Agricultural Health Safety

M.J. Perry

The George Washington University,

 Washington, DC, USA

(© 2014 Elsevier Inc. All rights reserved.)

Melissa Perry

Scope of the Problem

           Agriculture originated more than 11 000 years ago and is one of the world’s oldest and largest industries. Currently more than a third of the world’s employed population is engaged in agriculture, totaling 1.05 billion people in 2012 (International Labour Organization, ILO, 2013a). Agriculture employment patterns vary in part by the level of a country’s economic development. In many developed nations, the largest share of employment is in the services sector, followed by industry, with a small proportion, usually less than 10%, in agriculture. In other nations, predominantly transitional economies, agriculture accounts for the largest proportion of employment, followed by services and then industry (International Labour Organization, ILO, 2013a). For example, in North America 7 million people are engaged in agriculture, whereas in Asia about 400 million people are working on farms consisting primarily of family-owned plots. Farming in developed countries has transitioned into large-scale production agriculture involving larger farms often owned by companies rather than individuals. In North America and Europe, the number of family owned farms is shrinking and the holdings of the remaining farms are increasing. In developed and developing nations, peasants and subsistence farmers working only small plots of land produce four-fifths of developing countries’ food supply, yet these agricultural workers may be among the poorest sectors of society. They may live in isolated rural conditions with substandard housing, inadequate access to clean water and health care, and with little or no educational opportunities or other economic options.

        The economic hardships of rural poverty are compounded by the health demands intrinsic to agricultural labor. Farming is one of the most hazardous occupations and people working on farms worldwide experience injuries and disease associated with both subsistence and production agriculture. Sources of hazards can be broadly grouped into those from trauma, chemical exposure, psychosocial stressors, and pulmonary exposures. Regardless of the scale of operations, agricultural work entails numerous occupational health risks, many of which can be targeted for prevention. For the most part, this article discusses health issues experienced by individuals working in agriculture including farm owners, farm family members, and farmworkers. Risks to children living or working in the farm environment are also discussed.

Agricultural Workers and Their Families

         Some of the major health problems, both acute and chronic, among adult farming populations include respiratory disorders, cancer, neurologic problems, injuries and traumatic deaths, skin diseases, hearing loss, stress, and problems in reproduction. In countries where mechanization is a routine part of farming, the leading agents of fatal and nonfatal injuries to farmers and farmworkers are tractors and farm machinery, followed by livestock, building structures, falls, and bodies of water. Environmental exposures include pesticides, volatile organic compounds (fuel), noxious gases, airborne irritants, noise, vibration, zoonoses, and stress. Farm family members may also be exposed to these hazards, making agriculture a unique example of the intersection of occupational and environmental exposures. On the approximately 2.2 million farms in the United States in 2010, for example, there were about 800,000 farm workers and 6.2 million farm residents. In 2010 the number employed in the agriculture sector in the 27 member countries of the European Union (EU27) was over 10 million people. The 2011 rate of nonfatal injuries in the EU27 was 1870 per 100 000 workers, and the leading agents responsible are similar to those in the United States, which includes machinery, falls, and hazardous environmental exposures. In countries where mechanization is not routine, the leading agents of fatal and nonfatal injuries to farmers and farmworkers are livestock, pesticides, zoonoses, and stress.

        Farming is also unique in that child labor is common. Special consideration must be given to the health risks faced by children working in agriculture. The maturing organ systems of children and adolescents may be especially vulnerable to the harmful effects of hazards commonplace in agriculture, such as chemical exposures and physical stressors. Data on the scope of child farm labor in developing countries are scarce; however, estimates from 2012 suggest around 101 million children worldwide are working in agriculture (International Labour Organization, ILO, 2013b). Globally, child labor has been a part of plantation agriculture throughout its history; families working on plantations as contract laborers must rely on all members of the family unit working together to increase productivity and in turn, their compensation. On family-owned farms in the United States, approximately 27% of farm residents are youths less than 20 years old, and at least 300 000 youths between the ages of 15 and 17 work alongside their parents as farmworkers. Although the exact number of youths exposed to farm hazards annually in the United States is unknown, it has been estimated at more than 2 million.

