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Review of Outreach Activities: Knowledge Diffusion and Technology Transfer

STRATEGIC GOALS AND OBJECTIVES

Goal 5: Outreach—Reduce injuries and illnesses by informing and educating employers and employees in agriculture, forestry, and fishing (AFF) about occupational safety and health hazards and control systems.

In the evidence package (NIOSH, 2006a), the AFF Program provides examples of activities, outputs, intermediate outcomes, and impacts that reflect the results of the translation of knowledge and its transfer to diverse audiences and the implementation of recommendations. Some of the examples involve important interventions to support the adoption of safety innovations and included evaluations of their success and their impacts. The knowledge diffusion and technology transfer occurred through legislation, improved technology, protective equipment and clothing, and effective communication and education programming.

LOGIC SUBMODEL

Goal 5 incorporates a logic model directly associated with the “supply chain of knowledge”. The concept of a supply chain of knowledge is related to the inputs needed for the development of knowledge, the transfer and communication of knowledge, as well as the surveillance and evaluation of and feedback about the impacts of these delivery mechanisms such as websites, conferences, and training programs. In the concept of a supply chain, links at each stage need to be strong



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8 Review of Outreach Activities: Knowledge Diffusion and Technology Transfer STRATEGIC GOALS AND OBJECTIVES Goal 5: Outreach—Reduce injuries and illnesses by informing and educating employers and employees in agriculture, forestry, and fishing (AFF) about occupa- tional safety and health hazards and control systems. In the evidence package (NIOSH, 2006a), the AFF Program provides examples of activities, outputs, intermediate outcomes, and impacts that reflect the results of the translation of knowledge and its transfer to diverse audiences and the implementation of recommendations. Some of the examples involve important interventions to support the adoption of safety innovations and included evalua- tions of their success and their impacts. The knowledge diffusion and technology transfer occurred through legislation, improved technology, protective equipment and clothing, and effective communication and education programming. LOGIC SUBMODEL Goal 5 incorporates a logic model directly associated with the “supply chain of knowledge”. The concept of a supply chain of knowledge is related to the inputs needed for the development of knowledge, the transfer and communication of knowledge, as well as the surveillance and evaluation of and feedback about the impacts of these delivery mechanisms such as websites, conferences, and training programs. In the concept of a supply chain, links at each stage need to be strong 4

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knowledge diffusion technology transfer and 5 and connected to move the results of surveillance, research, and intervention to the appropriate target populations at risk, whether employees or employers. The logic submodel (Figure 8-1) identifies inputs, activities, outputs, and intermediate and end outcomes. INPUTS On the basis of the materials in the evidence package, the committee concluded that about 17 percent of the National Institute for Occupational Safety and Health (NIOSH) budget was devoted to Goal 5 over the period 1997-2006. That translates to about $800,000 per year for the intramural programs and $2.1 million per year for the extramural programs. The work involved about six full-time equivalents (FTEs) at NIOSH per year. The committee was unable to break out the funding or FTEs associated with Goal 5 at the NIOSH Centers for Agricultural Disease and Injury Research, Education, and Prevention (Ag Centers) but summarizes here the activities, outputs, and outcomes from the evidence package. Planning inputs included the National Occupational Research Agenda (NORA, 2000), the National Coalition on Occupational Safety and Health (NCASH) report, and congressional directives. Many of the conferences, workshops, and symposia cited in Chapter 10 may also have helped to set priorities for this goal and other AFF efforts, but they are not so referenced. The logic model starts with the iden- tification of the problems, knowledge gaps, and documentation of areas of severe or significant mortality, morbidity, and injuries. NIOSH identifies them in the opening chapters of the evidence package, but the evidence package often does not connect the materials to the goal of knowledge diffusion and technology transfer. The second input required is a planning and priority-setting process commu- nicated to NIOSH through the NORA process or from stakeholders. This process is currently underway. The third stage is the application of priorities to intramural or extramu- ral research through requests for proposals and principal-investigator initiatives. Surveillance projects and research conducted at this stage are expected to provide results for dissemination and improved processes, equipment, personal protective gear, and behavioral changes. The mechanisms for improvement include identifi- able actions and proposed solutions, but these still need implementation through engineering, behavioral, or regulatory actions. The engineering solutions require diffusion of knowledge and implementation at the level of the manufacturer or employer and occasionally the worker. Behavioral changes require a mechanism for knowledge diffusion and attitude, motivational, and behavioral changes in practices associated with the workplace. Regulatory changes require a process to pass laws, write regulations or rules associated with the workplace, and have them

