Agricultural injuries among operation household members: RRIS-II 1999.

The purpose of this study was to determine the magnitude and consequences of agricultural injuries, and to reveal potential risk factors among agricultural household members. The Regional Rural Injury Study (RRIS-II) collected injury and exposure data on agricultural households of 16,538 people in Minnesota, Wisconsin, North Dakota, South Dakota, and Nebraska for each six-month period of 1999. Adjusted injury rates, consequences, and potential risk factors were identified through analyses. Selection of variables for multivariate analyses was based on a causal model. Injuries reported here occurred while the individuals were involved in activities associated with their own farm or ranch, unless otherwise stated. Estimates of injury rates and the effects of various exposures were derived by Poisson and logistic regression. These models accounted for correlation within both subject and household, and were adjusted for non-response. The rate of agricultural injury to household members on their own operation was 74.5 injuries per 1,000 persons per year. Differences in rates due to age and gender diminished when rates were calculated according to hours worked. Although only 5% of injured persons required in-patient hospitalization, 28% required emergency department treatment, and 84% required some type of professional health care. Moreover, 47% of all injuries required time off from agricultural work, and 7% required time off from non-agricultural work. In multivariate analyses, decreased risks were associated with Minnesota, and increased risks were identified for those with prior injuries and for males.This study provides a basis for further research on agricultural injuries and their prevention.

Sports and recreational injuries: regional rural injury study-II: impact on agricultural households and operations.

OBJECTIVES: To identify the incidence, severity, and potential risk factors for sports/recreational injuries incurred by children and adults in a five state, rural, Midwest, agricultural household population. METHODS: Computer assisted telephone interviews that included questions about all injuries were completed for eligible, participating households for 1999; 16,538 people participated, including 8488 children less than 20 years of age. Rates and 95% confidence intervals were calculated, and causal models guided multivariate models. RESULTS: Of a total of 2586 injuries, 1301 (50%) were not related to agricultural activity. Among these, 733 (28%) were associated with sports/recreational activities including multiple person sports (64%), general play activities (19%), and single person sports (14%). The overall rate was 46.4 injury events per 1000 persons per year. Rates for children were 99.4 for boys and 64.3 for girls. For adults (aged 20 and above), rates were 11.9 for men and 4.8 for women. For children, 93% received health care, 44% were restricted for seven or more days, and 18% lost agricultural work time of seven or more days; the respective proportions for adults were 88%, 45%, and 17%. Multivariate analysis for children showed increased risks for Nebraska residents, males, and those 10-14 or 15-19 years. For adults, increased risks were identified for males and those 20-24 years; decreased risks were observed for Nebraska residents and those 45-54 years. CONCLUSIONS: Sports/recreational activities are an important source of injury with relevant consequences for this population, including significant restricted daily activity and lost agricultural work time. Key findings provide a basis for further study to address these burdens.

Relation between policies and work related assault: Minnesota Nurses' Study.

AIMS: To assess the relation between violence prevention policies and work related assault. METHODS: From Phase 1 of the Minnesota Nurses' Study, a population based survey of 6300 Minnesota nurses (response 79%), 13.2% reported experiencing work related physical assault in the past year. In Phase 2, a case-control study, 1900 nurses (response 75%) were questioned about exposures relevant to violence, including eight work related violence prevention policy items. A comprehensive causal model served as a basis for survey design, analyses, and interpretation. Sensitivity analyses were conducted for potential exposure misclassification and the presence of an unmeasured confounder. RESULTS: Results of multiple regression analyses, controlling for appropriate factors, indicated that the odds of physical assault decreased for having a zero tolerance policy (OR = 0.5, 95% CI 0.4 to 0.8) and having policies regarding types of prohibited violent behaviours (OR = 0.5, 95% CI 0.3 to 0.9). Analyses adjusted for non-response and non-selection resulted in wider confidence intervals, but no substantial change in effect estimates. CONCLUSIONS: It appears that some work related violence policies may be protective for the population of Minnesota nurses.

Risk factors for work related violence in a health care organization.

