A Summary of Fatal Injury Surveillance Methods in Australian Agriculture and Their Impact on Safety Policies and Practices.

Agriculture is one of the most important and also hazardous industries in Australia. Having a sound knowledge and understanding of the circumstance of injury events is critical to developing evidence-based intervention programs. This paper aims to provide a brief historical snapshot of the development of data systems underpinning the assessment of fatal farm injury in Australia and how it has impacted on safety policy and practice. The first Australian studies used coronial information to explore agricultural fatalities, these studies reviewed paper-based records (in-situ) and collected the information for analysis and reporting. This task was laborious and costly. When the National Coronial Information System (NCIS) was established in 2000, this allowed access to coronial records online. Information provided about the deceased includes demographics, contextual details on the nature of the fatality and autopsy, toxicology, and police reports, as-well-as the coroner's finding. Information from the NCIS, along with media reports, have been used to develop the farm fatality database. This information has been used to inform the safety goals and targets for farm commodity groups, identify key risks, provide long-term benchmark indicators and underpin the development of prevention materials and training resources. Without accurate, timely, concise and relevant data about injury occurring on farms, there is no evidence to drive policy and practice or to evaluate programs of work. As such, the continued utilization and extension of the NCIS data will prove crucial to further reducing the burden of preventable fatal injuries on Australian farms.

A Narrative Review of Fatigue in Agriculture and Its Impact on Injury and Fatality in Australia.

OBJECTIVES: To identify current knowledge about the role of fatigue in occupational injury in the agricultural sector and briefly assess potential intervention approaches. METHODS: Narrative review of peer reviewed literature (in English) from 2010 to 2022 focusing on fatigue in agricultural and other sectors. Data were extracted from Medline, Scopus, and Google Scholar. RESULTS: The initial search revealed 6,031 papers, of these 33 met the inclusion criteria. The literature unanimously agreed that fatigue contributes to occupational injury in agriculture and related industries. However, there was a scarcity of literature specific to Australia or agriculture. This limits the ability to draw conclusions about the true relationship between fatigue and injury. CONCLUSION: While fatigue is likely a major contributor to occupational injury in Australian agriculture, the limited literature impedes the ability to draw conclusions and extrapolate interventions used by other industries that are practical and feasible, to agriculture. Future studies should establish the nature of the problem in Australian agriculture and consult with members of the sector to establish the best interventions to ameliorate the problem, then implement and robustly evaluate intervention studies.

Fatal Animal Related Incidents on Australian Farms - a 20-Year Review.

Objectives To assess demographic and causal factors of fatal farm incidents involving animals in Australia. Methods Descriptive study of the National Coronial Information System for persons fatally injured by an animal on an Australian farm over the 2001-20 period. Data were analysed in relation to age, sex, state where incident occurred, work-relatedness and causal agents. Results There has been little change in the mean number of animal-related injury deaths across Australia in the 2001-20 period (mean 6.5), however this is a 35% reduction on an earlier 1989-92 assessment (mean 10). The majority of incidents (81%) involved horses (n = 75) and cattle (n = 31). Males were involved in 86 (66%) cases, with 54 female cases. People aged 60 years and over accounted for 46% of the cases, with more than half occurring during work. Of the decedents, 85% fell from or were struck by an animal at the time of the incident, with 40% resulting in a head injury. Conclusion While annualized case numbers have decreased slightly, the leading agents remain consistent with previous studies. The lack of genuine progress in addressing fatalities related to horses and cattle, along with the representation of older persons in the cohort, require attention drawing on the Hierarchy of Controls.

Farm-related injury deaths in Australia (2001-20).

