led farm safety intervention as a promising strategy for improving the tractor safety behaviors (wearing seatbelts on Roll Over Protection Structure-equipped tractors) of fathers as well as their youth.

of fatal and nonfatal injuries to children working on farms [3,4]. The Roll-Over Protective Structure (ROPS) serves to create a safety zone around the tractor operator that protects the operator in the event of a rollover. Less than one half of the approximately 4.8 million tractors in the United States are equipped with ROPS [5,6]. Equipment manufacturers have developed voluntary standards, and since 1985 almost all new tractors sold in the United States are equipped with ROPS or crush-proof cabs [7,8]. The effectiveness of ROPS is limited if the farmer does not

1054-139X/$ e see front matter Ó 2014 Society for Adolescent Health and Medicine. All rights reserved. http://dx.doi.org/10.1016/j.jadohealth.2013.10.010

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use a seatbelt. Seatbelts restrain operators within a safety zone in the event of a rollover and keep them from falling from the tractor seat or being crushed [9]. ROPS along with a fastened seatbelt can prevent almost all injuries and fatalities from tractor overturns [10e12]. Despite this knowledge, the use of seatbelts by farmers on ROPS tractors remains low. Almost half of the operators on seatbelt-equipped tractors never use the seatbelt [13,14]. Efforts to increase seatbelt usage compliance are needed [14,15]. In the United States, children on family farms are exempt from occupational safety regulations and have no safety training requirements [16]. Farm youth learn about farm safety primarily from their parents as they are introduced to new tasks and chores [17]. Fathers are powerful role models, especially for sons [18]. Farming knowledge is passed from generation to generation, often through fathers and sons [19,20]. It is important for farm fathers to recognize the importance of setting good examples for their children so that children learn to work safely [19]. Systematic reviews of farm safety interventions indicate a paucity of interventions that have been rigorously evaluated using randomized controlled designs [21e23]. Most approaches in farm injury prevention have focused on educational interventions for youth with knowledge as the primary outcome and have ignored the important role played by parents in youth farm safety [22]. This study treats farm safety as a family issue and builds on the central role of parents as teachers and role models of farm safety. Methods Research design This research study used a longitudinal, repeated-measures, randomized-control design to evaluate the effectiveness of an intervention to encourage farmers to adopt injury control methods to protect youth. This article specifically focuses on changing tractor seatbelt safety behaviors of youth, by involving the father in teaching youth about safety. Farm families who had children between 10 and 19 years of age were randomly assigned to either of two intervention groups (parent-led group and staff-led group) or the control group. Baseline and post-test data were collected from the father, mother and target (most active) youth. All participants were paid an honorarium of $490 for completing all project activities and data sheets. The research study was approved by the Institutional Review Board at the University of Georgia. Family recruitment Participant families that were representative of local farm production were recruited from rural South Georgia. A multitude of methods were used for family recruitment. A mailing list of the Farmers and Consumers Market Bulletin, published by the Georgia Department of Agriculture, was used. The Future Farmers of America chapters, Georgia Young Farmer’s Associations, and network of University of Georgia Cooperative Extension Service agents in the targeted counties were used for recruitment. Advertisements were posted in the local newspapers and recruitment posters were hung in feed stores, farm equipment dealerships, and other agriculture-related organizations. Inclusion criteria for the study were: (1) farms produced row crops, which were in production during the study; (2) the family had at least one child between the ages of 10 and 19 years; (3) the farm was owned and operated by the parent or extended family; (4) the child worked on

