Farm Dinner Theater: Testing an innovative health and safety intervention among older farmers and their families.

PURPOSE: The effectiveness of a novel intervention for increasing health and safety behaviors of older farmers was tested. Blending didactic and readers' theater techniques, Farm Dinner Theater (FDT) engages farmers in discussions of health and safety in a nonthreatening social atmosphere supportive of potential changes. METHODS: Through community collaborations, farmers 45 years and older were recruited in 8 communities for the FDT. For each site, 3 scripts were prepared highlighting health and safety issues especially relevant for older farmers. The brief plays were performed in a dinner theater format, with group discussion following each play. Printed educational packets (EPs) addressing the same topics were mailed to comparison groups of participants in 9 communities. In telephone interviews conducted 2 weeks and 2 months later, 870 participants (553 FDT and 317 EP) reported health and safety-related changes they had made in their farm operations. FINDINGS: FDT participants were more likely than EP participants to report having made any changes and reported making more changes on both the 2-week and 2-month follow-up assessments. This outcome occurred when analyzing all farms and when considering only farms with at least 1 participant who spent 10 or more hours per week farming. CONCLUSIONS: FDT is a fun, relaxing intervention; it is acceptable to farming communities; and it is more effective in producing health and safety-related changes than the common approach of providing printed materials. FDT not only had a greater impact than EP, but it has the potential to reach larger audiences due to its greater appeal.

Obesity and Work-Related Injuries Among Farmers in Kentucky, Tennessee, and West Virginia.

BACKGROUND: Obesity is a recognized risk factor for work-related injuries (WRI). Despite the inherent safety hazards associated with farm work, research on obesity among farmers is limited giving little guidance to occupational health providers on obesity as a risk factor in farm WRI. This study evaluated the association between obesity and farm WRI. METHODS: Cross-sectional data were collected from farmers (n = 100) in Kentucky, Tennessee, and West Virginia. Data included a survey (demographic data, farm factors, health indicators, occurrences of work-related injuries consistent with the definition of Occupational Safety and Health Administration [OSHA] recordable injuries) and direct anthropometric measures (height, weight, and waist circumference). Logistic regression was used to model any work-related injury, injuries consistent with the definition of OSHA recordables (herein called OSHA-recordable injuries), and recurrent injuries occurring during farm work performance on body mass index (BMI) and waist circumference. FINDINGS: Twenty-five percent of the participants reported any injuries, and 18% reported OSHA-recordable injuries. Farmers with a BMI ≥30 kg/m2 had 3 times the risk for OSHA-recordable injuries and 5 times the risk for recurrent injuries. No significant relationship was identified between waist circumference and farm WRI. CONCLUSION: This study provides evidence that increased BMI is a safety risk for farmers. Prospective studies with a larger sample are needed. Occupational health nurses and providers should educate farmers on the potential safety risk of obesity and implement weight management programs addressing obesity in farmers.

Changing Health Practices Through Research to Practice Collaboration: The Farm Dinner Theater Experience.

Production agriculture ranks as one of the most hazardous occupations in the United States, with older producers suffering 3.5 times the fatalities compared with their younger counterparts. Previous interventions have not significantly improved the health or work behaviors of farmers. Through careful collaboration among academics and Cooperative Extension agents, we developed, tested, and expanded a unique educational experience, Farm Dinner Theater (FDT), for farmers aged 45 years and more and their families across three states (n = 8 communities, 573 participants). More than 50% of the participants made health or safety changes following the theater. Communities requested more theater events, noting the realism and applicability of the content and the engaging atmosphere for discussion. Participants remarked that the theater should be used across all age-groups. The FDT project created a community of "champions" that synergized the initial research project and fostered expansion and sustainability of the intervention. Process evaluation guided refinement of the theater intervention and built trust, respect, and further cooperative work among all collaborators. Members of the FDT partnership have received national recognition and funding to upscale the concept. The number of FDTs has expanded under local leadership. A toolkit that resulted from the project is available to the public and is constantly updated as more adopters contribute insight and scripts. This article describes the collaborative theater concept and demonstrates how sustained translation from research to practice can be accomplished through continued community engagement, collaboration, and outreach.