OBJECTIVE: Identify the exposure effects of job family, patient contact, and supervisor support on physical and non-physical work related violence. DESIGN: Cross sectional study of employees in a Midwest health care organization, utilizing a specially designed mailed questionnaire and employer secondary data. SUBJECTS: Respondents included 1751 current and former employees (42% response rate). RESULTS: Physical and non-physical violence was experienced by 127 (7.2%) and 536 (30.6%) of the respondents, respectively. Multivariate analyses of physical violence identified increased odds for patient care assistants (odds ratio (OR) 2.5, 95% confidence interval (CI) 1. 1 to 6.1) and decreased odds for clerical workers (OR 0.1, 95% CI 0.03 to 0.5). Adjusted for job family, increased odds of physical violence were identified for moderate (OR 5.9, 95% CI 2.1 to 16.0) and high (OR 7.8, 95% CI 2.9 to 20.8) patient contact. Similar trends were identified for non-physical violence (OR 1.4, 95% CI 1.1 to 2.0 and OR 1.7, 95% CI 1.3 to 2.3). Increased supervisor support decreased the odds of both physical (OR 0.7, 95% CI 0.6 to 0.95) and non-physical violence (OR 0.5, 95% CI 0.4 to 0.6), adjusting for job family and demographic characteristics. CONCLUSIONS: Increased odds of physical violence were identified for the job family of nurses, even when adjusted for patient contact. Increased patient contact resulted in increased physical and non-physical violence, independent of job family, while supervisor support resulted in decreased odds of physical and non-physical violence.

An epidemiological study of the magnitude and consequences of work related violence: the Minnesota Nurses' Study.

AIMS: To identify the magnitude of and potential risk factors for violence within a major occupational population. METHODS: Comprehensive surveys were sent to 6300 Minnesota licensed registered (RNs) and practical (LPNs) nurses to collect data on physical and non-physical violence for the prior 12 months. Re-weighting enabled adjustment for potential biases associated with non-response, accounting for unknown eligibility. RESULTS: From the 78% responding, combined with non-response rate information, respective adjusted rates per 100 persons per year (95% CI) for physical and non-physical violence were 13.2 (12.2 to 14.3) and 38.8 (37.4 to 40.4); assault rates were increased, respectively, for LPNs versus RNs (16.4 and 12.0) and males versus females (19.4 and 12.9). Perpetrators of physical and non-physical events were patients/clients (97% and 67%, respectively). Consequences appeared greater for non-physical than physical violence. Multivariate modelling identified increased rates for both physical and non-physical violence for working: in a nursing home/long term care facility; in intensive care, psychiatric/behavioural or emergency departments; and with geriatric patients. CONCLUSIONS: Results show that non-fatal physical assault and non-physical forms of violence, and relevant consequences, are frequent among both RNs and LPNs; such violence is mostly perpetrated by patients or clients; and certain environmental factors appear to affect the risk of violence. This serves as the basis for further analytical studies that can enable the development of appropriate prevention and control efforts.

Traumatic injuries in agriculture.

The National Coalition for Agricultural Safety and Health (NCASH) in 1988 addressed issues in agriculture and noted "a sense of urgency... arose from the recognition of the unabating epidemic of traumatic death and injury in American farming . . ." This article provides an update to the NCASH conference on traumatic injuries in agriculture, a history on how the facts and figures were arrived at for the NCASH conference, and a current report on the status of traumatic injuries in agriculture in the U.S. Fatal and nonfatal injuries are addressed along with national and regional surveillance systems. The Census of Fatal Occupational Injuries (CFOI) was used for reporting national agricultural production fatal injuries from 1992-1998 (25.8 deaths per 100,000 workers), the Traumatic Injury Surveillance of Farmers (TISF) 1993-1995 was used to report nonfatal injuries occurring nationally (7.5/100 workers), and Regional Rural Injury Studies I and II (RRIS-I and RRIS-II) were used to illustrate a regional approach along with in-depth, specific analyses. Fatality rates, which showed some decline in the 1980s, were fairly constant during the 1990s. Changes in nonfatal injury rates for this sector could not be assessed due to a lack of benchmark data. The main concerns identified in the 1989 NCASH report continue today: tractors are the leading cause of farm-related death due mostly to overturns; older farmers continue to be at the highest risk for farm fatalities; and traumatic injuries continue to be a major concern for youth living or working on U.S. farms. Fatal and nonfatal traumatic injuries associated with agricultural production are a major public health problem that needs to be addressed through comprehensive approaches that include further delineation of the problem, particularly in children and older adults, and identification of specific risk factors through analytic efforts. Continued development of relevant surveillance systems and implementation of appropriate interventions are the primary challenges for the current decade.