       Women account for over half of the global agricultural workforce; however, they are often overlooked in international labor statistics. In addition to facing the same hazards as male agricultural workers face, women working in agriculture during their reproductive years may be exposed to toxic chemicals or physical demands that can also cause problems with reproduction and pregnancy maintenance. There is also concern that women who are exposed to biologically active chemicals during agricultural work may be at risk for hormone disruption across the lifespan, from their pre-reproductive years through menopause and beyond.

Sources of Hazards and Health Risks

         Two health specialty areas dealing with agriculture are worth noting. Agricultural medicine refers to the subdivision of public health and/or occupational medicine included in the training and practice of health professionals. Agro-medicine refers to a specialty partnership between agricultural and medical professionals invested in reducing illness and deaths related to agriculture. Agro-medicine has focused on core health areas of traumatic injury, pulmonary exposures, and agrochemical injury. Table 1 provides a general guide to these agriculture-related health risks. Rather than serving as a complete guide, the table is designed to highlight the principal exposures and possible manifestations that public health practitioners should be aware of when designing programs to improve health and safety in the agricultural environment (Zejda et al., 1993).

Fatal and Nonfatal Injuries

         Disabling injuries and accidental deaths represent one of the most disturbing aspects of safety risks in agriculture. Globally 170 000 agricultural workers die each year from traumatic injuries and the fatal injury rate in agriculture is twice that of other industries. Injuries on the farm involve tractor rollovers, machine injuries, animal injuries, and farmyard injuries. An estimated 15 000 children under the age of 20 years who lived on, worked on, or visited farms and ranches were injured in 1998, and approximately 100 unintentional injury deaths occur annually among children and adolescents on U.S. farms (Myers and Hendricks, 2001). Children account for about 20% of all U.S. farm fatalities and a higher proportion of the total number of nonfatal farm injuries. Farm machinery (including tractors) is the leading cause of fatality to farm youth less than 20 years of age in the United States. Thirty percent of farm machinery-related deaths are among children less than 5 years of age. Drowning is the second leading cause of death on farms with children less than 5 years of age, accounting for 32% of the deaths. The most common injury resulting in death is to the head or brain, accounting for nearly two-thirds of the total. The leading sources of nonfatal injuries are surfaces, animals, and nonindustrial off-road vehicles; and the leading causes of these injuries are falls, off-road transportation accidents, and being struck by objects. The parts of the body most commonly injured are hands, head, and legs and the most frequent types of injury are lacerations, fractures, and scrapes or abrasions.

         For all workers, especially field workers, fatigue increases the risk of injury. Long hours, early morning hours, and work in very hot conditions all increase fatigue, as does the heavy physical labor entailed in most agricultural work. The relative inexperience of young workers also increases their risk of accidents and injury. Farmers identify stress and overwork as a main reason for forgoing pesticide safety practices and rushing is a well-established risk factor for machine-related injury in a variety of settings. Younger age, the presence of hearing loss or joint trouble, and working more hours per day are also strong predictors of severe injury (Hwang et al., 2001).

Trauma from Overexertion or Repetitive Motion

        Ergonomic hazards refer to physical demands placed on the body that can lead to disorders and loss of function. Agricultural work in particular has been linked to musculoskeletal trauma due to the stresses on the body of constant bending, lifting, twisting, and other awkward or punishing work. In the European Union, for example, close to 60% of workers in agriculture and fishing are exposed to painful positions at work half the time or more and 50% carry heavy loads at work half the time or more. Numerous farming tasks such as propagation and harvesting require workers to stand, bend, or stoop in demanding positions for long periods of time. Sprains, strains, and overexertion are all common injuries, especially for workers engaged in manual cultivation. Nursery workers engage in repetitive gripping and cutting. They work virtually full-time year round without rotation to other jobs. In the short term, horticultural workers often report pain and numbness in the hand, wrist, and arm. After an extended time on the job, they are at high risk for carpal tunnel syndrome, a disabling condition of the hand.

