1
Introduction

The National Institute for Occupational Safety and Health (NIOSH) was established by the Occupational Safety and Health Act of 1970 (U.S. Congress, 1970). Today, the agency is part of the Centers for Disease Control and Prevention (CDC) of the U.S. Department of Health and Human Services. NIOSH is charged with the responsibility to “conduct … research, experiments, and demonstrations relating to occupational safety and health” and to develop “innovative methods, techniques, and approaches for dealing with [those] problems” (U.S. Congress, 1970). Its research targets include identifying criteria for use in setting worker exposure standards and exploring new problems that may arise in the workplace. NIOSH does not have the authority to establish or enforce regulations for workplace safety and health. Regulatory and enforcement authority rests with such agencies as the Occupational Safety and Health Administration (OSHA) and the Mine Safety and Health Administration (MSHA).

STUDY CHARGE AND EVALUATION COMMITTEE

NIOSH asked the National Academies to conduct reviews of as many as 15 of its research programs with respect to their impact on and relevance to reducing workplace injury and illness and to identify directions for future research. The NIOSH Agriculture, Forestry, and Fishing Research Program (the AFF Program) is the third to undergo such evaluation: the Hearing Loss Research Program and the Mining Safety and Health Research Program were the first two programs evalu-



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1 Introduction The National Institute for Occupational Safety and Health (NIOSH) was es- tablished by the Occupational Safety and Health Act of 1970 (U.S. Congress, 1970). Today, the agency is part of the Centers for Disease Control and Prevention (CDC) of the U.S. Department of Health and Human Services. NIOSH is charged with the responsibility to “conduct . . . research, experiments, and demonstrations relat- ing to occupational safety and health” and to develop “innovative methods, tech- niques, and approaches for dealing with [those] problems” (U.S. Congress, 1970). Its research targets include identifying criteria for use in setting worker exposure standards and exploring new problems that may arise in the workplace. NIOSH does not have the authority to establish or enforce regulations for workplace safety and health. Regulatory and enforcement authority rests with such agencies as the Occupational Safety and Health Administration (OSHA) and the Mine Safety and Health Administration (MSHA). STUDY CHARGE AND EVALUATION COMMITTEE NIOSH asked the National Academies to conduct reviews of as many as 15 of its research programs with respect to their impact on and relevance to reducing workplace injury and illness and to identify directions for future research. The NIOSH Agriculture, Forestry, and Fishing Research Program (the AFF Program) is the third to undergo such evaluation: the Hearing Loss Research Program and the Mining Safety and Health Research Program were the first two programs evalu- 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 ated, respectively, and used evaluation criteria and scoring mechanisms provided by the Committee for the Review of NIOSH Research Programs (IOM and NRC, 2006; NRC and IOM, 2007). The Committee to Review the NIOSH Agriculture, Forestry, and Fishing Re- search Program was convened by the National Research Council in late 2006 under the auspices of the Board on Agriculture and Natural Resources (see Appendix G). Committee members were chosen because of their expertise in epidemiology, agricultural engineering, industrial hygiene, respiratory diseases, zoonotic diseases, mental health, rural health, exposure assessment, child and adolescent safety, ergo- nomics, farmworker safety and health, and fishing safety and health. Committee members have varied experience in such settings as academe, industry, and labor organizations. The statement of task for the committee is in Box 1-1. EVALUATION APPROACH The committee was charged with reviewing the AFF Program, evaluating the relevance of its work to improvements in occupational safety and health, and evalu- ating its impact on reducing workplace illnesses and injuries. As suggested in the statement of task, the committee’s review was guided by the Framework Document (Appendix A) that was developed by the National Academies’ Committee for the Review of NIOSH Research Programs. The Framework Document The Framework Document directs that relevance be evaluated in terms of the significance of research and connection to improvements in workplace protection. It identifies factors to take into account, including the frequency and severity of health outcomes and the number of people at risk, the structure of the program, and the degree of consideration of stakeholder input. The impact of the program’s research is to be evaluated in terms of its contributions to worker safety and health. The evaluation is to take the form of qualitative assessments and the assignment of integer scores of 1-5 for the relevance and impact of the AFF Program’s research and other activities. The guidance in the Framework Document reflects the terminology and orga- nization of a logic model adopted by NIOSH to characterize the steps in its work. The logic model used by the AFF Program appears as Figure 1-1. To assess the rel- evance of the program’s research, the committee examined goals, inputs, activities, and outputs; to evaluate the impact of the program’s research, it focused principally on intermediate and end outcomes. External factors were taken into consideration in the evaluation. The committee separately envisioned what an ideal AFF research

