Using motor vehicle crash records for injury surveillance and research in agriculture and forestry.

PROBLEM: Fatal injuries in the agriculture, forestry, and fishing sector (AgFF) outweigh those across all sectors in the United States. Transportation-related injuries are among the top contributors to these fatal events. However, traditional occupational injury surveillance systems may not completely capture crashes involving farm vehicles and logging trucks, specifically nonfatal events. METHODS: The study aimed to develop an integrated database of AgFF-related motor-vehicle crashes for the southwest (Arkansas, Louisiana, New Mexico, Oklahoma, and Texas) and to use these data to conduct surveillance and research. Lessons learned during the pursuit of these aims were cataloged. Activities centered around the conduct of traditional statistical and geospatial analyses of structured data fields and natural language processing of free-text crash narratives. RESULTS: The structured crash data in each state include fields that allowed farm vehicles or equipment and logging trucks to be identified. The variable definitions and coding were not consistent across states but could be harmonized. All states recorded data fields pertaining to person, vehicle, and crash/environmental factors. Structured data supported the construction of crash severity models and geospatial analyses. Law enforcement provided additional details on crash causation in free-text narratives. Crash narratives contained sufficient text to support viable machine learning models for farm vehicle or equipment crashes, but not for logging truck narratives. DISCUSSION: Crash records can help to fill research and surveillance gaps in AgFF in the southwest region. This supports traffic safety's evolution to the current Safe System paradigm. There is a conceptual linkage between the Safe System and Total Worker Health approaches, providing a bridge between traffic safety and occupational health. PRACTICAL APPLICATIONS: Despite limitations, crash records can be an important component of injury surveillance for events involving AgFF vehicles. They also can be used to inform the selection and evaluation of traffic countermeasures and behavioral interventions.

Influence of Work on Elevated Blood Pressure in Hispanic Adolescents in South Texas.

Literature supports an association between work and cardiovascular disease in adults. The objective of this study was to examine the relationship between current work status and elevated blood pressure in Hispanic adolescents. Participants were students in Hidalgo County, located along the Texas-Mexico border. Participants enrolled in the cohort study in ninth grade with assessments completed once a year for up to three years. Participants completed a self-report survey, while staff measured height, weight, waist circumference, blood pressure, and were screened for acanthosis nigricans. A generalized linear regression model with a logit link function was constructed to assess current work status and elevated blood pressure. Of the 508 participants, 29% had elevated blood pressure, which was associated with being male and other chronic disease indicators (e.g., acanthosis nigricans, overweight/obesity). The mean probability for elevated blood pressure was higher among currently working adolescents compared to those who were not. Findings were statistically significant (p < 0.05) at baseline. The findings illustrate that a large proportion of adolescents along the Texas-Mexico border may have elevated blood pressure and that working may be associated with it. Subsequent research is needed to confirm these findings, as well as to identify the mechanism for how work may increase hypertension in adolescents.

Feasibility of Portable Fingerstick Cholinesterase Testing in Adolescents in South Texas.

Adolescents are particularly vulnerable to the impacts of pesticide exposures, which can be assessed using surveys, environmental measurements, and biomonitoring. Biomonitoring of blood cholinesterase can be used to determine if an individual has been exposed to pesticides. A limitation of blood cholinesterase testing can be the use of a laboratory as well as time to receive results. In addition to laboratory tests, there are fingerstick cholinesterase (ChE) tests, which can eliminate the need for laboratory testing. Some populations, such as farmworkers, would benefit through fingerstick ChE tests. The objective of this pilot study is to determine the feasibility (eg, can the testing be used to assess ChE levels) of using fingerstick ChE testing in adolescent populations living along the Texas-Mexico border where adolescents who often engage in farm work live. A sub-objective was to explore differences in ChE levels by sex. The Model 400 Test-Mate ChE kit by EQM Research Inc (Cincinnati, OH) was used to assess for ChE inhibition in the participants, specifically acetylcholinesterase (AChE), which is 1 of the 2 ChE enzymes. During the postassessment, males had a mean AChE value of 3.75 U/mL (95% CI 3.51-3.98); whereas females had a mean AChE value of 2.86 U/mL (95% CI 2.64-3.08), which was statistically significant. Overall, the study supports the use of field ChE testing in adolescent populations with a small percentage (6.90%) refusing to complete ChE testing.