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6 Inputs Activities Outputs Intermediate Outcomes End Outcomes Planning inputs: 1. Intramural 1. Reduction in pesticide 1. Intramural 1. KAP Changes 1.NORA workshops with poisonings Web sites Surveillance Changes in Knowledge stakeholder input Brochures Research Changes in Attitudes 2.Strategic plans and 2. Reduction in fatal injuries FACE reports Intervention Changes in Practices priorities in farm youth Evaluation 3.Annual action plans 2. Extramural 2. Technological changes 3. Reduction in logging None Described NAGCAT (evaluations) 2. Extramural Adoption of new technology, accidents, helicopter Needed: identify Training programs ROPS, tubs, ladders Surveillance crashes populations at risk Ag Center programs Research forestry 3. Personal protective devices Intervention 4. Decline in fishing deaths fishing 3. Both Evaluation and accidents agriculture 4. Legislation or regulations National Ag Safety medfly control in Florida Database 3. Dissemination 5. Reduction in eye injuries logging practices Publications among migrant farm Production Inputs: fishing vessel safety, Alaska Conferences, workshops 4. Training and education workers through use of 1. Budget residential use of pesticides Engineering solutions, safety glasses Intramural, $0.80 m/yr 5. Education and Research patents monitoring cholinesterase in (est.) Centers Washington and California Evaluation feedback Extramural, $ 2.1m/yr prohibiting tractor driving on (est.) highways by children under Overall, est. 17% of 16, Wisconsin NIOSH budgets for 1997- 2006 5. Research to practice of Ag Centers (unable to research to other alternatives breakout or estimate amount for this goal) 2. Intramural staff 6 FTE/yr (est.) 3. Infrastructure (not described) FIGURE 8-1 Knowledge diffusion and technology transfer logic submodel. FACE = Fatality Assessment and Control Evaluation, FTE = full-time equivalent, NAGCAT = North American Guidelines for Children’s Agricul- tural Tasks, ROPS = rollover protective structure.

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knowledge diffusion technology transfer and  implemented by employers and employees. Where those mechanisms for improve- ment have been undertaken, the logic model calls for evaluation of the impact and feedback to NIOSH staff to determine whether the changes have filled the knowledge gaps and reduced mortality, morbidity, or injuries associated with the workplace and the populations at risk. An excellent example from the evidence package is the safety inspection and training associated with the fisheries program, in which the application of all three mechanisms to the fisheries industry led to a substantial reduction in boating accidents and loss of fishermen. Another excellent example of such a logic model is exhibited in the Pacific Northwest Agricultural Safety and Health (PNASH) Center report (Figure 8-2), which incorporates all the elements of inputs from diverse FIGURE 8-2 The PNASH Center partnership model. SOURCE: Appendix 2-10 in NIOSH, 2006a. 8-2.eps

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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 stakeholders, feedback mechanisms, and evaluation. In this case, the research team from Washington State University, Oregon Health Science University, and Idaho State University collaborate with NIOSH and the U.S. Environmental Protection Agency (EPA), and other NIOSH Ag Centers as they listen to the needs of the part- ners including other health and safety workers (H&S) and the diverse agricultural community to identify the needs and share results of research. ACTIVITIES The activities that contribute to Goal 5 are summarized extensively in Chap- ters 7-10. This section summarizes the activities of the Ag Centers that are related specifically to knowledge diffusion and technology transfer. Although the committee did not receive materials describing the NIOSH Edu- cation and Research Centers (ERCs), a review of their Web sites showed at least some research and educational activity devoted to agricultural issues by the ERCs at the University of California, Davis, University of Iowa, University of Texas, and University of South Florida. The others may have been active in the general train- ing of practitioners in health and occupational safety. In the evidence package, NIOSH reviewed the following major interventions: • Agricultural health and agricultural safety promotion systems (1990- 1993) • Occupational Health Nurses in Agricultural Communities (1990-1996) • Community Partners for Healthy Farming Intervention Research (1996- 2003) • Diffusion of safety innovations (1997-2005) • Safe Communities coalitions (1998-2000) • Certified Safe Farm (1998-present) • Other outreach programs Those programs are discussed in the evidence package, and it is not necessary to describe them here except to note that they are all completed. The documentation demonstrates numerous efforts from 1990-2005 to extend the results of research into the respective communities. No new programs were proposed. OUTPUTS The outputs listed constitute a mixture of publications, abstracts, CD-ROMs, booklets, pamphlets and fact sheets, training curricula, books, Web sites, and presentations, but internal NIOSH staff are not differentiated from external AFF