Noise

        Although little population-based data are available, as much as 55% of farmers older than 50 may have clinically significant hearing impairment. Hearing impairment related to noise generated by farm equipment develops early in life. Rural students have a 2.5 times greater hearing loss than urban students and that discrepancy increases with age and number of years worked in farming. Farmers and farm family members are exposed to excessive noise from equipment used on the farm, including tractors, grain dryers, combines, bush hogs, and chain saws. Noise- induced hearing loss occurs with continued exposure to high levels of noise; it is cumulative and irreversible. Noise-induced hearing loss results from the destruction of the cochlear hair cells in the inner ear. There are two types of hearing damage caused by excessive noise. Acoustic trauma occurs when the ears are exposed to a single sudden sound above 140 dB(A) (decibels measured on the A scale, which incorporates weighing that takes into account the ear’s varying response to sounds of different frequencies) and the sensory cells are permanently dislodged and destroyed. Gunshot blasts or explosions can cause acoustic trauma. Prolonged exposure to noises above 85 dB(A) can result in damage, though not necessarily permanent, to the cochlear nerve cells. Permanent damage to hearing occurs when exposure to excessive noise levels continues and the nerve cells are not given sufficient time to recover. There is no universal agreement on recovery duration. There is ample evidence that the damage is insidious, usually beginning at a young age, and in the long run, usually severe enough to affect a person’s ability to hear and understand speech. Some evidence suggests that chemicals such as solvents and pesticides can interact with occupational noise exposure, resulting in a greater risk for hearing loss than noise exposure alone. This mixture of exposures may be particularly harmful for young farmworkers (Perry and May, 2005).

Stress

        There is little doubt that farming is one of the most stressful occupations in both developed and developing countries. Both farm workers and farm family members are exposed to the economic pressures of their family livelihood, the future of which remains precarious at best. The influence of stress is manifested by psychological or emotional disturbance such as alcohol abuse among family members, as well as by the creation of insecure working conditions. Being unmarried, having negative life events within the past year (legal problems, substantial income decline, and/or loss of something of sentimental value), and lower perceived general health status have been identified as significant risk factors for depressive symptoms among male farmers in the United States. 

        Farm workers in general have high rates of depression. Extreme poverty and hardship, the stress of job uncertainty and frequent moves, and social stigmatization and isolation are contributing factors. This is true for children and youth as well. Studies have also linked depression in workers to long hours of work in high-intensity, low- skilled jobs, precisely the kind of labor undertaken by farm workers.

        Having one’s livelihood controlled by the uncertainty of the weather and the agricultural market combined with the social isolation often experienced by rural inhabitants increase the risk for psychological distress. Rural areas of China and Sri Lanka, for example, have seen an increase in suicides among subsistence farmers, many of whom are using toxic farm chemicals to poison themselves. Identifying symptoms of psychosocial stress in farmers requires history taking and consultation to determine current social and economic conditions in the family. Depressive symptoms are expressed differently in men and women. Knowing that adult farm owners and farm workers are at higher risk for psychological disturbance should alert health-care providers and public health practitioners to the need for outreach to these high-risk groups. Because health-care providers are usually the first mental health contact for rural residents, they play an important role in the early identification of psychological distress in farmers, farm workers, and their families.

Sanitation

       Agricultural health clinicians have identified hygiene as being key in preventing bacterial infections from animals and dermatoses caused by chemical contamination. However, farmers themselves may forego the minimum sanitation requirements when working in fields as a means of saving time and effort or because water is simply not available. Regulations in the United States illustrate how basic public health protections may not be in place for agricultural workers. Access to clean drinking water, water for hand washing, and toilet facilities are the minimum sanitation requirements imposed on farms by the Occupational Safety and Health Administration (OSHA), the occupational regulatory agency in the United States. Even these minimal requirements, however, may be ignored by growers and by the farm labor contractors who bring in workers. Furthermore, labor laws prohibit enforcement of these regulations on farms with ten employees or less, essentially exempting small farms. An estimated 95% of all U.S. farms fall under this exemption. Health-care providers and public health practitioners should consider the multiple sources of contamination in the farm environment and consider hygiene as having a role in sources of infections, especially of the skin.

Heat

        Heat-related illnesses can lead to death or brain damage and are an ever-present danger for field workers. In the United States alone, there are approximately 400 deaths annually from heat-related illnesses. Risk for heat stress during the growing season is particularly acute, especially during haying and harvesting. It is recommended that workers laboring under hot weather conditions drink a minimum of 8 oz of water every half hour. Very high heat or humidity increases the amount of recommended water, so that, for example, a person working in 90 F heat under a full sun should drink 8 oz of water every 15 min. Ensuring sources of fresh water are abundant is critical to maintain workers’ hydration needs. Excessive sun exposure places farmers at risk for future skin malignancies and must be prevented with proper head and body covering, which can also increase the risk of heat stress from too much clothing. Keeping farmers hydrated, protected from the sun, and ensuring a minimum of 10 min of break time during each hour can reduce the risk of illnesses from overexposure to heat and sun.