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introduction  BOX 1-1 Statement of Task In response to a request from the National Institute for Occupational Safety and Health (NIOSH), the Institute of Medicine and the Division of Earth and Life Studies of the National Academies are conducting a series of evaluations of NIOSH research programs. Each evaluation will be conducted by an ad hoc committee, using a methodology and framework developed by the Committee for the Review of NIOSH Research Programs (framework committee). Each evaluation committee will review the program’s impact, relevance, and future di- rections. The evaluation committee will evaluate not only what the NIOSH research program is producing, but will also determine whether it is appropriate to credit NIOSH research with changes in workplace practices, hazardous exposures, and/or occupational illnesses and injuries, or whether the changes are the result of other factors unrelated to NIOSH. The program reviews should focus on evaluating the program’s impact and relevance to health and safety issues in the workplace and make recommendations for improvement. In conducting the review, the evaluation committee will address the following elements: 1. Assessment of the program’s contribution through occupational safety and health research to reductions in workplace hazardous exposures, illnesses, or injuries through a. an assessment of the relevance of the program’s activities to the improvement of occupational safety and health, and b. an evaluation of the impact that the program’s research has had in reducing work- related hazardous exposures, illnesses, and injuries. The evaluation committee will rate the performance of the program for its relevance and impact using an integer score of 1 to 5. Impact may be assessed directly (e.g., reductions in illnesses or injuries) or, as necessary, using intermediate outcomes to estimate impact. Qualitative narrative evaluations should be included to explain the numerical ratings. 2. Assessment of the program’s effectiveness in targeting new research areas and identifying emerging issues in occupational safety and health most relevant to future im- provements in workplace protection. The committee will provide a qualitative narrative as- sessment of the program’s efforts and suggestions about emerging issues that the program should be prepared to address. program would entail (Chapter 2) and used the components of an ideal program as a benchmark with which to compare the existing program. The terms used and the details of the committee’s evaluation are presented in Chapters 3 and 4. The study charge also directed the committee to review the progress that the AFF Program has made in identifying new research and provided the committee with the opportunity to identify emerging research relevant to the program’s mis-

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8 Intermediate End Inputs Activities Outputs Outcomes Outcomes Surveillance Recommendations Production Technologies Inputs Research Publications Budget, Staff, Facilities, Trained and Improvements Intervention Investigation Educated Managerial in Occupational Professionals Studies Reports Infrastructure, Safety and Extramural Health in Response to Training Materials Demonstrated Systems Requests for Results Agriculture, Assistance Scientific Forestry, and Manuscripts Standards and Fishing Planning Regulations Dissemination of Inputs Information Engineering Surveillance Designs Research to Data, Practice Training and 1-1.eps Stakeholder Education Alternative Needs, Methods Informed Citizens Collaborator Centers of Aims, Excellence Conference Change in Social Goals and Proceedings Norms Subgoals External Factors Economic and Social Conditions and Regulatory Environment FIGURE 1-1 The AFF Program logic model. SOURCE: NIOSH, 2006a.

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introduction 9 sion. According to the Framework Document, the committee’s identification of emerging research areas is to be based on members’ expert judgment rather than a formal research-needs identification effort. Program Period Evaluated The committee was given the discretion to determine the period to be covered by its review. To evaluate the research program’s work in its entirety, the commit- tee chose to evaluate it from its inception in 1990 to the most current timeframe in 2006. In 1990, Congress directed NIOSH to develop an extensive agricultural safety and health program in surveillance, research, and intervention to address the high risks of injuries and illnesses in agricultural workers and their families (U.S. Congress, 1990b). The Congressional Agricultural Occupational Safety and Health Initiative applies directly to activities in agriculture, but timber harvesting and commercial fishing-related activities are implicitly included. Information Gathering The review of the AFF Program was based in large part on written materials provided by NIOSH (see Appendix C). The AFF Program gave the committee a 350-page evidence package and a CD containing more than 3000 pages of appen- dixes (NIOSH, 2006a). The committee also submitted written requests to NIOSH for additional information on the AFF Program. The committee met three times from January 2007 through May 2007 and conducted additional deliberations through conference calls and e-mail. Information gathering included presentations by NIOSH staff and other invited guests in open sessions of committee meetings in January and March (see Appendix B). The committee also invited comments from stakeholders, that is, organiza- tions and individuals with a potential interest in the AFF Program. Given that the research program is related to an enormous and disparate portfolio of sec- tors—agriculture, forestry, and fishing—the population of potential stakeholders is diverse and not easily defined. As a result, the committee made an effort to reach a varied national and international audience in federal and state agencies, industry, labor, and academe but did not attempt to make its information-gathering effort a comprehensive or systematic survey of the program’s stakeholders, because of the short timeframe for its work. (Additional details on committee methods and a list of stakeholders who provided information to the committee are available in Appendix B.) The committee chose not to visit facilities used by the AFF Program staff, inas- much as most members had a working knowledge of the facilities based on visits in