Single Vehicle Logging-Related Traffic Crashes in Louisiana from 2010-2015.

OBJECTIVES: According to the Centers for Disease Control and Prevention (CDC), highway transportation crashes are the number one cause of fatal occupational injuries in the United States. The rate of fatal crashes in logging far exceeds the average annual rate for all sectors combined, yet few studies examine logging-related transportation crashes, and little is known about factors influencing the frequency of these crashes. The purpose of this study was to identify factors associated with fatal and nonfatal injuries among drivers involved in a single vehicle logging-related crash in Louisiana. METHODS: All crashes involving a single logging vehicle from 2010 to 2015 were extracted from a dataset provided by the Louisiana Department of Transportation and Development. Descriptive statistics were computed to characterize crashes by person, vehicle, and environmental factors. A multiple logistic regression model was constructed to identify variables associated with driver injury (fatal and non-fatal). RESULTS: There were 361 crashes involving a single logging vehicle from 2010 to 2015 in Louisiana. Variables associated with driver injury included no seat belt use (OR = 3.23; 95% CI = 1.47-7.10), a violation issued for careless operation of the vehicle (OR = 3.23; 95% CI = 1.40-7.46), a harmful event classified as cargo or equipment loss or shift (OR = 2.47; 95% CI = 1.27-4.82), and a harmful event classified as the vehicle running off the road to the left (OR = 2.29; 95% CI = 1.12-4.70). CONCLUSION: Injury prevention efforts in the logging industry in Louisiana, including commercial vehicle licensing procedures, could benefit from additional driver training to improve crash avoidance skills and careless driving, seat belt use, and methods for securing loads.

Impact of school health management committees on health services delivery in Ghana: A national level assessment.

OBJECTIVES: To examine the prevalence, determinants, and impact of local school health management committees on implementation of minimum-recommended school health services delivery among basic and secondary schools in Ghana. METHODS: National level cross-sectional data from the first-ever assessment of Ghana Global-School Health Policies and Practices Survey was utilized. Complex sample analyses were used to quantify school-level implementation of recommended minimum package for health services delivery. RESULTS: Of 307 schools, 98% were basic and government run, and 33% offered at least half of the recommended health service delivery areas measured. Schools with a school health management committee (53%) were 4.8 (95% CI = 3.23-5.18) times as likely to offer at least 50% of the minimum health services package than schools that did not. CONCLUSIONS: There is significant deficit concerning delivery of school health services in schools across Ghana. However, school health management committees positively impact implementation of health service delivery. POLICY IMPLICATIONS: School health management committees provide a significant impact on delivery of school health services; thus, it is recommended that policy makers and programmers place greater emphasis on the value and need for these advisory boards in all Ghanaian schools.

Exploring Demographic and Environmental Factors Related to Unintentional Pesticide Poisonings in Children and Adolescents in Texas.

