11
New and Emerging Research in Agricultural, Forestry, and Fishing Safety and Health

The committee to review the National Institute for Occupational Safety and Health (NIOSH) Agriculture, Forestry, and Fishing Research Program (AFF Program) was charged with assessing the program’s targeting of new research in occupational safety and health most relevant to future improvements in workplace protection. The committee was also asked to identify emerging issues important for NIOSH and the program. In keeping with the guidance of the Framework Document, this chapter provides the committee’s suggestions based on expertise of individual members rather than as a product of a formal process to explore and synthesize recommendations that could be developed through a comprehensive review of the field.

IDENTIFICATION OF NEW AND EMERGING RESEARCH BY THE NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH

Process for Identifying New and Emerging Research

The AFF Program identifies new and emerging research through planning inputs consisting of surveillance data, stakeholder needs, partner aims, information exchanged in symposia and conferences, and program evaluations.

Surveillance data and trends from the following sources are reviewed: Bureau of Labor and Statistics Census of Fatal Occupational Injuries, Traumatic Injury Surveillance of Farmers, Occupational Injury Surveillance of Production



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11 New and Emerging Research in Agricultural, Forestry, and Fishing Safety and Health The committee to review the National Institute for Occupational Safety and Health (NIOSH) Agriculture, Forestry, and Fishing Research Program (AFF Pro- gram) was charged with assessing the program’s targeting of new research in oc- cupational safety and health most relevant to future improvements in workplace protection. The committee was also asked to identify emerging issues important for NIOSH and the program. In keeping with the guidance of the Framework Document, this chapter provides the committee’s suggestions based on expertise of individual members rather than as a product of a formal process to explore and synthesize recommendations that could be developed through a comprehensive review of the field. IDENTIFICATION OF NEW AND EMERGING RESEARCH BY THE NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH Process for Identifying New and Emerging Research The AFF Program identifies new and emerging research through planning in- puts consisting of surveillance data, stakeholder needs, partner aims, information exchanged in symposia and conferences, and program evaluations. Surveillance data and trends from the following sources are reviewed: Bu- reau of Labor and Statistics Census of Fatal Occupational Injuries, Traumatic Injury Surveillance of Farmers, Occupational Injury Surveillance of Production 5

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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 Agriculture, Occupational Health Nurses in Agricultural Communities, Commu- nity Partners for Healthy Farming, Analysis of Surveillance Data for Agricultural Injuries, Cancer Control Demonstration Projects for Farming Populations, Birth Defects and Parental Occupational Exposures, Agricultural Health Study, Centers for Disease Control and Prevention Birth Defects Registry, Fatality Assessment and Control Evaluation (FACE), State-Based Fatality Surveillance Using FACE Model, Childhood Agricultural Injury Surveillance, National Agricultural Workers Survey, National Health Interview Survey, National Electronic Injury Surveillance System, Farm Family Health and Hazard Surveillance, Sentinel Event Notification System for Occupational Risk, Keokuk County Rural Health Study, Farmer Health Study, and the Work-Related Lung Disease Surveillance Report. The NIOSH AFF Program identifies the following stakeholders and partners: farmers, hired farm workers, children as workers or bystanders, unpaid workers, forestry services workers, and fishermen. Stakeholders also include organizations, such as the Grange, United Farm Workers of America, Farm Safety 4 Just Kids, and the National Institute for Farm Safety. Private-sector stakeholders include equipment manufacturers, insurance companies, commodity groups, and workers’ compensation organizations. Federal entities include the U.S. Department of Agri- culture (USDA) extension agents, the U.S. Environmental Protection Agency, and the U.S. Coast Guard (USCG). Advisory groups have included the NIOSH Agricultural Steering Commit- tee and the NIOSH Board of Scientific Counselors. In addition, several program evaluations have been conducted, including a Progress Review Workshop (1992), a Project Facts Evaluability Assessment (1992), and an Extramural Committee Review of the Extramural Cooperative Agreement Programs (1995). As a result of the aforementioned methods used to identify new and emerging research, the AFF Program has listed the following new technologies and potential emerging issues as potentially relevant for new research: • Automatic steering, autopilot, and computer-operated equipment • Biological manufacturing • Biosensors • Biotechnology • Changing farmer demographics • DNA sensing chips and nanolasers • Exposure to genetically modified organisms • Exposure to high-pressure hydraulic systems • Fatigue • High-speed equipment • Irradiation of food