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a g r i c u lt u r e , f o r e s t r y , fishing research niosh and at 0 their professional activities. Furthermore, relative to the AFF Program’s extramural portfolio, the committee was confident that they had received sufficient input from a few directors of the extramurally funded NIOSH Agricultural Centers (Ag Centers): The director of the National Children’s Center for Rural and Agricultural Health and Safety presented information at the first committee meeting in Janu- ary 2007, four Ag Center directors were invited to speak at the second committee meeting in March 2007, the other five directors were queried by the committee for additional information. Evaluation Data Limitations In the 9 months given to conduct the program evaluation, the committee based its assessment of the AFF Program on the “evidence package” (NIOSH, 2006a) and supplemental information (Appendix C) provided by NIOSH, and also consulted with experts and conducted information searches. The committee found that the materials provided by NIOSH were neither a comprehensive nor an accurate reflection of work that has been done by the AFF Program; rather it was a mere snapshot of the program that poorly cataloged basic information about the pro- gram’s work. The committee knows of seminal publications and substantial data that were not included in the evidence package or in the supplemental materials. In addition, several committee members who had worked with the AFF Program in the past noted that there were several insightful internal publications (such as NIOSH, 1992b) that should have been publicly released years ago, which would have been helpful for the evaluation. The committee is concerned that the AFF Program is unaware of its own work. THE U.S. AGRICULTURE, FORESTRY, AND FISHING INDUSTRIES The agriculture, forestry, and fishing sectors are the cornerstone of industries that produce and market food, fiber, and fuel. Collectively, the three sectors make up a huge component of the U.S. economy and are a major employer in the United States (GAO, 2007). Annually, these industries generate more than $1 trillion and create exports exceeding $68 billion. NIOSH estimates that more than 5.5 million workers are employed in agriculture, forestry, and fishing (2007). These sectors also consistently rank in the top six most hazardous occupations; fishermen and loggers have the highest fatality rates (BLS, 2007a). Collectively, the three sectors consistently have the highest injury and fatality rates of any U.S. industries, so the overall effect on the safety and health of exposed populations in agricultural, forestry, and fishing worksites is enormous (Hard et al., 2002; Frank et al., 2004; BLS, 2007a).

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introduction  Agriculture Sector The agriculture sector, which the 1990 enabling legislation targeted, is com- posed of about 2.1 million farms (Hoppe and Banker, 2006). Its structure is bifur- cated: large capital-intensive operations rely on scale to survive economically, and smaller operations rely on niche production of high-value commodities (Midwest Center for Agricultural Research, Education, and Disease & Injury Prevention, 2002). The former constitute about 7 percent of all farms in the United States; these farms typically each have agricultural product sales of $1 million or more per year and generate 75 percent of farm cash receipts from the sale of agricultural com- modities (USDA, 2004; Hoppe and Banker, 2006). They operate enterprises on 44 percent of all U.S. harvested cropland and account for a large majority of farm cash receipts in every category of agricultural commodity except tobacco and specialty livestock, such as sheep, goats, and horses (USDA, 2004). In 1987, a ranking of farms by value of commodities marketed demonstrated that the largest 13 percent accounted for 75 percent of total sales (USDA, 1987). Thus, from 1987 to 2002, the size concentration in the U.S. agricultural sector doubled (USDA, 1987, 2004). At the other extreme are agricultural enterprises that operate on 56 percent of U.S. cropland and generate 25 percent of total farm cash receipts (USDA, 2004; Hoppe and Banker, 2006). Some are limited-resource farms, which report gross product sales of less than $100,000 in 2003 dollar equivalents and low (below the poverty level) operator household income; others are retirement farms (run by retirees who are also farm operators), residential or lifestyle farms (smaller enterprises whose operators report a major occupation other than farming), or conventional farming-occupation farms (such as family farms whose operators report farming as their major occupation) (Hoppe and Banker, 2006). The com- mittee recognizes that congressional testimony surrounding NIOSH’s 1990 agricul- tural health and safety mandate used findings from midwestern and northeastern (largely New York) family operations, and public and congressional debate relative to the role of family farm operations in the agriculture sector has been spirited. However, the committee believes that in the context of NIOSH’s agricultural health and safety initiatives the most useful definition of a “family farm” is the one used by Congress in the 1985 Food Security Act: any farm that is organized as a sole pro- prietorship, partnership, or family corporation and uses less than 1.5 person-years of hired labor per year (U.S. Congress, 1985). This definition has the advantage of including the notion that family owners are responsible for providing the major share of labor required to operate the farm—an important dimension in allocat- ing federal resources to surveillance and intervention among different agricultural settings in the sector.

