The projects undertaken by the PNASH Center span a variety of subjects and research disciplines. During project development, we select topics that:

• Address hazards that are the most serious, affect the greatest number of workers, and where that research will make a difference.
• Meet the needs of Northwest employers, workers, and service providers. We have established a process that engage constituencies from agricultural, health, and safety to help us establish research priorities.

PNASH Research Priorities:
      National Occupational Research Agenda for Farming, Fishing and Forestry
      Occupational Research Agenda for Northwest Farming (pdf)
      Occupational Research Agenda for Northwest Forestlands (pdf)

Key:

PAGE CONTENTS
Chemical Exposure	Respiratory	Community Partnership
Hearing and Noise Exposure	Hazard Evaluations	Research/Interventions
Musculoskeletal and Traumatic Injury	Social and Economic Foundations	Educational Interventions
Neurological Effects	Research and Health Care Tools	Outreach and Professional Education

 

Chemical Exposure

Pilot Project: Inhibition of Cholinesterase by Pharmacological and Dietary Agents
(NIOSH/CDC, 2007-2009)
Organo-phosphorus pesticides (OPs) have widespread commercial application in the United States and worldwide, and their primary toxicological effect is associated with inhibition of cholinesterase (ChE). In Washington State, cholinesterase activity is measured in farmworkers expected to have high exposures to OPs, and when depression in cholinesterase activity is observed, remedial actions are undertaken to reduce exposures and protect worker health. However, the cholinesterase assay lacks specificity: there are a number of dietary and pharmacological agents that can depress cholinesterase levels. In the context of the Washington State cholinesterase monitoring rule, this would lead to an incorrect conclusion that the worker had been overexposed to pesticide. This misclassification of exposure confounds epidemiological studies of farmworker health and pesticide exposure, and undermines worker and employer confidence in the cholinesterase monitoring program.

This pilot study measures the effect of quinine and acetaminophen on cholinesterase levels in vivo in humans. Quinine is a known inhibitor of cholinesterase, and the potential for exposure to quinine is high due to its presence as an ingredient in tonic water. Quinine and its analogs are also used medicinally as prophylaxis for malaria and muscle cramping. Acetaminophen (brand names: tylenol, paracetamol) is a common over the counter and prescription medication for pain relief and fever reduction. Acetaminophen is a known hepatotoxin, and has been shown to reduce cholinesterase levels in vitro. Both compounds have bees suggested as potential confounders to the use of cholinesterase measurements as a marker for pesticide exposure.

Human volunteers ingest either quinine (singe acute dose) or acetaminophen (3g/day for up to 6 days), and the effect on plasma cholinesterase and acetylcholinesterase will be monitored. If these two agents do cause cholinesterase depression in our pilot studies, it would have important implications for the reliability of the cholinesterase monitoring program. Conversely, if the agents do not cause cholinesterase depression in our pilot studies, confidence cholinesterase measurements as surrogates of pesticide exposure will be enhanced.

Risk Factors for Cholinesterase Depression Among Pesticide Handlers
This project seeks to identify the key risk factors responsible for ChE depressions, including individual genetic susceptibility. Worker exposure information is collected at health clinic visits and compared to their ChE results. English PPT - Spanish PPT download

In 2004, the Washington State Department of Labor and Industries (L&I), under mandate from the Washington State Supreme Court, initiated a new cholinesterase (ChE) monitoring program for agricultural workers who handle toxicity class I or II organophosphate (OP) or N-methyl-carbamate (CB) pesticides. The ChE enzyme, which plays an essential role in the regulation of neural signaling, is inhibited by OP and CB pesticides. Washington is
only the second state in the union to establish a ChE monitoring program; California has required ChE monitoring since 1974.

Approximately 1,200 handlers will be recruited over a 5-year period in collaboration with the three main occupational medicine clinics in agricultural regions of Washington State. A participant's risk of ChE depression will be evaluated with respect to workplace, behavioral, and genetic characteristics (paraoxonase or PON1 status). The results of this study will improve our understanding of potential routes and mechanisms of pesticide overexposure, and will help to prevent such exposures among pesticide handlers.

Enhancements to Cholinesterase Monitoring: Oxime Reactivation and OP-ChE Adducts
Scientists at PNASH and the Centers for Disease Control (CDC) are working to improve the current ChE laboratory test – increasing accuracy to ensure a ChE depression is due to pesticide exposure and identify the specific pesticide involved.

