10
Program Scoring and Rationale

The committee was charged with evaluating the relevance and impact of the National Institute for Occupational Safety and Health (NIOSH) Agriculture, Forestry, and Fishing Research Program (AFF Program) on an integer scale of 1-5. Following the guidelines and questions provided in the Framework Document (Appendix A), the committee used its expert judgment to rate the relevance and impact of the overall research program by summarizing its assessment of the major subprograms before arriving at overall scores for relevance and impact.

The Framework Document does not prescribe a method for arriving at an overall quantitative score on the basis of qualitative evaluations of separate subprogram areas; it allows individual evaluation committees to tailor the scoring process. The present committee considered many ways of determining a single score to convey the relevance and impact of the program in its entirety. It originally considered assigning numeric scores to each of the three sectors but decided, because the AFF Program devoted most of its efforts to agricultural safety and health, that individual scores for forestry and fishing safety and health would be difficult to interpret. The committee decided to reach a single score that included consideration of the successes of the forestry and fishing safety and health subprograms in spite of the much smaller amount of funds and personnel committed to them. The assessment of those subprograms was based primarily on input received from experts on safety and health in the forestry and fishing sectors, as well as its review of the documentation on the subprograms and the NIOSH Centers for Agricultural Disease and Injury Research, Education, and Prevention (Ag Centers).



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10 Program Scoring and Rationale The committee was charged with evaluating the relevance and impact of the National Institute for Occupational Safety and Health (NIOSH) Agriculture, For- estry, and Fishing Research Program (AFF Program) on an integer scale of 1-5. Following the guidelines and questions provided in the Framework Document (Appendix A), the committee used its expert judgment to rate the relevance and impact of the overall research program by summarizing its assessment of the major subprograms before arriving at overall scores for relevance and impact. The Framework Document does not prescribe a method for arriving at an over- all quantitative score on the basis of qualitative evaluations of separate subprogram areas; it allows individual evaluation committees to tailor the scoring process. The present committee considered many ways of determining a single score to convey the relevance and impact of the program in its entirety. It originally considered assigning numeric scores to each of the three sectors but decided, because the AFF Program devoted most of its efforts to agricultural safety and health, that individual scores for forestry and fishing safety and health would be difficult to interpret. The committee decided to reach a single score that included consideration of the successes of the forestry and fishing safety and health subprograms in spite of the much smaller amount of funds and personnel committed to them. The assessment of those subprograms was based primarily on input received from experts on safety and health in the forestry and fishing sectors, as well as its review of the documen- tation on the subprograms and the NIOSH Centers for Agricultural Disease and Injury Research, Education, and Prevention (Ag Centers). 58

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Program scoring r at i o n a l e and 59 The committee also considered external factors outlined in Chapter 3 in scor- ing for program relevance and program impact. ASSESSMENT OF AGRICULTURE, FORESTRY, AND FISHING RESEARCH PROGRAM RELEVANCE AND IMPACT Score for Relevance On the basis of information provided by NIOSH and others and its own experi- ence and expertise, the committee assessed the degree to which the AFF Program has led and carried out research most relevant to improvements in workplace protection in agriculture, forestry, and fishing. The committee converted that as- sessment into a score of 4 for relevance, based on a 5-point scale described in the Framework Document (Box 10-1). The committee arrived at this score for the program as a whole after consider- able deliberation. As one would expect for any research program as diverse as the AFF Program, the research carried out in some subprograms was more relevant than in others, as shown in the detailed evaluations presented in Chapters 4-9. In addition, the rating scale for relevance provided in Box 10-1 required the commit- tee to consider more than one characteristic of relevance (e.g., priority of research, level of engagement in transfer activities), and the committee’s evaluation of these different characteristics did not always fit neatly into a single score. For example, BOX 10-1 Scale for Rating Program Relevance 5 = Research is in highest-priority subject areas and highly relevant to improvements in workplace protection; research results in, and NIOSH is engaged in, transfer activities at a significant level (highest rating). 4 = Research is in high-priority subject area and adequately connected to improvements in workplace protection; research results in, and NIOSH is engaged in, transfer activities. 3 = Research focuses on lesser priorities and is loosely or only indirectly connected to workplace protection; NIOSH is not significantly involved in transfer activities. 2 = Research program is not well integrated or well focused on priorities and is not clearly connected to workplace protection and inadequately connected to transfer activities. 1 = Research in the research program is an ad hoc collection of projects, is not integrated into a program, and is not likely to improve workplace safety or health.