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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  Of all farms in the United States, 61 percent do not participate in any federal farm program (Hoppe and Banker, 2006) and so have no incentive to respond to agricultural subsidies, federally subsidized conservation programs, or acreage set- asides. That occurs because of absentee ownership (for example, over 50 percent of the land in Iowa); targeting of national agricultural policy, which excludes many agricultural commodities; and individual owner, operator, or corporate decisions to remain out of program spheres (Duffy, 2004; Hoppe and Banker, 2006). Since Congress passed NIOSH’s enabling legislation in 1990, the role of farm management companies, agricultural labor contractors, and other types of non- owner operation has substantially increased in importance. In part, that has oc- curred because of shifts in the demographic profile of those who own land and facilities, technological changes in production practices, capitalization require- ments, and incentives embedded in federal agricultural policy (Stofferhan, 2006). The result has been a large change in who is exposed to worksite risk: custom farmers and other employees who are under contract to agricultural management companies are typically as important as farm owner-operators in large sections of the Midwest and Southwest where row crops (corn, potatoes, sorghum, soybeans, and sugar beets) predominate and the West Coast where vineyards are present and other specialty crops are grown (CIRS, 2006). The trend could intensify as a “bioeconomy” based on agricultural biomass emerges in portions of the nation’s cropland, spurring both monocultures of annual and perennial crops and semi- natural plant communities and the intensive industrialization of cropping activity (Hunt, 2006; Jordan et al., 2007). Other exposed populations have also increased in importance, including hired workers, many of whom are immigrants—probably the majority of employees in the agriculture workforce. The agriculture workforce is estimated to number about 5,296,000 people, in- cluding self-employed workers and working youth (see Table 1-1). U.S. agriculture TABLE 1-1 Size of Agriculture, Forestry, and Fishing Workforce Populations Workforce Sector Number of Persons at Risk 3,167,000a-5,296,000b Agriculture 88,000c-202,000d Logging and forestry 55,000d-160,000e Fishing and hunting TOTAL 3,314,000-5,658,000 aSource: Farm Labor, NASS, USDA, November 2001, p. 13. bSource: Occupational Injury Survey of Production, Response to Committee Question #4, NIOSH, February 16, 2007. cSource: Occupational Outlook Handbook, Bureau of Labor Statistics, 2008. dSource: Current Population Survey, Bureau of Labor Statistics, 2007c. eSource: U.S. Fishing Industry, NIOSH, 2007b.

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introduction 3 has typically employed proportionally more people 16-19 years old and 55 years old and above than have other economic sectors (BLS, 2001a). Of the total workforce in 2001, about 993,000 were 15 years old and younger and reported to be working on U.S. farms and ranches (NIOSH, 2006b). The injury and occupational disease experience of the agriculture workforce has varied with age, gender, cohort, and calendar interval. Fatal injury rates are proportionately lower than in the other two AFF sectors (see below), but nonfatal injuries occur in as many as 10 percent of exposed workers (NIOSH, 2006a). Other nonfatal occupational hazards result in eye injury, cumulative hearing loss, low-back and other musculoskeletal injury, cumulative trauma disorders, some cancers, and respiratory disease. Most of those conditions, excluding cancer, were known to occur among working agricultural populations when Congress established the AFF Program in NIOSH. Forestry Sector The forestry sector has played a pivotal role in the economic, social, and cul- tural development of the United States. It comprises an array of lands managed for an evolving constellation of objectives: timber and other commodity production, recreation, maintenance of wildlife habitat, water-quality protection, wilderness and open-space preservation, and more recently as a buffer against climate change and an effective carbon sink (Holmgren and Thuresson, 1998; Peterson et al., 1999). The total U.S. forest land area has remained relatively unchanged since the 1920s (Peterson et al., 1999). Currently, about one-third of the nation’s overall land base, 737 million acres, is forested (Peterson et al., 1999). The federal government controls about 35 percent (249 million acres) of all forest land, and about 10 mil- lion private owners control over 60 percent of it (Rand, 1990; Garland, 2007). In the East, most forested land is under state and private control; however the federal government is the principal owner of forestland in the West (Powell et al., 1993). The forestry workforce is composed of all who harvest forest and forest-related products and those who provide other support services for the maintenance and sustaining of the nation’s forests. It includes owners and managers of forested acreage, timber harvesters (loggers and fellers), caretakers (involved in silvicultural activities and fire control), harvesters of non-wood forest products (such as nuts, cones, other greenery, and mushrooms), transport drivers and road-building and -maintenance crews, and others in support functions, such as machinery manu- facturers, logging-rigging outlets, recreation managers and guides, and state and federal natural resources employees. The size of the workforce has been estimated to range from 88,000 to 202,000 workers (BLS, 2007b, 2008). This workforce has been described as relatively isolated geographically and possessing a unique sub- culture (Myers and Fosbroke, 1994; Garland, 2007). Historically, the workforce has