Injuries among children and youth in farm households: Regional Rural Injury Study-I.

OBJECTIVES: The purpose of this effort was to identify the incidence and consequences of both farming and non-farming related injuries and the potential risk factors for farming related injuries among children and youth, aged 0-19 years, who lived in farm households in a large region of the United States. METHODS: Data were collected from randomly selected farm households during 1990. Rates and rate ratios with 95% confidence intervals were calculated for sociodemographic and exposure variables. Multivariate analyses were conducted, using a priori and backward stepwise logistic regression models. RESULTS: Within the population of 3,939 farm households and 13,144 persons, children and youth accounted for 33%. Injury rates for farming and non-farming sources, respectively, were 1,683 and 6,980 per 100,000 persons. Animals (40%) were the primary sources of the farming operation related injuries; sports/recreation sources (61%) were associated primarily with non-farming related injuries. Of the farming and non-farming operation related injury cases, 83% and 90%, respectively, required some type of health care; moreover, 17% and 24%, respectively, were restricted from regular activities for one month or more. Through multivariate analyses, important increased rate ratios were observed for operating a tractor, working with dairy cattle, and being male. Increased rate ratios for working with beef cattle, operating a harvester, and living on a farm where there were all terrain vehicles in use, and a decreased rate ratio for living on a farm where there were sheep, appeared suggestive. CONCLUSIONS: Based on the relevant rates, injury consequences, and potential risk factors identified, injuries to children and youth on farms represent a significant problem. Future analytic studies are essential to identify more specific risk factors that can serve as a basis for development of appropriate intervention efforts. Given the population at risk, and the opportunity for intervention in this unique occupational setting, many of these injuries may be readily amenable to prevention efforts.

The cost of work-related physical assaults in Minnesota.

OBJECTIVE: To describe the long-term productivity costs of occupational assaults. DATA SOURCES/STUDY SETTING: All incidents of physical assaults that resulted in indemnity payments, identified from the Minnesota Department of Labor and Industry (DLI) Workers' Compensation system in 1992. Medical expenditures were obtained from insurers, and data on lost wages, legal fees, and permanency ratings were collected from DLI records. Insurance administrative expenses were estimated. Lost fringe benefits and household production losses were imputed. STUDY DESIGN: The human capital approach was used to describe the long-term costs of occupational assaults. Economic software was used to apply a modified version of Rice, MacKenzie, and Associates' (1989) model for estimating the present value of past losses from 1992 through 1995 for all cases, and the future losses for cases open in 1996. PRINCIPAL FINDINGS: The total costs for 344 nonfatal work-related assaults were estimated at $5,885,448 (1996 dollars). Calculation of injury incidence and average costs per case and per employee identified populations with an elevated risk of assault. An analysis by industry revealed an elevated risk for workers employed in justice and safety (incidence: 198/100,000; $19,251 per case; $38 per employee), social service (incidence: 127/100,000; $24,210 per case; $31 per employee), and health care (incidence: 76/100,000; $13,197 per case; $10 per employee). CONCLUSIONS: Identified subgroups warrant attention for risk factor identification and prevention efforts. Cost estimates can serve as the basis for business calculations on the potential value of risk management interventions.

Out-of-hospital violence injury surveillance: quality of data collection.

STUDY OBJECTIVE: The recognized need to improve data collection for violence prevention may be met, in part, by using out-of-hospital data for injury surveillance. The purpose of the Prehospital Violence Injury Surveillance project was to examine the extent to which paramedics can adequately collect information about injuries, particularly intentional injuries, at emergency scenes. METHODS: Paramedics in a large Midwestern metropolitan area were trained to assess violence-related events and collect relevant data using a modified ambulance run report form. Data collected from 8 violence-related training scenarios and from 13 ride-along observations were analyzed to estimate paramedic interrater reliability using the kappa statistic. Data from 7,363 run report forms, filed during a 3-month study period, were abstracted and analyzed for completeness and quality. RESULTS: Paramedics demonstrated fair to good, and sometimes excellent, interrater agreement when documenting the training scenarios. Paramedics revealed barriers to collecting violence-related out-of-hospital data. The paramedics and the observer disagreed in documenting 77% of the ride-along observations. Overall, 73% of abstracted run report forms showed documentation errors, with more than 99% of these reports containing errors of omission and 29% showing internal documentation inconsistencies. Despite the emphasis on violence-related data, documentation of domestic abuse screening was missing from more than 99% of run reports from female patients. CONCLUSION: Significant barriers to quality out-of-hospital data collection were identified during study implementation and in abstracted run reports. These barriers included the following: lack of organizational support; characteristics of the violence-related data elements; design of the ambulance run report form; and paramedic knowledge, attitudes, and behaviors regarding data collection.