Predictors of Job Satisfaction in Female Farmers Aged 50 and Over: Implications for Occupational Health Nurses.

BACKGROUND: Over the past three decades, the number of female farmers in the United States has increased to nearly 1 million, yet research on this occupational group is limited. Job stress arising from job dissatisfaction in other occupations is associated with both acute and chronic diseases. The purpose of this study was to examine the associations of demographic characteristics, agricultural occupational factors, and health indicators with farm-work satisfaction among female farmers. METHODS: Cross-sectional data from the Sustained Work Indicators of Older Farmers Study (2002-2006) was used to examine older female farmers (N = 332) from North Carolina and Kentucky. This secondary data analysis used farm-work questions adapted from the Kentucky Farm Health and Hazard Surveillance Project to measure demographics and occupational factors, the 20-item Center for Epidemiologic Studies-Depression Scale to measure depressive symptoms, and a single item from the National Health Interview Survey to measure self-perceived health status. FINDINGS: Controlling for demographic characteristics, work factors, and health indicators, the female farmers were more likely to report satisfaction with farm work when they had performed a greater number of agricultural tasks in the past year and if they had lower levels of depressive symptoms. CONCLUSIONS/APPLICATION TO PRACTICE: This study provides an initial basis for further research with women working in agriculture. Occupational health nurses, particularly those practicing in agricultural areas, can enhance their quality of care by having a greater understanding of the factors associated with farming and farm life that affect female farmers' overall health.

Risk for Depressive Symptoms and Suicide Among U.S. Primary Farmers and Family Members: A Systematic Literature Review.

Background: About 84% of the agriculture, fishing, and forestry occupational sector is comprised of farmers. This sector is at high risk for suicide in the United States. Recent disasters and trade upheavals may make farmers and their families more vulnerable to depression and suicide. This review focused on the risk for depression and suicide among United States' primary farm operators and their families. Methods: A systematic search of the literature published between January 2000 and June 2019, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was conducted. Results: A total of 30 articles met full inclusion criteria. Seventeen reports emanated from the midwest. Twenty studies used a cross-sectional design, primarily assessing a convenience sample or random stratified sample from a limited geographic area. We discovered only one intervention evaluation study. Depressive symptoms were assessed as part of the studies, but it was not the major focus. A variety of instruments measured depressive symptoms, with the Centers for Disease Control Epidemiologic Studies-Depression (CES-D) Scale used more frequently than other scales. Thirteen studies focused on the relationship between pesticide/chemical exposure and depression or suicide risk. Increased stress, poor physical health, compromised financial position, and previous injury were among the leading indicators of depression. Conclusion/Application to Practice: The limited number of studies that was discovered identified the need for more robust science where the risk for depression and suicide is the primary focus of the study and for intervention studies grounded in science. Occupational health providers should be vigilant about farm exposure and be aware of factors that may influence depressive symptoms of workers who operate farm establishments.

Poor sleep quality is associated with obesity and depression in farmers.

BACKGROUND: Farmers' work schedules can result in inconsistent sleep patterns which negatively impact health. PURPOSE: To explore the relationships between sleep, obesity, and depression in working, older farmers and their spouses. Covariates included body mass index (BMI), age, and gender. METHODS: Sleep quality, BMI, and depression were assessed in farmers (n = 1,394) 50 years and older. Bivariate associations among all covariates (i.e., age, gender, BMI, sleep) and dependent variable (i.e., depression) were analyzed using Pearson's correlation. Multivariable associations of the Center for Epidemiologic Studies Depression Scale (CESD). BMI with other study variables were assessed using linear regression. RESULTS: BMI was positively associated with sleep apnea symptoms (p ≤ 0.0001) and CESD scores (p = 0.0006). Participants with difficulty falling asleep were more likely to have poor sleep quality (p ≤ 0.0001) and higher CESD scores (p ≤ 0.0001). Poor sleep quality was associated with higher CESD scores (p ≤ 0.0001). Increased age, female gender, higher BMI, sleep apnea symptoms, and poorer sleep quality were all predictive of higher depressive symptoms. DISCUSSION: Farmers have unique lifestyles that increase the risk of poor sleep. Screening for sleep pattern disruption and understanding its impact could result in lower rates of depression and obesity in this group of high-risk individuals.