OBJECTIVE: To describe the agents, pattern and trends of unintentional farm fatalities in Australia (2001-2020). METHODS: Review of study of National Coronial Information System data. DESIGN: Descriptive. SETTING: Australia (2001-2020). PARTICIPANTS: All cases involving fatal work and non-work injury events on a farm. MAIN OUTCOME MEASURES: Patterns and agents of injury events, with trends for all-cause deaths based on rates per 10 000 farms and work-related incidents (per 100 000 workers and 1 000 000 h worked). RESULTS: There were 1584 unintentional farm fatalities (annual mean 79). Two-thirds of cases were work-related (68%). Major agents of injury were farm vehicles (39%) and machinery (26%). Persons aged over 55 years were involved in 58% of all work-related incidents and were significantly more likely to die than younger cohorts when assessed against hours worked. Death rates involving all on-farm fatal incidents (both work and non-work) per 10 000 farms (p = 0.015) and work-related rates per 100 000 workers (p = 0.015) reduced over the period, with both demonstrating a fluctuating rate. There was no change in the work-related rates when assessed against hours worked (p = 0.276). CONCLUSION: Over the period, the annualised number of deaths fell by approximately 24% (98-75), with agents of injury remaining similar. General trends suggest a reduction in the overall death rates for work and non-work incidents. However, trends were less apparent when the reduction of farms (~19%), workers (~7%) and hours worked (no change), were accounted for. Targeted approaches are required to stimulate improvements in these preventable incidents.

A descriptive review of quad-related deaths in Australia (2011-20).

OBJECTIVE: To assess Australian quad-related deaths during the 2011-20 period in relation to introduction of the Consumer Goods (Quad Bikes) Safety Standard 2019. METHODS: All Australian quad-related deaths retrieved through the National Coronial Information System. RESULTS: There were 155 cases, with 116 occurring on a farm and 39 in a non-farm context. Deaths were evenly split between work (52%) and non-work activities, however, 66% of all farm incidents involved work. Rollovers were responsible for 59% of cases and occurred largely on farms (86%), whilst working (69%). Head injury (32%) and asphyxiation (29%) were primary causes of death. Helmet use was low (<5%) in the head injury cases, with 80% of the asphyxiation cases incurring no life-threatening injury other than being entrapped by the quad. CONCLUSION: Quad-related deaths are prevalent, with minimal variation in the pattern of incidents from previous Australian studies. Rollover incidents continue to be a major problem especially in a farm context. IMPLICATIONS FOR PUBLIC HEALTH: In tandem with existing efforts to enhance behavioural compliance (e.g. helmet use, no child access) and retrofitting Operator Protector Devices, these data support the introduction of the new Standard addressing vehicle stability and fitting Operator Protector Devices to limit potential for asphyxiation.

Comparison of severe on-farm injuries to older and younger persons in New South Wales (2012-2016).

OBJECTIVES: To assess and compare rates of severe on-farm injury for older (> 50 years) and younger (15-49 years) cohorts, on NSW farms. DESIGN: Descriptive retrospective epidemiological study of the New South Wales Trauma Registry (Institute of Trauma and Injury Management - ITIM) for persons injured on a farm. SETTING: New South Wales, Australia. PARTICIPANTS: Cases involving persons (≥15 years), with data on the NSW Trauma Registry (2012-16). MAIN OUTCOME MEASURES: Comparison of injury rates and severity between younger (15-49 years) and older (50+ years) cohorts over the 2012-16 period based on Injury Severity Scores (ISS). RESULTS: Older males are injured at a rate that is roughly 18% higher than younger males and 13% higher than the overall injury rate. Older individuals also have significantly longer hospital stays post-injury (P = 0.01), with this being most pronounced for older men (P < 0.01). There was no statistically significant difference in ISS demonstrated between the age cohorts (P = 0.64), except for younger women having higher median ISS than their older female counterparts (P = 0.02). CONCLUSION: Overall, the general trends displayed support the contention that older males are more likely to incur a severe on-farm injury than their younger counterparts. This provides support for a preventative focus targeting older farmers in NSW.

Patterns of emergency department use in rural and metropolitan New South Wales from 2012 to 2018.