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new emerging research and  • Land application of sludge • Managing safety in on-farm valued-added processing operations • Power-transmission lines and communication towers (electric and mag- netic fields and radiofrequency) • Remotely controlled tractors and machinery • Site-specific management • Using global positioning systems to monitor worker activities • Zoonotic-disease outbreaks Assessment of the Agriculture, Forestry, and Fishing Research Program’s Effectiveness in Targeting New Research Given the trends in agriculture, forestry, and fishing, the worksites of tomorrow clearly will be different from the worksites of today. The changes, both predicted and unpredicted, will fuel the need for surveillance of such human factors as worksite organization and management; climate, technology, and policy change and of economics. On the basis of information provided by NIOSH, the committee concludes that the AFF Program has not developed a consistent process for iden- tifying new research issues and developing a way to address emerging issues. The success of a public health research program is marked by its ability to recognize and address the needs of a targeted population. Because the AFF Program on the whole has struggled to conduct surveillance to understand the current needs of its worker populations, it is unable to forecast future needs. In light of the fact that the program lacks an established procedure for assess- ing emerging issues in agriculture, forestry, and fishing, the committee further concludes that the AFF Program has fallen behind in understanding current prac- tices and how these practices can create new hazards for workers. The program has instead focused resources on issues that have already been partly resolved by changes in work practices and environments. Thus, the AFF Program has not kept up with emerging issues and has lost the capability to gain useful knowledge and to respond with appropriate new technologies. A few projects, however, have more successfully identified emerging issues and conducted research to address them. The fishing projects in Alaska and the farm-resident child-injury initiatives, for example, have consistently carried out sound research practices to affect fishermen and children, respectively, and have been able to identify new and emerging issues for these populations. Key factors in their success include the continuity of funding and staff. Long-term funding (3-5 years) enables researchers to carry out adequate surveillance, research, and outreach and to identify relevant issues on the horizon. Training and retention of key staff members are also vital for the successful execution of research from project

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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 8 initiation to completion and for researchers to recognize such issues as changes in workplace practices. The list of new technologies and potential emerging issues identified by NIOSH above appears to be a smorgasbord of unexplained significance; rather than reflect- ing a process by which the AFF Program can systematically identify and set priori- ties among new and emerging issues, the list appears to be simply a compilation of concerns and technologies. Regardless of how the list was assembled, the commit- tee concurs that such issues as automated equipment, value-added processing on farms, changing farmer demographics, and zoonoses are emerging research issues and technologies that would benefit from NIOSH investigation. NEW RESEARCH IDENTIFIED BY THE COMMITTEE In evaluating the AFF Program’s research, the committee identified several kinds of research missing in health effects, health services, intervention, and regu- latory policies. Some research issues that have not been investigated are of great relevance to improvement of AFF worker safety and health and could substantially affect safety and health with help from NIOSH. Health Effects Research Health effects research is complex, and future efforts need to be directed to- ward more extensive collaboration among all scientists working in AFF, in both intramural and extramural settings. Collaboration in multicenter studies of key clinical problems would increase the power of studies to answer important scien- tific questions. Future efforts might take investigators in new directions, such as studying the health effects of shift work and other causes of sleep deprivation on the AFF workforce, or studying the risk of cancer among fishermen (Spitzer et al., 1975; Gallagher et al., 1985; Andersen et al., 1999). The AFF Program has traditionally relied on engineering controls to eliminate or alleviate work environment hazards. In the new era of genetic and non-genetic marker technologies, the AFF Program needs to consider using these new preven- tive technologies for environmental and occupational disease prevention and con- trol. At least one study has been funded on the emerging issue of gene-environment interactions; additional research needs to be conducted on preclinical identification of health hazards through biomarker technologies and include discussions on ethi- cal concerns surrounding this issue. New projects, which might be larger than those often funded by NIOSH, need to have adequate infrastructure to allow them to operate smoothly. The Agricultural Health Study—an important prospective cohort study of nearly 90,000 farmers and

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new emerging research and 9 their wives to explore the potential causes of cancer and other diseases—is a good example of extensive collaboration among NIOSH, the National Cancer Institute, the National Institute of Environmental Health Sciences, EPA, and various universi- ties and institutes (National Cancer Institute, 2007). Clinician scientists would need to collaborate with laboratory-based scientists and epidemiologists to facilitate translation of knowledge into a form that can be communicated directly to AFF workers and those who provide health and safety services to them. Representatives of AFF communities need to play a large role in that dissemination process. Suc- cessful knowledge translation and dissemination will require that ways be found to overcome barriers of geography, economics, language, culture, and politics. A rigorous evaluation plan needs to be in place for all efforts of this nature. The focus of health effects research may need to change as the AFF Program evolves. It may be wise to review priorities and accomplishments before the AFF Program enters its next phase, with input from NIOSH intramural and extramural researchers, scientists who are studying AFF issues through other funding streams, AFF workers, and medical and safety professionals who serve the AFF sector. Scien- tific information obtained through the efforts of all scientists working in AFF needs to be considered as future directions are determined. AFF workers from all levels of the workplace hierarchy need to be at the table when priorities and approaches to problems are considered. Health Services Research and Training NIOSH can identify useful structures that might function in advising the Edu- cation and Research Centers (ERCs) and the Centers for Agricultural Disease and Injury Research, Education, and Prevention (Ag Centers) so that training materials developed for occupational venues are clinically accurate, reflect current practice standards, integrate contemporary scientific and clinical findings, and are formally vetted before they are released for general use under the aegis of NIOSH. Clinical science relative to occupational exposure assessment and intervention is advancing rapidly, including tools to identify workers with specific combinations of genetic variants and environmental stressors that put them at higher than normal risks of disease. NIOSH will need a mechanism to quickly feed such science into training curricula. AFF safety and health professionals need appropriate translation of the findings because they deal directly with AFF workers. Such discovery leads to specifically targeted therapies and intervention techniques for disease prevention and control—the very reason for conducting health services research and training. Telehealth is an emerging application used to expand access to healthcare services and training, especially for practitioners in rural communities: it serves as a means of providing AFF worker populations with access to medical specialist consultations