Suicide: An Unrecognized Epidemic Among Farmers.

Stress and depression are prevalent among farmers, and suicide has reached epidemic status. Occupational health nurses are in key positions to recognize these mental health issues and use strategies to control this epidemic.

Postoperative Symptom Distress of Laparoscopic Cholecystectomy Ambulatory Surgery Patients.

PURPOSE: The purposes of this study were to (1) identify symptoms that cause postoperative distress in ambulatory surgery patients; (2) identify symptom management techniques that effectively reduce distress of laparoscopic cholecystectomy (LC) postoperative symptoms at home after ambulatory surgery; and (3) identify facilitators and barriers to self-management of postoperative symptoms. DESIGN: A qualitative descriptive study. METHODS: Two focus groups of ambulatory surgery patients who had experienced a laparoscopic cholecystectomy procedure and their caregivers were queried to elicit understanding of postoperative symptoms and symptom management techniques. FINDINGS: Themes identified included distressing symptoms and consequences of surgery, symptom management, and self-management facilitators and barriers. Pain was a major symptom after surgery and impacted mobility and sleep. Participants in our study wanted realistic information about symptoms and more specific information on symptom management. Caregivers were important to the success of symptom management but experienced their own stress. CONCLUSIONS: Perianesthesia nurses should focus not only on the immediate recovery, but also prepare patients and their caregivers for the more prolonged issues of recovery at home.

Postoperative Distress of Orthopedic Ambulatory Surgery Patients.

Patients who undergo orthopedic ambulatory surgery have reported high levels of symptom distress during recovery at home. Content analysis of this qualitative descriptive study identified techniques of symptom management that effectively reduce postoperative symptom distress after orthopedic ambulatory surgery and provided insight into facilitators and barriers to postsurgery self-management. Focus groups consisted of 19 patients and caregivers recruited from a university orthopedic surgery office. The authors identified the common themes as distressing symptoms and consequences of surgery, management of symptoms, and self-management facilitators and barriers. Participants in our study noted the lack of continuity of care after discharge and wanted to know the realities of symptoms and receive more detailed information from care providers on how to self-manage symptoms. Nurses involved in the care of these patients should focus not only on short-term recovery, but on preparing patients to manage sustained recovery issues at home.

Moving social work norms via theater for senior farmers.

PROBLEM: Senior farmers have a 2.6-fold risk of fatal injury compared to their younger counterparts. Usual educational interventions have resulted in limited success in reducing injury. METHOD: An innovative strategy, didactic readers theater, was piloted. Farmers' stories provided the foundation for the scripts. The approach incorporated adult learning strategies based on Ajzen's Theory of Planned Behavior. The intervention was marketed as a "dinner theater" to farm couples. Three short socio-novels (plays) were presented by local farmers who served as actors. Following each play participants completed a reaction form and participated in a short discussion about the play's content. One week later a phone survey was completed that tapped further reaction to the content and behavior changes. RESULTS: Thirty-three farm household individuals (including 16 couples) participated. Participants expressed favorable reaction to the intervention. Within one week post intervention, 42% had made safety changes and 67% were "thinking about/intending" to make changes. DISCUSSION: The use of real stories contributed to the success of this intervention. Farmers identified with the stories and began to think and talk about the impact that aging exerts on their health and safety. Interaction among the group identified work modifications which empowered the farmers to make positive changes in their own work behavior. SUMMARY: Educational interventions with farmers have met with limited success in reducing farm-related injuries. Moreover, few interventions have utilized the family unit. This novel program, incorporating local organizations and using limited financial resources, resulted in swift behavior changes. PRACTICAL APPLICATIONS: Total Worker Health includes not only the worker, but also the family. Interventions that include family units should be considered when possible. This format is effective, easily adapted to local issues, can be delivered using existing infrastructure, and is acceptable to the farm community. It is currently being tested on a larger scale.

Farm work injuries among a cohort of children in Kentucky, USA.