OBJECTIVE: To explore the patterns of and investigate the factors associated with rises in emergency department presentations in rural and metropolitan New South Wales from 2012 to 2018. DESIGN: A retrospective descriptive study of de-identified data from the New South Wales Emergency Department Data Collection. SETTING: New South Wales, Australia. PARTICIPANTS: All individuals presenting to 99 New South Wales emergency departments, which continuously reported to the Emergency Department Data Collection between 2012 and 2018. A total of 2 166 449 presentations recorded throughout New South Wales in 2012 (rural 786 278; metropolitan 1 380 171) and 2 477 192 in 2018 (rural 861 761; metropolitan 1 615 431). MAIN OUTCOME MEASURES: Total emergency department presentations, plus Poisson regression modelled annual changes in emergency department presentations over the period 2012-2018. RESULTS: Growth in emergency department presentations outpaced population growth in both rural and metropolitan New South Wales between 2012 and 2018. The patterns of age-standardised rates of presentations were broadly similar between rural and metropolitan areas, with highest rates observed in the youngest (0-4 years) and oldest (85+ years) cohorts. The rural sample also displayed a distinct third peak in ages 15-39 years, and rates were higher across all age groups. Rural New South Wales displayed disproportionately higher emergency department presentations in the two most deprived socio-economic status quintiles. While rural New South Wales displayed significant reductions in triage category 5 (non-urgent cases) over time, the relative proportion remained approximately double that of metropolitan sites. CONCLUSIONS: There are differences between rural and metropolitan emergency department presentations relating to demographic factors, triage levels, acuity and admissions. Detailed local investigations are required to determine specific contextual issues that impact on emergency department demand.

Protecting the future: Fatal incidents on Australian farms involving children (2001-2019).

OBJECTIVES: To assess the demographic and causal factors, plus trends in rates of fatal farm incidents involving children (<15 years) in Australia over the 2001-2019 period. DESIGN: A descriptive retrospective epidemiological study of the National Coronial Information System. SETTING: Australia. PARTICIPANTS: Cases involving children (<15 years), where incidents have occurred on a farm (1 January 2001-31 December 2019). RESULTS: There has been essentially no change in the fatality rate for farm-related child injury deaths across Australia in the 2001-2019 period (-0.009/year). Men and children aged 0-4 years were significantly more likely to be involved in these incidents. Most cases were recreational in nature (81%), with seven agents (water bodies, quads [all-terrain vehicles], tractors, utes, cars, motorbikes and horses), accounting for 75% of cases. Water bodies were responsible for over 31% of deaths. CONCLUSION: The lack of progress addressing child farm injury mortality requires urgent attention. The overall rates and pattern of injury-related deaths have stagnated, necessitating new and innovative approaches to address the issue. The emerging National Injury Prevention Plan might provide scope to improve the focus on and implementation of evidence-based approaches.

Comparative use of cancer therapies in Australian farm, rural nonfarm and urban residents aged 45 years and older.

Objectives and importance of the study: To determine whether use of selected therapies for prostate, breast and colorectal cancer in farm residents differs from that in rural nonfarm and urban counterparts. Little is known about cancer therapies used by farm residents. STUDY TYPE: Data linkage cohort study. METHODS: Baseline survey information from the Sax Institute's 45 and Up Study cohort was linked with data from the New South Wales Admitted Patient Data Collection for 2006-2012. Adjusted odds of receiving surgery, chemotherapy, radiotherapy and/or brachytherapy for each cancer were compared between groups, controlling for selected variables. RESULTS: Differences in the likelihood of surgery for breast and colorectal cancer between groups were not significant. However, for prostate cancer, farm men had 35% greater odds of prostatectomy than rural nonfarm men (odds ratio [OR] 1.35; 95% CI 1.05, 1.72). Urban men were most likely to have had brachytherapy, with three times greater odds of treatment than farm men (OR 2.90; 95% CI 1.51, 5.56). Urban women were most likely to have had chemotherapy for breast cancer, having twice the odds of receiving this treatment as farm women (OR 2.24; 95% CI 1.25, 4.04). The odds of chemotherapy for colorectal cancer among rural nonfarm residents were two-thirds the odds among urban men (OR 0.62; 95% CI 0.44, 0.90) and urban women (OR 0.57; 95% CI 0.37, 0.88). Age, distance, income and health insurance factors contributed to differences in nonsurgical care between groups. CONCLUSIONS: Cancer-related surgical services for breast and colorectal cancer were comparable between groups. Farm and rural nonfarm residents may have been disadvantaged in relation to nonsurgical therapies for prostate, breast and colorectal cancer compared with urban counterparts.