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a g r i c u lt u r e , f o r e s t r y , fishing research niosh and at 60 according to the Framework scale, a score of 4 should be assigned if the research is in high-priority subject areas and is adequately connected to improvements in workplace protection, and the program is engaged in transfer activities. The com- mittee concluded that some, but not all, research in the AFF Program has been in high-priority subject areas, and that the program has somewhat been engaged in transfer activities, but not always the most appropriate. In contrast, assigning a score of 3 would indicate that the research focuses on lesser priorities and is not significantly involved in transfer activities, and this also was not entirely accurate for the AFF Program. Had the committee been given the option of providing non-integer scores, the score for program relevance most likely would have been between 3 and 4. To arrive at a single integer score for relevance, the committee examined sepa- rately the two main components of the relevance score: the priority of research and the level of engagement in transfer activities. For the former, the committee concluded that although not all research activities of the AFF Program fulfilled all the qualifications of a 4, it more often than not met the standard for engaging in high- priority research. In assessing the program’s level of engagement in transfer activi- ties, the committee focused on the applicability of transfer activities and concluded that the AFF Program was engaged in transfer activities and at least some transfer activities took place in appropriate areas. The committee therefore concluded that a score of 4 for relevance was more appropriate for the program overall. Score for Impact On the basis of the Framework Document’s scoring criteria for program im- pact (Box 10-2), the committee assigned the AFF Program a score of 3 out of a possible high score of 5. DISCUSSION OF RATINGS FOR RELEVANCE AND IMPACT As it thought about the relevance and impact of the AFF Program, the com- mittee was influenced by general aspects of the program that contributed to its successes, some of which are described below. Further discussion of the conclu- sions that led to the committee’s scores for relevance and impact, respectively, are described in subsequent sections of this chapter. Breadth of the Program Resources have been inadequate for the AFF Program to carry out its con- gressional mandate in the area of agriculture, let alone in the additional areas of

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Program scoring r at i o n a l e and 6 BOX 10-2 Scale for Rating Program Impact 5 = Research program has made a major contribution to worker health and safety on the basis of end outcomes or well-accepted intermediate outcomes. 4 = Research program has made a moderate contribution on the basis of end outcomes or well-accepted intermediate outcomes; research program generated important new knowledge and is engaged in transfer activities, but well-accepted intermediate out- comes or end outcomes have not been documented. 3 = Research program activities or outputs are going on and are likely to produce improve- ments in worker health and safety (with explanation of why not rated higher). 2 = Research program activities or outputs are going on and may result in new knowledge or technology, but only limited application is expected. 1 = Research activities and outputs are NOT likely to have any application. NA = Impact cannot be assessed; program not mature enough. forestry and fishing. In contrast with other NIOSH programs that focus research on narrow sectors and well-defined problems, the AFF Program has the task of ad- dressing manifold issues that affect the occupational safety and health of nearly all natural resource workers on land and sea. That task touches on more than a million businesses, a huge array of products, and multiple workplace exposure. NIOSH non-sector based programs address extremely narrow topics and can focus good science on well-defined problems, whereas the AFF Program is expected to spread its resources to address broad issues, so it is difficult to conduct research on all of them. In agriculture, the AFF Program responded in a reasonably effective manner to the extreme diversity that characterizes agricultural production in the United States. The extensive sectoral, technical, and geographic diversity of the agricultural industry left NIOSH with no alternative but to focus on key subjects. Focused Research Areas Despite those enormous challenges, the AFF Program has proved that it is able to conduct sound research on focused areas when given the opportunity. That is the case with the Alaska commercial fishing program (see Box 10-3), which is an exemplary research program with concentrated research topics, clear goals, and adequate resources. Several factors contributed to the success of the well-executed program: research that was focused and targeted, use of clear and consistent sur-