the farm at least 1 day a week during the times when crops were in production; and (5) all family members spoke English. The intervention The AgTeen farm safety intervention incorporated knowledge transfer, active learning, and skill building activities. Two lessons on farm safety were developed and implemented. The first focused on Power Take-Off safety and the second on tractor safety. This report focuses on tractor seatbelt safety. The lesson was presented as a set of laminated flipcharts bound together. Families were also given information on child development, and the North American Guidelines for Children’s Agricultural Tasks (NAGCAT) tractor guidelines. A motivating/mildly fear-inducing video on tractor safety and a video on teenage brain development were shown to fathers. Dynamic and interactive demonstration models were developed to illustrate tractor rollovers and seatbelt safety. Handouts on the NAGCAT tractor guidelines and farm accident stories were distributed. Implementation and data collection Once a family was eligible and agreed to participate, the project staff went to the family’s home to get both parents and all youth participating in the study to fill out written consent forms. Families completed pre-test data and received group assignment. We ensured that the father, mother, and target youth were present for the lessons. If not, it was rescheduled. To ensure confidentiality among family members, each family member sealed the completed data sheets in a separate envelope, identified only by the family number. All of the individually sealed envelopes were then placed in a United States Postal Service mailing box to be sent to the university in Athens. From this point forward, research procedures differed for the three groups. Parent-led intervention. In this group, the primary farmer took the lead in teaching the tractor safety lesson to the family. Because of the preponderance of men, primary farmers are referred to as “fathers.” A pre-training meeting was conducted, during which the staff trained the father in implementing the tractor safety lesson. A meeting was set up for the family tractor lesson about 3 weeks later. During this visit, the family completed data and the staff set up the tractor model and the camera for recording. The father then taught the Tractor Lesson to the whole family. The final set of post-test data was mailed to these families about 3 weeks after completing the tractor lesson. Staff-led intervention. In this group, a project staff member who was a peer farmer from the local community taught the tractor safety lesson to the whole family. The family completed data and the father viewed the relevant videos. Control group intervention. This group did not receive the tractor lesson but completed pre- and post-test data corresponding to the study families. Video recordings of the safety lesson and all other intervention material were sent to these families after study completion. To ensure that the research data were completed during times of high activity on the farm (either planting or harvest), some of the lessons were staggered to coincide with farm activity level. The average time lag between pre- and post-test was 7 months.

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families that agreed to participate, 114 completed the study, with a retention rate of 75.5% and an attrition rate of 24.5%.

Fidelity of intervention To monitor the extent to which parents implemented the primary intervention as planned, all parent-led in-home lessons were video recorded. The video tapes were collected at the headquarters, where they were coded by a research assistant. A list of key components was developed. The research assistant went over the tapes to make sure each of the key components was covered by the father. Participant recruitment and enrollment flow Figure 1 displays participant recruitment and enrollment flow. Of the 168 eligible families, 151 agreed to participate and were randomized into three groups: parent-led (47), staff-led (53), and control (51). A total of 118 families completed Home Lesson 1 and 107 families completed Home Lesson 2. Of the 151

Demographic characteristics The success of randomization was tested by comparing families assigned to the three conditions on demographic variables. For the randomized sample, the three groups did not differ from each other on demographic variables. No pre-intervention differences were found between those who completed the study and those who did not. We compared the lost-to-follow-up rates among the three study conditions. The staff-led group had better retention to post-data (.85) than the controls (.69) or the parentled group (.72). Farmers in the staff-led group who dropped out had larger farms than those who stayed in the study; the youth in these families worked more hours per week on the farm compared with those who completed the study. The sample was

Figure 1. Participant recruitment and enrollment flowchart.

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Table 1 Demographics of randomized sample as a whole and by group Demographic variable Primary farmer Age, years Mean (SD) Median (range) Years of farming Mean (SD) Median (range) Size of farm, acres Mean (SD) Median (range) Lived on farm as child, % (n) Median educational level Median income range, dollars Target youth Age, years Mean (SD) Median (range) Hours worked on farm/week Mean (SD) Median (range) Gender, male (% [n]) Gender, female (% [n]) Drive tractor, % (n)

All participants (n ¼ 151)

Parent (n ¼ 47)

Staff (n ¼ 53)

Control (n ¼ 51)

44.47 (6.72) 42.50 (34e65)

45.4 (6.8) 44 (36e65)

43.5 (5.3) 42 (35e55)

44.9 (8.1) 43 (34e64)

25.26 (10.96) 25 (2e50)

25.0 (10.6) 25 (2e50)

22.7 (9.7) 20.5 (3e45)

28.3 (10.4) 30 (8e50)

945 (1,209) 475 (20e5,700) 83 (105) Some college or technical school 80,000e89,000

741 (961) 355 (20e5,000) 61.7 (29) Some college or technical school 80,000e89,000

996 (1,454) 624 (57e5,700) 73.6 (39) Some college or technical school 80,000e89,000

13.82 (2.63) 14 (9e19)

14.3 (2.7) 14 (10e19)

14.8 (3.1) 15 (10e19)

13.8 (2.4) 13 (10e19)