Children residing on farms with livestock may be at an increased risk for work-related injuries, compared to children who work on other commodity farms. This study characterizes children's work tasks on Kentucky farms and assesses whether children who work on beef cattle farms are at an increased risk for farm work injuries. The results of a cohort study of children aged 5-18 years (N=999 at baseline) working on family farms in Kentucky, followed for two consecutive years after an initial enumeration five years previously, found that 70% of the children were involved in animal-related chores. Across all age groups, children on beef cattle farms devoted a greater number of hours per week to farm work, compared to children living on other commodity farms, especially during the school year. For all children in the study, working more than 180 days per year, performing farm work independently, and working on a beef cattle farm (compared to other commodity farm), increased the risk of a farm work injury. However, none of these associations were statistically significant. For male children only, the performance of work tasks independently was significantly associated with a 2.4-fold increased risk (OR = 2.41; 95% CI: 1.15-5.06; P=0.02) for a farm work injury, after controlling for days of working, age, period of data collection, and commodity type of the farm.

Depression in Registered Nurses: A State of the Science.

Registered nurses suffer from depression at almost twice the rate of individuals in other professions. Major depression affects both employees and organizations. Depression is linked to increases in work absenteeism, short-term disability, and decreased productivity and presenteeism. Depression experienced by registered nurses may not be fully preventable, but realizing its presence and prevalence in the workplace is of vital importance. It is essential that we have a healthy, vibrant, and present registered nurse workforce to ensure that quality patient outcomes are achieved. This review of 36 articles assesses the current state of the science related to depression in registered nurses so that occupational health nurses can create pathways and work environments for better mental health for registered nurses.

Predictors of depressive symptoms in older rural couples: the impact of work, stress and health.

PURPOSE: Older farmers experience a high rate of suicide, and depression is closely aligned with suicide among agricultural workers. Depressive symptoms may be influenced by work patterns, work satisfaction, stress, and health status. In addition, members of a couple may affect each other's depressive symptoms. The purpose was to determine whether depressive symptoms score is predicted by hours worked on the farm, satisfaction with work, number of health conditions, perceived stress, and demographics in a sample of older farm couples, and to assess the degree of influence on depressive symptoms spouses have on each other. METHODS: A total of 494 couples participated in the initial interview for a longitudinal study of farmers aged 50 and above. Data from husbands and wives were used together in a multilevel, dyad-based regression model to determine predictors of depressive symptoms. FINDINGS: Men's depressive symptoms scores were predicted by their own number of health conditions and stress and by their wives' stress and health conditions. Women's depressive symptoms scores were predicted by their own work satisfaction, stress, and number of health conditions and their husbands' time spent working on the farm and stress. CONCLUSIONS: Stress management may be particularly important in older farm couples, since perceived duress of 1 member of the dyad impacts both. Work factors and health conditions also affect depressive symptoms in older rural couples, but these may be less easily modified.

Occupational injuries on thoroughbred horse farms: a description of Latino and non-Latino workers' experiences.

Animal production is a dangerous industry and increasingly reliant on a Latino workforce. Within animal production, little is known about the risks or the occupational hazards of working on farms involved in various aspects of thoroughbred horse breeding. Extant research suggests that horse workers are at risk of musculoskeletal and respiratory symptoms, kicks, and other injuries. However, limited known research has examined the experiences of the industry's workers, including immigrant workers, despite their prominence and increased vulnerability. Using data collected from thoroughbred farm representatives via a phone-administered survey, a 2-hour face-to-face semi-structured interview, and farm injury logs, this article identifies and describes types of injuries experienced by workers (N = 284) and their surrounding circumstances. Results indicate that general injuries and musculoskeletal strains, sprains, and tears account for a majority of injuries among workers on thoroughbred farms. Upper limbs and extremities are most frequently injured, while direct contact with the horse accounted for over half of all injuries. No differences in the diagnoses or distribution of injury were found by ethnicity; however, Latinos were more often struck by or trampled by a horse while non-Latinos were more often injured by an insect or plant. Implications and opportunities for future research are discussed.

Active coping, personal satisfaction, and attachment to land in older African-American farmers.

Elevated suicide mortality rates have been reported for farmers and for the elderly. Very little literature exists that looks at the health of older minority farmers. This mixed-method study describes older African-American farmers (N = 156) in the contexts of active coping, personal satisfaction from farm work, and attachment to their farmland to provide insight into the psychosocial dimensions of their mental health. Findings show that the farmers have positive perspectives on work and farm future, and strong attachment to the land. Differences were noted by gender. Nurses can use these findings to frame culturally appropriate strategies for aging farmers to maximize positive outcomes.