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a g r i c u lt u r e , f o r e s t r y , fishing research niosh and at 6 BOX 10-3 An Exemplary AFF Program: Commercial Fishing Injuries and Fatalities, NIOSH Alaska Field Station While the committee evaluated several projects in the AFF Program and found many of them lacking relative to how a research program ought to conduct research, the work by the NIOSH Alaska Field Station on commercial fishing safety has proven to be effective, and the station has executed its research according to how an ideal program would operate. NIOSH established the Alaska research field station in 1991 to address the high occupational fatality rate in Alaskan commercial fishermen. Members of the field station quickly identified the excessively high fatality rate in Alaskan commercial fishing of 200 per 100,000 per year for the 2-year period 1991-1992 (NIOSH, 2002). An epidemiologist was brought on to collect data on commercial fishing fatalities in Alaska and used the Alaska Occupational Injury Surveillance System database to focus on industries, workers, causes, and risk factors for injuries for priority setting and prevention research. Members of the field station recognized that they did not have a good understanding of the commercial fishing industry. Therefore, in October 1992, NIOSH sponsored the first National Fishing Industry Safety and Health Workshop to • Introduce members of the NIOSH Alaska research field station to the fishing industry. • Identify players involved in commercial fishing safety. • Learn about the fishing industry. • Learn about existing regulations. • Figure out how NIOSH could fit in and make a difference. The meeting laid the foundation for how researchers would approach industry challenges, gave researchers insight into differences among the various industry segments, and illuminated the need for varied and flexible approaches to problems centering around people in the industry. Researchers developed peer relationships with industry stakeholders, and information was easily exchanged between the two; U.S. Coast Guard (USCG) has numerous copies of all publications written by the Alaska Field Station and refers to them often. NIOSH has been a resource for the USCG Commercial Fishing Industry Vessel Safety Advi- sory Committee. By walking the docks, talking to fishermen, and holding forums in numerous locations in Alaska with fishermen from various fisheries, the Alaska Field Station staff were able to outline four main categories of concern and set priorities for efforts according to magnitude of risk. In 1997, NIOSH published a bulletin indicating that the Commercial Fishing Industry Vessel Safety Act of 1988 had contributed to reducing deaths in the industry in Alaska, but the root issues that put people at risk persisted at the same level. It went on to recommend 11 focused improvements. The second National Fishing Industry Safety and Health Workshop, held in 1997, drew international interest. Through forums and subcommittees, meeting participants outlined four main subjects of focus: vessel sinkings, man overboard, deck injuries, and diving deaths. Vessel Sinkings—As a result of NIOSH Alaska Field Station research on fishing vessel sinkings, USCG in Seattle and Alaska initiated a standard practice of preseason boardings to conduct safety checks and advise vessel operators of issues that need to be addressed before departure. That activity led to the development of a voluntary commercial fishing vessel safety inspection and certification program that has now become

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Program scoring r at i o n a l e and 63 a requirement for any vessels carrying a National Marine Fisheries Service observer onboard. Another advance has been the recent USCG development of an alternative compliance safety agreement for a class of vessels operating in Alaska. NIOSH has had little direct involvement in the latest developments, but it appears that NIOSH efforts provided the necessary catalyst. Man Overboard—Although time and resources have not allowed the Alaska Field Station to focus much effort on man overboard injuries and deaths, a National Occupational Research Agenda project is under way to gather the various devices, ideas, and practices used in man overboard prevention and recovery. The project will evaluate the effectiveness of the prevention and recovery methods, identify barriers to nation-wide implementation, and look at ways to improve. Deck Injuries—After crab fishing was identified as the largest contributor to occupational injuries and deaths in Alaska, members of the field station sought out fishermen to discuss the issues. Their discussions and open-minded face-to-face approaches resulted in the publication of Deck Safety for Crab Fishermen, a 37- page practical guide to techniques and modifications to improve safety on crab vessels. Additional forums and cooperative efforts with the NIOSH Spokane Research Laboratory identified entanglement as an issue for fishermen. That resulted in the development and successful testing of a unique emergency stop arrangement for capstan winches commonly used in purse seining. NIOSH took the capstan winch emergency stop to the Pacific Marine Expo and other events to share the invention with fishermen and has partnered with manufacturers to spread the use of the emergency stop on fishing vessels. Watertight integrity and vessel stability are major causes of vessel losses and deaths, as demonstrated by the Arctic Rose sinking in 2001 that resulted in the loss of 15 lives—the largest loss of life in U.S. commercial fishing history. An engineering innovation now being tested is a fiber optics-based system for monitoring watertight hatches on fishing vessels to ensure watertight integrity. The system enables a captain to ascertain at a glance whether the important hatches are secured. Watertight hatches were not considered a viable option until recently because of the demanding vessel environment. Diving Deaths—The 1997 Alaska Diving Safety Workshop (at which a member of the Alaska Field Station presented), sponsored by the Alaska Marine Safety Education Association (AMSEA) and Alaska Sea Grant, led to new diving regulations in Alaska and led NIOSH-supported AMSEA to develop an educational video about dive-harvest safety that introduces dive tenders to vessel safety, basic dive operations, and dive emergencies. By highlighting those four issues, NIOSH confirmed USCG’s belief that fishing safety was important, and the research data prompted action and showed USCG how to set priorities among its efforts. Rather than measuring success by the number, volume, and weight of peer-reviewed articles and publications, the Alaska research field group has used practical methods to generate impact. Staff at the field station have used commercial fishing trade journals and newsletters, such as those of the North Pa- cific Fishing Vessel Owners’ Association (NPFVOA) and AMSEA, to provide the latest safety information to commercial fishermen. The research and outreach work in commercial fishing safety has had a great impact not only on local fisheries but on national and even international fisheries. This work and other publications have generated worldwide interest and resulted in NIOSH-sponsored international conferences on fishing industry safety and health: the first International Fishing Industry Safety and Health (IFISH) conference was held in Woods continued