Organophosphorus pesticides (OPs) have widespread commercial application in the United States and worldwide, and their primary toxicological effect is associated with inhibition of cholinesterase (ChE). In Washington State, cholinesterase activity is measured in farmworkers expected to have high exposures to OPs, and when depression in cholinesterase activity is observed, remedial actions are undertaken to reduce exposures and protect worker health. However, the cholinesterase assay lacks sensitivity and specificity, with the result that a substantial number of false-positive and false-negative measurements are obtained. Misclassification of overexposure comes with substantial economic costs to local authorities and growers, and causes unnecessary psychological distress for the farmworkers. In the case of false-negative data, exposure misclassification fails to identify and correct situations where overexposure to pesticides has occurred.

To augment and improve cholinesterase monitoring, we will develop and validate two analytical methods designed to measure the interaction of OP pesticides with cholinesterase enzyme. These assays will be validated via a series of in vitro studies using human plasma, and in vivo studies in rats and in humans with occupational exposure to OP pesticides. Finally, the assays developed during this project will be incorporated into the practice of OP pesticide exposure monitoring in Washington State.

Pilot: Inhibition of Cholinesterase by Pharmacological and Dietary Agents (NIOSH/CDC 2007-2009)
Dietary and pharmacological agents can depress cholinesterase levels, which may lead to an incorrect conclusion that a worker has been overexposed to a pesticide. This pilot tests potential confounders to assess the reliability of ChE monitoring.

Risk Factors for Cholinesterase Depression Among Pesticide Handlers(NIOSH/CDC 2006-2011)
This project works in coordination with the Washington State Cholinesterase (ChE) Monitoring Program to identify the key risk factors responsible for ChE depressions, including individual genetic susceptibility. Worker exposure informatin is collected at health clinc visits and compared to their ChE results.

Introducing a Cholinesterase Test Kit into Clinical Practice We have shown the Test-mate™ kit to be an effective, cost-efficient test that can provide rapid results for workers - important if they are shown to have a ChE depression. Now, we are bringing this technology to clinical providers, allowing them to conduct ‘on-the-spot’ evaluations of workers.

The kit has been used in countries around the globe and has been reported upon in many studies in the published literature. It has shown good performance when compared to laboratory-based systems. Easy to apply in a clinician’s office, the Test-mate can substantially reduce the time necessary to detect a cholinesterase inhibitor overexposure and will speed the response of the clinician with regard to removing over-exposed workers. This project will introduce the Test-mate to clinics and work with large and small programs to facilitate the introduction by developing several "use models" based on the way the clinic conducts testing.

Once developed, these use models will be used to disseminate the technology to other clinics in the area. Monitoring workers for overexposure to pesticides is a labor and resource intensive process. This project will take a proven methodology, reconfirm its value and introduce it into the cholinesterase testing process aiming at reducing the work, cost and improving the quality of information and response time of the cholinesterase monitoring process.

Pesticide Exposure Pathways in Agricultural Communities
Children of agricultural producers and workers can be exposed to pesticides and other agricultural chemicals if workplace chemicals are inadvertently brought into their homes. The purpose of this research is to prevent or reduce take home pesticide exposure among agricultural workers and their families in Northwest farming communities. This project will result in new methods for the characterization of the take home exposure pathway, and for interventions to reduce children’s exposures to pesticides.

• Publication List

Communication of Pesticide Health Risks Health Care Providers for Children of Agricultural Families (2004-2007)
Through educational courses and workshops, we provided health care professionals with current scientific information regarding neurodevelopmental health risks for children with exposure to OP pesticides. This information was needed to understand the known, and sometimes uncertain, health risks to their pediatric patients. Based on our audience research, PNASH is developing educational formats that meet health care professionals need for current scientific information. For the web-based CME course, Organophosphate Pesticides and Child Health: A Primer for Health Care Providers, visit: http://depts.washington.edu/pehsu/pesticide/.

Communication of Pesticide Health Risks Producers, Workers and their Families (2005-2007)
We are providing the farming community with educational resources to promote the understanding of current science regarding the risks of OP pesticides. Our survey of producers and pesticide handlers in Washington state showed that respondents most often obtained their information on pesticides from product labels and dealers. They expressed interest in learning more about acute pesticide illness, cancer, ChE testing, and children’s health. The survey also showed the preferred route for received information to be from conferences, recertification classes, or articles. In addition, the Spanish speakers surveyed preferred to receive their information verbally at the job site or from a medical person. PNASH is currently working to develop and deliver this information in both English and Spanish.

