Down on the Farm: Preventing Farm Accidents in Children

By Conway, Alice E; McClune, Amy J; Nosel, Patricia

Agriculture continues to rank as the most dangerous industry in the United States. The objectives of this pilot study were to identify the incidence of care provided to children involved in farm accidents, examine barriers to utilization of farm safety materials by primary health care practitioners (PHCPs), and determine the percentage of PHCPs who provide anticipatory guidance related to farm safety. Pender’s revised Health Promotion Model (2006) was used. A survey was developed and mailed to 110 PHCPs of all levels in North West Pennsylvania. The return rate was 20%. Types of injuries identified by the PHCPs included lacerations and musculosketal injuries caused by animals and farm equipment. Forty- five percent of the PHCPs reporting asked new patients/families if their children lived or worked on a farm. Eighteen percent specifically focused on farm-related injury prevention. Fourteen percent were aware of farm injury prevention materials and 73% were interested in receiving such materials. A larger study needs to be conducted to validate these findings.

The sun peeks its head above the horizon, casting its first rays upon acres of lush green fields, glistening from the morning dew. A rooster crows, marking the advent of a new day. The air is fragrant with fresh soil and warm homemade bread. These tranquil images are what we associate with farm life. It seems like a utopia, a close knit family working side by side for the betterment of the farm and ultimately each other. Unfortunately farm life is far from a utopia.

Significance

Agriculture continues to rank as the most dangerous industry in the United States, with an accidental work-related death rate six times that of all other industries combined (DeMuri & Purschwitz, 2000). It is a unique industry, in that it is often a family business, where parents and children both live and work. In 1999, according to the National Agricultural Statistics Service (NASS) (n.d.), there were more than 2 million farms in the United States, with 1.5 million children and adolescents living and/or working on farms. In the United States, 100 children die and more than 100,000 are injured each year on these farms where they live, work, and play.

With 23% of its citizens residing in rural areas, Pennsylvania ranks 6th in the nation in total population and ranks 1st in rural population (The Center for Rural Pennsylvania, 2000). The Center for Rural Pennsylvania defines rural and urban based on population density. Rural population refers to a municipality, either a county or school district, that has less than 274 persons per square mile, or a municipality whose population is less than 2500 persons. Forty- eight of Pennsylvania’s 67 counties fall into the rural category (The Center for Rural Pennsylvania, 2000).

Between 1982 and 1996, Pennsylvania ranked 3rd in the nation, behind Texas and North Carolina, for fatal farm-related injuries in children under 20 years of age. Nationwide, the group most likely to experience nonfatal farm accidents is adolescents (Reed, Westneat, & Kidd, 2003); however, in Pennsylvania [with] 40% of farm fatalities occurred in children under 5 years of age (Adekoya & Pratt, 2001). Between 2000 and 2002, a total of 82 farm-related fatalities were reported across the Commonwealth; 27% involved children 19 years of age or younger. Of the 22 child fatalities, 14 (63.6%) involved children under the age of 5 years. Of the total of 82 farmrelated fatalities that occurred in that same time period, 27% involved children 19 years of age or younger (see Table 1).

Various groups, including the National Committee for Childhood Agricultural Injury Prevention (NCAIP, 1996) and Farm Safety 4 Just Kids (n.d.), provide resources for farm safety education. These resources include a Farm Safety Day Camp; age-appropriate publications such as story books and coloring books featuring the character Cawshus the Crow; DVDs; and a rural health and safety kit that includes games, puzzles, and brochures on topics such as food safety, sun safety, and hearing protection. Still, farm-related injuries and fatalities continue to occur. Many factors have been proposed as contributing to this problem: the lack of parental supervision, operator fatigue, children performing tasks inappropriate for age, and the purposeful disabling of safety devices (DeMuri & Purschwitz, 2000).