Hazardous Organic and Inorganic Exposures

       Potentially harmful exposures exist in a variety of forms in the farm environment, including solvents, pesticides, paints, welding and combustion fumes, plant toxins, and animal bacteria and viruses. Their possible health effects vary widely and can include acute intoxication, Parkinson’s disease, peripheral neuritis, acute and chronic encephalopathy, various cancers, and reproductive problems.

Solvents

        A solvent is a liquid used to dissolve other substances. The most toxic solvents are extracted or manufactured for chemical use. Most solvents are colorless liquids at room temperature that volatilize easily and have strong odors. These compounds may be referred to as volatile organic compounds (VOCs) in reference to their physiochemical properties. Many commonly used solvents such as gasoline, kerosene, and jet fuel are mixtures of solvents and other chemicals. They are widely used for manufacturing, degreasing and other cleaning, and as carrying agents in products ranging from insecticides to glues and paints. The most common solvents and solvent mixtures found in the farm environment include pesticides, fuels, paints, and metal degreasers. There is little information from animal or human studies about the health effects of chronic low-dose exposure. Solvents are most commonly inhaled in their volatilized form and absorbed via the respiratory track.

      Significant doses of solvents may occur through skin exposure and absorption. Most solvents are lipid-soluble but some are water-soluble. Animal studies in the toxicology literature emphasize the role of solvents as neurotoxins. The majority of solvents are central nervous system depressants and some have long-term neuropsychological effects, including chronic toxic encephalopathy. In adults, the following neurobehavioral problems resulting from chronic solvent exposure have been recorded in the literature: memory loss, decreased problem-solving ability, decreased attention span, impaired dexterity and hand–eye coordination, altered reaction time, reduced psychomotor function, and altered personality or mood. In addition to neurotoxic effects, other documented health effects from solvent exposure in adults are pulmonary sensitization, bradycardia, and ventricular fibrillation, defatting of the dermis, chemical burns, and hearing loss.

Pesticides

         Agriculture experienced a chemical revolution after the Second World War with the broad-scale introduction of pesticides to control unwanted pests and fertilizers to enhance soil productivity. This revolution brought with it a series of unintended occupational and environmental health consequences, and exposure to pesticides is a serious risk to farmworkers worldwide. Data from the United States illustrate exposure circumstances for people both working in and living in the agricultural environment. The U.S. Environmental Protection Agency (EPA) estimates that as many as 300 000 farmworkers suffer pesticide poisoning each year while the U.S. Natural Resources Defense Council estimates as many as 40 000 physician-diagnosed poisonings occur each year (Natural Resources Defense Council, NRDC, 1998). The International Labour Organization reports that globally 70 000 agricultural workers die annually from exposures to pesticides. Only a small percentage of pesticide-related illnesses are reported to government or health officials.

         Pesticides include herbicides to control weeds, insecticides to control a range of insects, nematocides to control worms, and fungicides to control molds, fungi, and other mycotoxins. Exposures can happen when workers are mixing, loading, transporting, or applying pesticides, and the three main routes of exposure are dermal, inhalation, or ingestion. Risk of exposure can be compounded by lack of or improper protective gear, leaking containers, illicit formulations, faulty labeling of the chemical, improper application, and illiteracy. Workers may also be exposed to pesticides if they drink from, wash their hands, or bathe in irrigation canals or holding ponds, where pesticides can accumulate.

         While acute pesticide health effects have been well documented, epidemiological investigations continue to evaluate chronic health effects. Toxicologic and epidemiologic data reviewed in this section largely originate from adult animal and adult human studies. Infants and children may be exceptionally vulnerable to health complications from exposures due to their developing neurological, immunological, and reproductive systems and due to differences in their ability to metabolize and excrete toxicants

(Perry, 2003).

         There is evidence that farm families experience elevated levels of pesticide residues in their blood and urine. A recent investigation from the U.S. Agricultural Health Study reported that agricultural families could receive an absorbed dose of pesticides after application by a member of the family. The report used indoor air sampling, hand wipe sampling, serum, and urine monitoring to evaluate exposures to the family of a single farm applicator. The farmer applied the carbamate insecticidecarbaryl to pumpkins using a hand-cranked duster. His serum carbaryl levels rose by 3 orders of magnitude following use of thepesticide, and the carbaryl metabolite was detectable in his urine. Urine metabolite measurements taken from his wife and twochildren showed a doubling of excretion of the carbaryl metabolite following application of the pesticide. These results were seen in the absence of a quantifiable increased carbaryl concentration in indoor air or house dust (Shealy et al., 1997).