Workplace Determinants of Take-Home Pesticide Exposure (NIOSH/CDC 2001-2007) This series of field-based studies has confirmed that agricultural pesticides are moving from the workplace to workers’ homes and that commuter vehicles play a role in this transmission. A major finding of the intervention development and evaluation is that vacuuming personal vehicles significantly reduces pesticide residues found in workers’ homes. PNASH will be widely promoting the practice of vehicle vacuuming and will be continuing to develop practical and effective workplace interventions designed to interrupt the take-home pathway.

Salivary Biomonitoring for Organophosphorus Pesticide Exposure in Children
This project was designed to investigate the feasibility of measuring pesticide exposure using saliva in children. Conventional biomonitoring methods, such as blood and urine collections, have several, inherent practical limitations, which prohibit its application to large-scale studies or to studies involving sub-populations, such as children.  Saliva biomonitoring could provide a useful tool for researchers in determining not only the exposure to certain chemicals, such as pesticides, but the absorbed dose as well. A cohort of children who live in an agricultural community has been identified and recruited for this feasibility study. Saliva samples have been collected before and after the application of pesticides to fields close to their homes, and will be analyzed for pesticide residues.

Children's Exposure to Lead and Arsenic in Orchard Soils
Lead arsenate was used in large quantities in orchards in Washington State for about four decades. Although lead arsenate is no longer used in the fruit industry, residual contamination is evident in orchard soils. Several potential routes of exposure to children exist. Adult workers in the orchards may inadvertently transport soil and dust to their homes or children residing in close proximity may play in the orchards. Orchard land may also be subdivided and converted to residential property. This project measured lead and arsenic levels in orchard and residential soil, house dust, and urinary biological specimens in children of farm workers employed in orchards formerly treated with lead arsenate.

Children's Pesticide Exposure
This investigation focused on the measurement of pesticide exposures in children of agricultural producers and farm workers and an analysis of risks associated with such exposures. It also explored new exposure assessment methods for evaluating exposure and risk in these populations. The project demonstrated that soil and house dust concentrations in and around the homes of agricultural families are significantly higher than those found for reference families in the same community, and that such patterns continue over several years. It has also been demonstrated that children of pesticide applicators had four times higher organophosphorus pesticide metabolite levels in urine as did reference children during the spraying season.

• Publication List

Pilot: Farm Exposures to Deposited Arsenic and Lead on Vashon Island
Vashon Island, Washington, is situated north of the former ASARCO smelter in Ruston/Tacoma. Prevailing winds carried arsenic and lead from the smelter to the Island. Surface soils are contaminated at levels well above background for both elements. Persons living on the island are subject to potentially elevated exposures to arsenic and lead. Persons at highest risk of exposure are likely to be those who have relatively intimate contact with soil. Those who eat locally grown crops are also at risk. Island farmers and their children are obvious targets for exposure assessment. A stakeholder group, the Vashon Island Growers’ Association, requested testing of farms and farmers for evidence of smelter residue contamination. During this project we collaborated with the community to investigate an at risk population and answered some of their questions.

Pilot: Human Exposure to OP Pesticides: The Role of Oxidative Stress
Compelling evidence from whole-animal and tissue culture studies indicate that pesticides, especially organophosphate pesticides (OP), induce oxidative stress. While the cholinergic properties of OPs are well-established, our understanding of their oxidative stress properties (especially on humans) is limited. Given the importance of oxidative stress in disease and the widespread use of pesticides, this project studied the relationship between OP pesticides and stress in humans by analyzing oxidative stress biomarkers in urine and lymphocytes of pesticide mixer/applicators. Work histories and information on current work practices was obtained. Dialkylphosphate metabolites, and work histories were used to estimate the internal dose and the levels of exposure. The project focused on the problem of chemical exposure in the agricultural work environment and how biomarkers can be used to assess the possible health hazards associated with chronic exposure to agrochemicals.