Australian beef industry worker's knowledge, attitudes and practices regarding Q fever: A pilot study.

BACKGROUND: Q fever is a vaccine-preventable zoonotic infection with potentially severe health outcomes and high economic costs that affects agricultural workers, including beef and cattle industry workers, however this population historically have sub-optimal vaccine uptake. OBJECTIVE: To gather quantitative and qualitative pilot data from Australian beef industry workers on their knowledge, attitudes and practices around Q fever and Q fever vaccination. METHODS: A mixed methods approach was used to ascertain the Q fever disease risk perception and vaccination behavior of a purposive convenience sample of beef industry workers attending an industry expo in Rockhampton, Queensland, Australia between May 7th and 9th, 2018. RESULTS: The quantitative survey response rate was 83% (n = 86). More than 70% of respondents reported exposure to known Q fever risk factors. Eighty six percent were aware of Q fever, the self-reported uptake of Q fever vaccine was 27% and 9% reported undertaking testing which showed evidence of previous infection. Five main themes emerged from the qualitative data: "Finding the time" among other life priorities to attend a doctor for a vaccine; "Employer responsibility" to provide the vaccine; "My doctor knows me" and could suggest Q fever vaccination; "Assigning Risk" across a range of attitudes, including thinking it would not happen to them, 'fatalism', and knowing the danger but taking the risk anyway; and "The Need for Outreach" vaccine delivery services in their communities. SIGNIFICANCE: These data suggest that a coordinated public health approach to testing and vaccine provision, coupled with an awareness campaign among regional doctors to prompt them to routinely ask patients about their Q fever risk and vaccination history, should form part of a broad approach to Q fever control and prevention.

Rural-urban variation in injury-related hospitalisation, health outcomes and treatment cost in New South Wales.

OBJECTIVE: To compare differences in injury characteristics, health outcomes and treatment costs between urban and rural residents who were hospitalised following an injury. DESIGN: A retrospective examination of injury-linked hospitalisation and mortality data in New South Wales from 1 January 2010 to 30 June 2014. PARTICIPANTS: Urban (496 325) and rural (213 139) residents who were hospitalised following an injury. MAIN OUTCOME MEASURES: Demographic and injury characteristics, injury severity, hospital length of stay, 28-day hospital readmission, 90-day mortality and treatment cost. RESULTS: Rural residents had an increased likelihood of being hospitalised for injuries from motorcycles, vehicles, animate causes, venomous animals or plants and assault compared to urban residents. Rural residents were less likely to be readmitted to hospital within 28 days and had a lower length of stay and age-adjusted length of stay than urban residents. Injury-related hospitalisations for urban and rural residents cost $4.4 billion and $1.7 billion, respectively. Annually, acute injury treatment ($1.1 billion), rehabilitation ($130 million) and subacute non-acute patient care ($57 million) cost $1.3 billion ($990 million for urban and $384 million for rural residents) in New South Wales. Fall-related injuries and transport incidents were the costliest injury mechanisms for both urban and rural residents. CONCLUSIONS: Injuries contribute substantially to hospitalised morbidity and its cost. The development and implementation of injury prevention strategies targeting the most common injuries for urban and rural residents will go some way towards reducing hospitalised injury and its cost.

Farm safety-Time to act.