There is limited literature on the frequency and distribution of pesticide exposures, specifically with respect to demographic and environmental factors in the United States. The purpose of this exploratory study was to investigate geographic trends and factors associated with unintentional pesticide exposures in children and adolescents in Texas. The study used an ecological design with secondary data. A spatial scan statistic, based on a Poisson regression model, was employed to identify spatial clusters of unintentional pesticide-related poison center exposures. Next, logistic regression models were constructed to identify potential demographic and environmental factors associated with unintentional pesticide-related poison center exposures. There were 59,477 unintentional pesticide-related poison center exposures from 2000 to 2013. The spatial scan statistic found a change in the number of counties in the identified clusters (e.g. , aggregation of counties with higher than expected exposures) for two time periods (2000-2006; 2007-2013). Based on the logistic regression models, factors associated with unintentional pesticide-related poison center exposures were percent black or African American population, year structure built, and percent moved in the past 12 months. In conclusion, this study found certain demographic and environmental factors may be associated with unintentional pesticide-related poison center exposures. Through understanding trends and associated factors, public health professionals can design interventions for populations at higher risk of pesticide exposures. This study also supports the use of spatial methods being utilized to expand upon current analysis of poison center data. Future research should confirm and build upon these findings.

Characteristics of acute occupational pesticide exposures reported to poison control centers in Texas, 2000-2015.

In the United States, there is limited literature on occupational pesticide exposures despite being associated with adverse health outcomes, including in large states such as Texas. The purpose of this article is to characterize occupational pesticide poison center exposures in Texas. Descriptive statistics were used to describe exposures (eg, exposure routes, type of pesticide, medical outcome, clinical effects, and temporal/seasonal patterns). From 2000 to 2015, there were 2,303 occupational pesticide poison center exposures. Common types of reported pesticides were insecticides (67.3%), herbicides (17.7%), and repellents (5.8%). The highest proportion of exposures were among those aged 20 to 29 years (24.9%). The top clinical effect categories were gastrointestinal (25.8%), neurological (19.2%), and dermal (14.9%). Characterizing occupational pesticide poison center exposures can support improved surveillance systems and guide future research or interventions.

Pesticide-Related Hospitalizations Among Children and Teenagers in Texas, 2004-2013.

OBJECTIVE: Acute exposure to pesticides is associated with nausea, headaches, rashes, eye irritation, seizures, and, in severe cases, death. We characterized pesticide-related hospitalizations in Texas among children and teenagers for 2004-2013 to characterize exposures in this population, which is less well understood than pesticide exposure among adults. METHODS: We abstracted information on pesticide-related hospitalizations from hospitalization data using pesticide-related International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes and E-codes. We calculated the prevalence of pesticide-related hospitalizations among children and teenagers aged #19 years for all hospitalizations, unintentional exposures, intentional exposures, pesticide classifications, and illness severity. We also calculated age- and sex-specific prevalence of pesticide-related hospitalizations among children. RESULTS: The prevalence of pesticide-related hospitalizations among children and teenagers was 2.1 per 100,000 population. The prevalence of pesticide-related hospitalizations per 100,000 population was 2.7 for boys and 1.5 for girls. The age-specific prevalence per 100,000 population was 5.3 for children aged 0-4 years, 0.3 for children and teenagers aged 5-14 years, and 2.3 for teenagers aged 15-19 years. Children aged 0-4 years had the highest prevalence of unintentional exposures, whereas teenagers aged 15-19 years had the highest prevalence of intentional exposures. Commonly reported pesticide categories were organophosphates/carbamates, disinfectants, rodenticides, and other pesticides (e.g., pyrethrins, pyrethroids). Of the 158 pesticide-related hospitalizations, most were coded as having minor (n=86) or moderate (n=40) illness severity. CONCLUSION: Characterizing the prevalence of pesticide-related hospitalizations among children and teenagers leads to a better understanding of the burden of pesticide exposures, including the type of pesticides used and the severity of potential health effects. This study found differences in the frequency of pesticide-related hospitalizations by sex, age, and intent (e.g., unintentional vs. intentional).

Pesticide-related poison center exposures in children and adolescents aged ≤19 years in Texas, 2000-2013.

