An analysis of self-reported joint pain among New York farmers.

Data from the telephone interview portion of the New York State Farm Family Health and Hazard Surveillance Project were used to study the prevalence and predictors of joint pain in a cohort of farmers and farm residents. The participants were owner/operators, workers, and residents from a representative sample of farms from 12 New York counties. A total of 1706 participants completed a telephone interview on musculoskeletal conditions. Joint trouble was defined as self-reported aches, pain, or discomfort in the past year in each of five different joint areas. The 12-month prevalence of joint trouble was: lower back 41%, neck/shoulders 35%, knees 29%, hands/wrists 28%, and hips 15%. Using logistic regression modeling, significant risk factors for joint trouble were identified (p < 0.05). Older age and being female increased the risk of aches, pain, or discomfort in most joints. Being the owner/operator increased the risk of neck/shoulder and lower back trouble, and being a worker increased the risk of neck/shoulder trouble. Doing tractor work was associated with trouble in all five joint areas, and milking was associated with knee trouble. These findings indicate that personal risk factors and the intensity and nature of the farm work contribute to joint trouble. Ergonomic improvements to tractors and milking facilities should be a high priority.

Predictors of hearing loss in New York farmers.

BACKGROUND: Data from the telephone interview portion of the New York Farm Family Health and Hazard Surveillance were used to study self-reported hearing loss in New York farmers. METHODS: One thousand six hundred and twenty-two persons completed the hearing loss and noise exposure interview. Hearing loss was defined as at least some trouble hearing in one or both ears. Predictors of hearing loss were determined using logistic regression. RESULTS: Twenty-two percent of participants reported hearing loss. From the logistic regression, significant confounders are age (P = 0.0001), gender (P = 0.0001), being from a livestock farm (P = 0.012), and loss of consciousness due to head trauma (P = 0.04). Significant noise exposures are more hours of lifetime exposure to noisy farm equipment (P = 0.001) and having had a noisy non-farm job (with some hearing protection P = 0.002, without any hearing protection P = 0.0001). CONCLUSIONS: Farm noise exposure is a serious risk to the hearing of this population. Although use of hearing protection should be encouraged, replacing and modifying farm equipment to decrease noise at the source should be the first priority.

Severe farm injuries among New York farmers.

BACKGROUND: Data from the telephone interview portion of the New York State Farm Family Health and Hazard Surveillance were used to study the incidence and predictors of severe farm injury. METHODS: One thousand seven hundred and six participants completed two telephone interviews in which they reported all injuries over a 12-month period. RESULTS: Nine percent of participants reported at least one severe farm injury. Using logistic regression the significant risk factors for sustaining at least one severe farm injury are younger age, the presence of hearing loss or joint trouble, working more hours per day, being the owner/operator of the farm, and being from a farm with higher gross sales. CONCLUSIONS: There needs to be continuing education of all farmers as to the risks of injury. However, when resources are limited, we recommend that injury education and interventions in this farming population should target younger farmers, those who work longer hours, owner/operators, farmers from higher grossing farms, with special attention to farmers who have physical impairments.

A comparison of self-reported hearing loss and audiometry in a cohort of New York farmers.

The New York State Farm Family Health and Hazard Surveillance was conducted to assess the health status and safety practices among year-round adult farmers and farm residents in New York State and included a telephone interview survey of 1,727 persons from 552 farms. To determine the extent to which self-reported hearing loss is in agreement with audiometry, a subset of 376 participants who completed a hearing loss interview and pure-tone audiometry was analyzed. Thirty-six percent of the participants had self-reported hearing loss, defined as at least some difficulty hearing in one or both ears. The prevalence of audiometric hearing impairment, defined as a threshold average greater than 25 dB hearing level, was 9% for the binaural low-frequency average (500, 1000, and 2000 Hz), 29% for the binaural mid-frequency average (1000, 2000, 3000, and 4000 Hz), and 47% for the binaural high-frequency average (3000, 4000, 6000, and 8000 Hz). Agreement between self-report and audiometry was highest for the binaural mid-frequency average (kappa statistic 55%, sensitivity 77%, and specificity 82%). Self-reported hearing loss was found to be a moderately good measure of hearing impairment. We conclude that a simple questionnaire focusing on hearing difficulty is a useful and valid tool for conducting epidemiologic studies of farmers. Whenever possible, a substudy using audiometry should be conducted.

Radon awareness, testing, and remediation survey among New York State residents.