12.84 8 72.8 27.2 76

10.4 5 78.7 21.3 76.6

14.8 10 66 34 73.6

13.3 10 74.5 25.5 72.5

(13.11) (.5e72) (110) (41) (115)

(13.3) (.50e72) (37) (10) (36)

(14.1) (1e55) (35) (18) (39)

1,092 (1,138) 396 (25e4,400) 72.5 (37) Some college or technical school 70,000e79,000

(11.9) (.50e60) (38) (13) (37)

SD ¼ standard deviation.

composed of 147 males (142 fathers, three grandfathers, and two single fathers) and four females (one was a single mother) as primary farmers. The demographic characteristics of primary farmers and youth for the whole sample and by group assignment are presented in Table 1. The average age for onset of youth tractor operation was 8.7 years. Most youth said it was their father who decided they were old enough to operate a tractor (86%). On an average, the youth worked 12.8 hours on farm per week. Farms varied in size from small to very large farms, with an average size of 945 acres. Measures Many of the measures were asked both at pre-test as well as post-test. In general, at pre-test, respondents in all three groups reported about their behaviors for the past year. At post-test, respondents in the two intervention groups reported about their behaviors from the time of the completing the tractor lesson. Control families reported about behaviors since they last completed a set of data forms. Father and youth tractor safety behaviors, attitudes toward injury susceptibility, and intentions were measured. The selection of variables was guided by the Theory of Planned Behavior [24]. Fathers’ and youths’ behaviors related to tractor seatbelts were assessed by asking how often they operated a ROPS tractor without a seatbelt, rating it on a 4point scale (“never” to “frequently”) at pre-test as well as posttest. This item was adapted from the Risky Behaviors Scale, a 16-item measure guided by the Theory of Planned Behavior [25] used to measure farm safety behavior of fathers and youth. At post-test, fathers were asked whether “they had begun using seatbelts on ROPS tractors.” Respondents answered it as a yes/no item. We measured fathers’ perceptions of injury susceptibility for youth by asking, “Would your child who works on your farm the most be likely to be injured if he/she engaged in these behaviors?” at pre-test as well as post-test. Statements were rated on 4-point scale from “definitely yes” to “no.” Fathers were asked

whether they had created seatbelt-related rules at post-test by asking them “if they had restricted their youth to wear seatbelts on ROPS-equipped tractors.” To assess parental communication with youth about tractor seatbelt safety, youth were asked, “Have your parents talked to you about the importance of wearing seatbelts on ROPS tractors?” Responses ranged from “yes, a lot” to “yes, briefly” and “no” at pre-test as well as post-test. Data analysis We ran a series of Analysis of Covariance (ANCOVA) models on the final wave of data collected, controlling for preintervention levels of the outcome variables. Because the intervention was implemented in a phased manner, families varied in the amount of time they took to complete the study. To control for the confounding effect of this variance, we included time lag between pre- and post-data as a covariate in relevant study analyses. In addition, for some youth, safety behaviors at post-test were collected over the phone. To control for this difference, a phone data collection variable was used as a covariate. Effect size estimates were obtained by calculating Cohen’s d (standardized mean difference). This was done by comparing pre- and postintervention means (with pooled standard deviations) for each of the key variables. Results Almost all variables were approximately normally distributed (skewness, .13 to .65). The pre-test variable for fathers’ behaviors was slightly skewed but the mean, median, and modes were similar, so we can assume approximate normal distribution. Tests for normality revealed that the time lag variable (between pre- and post-data collection) was positively skewed, so we performed a log transformation of this variable. This new transformed variable was approximately normally distributed (Kolmogorov-Smirnov test was nonsignificant) and was used for

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Table 2 Baseline and post-intervention means for the three treatment groups Variable

Father unsafe behavior Father’s perception for youth Youth report on parent communication Youth unsafe behaviors

Baseline mean (standard deviation)

Post-test mean (standard deviation)

Parent-led

Staff-led

Control

Parent-led

Staff-led

Control

2.51 2.68 .68 2.04

2.61 2.43 .56 2.09

2.54 2.53 .67 1.85

1.46 2.55 1.15 1.43

1.91 2.36 .74 1.39

2.11 2.07 .59 1.76

(.51) (.84) (.73) (1.20)

