Northeast Community Collaboration for Farmworker Health and Safety

Overview

The Northeast Center for Agricultural Health's (NEC) community-based partnerships are addressing important health and safety issues in diverse agricultural populations at several sites across the northeast. In most of these projects, the key effector is a "work team" composed of workers, employers and other interested parties. Work teams are organized and facilitated by staff from NEC and local partner community groups. With community input, these work teams define priority problems, select interventions, assist in the testing and evaluation of the proposed interventions and help with the dissemination of proven interventions.

NEC has found that: 1) employers and farm workers can collaborate to identify and address occupational health problems; 2) farm workers and employers both provide valuable insights into solutions from the design of implements to educational materials; 3) these types of community-based efforts can help identify other issues affecting farm worker populations.

CT CBPR

NEC partnered with University of Connecticut (UCONN) to use community based participatory research (CBPR) as a means of reducing occupational injuries experienced by farmworkers employed at shade tobacco farms in the Connecticut River Valley. Focus groups, work team meetings and other face-to- face meetings with the workers and growers identified several occupational health issues. Three farms initially joined the coalition. Medical chart review data was collected from UCONN's mobile clinic which services these farms. Skin irritation (38%), musculoskeletal pain and strain (35%), and eye irritation (14%) were the most prevalently diagnosed occupational injuries. Intervention discussions by the CBPR Work Team revealed two opposing views of why skin and eye irritation were problems  problems with worker hygiene vs. adequacy of field sanitation stations. Initial field observations and reports of workers suggested that most farms did not reliably have soap and towels available in the fields. Education of both employers and workers became a focus to address these different perspectives.

The Work Team established and developed multidimensional interventions for both growers and farm workers. The primary objective of the interventions was reduction of work-related eye and skin irritation. Interventions for farmworkers included personal hygiene training (during work in the fields and after work at their barracks) and the provision of personal protective equipment incentives (no-cost protective glasses, sweat bands, gloves and other personal protection kits). Interventions for growers focused on ways to enhance and reinforce the availability of field personal hygiene for workers. Researchers created low cost solutions for paper towel dispensers and "soap on a rope" (bar soap tied in nylon socks). One participating farm modified their water stations with more spigots for easier worker access. Follow up shows high rates of field sanitation compliance.

Since 2006, the project has trained over 1,500 farmworkers on workplace health and safety practices to reduce eye and skin irritation. During 2010, the Work Team identified the need to continue health and safety trainings on farms once the research ends, and therefore, new collaborations were sought to introduce another training intervention. The Work Team contacted Eastern CT AHEC, a group that established several effective Promotores de Salud Programs for farmworkers (community health advocate programs). These programs train workers within their community to provide public health education. Scientific literature supports the community health worker model as an effective intervention to prevent and control chronic diseases and illnesses. Promotores increase access to health and social services; deliver culturally acceptable health education and advocate for individual and community health needs. Material development and promotores training has been completed.

Project Update:
In 2011, eleven workers at the largest participating farm received instruction as farm health and safety promotores. Low literacy, bi-lingual education material was developed by the site coordinator, research coordinator, AHEC student volunteers, and UCONN staff. The promotores participated in twelve hours of instruction. Over the course of six weeks, seven promotores delivered components of the safe work practice training to 114 workers. The promotores also reported they engaged an additional five groups of workers, but exact attendance was not accounted for. Outreach staff assisted the promotores in data collection. Promoters received compensation in the form of gift cards and an end of season celebration. Many of these promoters return to work in Connecticut tobacco year after year. They were interested in continuing as promotores and requested training in other health topics such as blood pressure monitoring and first aid.

The Farm Health and Safety Promoters program continued during the 2012 growing season at the same farm. A total of 13 workers participated, sharing safe work practices such as hygiene and hydration in 552 coworker encounters. One promotoro participated both years. They received the same twelve hour training but felt more training would assist them to be bettered prepared to help their coworkers. This group also became certified in first aid. Data collection and compensation were consistent with the first year of the program.

 

CBPR

The community collaborations project in the Black Dirt region of Orange County, NY builds on a previously established work team. Several years ago, the community engaged in a CBPR project that focused on eye irritation. The fine soil of this region creates excellent growing conditions, however, it also is easily transferred to hands, clothing and transmitted through the air. The project work team successfully developed an intervention consisting of safety glasses, saline solution and educational materials distributed to farmworkers. Subsequent evaluation demonstrated a decrease in eye irritation.

Now, this work team has identified low back pain as the priority concern. Many agricultural tasks can influence musculoskeletal strain and pain. Awkward postures and repetitive movements associated with crop farming can lead to chronic aching muscles and pain in shoulders, backs and wrists. The primary crop grown in this area is dry onions, however, many farms have diversified crops to meet consumer needs and sustain production activity. Lettuce, squash and assorted vegetables are also being grown here. The tasks selected by the work team and its consulting ergonomist as leading causes of back pain are weeding and stacking bagged onions.

Intervention identification, development and testing is underway. Some tools can be used by farmworkers for weeding, but must be small bladed to allow precision near the plant roots to avoid damage to the plant. An interchangeable bladed hoe with several specially designed blades wasbe tested during the 2011 season. There are times when a tool is not feasible and workers must meticulously hand weed row after row of lettuce. For this type of work, a new wearable kneeling pad has been designed to alleviate worker discomfort. Changes to the stacking process in the onion packing houses are challenging, but are being studied and intervention designs have been initiated.

Project Update:
The tools were pilot tested in a field study during the 2011 growing season. Workers tried the tool for an hour during the course of a regular work day. The tools were left with the workers for one to two weeks. After the acclimation period, data were collected by measuring the time it takes to weed a given area (100 feet) by hoe and by hand as well as measure the amount of weeds removed for comparison purposes.