Between November 1995 and January 1997, a radon awareness, testing, and remediation survey was conducted to measure general awareness and factual knowledge about radon and prevalence of radon testing and remediation among New York State residents. The survey found that 82% of 1,209 respondents had heard of radon, but only 21% were knowledgeably aware of radon. With regard to radon testing, only 15% of respondents who were aware of radon had their homes tested. The percentage of respondents who were aware or knowledgeably aware of radon increased with increasing education level. The findings from the study suggest that the New York State public awareness programs that targeted high radon areas did show some effect both by increasing public awareness and promoting residential testing. The relatively low percentage of respondents who were knowledgeably aware of radon and the low percentage who had tested their homes strongly suggest that renewed efforts by the public health community are needed to increase knowledge about radon and its health effects and to encourage radon testing and remediation.

Safety awareness among New York farmers.

BACKGROUND: This study was conducted to assess the health status and safety practices among year-round adult farm workers and residents and included a telephone interview survey of 1,727 persons from 552 farms. METHODS: Logistic regression was used to analyze four safety questions. RESULTS: Among 541 farm owner/operators significant predictors of making substitutions in the use of chemicals and major changes to equipment include younger age, more persons assisting on the farm, and higher gross sales. Having training is associated with having more than a high school education. Among all participants the perception that personal protective equipment are useful is associated with being younger, male, an owner/operator or worker, and having at least a high school education. CONCLUSIONS: These findings suggest that older and less educated farmers should be targeted for health and safety programs.

Variation in blood lead and hematocrit levels during pregnancy in a socioeconomically disadvantaged population.

Lead is a long-recognized human toxicant that crosses the placenta. Fetal sensitivity to environmental agents can vary with stage of development; therefore, how maternal blood lead levels change during pregnancy and how fetal exposure is influenced provide useful knowledge. In this study, the authors describe longitudinal changes in blood lead levels during the course of pregnancy in a sample of socioeconomically disadvantaged pregnant women. The women were recruited early in pregnancy when they sought care at one of two obstetrics clinics in Albany, New York. Maternal blood lead levels changed between the 1st and 2nd trimesters, from 1.99 microg/dl to 1.69 microg/dl (hematocrit corrected, 1.70-1.62); between the 2nd and 3rd trimester from 1.78 microg/dl to 1.86 microg/dl (hematocrit corrected, 1.65-1.72); and between 3rd trimester and delivery from 1.80 microg/dl to 2.17 microg/dl (hematocrit corrected, 1.70-1.86). These changes were statistically significant and were corrected for secular trends. The rate of change per day in lead levels averaged -36.6% from trimester 1 to trimester 2, 18.3% from trimester 2 to trimester 3, and -40.8% from trimester 3 to delivery. The patterns in our study were consistent with the patterns reported in a few other longitudinal studies of change in lead level during pregnancy. Findings reveal significant associations between maternal blood lead levels and both hematocrit and trimester of pregnancy. Clinicians who interpret test results should take into account the dynamics of these variables when determining appropriate care for both mother and neonate.

Radon mitigation survey among New York State residents living in high radon homes.

Residential exposure to radon has been considered an important environmental risk factor for lung cancer. Since 1986, U.S. EPA has recommended that all dwellings below the third floor be tested for the presence of radon and be mitigated to reduce indoor radon in homes with levels exceeding 148 Bq m(-3). In order to evaluate the effectiveness of New York State Department of Health's efforts to increase public awareness about radon risk and to promote radon testing and mitigation in compliance with EPA's guideline, a statewide radon mitigation survey was conducted between September 1995 and January 1996 among New York State residents whose homes had radon levels equal to or greater than 148 Bq m(-3) on the first floor (or above) living areas. The survey found that about 60% of 1,113 participants had taken actions for radon mitigation. The percentage of respondents who took actions to reduce radon levels in their homes increased with increasing education level as well as household income level. The method of installing a powered system to provide more ventilation was a more effective mitigation method than opening widows/doors or sealing cracks/openings in the basement. Mitigation performed by contractors was more effective in reducing radon levels than mitigation performed by residents. The reasons for performing radon mitigation given by the majority of respondents were those strongly related to radon health risk. High home radon level was an important motivational factor to stimulate radon mitigation. On the other hand, the cost of radon mitigation was a major barrier in decision making for performing radon mitigation and for selecting mitigation measures. Thus, public educational campaigns that focus on increasing awareness and knowledge about radon health risks and development of less expensive radon mitigation methods may help in promoting radon mitigation.

Blood lead level, by year and season, among poor pregnant women.