(.81) (.71) (.67) (1.16)

further analysis. Table 2 presents the means and standard deviations for key variables pre- and post-test by group. A series of ANCOVAs were conducted to compare changes in the three groups on various father and youth tractor-related variables. Preintervention scores and time lag between pre- and post-test were used as covariates. As seen in the Table 3, the overall ANCOVAs for all four variables were significant. Additional group comparison analyses were conducted by computing the effect sizes using Cohen’s d. Results revealed that fathers in the parentled group were significantly less likely to have operated a ROPS tractor without a seatbelt compared with fathers in the staff-led group (.75; 95% confidence interval [CI], 1.07e.47) and control group (.84; 95% CI, 1.16e.53). Staff-led fathers did not differ from control fathers. Additional chi-square analysis revealed that at post-test, more fathers in the parent-led group (70%) reported they had begun using seatbelts on ROPS tractors compared with fathers in the staff-led (40%) and control groups (42%) (c2 ¼ 7.53; degrees of freedom ¼ 2; N ¼ 104; p ¼ .02). Fathers in the parentled group (.92; 95% CI, .73e1.12) as well as the staff-led group (.66; 95% CI, .49e.85) were more likely than fathers in the control group to believe that their youth could be injured when operating a tractor without a seatbelt. Additional chi-square analysis revealed fathers in the parent-led group (77%) were more likely to have required their tractor-operating youth to wear seatbelts when operating a ROPS-equipped tractor compared with staff-led fathers (47%) (c2 ¼ 6.57; degrees of freedom ¼ 2; N ¼ 99; p ¼ .04). Youth in the parent-led group were more likely to say their parents had talked to them about using seatbelts compared with youth in the control group (.94; 95% CI, .71e1.17). Staff-led youth did not differ significantly from either the parent-led or control group youth. As a result of parental communication and rule setting, tractor-operating youth in the parent-led group were less likely to have operated a ROPS tractor without a seatbelt compared with those in the control group (.79; 95% CI, 1.39e.26). Discussion Youth in this study reported they primarily learned about farming either through direct instruction by their father (95%) or by watching their father work on the farm (92%), which is in line

(.65) (.73) (.69) (1.13)

(1.09) (.68) (.71) (1.29)

(.97) (.71) (.64) (1.26)

(.98) (.46) (.63) (1.20)

with other studies on youth farm safety [17]. Because fathers play such an important role in determining youth farm behaviors, this study took a systemic approach by actively involving fathers in affecting youth farm safety behaviors. The parent-led group involved fathers as teachers and role models of tractor seatbelt safety. Results revealed that fathers in this group were less likely to have operated a ROPS tractor without a seatbelt compared with staff and control groups. Almost two-thirds of the farmers in the parent-led group (70%) reported beginning to use seatbelts on ROPS tractors by post-test compared with 40% of the others. Also, 77% of parent-led fathers had required their youth to wear seatbelts on ROPS tractors compared with 47% in others. Fathers in this group also showed a positive change in perception of injury susceptibility for youth compared with the control group. These fathers were more likely to have communicated with their youth about the importance of wearing seatbelts and set expectations restricting them to wear seatbelts on ROPS tractors, compared with the control group. Consequently, youth in the parent-led group were less likely to have operated a ROPS tractor without a seatbelt than the control group at post-test. When fathers were involved in teaching and modeling tractor seatbelt safety for youth, it increased the likelihood of both fathers as well as youth wearing seatbelts on ROPS tractors. This can partly be explained using the theory of cognitive dissonance [26]. As fathers instruct their children about safety behaviors that they do not themselves employ, dissonance is created. There was a tendency for fathers to reduce this dissonance by employing the safety behaviors that are consistent with their teaching. Also, recurring behaviors such as wearing seatbelts each time you are on a ROPS tractor cannot be maintained just by the fear of overturns or injuries because those incidents are rare. Such behaviors require frequent positive reinforcers [27]. In the present study, wearing seatbelts made fathers feel better about themselves for protecting their families. The increased peace of mind they experienced, knowing their modeling of this behavior could potentially keep their youth safe, proved to be a strong motivator for changing their seatbelt behavior. This randomized control trial supports the effectiveness of a home-based, father-led farm safety intervention as a promising strategy for increasing youths’ as well as fathers’ use of seatbelts

Table 3 Analysis of covariance for father and youth tractor seatbelt variables with pre-variable and time lag as covariates Variable

Adjusted Parent-led M

Father unsafe behavior: operated ROPS tractor without seatbelt 1.36 Father’s perception for youth: Will youth be injured operating ROPS tractor without seatbelt? 2.55 Youth report on parent communication: Father talked to me about using a seatbelt 1.13 Youth unsafe behaviors: operated ROPS tractor without seatbelt 1.02 df ¼ degrees of freedom; M ¼ mean; SE ¼ standard error.