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Hearing and Noise Exposure

Hearing Conservation in Agricultural Industries
This project evaluated noise exposures and hearing conservation practices in selected agricultural industries identified as having high numbers and/or incidence rates of workers' compensation claims for hearing loss. The proposed project augmented an ongoing, NIOSH-funded study (Daniell, PI; 1-R01-OH03894-01; "Epidemic occupational hearing loss in Washington State"). The PNASH support expanded the study to include agricultural industries with worksites beyond the planned study area. Project aims included determining if there is substantial work-related risk of hearing loss among workers in industries with a high number and rates of claims for occupational hearing loss and assessing relative effectiveness of approaches using claims data to "target" industries with remediable risk factors for hearing loss. Investigators selected target industries to represent a wide range of above average "prevention index" values (including fruit and vegetable processing sites); conducted worksite evaluations, personal noise dosimetry measures and questionnaires; and assessed worksite compliance with applicable regulations and effectiveness of the hearing conservation program.

Vibration and Noise Exposure in Forestry Workers
Workers in the forest industry are exposed to a number of sources of hand-arm and whole-body vibration, including a variety of hand tools and heavy equipment. Vibration exposure in forestry workers has been associated with negative health effects such as hand-arm vibration syndrome (HAVS) in several countries. The development of HAVS, or any of the ailments it encompasses can force workers out of their employment by preventing them from performing their normal job tasks. This study collected task-based vibration measurements on forestry workers using a variety of vibration-producing equipment. The vibration assessments performed include hand-arm (segmental) vibration and whole-body vibration. Noise exposures measurements were taken simultaneously in order to estimate the degree to which vibration exposure levels may be predicted by noise exposure levels. This study generated data which will also provide a basis for possible exposure control methodologies.

• Publication List

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Musculoskeletal and Traumatic Injury

Identification and Prevention of Injuries in Northwest Orchards (NIOSH/CDC 2001-2007) This study found that ladders were the leading cause of orchard injuries, accounting for 30% of injury claims and costing $21.5 million over a six-year period. Ladder accidents were a consequence of unstable placement, over-extension of the third leg, slipping while descending, or being struck by a falling ladder. These hazards most commonly resulted in sprains and strains, eye injuries, and fractures and dislocations. Study results were drawn from comprehensive review of injury claims and personal interviews. To solve these problems, three prototype interventions were developed: a new ladder with built-in sensors that can, as a training tool, both warn workers and monitor risk conditions; a modification to a ladder that alerts workers to when they have reached the last step; and a simple plug that stabilizes the third leg. • Publication list Hofmann J, Snyder K, Keifer M. A descriptive study of workers' compensation claims in Washington State orchards. Occup Med (Lond). 2006 Jun;56(4):251-7. Epub 2006 Apr 20. PMID: 16627546 Salazar MK, Keifer M, Negrete M, Estrada F, Synder K.  Occupational risk among orchard workers: a descriptive study. Fam Community Health. 2005 Jul-Sep;28(3):239-52. PMID: 15958882

Feasibility: Wildland Firefighter Injuries in Idaho and Montana
In an effort to reduce wildland firefighter injury and illness, PNASH is working with the USDA Forest Service and Blackbull Wildfire Services to characterize injuries to wildland firefighters. The study has collected injury data from major Northwestern fires in the 2000 season and is currently analyzing the association between the type, severity and rate of injuries, the class of firefighter involved, and the time spent fighting the fire.

Identification of Injury Problem Areas
The specific aims of this project were to estimate the one-year, cumulative incidence of work-related injury, and determine the type of medical treatment sought for agricultural-related injuries and the reporting of work-related injuries to the Washington state workers’ compensation system by Hispanic agricultural workers 18 years and older. A random digit dial survey was conducted of 1600 households in Sunnyside, Washington. More in-depth interviews were conducted with participants who experienced an injury and consented to be contacted further regarding details of the incident. The results helped to shape later Center projects targeting the prevention and intervention of agricultural injuries in the region.

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Neurological Effects

Neurobehavioral Assessment of Pesticide Exposure in Children
The objective of this project based at Oregon Health Sciences University is to identify and characterize OP exposure in the homes of pesticide mixer-loaderapplicators and to relate those exposures to neurobehavioral performance of children of pesticide applicators over two years in a longitudinal study that examines neurodevelopmental changes.

There is increasing concern that the widespread use of pesticides in agriculture may be affecting farmworker communities, a potential public health problem. Agricultural workers are at risk of pesticide exposure from occupational exposures and they and their family are at risk of exposures in the home. Detectable levels of pesticides have been reported in home dust, primarily in families residing in agricultural areas. Studies have also documented the presence of biological markers of pesticide exposure in adults and children and there are higher levels of exposure in residents of agricultural communities when compared to non-agricultural communities. Neurobehavioral tests have identified deficits in adult populations exposed to and poisoned by OP pesticides. However, little research has examined the impact on children.