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a g r i c u lt u r e , f o r e s t r y , fishing research niosh and at 4 had little labor organization; however, with the advent of offsite management firms that specialize in providing workers during times of high need, such as for fire sup- pression or mandated vegetative removal, the population exposed to forestry risk has changed to include numerous newly immigrant workers of Hispanic, Asian, and eastern European origin. The workforce, particularly that involved in felling and logging, has experi- enced some of the highest injury rates in the AFF sector. In 1955, the fatality rate was 214 per 100,000 workers, and the nonfatal injury rate was 16 events per 100 full-time workers (NIOSH, 2006a). By the late 1980s, deaths attributed to injury had dropped to 161 per 100,000 workers (NIOSH, 2006a); but nonfatal injuries had increased to almost 20 events per 100 full-time workers (BLS, 1990). By 1996, the fatality rates had dropped even further, to 128 per 100,000 workers (NIOSH, 2006a). More recent reliable injury-related data are unavailable, and numerous types of worker categories have not been included in published analyses because of reliance on “official” numerator (event) and denominator (population-at-risk) data. The prevalence of occupational diseases is unknown. Fishing Sector The fishing portion of AFF comprise several fisheries, which are identified by region: the Northeast, the mid-Atlantic, the Southeast, the Gulf Coast, the West, and the Alaskan shelf. Fishing is conducted in both the open ocean and adjoining states’ internal waters by vessels that vary in size and fitting, totaling approximately 82,000 operating units in 2006 (U.S. Coast Guard, 2007). Operations can range from technologically sophisticated with expensive gear and advanced electronics to those with simple gear and modest electronics. Most fishing vessels along the Northeast, mid-Atlantic, and Gulf Coast are small owner-operated, whereas many vessels in the West and Alaska are in larger multi-vessel enterprises. At-risk workers can range from one, two, or three per boat to upwards of 150 (U.S. Coast Guard, 2007). The U.S. Coast Guard regulates most aspects of the industry; its Commer- cial Fishing Industry Vessel Safety Advisory Committee is charged with developing workable recommendations for the health and safety of vessel employees. The workforce is composed of both native-born and immigrant populations, including workers from several African nations. Of the estimated 55,000-160,000 workers exposed to occupational risk while engaged in maritime fishing activity (BLS, 2007b; NIOSH, 2007b), more than half are self-employed. The workforce experienced the nation’s highest occupational fatality rate due to occupational exposures in 2006: 141.7 per 100,000, nearly 30 times higher than the rate in the overall workforce (BLS, 2007a). Its overall nonfatal injury rate is unknown, but the Alaska fishery had 410 injury hospitalizations per 100,000 full-time fishermen

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introduction 5 (NIOSH, 2007b). Fishermen go out to sea in poor weather, especially in heavy New England seas and Aleutian Island storms, and a fall overboard often results in drowning. Fishermen also work with dangerous power tools, such as huge winches and hoists, and heavy nets and cages, all of which can turn into lethal missiles on slippery wet or icy decks in heavy seas. The prevalence of occupational diseases is unknown. LEGISLATIVE HISTORY AND HISTORICAL PERSPECTIVE The U.S. Census Bureau’s North American Industry Classification System (NAICS) classifies economic units that have similar production processes in the same industry (BLS, 2001b), and categorizes agriculture, forestry, and fishing in the same industry classification because the three sectors are involved in the harvesting of food, fiber, and fuel. NIOSH is obligated to address all three sectors under the NAICS while the original congressional mandate only specifies funds for agricul- ture (U.S. Congress, 1990a; BLS, 2001b). However, as early as March 1992, NIOSH included loggers, fishermen, children, unpaid workers, and racial minorities when developing goals to carry out the new NIOSH research program in agricultural safety and health (NIOSH, 1992b). In 1991, 1992, and 1996, congressional ap- propriations language continued to specify funds for agriculture, and NIOSH has continued to carry out plans according to the original mandate. Perhaps future appropriations language may specify funding allocation among the three sectors, but as it stands agriculture will continue to dominate the program’s portfolio unless AFF Program leadership directs otherwise. Because the AFF Program only addresses occupational issues related to harvesting of food, fiber, and fuel, it does not address processing concerns related to food processing, lumber mills, or fish processing. Agriculture Attention to injury and disease prevalence among farmers and ranchers took a long time to take root in the last century. Though the farm injury toll was recognized from the introduction of the steam traction engine in 1908 (Avery Machine Corporation, 1912), it was not until 1938 that the farm injury problem attracted national attention at the annual National Safety Congress sponsored by the National Safety Council (Rasmussen, 1989). The mentality emerged that “The careless farmer who gets injured in an accident this year not only hurts himself and his family, but he curtails the nation’s ‘Food for Freedom program’” (Wickard, 1943). A few years later, the wartime labor shortage allowed the safety community to create a national consensus focusing efforts on improving worker safety (Hall,