What we know about the effectiveness of farm safety day programs and what we need to know.

BACKGROUND: Farm safety day camps are grassroots educational interventions organized and conducted by members of a local community. These events are held in an effort to promote safety knowledge and behavior in children who live on family farms or are exposed to the hazards of the agricultural industry. Since the dramatic increase in farm safety day camps beginning in the 1990s, researchers have been called upon to evaluate their effectiveness. PURPOSE: The current paper reviews more than a decade of research, describing what is currently known about the effectiveness of farm safety days and suggesting potential methods for addressing questions regarding gaps in what we know about their effectiveness. CONCLUSIONS: The results of these evaluations indicate that farm safety days have a positive impact on children's safety behavior and knowledge; however, much remains to be investigated regarding the effectiveness and impact of these interventions.

Farm elders define health as the ability to work.

Thirty percent of America's 2.2 million farms are operated by individuals older than 65 years. This study examined how older farmers define health and determined whether demographic characteristics, farm work, and physical and mental health status predict health definition. Data were collected via telephone and mailed surveys during the baseline wave of data collection in a longitudinal study of family farmers residing in two southern states (n=1,288). Nearly 42% defined health as the "ability to work" compared to a physical health-related definition. Predictors of defining health as the ability to work included being White, performing more farm tasks in the past week, taking prescription medications daily, and having minimal health-related limitations to farm work. Health behaviors are centered on the individual's perception of health. Understanding the defining attributes of health can support better approaches to health care and health promotion, particularly among rural subcultures such as farmers, whose identity is rooted in their work.

Patient's perception of quality patient--provider communication.

PURPOSE: To develop a model of patients' perception of quality patient-healthcare provider communication. METHODS/SAMPLE: Fifteen patients with rheumatoid arthritis participated in in-depth, audiorecorded interviews. Following transcription verification, interviews were analyzed using constant comparative analysis to identify primary themes and develop a model of patients' perception of quality patient-healthcare provider communication. FINDINGS: The participants described a multifaceted, dynamic process of quality patient-healthcare provider communication involving the interrelationship between appropriate time and 4 key communication exchanges: patient honesty when explaining symptoms, patients asking questions and offering opinions, healthcare providers asking questions and offering opinions, and healthcare providers disseminating information. CONCLUSION: By understanding patient-healthcare provider communication from the patient perspective within the rubric of this model, healthcare providers can adapt interactions with patients with rheumatoid arthritis to incorporate dimensions of the exchange that their patients feel create effective communication.

Exercise among commercial truck drivers.

This study examines the exercise habits and perceived barriers to exercise of a convenience sample of 300 commercial truck drivers. Participants reported minimal amounts of exercise, with nearly 20% not exercising in the past week. A high prevalence of obesity was found in this sample: 93.3% of study participants had a body mass index (BMI) of 25 or higher. Drivers with BMIs of greater than 30 were significantly more likely to rate the exercise environment as terrible/bad. Drivers who had at least one health condition engaged in significantly less aerobic exercise, used fewer strengthening exercises, did not exercise for 30 minutes continuously, and had a higher BMI. Drivers who spent most of their off-duty time in their truck while their partner drove were also significantly more likely to not exercise regularly. Most drivers cited lack of time and place as the primary barriers to exercising. This study adds to the limited knowledge about exercise behaviors among commercial truck drivers.

Determinants of work hours among a cohort of male and female farmers 50 years and older in Kentucky and South Carolina (2002-2005).

The average age of United States farmers has been increasing for 20 years. The objective is to examine the factors associated with hours worked among farmers age 50 and older. A cohort of Kentucky and South Carolina farmers (n = 1394) over age 50 were surveyed annually during 2002-2005. Of those that reported any farm work, males worked 24 mean hours/week and females worked 14 mean hours/week. Greater satisfaction and more experience farming, increased acreage, and presence of animals significantly increased estimated hours farmed, whereas chronic health problems, although prevalent, had a minor role in determining work hours.