Mortality Patterns among a Cohort of Washington State Orchardists and Neurobehavioral Performance among a Sample of Surviving Members

Neurological Effects of Organophosphorus Insecticides in Farmworkers
The overall goal of this study was to determine whether farm workers who thin fruit trees exhibit neurological changes following one season of exposure to low levels of organophosphorus insecticides compared to workers who were not exposed. Data were collected on 137 exposed and non-exposed farm workers in the first round of testing and 97 in follow-up testing. A wide ranging number of tests, including peripheral and central nervous system function, were applied to both groups. Cholinesterase was measured both after the exposure season and after the period of non-exposure. Cross-sectional analysis of peripheral neurological outcomes after exposure revealed that there were no significant differences between exposed and non-exposed farm workers.

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Respiratory

Pilot: Characterization of Bioaerosols in Washington Dairy Barn (NIOSH/CDC, 2007-2008)
Dairy workers in concentrated animal feeding operations may be a risk for respiratory illness from bioaerosols. This exploratory project in partnership with Washington State University will quantify both organism and endotoxin levels and correlate them with environmental factors.

Feasibility: Assessment of Farmers’ Exposure to Smoke from Agricultural Burning
The aim of this project is to investigate farm workers’ exposure to agricultural burning smoke and the resulting airborne pollutants and to assess the potential health hazards. A prolonged burning ban delayed this project but has recently been lifted. Washington State University is our principal partner on the project.

Respiratory Health in the Seafood Processing Industry
Aerosolized crab antigens are suspected etiologic agents for asthma among crab processing workers. The goal of this study was to characterize crab antigen levels in processing facilities in relative to the prevalence of respiratory symptoms. Industry and labor representatives in the Northwest have identified respiratory illness, specifically asthma, among those who process crab. In addition, industry representatives have noted difficulty in determining which processing areas may be associated with the greatest risk. UniSea, a Dutch Harbor, Alaska crab processing company, was identified as a research study site to assess the respiratory health of crab processing workers. Specifically, the project goals were to characterize the cross-seasonal changes in respiratory function, as well as determine the incidence of respiratory symptoms, particularly those meeting a rigorous case definition of asthma. The study included pre- and post-season questionnaire administration, pulmonary function testing including methacholine challenge, blood collection to assess immune system responsiveness to crab proteins, and crab antigen exposure assessment.

• Publication list

 

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Hazard Evaluations

Pilot: Safety and Health of Immigrant Forest Workers on the Olympic Peninsula
(NIOSH/CDC, 2007-2009)
Latino immigrant workers are increasing the forest laborers in the Northwest. This project will provide a baseline understanding of the hazards faced by salvage cedar block cutters and barriers they face in addressing hazards.

Assessment of Job-related Exposures for Diarrheal Illness in Farmworker Families
This two-year exploratory project investigates a probable cause of Yakima County’s high rates of diarrheal illness – bacterial pathogens from livestock, taken home or in well water.

Pilot: Agricultural Work and Injuries in Teenagers
Direct assessment of the proportion of teenagers working in agriculture and the percent injured, is sparsely reported in the literature and has not been performed in the Northwest United States. This project estimated the proportion of teenage children who work for pay in agriculturally related jobs in a rural town in Washington's Yakima Valley. Secondary goals were to estimate the injury rate among the teenage workers in the sample, to identify the patterns of work in relationship to school, and to characterize the treatment and outcome of these work related injuries. A random digit dialing survey targeted to a rural town composed of non-migratory agriculture workers of Mexican descent was employed to obtain these estimates.

A Hazard Evaluation in the Apple Warehouse Industry
During the past decade, the apple warehouse industry in Washington state has grown considerably, both in production and technology. Upto 15,000 employees work in warehouses with a large percentage of  women. Approximately two-thirds of these workers are of Mexican descent. Both management and labor have identified health and safety concerns in the industry, such as musculoskeletal diseases, carbon monoxide poisoning, and slips and falls. Reported occupational health and safety research and evaluations have, for the most part, taken place in the more traditional and hazardous food processing plants, such as meat packing facilities and canneries. No studies evaluating the hazards associated with manually packing fresh fruit for market and cold room storage have been identified. Our project was designed to characterize and better understand the health, ergonomic, and safety hazards in the Washington apple warehouse industry, and to identify any controls currently in use that are designed to reduce worker injury and illness.