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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 80 and as a way of providing continuing education to a variety of health practitioners on AFF topics. The committee is impressed by efforts in the U.S. Public Health Service to explore factors that affect health outcomes. Much of the endeavor involves urban and suburban populations, and the committee encourages NIOSH to investigate with sister agencies on opportunities to conduct, endorse, or fund health outcomes research in rural AFF populations. Those populations have been only lightly stud- ied despite the fact that their occupational pursuits and rural residence and work locations predispose them to some kinds of exposure and affect their access to healthcare. Such work might build on successful activities in urban settings. NIOSH can explore ways to enhance attention to AFF issues in university-based clinical research training. Because NIOSH has excellent linkage through its ERCs, the potential to affect clinical curricula is enormous. Such linkage might capture nontrivial issues of rural geography, spatial isolation, lack of access to high-speed Internet infrastructures, cultural features, indigenous languages, and rural work patterns that are markedly different from those with which most urban-based clinical researchers have contact. A continuing supply of physicians knowledgeable in the AFF arena and in other areas of occupational and environmental health is needed, as are incentives that would include occupational and environment health training and continuing edu- cation in medical school curricula. NIOSH can develop standardized assessment tools for extramural occupational health training activity so that there will be a mechanism to corral data on program relevance, quality, and execution. Recogniz- ing that academic communities, volunteer organizations, and workers often have strong desires to implement interventions to prevent occupational injuries and illnesses and that they may lack resources to evaluate programs to guide the best use of their resources, the committee believes that a coordinated approach to train- ing program evaluation has merit. Development of such tools would contribute information on knowledge and skill gaps, clinical and other professional relevance, needs for training and other professional experience, the ability of instructors and others to convey key messages, and incentives that might propel future collabora- tive activity in occupational training venues. Intervention Research The AFF Program needs a more systematic and unified approach to evaluating and disseminating intervention research. It has taken a unified approach with the National Agricultural Tractor Safety Initiative, albeit a decade or so late, and needs to take a similar approach to intervention research in general. Although there are regional differences among the activities undertaken by AFF workers, the many

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new emerging research and 8 similarities make it likely that a successful intervention developed in one Ag Cen- ter, such as a redesigned apple-picking basket in the Northeast Ag Center, would be useful in another center’s work. The AFF Program needs a formal nationally coordinated mechanism for targeting intervention research to the highest-priority populations and highest-priority health effects so that the program can develop, pilot test, and evaluate appropriate interventions in an Ag Center and then expand interventions that have the greatest potential for success on a national scale. If an intervention has proved effective on a large scale, it needs to be aggressively dis- seminated to stakeholders through all available channels (such as trade and labor associations, publications, presentations, and extension agents), not merely posted on the National Agriculture Safety Database in the hope that employers and work- ers will visit the NIOSH Web site to search for solutions. The North American Guidelines for Children’s Agricultural Tasks seem to be a good model for this kind of systematic development and rollout of an intervention, but the issues and most effective approaches may differ from children and adult AFF workers. Regulatory Policies Impact of Ending Statutory and Labor Exemptions for Agriculture New research could be conducted on the safety impact of ending the long- standing statutory exemptions for agriculture under the Fair Labor Standards Act and the Occupational Safety and Health Act. As demonstrated by the remarkable success of Pacific and Northwest agriculture, in which all but a few of those exemp- tions have been superseded by state laws, there is a serious question of whether American agriculture would be harmed by abolishing the federal exemptions. NIOSH is uniquely positioned to compare state-level workplace regulations and safety outcomes with the corresponding performance of each state’s farming sec- tor. The much more limited exemptions for small forestry and fishing operations can also be examined. New research could be conducted on the effect of ending child labor exemp- tions for agriculture. The General Accounting Office (GAO; now the Government Accountability Office) reports that there are compelling reasons to question regu- lations that exempt hired and unpaid family child workers in agriculture while children in all other industries are protected (GAO, 1998). Rather than continue its piecemeal approach of seeking corrections to various specific hazardous orders that apply to child workers, the AFF Program can focus on new research to examine the effects of eliminating statutory exemptions for hired and unpaid family child workers in agriculture. Research shows that nearly one-fourth of child farm injuries were among immediate family members, and at least one-third of these injured