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knowledge diffusion technology transfer and 9 Program participants. Over 18 conferences, workshops, and symposia have been held since 1991 to address childhood agricultural injury, minority-group popula- tions, logging, and safety in the fishing industry. The outputs from Goal 5 also include extensive partnerships with other orga- nizations to communicate and transfer knowledge to employers and employees. Although researchers have long recognized the lack of correspondence between knowledge, on the one hand, and attitudes and behaviors related to safety and health practices in farm populations, on the other (Murphy, 1992; Elkind, 1993; Freeman et al., 2003), a great deal of NIOSH staff effort has gone into providing educational materials. There are many other products of the NIOSH research ac- tivities and uses as evidenced in Box 8-1, Research to Practice. The evidence package provides examples of program efforts over the last 15 years and, most recently, new intervention research associated with the rollover protective structure (ROPS) program in 23 states. Other examples cited include the reduction in dairy injuries, the youth safety training program, the reduction in green tobacco sickness, and the use of appropriate eyewear in Illinois and Michigan. AFF Program staff collected case reports of rollovers to use in developing real- istic stories. These were used to develop a ROPS notebook for farmers and to assess its effectiveness. The involvement of NIOSH AFF staff is not clearly described. INTERMEDIATE OUTCOMES The National Agriculture Safety Database (NASD) Web site was created at the request of NIOSH agricultural extension agreement participants to provide a national information resource for the purposes of dissemination, leveraging resources, and avoiding duplication of efforts. “It is widely recognized and heavily used by the diverse community involved in agriculture (farmers, agribusinesses, universities, and government agencies).” The Web site receives over 500,000 hits per month from 75,000 unique users. It contains over 3,000 publications and links to other organizations. However, only 34 states are listed as contributing to the NASD. That is odd inasmuch as all the Ag Centers are contributing, and they cover all the states. In fact, although recent reports from Washington state had been submitted by the PNASH Center, Washington is not listed among the states for which one can get information. Recent examples of new materials include the ATV Safety Packet from the Children’s Safety Network, submitted in 2006. The NASD may need better funding or a mechanism to incorporate all the states into the database via the Ag Centers. The National Ag Safety Disc, a PC-based CD-ROM that contains a compen- dium of educational and information resources, was released in 1994 and after

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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 30 BOX 8-1 Research to Practice (r2p) In the recent Evaluation of the Agricultural Safety Centers (2006), NIOSH staff worked with the Agricultural Centers Evaluation team to define categories of “research to practice” (r2p) to illustrate various methods of moving results of projects into use by others. Research to practice was defined as research findings or products that are accepted and used by target audiences. The eight categories that were represented were research to intervention and education, research to research, research to field use, research to evaluation, research to aca- deme, research to policy, research to surveillance, and research to technical assistance. An interesting result of this study was the distribution of r2p activities. First, 71 percent, or 94 of 133 projects, evaluated were in the r2p realm, and the 94 were classified in the eight r2p categories: % Research to Practice 57 R to intervention and education 13 R to research 10 R to field use 6 R to evaluation 4 R to teaching 4 R to policy 3 R to surveillance 2 R to technical assistance 99 Total One might interpret the classification scheme broadly and combine all categories except research to research; all the other categories involve research to some form of practice. Uses in the field, for evaluation, for policy purposes, in the classroom, and for technical assistance are all related to practice in different contexts. If we omit research to research, 86-87 percent of research went to practice in some form, and 13 percent was used as an input for further research. That approach, however, was not used in the evidence documents that were provided. This may be a useful categorization; but no one seems to have asked the question of why NIOSH came up with this set of categories and what NIOSH is doing with it. Is it meaningful in some administrative way? Does it help understand the flow of knowledge from research through other indirect routes to final use in education and intervention? SOURCE: Buchan and Holmquist-Johnson, 2007. beta testing was scheduled to be released in final form in 1995 (Jones et al., 1995). This project is not mentioned in the materials provided by NIOSH. The database described above may be the expanded phase of this dissemination activity.