Work-related assault injuries among nurses.

Work-related violence is a major public health problem; however, there is a serious deficiency in the knowledge of risk factors for this problem. The purpose of this case-control study was to identify risk factors for work-related assault injuries among nurses. We used unconditional logistic regression to model the dependence of work-related assault injuries on each exposure of interest and the respective confounders. We found a decreased rate for the presence of security personnel (RR = 0.40; 95% CI = 0.19-0.82). We found increased rates for the following factors: the perception that administrators considered assault to be part of the job (RR = 8.14; 95% CI = 3.76-17.60); having received assault prevention training in the current workplace (RR = 4.64; 95% CI = 2.33-9.23); a high (>5) vs. low (<2) patient/personnel ratio (RR = 2.54; 95% CI = 1.13-5.70); working predominantly with patients with mental illness (RR = 3.5; 95% CI = 1.41-8.85); and working with patients who had more than 1- to 4-week and more than 4-week lengths of stay in the institution vs. <1 day (RR = 8.85; 95% CI = 1.58-49.52 and 4.25; 95% CI = 1.17-15.39, respectively).

Machinery-related injuries: regional rural injury study--I (RRIS--I).

Although it is known that farm machinery is a source of serious and catastrophic farm work-related injuries, little is known about the magnitude of, and potential risk factors for, this problem. The study population is from the five-state Regional Rural Injury Study--I (RRIS--I) that included 3,939 farm households and 13,144 persons who were interviewed about their injury experience and farming operation-related exposures during 1990. Rates were calculated for sociodemographic variables and various exposures pertinent to large farm machinery (excluding tractors). Multivariate analyses were conducted using logistic regression, based on a model developed a priori and further confirmed using backward stepwise logistic regression. Among the total farming-related injury events (n = 764), 151 (20%) were related to large machinery use (1,127 injured persons per 100,000 persons per year). Through multivariate analyses, several variables were associated with elevated rate ratios that were important in both models: hours worked per week on the farm (40-59, 60-79, 80+); operation of an auger; field crops as the enterprise requiring the most time; and male gender. In addition, in the backward stepwise model, certain marital status categories (married; separated/widowed/divorced) were also associated with elevated rate ratios that were important. The majority of injury events occurred while persons were lifting, pushing, or pulling (21%), adjusting a machine (20%), or repairing a machine (17%). While only 5% of the cases were hospitalized, 79% required some type of health care. Among all injured persons, 34% were restricted from regular activities for 1 week or more and 19% were restricted for 1 month or more; 25% continued to have persistent problems. In summary, the RRIS-I permitted one of the most comprehensive studies of agricultural machinery-related injuries, to date. The findings indicate that these injuries represent a significant problem, based on the relevant rates, potential risk factors, and consequences from trauma.

Marijuana use and medically attended injury events.

STUDY OBJECTIVE: This study evaluated the relation between self-reported marijuana use and 3-year incidence of injury. METHODS: We conducted a retrospective cohort study of adult Kaiser Permanente Medical Care Program members who underwent multiphasic health examinations between 1979 and 1986 (n=4,462). Injury-related outpatient visits, hospitalizations, and fatalities within 3 years of examination were determined. RESULTS: Outpatient injury events totaled 2,524; 1,611 participants (36%) had at least 1 injury-related outpatient visit. Injury-related hospitalizations (n=22) and fatalities (n=3) were rare. Among men, there was no consistent relation between marijuana use and injury incidence for either former users (rate ratio, 1.15; 95% confidence interval [CI], .97 to 1.36) or current users (rate ratio, 0.97; 95% CI, .81 to 1.17), compared with those who had never used marijuana. Among women, former and current users showed little difference in their rate of later injury compared with never users; the rate ratios were 1.05 (95% CI, .87 to 1.26) and 1.20 (95% CI, 1.00 to 1.44), respectively. No statistically significant associations were noted between marijuana use and cause-specific injury incidence in men or women. CONCLUSION: Among members of a health maintenance organization, self-reported marijuana use in adult men or women was not associated with outpatient injury within 3 years of marijuana use ascertainment.