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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 8 children were performing tasks prohibited by hazardous work orders in hired child workers of the same age (Marlenga et al., 2007). Furthermore, 76 percent of workers less than 16 years old who died in connection with their work were working in a family business and were thus exempt from child labor laws. The committee recommends that the AFF Program continue research on how ending the “family farm exemption” would affect the labor market and other family farm workers. A related question is how raising the age restriction from 16 to 18 years for hazardous agricultural work would affect safety and health. As the GAO review points out, there are compelling reasons to question why children ages 16 and 17 are permitted to perform hazardous tasks in agriculture but would be forbidden to perform the same tasks in any other industry (GAO, 1998). The committee recommends that the AFF Program continue to support research to inform this question. Impact of State Policies on Agriculture, Forestry, and Fishing Worker Safety and Health New research is needed to study the effect of state policies on workplace safety and health. State policy initiatives, such as increases in minimum wage, are becoming more important because some state policies on occupational safety and health (such as those in California) are more stringent than federal regulations. An annually updated online reference source describing federal and state employ- ment standards for the entire AFF workforce would be helpful. In 1988, a remark- ably complete review of federal and state employment standards was published (Craddock, 1988); updating this document would be a good place for the AFF Program to start. It would become a valuable resource for employers, employees, and AFF safety and health professionals. It appears that no document of that kind has ever addressed the fishing and forestry industries. High-quality surveillance and public policy assessment are clearly related, as was shown through a recent review of the enforcement and education activities of California’s Cal/OSHA Program. California law states that employees must be insured under workers’ compensation (by law, only employees earning less than $100 in any calendar quarter are exempt from this requirement); this system has been in place for more than 75 years. The Workers’ Compensation Insurance Rating Bureau of California (WCIRB), the actuarial agency that reviews all paid claims, issues annual summaries of paid claims by frequency and severity. It produces a comprehensive record of the most serious injuries and deaths by job type and by the important factors involved in each claim, and its reports are extremely useful for surveillance purposes (Villarejo, 1998).

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new emerging research and 83 The WCIRB issued an analysis of all noncumulative workplace injuries and illnesses over a 3-year period for which an indemnity payment was made.1 The analysis was multivariate and included independent variables, such as age of the worker, lack of work authorization (in the case of immigrant workers), duration of employment, and sex. The most significant finding was that only one factor was statistically shown to be associated with a reduction in overall noncumulative in- demnity paid claims: Cal/OSHA enforcement and education (WCIRB, 2002). That finding suggests that the state’s policy of enforcement and education has benefited both employers and workers. EMERGING RESEARCH AND ISSUES IDENTIFIED BY THE COMMITTEE The committee emerged from the review process with its own view of future AFF worksite challenges and opportunities for injury and disease prevention and promotion of healthy worker behavior. For NIOSH to continue safeguarding workers in agriculture, forestry, and fishing, the AFF Program needs to consider emerging research that the committee has identified as priority areas. The com- mittee formulated these research issues and categorized them as high-, medium-, and low-priority to reflect their potential magnitude in AFF work environments while simultaneously recognizing the scarcity of NIOSH resources and the need to conduct research in focused areas. It is understood that the AFF Program needs to forge links with industry sectors capable of yielding key information and that these cross-cutting issues require bold program management with streamlined proce- dures and processes to aid cross-division research and interdisciplinary projects. High-Priority Research The committee identified several issues and research categories as having high- priority: changes in the demographic characteristics of the workforce, changes in the fishing industry, emerging forestry issues, blurring boundaries for food har- vesting and food processing, food safety and food security, and the transformation and industrialization of agriculture. The committee hopes that the AFF Program will consider those crucial issues in the immediate future as it moves its research agenda forward. 1 Indemnity payments are required for death or permanent disability, whether major or minor. In the event of a temporary disability, an indemnity payment for lost wages is required if the worker is hospitalized or is unable to work for more than 3 days.

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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 84 Changes in Demographic Characteristics of the Workforce It is important to monitor changes in the population at risk so that appropri- ate interventions can be targeted to reduce hazards, injuries, and illnesses related to work. The AFF working population has been undergoing substantial changes over the last several decades. For example, hired workers are increasingly involved in agricultural operations, such as dairy farming or row cropping, for which they may not be trained. The percentage of workers in agriculture who are hired rather than being owners or operators has increased dramatically in recent years, and the same may also be true for fishing. Hired workers may be recent immigrants, H-2A workers, or seasonal workers who come from other countries. Those changes un- derscore the need to develop surveillance systems that include hired workers to a much greater extent than has been the case. Continuous review of the working population is needed to adapt research and interventions to other emerging characteristics of the aging workforce. The aging AFF workforce is a considerable issue (Robert Rummer, USDA Forest Service, presentation to committee, March 28, 2007; Jerry Dzugan, AMSEA, presentation to committee, March 29, 2007). For example, the average age of farm owners in the United States has increased over the last several decades (USDA, 2002); as these people continue to work through what would commonly be considered retirement age, the health and safety hazards of work will create new problems that need to be addressed. The percentage of farm operators who are female has also increased in recent years, and the risks to females associated with farm work have not been addressed to any great extent in the NIOSH AFF Program. Changes in the Fishing Industry After years of effort on the part of NIOSH’s Alaska Field Station, USCG, the Occupational Safety and Health Administration, the Alaska Marine Safety Educa- tion Association (AMSEA), the North Pacific Fishing Vessel Owners’ Association (NPFVOA), and industry and fisheries management, the commercial fishing death toll in Alaska has begun a downward trend (NIOSH, 2002). In 2006, however, commercial fishing still ranked as the most dangerous occupation in the United States, with a mortality of 141.7 per 100,000 fishermen (BLS, 2007a). The USCG report Analysis of Fishing Vessel Casualties (2006) showed that it was more danger- ous to be a commercial fisherman in the Gulf of Mexico than in Alaska. NIOSH has been slow to expand its successes in Alaska to the commercial fishing centers in the lower 48 states, and it needs to begin to do so quickly in regions where the model could be transferable. In-shore fishery—consisting in New England mainly of lobstermen and shell fisherman; in the Chesapeake Bay, watermen involved in crabbing and oysters; and in the Gulf, shrimp fishermen—is substantially different