         Additional preliminary results from the Agricultural Health Study revealed that elevated blood serum pesticide levels were detected in some farm families. The very potent organochlorine insecticide dieldrin, which has been banned in the United States since 1987, was found at significantly elevated levels in the blood of all members of one of the six farm families sampled. Further investigation revealed persistently elevated levels of this pesticide in food samples on the farm, although all legal food uses of this pesticide were canceled in 1974. Other persistent organochlorine pesticides identified in the blood of farm families included chlordane and transnonachlor (Brock et al., 1998).

         Residents living near fields sprayed with organophosphate pesticides had small reductions in plasma and whole blood levels of the neurotransmitter enzyme cholinesterase during the spraying season compared with residents living farther from the fields and with their own cholinesterase levels off-season. At the same time, infirmary records indicated a significant increase in visits for certain symptoms on days when organophosphate pesticides were sprayed. Symptoms included respiratory problems, headache, and eye irritation (Richter et al., 1986). These data suggested that exposures to organophosphate pesticide drift might result in quantifiable cholinesterase inhibition and symptoms requiring medical treatment in residents living nearby application fields.

         In adults, acute pesticide exposures resulting in poisoning symptoms have been well documented. The chronic health effects

from pesticide exposures that have been reported include neurobehavioral problems, Parkinson’s symptoms, various cancers, and problems in reproduction including sterility.

         The problem of unintended consequences of pesticide exposures globally is compounded by poor public health protections for workers and a lack of comprehensive regulations focused on controlling exposures for citizens. The World Health Organization (Dinham and Malik, 2003) estimates that 20000 women, men, and children die of accidental pesticide poisonings each year; three million are nonfatally poisoned, and nearly three-fourths of a million new people each year experience chronic effects from exposure. Some industrializing countries in Asia and Africa are either importing pesticides that are banned elsewhere or are producing them locally. Compounds known to have considerable toxicity and that are environmentally or biologically persistent such as organochlorines remain in use in over 20 different countries today, while the long-term ecological and public health consequences of continued use remain unknown.

Microbes and Their Toxins

         Grain dusts, molds, and fungi are among several plant-based irritants that abound in the agricultural environment and that cause a host of respiratory problems in adult farmers. The clinical features of adult illnesses caused by these irritants should be considered with regard to the potential for child exposures as well. As with other chronic diseases, chronic respiratory diseases are likely to originate during early exposures, with damage accumulating over time until eventual clinical symptoms appear. Preventing suchexposures early may be the key to reducing respiratory disease in adulthood.

         Grain dust is a complex substance composed of plant debris, insect parts, silica, chemical residues, molds, fungi and bacteria and their metabolites, including endotoxins. Approximately 40% of its particles are less than 5 mmin mean diameter and representa respirable piece that can penetrate the terminal bronchioles. Exposure to antigens from organic dusts may be responsible for hypersensitivity pneumonitis, which has a reported prevalence of 0.1–15% among adult farmers. Hypersensitivity pneumonitis is difficult to diagnose in adult farmers because it has an insidious course and appears as recurrent influenza-like episodes or nonspecific respiratory symptoms and may result in chronic respiratory problems that look like pulmonary fibrosis.

         The organic-dust toxic syndrome is an acute response to inhaling organic dust, usually characterized by a delayed onset of fever, malaise, and chest tightness that does not evidence immunologic involvement and has an apparently benign course without longterm respiratory impairment. Possible mechanisms include a toxic reaction to endotoxins, mycotoxins, or proteinase enzymes of moldy plant materials. It is related to dust level and can be reproduced in laboratory subjects exposed to high concentrations of grain dust. Exposures responsible for the related condition extrinsic allergic alveolitis (farmer’s lung) are actinomycetes such as Micropolyspora faeni, fungi, and animal proteins present in many agricultural environments.

       Working in confined spaces such as silos or manure pits can pose risks for exposure to toxic gases such as nitrogen dioxide from fermented grain or methane gas emitted from manure. Both of these gases can be fatal when inhaled, therefore proper ventilation of enclosures is critical for mitigating acute exposures.