ISSUES ADDRESSED: Agriculture is recognised as a highly dangerous sector worldwide; hence, the use of evidence-based solutions to address injury-related incidents is critical to prevention. The main of this article was to determine the potential for prevention by use of existing controls based on deaths data from 2001-2016. METHODS: This study assesses data from the National Coroner's Information System for the period 2001-2016 in regard to unintentional farm injury deaths in Australia (n = 1271). The six leading causes of death (tractors, quads [ATVs], water/dams, farm utilities [pickups], motorcycles and horses: n = 644) are reviewed against existing evidence-based practice recommendations to ascertain the potential capacity to prevent and/or ameliorate the severity of the fatal incidents. Projections of economic costs associated with these incidents in the past five years (2012-2016) are outlined. RESULTS: Of the cases involving the six leading agents (n = 644), 36% (n = 235) have the potential to be prevented with the use of designated evidence-based controls. Meanwhile, the costs attributed to deaths involving the six leading agents in the 2012-2016 period, exceeded $313 million. CONCLUSIONS: Farm injury incidents and their related economic costs can be reduced by enhanced adoption of the existing evidence-based controls. SO WHAT: Farm safety efforts in Australia require reinvigoration and funding to focus on evidence-based controls supported by enforcement to attain maximum impact.

Comparison of cancer incidence in Australian farm residents 45 years and over, compared to rural non-farm and urban residents - a data linkage study.

BACKGROUND: It is not known if the incidence of common cancers in Australian farm residents is different to rural non-farm or urban residents. METHODS: Data from farm, rural non-farm and urban participants of the 45 and Up Study cohort in New South Wales, Australia, were linked with state cancer registry data for the years 2006-2009. Directly standardised rate ratios for cancer incidence were compared for all-cancer, prostate, breast, colorectal cancer, melanoma and non-Hodgkin Lymphoma (NHL). Proportional hazards regression was used to generate incidence hazard ratios for each cancer type adjusted for relevant confounders. RESULTS: Farm women had a significantly lower all-cancer hazard ratio than rural non-farm women (1.14, 1.01-1.29). However, the lower all-cancer risk observed in farm men, was not significant when compared to rural non-farm and urban counterparts. The all-cancer adjusted hazard ratio for combined rural non-farm and urban groups compared to farm referents, was significant for men (1.08,1.01-1.17) and women (1.13, 1.04-1.23). Confidence intervals did not exclude unity for differences in risk for prostate, breast, colorectal or lung cancers, NHL or melanoma. Whilst non-significant, farm residents had considerably lower risk of lung cancer than other residents after controlling for smoking and other factors. CONCLUSIONS: All-cancer risk was significantly lower in farm residents compared to combined rural non-farm and urban groups. Farm women had a significantly lower all-cancer adjusted hazard ratio than rural non-farm women. These differences appeared to be mainly due to lower lung cancer incidence in farm residents.

Stage of diagnosis of prostate, breast and colorectal cancer in farm residents compared with other rural and urban residents in New South Wales.

OBJECTIVE: To determine if stage at diagnosis of prostate, breast and colorectal cancers differs between farm, rural non-farm and urban residents. DESIGN: Data linkage of baseline survey information from a large cohort study, with state cancer registry records from 2006 to 2009. SETTING: New South Wales, Australia. PARTICIPANTS: New South Wales residents enrolled in the 45 and Up Study cohort. MAIN OUTCOME MEASURES: Adjusted odds ratio of non-localised cancer stage was modelled using binary logistic regression, controlling for commonly known cancer risk factors. RESULTS: Overall differences in the odds ratios for later stage prostate, breast and colorectal cancer diagnosis in farm men and women compared with rural non-farm and urban counterparts were not statistically significant, although farm men had twice the odds of either group of being diagnosed at later stage colorectal cancer. The odds of later stage prostate cancer for farm and urban men were similar, but rural non-farm men were significantly less likely than urban men to be diagnosed at later stage. Higher household income was associated with later stage breast and prostate cancer; and private health insurance with extras was negatively associated with later stage prostate cancer. CONCLUSIONS: Differences in stage of cancer diagnosis, particularly between farm and rural non-farm men, remain unexplained but were not statistically significant. Farm men may be at higher risk of later stage colorectal cancer diagnosis, which if confirmed has implications for research on possible reasons, and for the delivery of appropriate cancer diagnostic services in rural areas.