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new emerging research and 85 from offshore Alaska fishing. Offshore fishing in the Northeast is facing extinction due to depletion of the Gorges bank fishery, and these businesses tend to be non- corporate. These other fishing regions lack a support structure, such as AMSEA and NPFVOA, to provide training and outreach. Another important source of risk in fishing is environmental degradation. As fish become scarcer and as fisheries close, margins for fishermen grow tighter and the cost of safety is weighed against the ability to operate the vessels. Overfishing can lead to rapid changes in technologies, spatial shifts in fishing, new manage- ment initiatives, and so forth that have the potential to impact fishing safety (Dolan et al., 2005). With the ever-increasing demand for seafood outpacing the natural supply, there has been huge growth in aquaculture in the United States and around the world. Resources need to be dedicated to investigating safety and health issues emerging from aquaculture. Populations with little or no previous exposure to aquaculture are joining the industry and learning as they go. What hazards exist that they are unaware of? What challenges do they face in the exponential growth of a new industry? Emerging Forestry Issues The fatality rate in forestry workers is unacceptably high. According to presen- tations and public comments provided to the committee, some loggers are easily acquiring and using antiquated tools to harvest trees. Some loggers do not have formal training with logging equipment or electric tools, and many are unfamiliar with safety practices. The problem is compounded by the aging of the logging workforce, and older workers may face different and greater risks of injury and death than younger ones. The U.S. forestry industry is undergoing substantial change due to mechani- zation, changing worksite labor organization, and increased use of contract labor for specified tasks. The increased use of mechanization is a challenge because it may increase some forms of worker exposure while decreasing others (Grevsten and Sjorgren, 1996; Attebrant et al., 1997; Axelsson, 1998; Neitzel and Yost, 2002). Resource degradation in forestry can limit the ability to use mechanical harvesters or potentially increase their risk by pushing harvesting onto steep slopes, degraded sites, or on other unstable terra firma. At the same time, mechanization may intro- duce ergonomic issues that have yet to be encountered (Gellerstedt, 1997; Oliver et al., 2000). Evolving workplace organization structures and the use of contract labor could exacerbate exposures, given management’s desire to complete tasks quickly under environmental- and weather-related pressure and some workers’ preference to work long hours at piece work rates (International Labour Organiza-

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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 86 tion, 2000). The AFF Program needs to address these emerging developments in forestry services with targeted surveillance and research so that workers can avoid or mitigate such exposures. Blurring Boundaries for Food Harvesting and Food Processing With continuing changes in available technologies and economic pressures to increase profits by providing value-added products, many farms are increasing the amount of food processing performed on site. Post-harvest food processing gener- ally entails cooling, cleaning, sorting, and packing. The primary goals of moving food processing closer to the fields and to the sea are to control undesirable chemi- cal changes in the product, minimize physical damage, and obtain better control of pathogens through sanitation procedures. As these processes become more closely integrated with traditional harvesting activities, workers may be exposed to new hazards with which they are not familiar. There is a potential for increased worker exposure to risks and hazards when preventing food contamination and when maintaining ready access to sanitary facilities, drinking water, and food during the workday. Potential hazards include exposure to chemicals used as pesticides, or to control or enhance ripening or retard spoilage (such as argon, carbon dioxide, and carbon monoxide), or as sanitizers (such as hypochlorite solutions and ozone). Increased risk of repetitive motion injuries may result from new tasks associated with processing and packaging produce, such as twisting motions required to core lettuce. Additional surveillance and research activities may be required to fully characterize the magnitude and nature of these new hazards, and to develop ap- propriate intervention strategies. Food Safety and Food Security Hazardous food agents or contaminants can cause illness among people di- rectly involved in food production. The list of hazardous agents is long and includes microbial and parasitic agents, multi-drug resistant bacteria, and antibiotic and pesticide residues. Other controversial issues, such as genetically modified foods that could contain allergens or toxins not found in conventionally produced foods, are also receiving attention from consumer and producer groups. Consumer prefer- ences for ready-to-eat foods, changes in demographics and climate, and access to global markets have changed the incidence of food safety risks. In addition, there is a risk of intentional and unintentional food contamination due to agroterror- ism or lack of oversight of food quality control. Those are all major concerns for public and private institutions. Studies that integrate all the players and steps in the food chain—from farmers, ranchers, hired workers, forestry service workers, and fishermen to transport and