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knowledge diffusion technology transfer and 3 END OUTCOMES The following are specific examples of outcomes that NIOSH identified as a result of its programs: • A reduction, as a result of surveillance and research activities, in acute pesticide poisoning from 13.1 to 8.9 cases per 100,000. • A reduction in youth injuries, in terms of both actual numbers and rates. • Reductions in logging accidents and helicopter crashes. • A substantial decline, as a result of safety training and inspections, in fish- ery accidents and deaths. • A reduction in eye injuries in migrant and seasonal farm workers through the use of safety glasses. Cited examples that result from the development of legislation include the management of pesticides at both the federal and state level, specifically in Cali- fornia, and Wisconsin legislation prohibiting driving of a tractor on a highway by people under 16 years old unless they have successfully completed a tractor certification course. An interesting evaluation analysis, however, showed that the Wisconsin law did not affect injury rates. The transfer of knowledge into regulations is seen in Mediterranean fruit fly (medfly) control in Florida, logging practices in the Northwest, and vessel safety in Alaska. Other regulations are related to the residential use of pesticides, the moni- toring of cholinesterase in California, and rules associated with the application of and new standards for ROPS. The transfer of knowledge through improved technology is shown by the new ROPS technology and seatbelts on tractors, the winch shutoff on fishing boats, and monitoring sensors. Examples of improvements by engineering include machine guards on hay bal- ers and the ergonomic apple bag; by administrative intervention, the requirement that fishermen wear personal flotation devices; and by protective equipment and clothing, the use of safety glasses. Examples of effective communication in education include day camps and safety programs for young people, the report on leading causes of death in logging, and the social marketing efforts in California. Those examples are cited in the Executive Summary of the evidence package and further elaborated on in the various sections of the evidence package (NIOSH, 2006a). The examples reflect the effort to identify impacts of all programs but most specifically Goal 5 and the outreach, education, and communication programs. The evidence document concludes with a statement that NIOSH was unable to link intermediate outcomes causally with occupational injury, illness, fatality,

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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 3 or hazard exposure data; nevertheless, these many examples provide ample docu- mentation of intermediate and end outcomes. REVIEW OF THE NIOSH CENTERS FOR AGRICULTURAL DISEASE AND INJURY RESEARCH, EDUCATION, AND PREVENTION (AG CENTERS) The programs of the NIOSH Centers for Agricultural Disease and Injury Re- search, Education, and Prevention (Ag Centers) were reviewed from the perspective of the diffusion of knowledge and the incorporation of research results in outreach programs. Western Center for Agricultural Health and Safety The Western Center for Agricultural Health and Safety (http://agcenter.ucdavis. edu) serves California, Hawaii, Nevada, and Arizona. The Western Center dem- onstrated substantial research and extension partnerships with state agencies in pesticide exposure and illnesses and incorporated a major r2p effort. As part of the r2p program, the center used social marketing approaches, increased electronic communication, and supplied some funding for the AgSafe conference to provide education, train the trainers, and educate agriculture workers. There is no evidence of an evaluation of the impact and outcomes of the effort, but several long-term evaluation studies are proposed or under way. Pacific Northwest Agricultural Safety and Health Center The Pacific Northwest Agricultural Safety and Health Center (PNASH, http:// depts.washington.edu/pnash/) works with employers, workers, health professionals, and government agencies to identify hazards and implement solutions that will prevent or reduce workplace injuries and illnesses in northwestern farming, for- estry, and fishing. The center operates in Washington, Oregon, Idaho, and Alaska. Through its Advisory Board and using a priority-setting process in which stake- holders provided input, it initiated forums for outreach and extension to workers, employers, and health professionals. The focus was on pesticide exposure and the use of technology, intervention measures, and training to reduce exposure. The research program also addressed ergonomics and injuries in vineyards, orchards, packing sheds, and forests—specifically, traumatic injuries, musculoskeletal dis- orders, noise, and vibration exposure. Special populations at risk were hired farm workers, family workers, and family members; a goal was to prevent pesticides from being carried home in vehicles and on clothes. The center has also undertaken a capacity-building effort in the Hispanic communities, with agricultural employers,

