1. 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.

2. 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

3. National Agricultural Workers Survey  1999-2004 NIOSH occupational health supplemental modules  Injury: 1999, 2002-2004  Musculoskeletal pain: 1999-2004  Dermatitis: 1999-2003  Health conditions: 1999-2004  asthma, diabetes, high blood pressure, tuberculosis, heart disease, urinary tract infections

4. MethodsMethods

5. 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

6. 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

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

9. 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

10. ResultsResults

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

12. Musculoskeletal Pain, 1999-2004  Musculoskeletal pain complaints (MPC):  Weighted estimate = 4,021 complaints  Crude incidence = 43.3 MPC/100 FTE WB

13.  23 independent variables were associated with the incidence of musculoskeletal pain (α=0.05)  8 demographic, 5 employment, 10 socio- economic

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

15.  Demographic: Health conditions  Demographic: Sex IllnessesOR adj L95%U95% 2 ≥ illnesses2.131.782.55 1 illness1.581.361.72 No illnesses1.00--- SexOR adj L95%U95% Female1.661.471.87 Male1.00---

16.  Demographic: Education Formal EducationOR adj L95%U95% None1.511. 201.90 Any education1.00--- RegionOR adj L95%U95% California1.501.221.85 Southeast1.401.131.74 Southwest1.320.991.75 Midwest1.271.021.57 West1.260.991.60 East1.00---

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

18.  Employment: Workers’ compensation  Employment: Current crop worked on Known CoverageOR adj L95%U95% None1.831.582.13 Medical or indemnity1.431.261.63 Medical & indemnity1.00--- CropOR adj L95%U95% Multiple1.601.222.10 Fruit & nuts1.541.291.85 Vegetables1.531.291.82 Field crops1.511.241.83 Horticultural1.00---

19.  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

20.  Socio-economic: Used U.S. health care  Socio-economic: Healthcare payment method Used healthcareOR adj L95%U95% Yes1.961.203.43 No1.00--- How paidOR adj L95%U95% Did not pay1.991.362.91 Employer/WC1.171.001.37 None used1.190.682.07 Other insurance1.00---

21.  Socio-economic: Farm work income  Socio-economic: Migrant type IncomeOR adj L95%U95% None2.181.632.91 < $15,0001.090.971.22 ≥ $15,0001.00--- Migrant typeOR adj L95%U95% Shuttle1.721.442.06 Settled1.120.951.33 Follow the crop1.00---

22. SummarySummary

23. 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.

24. 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

25. 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

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

27. 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

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

29. Questions ?