CONTEXT: Although national poison center data show that pesticides were the 8th most commonly reported substance category (3.27%) for children aged ≤5 years in 2014, there is limited information on childhood and adolescent pesticide exposures. OBJECTIVE: This study assessed pesticide-related poison center exposures in children and adolescents aged ≤19 years from 2000-2013 in Texas to characterize the potential burden of pesticides. MATERIALS AND METHODS: Pesticide-related poison center exposures among children and adolescents aged ≤19 years reported to Texas poison centers were identified. The distribution of exposures was estimated by gender, age category, medical outcome, management site, exposure route, and pesticide category. RESULTS: From 2000 to 2013, there were 61,147 pesticide-related poison center exposures in children and adolescents aged ≤19 years. The prevalence was highest among males at 864.24 per 100,000 population. The prevalence of unintentional exposures was highest among children aged ≤5 years at 2310.69 per 100,000 population, whereas the prevalence of intentional exposures was highest among adolescents aged 13-19 years at 13.82 per 100,000 population. A majority of medical outcomes reported were classified as having no effect (30.24%) and not followed, but minimal clinical effects possible (42.74%). Of all the exposures, 81.24% were managed on site. However, 57% of intentional exposures were referred to or treated at a health-care facility. The most common routes of exposure were ingestion (80.83%) and dermal (17.21%). The most common pesticide categories included rodenticides (30.02%), pyrethrins/pyrethroids (20.69%), and other and unspecified insecticides (18.14%). DISCUSSION: The study found differences in the frequency of exposures by intent for sex and age categories, and identified the most common medical outcomes, management site, exposure route, and pesticide category. CONCLUSION: Through characterizing pesticide-related poison center exposures, future interventions can be designed to address groups with higher prevalence of exposure.

Ergonomics and Beyond: Understanding How Chemical and Heat Exposures and Physical Exertions at Work Affect Functional Ability, Injury, and Long-Term Health.

OBJECTIVE: To honor Tom Waters's work on emerging occupational health issues, we review the literature on physical along with chemical exposures and their impact on functional outcomes. BACKGROUND: Many occupations present the opportunity for exposure to multiple hazardous exposures, including both physical and chemical factors. However, little is known about how these different factors affect functional ability and injury. The goal of this review is to examine the relationships between these exposures, impairment of the neuromuscular and musculoskeletal systems, functional outcomes, and health problems with a focus on acute injury. METHOD: Literature was identified using online databases, including PubMed, Ovid Medline, and Google Scholar. References from included articles were searched for additional relevant articles. RESULTS: This review documented the limited existing literature that discussed cognitive impairment and functional disorders via neurotoxicity for physical exposures (heat and repetitive loading) and chemical exposures (pesticides, volatile organic compounds [VOCs], and heavy metals). CONCLUSION: This review supports that workers are exposed to physical and chemical exposures that are associated with negative health effects, including functional impairment and injury. Innovation in exposure assessment with respect to quantifying the joint exposure to these different exposures is especially needed for developing risk assessment models and, ultimately, preventive measures. APPLICATION: Along with physical exposures, chemical exposures need to be considered, alone and in combination, in assessing functional ability and occupationally related injuries.

A Pilot Study of Changes in Environmental Knowledge and Behaviors among Head Start Employees and Parents Following Environmental Health Training in Webb County, TX.

Head Start centers in Webb County, Texas primarily serve low-income Hispanic families disproportionately affected by environmental exposures. A total of 560 parents and employees attended environmental trainings. Pre- and post-assessments measured whether the trainings were effective at improving related knowledge and behaviors. A total of 152 parents and 94 employees signed consent forms. Only the 64 parents and 50 employees who completed all questionnaires were included in the data analysis. Paired t tests and McNemar tests found significant improvements in knowledge and behaviors related to multiple environmental topics (p < 0.05). Mean scores out of eleven for knowledge before and immediately after were 9.69 (95 % CI 9.44, 9.94) and 10.58 (95 % CI 10.42, 10.74), respectively. Mean scores out of ten for behavior before and 1 month after training were 8.00 (95 % CI 7.71, 8.29) and 9.29 (95 % CI 9.10, 9.48), respectively. This pilot study found improved knowledge and behaviors following environmental health training.