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new emerging research and 8 processing and packing industries to consumers—are needed to understand the risks of acute and chronic illnesses and how to prevent, monitor, and control them. Industrialization of Agriculture Several developments are converging in production agriculture that create new needs for robust programs in surveillance and health effects. For example, dairy and meat production capacity is increasingly concentrated in confinement operations, which results in larger aggregates of livestock at single farm sites. The environ- mental and ecological issues associated with concentrated animal feed operations have been subject to intense public scrutiny (NRC, 2003), but the health effects on employees and others associated with these worksites have been less intensively analyzed. Safety interventions need to also be studied for those working around large numbers of animals. In addition, large concentrated operations employ large numbers of workers and necessitate management and oversight functions far in ex- cess of those of more conventional operations. Workforce issues affecting the injury and disease experience in such operations deserve attention, and NIOSH has the experience in other industrial sectors needed to plan and conduct such work. The committee encourages NIOSH to begin such analyses without delay and recom- mends that NIOSH provide encouragement and targeted funding for Ag Centers that may be in the best position to mount such efforts with dispatch. Medium-Priority Research Medium-priority issues and research subjects that are potentially critical in the near future were identified: the development of biofuels and their impact on workers and the environment, conditions of farm labor housing and its impact on public health, the rising demand for specialty agriculture, the integration of human and animal health, and the need to review equipment safety issues. Biofuels Biofuels have come to national attention in the last few years as a promising source of renewable energy. By developing technologies to convert corn, soybeans, plant residues, and other biomass materials into fuels, chemicals, and power, the United States could tap into cleaner and cheaper alternatives to petroleum (The White House, 2006). Biofuels have the potential to transform the energy sector and with it the industries associated with biofuels. Agriculture and forestry could face the greatest revolution since their industrialization at the outset of the 20th century.

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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 88 The transition to a biofuels-based economy will alter the use of land, the types of crops planted, and the use of pesticides and machinery. With corn production concentrated in the Midwest, forestry biomass in the South and West, sugar pro- duction in the South and Midwest, and grass-based biomass on the High Plains, there could be a shift toward working in rural America and later a substantial in- crease in resource use. Those changes would be accompanied by the potential for additional safety and health issues that need to be considered by NIOSH: • How will crop production technologies, seasonal work cycles, and distri- bution and transportation of raw materials and products? For example, if ethanol plants are built in rural communities, large concentrations of trucks will be trans- porting grain, other bulk byproducts, and ethanol to and from plants on two-lane roads. How will that affect the safety of rural residents? Could increased traffic in rural areas lead to an increase in collisions? • How will new dedicated energy crop production systems affect worker safety? • Will reduction in fossil fuel use by agricultural producers change exposures to farm equipment-related morbidity and injuries? Farm-Labor Housing The central importance of housing conditions for health status has been well understood in the public health community for more than a century. The first effort to address the living conditions specifically of hired farm laborers was California’s 1915 Labor Camp Act, a response to horrific labor camp conditions that led to the Wheatland Hop Riot of 1913. There have been serious improvements in housing conditions of many migrant farm laborers, but virtually all recent health survey research have demonstrated that a large share of this workforce is still experienc- ing unwarranted risks to health that are associated with their housing conditions. Pesticides carried into a residence on work clothes, lack of refrigeration for food storage, absence of sanitary facilities, and extreme overcrowding have all been linked to adverse health outcomes in farm laborers. Forestry services workers and fishermen may also face similar housing issues. The issue is complex: socioeco- nomic status, housing conditions, risky behavior, workplace exposure, and immi- grant worker acculturation may all be linked in unknown ways to observed health outcomes. The challenge to public health investigators to untangle those factors is daunting, and the committee recommends that NIOSH pursue such effort without further delay.

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new emerging research and 89 Specialty Agriculture Production agriculture has rapidly shifted to accommodate the demands fos- tered by the globalization of the nation’s food economy. Demand has increased for organic products (USDA, 2007) and for exotic plants and animals (Blisard et al., 2002). Vast stretches of cereal grain and row-crop production are now interspersed by acreage devoted to raising ornamentals, shrubs, and other nursery products; vegetables (including indoor hydroponic vegetables) and fruits; and specialty live- stock (such as free range hens, milking goats, and North American bison). Those enterprises may entail activities and management practices noticeably different from the more conventional forms of American agriculture and may organize and pursue work tasks differently from other sectors and lead to different exposures of workers (David Runsten, Community Alliance with Family Farms, presentation to committee, March 28, 2007). NIOSH is encouraged to monitor, through USDA’s National Agricultural Statistics Service surveillance, the emergence and develop- ment of those forms of production agriculture. Integration of Human and Animal Health Emerging and re-emerging pathogens include parasites and zoonotic agents that in recent decades have been associated with changes in the demographics of the workforce, in herd health practices, and in the practice of medicine and veterinary medicine in connection with the use of the same antimicrobial agents in humans and animals or the use in animals of antimicrobial agents that could be harmful to humans. For example, the accidental injection of Micotil (tilmicosin), a bovine antibiotic approved for use to prevent shipping fever in cattle), can cause death in humans when injected into the bloodstream. That is one example of human error causing an unforeseeable consequence to health. There needs to be a forum in which animal scientists, veterinarians, food safety experts, and social scientists come together to examine the complexity and hazard of animal handling and herd health issues in humans. The panel’s expertise needs to include bioethics so that the humane treatment of animals and concurrent protection of human life are addressed. Another example of the need for an integrative approach to animal husbandry, production, and human health is the rising prevalence of neurocysti- cercosis, which was originally eradicated in the United States in the early 1900s. Neurocysticercosis is a parasitic infection that affects humans and pigs and was endemic only in Latin America, Asia, and Africa until the 1980s. The current in- crease in its incidence is related to the recent migration of hired labor from Latin American countries (Wallin and Kurtzke, 2004; DeGiorgio et al., 2005). Many neurocysticercosis patients may harbor the adult tapeworm Taenia solium in the intestines and could infect other humans and pigs. The complexity of the disease