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knowledge diffusion technology transfer and 33 and with health professionals. An important study of protective clothing and its performance resulted in changes in use patterns and reduced exposure of workers to pesticides and in the design of effective protective clothing. A demonstrated ef- fective training technique is the fluorescent-tracer technique to identify exposure. The center used diverse communication methods to reach specific audiences: His- panic children, parents, and farm workers (page 537 of Appendix 2-10 in NIOSH, 2006a). Southwest Center for Agricultural Health, Injury Prevention, and Education The Southwest Center for Agricultural Health, Injury Prevention and Educa- tion (SW Center, http://swcenter.uthct.edu) is at the University of Texas Health Center at Tyler, Texas (UTHCT), and funds projects in three core categories: research, intervention and prevention, and outreach and education. Project direc- tors are based in various institutions in the five states served by the SW Center: Arkansas, Louisiana, New Mexico, Oklahoma, and Texas. In partnership with clinics, the SW Center tried to build capacity and prevent animal-caused injuries. It focused on cattle handling among tribal members, as well as the general farm population. Special populations included farm women, children, and the Navajo. It also looked at injuries of Vietnamese shrimpers. The diffusion process focused on social marketing techniques. Midwest Center for Agricultural Disease and Injury Research, Education, and Prevention The Midwest Center for Agricultural Disease and Injury Research, Education, and Prevention (http://www.marshfieldclinic.org/nfmc/projects/) is housed in the National Farm Medicine Center at Marshfield Clinic, in Wisconsin. The center has conducted research on back pain, fatality risks from livestock manure storage facilities, safety guidelines for children’s agricultural tasks, women’s reproductive health, and agricultural zoonoses and various evaluation studies. It serves a region that includes Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin. NIOSH funding for the Midwest Center ended in 2002, and information about the center was not provided in the evidence package. Great Lakes Center for Agricultural Safety and Health The Great Lakes Center for Agricultural Safety and Health (http://www. ag.ohio-state.edu/~agsafety/) serves Illinois, Indiana, Kentucky, Michigan, Ohio, Pennsylvania, West Virginia, and Wisconsin. The center is based at Ohio State Uni-

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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 34 versity. It focuses on ergonomics, pesticide exposure and health effects assessment, acute unintentional injury, virtual-reality simulation of hazardous agricultural jobs, and agricultural safety and health education and outreach. Although it is only 5 years old, the center focused heavily on ROPS, protection from sun and heat, and grain engulfment. It has provided some training, a ROPS video, fact sheets, hazard alerts, and grain-bin safety standards but little r2p programming. An interesting research project, related to the New York Study described in the next section, is evaluating the use of hazard audits for insurance companies; there are no results yet. Northeast Center for Agricultural and Occupational Health The Northeast Center for Agricultural and Occupational Health (NEC, http:// www.nycamh.com) is at the New York Center for Agricultural Medicine and Health (NYCAMH) in Fly Creek, NY. NEC serves a 13-state region from Maine to Virginia. The center focused on tractor accidents and injuries to migrants and children, with Advisory Board input in selecting high-priority issues. The focus was primarily on musculoskeletal injuries, hearing loss, and other ergonomic injuries. The center provided considerable outreach and knowledge transfer, including the newly devel- oped ergonomic apple bag for migrant workers, the ROPS program, and extensive safety training and health screening. But about 52 percent of tractors on the farms that produce the top five New York commodities have no ROPS. The committee noted Goal 5 of NEC: “Carefully evaluate all education and prevention projects.” However, evaluation seems to focus on the use of materials rather than outcomes in reduction in injuries and mortality (page 391 of Appen- dix 2-10 in NIOSH, 2006a). Although most evaluation studies focus on use of materials rather than out- comes, one exception is the North American Guidelines for Children’s Agricultural Tasks (NAGCAT) interventions study. In this project, the valuation compared intervention versus control farms and demonstrated a significantly longer time to occurrence of injuries after the intervention was provided (pages 407-501 in NIOSH, 2006a). Another discovery is that only about half the recorded injuries were in NAGCAT-covered categories; this result was explained by the fact that about half the accidents involving children occurred on farms but not during work, and it has resulted in NAGCAT reports on safe play areas on farms. A second successful program is the Agricultural Hazard Assessment and Train- ing program, in which insurance claims declined from 90 to 50; losses in costs were also reduced over the 4 years of intervention on the 50 farms in the NY Study. The severity of injuries was also lower than on the control farms. The insurance com- pany now uses risk assessment instruments in three other states (pages 410-501 in NIOSH, 2006a).