In this pilot study, the length of time to weed 100 feet was similar in both conditions (hand and tool). The modest amount of time (average 13 minutes) to weed the measured area was not sufficient to determine improved efficiency during task. The tool itself needed modifications. The attachment system of the blade to the handle created unwanted weed accumulation on the tool. Several blades were identified as too heavy and not well liked by the workers. Some workers wanted the handle to be shorter. However, the majority of workers who tried the tool wanted to use it again.

In 2012, changes made to the tool included: unobtrusive attachment hardware, holes added to heavy blades to reduce weight and allow for dirt flow through the holes, and the tool handles were shortened by 6 inches on half of the equipment. Field testing was designed as a cross-over study where farms were randomly assigned to intervention or control and then after several weeks, changed to the alternative condition. In this study, participants were again given an acclimation period of at least 2 weeks. Working on the farmer's schedule, participants were asked to weed for 2 hours in the assigned condition and the distance weeded was measured. The data was then analyzed.

At the end of the study, workers were asked their opinion regarding hand weeding versus weeding with the tool. Over 60% responded that the tool is more comfortable and less tiring than hand weeding and 58% prefer to use the tool over hand weeding. Thirty-five percent felt it was faster to weed with the tool and 35% responded that it depended on the kind of plant being weeded. Twenty-nine percent felt weeding by hand was faster. Farm owners were very cooperative in this field trial despite the majority of owners believing that hand weeding is faster and better than weeding with a tool.

Kneeling pads have undergone a major redesign to overcome wear-ability issues. Prior to the tool field trial this past season, several workers were given the opportunity to try out the kneeling pads during early spring planting. The original design used a garden kneeling pad worn in a rip-stop nylon gaiter, pulled over the wearer's pants and shoe, and had adjustable nylon straps and buckles to secure the fit. However, the nylon is slick and frequently slid around when worn. Anthropometric considerations also needed to be considered as leg length and width varied. Additionally, the kneeling pad was bulkier than the average pant leg and intruded in to the plant rows. Worker acceptance was another important variable.

The new design is much smaller and user-friendly. Elastic and Velcro are now used in place of the buckle system, which accommodate many leg widths. The exterior of the kneeling pad is still made of the rip-stop nylon, however the back is made of denim which eliminates the sliding problem. The cushion itself has also changed so that it conforms to the wearer's leg and does not interfere with the plants. The size of the actual kneeling pad has been greatly reduced which increases worker's acceptance to wear. We were able to work with local community members to assemble the simplified version for field testing.

This project is an educational intervention aimed at delivering agricultural safety information to Mennonite youth, grades one to eight, in their one-room schoolhouses. The purpose of this intervention is to reduce agricultural injuries and fatalities in the Groffdale Conference, an Old Order Mennonite community located in Yates County, New York.

Using the community participatory research model, NYCAMH assisted concerned community members to create a culturally appropriate farm safety presentation for Mennonite children. The educational program is delivered over a three year cycle to the 31 schools in the Groffdale Conference. Approximately a third of the schools receive the program each year. The program is delivered by members of the Yates County Farm Safety in Schools Committee. It is approximately an hour in length and utilizes a 20 page flip chart and interactive presentations. A graphically based pre-post evaluation was used to evaluate the effectiveness of the program. Each year, half of the participating schools were randomly chosen to receive a pre-evaluation and the remaining schools were given the post-evaluation. Additionally, NYCAMH safety educators and the committee members have conducted follow-up qualitative evaluations with each school one year after receiving the program.

As of spring, 2011, over 1000 school children have received this farm safety training. Pre/post testing results are mixed. Comparison of the pre-post evaluations from the first year of trainings showed statistically significantly higher scores in the post evaluation group indicating some knowledge gain. In 2010, the program was delivered to 266 students in ten schools. There was no statistical difference between the pre-post scores with this group of students. The third year of this program was delivered in January and February 2011 to the remaining ten Groffdale Conference schools. Results of the follow-up evaluation conducted with seven of the first year schools showed that most students remembered the program from the previous year and reported talking about the program with their parents. Significant changes to farm practices such as installing PTO shield guards, disallowance of extra riders and additions of fences around manure pit have been reported by the school children.

A vital aspect of this approach is that members of the Old Order community are the educators who are delivering the information in a culturally appropriate and accepted manner. As an outside organization, it is highly unlikely that NYCAMH would have access to this population to directly deliver youth farm safety education.

North Country Dairy 1st Aid Trainings

For this project, NYCAMH has partnered with the Opportunities for Oswego outreach team in Jefferson and Lewis counties in northern New York. Information regarding priority areas to address was gathered at migrant coalition meetings, farm owner interviews and farmworker focus groups. Response to farm emergencies and Hispanic farmworker knowledge of farm location to provide key information to emergency personnel is the top concern in this location.

NYCAMH already offers on farm safety trainings including certified CPR and First Aid trainings. However, these trainings can take up to three hours to complete and farmworker time constraints can limit participation. Using farm injury surveillance data currently being collected by NYCAMH, a revised emergency response training has been developed with a focus on the most common farm injuries identified by the surveillance data. These injuries include:

  • Struck  equipment and animal related
  • Tractor rollovers
  • Falls from farm structures
  • Machinery entanglement
  • Tractor/equipment runovers

To address the concern of farmworker knowledge of location, NYCAMH developed an emergency information sheet that folds to business card size to carry in a wallet. The outside of the sheet contains emergency response procedures. The inside provides space for farmworkers to record contact information, farm owner data, farm location, emergency contacts and pertinent medical details such as any health conditions or current medications.

If you are a New York dairy farmer and interested in having this training provided to your farmworkers for free at your farm, please contact info@nycamh.org or call 800-343-7527.