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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 90 goes beyond neurological consequences to range from seizures to permanent brain damage and ultimately death; sociocultural issues associated with food consump- tion and personal hygiene also have to be considered. Outreach activities need to be developed in conjunction with programs to respond promptly to the needs of producers and consumers. Priority needs to be given to these outreach activities, considering the large number of people exposed to and affected by the hazards of animal handling. Furthermore, safety standards would be evaluated and updated as needed. The activities would include continuing critical analysis to determine whether target populations have been reached and their needs addressed. The integration of the cooperative extension service system, colleges of veterinary medicine and animal sciences, and the National Institute of Environmental Health Sciences is fundamental for the development of a much needed holistic approach to decipher and solve these complex problems. Review of Equipment-Safety Issues Advances in tools, equipment, and machinery are occurring rapidly. Cowboys are now riding motorcycles and all-terrain vehicles (ATVs) instead of horses, fisher- men are using such advanced fibers as Spectra and Dyneema instead of wire rope, and former tobacco farmers are pulling fish out of ponds or trying their hand at organic food production. All those changes come about in an effort by AFF em- ployers and workers to improve efficiency and perhaps make their jobs easier, but often they are embarking on a path with unknown risks. Many riders of ATVs are not trained to drive these fast-moving vehicles, and most do not wear protective helmets. Spectra and Dyneema appear amazingly strong but cannot be endorsed as reliable fishing tools, because of the lack of inspection standards. Farm equip- ment is being adapted for uses that were never foreseen by its manufacturers. In one photograph shown to the committee, a group of workers were shown lying face down on a platform attached to a tractor so that they could weed without bending over. The effort was probably intended to improve ergonomics and reduce back pain, but it could come at the cost of unforeseen consequences. The AFF Program needs to be constantly active in looking at emerging trends in AFF and take a more active role in foreseeing and addressing possible hazards from new and existing machinery. Low-Priority Research The committee identified four wide-reaching issues and research subjects that are candidates for long-term study: the impact of nutrient enrichment of food and genetically modified organisms (GMOs) on worker safety and health, transporta-

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new emerging research and 9 tion injuries, the impact of global warming on growing and harvesting practices and worker conditions, and the use of labor-management committees. Nutrient Enrichment of Food and Genetically Modified Organisms Micronutrient enhancement to reduce nutritional deficiencies in human popu- lations globally is under study (Schreiner, 2005; Welch and Graham, 2005). These activities and the increasing use of GMOs to produce genetically modified crops may have an impact on aspects of agricultural safety and the health of workers involved in the production of these crops. From 1996 to 2005, the total surface area of land cultivated with GMOs increased from 4.2 million acres to 222 million acres, of which 55 percent was in the United States. Controversies surrounding genetically modified foods focus on consumer health and safety but not the health and safety of the farm workers. Transportation Injuries Hispanic farm workers have been reported to have 20 percent higher work- related mortality than non-Hispanic white farm workers. In Colorado, skull frac- tures and fatal intracranial head injuries have been reported to be more frequent in farmers and farm workers than in the general population; the risk in Hispanic farmers is 1.79 times greater than the risk in non-Hispanic farmers, and the risk in Hispanic farm workers is 2.50 times greater than the risk in non-Hispanic farm workers (Stallones and Sweitzer, 2000). Head injuries have been reported to be the leading cause of work injury-related death in farm workers in Texas (May-Lambert et al., 1998). Motor-vehicle collisions are the leading cause of head injury, but it has rarely been considered an issue related to the health and safety of migrant and seasonal farm workers. The mobility of the population in question, which follows crops, exposes them to motor-vehicle injuries as part of their normal work environment. There is adequate evidence that Hispanic populations in Colorado have higher rates of fatal motor-vehicle collisions (relative risk [RR], 1.7), seatbelt nonuse (RR, 1.8), alcohol intoxication (RR, 2.7), speeding and invalid licensure (RR, 2.6) than non- Hispanic whites involved in fatal motor-vehicle collisions (Harper et al., 2000). In the United States, farm workers reportedly have higher than expected death rates related to motor vehicles (Colt et al., 2001). A study of Hispanic farm workers in California reported low use of seatbelts and car seats (Stiles and Grieshop, 1999). In Colorado, 53 percent of Hispanics reported not always wearing their seatbelts compared with 37 percent of all survey respondents (CDPHE, 2002). Driving while drowsy has been reported to cause 100,000 collisions a year and to result in 71,000 injuries and 1,550 deaths (NHTSA, 2002).