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knowledge diffusion technology transfer and 35 Southern Coastal Agromedicine Center The Southern Coastal Agromedicine Center (http://www.ncagromedicine.org/ scac.htm) is at the North Carolina Agromedicine Institute and serves Alabama, Florida, Georgia, Mississippi, North Carolina, Puerto Rico, South Carolina, Vir- ginia, and the Virgin Islands. The institute, based at East Carolina University, is a collaborative institute of that university, North Carolina Agriculture and Technical State University, and North Carolina State University. The center’s high priorities are ergonomic research, vehicle safety, heat-related disorders and dehydration, and skin disorders of fishermen. The center looked at selected agricultural injury surveillance activities among African-American farmers and ranchers and among agricultural workers with work permits, arthropod allergens in large-scale swine production, and development of farm safety teams composed of high school stu- dents. It put in place a timber-medic training program to assist emergency medical technicians working with injuries in the forests and on Christmas-tree farms. It also established a network with healthcare providers to address issues associated with safety and the use of pesticides by migrant workers and greenhouse workers and with farm vehicle safety. Little evaluative research has been completed on the outcomes with respect to health and mortality. Southeast Center for Agricultural Health and Injury Prevention The Southeast Center for Agricultural Health and Injury Prevention (http:// www.mc.uky.edu/scahi/) serves Georgia, Kentucky, North Carolina, South Carolina, Tennessee, and Virginia. The center focused on ROPS, family and child health on beef-cattle farms, and youth education. It concentrates on underserved populations of women, children, migrants, and older farmers. Its projects for dissemination and diffusion include the Agricultural Disability Awareness and Risk Education (AgDARE), the Kentucky ROPS project, Farm Safety 4 Just Kids, and the Kentucky Women in Agriculture Conference. The ROPS project was the most comprehensive, with pre-intervention and post-intervention evaluation. No evaluation of health or injury outcomes was provided except for the ROPS project, which demon- strated both cost effectiveness of dissemination and intervention and the value of community-university partnerships in such efforts. Great Plains Center for Agricultural Health The Great Plains Center for Agricultural Health (http://www.public-health. uiowa.edu/GPCAH/) is at the University of Iowa’s Institute for Rural and Environ- mental Health in Iowa City, Iowa, and serves Iowa, Kansas, Missouri, and Nebraska.