Purpose

The purpose of this pilot study was to identify health promotion procedures that primary health care practitioners (PHCPs) use to educate children and their families about farm safety. Pender’s model was used in this study to describe how PHCPs used the opportunity in their practice to engage patients in health- promoting behaviors related to farm safety. Specifically, the project sought to (a) identify the number of farm accidents involving children, as reported by PHCPs; (b) examine the barriers to utilization of farm safety materials by PHCPs; and (c) determine the percentage of PHCPs who provide anticipatory guidance related to farm safety.

Conceptual Framework

Pender’s 1996 revised Health Promotion Model (HPM) (Pender, Murdaugh, & Parsons, 2006), served as the conceptual framework for this study. “The HPM attempts to depict the multidimensional nature of persons interacting in their interpersonal and physical environments as they pursue health” (p. 50). One of Pender’s major assumptions is that individuals in all their psychosocial complexity interact with their environment, progressively transforming the environment while at the same time being transformed.

In attempting to influence healthpromoting behaviors, Pender’s model advocates being cognizant of the individual’s characteristics and experiences, including biological, psychological, and sociocultural factors. Predicting of future health-promoting behavior begins with developing awareness of relevant past behavior, and then identifying behavior-specific cognitions and affects. These variables are considered to have major motivational significance because they are subject to modification. The individual variables of perceived benefits of action, personal barriers of action, perceived self-efficacy, activity-related affects, situational influences, and interpersonal influences can be modified to increase health-promoting behaviors.

Self-efficacy is defined as the judgment of personal capability to organize and carry out a particular course of action. Activity- related affect is the subjective feelings prior to, during, and following an activity. Interpersonal influences include behaviors, beliefs, and attitudes of others. Pender considers the primary sources of interpersonal behaviors to be family, peers, and health care providers. Behavior-specific cognitions and affects are influenced by immediate competing demands and preferences that can lead to a commitment to a plan of action and to healthpromoting behavior, which is the desired outcome of the HPM. An important theoretical assertion of Pender’s model is that families, peers, and health care providers are important sources of interpersonal influences that can increase or decrease commitment to and engagement in health-promoting behavior.

Methods

Survey methods were used to determine farm safety issues facing PHCPs in Northwestern Pennsylvania (NWPA). The authors developed the survey, “Primary Care Providers’ Knowledge Regarding Farm Safety and Health Promotion of Living on Farms,” based on a review of the literature and the authors’ experience. Demographic data, questions regarding the incidence of farm injuries seen in individual practices, and the knowledge of related health-promotion materials were included. The content validity was ensured using expert review by a panel of both pediatric and measurement experts. Human Subjects Review was secured from the researchers’ academic institution prior to collecting data. A convenience sample (N=110) of PHCPs in five NWPA counties was selected using local telephone books. Anonymous surveys were mailed to study participants with an enclosed return envelope. Follow-up reminders were sent out after 2 weeks in an effort to increase the response rate.

Results

Twenty-two surveys were received for reviewing results in a 20% return rate. Although the return rate was low, the range of practitioners included medical, osteopathic, and chiropractic physicians along with physician’s assistants and nurse practitioners. Types of injuries identified by the PHCPs included lacerations and musculoskeletal injuries caused by animals, and muscular strains and injuries related to farm machinery and equipment. One fatality was reported and one child required extensive surgery after being gored by a bull (see Table 2).

Forty-five percent (45%) of the PCHPs responding reportedly asked new patients/families if their children lived or worked on a farm as part of the intake history. Eighteen percent (18%) specifically focused on farm-related injury prevention during that first visit. Although 14% were aware of the available farm safety materials, only 5% of the PHCPs had these materials available for distribution. Seventy-three percent (73%) of PHCPs were interested in receiving farm-related injury prevention materials.

The Pennsylvania State University, through the College of Agricultural Sciences and the Cooperative Exte\nsion, has been instrumental in performing research and providing information to the public and private sectors regarding agricultural safety. Although this information is available, based on the results of our pilot study, PHCPs are not aware of the resources, or the resources are not readily accessible. As a continuation of this pilot study, research is needed to validate these findings across the state and ultimately to make developmentally appropriate resources available to primary care providers to use in the education of both parents and children who live and work on farms.