The authors conducted a longitudinal study of poor pregnant women and their infants to examine the determinants of maternal and infant lead levels. To accurately depict these determinants, one must account for secular and seasonal variations in these levels. The women's lead levels declined over the 5-y period of study by approximately 20%/y, depending on when in the course of pregnancy measurements were made. After correction for secular trend, we found a periodic effect that differed from that typically seen in children (i.e., peak occurs in summer). In this study, lead levels in these women peaked during December-March. If the effects of lead are greatest in the youngest conceptus, early pregnancies that occur in the December-March period pose the largest prenatal risk.

Social support and adverse pregnancy outcome in a high-risk population.

Low birth weight is a significant health problem in the United States, particularly among poor women. By combining traditional predictors of birth weight with social support indicators, we were able to substantially improve the discrimination between the highest birth weight quartile from the lowest among high-risk gravidae receiving first time prenatal care at the Albany, New York, County Department of Health. The impact of traditional predictors and social support indicators varied considerably between African-American and white women. Providers of care to poor women can utilize this information to maximize the likelihood of a good birth outcome.

Mesothelioma, asbestos, and reported history of cancer in first-degree relatives.

BACKGROUND: Although malignant mesothelioma is known to be strongly related to asbestos exposure, its relationship to familial factors is unclear. METHODS: We compared reported histories of cancer in first-degree relatives, obtained from telephone interviews with the next-of-kin of 196 patients who had a pathologic diagnosis of mesothelioma, and with those from 511 decreased controls. RESULTS: Among men exposed to asbestos, we found a statistically significant twofold elevation in the risk of mesothelioma for patients reporting cancer in two or more first-degree relatives. We found no significant elevation in women or among the small number of men without asbestos exposure. The next-of-kin of three patients (but no controls) reported a possible mesothelioma in a first-degree relative; asbestos exposure could not be ruled out in those relatives. Associations of asbestos with pleural mesothelioma were stronger among men with a reported family history of cancer than men without, although no statistical evidence of an interaction was detected. CONCLUSIONS: These results provide suggestive, but limited, evidence that a family history of cancer may be a risk factor for mesothelioma, or may indicate an increased susceptibility to mesothelioma given asbestos exposure.

Exposure to asbestiform minerals and radiographic chest abnormalities in a talc mining region of upstate New York.

A radiologist in New York reported a high prevalence of pulmonary fibrosis in St. Lawrence and Jefferson counties. The New York State Department of Health responded by conducting a case history study of radiographic abnormalities found in the lung parenchyma and pleura of residents in Lawrence and Jefferson counties, where tremolitic talc has been mined for many years. During a 1-y period, all radiographs from 6 hospitals in the region were reviewed. A B-reader confirmed that 355 of 9,442 patients who were at least 40 y of age (3.8%) had a relevant abnormality; 60% of them reported occupational exposure to asbestiform minerals, and another 15% had a chest condition or injury that could have accounted for the abnormal radiograph. The results should be interpreted cautiously, but there was no evidence of widespread radiographic abnormalities resulting from ambient dust exposure. The data, however, support earlier studies that indicate that talc miners and millers experience excess parenchymal fibrosis and pleural changes. The data also suggest that individuals in the paper industry and construction trades may be at risk.

Familial clustering of neural tube defects and gastric cancer.

A retrospective cohort study was conducted to determine whether producing an offspring with a neural tube defect (NTD) is associated with the development of unusual patterns of cancer among the parents in subsequent years. Mothers and fathers who had a child with an NTD in Upstate New York from 1945 to 1955 were followed through 1979 and compared to a control group of parents with normal offspring. Overall mortality and site-specific cancer incidence were not significantly different for case parents versus control parents, with the exception of gastric cancer, which occurred significantly more frequently in case parents. The finding of a familial association between NTDs and gastric cancer, coupled with a parallel decline in rates of these two diseases, suggests a common aetiology, perhaps related to dietary factors.

A retrospective cohort study of cancer incidence among New York State Farm Bureau members.

Cancer incidence from 1973 through 1983 in 18,811 New York Farm Bureau members was examined using a retrospective cohort study design. The observed number of cancers for all age groups was 72% of the expected, and the major deficits in incidence occurred for lung (52% of expected), gastrointestinal (67% of expected), and bladder (78% of expected). Similar deficits have been reported by other researchers. Unlike other studies, we did not find a significant excess of cancer of any site. Given the healthy worker effect and the small numbers of incident tumors at some sites, the Standardized Cancer Incidence Ratios that were over 100 in value (i.e., lip, melanoma of the skin, prostate, multiple myeloma) merit further investigation. This study differs from previous research in population, setting, and method. Nonetheless, the general pattern of results is consistent with the findings of other investigations.