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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 1943; Anon, 1944; Oden, 2005), and resulted in President Franklin D. Roosevelt instituting policy (USDA, 1942), which would be used decades later as the basis of the 1990 congressional appropriations language to establish the NIOSH AFF Program. In 1944, the first farm safety week was jointly sponsored by Cooperative Ex- tension across the nation, the U.S. Department of Agriculture (USDA), and the National Safety Council (NSC, 1954), and was a sentinel development because it paved the way for key players to closely cooperate over the next 3 decades. The NSC, an organization dedicated to protecting life and promoting health, con- vened annual conferences from the late 1940s onward to highlight intentional and unintentional injuries at agricultural worksites and provided a training and networking venue for state-level agricultural safety specialists and others engaged in agricultural safety. In the 1950s, the National Institute for Farm Safety (NIFS) was formed by agricultural safety and health leaders. NIFS formed single-purpose committees—such as those on tractor and safety, fire and electricity, emergency preparedness, home and farmstead, rural traffic, and farm chemicals—to identify unique agricultural worksite and home-site risks and dangers, and explore ways of reducing injuries for farmers and ranchers. The NSC provided needed national leadership until 1972 and aided in the continual development of engineering safety standards by the American Society of Agricultural Engineers. By the mid-1970s, however, controversy emerged that was fueled by the passage of the Occupational Health and Safety Act and alarmed many in agricultural production, as profes- sionals involved in agricultural safety and health desired greater autonomy for its educational and other professional venues (Oden, 2005). Numerous technological and other workforce developments in production agriculture galvanized professionals and others around the injury experience of the nation’s farmers and ranchers. As early as 1915, California enacted provisions regulating agricultural labor camps (Parker, 1915; California Department of Hous- ing and Community Development, 2007). The adoption of corn picker technology on American farms quickened by 1950 because it yielded enormous labor savings, but the injury toll mounted: in Iowa alone in 1951, 299 fingers, 32 thumbs, and 32 hands were severed by the corn picker technology (Wallaces’ Farmer, 1952; Scranton, 1952). California was an early leader with its enactment of legislation in the 1970s limiting the use of short-handled hoes to reduce cumulative trauma (Jourdane, 2004). As the overall agricultural health and safety movement came of age, professional perspectives diverged from time to time, including controversy about which federal entity should be charged with overall programmatic respon- sibility (Burke, 1968). In 1972, the Congress appropriated $1 million to fund state-level safety efforts in the 50 agricultural extension services (Murphy, 2003) that functioned at the state level. The resources could be used to fund extension safety positions or to fund

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introduction  safety programs with a blend of state and federal funding. The effort continued until Congress eliminated the funding from its agricultural appropriations activity in 2002 (Farm Security and Rural Investment Act of 2002), thus spelling a near total collapse of extension activity in agricultural safety and health. While nearly all agricultural safety professionals were united behind the ban- ner of more safety education for all exposed to agricultural and forestry risks (fishing was not mentioned at this early stage), lone voices were calling for public policy intervention (Plambeck, 1983). OSHA’s regulatory activities were not only controversial in agriculture and forestry but attracted an unusual array of critics in a variety of other American worksite sectors (Stang, 1952; OSHA, 1974). As enthusiasm for policy advocacy waned, educational approaches gained popularity; however, the efficacy of such approaches was continually questioned, and targeting the appropriate population proved to be elusive as unintentional injuries continued to mount. Independently of those activities, clinical interest in and response to the mounting disease and injury toll were being documented. The Institute of Agri- cultural Medicine and Occupational Health was established at the University of Iowa in the 1950s, the National Farm Medicine Center of Wisconsin in the 1970s, and the Farm Safety and Health Center at the Mary Imogene Bassett Hospital in Cooperstown, New York, in the 1980s. Clinical acumen was gathered to target disease syndromes and acute and chronic injuries related to agricultural work. Clinicians in Canada were hosting international symposia to highlight exposures and results of selected interventions across the whole of North America and in se- lected European and Asian countries, and Scandinavians in agricultural safety and occupational health developed specific clinical “tracks” at European occupational symposia (see, for example, Dosman and Cockcroft, 1989; Svanström et al., 1989). By the mid-1980s, the CDC had awarded the first substantial resources for unin- tentional injury surveillance in rural areas of the United States (Gerberich et al., 1990). All those efforts added weight to the proposition that a national effort was needed, at the very least, as a response to moral imperatives surrounding a decent society and national security interests—security interests that suggested that a safe and affordable food supply for the nation’s growing population was essential (Eken, 1991). Several federal agencies other than NIOSH have contributed to AFF work- related research, including the CDC’s Injury Prevention Branch, USDA, the National Institutes of Health’s National Cancer Institute (NCI), the National Institute of Envi- ronmental Health Services (NIEHS), and the National Center for Health Statistics (NCHS). Fatal occupational injury surveillance efforts were provided by NIOSH, the NCHS, and several state-level agricultural safety specialists funded by USDA and state-level funding; occupational disease surveillance was conducted by NIOSH and NCI; rural injury surveillance was done through the CDC; intentional death