Staff-led

Control

df

SE

M

SE

M

.16 .10 .11 .29

2.05 2.41 .78 1.36

.15 2.13 .16 2.104 .09 2.06 .10 2.91 .11 .55 .12 2.91 .24 2.02 .27 2.61

F

p

Partial h2

7.18 6.17 6.40 3.06

.001 .003 .003 .05

.12 .12 .12 .09

SE

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on ROPS tractors on family farms. It is encouraging that this father-led intervention was able to achieve small to moderate effect sizes using rigorous analyses for behaviors. Past interventions have targeted either the father or the youth [28].This approach focused on multiple systems within the family unit by exploring the interaction of the parental and youth systems [29]. The results validate the notion of intergenerational transmission of farm risk behaviors suggested by Morrongiello et al [30]. To date, all three literature reviews on youth farm safety interventions have highlighted a strong need for rigorous randomized control evaluations [22,23,31]. Although randomized control designs are not a panacea, they strengthen the evidence base in a given field. The present study addressed the need for more randomized evaluations of youth agricultural safety interventions. The Cochrane review on farm injury prevention interventions found only two randomized control studies [31e33] aimed at reducing injuries among children and adolescents. Past studies have shown that didactic, short-term educational interventions focusing only on increasing safety knowledge have minimal effect on actual behaviors [22]. The present intervention went beyond knowledge and focused on behavioral change. Farmers exhibit great resistance to wearing seatbelts on tractors because it is perceived to be a hassle in their busy routine. Over time, these beliefs have become deeply entrenched into the farming culture and have proved to be difficult to change. This intervention approach focused on the paternal role of the farmer and appealed to farm fathers’ strong motivation to practice tractor safety for the sake of their youth. When fathers were involved in implementing the intervention, they seemed to gain an increased recognition of their role as teachers and role models of safe practices for their youth. Fathers began using seatbelts on ROPS tractors for the sake of their youth. They also talked to their youth about importance of seatbelts and required them to wear those while operating ROPS tractors. As a result, youth increased their use of seatbelts while operating ROPS tractors. This is one of the first studies to test the effect of involving fathers in teaching youth about safety. It is a good start, but further research on ways to involve and engage families in affecting youth unsafe farm behaviors is needed. The AgTeen training module is a research-based module that can be used as a farm safety education resource for families. The applicability of this module for other ethnic and income groups needs to be tested. Online versions of this module need to be created, implemented, and evaluated. An important implication of these findings is that families should be encouraged to have an active role in communicating with their youth about farm safety and creating mutually agreed-upon rules. Health communication and social marketing campaigns need to focus on the message of fathers taking the time to talk to their youth about safety. Information and resources on how fathers can take a more active role in teaching their youth about farm safety need to be made available and accessible to families. Limitations These results need to be interpreted in light of certain limitations. First, the reliance on self-reports rather than naturalistic observations of behavior presents limitations. Although the randomized control design was a major strength of this study, inherent in it is the limitation that the sample may not be representative of the larger population. Although