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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 36 Focused on exposure to agricultural chemicals and health, it conducts basic re- search, houses major surveillance efforts, and collaborates with Farm Safety 4 Just Kids. Its studies were primarily on toxicant inhalants and respiratory problems associated with swine. Center staff conducted multiple interventions, including a 700-farm family and community partnership for a health training (Keokuk County) program that was a successful intensive educational training and support model. Evaluation has shown that agricultural health and safety training correlated with a reduction in fatalities. (The authors, however, are cautious about claiming credit.) The AgriSafe Network provided ongoing agricultural occupational safety and health education for health professionals. Great Plains Center reports are clearly presented using the logic model. High Plains Intermountain Center for Agricultural Health and Safety The High Plains Intermountain Center for Agricultural Health and Safety (HICAHS, http://www.hicahs.colostate.edu) serves the residents of Colorado, the High Plains, and the Rocky Mountain Region. It is on the Colorado State University campus in Fort Collins and is a multidisciplinary organization with input from such fields as engineering, industrial hygiene, education, toxicology, social work, epidemiology, environmental health, and agricultural sciences. HICAHS conducted outreach (training and education) primarily through Cooperative Extension and in partnership with public health professionals in the schools. It undertook hazard- evaluation site visits and surveys and extensive outreach to the migrant community. The model it used was a regional multistate effort in coordination with extension specialists at universities. It used a participatory learning model for technology transfer and knowledge diffusion. It seems to have neglected the American Indian population. Its focus is on exposure to pesticides, lung diseases, and engineering controls, education, and training in regional projects. Considerable evaluation of projects is an integral part of center work. Rather than relying only on cooperative extension for r2p, the program es- tablished new partnerships with agricultural associations, equipment and service companies, insurance carriers, dairy owners, community health clinics, and other organizations, such as Easter Seals. That broadened the range of distribution and contacts. As a result of the broad-based participatory approach, the center provided many “customized” training programs. This approach allows greater input on re- search needs from end users, provides more effective documentation, and affords greater attention to regional needs of agricultural partners that have direct access to end users (farmers, ranchers, farm facilities, and migrant and seasonal workers) (page 99 of Appendix 2-10 in NIOSH, 2006a).

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knowledge diffusion technology transfer and 3 Evaluation of the ROPS design for pre-ROPS tractors (page 109 of Appen- dix 2-10 in NIOSH, 2006a) indicated that all stages of activity—including design, testing, and selling commercially—were accomplished for Ford and selected other small tractors. Commercial tests before sales are still under way for John Deere and Allis Chalmers models. National Children’s Center for Rural and Agricultural Health and Safety The National Children’s Center for Rural and Agricultural Health and Safety (http://research.marshfieldclinic.org/children/)—located at the National Farm Medi- cine Center in Marshfield, Wisconsin—strives to enhance the health and safety of all children exposed to hazards associated with agricultural work and rural environ- ments. The center is a model for inputs and priority identification and funding. It developed a newsletter, the NAGCAT, networks of advocates, and workshops, and it incorporated a small grant model to move research results to educational programs and practices. An important element in the National Children’s Center program is evaluation of dissemination processes. Deep-South Center for Agricultural Disease and Injury Research, Education, and Prevention The Deep-South Center for Agricultural Disease and Injury Research, Educa- tion, and Prevention—located at the University of South Florida in Tampa—served the target populations of Alabama, Florida, and Mississippi. The Deep-South Cen- ter focused research on safety and health problems of special agricultural popula- tions in the region including minority, migrant, and low-income farmers and farm workers. Its activities included the design of educational and health promotion interventions for farmers and farm workers; archive of educational and disease prevention/health promotion materials designed for use by agricultural safety and health specialists, clinicians, and health educators; design of models for use of rural public health and clinical nurses when engaged in problem identification and de- livery of interventions; and design of aids to assist in hand-arm movement during planting, weeding, or harvesting. Funding for the center ended in 2001. Assessment of Comparative Strengths and Weaknesses of the NIOSH Ag Centers NEC provided a thoughtful assessment of the diverse approaches to knowl- edge diffusion and transfer (page 160 of Appendix 2-10 in NIOSH, 2006a). First, enforcement is difficult to accomplish. Second, engineering may be a preferred