Carcinogens

         While the epidemiologic data are not conclusive enough to demonstrate causality for any one agricultural exposure, a number of increased cancer risks have been associated with either farming or specifically with pesticide exposure, including non-Hodgkin’s lymphoma, leukemia, multiple myeloma, soft tissue sarcoma, Hodgkin’s disease, and cancer of the prostate, pancreas, ovary,

breast, and testis. Currently only arsenic-containing insecticides are recognized as known human carcinogens by the International Agency for Research on Cancer, but many other pesticides are suspected. Agricultural workers are also at excess risk for developing skin cancer, which is most often caused by chronic exposure to ultraviolet radiation from the sun.

Skin Irritants

         Data from studies of adult farmers indicate that skin irritation starts soon after employment commencement and increases to involve more than 60% of workers after 4 years of employment in the grain industry (Zejda et al., 1993). Skin cancers, dermatophyte infections, and pesticide-related skin diseases are common in farmers.

         The impact of microscopic fungi on farmers’ health seems to be greater than originally understood. The infection may be transmitted from infected humans, animals, plants, or soil. To date, little epidemiological data on fungal skin disease in farmers are available. Epidemiological studies from Poland suggest that mycoses are the most prevalent skin diseases in farmers and may be present in over 20% of the population (Spiewak, 1998). Working conditions on farms directly contribute to the development of fungal infections. Farmers may spend extended periods working in humid conditions and long hours wearing rubber boots or gloves. Besides infection, fungi may also cause noninvasive forms of skin disease, such as dermato-mycotoxicosis professionalis or alternariosis. Most pesticide-related dermatoses are contact dermatitis, both allergic and irritant. Rare clinical forms also occur, including urticaria, erythema multiforme, ashy dermatosis, para- keratosis variegata, porphyria cutanea tarda, chloracne, skin hypopigmentation, and nail and hair disorders.

Reducing Health Risks to Agricultural Workers

         In a work environment such as agriculture with an assortment of hazards, what is the best approach to preventing injuries and disease? A useful way of thinking about prevention is to adopt an integrated strategy that draws upon key aspects from public health, industrial hygiene, and environmental leadership models. Occupational disease and injury are caused by exposure to hazards on the job, and prevention requires controlling exposures. Anticipation of hazardous exposures, surveillance of hazards and health effects, analysis of health effects, and ultimately hazard control are all critical parts of an integrated approach to prevention.

         Four basic choices for controlling hazards, in order of their preference, are agricultural production process reengineering, work

environment controls, administrative controls, and worker behavior controls, including personal protective equipment and devices. Reengineering production agriculture means rethinking the machinery, tools, equipment, and chemicals used to produce food world-wide. In developed countries where farmers rely on machinery for sowing, tilling, and cultivating crops, this can mean redesigning how workers must interact directly with machinery or the ways machines operate. In developing countries, productionprocess reengineering can mean introducing machinery to reduce the amount of punishing physical labor farmers must endure. Another example of production-process reengineering is transitioning to less chemically intensive agricultural practices. Known as Integrated Pest Management (IPM), this comprehensive approach relies on crop diversity and natural pest resistance sources such as beneficial insects, reducing reliance on commercial inputs such as fertilizers and pesticides. Integrated Pest Management programs can be economically feasible, environmentally sustainable, and health promoting by reducing harmful exposures to

workers and their families.

         Developing healthy agricultural work environments can be as basic as ensuring adequate access to clean drinking water or as multifaceted as diversifying tasks within farm cooperatives to reduce psychological monotony and repetitive physical strain. Machine guarding the power take off (PTOs) units on farm machines such as tractors, hay bailers, and combines is a simple yet effective occupational safety intervention focused on placing physical barriers between workers and hazards. Optimizing administrative controls to reduce risks to workers’ health includes enforcement of public health protections, from child labor restrictions

to controls over pesticide manufacturing and distribution. It is preferable to change the working environment rather than the worker; however, giving workers’ access to adequate information and training is a necessary part of promoting healthy working environments. Adequate training in the health risks posed by personal exposures to pesticides and strategies for protection is a good example of targeting worker behavior controls to decrease hazardous exposures.

References

1)    Brock JW, Melnyk LJ, Caudill SP, Needham LL, and Bond AE (1998) Serum levels of several organochlorine pesticides in farmers correspond with dietary exposure and local use history. Toxicology and Industrial Health 14(1–2): 275–289.