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a g r i c u lt u r e , f o r e s t r y , fishing research niosh and at 64 BOX 10-3 Continued Hole, Massachusetts, in 2000; IFISH II was held in Sitka, Alaska, in 2003; and IFISH III was held in Mahabalipuram, India, in 2006. Those conferences have generated proceedings that are used around the world to help spur further conversations, research, and regulations on commercial fishing safety. The NIOSH Alaska Field Station was able to show progress in many elements of com- mercial fishing through assorted cooperative efforts with USCG, NPFVOA, AMSEA, industry stakeholders, and other partners. Since the inception of the Alaska Field Station, there has been a 51 percent decline in the annual death rate in Alaskan commercial fishermen, active interagency cooperation is occurring, and, perhaps most important, NIOSH has achieved buy-in and respect from the commercial fishermen themselves. The research methods and practices of the NIOSH Alaska Field Station are exemplary: they are focused, priorities have been set, they are timely, and they include stakeholder feedback. Through hands-on approaches to problem solving, determined efforts to gather and improve death and injury surveillance data, and a willingness to take the extra effort to assign high priority to face-to-face communication, the station has had incredible impacts on fishing safety. The main weaknesses of the program are attributed to external factors. The committee applauds the work done by this small group of researchers. The Alaska Field Station has proved itself to be an effective program that has been relevant to the needs of commercial fishermen and has demonstrated that the outputs and intermediate outcomes of its effort have had a considerable impact in reducing injuries and deaths. SOURCES: NIOSH, 1997a, 2002, 2006a; Chris Woodley and Michael Rosecrans, USCG, personal communication, August 31, 2007; Jennifer Lincoln, NIOSH, personal communica- tion, August 31, 2007. veillance methods, involvement of key stakeholders, and motivated core staff to ensure project continuity. Examples of Cutting-Edge Research Work on agricultural risks to respiratory health conducted by AFF Program staff in collaboration with other researchers has included cutting-edge research that has moved the field forward. Successes include significant contributions to the development of laboratory methods in studying respiratory risks, development of field methods for collecting dust samples, and etiological knowledge of hazards.

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Program scoring r at i o n a l e and 65 Hand-arm vibration syndrome (HAVS), or white finger syndrome, is a com- mon problem among forestry workers. NIOSH studies demonstrated the strength of association between the use of chain saws and HAVS (NIOSH, 1997b), leading scientists and engineers in manufacturing companies to develop anti-vibration devices that could be mounted in chain saw engines to reduce vibration transfer- ence from engine to handle. NIOSH researchers also studied the problem on a global scale and saw a decreased prevalence of HAVS symptoms in Finnish and Japanese forestry workers following the introduction of light-weight, low-vibration chain saws (Futatsuka and Uneno, 1985a, 1985b; Koskimies et al., 1992; NIOSH, 1997b). Contributions of Extramural Research Information related to hazards encountered by AFF workers is of critical im- portance to efforts designed to protect those workers. With the support of AFF Pro- gram funding, the Farm Family Health and Hazard Surveillance (FFHHS) projects continue to expand the knowledge base about health and hazards associated with agriculture. Based on information from these projects, AFF Program staff system- atically developed and widely disseminated training materials for conducting safety “walk-throughs.” The Occupational Health Nurses in Agricultural Communities (OHNAC) program, another extramural program, developed important training for nurses in rural areas and provided many alerts to agricultural workers. A num- ber of the Education and Research Centers (ERCs) continue to provide training in agricultural safety and health for occupational safety and health professionals. Contributions of NIOSH Ag Centers The NIOSH Ag Centers are an invaluable component of the AFF Program and have contributed to its successes. The Ag Centers serve as a national resource for addressing agricultural safety and health problems through research, education, prevention, and intervention. The regional nature of the centers allows research to be focused, targeted, and relevant to U.S. worker populations. The centers are based in university settings, enabling researchers to draw on university resources. Overall, the Ag Centers have methodically carried out and encompassed the neces- sary components of an occupational safety and health research program: surveil- lance, research in various subject areas, partnerships and collaborations with state and local stakeholders, and information dissemination. Nearly one-third of the research conducted by the AFF Program was conducted through the Ag Centers, and the centers have strategically addressed issues that affect various populations. Examples of these components include the following:

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a g r i c u lt u r e , f o r e s t r y , fishing research niosh and at 66 Involving Stakeholders The Ag Centers use community-based approaches to identify issues deserv- ing etiological or other exploratory research. These centers have established both community-based program advisory structures and technical working groups to enhance research, educational, and outreach efforts. Not surprisingly, some advi- sory structures have performed better than others. By using community-based methods designed to engage workers, several Ag Centers have developed some successful programs to address occupational safety and health concerns of hired farm workers. For example, the Western Center for Agricultural Health and Safety (WCAHS), in collaboration with the California Institute for Rural Studies, held a conference in 1990 that included hired farm workers, farm labor advocates, and community-based medical providers (Villarejo, 1990). The success of this conference signaled the active and serious interest of university researchers in engaging workers and their representatives. Outreach Early in the development of its outreach activities, the WCAHS partnered with the Statewide Integrated Pest Management (IPM) Program staff of the University of California Division of Agriculture and Natural Resources to initiate a project to train workers in safe work practices in settings where restricted chemicals are used. The two-stage “Train the Trainers” program focused on bilingual (Spanish- English) training for supervisors, farmers, crew leaders, labor contractors, and other human resource specialists in the California agricultural workforce (O’Connor- Marer, 2000). Each participant who successfully completes this program becomes a certified pesticide safety trainer, meeting U.S. Environmental Protection Agency (EPA) guidelines. In turn, newly certified trainers provide training for hired farm laborers. Key to the process is the trainer-worker relationship in which individu- als may raise questions or otherwise bring workplace safety issues to the fore. The most recent findings of the National Agricultural Workers Survey (NAWS) indicate that 86 percent of California’s hired crop farm workers interviewed in 2003-2004 said they had received pesticide safety training from their current employer, up 8 percentage points from the 78 percent who similarly reported receiving such training in 1999-2000 (Aguirre International, 2005). There are no comparable data available for earlier years. The “Train the Trainers” model for pesticide safety training has been widely adopted elsewhere (Buhler et al., 2002), and the concept is encouraged by the EPA (EPA, 2007).

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Program scoring r at i o n a l e and 6 Influencing Policy In California, current state law requires labor contractors to participate annu- ally in continuing education intended to improve their personnel practices, and safety is a key component of the curriculum. That policy developed from the find- ings of a survey of the employment practices of California’s farm labor contractors during the late 1980s and early 1990s, when many farm operators turned to labor contractors for their short-term labor needs. The WCAHS and the California De- partment of Employment Development supported the research, which included interviews of more than 180 farm labor contractors (California EDD, 1992) that eventually led the Agricultural Personnel Management Program (APMP) of UC Cooperative Extension and the California Institute for Rural Studies to initiate training workshops to address their needs. The establishment of reliable standards and more accurate techniques for in- field measurement of acetylcholinesterase (AChE) depression in the blood serum of workers was a factor in encouraging the State of Washington to provisionally require analogous measurement of AChE depression among hired farm workers in that state. That decision was based in large part on the WCAHS research (Wilson, 1996). Measurement of this biomarker is in workers who may have been exposed to organophosphate pesticides and is required under California pesticide regula- tions, but techniques for in-field measurements had previously yielded statistically unstable results in many cases, so the improvements to the tests made results more reliable and credible. Role of Occupational Safety and Health Journals Scientists and practitioners need mechanisms for communicating, and support from the AFF Program for two journals that address agricultural safety and health have provided just that. The Journal of Agromedicine and the Journal of Agricultural Safety and Health serve as a central clearinghouse for the publication and dis- semination of research findings. Clearly these journals serve the community in a fundamentally critical way and facilitate the work of scientists and practitioners. ADDITIONAL COMMENTS ABOUT RELEVANCE The committee assigned the AFF Program a score of 4 for relevance because it found that research has been in high-priority and priority subject areas, and research has resulted in some successful transfer activities. The following section elaborates on this finding. The AFF Program has engaged in some high-priority research areas and has done an adequate job of addressing major problems. Several relevant, effective,

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a g r i c u lt u r e , f o r e s t r y , fishing research niosh and at 68 and important research and intervention pieces have resulted from the program. As previously mentioned, the work on Alaska commercial fishing has focused on highly important issues and has had an impact. The Childhood Agricultural Injury Prevention Initiative is extremely relevant, and some evaluations of the North American Guidelines for Children’s Agricultural Tasks have shown reduced injuries when the guidelines were applied. The National Agricultural Tractor Safety Initiative is another example of a focused research effort that has been extremely relevant. Research on musculoskeletal disorders that assessed simple and direct solutions for agricultural worker populations is an important issue that was ad- dressed and that had a direct impact on workers. The research conducted on inju- ries and respiratory diseases is notable, though efforts were somewhat disjointed at times. The AFF Program’s current collaboration with other federal agencies on the Agricultural Health Study is a crucial endeavor that addresses the effects of environmental, occupational, dietary, and genetic factors on the health of the agricultural population. Although the AFF Program has been engaged in some high-priority research, it has not balanced its research efforts to reflect areas that merit the highest priority. Forestry work remains one of the deadliest occupations in the United States, but the AFF Program has yet to demonstrate substantial effort in this area outside of Alaska and the southeastern United States. The committee is concerned that the AFF Program is not in tune with modern agricultural and forestry practices, lacks the ability to review efforts and know when to move on to other emerging issues, and consequently NIOSH does not have an accurate grasp of issues most pressing to agriculture and forestry workers. As seen in information provided to the com- mittee, the AFF Program has struggled to conduct surveillance to identify subjects that warrant the highest priority for attention and has not been able to accurately define the populations that it serves. It has also struggled to effectively engage stakeholders to identify current issues and to disseminate its research findings to practice. Those are important matters that affect the kinds of research conducted; leaving them unaddressed will severely hinder the AFF Program’s ability to conduct research relevant to worker safety and health. The AFF Program is engaged in transfer activities, but it has not been entirely successful in developing integrated approaches to disseminating research findings so as to yield additional reductions in injuries and illnesses in the AFF sectors. The AFF Pro- gram does not appear to be as heavily involved in translational research activities as it needs to be. Where it is involved, it does not always appear to know how and to take credit for that involvement. The outreach approaches that do exist tended to have been developed in other industrial settings and have not been appropriate or effective in reaching most target AFF populations; industrial settings differ dra- matically from AFF worksites and workforce, and different approaches are needed