Trends and Patterns in Unintentional Injury Fatalities in Australian Agriculture.

Agriculture is recognized internationally as a hazardous industry. This article describes the trends and patterns of unintentional farm fatalities in Australia. Data from the National Coronial Information System were analyzed to assess all unintentional farm fatalities for the 2001-2015 period. A secondary comparison with earlier coronial system data from 1989-1992 was also completed to ascertain historical changes. There was no statistically significant change in the rate of work-related fatalities per 100,000 workers in the 2001-2015 period. However, there was a significant curvilinear reduction in all cases of fatality (work and non-work related) per 10,000 agricultural establishments, which decreased from 2001 to 2009-2011 and then increased to 2015. The longer-term data from 1989-2015 revealed a reduction of 30% in work-related cases per 100,000 workers and a reduction of 35% in all cases (work and non-work) per 10,000 agricultural establishments. For both work-related and all cases, there was a statistically significant reduction from 1989 to 2005 and then no change thereafter. The longer-term reduction in farm fatalities ceased in the mid-2000s, and the rate has remained stable since. Fatal injuries continue to impose a significant burden on Australian farming communities, with the rate remaining relatively static for the past ten years. New evidence-based interventions targeting priority areas are required to reduce the incidence of fatalities in Australia agriculture.

Depression and Risk of Unintentional Injury in Rural Communities-A Longitudinal Analysis of the Australian Rural Mental Health Study.

Limited longitudinal research has examined relationships between depression and injury, particularly in rural contexts. This paper reports cross-sectional and longitudinal analyses from the Australian Rural Mental Health Study (ARMHS) exploring relationships between "probable depression" episodes and unintentional injury. Participants completed four surveys over five years. Multivariate logistic regressions were employed to assess the causal effect of prior depression episodes on subsequent injury risk. Of 2621 baseline participants, 23.3% experienced a probable depression episode recently and 15.9% reported a serious injury during the previous 12 months. Factors associated with a 12-month injury at baseline included male gender, being unemployed or unable to work, being involved in a serious incident, hazardous alcohol use, and having experienced a recent depression episode. Longitudinal analyses revealed that probable depression was significantly associated with subsequent unintentional injury (OR 1.68, 99%CI 1.20-2.35), as was male gender (OR 1.39, 99%CI 1.06-1.82), while alcohol consumption did not mediate these relationships. Campaigns to reduce the impact of mental illness should consider unintentional injuries as a contributor, while injury prevention initiatives may benefit from addressing mental health issues. Such strategies are particularly important in rural and remote areas where injuries are more common and mental health services are less readily available.

Farm injury hospitalisations in New South Wales (2010 to 2014).

OBJECTIVE: To examine gender differences in the characteristics, treatment costs and health outcomes of farm injuries resulting in hospitalisation of New South Wales (NSW) residents. METHOD: A population-based study of individuals injured on a farm and admitted to hospital using linked hospital admission and mortality records from 1 January 2010 to 30 June 2014 in NSW. Health outcomes, including injury severity, hospital length of stay (LOS), 28-day readmission and 30-day mortality were examined by gender. RESULTS: A total of 6,270 hospitalisations were identified, with males having a higher proportion of work-related injuries and injuries involving motorbikes compared to females. Females had a higher proportion of equestrian-related injuries. There were no differences in injury severity, with around 20% serious injuries, in mean LOS or 28-day hospital re-admission. Treatment costs totalled $42.7 million, with males accounting for just under 80% of the total. CONCLUSIONS: There are some gender differences in the characteristics of farm injury-related hospitalisations. Farm injury imposes modest, but nonetheless relatively considerable, financial costs on hospital services in NSW. Implications for public health: Continued efforts to ameliorate these injuries in a farm environment, which are mainly preventable, will have personal and societal benefits.