A survey of community-based violence prevention and control efforts in Minnesota.

Rates of interpersonal violence at the national level in the United States exceed those of other industrialized nations; evidence of violence exists at the state level as well. Yet, data that identify the magnitude of the problem, pertinent risk factors, and efficacy of intervention efforts are limited. Faculty at the University of Minnesota School of Public Health conducted a survey to assess the extent to which violence prevention research and programmatic efforts exist statewide. Study findings served as a basis for developing a relevant research agenda and prioritizing limited academic resources. This paper describes the survey and development of an academic-community partnership that fosters collaborative research on violence prevention that will hopefully contribute to control of the violence epidemic.

Work-related physical assault.

Violence in the workplace is a serious public health problem. Yet, to date, little has been documented relevant to non-fatal events associated with physical assault. The aim of the present study was to identify the magnitude of work-related physical assault in Minnesota and to identify potential risk factors; both fatal and non-fatal cases were included. Minnesota workers' compensation records, relevant to assault, were used to identify 712 cases involving more than three days of lost work time for 1992; six homicide cases were included. Assault rates were calculated by industry and occupation. Women had an assault rate twice that of men (51 versus 26 per 100,000 workers). Workers in industries of social services (340), health services (202), and transportation (914) had the highest rates of assault per 100,000 full-time employees. The fact that in addition to overall workers' compensation costs of $1.6 million, the average lost time for closed compensated cases was 54 days (median, 14 days) and time to reach maximum medical improvement for 44% of the cases reporting was 156 days (median, 83 days), indicates a major problem. The findings suggest that specific groups of workers are at risk for physical assault on the job. Further research is essential to identify specific risk factors that will enable the development of appropriate prevention strategies.

Alternative approaches to analytical designs in occupational injury epidemiology.

In this paper, we discuss the theoretical framework upon which observational studies of occupational injuries are based. Following a general description of how causal effects are estimated, the challenges faced by researchers working in this area are outlined, with an emphasis on case-control studies. These challenges include defining the at-risk period for workers whose tasks change over time and whose hazard period may be very brief, evaluating the underreporting of both exposures and injuries, and considering the effects of multiple injuries per individual on study design and data analysis. We review both the theoretical and practical considerations in the design and conduct of traditional case-control studies, based on the collection of individual level data, as well as other approaches, such as using information culled from administrative and descriptive databases, and case-control studies in which the plant or work site is the unit of analysis. The case-crossover design is also reviewed and its utility for reducing confounding due to differences between individuals by self-matching is highlighted. While this design has not yet been applied to the work setting, its potential for increasing our understanding of the causes of acute-onset occupational injuries seems promising. Finally, a variety of hybrid designs are discussed, including combinations of case-control, case-crossover, and cohort designs.

Risk factors for work-related violent victimization.

This case-control study used the National Crime Victimization Survey database (a national sample of housing addresses) to examine sociodemographic risk factors for becoming a victim of work-related robbery and assault. Cases (N = 267) reported having been violently victimized in the previous 6 months. Controls (N = 1,783) were chosen from all nonvictims of violent crime at the end of the 6-month period. Risk factors varied by type of victimization, and differences were evident between men and women. Men less than 45 years of age had an increased risk for assault [odds ratio (OR) = 2.0-2.7], compared with those 55 years of age and older; and those with a family income of less than $40,000 had an increased risk for assault (OR = 1.7-1.9), compared with those having a family income of $50,000 or more. We found a decreased risk for those with a high school education (OR = 0.6), compared with those with some college education. For women, an increased risk was seen for ages 16-18 years (OR = 3.3) and 25-34 years (OR = 2.3), compared with those 55 years of age or older. Women who were divorced or separated (OR = 4.4) and never-married (OR = 2.1) were at higher risk than women who were married. We found a decreased risk for nonwhites (OR = 0.5), compared with whites.

Injury from dairy cattle activities.

Animals have been implicated as an important source of injury for farm household members. Little is known, however, about the specific activities associated with the animal/livestock operations that place a person at increased or decreased risk for injuries. The primary aim of this case-control study was to identify which dairy cattle operation activities (that is, milking, feeding, cleaning barns, trimming and treating feet, dehorning, assisting with difficult calvings, and doing treatments) were associated with an increased or decreased risk of injury. We found milking to have the greatest increase in risk for injury. The ratios for increasing hours per week spent at milking (0, 1-10, 11-20, 21-30, 31-63) were 1.0, 2.3, 5.5, 10.9, and 20.6, respectively. We also found an increased rate ratio associated with trimming or treating hooves (rate ratio = 4.2).