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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 surveillance was conducted by the NCHS and select state health departments (Burkart et al., 1978; Marx et al., 1985; Zey et al., 1985; Gunderson et al., 1987, 1993; Blair, 1988; Meyers, 1988; National Mental Health Association, 1988; Pearce and Reif, 1988; Rodricks and Rachman, 1988; Stallones, 1988; Cohen et al., 1989; Wiener et al., 1989; Bresnitz et al., 1990), and a large body of educational initiatives was supplemented by those in academe involved in intervention research (Roman, 1987; NCASH, 1988; Gunderson, 1989, 1990; Schwartz and Cohen, 1990; Lexau et al., 1993; Ambruster, 1991; McGinnis, 1991; Von Essen, 1996). This has resulted in a body of research literature, clinical findings, and injury control education. By 1988, state agricultural safety specialists, epidemiologists, policy analysts, and public health professionals were routinely meeting at professional conferences to explore the potential for national congressional action. Working from a template constructed by the Association of Schools of Public Health, they consulted with U.S. House and Senate staff as ideas entered formal stages (ASPH, 1988). Meet- ings, such as one sponsored by the National Coalition for Agricultural Safety and Health (NCASH) in 1988, provided an opportunity to explore recent surveillance findings and potential interventions (Donham and Storm, 1988; NCASH, 1988). Those efforts culminated in the passage by Congress of Public Law 101-517 in 1990 (U.S. Congress, 1990a), which directed NIOSH to establish a program for improv- ing the health and safety of agricultural workers and their families. P.L. 101-517 specifically called for • A Farm Family Health and Hazard Survey in order to develop more com- plete information on the circumstances of agricultural injury and other disease problems. • Research exploring the etiology of agricultural injuries and disease. • Establishment of extramural Centers for Agricultural Disease and Injury Research, Education, and Prevention at selected universities. • Establishment of a national Agricultural Health Promotion System in col- laboration with the nation’s county extension agents. • An Agricultural Health Nurse Surveillance Program in which rural hospitals would provide ongoing responsive (focused at intervention) surveillance to identify agriculture-related disease and injury problems. Congress recognized that agricultural workers were suffering higher rates of unintentional injury and illness than other U.S. workers, even those in other extrac- tive industries. Congress was led to believe, by the sheer weight of expert testimony delivered in support of P.L. 101-517, that NIOSH was capable of leading a compre- hensive national effort devoted to preventing injury and disease in the nation’s 3.4 million workers in agricultural settings (NIOSH, 1992a). The testimony pertained to production agriculture alone; forestry and fishing were not conceptually ad-