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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 9 The National Highway Transportation Safety Administration conducted a study to identify issues in and strategies for highway safety in American Hispanic communities (Martinez and Veloz, 1996). The problem most often mentioned by Hispanic focus group participants and agency and organization representatives was drinking and driving, followed by low seatbelt use (Martinez and Veloz, 1996). Seven major challenges in addressing prevention in that population were identi- fied: language; cultural differences within the Hispanic communities; low income coupled with low expectations for the future and limited resources for organiza- tions to provide services to everyone in need; heavy use of alcohol combined with a lack of knowledge of the effects of alcohol on driving and confusion regarding alcohol laws; recent immigrants’ lack of knowledge of American laws, inability to read signs and lack of valid drivers’ licenses; Hispanic immigrants’ lack of orien- tation to health maintenance and failure to accept safety readily as an issue; and absence of traffic-safety data on specific racial and ethnic groups (Martinez and Veloz, 1996). Increased concern about health and safety among agricultural workers who commute from field to field and farm to farm during peak agricultural seasons has not increased the number of programs targeted at preventing specific types of injuries that are closely associated with the mode of travel of these workers and their families (Grieshop et al., 1998). The safety of motor vehicles used to trans- port migrant and seasonal agricultural workers is regulated by the Department of Labor under the Migrant and Seasonal Agricultural Worker Protection Act (29 USC §1801 et seq.), and these vehicles must comply with federal and state safety regulations. However, regulations promulgated under the act must consider “the extent to which a proposed standard would cause an undue burden on agricul- tural employers, agricultural associations, or farm labor contractors.” The act also precludes the transportation of a worker on a tractor, combine, harvester, picker, or similar machinery or equipment while the worker is engaged in planting, cul- tivating, or harvesting agricultural commodities or caring for livestock or poultry. Regulations require the safe transport of migrant and seasonal farm workers, but it is not clear that they are being applied or what barriers impede the application of regulations that would improve safe transport. Global Warming Human-induced climate change, its potential impacts upon AFF working populations, and options for potentially effective interventions to preserve health status has received increasingly more attention in the last few years (Kilbourne, 1992; IPCC, 2007). The Intergovernmental Panel on Climate Change report fore- casts an average global temperature increase of between 1.1 and 6.4 degrees Celsius, suggesting that warming of the climate system is unequivocal (IPCC, 2007).

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new emerging research and 93 Global climate change presently captures the attention of scientists the world over; however, its impact upon working agricultural populations is difficult to pre- dict. For workers in AFF worksites, those effects may span a continuum from im- pact on wardrobes and safety gear to unexpected exposure to mold, fungi, insects, and ultraviolet radiation. Given that many AFF production sites are outdoors and unprotected, the warming of Earth’s surface causes some concern, which in some areas may lead to increased problems with heat stress. Resistance to the use of safety protection in hot or humid environments is widespread among AFF populations, and this poses a challenge to adoption of protective barriers in affected settings. Such warming may contribute to a greater incidence of dermatological, infectious, inflammatory, and respiratory forms of human disease (Kilbourne, 1992). AFF worker exposures in warmer climates have been only lightly documented, and the committee recommends that NIOSH convene a panel of internationally recognized experts to identify the most important human exposures so that disease surveil- lance can be efficiently targeted. Finally, the committee recommends NIOSH moni- tor the spread of diseases typically associated only with tropical and subtropical environments, because the southern states will ultimately experience subtropical heat and humidity in large portions of the calendar year. The agriculture, forestry, and fishing industries will also be affected. As the demand for seafood increases in the United States, the aquaculture industry will continue to grow. Those unfamiliar with raising seafood products will face unfore- seen hazards associated with an increasingly warm planet, from microorganisms to plant infestations. Forests are being affected by beetles that survive in higher temperatures. Climate change may cause animals, plants, insects, and their as- sociated disease vectors to flourish in areas that were previously inhospitable for habitation, and the impact on worker safety and health is unknown; infestations found only in Florida today may thrive in Virginia if global warming continues. How will workers be informed about the handling of invasive species and how can they be protected from exposure to foreign pathogens? Joint Labor-Management Committees A potentially valuable but underdeveloped method for improving worker safety is the formation of joint management-worker safety committees. Workers often have direct experience and knowledge about the risks associated with their jobs that could be invaluable to correcting problems where feasible. Such collabo- rations are common in some other sections of industry than in the AFF sector. Evaluation of the few existing AFF agreements could inform future directions of workplace safety programs. At the same time, worker advocates caution that work- ers in non-union settings may feel too vulnerable to make safety recommendations, a comment that needs to also inform research on this topic.

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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 94 Joint management-worker safety committees may be construed as an unfair labor practice under the National Labor Relations Act (NLRA), especially if the worker members of a safety committee are selected in a company-wide secret ballot. However, hired agricultural workers, as previously described, are exempt from NLRA jurisdiction, so this would be of concern only to forestry and fishing firms. Moreover, the opinion of a knowledgeable labor attorney, provided on an informal basis and not constituting either legal advice or a legal opinion, indicates that such an election would not normally be considered an unfair labor practice under the NLRA (Joel Levinson, personal communication, May 11, 2007). It would be important to explore this concern further among both management and labor attorneys. CONCLUSION An essential and challenging aspect of NIOSH’s stated mission “to provide na- tional and world leadership to prevent work-related illnesses and injuries” includes the identification of emerging issues and new concerns for worker populations in agriculture, forestry, and fishing. The AFF Program should be at the forefront of efforts to review and define needs in agriculture, forestry, and fishing and should promote opportunities to pursue innovative ways of responding to these needs. The committee notes that the AFF Program has struggled in carrying out that task, and it has provided suggestions for approaching and undertaking such activities. However, the committee concedes that the task is important and warrants more extensive expert input and evaluation than the committee could provide in the context of its review. It hopes that the AFF Program will continue to engage its stakeholders and its advisory council for feedback and guidance.