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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 38 approach, and the best example is ROPS in which the universal application and use of the technology have not occurred, and tractor deaths occur at a greater rate than one might expect if the technology were fully adopted. With respect to education, one study reviewed 25 farm safety intervention education programs and found some changes in knowledge, attitudes, and behaviors, but “none showed sustained decrease in injuries or illnesses.” However, “multi-faceted programs appear most successful” (DeRoo and Rautiainen, 2000). Research on intervention over 20 years has found that no one theory or method is likely to create an effective, sustainable, and transferable program. Therefore, in the Great Plains Center, the Certified Safe Farm (CSF) model incorporated several theories and principles of intervention and health promotion from past research and experience (page 161 of Appendix 2-10 in NIOSH, 2006a). The CSF project included intervention and control farms and a triad of services: clinical services, education, and on-farm safety reviews. Demonstrable outcomes included increased use of personal protective equipment and reductions in respiratory problems, injury costs, and insurance claims. Another example of research with multiple interventions and evaluation of outcomes is the National Childhood Agricultural Injury Initiative. Although many alternative explanations may be offered for the results, there were clear declines in the number of injuries in children (from 32,800 to 22,600 from 1998 to 2001) and their rate from 1.7 to 1.4 per 100 farms in the same period. A similar drop in deaths and death rates occurred during the periods 1978-1983 and 1990-1993 (page 211 of Appendix 2-10 in NIOSH, 2006a). As part of r2p, many of the Ag Centers used social marketing, increased elec- tronic communication, and networking to provide education, train the trainers, and communicate with agricultural workers. They used diverse communication methods specific to audiences—Hispanic children, parents, farm workers. A ma- jor success story is the Keokuk County project, in which Center staff conducted multiple interventions including a 700-farm family and community partnership for a health training (Keokuk County) program. This was a successful intensive educational training and support model. Evaluation studies have shown that ag- ricultural health and safety training was correlated with a reduction in fatalities. (The authors, however, are cautious about claiming credit.) HICAHS conducted outreach (training and education) primarily through Cooperative Extension and in partnership with public health in K-12 schools. HICAHS researchers undertook hazard-evaluation site visits and surveys, and extensive outreach to the migrant community. The model it used was a regional multi-state effort in coordination with extension specialists at the universities. It used a participatory learning model for its technology transfer and knowledge diffusion efforts.

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knowledge diffusion technology transfer and 39 EVALUATION The AFF Program created a separate goal for its educational, knowledge diffu- sion, and technology transfer activities, which has created a separation of research from the dissemination functions. These dissemination activities would be inte- grated in all of the research priorities. In discussing the ideal AFF research program in Chapter 2, the committee recognized the needed role of research in knowledge diffusion and technology transfer to reach the at-risk populations. However, the separate goal continues to compartmentalize this outreach interaction as distinct from the processes used to inform the research questions, methods, and analyses. In part, this is a reflection of the logic model that guides the review. The concept of broader deliberation and decisionmaking among researchers and populations- at-risk from the inception of research ideas to their diffusion to the vulnerable populations is not explored in depth. Although there are substantial efforts to reach working populations, most NIOSH materials were provided through Web sites or written materials. This reflects a lack of understanding of the worker populations in agriculture. Some researchers have addressed the need to modify messages for farming populations (Grieshop et al., 1995; Cole, 2000, 2002; Morgan et al., 2002). The changing profile of the working populations involved in agriculture, forestry, and fishing needs to be taken into account in the development of programs designed to reach workers. Immigrant workers clearly have different cultural views of safety and disease that need to be assessed if culturally relevant information is to be provided. Farmers, ranchers, fishermen, and loggers similarly have specialized cultural contexts related to perceptions of risk and safety practices that influence adoption of new practices (Morgan et al., 2002; Freeman et al., 2003; Helmkamp et al., 2004; Effland, 2005). Incorporating representatives of target populations into the priority-setting pro- cess and actual dissemination processes would increase the likelihood of successful outreach and impacts. Much of the legislation that addresses worker health and safety is not applicable to farmers and ranchers, and many of the relevant regulations are not enforced (Murphy, 1992; Cole, 2002). Therefore, the effectiveness of legislation in reaching AFF working populations is questionable, yet legislation remains an important tool in the diffusion and implementation of new knowledge and technologies. Most education programs ignore the role of well-established habits in main- taining behavior and preventing the adoption of new behaviors (Murphy, 1992; Cole, 2002; Freeman et al., 2003). Failing to take habits and culture into account limits the ability of programs to modify behavior so as to increase safety and im- prove health. As noted above, multifaceted programs appear most successful and provide a rationale for using social marketing techniques. The recommendations in Chapter 12 will address these issues, especially the need for an integrated model of NIOSH research and diffusion programs.