Potential Risk Factors for Work-Related Musculoskeletal Pain to Hired Crop Workers in the U.S. John R. Myers and Larry A. Layne National Institute for Occupational Safety and Health The findings and conclusions in this Presentation are those of the authors and do not necessarily represent the views of the National Institute for Occupational Safety and Health. John R. Myers and Larry A. Layne National Institute for Occupational Safety and Health The findings and conclusions in this Presentation are those of the authors and do not necessarily represent the views of the National Institute for Occupational Safety and Health.

National Agricultural Workers Survey  National survey of hired crop workers in the U.S.  U.S. Department of Labor, Employment Training Administration  Began in 1989  Main focus: crop worker labor force stability, demographics, work histories, and economics

National Agricultural Workers Survey  NIOSH occupational health supplemental modules  Injury: 1999,  Musculoskeletal pain:  Dermatitis:  Health conditions:  asthma, diabetes, high blood pressure, tuberculosis, heart disease, urinary tract infections

MethodsMethods

Methods: NAWS  Retrospective, cross sectional study  Survey of the Continental U.S.--Excludes Hawaii and Alaska  Personal interview in worker’s primary language  Conducted in a location chosen by worker  Core questionnaire and supplemental modules  All hired crop workers eligible  Complex sampling weights

MethodsMethods  Demographic information on hired crop workers:  General: Age, Sex, Race/Ethnicity, Education, Language  Time of interview: Region, Migration pattern, US farm work experience, Health problems, Type of crop, Type of work, Socio-economic information

MethodsMethods  Musculoskeletal pain module:  Number of self-reported complaints of pain during the past year  Farm work-related events only

MethodsMethods  Modeling using SAS Proc Surveylogistic  Outcome = incidence of musculoskeletal complaints divided by weeks of farm work (adjusted range to be 0 - 1)  34 statistically significant independent variables from univariate models (α=0.05)  Multivariate model of these 34 variables  Backwards elimination approach

ResultsResults

Basic Survey Results  Survey response:  Operator participation rate: 69%  Crop worker participation rate: 94%  Number of interviewed hired crop workers just over 20,000

Musculoskeletal Pain,  Musculoskeletal pain complaints (MPC):  Weighted estimate = 4,021 complaints  Crude incidence = 43.3 MPC/100 FTE WB

 23 independent variables were associated with the incidence of musculoskeletal pain (α=0.05)  8 demographic, 5 employment, 10 socio- economic

 Demographic variables:  Age  Sex  Education  Marital status  Region  Years of farm work in U.S.  Health conditions  English speaking skills

 Demographic: Health conditions  Demographic: Sex IllnessesOR adj L95%U95% 2 ≥ illnesses illness No illnesses SexOR adj L95%U95% Female Male

 Demographic: Education Formal EducationOR adj L95%U95% None Any education RegionOR adj L95%U95% California Southeast Southwest Midwest West East

 Employment variables:  Workers’ compensation coverage  Crop currently harvesting  Task currently doing  Employer provided tools/equipment  Employer provided clean drinking water

 Employment: Workers’ compensation  Employment: Current crop worked on Known CoverageOR adj L95%U95% None Medical or indemnity Medical & indemnity CropOR adj L95%U95% Multiple Fruit & nuts Vegetables Field crops Horticultural

 Socio-economic variables:  Migrant type  Farm work income  Home ownership  US owned assets  Housing arrangements  Used unemployment insurance past year  Used U.S. healthcare past 2 years  Healthcare payment method  Number of Social services used  Below minimum wage

 Socio-economic: Used U.S. health care  Socio-economic: Healthcare payment method Used healthcareOR adj L95%U95% Yes No How paidOR adj L95%U95% Did not pay Employer/WC None used Other insurance

 Socio-economic: Farm work income  Socio-economic: Migrant type IncomeOR adj L95%U95% None < $15, ≥ $15, Migrant typeOR adj L95%U95% Shuttle Settled Follow the crop

SummarySummary

SummarySummary  The average incidence of musculoskeletal pain complaints was even higher—43.3 complaints/100 FTE WB.  Twenty-three of 34 independent variables were significantly associated with incidence of musculoskeletal pain in multivariate model  Mixture of demographic, employment, and socio-economic variables.

SummarySummary  Workers reporting responsible employment practices had lower odds of musculoskeletal complaints:  Told about workers’ compensation coverage  Provided fresh drinking water/cups  Provided tools and equipment

SummarySummary  Some variables suggest young/new workers have higher odds of musculoskeletal pain:  <20 years old highest adjusted odds ratio  ≤ 1 year U.S. farm work  No previous farm work income

SummarySummary  Other key potential risk factors:  Female worker  No reported education  Shuttle migrant  Reporting other health issues

Future Work  Work with NIOSH Ag centers, employers, and farm worker groups to address factors associated with work-related musculoskeletal pain  Need to focus on female farm workers and new hired crop workers  Approaches need tailored to low income workers with little formal education

LimitationsLimitations  Cross-sectional survey  Self-reported pain by farm workers  Small number of farm workers covered by the survey in some regions

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