2)    Dinham B and Malik S (2003) Pesticides and human rights. International Journal of Occupational & Environmental Health 9(1): 40–52.

3)    Hwang SA, Gomez MI, Stark AD, St John TL, May JJ, and Hallman EM (2001) Severe farm injuries among New York farmers. American Journal of Industrial Medicine 40(1): 32–41.

4)    International Labour Organization (ILO) (2013) Employment by Sector. Key Indicators of the Labor Market, 8th edition. http://www.ilo.org/empelm/what/WCMS_114240/lang–en/ index.htm.

5)    International Labour Organization (ILO) (2013) Global Child Labour Trends 2008–2012. http://www.ilo.org/ipecinfo/product/download.do?type.document&id.23015.

6)    Myers, J.R. & Hendricks, K.J. 2001, Injuries among youth on farms in the United States, 1998 [electronic resource]/John R. Myers and Kitty J. Hendricks, Atlanta, GA]: Dept. of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, 2001].

7)    Natural Resources Defense Council (NRDC) (1998) Trouble on the Farm: Growing Up with Pesticides in Agricultural Communities. New York: Natural Resources Defense Council.

8)    Perry MJ (2003) Children’s agricultural health: traumatic injuries and hazardous inorganic exposures. Journal of Rural Health 19(3): 269–278.

9)    Perry MJ and May JJ (2005) Noise and chemical induced hearing loss: special considerations for farm youth. Journal of Agromedicine 10(2): 49–55.

10) Richter ED, Rosenvald Z, Kaspi L, Levy S, and Gruener N (1986) Sequential cholinesterase tests and symptoms for monitoring organophosphate absorption in field workers and in persons exposed to pesticide spray drift. Toxicology Letters 33(1–3): 25–35.

11) Shealy DB, Barr JR, Ashley DL, Patterson DG Jr, Camann DE, and Bond AE (1997) Correlation of environmental carbaryl measurements with serum and urinary 1-naphthol measurements in a farmer applicator and his family. Environmental Health Perspectives 105(5): 510–513.

12) Spiewak R (1998) Zoophilic and geophilic fungi as a cause of skin disease in farmers. Annals of Agricultural and Environmental Medicine: AAEM 5(2): 97–102.

13) Zejda JE, McDuffie HH, and Dosman JA (1993) Epidemiology of health and safety risks in agriculture and related industries. Practical applications for rural physicians. The Western Journal of Medicine 158(1): 56–63.

Further Reading

Alavanja MCR, Hoppin J, and Kamel F (2004) Health effects of chronic pesticide exposure: Cancer and neurotoxicity. Annual Reviews of Public Health 25: 155–197.

Levy BS and Wegman DH (eds.) (2000) Occupational Health: Recognizing and Preventing Work-Related Disease and Injury, 4th edn Philadelphia, PA: Lippincott.

Schuman SH and Simpson WM (1997) AG-MED: The Rural Practitioner’s Guide to Agromedicine. Kansas City, MO: American Academy of Family Physicians.

Stellman JM (ed.) Encyclopedia of Occupational Health and Safety . (2011). Geneva, Switzerland: International Labour Office. online edn., ch. 64, Agriculture and Natural Resources Based Industries. http://www.ilo.org/oshenc/.

United States, Department of Agriculture (USDA) (2000) National Agricultural Statistics Service Agriculture Report 2000. Washington, DC: U.S. Government Printing Office.

United States, Department of Labor (USDL) (2005) Findings from the National Agricultural Workers Survey: 2001–2002. A Demographic and Employment Profile of United States

Farmworkers. Report No. 9, Washington, DC: U.S. Government Printing Office.

Relevant Websites

http://www.cehn.org – Children’s Environmental Health Network.

http://osha.europa.eu/sector/agriculture – European Agency for Safety and Health at Work.

http://www.fao.org – Food and Agriculture Organization of The United Nations.

http://www.ilo.org/public/english/index.htm – International Labour Organization.

http://www.ncfh.org – National Center for Farmworker Health.

http://www.nagcat.org – North American Guidelines for Children’s Agricultural Tasks (NAGCAT).

http://www.aghealth.org – U.S. Agricultural Health Study.

http://nasdonline.org/ – U.S. National Agricultural Safety Database.

http://www.cdc.gov/niosh/docs/2004–146/ – Worker Health, Chartbook.