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Program scoring r at i o n a l e and 69 to reach worker populations in the AFF sectors. Many examples of such models have been used by the Ag Centers and are described in Chapter 8. As previously mentioned, some projects have been successful in outreach because they first and foremost successfully engaged stakeholders and target populations and understood how to translate research results into workplace practices. The AFF Program has been ill equipped, even among university-based and clinical researchers, to address cultural and language barriers. Bench scientists can- not be expected to become instant experts in unfamiliar cultures, foreign languages, and rural lifestyles and practices. Several first-rate scientists have courageously and frankly admitted their lack of expertise and experience in community outreach and have asked for assistance in public conferences that involved the AFF Program (Frank et al., 2004). ADDITIONAL COMMENTS ABOUT IMPACT The committee concluded that AFF Program activities or outputs are likely to produce improvements in worker health and safety, and gave the AFF Program an impact score of 3. That score was merited by the fact that the program has made some contributions to worker safety and health, as seen in the success of projects that have affected children, commercial fishermen, and tractor operators. But the committee had a difficult time establishing a clear record of positive impacts because the AFF Program itself has not given much priority to documenting the impact of its efforts. In some instances, the committee was aware of impacts that could be attributed to the AFF Program for which the program itself did not take credit. In other cases, however, it is clear that the contributions of the program have not been accepted by stakeholders nor has the research program engaged sufficiently in transfer activities. The committee concluded that the impact of the AFF Program’s research has been hampered by a lack of leadership, stakeholder buy-in, and effective dissemination of knowledge and practices. The following section elaborates on these findings. The committee finds that the NIOSH AFF Program has made important contribu- tions that are likely to produce improvements in worker safety and health. The outputs of the AFF Program include a wealth of information that is still considered current and important by the scientific community. However, the information has not been organized in a manner that is understandable by or helpful to others and has not been accessible to its own researchers; the AFF Program holds great potential for impacting workers if it is able to organize information in an accessible, under- standable, and helpful format. Research has informed public policy and regulatory initiatives at the federal level and in several states. It is vital that independent, scientifically based research continue to inform policy and regulatory discourse.

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a g r i c u lt u r e , f o r e s t r y , fishing research niosh and at 0 Many in the AFF industries are well aware that safety and health are woven into the fabric of successful businesses. As illustrated by the tragic loss of life associated with the recent sinkings of fishing vessels off New Bedford, important gaps still allow extremely dangerous conditions to continue. NIOSH has a unique role as the only federal agency capable of convening all players dedicated to preventing workplace injury and disease, and it has deployed itself credibly on this task and funded other partners to function in consensus- building roles. NIOSH-sponsored symposia and workshops have had a great impact on the work of many occupational safety and health professionals and probably on the lives of AFF workers, but it is difficult to measure the direct impact of these indispensable capacity-building activities on worker safety and health. The AFF Program has made important contributions to occupational health services and training endeavors across the nation. The committee members them- selves have benefited from NIOSH-sponsored meetings and symposia, which have sparked the interest of occupational safety and health practitioners and provided others with valuable avenues for professional growth that would otherwise not have been available. It remains vital that NIOSH continue such support because it has singular influence in convening clinicians, scientists, and training institutions; con- ducting clinical research that produces occupational training insight; prescribing appropriate content for occupational training; and providing scientific and clini- cal evidence that informs practice standards. But there is room for improvement. For example, there is a need for physicians to become more involved in preparing training materials and to enroll in training courses. In light of the growing numbers of schools of public health, there is a need to prepare appropriate education and training curriculum materials for health professionals. The AFF Program evidence package and supplemental materials lacked substan- tial data demonstrating changes in the annual number of occupational fatalities or dis- abling injuries in hired farm workers and several other populations. The lack of data may be attributed in part to the failure to conduct surveillance comprehensively and to poor data management and collection; it may also be attributed to external factors as previously discussed in Chapter 3. There was also a lack of evidence of concerted efforts to address hazards, safety, and health in forestry workers and in fishermen outside of Alaska. Worker populations have not been adequately defined or tracked, therefore injuries and illnesses and changes in these populations have not been documented. The AFF Program’s unfamiliarity with standard sources of data on hired farm- worker employment, including the long-established U.S. Department of Agriculture (USDA) quarterly Farm Labor, is an indication of its inability to obtain accurate denominator data for its separate populations. The program has not used state- level data and data from other sources, such as workers’ compensation insurance