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introduction 9 dressed in expert testimony during the formative stages of the AFF initiative. And intentional injuries, largely suicides, were not addressed by the legislation. An innovative feature of P.L. 101-517 was the call to establish extramural cen- ters. The legislation specifically charged NIOSH with responsibility to select and fund agricultural occupational safety and health centers at select universities. Spe- cific language stated: “these centers would: (1) develop model programs for the pre- vention of illness among agricultural workers and their families; (2) develop model educational programs on agricultural safety and health for workers in agriculture; (3) evaluate agricultural injury and disease prevention programs implemented by agricultural extension programs, state health departments, federal agencies, and others; (4) conduct applied research and evaluations of engineering and ergonomic control technology and procedures developed by Federal and private agents; and (5) provide consultation to researchers, safety and health professionals, agriculture extension programs, and others” (NIOSH, 2000c). As surveillance results became available, the burden of injury borne by children and adolescents on farms and ranches was recognized (Gerberich et al., 1991). However, sentinel calls for attention to these vulnerable workers had been issued for decades, even when surveillance data were lacking. For at least 3 decades, chil- dren and youth had been the target of educational interventions (see, for example, National Safety Council, 1953; Farm Safety Review, 1954; or National 4-H Club News, 1958), even though the efficacy of such approaches was open to question. By 1958, the NSC had created the Youth Safety Activities Committee, whose role was to provide educational programming guidance and information exchange to individuals and agencies that wished to embark on youth safety programming. Those educational interventions for children in agriculture had high priority be- cause people under 16 years old were excluded from OSHA regulations, given the exemption of labor for family farms. The first national consensus conference relative to the unintentional injury burden in youth occurred in 1992 (Lee and Gunderson, 1992); other formative activities, including development of a National Action Plan for Childhood Agri- cultural Injury Prevention, followed and resulted in the design of a second national initiative that targeted vulnerable child and adolescent populations (NCCAIP, 1996). Congress adopted the plan in 1996 and passed legislation in the same year (P.L. 104-208), with the conference report (H. Rept. 104-863) specifically appro- priating for • Establishment of a national Children’s Center for Rural and Agricultural Health and Safety to plan and coordinate a national response to the epidemic of injury among children and adolescents exposed to agricultural worksite risk. • Surveillance exploring the etiology of child and adolescent agricultural injury.

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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 • Development of work guidelines and other aids for use by parents and supervisors in agricultural worksites. • Design of communication strategies capable of reaching agricultural populations. Fishing U.S. fishing industry policies predate the Fair Labor Standards Amendment of 1989 (P.L. 101-157). The hazards of commercial fishing did not fully capture con- gressional attention until the death of Peter Barry when the fishing vessel Western Sea sank in August 1985. Peter Barry was the son of Robert and Peggy Barry. He was chief U.S. delegate in North Atlantic Treaty Organization talks with the Soviet Union. With a variety of factors at play and the right timing, Peggy Barry made it her mission to bring the lack of safety regulations of commercial fishing to the attention of Congress and gave a voice to the efforts of many in the U.S. Coast Guard and other groups. Through their combined efforts, Congress enacted the Commercial Fishing Industry Vessel Safety Act (CFIVSA) of 1988 (P.L. 100-424). Among other items, the CFIVSA required each vessel to carry various survival equipment and charged the U.S. Coast Guard with regulation enforcement. It led to Regulation 26 CFR Part 28, released in 1991. The CFIVSA also directed the Secretary of Transportation to conduct an assessment of safety problems in the industry. The National Research Council completed the safety assessment in the 1991 report Fishing Vessel Safety—Guide to a National Program. The report’s recommendations included proposals for safety administration and for alternatives related to vessels, personnel, survival, and fish- ery management. The recommendations resulted in several programs: the Coast Guard Fishing Vessel Safety Decal Program (1992), the Fishing Vessel Safety Decal (1998), and the Dockside Enforcement Program for Crab Fisheries (1999) (DHS, 2005). More recently, rules pertaining to additional safety procedures and vessel seaworthiness assessment have been developed, but they have not been formally released. The National Transportation Safety Board also proposed several safety recommendations for the commercial fishing industry. NIOSH itself has com- mented on selected aspects of congressional interest in fishery management that affect worker safety and health (U.S. House of Representatives, 2007). Testimony on the affect of the Halibut and Sablefish Individual Fishing Quota policy on search and rescue efforts and fatalities was also used to develop recent crab rationaliza- tion efforts and other similar efforts in other fisheries, which allow fisheries to be managed by vessel-allocation quotas. The quota system enables fishermen to wait an additional day or so rather than rushing out to sea in tumultuous weather or using a vessel or equipment that needs repair.

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introduction 3 ORGANIZATION OF THE REPORT The remainder of the report presents the findings from the committee’s evalu- ation. Chapter 2 provides the committee’s assessment of the “ideal” research pro- gram in AFF, which is intended to provide a benchmark with which to compare the existing program. Chapter 3 evaluates the overall AFF Program according to its strategic goals and other elements. Chapters 4-8 review the subjects of the major research goals of the AFF Program: hazard surveillance, priority populations at risk, health effects of agricultural agent exposures, hazard control systems, and outreach. Chapter 9 evaluates other AFF Program elements that the committee identified as compared to its ideal program. Chapter 10 rates the research program’s relevance to and impact on reducing workplace injury and illness, and provides rationale for the AFF Program’s scores. Chapter 11 reviews the program’s mechanisms for identifying emerging issues in the AFF work sectors, and identifies issues that merit future attention. Chapter 12 provides recommendations to strengthen the NIOSH AFF Program and increase its relevance and impact.