farm families were selected randomly, most were Caucasian and from relatively educated, upper-income families. Selfselection bias was a potential limitation. It is not known whether the current results would be sustained over time. We measured beliefs and behavioral change but did not have the power to measure the prevalence of injuries. Future research studying the long-term impact of this intervention needs to be conducted. This randomized control trial supports the effectiveness of a home-based father-led farm safety intervention as a promising strategy for reducing youth- as well as father-unsafe behaviors (related to tractor seatbelts) on the farm. Further research is needed to more fully explore the nature of intergenerational transmission of injury risk via modeling and the processes via which they occur. A key implication of these findings is that we need to treat farm safety as a family issue and build on the central role of fathers as teachers and role models of farm safety. This template of involving parents as teachers and role models can be applied to other areas of youth safety and health. Acknowledgments This work was previously presented as “Family intervention to increase the use of seatbelts on ROPS tractors,” at the World Safety Conference 2012 in Wellington, New Zealand; and as “Farm fathers wear seatbelts on ROPS tractors for the sake of their youthdA randomized control trial,” at the International Society for Agricultural Safety and Health Conference, Sandusky, Ohio, June 2013. Funding Sources Funding for this research was received from National Institute on Occupational Safety and Health/Centers for Disease Control Grant 5 RO1 OH009210-03. References [1] Adekoya N, Pratt SG. Fatal unintentional farm injuries among persons less than 20 years of age in the United States: Geographic profiles. Cincinnati, OH: Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health; 2001. Available at: http://www.cdc.gov/niosh/docs/2001-131/pdfs/2001131.pdf. Accessed November 12, 2013. [2] Rivara FP. Fatal and non-fatal farm injuries to children and adolescents in the United States, 1990-3. Inj Prev 1997;3:190e4. [3] Heaney CA, Wilkins JR III, Dellinger W, et al. Protecting young workers in agriculture: Participation in tractor certification training. J Agric Saf Health 2006;12:181e90. [4] Pryor SK, Carruth AK, LaCour G, et al. Occupational risky business: Injury prevention behaviors of farm women and children. Issues Compr Pediatr Nurs 2005;28:17e31. [5] Centers for Disease control and prevention. Use of rollover protective structuresdIowa, Kentucky, and Ohio, 1992e1997. JAMA 1997;278:1144e5. [6] Myers JR, Snyder K. Roll-over protective structure use and the cost of retrofitting tractors in the United States, 1993. J Agric Saf Health 1995;1: 185e97. [7] Ayers P, Dickson M, Warner S. Model to evaluate exposure criteria during roll-over protective structures (ROPS) testing. Trans Am Soc Agric Biol Eng 1994;37:1763e8. [8] Moss C. Machinery hazards. Ann Occup Hyg 1969;12:69e75. [9] Lehtola C, Marley S, Melvin SA. A study of five years of tractor-related fatalities in Iowa. Appl Eng Agric 1994;10:627e32. [10] Myers M. Tractor risk abatement and control as a coherent strategy. J Agric Saf Health 2002;8:185e98. [11] Centers for Disease Control and Prevention. NIOSH reports on the preventability of tractor rollovers. Bethesda, (MD): Centers for Disease Control and Prevention; 1993.

H.A. Jinnah et al. / Journal of Adolescent Health 54 (2014) 255e261 [12] Reynolds SJ, Groves W. Effectiveness of roll-over protective structures in reducing farm tractor fatalities. Am J Prev Med 2000;18:63e9. [13] Myers M, Cole H, Westneat S. Seatbelt use during tractor overturns. J Agric Saf Health 2006;12:43. [14] Kelsey TW, May JJ, Jenkins PL. Farm tractors, and the use of seat belts and roll-over protective structures. Am J Ind Med 1996;30:447e51. [15] Hoy RM. Farm tractor rollover protection: Why simply getting rollover protective structures installed on all tractors is not sufficient. J Agric Saf Health 2009;15:3e4. [16] U.S. Department of Labor. Child Labor Requirements in Agricultural Occupations, Under the Fair Labor Standards Act; 2007. [17] Darragh AR, Stallones L, Sample PL, Sweitzer K. Perceptions of farm hazards and personal safety behavior among adolescent farmworkers. J Agric Saf Health 1998;1:159e61. [18] Masciadrelli BP, Pleck JH, Stueve JL. Fathers’ role model perceptions themes and linkages with involvement. Men Masculinities 2006;9:23e34. [19] Green K. Farm health and safety: Rural couples’ beliefs and practices. J Agric Saf Health 1999;5:83e96. [20] Leckie GJ. “They never trusted me to drive”: Farm girls and the gender relations of agricultural information transfer. Gend Place Cult 1996;3:309e26. [21] DeRoo LA, Rautiainen RH. A systematic review of farm safety interventions. Am J Prev Med 2000;18:51e62. [22] Hartling L, Brison RJ, Crumley ET, et al. A systematic review of interventions to prevent childhood farm injuries. Pediatrics 2004;114:e483e96. [23] Gallagher SS. Characteristics of evaluated childhood agricultural safety interventions. J Agromedicine 2012;17:109e26.

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Involving fathers in teaching youth about farm tractor seatbelt safety--a randomized control study.

Farm youth continue to experience high rates of injury and deaths as a result of agricultural activities. Farm machinery, especially tractors, is the ...
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