Implications and Conclusions

The results of this study support the premise that additional health promotion resources should be made available to PHCPs who serve rural populations. In NWPA, a primarily rural area, PHCPs provide care to children who live and/or work on farms, a significant number of which were victims of farmrelated accidents. Additionally, evidence demonstrated that children were involved in a significant number of farm injuries. The authors are currently conducting a larger follow-up study throughout the state of Pennsylvania to validate these data. Results from the follow-up will provide useful information in raising the awareness of farm safety issues among Pennsylvania’s rural PHs as well as the public.

Other studies considering children as a special population are examining factors such as the use of pesticides, the manner in which children are introduced to farm chores, and the circumstances surrounding injury and death related to farm accidents (Frank, McKnight, Kirkhorn, & Gunderson, 2004). Table 3 lists selected sites of an Internet search of a variety of publications and resources already available for use for parent and child education. As a result, a farm safety awareness campaign could be promoted in conjunction with governmental agencies with the goal of reducing the morbidity and mortality rates related to farm injuries for rural children.

It may seem that the utopia of the family farm lies far down the horizon. The goal of reducing farm-related injuries and fatalities may be met by identifying needs, locating and indexing available resources, and developing additional resources for use by health practitioners delivering care to these farm families. These actions will bring the utopia of a safe farm closer to reality.

References

Adekoya, N., & Pratt, S.G. (2001). Fatal intentional farm injuries among persons less than 20 years of age in the United States: Geographic profiles. Washington, DC: Department of Health and Human Services. Retrieved January 2, 2007 from http:// www.CDC.gov/niosh/childag.

DeMuri, G.P., & Purschwitz, M.A. (2000, December). Farm Injuries in children: A review, Wisconsin Medical Journal, 99(9), 51-55.

Frank, A.L., McKnight, R., Kirkhorn, S.R., & Gunderson, P. (2004). Issues of agricultural safety and health. Annual Review of Public Health, 25(1), 225-245.

National Agricultural Statistics Service. (n.d.). 1998 childhood agricultural injuries. Retrieved October 18, 2003, from htp:// osda.mannlib.cornell.edu/reports/nassr/other/injury/injr1099.pdf

National Committee for Childhood Agricultural Injury Prevention (1996). Childrend and agriculture: opportunities for safety and health. Marshfield, WI: Marshfield Clinic.

Pender, N.J., Murdaugh, C.L., & Parsons, M.A. (2006). Health promotion in nursing practice. (5th ed.). Upper Saddle River, NJ: Pearson Pentice Hall.

Reed, D.B., Westneat, S.C., & Kidd, P. (2003) Observation study of students who completed a high school agricultural safety education program. Journal of Agricultural Safety and Health, 9(4), 275-283.

The Center for Rural Pennsylvania (2000). Demographics: Rural/ Urban PA. Retrieved October 18, 2003 from http://ruralpa. org/ about.html

Yoder, A.M., (2003). Summary of fatal farm incidents. Unpublished manuscript. Pennsylvania State University, School of Agricultural and Biological Engineering.

Alice E. Conway, PhD, CRNP, APRN-BC, is Professor, Department of Nursing, Edinboro University of Pennsylvania, Edinboro, PA.

Amy J. McClune, PhD, RN, BC, is Assistant Professor, Department of Nursing, Edinboro University of Pennsylvania, Edinboro, PA.

Patricia Nosel, MN, RN, D.Ed(C), is Associate Professor, Department of Nursing, Edinboro University of Pennsylvania, Edinboro, PA.

Copyright Anthony J. Jannetti, Inc. Jan/Feb 2007

(c) 2007 Pediatric Nursing. Provided by ProQuest Information and Learning. All rights Reserved.