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Program scoring r at i o n a l e and  coverage, that contain a rich body of information on hired farmworker morbidity and mortality that would be valuable in informing discussions of changes in rates of occupational injury or illness (Villarejo, 1998). KEY PROGRAM LIMITATIONS Although on the whole the AFF Program demonstrated success in addressing some relevant issues and showed that it had impacted some populations, the com- mittee identified limitations that affected the program’s progress and effectiveness. The committee observed several issues that affected both the AFF Program’s ability to conduct research on issues relevant to AFF workers and its ability to conduct research that would have an impact on worker safety and health. Leadership and Strategic Planning The overarching concern about the AFF Program is the lack of a single cohesive vision to drive the research agenda. The lack of consistent leadership, long-term strategic planning, and periodic review of that course has led to a piecemeal ap- proach to the research program, and the program appears disjointed more often than not. However, the patchwork approach has produced some successful efforts because of the efforts of talented and dedicated researchers. The committee under- stands that the AFF Program is currently undergoing changes in leadership and is seeking guidance from its National Occupational Research Agenda (NORA) AFF Sector Council. Current reports to the committee on these efforts show great prom- ise, and the committee notes that effective leadership and stakeholder involvement will be essential in focusing the strategic plans of the AFF Program. Surveillance The AFF Program appears to have had considerable difficulty in applying the principles of and engaging in surveillance. Constraints to successfully implement- ing comprehensive surveillance may be due to external factors and funding. Basic demographic and health effects surveillance of each human population at risk of worksite exposure is essential because without it no effective targeting of other programmatic elements can occur, nor can one know when an intervention has been effective and move on to address other priorities. Surveillance needs to be broad-based in its population targets inasmuch as the sector is diverse in settings and employment practices and places that put populations at risk, such as children, spouses, and the elderly. Given the diversity of the target populations involved in the AFF sector, the focus on selected hazard surveillance (e.g., pesticides, rollover

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a g r i c u lt u r e , f o r e s t r y , fishing research niosh and at  protective structure [ROPS]) may have been the most efficient approach available, however creative partnering with other organizations, on items such as the NAWS survey might have provided additional information to guide program develop- ment. There are numerous examples beyond surveillance where NIOSH might reasonably let responsibility for an aspect of worker health and safety rest with another agency, but it was difficult to find that such a decision was arrived at after intentional consideration and decisionmaking. In the 1990s, the AFF Program attempted to conduct surveillance through the FFHHS program and the OHNAC program. In addition, the AFF Program funded the National Farm Medicine Center in Wisconsin and the Great Plains Center for Agricultural Health in Iowa to conduct surveillance in two rural surveillance catchment areas. More recently, a second phase of the Regional Rural Injury Study has been funded. The AFF Program needs to develop its surveillance program by using surveil- lance results in partnership with other organizations. Examples of some of these include the Centers for Disease Control and Prevention (CDC) National Center for Injury Prevention and Control, the National Center for Health Statistics (CDC), the National Animal Health Monitoring System (USDA), NIOSH Ag Centers, the Na- tional Children’s Center for Rural and Agricultural Health and Safety, agricultural safety specialists at 1862 land-grant institutions, equipment manufacturers, and such informal groups as agricultural, fishing, and forestry workers and employer focus groups. NIOSH program directors and managers have not fully used CDC’s surveillance findings for intervention targeting and development. Injury surveil- lance in the fishing industry appears to have been undertaken more expertly, at least for commercial systems of the far North, and health surveillance beyond hazard surveillance in the forestry industry is in programmatic infancy. Further, the use of hazard surveillance systems for nonfatal injuries and illnesses holds promise for being a more cost-effective model for identifying emerging issues. In addition, the use of sentinel monitoring of occupational illnesses and injuries, first proposed in 1983 (Rutstein et al., 1983) by NIOSH staff has not been actively pursued and may also be cost-effective. Stakeholders On the basis of the information provided by the AFF Program, remarks pro- vided by stakeholders, and comments submitted by the public, the committee un- derstands that the AFF Program has not fully engaged its stakeholders. It has had some remarkable partnerships to reach stakeholders, such as those with the com- mercial fishing industry in Alaska, but it has struggled to engage other stakeholders. The program has met the most success when it has understood stakeholder needs by asking for direct feedback from farm workers, loggers, and fishermen. It has also