A retrospective cohort study of mortality among New York State Farm Bureau members.

A retrospective cohort study was conducted to examine mortality among 18,811 male farm owners and operators in New York State from 1973-1984. Farm Bureau membership lists were used to identify the study population, and vital status was determined through record linkage with death certificate and motor vehicle files. The comparison group consisted of the 1980 United States Census population of men who resided in the same towns as did the farmers. The results indicated that the study cohort experienced fewer than the expected numbers of deaths overall and for each major cause category except accidents. Specific causes with significant mortality deficits included cancer of the lung (standardized mortality ratio [SMR] = 47.0); diabetes mellitus (SMR = 57.5); ischemic heart disease (SMR = 65.3); bronchitis, emphysema, and asthma (SMR = 26.7); and cirrhosis of the liver (SMR = 29.7). The only specific cause with a significantly elevated mortality was accidents other than motor vehicle (SMR = 146.5). The investigation differs from previous research in method, setting, and population, but the pattern of findings is generally consistent with that of other studies.

Health effects of low-level exposure to polychlorinated biphenyls.

A polychlorinated biphenyl (PCB) spill resulting from a transformer explosion in Syracuse, New York, with no subsequent fire, provided an opportunity for the examination of the effects of low-level PCB exposure without the confounding presence of furans and dioxins. The incident provided 52 individuals exposed to PCB among building personnel, police, firemen, and public utility employees. Sixty-eight nonexposed were matched to the exposed group by sex, age, employer, and job description. Data were collected on the exposed relative to their activities at the spill site, their location, possible routes of exposure, duration of exposure, and subsequent health effects. Exposed and nonexposed were interviewed for past medical history and relevant symptoms. Blood chemistries were studied inclusive of SGOT, SGPT, total protein, CBC, cholesterol, and triglyceride levels, as well as a fasting blood PCB level measurement. Six weeks after the spill, exposed and nonexposed were reinterviewed and had their blood work repeated except for the CBC and PCB levels. Exposed and nonexposed laboratory results were unremarkable. Some transient skin irritation believed to be associated with PCBs was noted. There were significant PCBs in blood level trends for occupation, age, duration of exposure, and level of alcohol consumption. Triglyceride level was highly correlated with PCB level. This relationship held when age and alcohol consumption were controlled for.

An example of record linkage methods to monitor mortality and cancer incidence.

Linkage of New York State record systems was the key strategy in a restrospective cohort study with a 24-34 year followup interval. Parents of children with anencephaly or spina bifida and matched control parents were traced to determine the parents' cancer and death experience. Birth certificates for Upstate New York for 1945-55 were the source of the study groups. This report describes the methodology employed. The New York State Health Department's Cancer Registry and vital records, the State motor vehicle license files, and city and phone directories were searched for the most recent record indicating residence in Upstate New York, cancer incidence, or death.Among the parents of the 1,152 index children were 18,571 person-years of followup for mothers and 21,675 person-years for fathers. Among the 1,152 controls, there were 19,682 person-years of followup for mothers and 22,596 person-years for fathers. Although losses were larger than the optimal, a large proportion of the maximum possible person-years were obtained, regardless of the birth year of the index child. Patterns of loss to followup were similar for cases and controls.Record linkage techniques are especially applicable in followup studies if the risk factor is identifiiable from routinely collected information (for example, congenital neural tube defects listed on birth certificates) and the outcome is also identifiable from such records (for example, cancer registry certificate or death certificate). If the outcome is definitive, reported routinely and comprehensively, and stored on a machine-readable medium, use of a computerized record linkage design is very efficient. A major advantage of the design is that cases and controls are treated equally with respect to outcome ascertainment and followup, so that some potential biases are eliminated. Finally, the method is non-intrusive; the subjects are never contacted or interviewed. Strictly maintained confidentiality is, of course, required.

Relationship of sociodemographic factors to blood lead concentrations in New Haven children.

From September 1974 to 28th February 1977 80% of the children in New Haven, Connecticut, aged from 1 month to 72 months were screened for blood lead concentrations. This report examines the relationship of several socioeconomic factors to blood lead concentrations. In addition, a set of hypotheses regarding the effect of environmental and social factors on blood level concentrations in racially defined groups was tested. Characteristics associated with increased blood lead concentrations were found to be those that tend to impair the ability of a family to provide the necessary care and supervision for the young child. The risk factors, however, produce different effects on the various race groups. The analyses support the belief that the elimination of childhood lead poisoning as a public health problem will require recognition of social-demographic and family operational factors that underlie the interactions of childhood behaviour and environmental lead potentially available to children.