Effects of brain injury on college academic performance.

Brain injury, a leading cause of mortality, morbidity and disability in the United States, has serious consequences and substantial costs. Although previous studies have assessed a variety of outcomes subsequent to brain injury, documentation of performance prior to brain injury using a case-control approach has not been included; preinjury performance differences may confound the estimate of the effects of brain injury on performance. The primary objective of this study was to compare academic performance before and after brain injury in a population of university undergraduate students to determine the extent to which the academic career of the brain-injured person was altered from what would have been expected in the absence of such an injury. Cases included all undergraduate students in a major university, between the ages of 17 and 27, who incurred a brain injury requiring hospitalization between 1980 and 1984 (n = 99). Two comparison groups were used to determine whether changes in academic performance were specifically related to brain injuries or injuries in general: (1) injured controls, i.e. 121 students between the ages of 17 and 27 years, hospitalized for injuries other than to the central nervous system, and (2) uninjured academic controls, i.e. 198 students with out injuries requiring hospitalization during the study period, matched 2:1 to the brain-injured students by age, gender, and completed course credits categorized as < 90, > or = 90. Although there were no differences when the total groups, including both males and females, were compared, there was a significant pre- to postinjury decrease in the grade point average for female cases when compared to their uninjured academic controls (p < 0.02). This difference was related to the effects of brain injury, and not to the effects of injury in general. No such difference was observed for the males. There were also no differences when the total groups, including males and females, were compared relevant to return to school. However, a significantly higher proportion of the female cases, compared with their uninjured academic controls, did not return to school after their injury; similar findings were identified for the injured controls as well. Thus, these differences were not specific to brain injury but rather to injury in general. In spite of this observation, the difference between female cases who returned and those who did not return was associated with neurological deficits, especially upper left limb motor deficits, as the time of hospital discharge. The findings from this effort are suggestive of gender differences in the consequences of brain injury and serve as a basis for further studies to evaluate the magnitude of this problem.

An epidemiological study of roadway fatalities related to farm vehicles: United States, 1988 to 1993.

Compared with the estimated injury fatality rate for workers in all occupations (nine in 100,000 in 1988) the farm fatality rate (48 in 100,000) was among the highest in the nation; in 1993, these rates were eight and 35 in 100,000, respectively. On-road farm-vehicle fatalities have been identified as a significant problem, yet these events apparently have not been investigated in a comprehensive manner. The purpose of this study was to investigate the circumstances surrounding all on-road, non-truck, farm-vehicle crash fatalities in the United States form 1988 through 1993. The National Highway Traffic Safety Administration's Fatal Accident Reporting System, which includes data for all US fatal on-road motor vehicle crashes, was the source of data. Driver-related variables were compared among farm vehicles, vehicles in collisions with farm vehicles, and all other vehicles in rural, fatal crashes; environmental variables were compared between rural farm-vehicle and non-farm-vehicle crashes. During 1988 to 1993, in rural areas, 444 farm-vehicle occupants were killed; in addition, 238 occupants of other vehicles or pedestrians were killed in collisions with the farm vehicles. The farm vehicles were disproportionately involved in overturns, rear-end collisions, and incidents in which the injured person fell from the vehicle, when compared with all other non-farm vehicles involved in rural-area fatal crashes. Of the farm vehicles involved in fatal crashes at night, dawn, or dusk, 65% were struck in the rear, compared with 4% of vehicles involved in fatal non-farm-vehicle crashes. Compared with drivers in all other rural crashes, farm-vehicle operators were more likely to be male, have a greater proportion of convictions for driving while intoxicated, and a lower proportion of previous speeding convictions. From this initial investigation, it appears that the fatal-crash involvement of farm vehicles are related to vehicle and environmental factors that are changeable. Given the proportion of overturns associated with farm-vehicle crashes (21%) compared with non-farm vehicles (9%), there is a need to investigate design characteristics of the farm vehicles. The large proportion of farm vehicles struck in the rear during daylight (24%) as well as night, dawn, or dusk hours (65%), compared with non-farm vehicles (4% and 4%, respectively), suggest factors related to visibility and perception of the farm vehicles' speed that provide a basis for further study.