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Program scoring r at i o n a l e and 3 garnered the most credibility when researchers have demonstrated that they are sensitive to stakeholder needs, which vary greatly among the three sectors. A recurrent important impediment to NIOSH-sponsored programs has been lack of credibility among stakeholders. NIOSH has demonstrated that it can forge helpful linkages with segments of economic sectors, as in the mining and construc- tion industries. However, such linkages to directly engage workers are not appar- ent between the AFF Program and two of its three target worker populations: in agriculture and forestry. Without a strong buy-in from its targeted populations, the program may appear to be out of touch with its stakeholders and unresponsive to the realities of the workplace environment, and its work may therefore not be credible among farm workers, loggers, and fishermen. Stakeholders have also at times confused NIOSH with the Occupational Safety and Health Administration (OSHA); most workers are more familiar with OSHA’s role in the workplace than with NIOSH’s research. That has led to reluctance to work with NIOSH, in that some stakeholders are hesitant to work with a regula- tory agency. In its recent NORA initiative, the AFF Program has formed a NORA AFF Sector Council. Self-employed and unpaid family workers are represented on this council, but it includes no current hired laborers in AFF or direct representatives of hired laborers who were elected in a direct and democratic process by current AFF workers. Populations at Risk The AFF Program targeted specific populations that it deemed at higher risk than others but omitted certain other populations and fell short in defining the entire population of AFF workers at risk of injury and illness. There has yet to be a program-wide endeavor to characterize the numbers and types of workers involved in agriculture, forestry, and fishing. Some populations, such as hired farm workers, have also been poorly defined or miscategorized, and others, such as ranchers, have been largely unaddressed. AFF Program leadership has a less than satisfactory record in addressing hired farm workers and did not respond to priority issues previously identified for this subpopulation. In May 1995, NIOSH convened a national task force of experts to identify priorities for surveillance and research on occupational safety and health of hired farm workers. The task force met, but the effort was stalled, and its work was put on hold. Three years later, Dr. Sherry Baron contacted a member of the task force to request that the California Institute for Rural Studies prepare the report, and the task force reached consensus without delay. Shortly after submitting their report to NIOSH for review in November 1998, task force members were informed that the report was issued (http://www.cdc.gov/niosh/hfw-index.html). For what

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a g r i c u lt u r e , f o r e s t r y , fishing research niosh and at 4 NIOSH refers to as priority populations for the period 1997-2006, the cumulative adjusted budget devoted to child safety was slightly more than $14 million, for fishing safety $2.4 million, for logging safety $0.2 million, and for “migrant and minority” populations an estimated $2.1 million (NIOSH Response to Question #5, 2007, see Appendix C). NIOSH has yet to allocate substantial resources that are consistent with the task force’s recommendations for hired farm workers. NIOSH has not accurately identified the hired farm workforce and continues to refer to this population as migrant and seasonal farm workers. Federal defini- tions of this population for the purpose of providing funds for education, health services, and legal services limits the eligible population to crop workers, but also includes food-processing workers. Furthermore, NIOSH has stated that “farm workers provide a good example of a population of non-English speaking, low- literacy immigrant workers who migrate between a series of temporary jobs” (Fine, 1996). That definition of the hired labor force is obsolete and unhelpful: although many hired farm workers are non-English speakers, some do speak English; 42 percent of hired farm workers migrate to find work, but most do not migrate (U.S. DOL, 2005); and many hired farm workers are immigrants, but quite a few are not. Moreover, large numbers of hired farm laborers work in livestock produc- tion, excluded from the current “migrant and seasonal” definitions. The basis of the inaccurate characterization of the hired workforce is federal legislation that funds services to address needs of “migrant and seasonal” workers, and cannot be attributed to NIOSH alone. CONCLUSION The AFF Program has conducted decent work but many opportunities for im- provement remain, including the setting of priorities with stakeholder input and a focus on research of utmost importance to and impact on AFF worker safety and health. The new challenge is to create a cohesive program that establishes strategic goals with the input of stakeholders so that researchers will understand the issues facing AFF workers, conduct surveillance of all subpopulations of AFF workers, and create a research-to-practice stream of information that will have an impact on the stakeholder communities. Successful implementation of the research-to- practice component of the AFF Program will need to include participatory involve- ment at the ground level to provide data to answer stakeholder questions, identify how stakeholders access information, and create a continuous discussion with stakeholders. Given the programmatic gaps and challenges, the committee offers suggestions and more formal recommendations in Chapters 11 and 12 to build on the efforts of the AFF Program to date and to improve the entire system of NIOSH research and knowledge transfer activities.