Towards a harmonised approach to reducing quad-related fatal injuries in Australia and New Zealand: a cross-sectional comparative analysis.

OBJECTIVE: This study compares the patterns of quad-related fatal injuries between Australia and New Zealand (NZ). METHOD: Fatal injuries from July 2007 to June 2012 involving a quad (quad bike or all-terrain vehicle) were identified from coronial files. Data described the socio-demographic, injury, vehicle and environment factors associated with incidents. Injury patterns were compared between countries. RESULTS: A total of 101 quad-related fatalities were identified: 69 in Australia and 32 in NZ (7.3 and 8.0 annual fatalities per 100,000 vehicles). Of these, 95 closed cases were examined in detail and factors in common included fatalities occurring mainly in males, on farms, involving a rollover and resulting in crush injuries to the head and thorax. Helmet use and alcohol/drug involvement were infrequent. Differences were observed with regard to age, season of fatal incident and the presence of a slope. CONCLUSIONS: Fatality patterns are broadly similar. The few differences could be attributed to differing agricultural commodity mix, demographics and topography. IMPLICATIONS: This study's findings support harmonised cross-country injury prevention efforts primarily focused on safe design and engineering principles to reduce this injury burden.

Influencing Safety in Australian Agriculture and Fisheries.

BACKGROUND: Improving the health and safety of those working in Australian agriculture and fishery industries is a recognized priority area for preventative activities. With Australian agricultural industries being among the nation's most dangerous workplaces, there is a need for action. While there are currently known solutions, their implementation is limited. Influential agents, i.e., people who can influence others, are important for helping engender action to enact solutions into practice. OBJECTIVE: This study examines agents that influence safety behavior either negatively (barriers) or positively (facilitators), in the Australian agriculture and fishery industries. METHODS: Focus groups were conducted with producers and industry representatives. Thematic analysis identified barriers and facilitators to improve health and safety. These were assessed against the Socioecological Model, which considers the various, and often intersecting, human (intrapersonal, i.e. values and attitudes, peers, familial, and cultural) factors influencing safety behavior. RESULTS: Seven categories of human influences were identified: self, peers, family, intergenerational change, industry agents, government agents, and other. Peers (including direct managers) and family were seen to be direct influencers. Individuals signal to others that safety is valued and important. This is reinforced by experience, skill, attitudes, and behavior. Safety practice knowledge acquisition occurred via the family unit, specific training, industry, or knowledge transfer between industries. Government influence predominately focused on legislation and while the source of this influence is distant, it does influence behavior. CONCLUSIONS/RECOMMENDATIONS: There is a need to support comprehensive programs. These should include strengthening relationships via peer-to-peer networking, sharing information about safety initiatives, appropriate legislation, and enhancing leadership of all influencers with regard to safety.

Farmers' knowledge of Q fever and prevention approaches in New South Wales.

OBJECTIVE: To identify what New South Wales (NSW) farmers know about Q fever to inform preventive approaches. DESIGN: Thematic analysis of qualitative data gathered through semi-structured individual interviews, focus groups and a community meeting. SETTING: Rural communities in NSW, Australia. PARTICIPANTS: A total of 25 farmers participated in individual interviews (n = 4) or three focus groups, each with seven participants (n = 21). A further 27 persons, were involved in a community meeting. MAIN OUTCOME MEASURES: Themes derived from the interviews, focus groups and community meeting. RESULTS: Knowledge variations regarding Q fever risk and transmission highlight a need for improved risk communication. Vaccination was viewed as the preferred prevention approach; barriers were raised including time, costs, access to screening/vaccination and General Practitioner (GP) knowledge about Q fever. Local vaccination initiatives were supported. CONCLUSIONS: Strengthening existing GP knowledge and services leading to expanded provision of screening/vaccination could improve the coverage of Q fever vaccine in endemic NSW farming and rural communities.