Hazard Priority Ranking in Farming, Fishing, and Forestry
The extent and severity of agricultural health and safety hazards are largely unknown in the Pacific Northwest region. This project was designed to engage various constituencies familiar with agricultural health and safety throughout Region X. This process aimed to look broadly and long-term at the issues of farming, fishing, and forestry occupational safety and health in our regions, including technical, social, and economic dimensions involve a diverse group of stakeholders in identifying issues that can be addressed by occupational safety and health research; establish a priority list, or agenda, of occupational safety and health research topics relevant to Northwest farming, fishing, and forestry; and provide a continuing forum for discussion of key health and safety issues for the region.

• Publication List

Occupational Skin Disorders in Region X Farming, Fishing, and Forestry
The objectives of this project were to: quantify the impact of dermatitis on the farming and forestry work force; characterize the most important causes; and develop interventions to control the major causes of farming and forestry workplace dermatitis in Region X.

This project also explored pre-collected data systems for use in characterizing dermatitis in commercial fishing.

Vegetation was the leading cause of agricultural dermatitis but "unknown" was the second leading cause followed by "unspecified chemicals," "insecticides," and "soaps and detergents." Farm workers were the category of workers who were represented most frequently among agricultural dermatitis claims, representing 58.7% of all agricultural dermatoses claims. The majority of funds supporting this project derived from the Washington Medical Aid and Accident Fund through the Center.

Prevention of Agricultural Injuries Resulting from Ladder Falls
Researchers evaluated a Washington State Department of Labor and Industries’ accident prevention program implemented by their Yakima regional office in Kittitas, Grant, and Adams counties. The three-year injury prevention program aimed to reduce the frequency and cost of claims that are related to falls from ladders in the orchard and to eye injuries. Researchers conducted semi-structured interviews with farm workers who were injured on the job following a fall from a ladder and who filed a claim prior to the L&I implementation of the prevention program. Information was collected on the circumstances of the injury, prior training, knowledge of and barriers to the use of preventive practices, and the injured worker’s perception of what could have been done to prevent the accident and related injury. Investigators then conducted field assessments of the level of program implementation and analyzed pre- and post-program claims data among intervention and non-intervention growers to determine the degree of program effectiveness.

Purse Seiner Survey
The objectives of this cross-sectional questionnaire study were to: estimate the frequency of injuries among Washington state purse seiners; identify major injury patterns among seiners; characterize the most hazardous tasks and potential methods for intervention among the purse seiner fleet.

Self-reporting and self-mailing questionnaires were distributed to the purse seiner fleet during the fishing season in southeast Alaska. The vast majority of these boats are owned and operated by Washington state residents.

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Social and Economic Foundations

Sustainable Harvest Project (Laura Jane Musser Foundation, 2008-2009)
Sustainable Harvest Project. This stakeholder driven project aims to reduce unpermitted harvesting of special forest products (SFPs) in the Forks, WA area and increase the overall health of the environment and the workers. In a one-year effort, the Sustainable Harvest project will bring together harvesters, public and private landowners, local city and tribal government representatives. The project will simultaneously build the capacity of these stakeholders to work across cultural and linguistic differences to solve this and future conflicts, and demonstrate the value of a participatory and collaborative approach to special forest product management. SFPs such as salal (and other wildly occurring floral greens), moss, mushrooms, and medicinal plants are highly significant in their cultural, economic and ecological importance on the Olympic Peninsula. It is estimated there are 4,000 western WA immigrants from Southeast Asia, México and Central America who rely on SFP harvest as their primary livelihood.

Pilot: Farm Families and the Employment, Training, and Supervision of Children
This project furthered agricultural health and safety research on children by looking at parents’ attitudes towards farm safety and children’s labor. It considered how these attitudes and characteristics of farm operation affect the use of children’s labor as well as the quality of safety-related training and supervision received by children. Data were collected through interviews with twenty-five farm families in two counties in eastern Washington. Open-ended questions were used to assess the types of farm work done by children, the conditions under which children perform various tasks, and the extent and nature of parental training and supervision of children.

Agricultural Safety and Health Decision-Making in Farming Families
This project explored the way specific demographics, context, process, and outcome factors influence farm health and safety decisions made by women who are farmers, farm wives, or partners. The intervention program designed for women and their farm partners was based on the results of this project’s initial research. It included safety farm assessment training for farm women and an evaluation component to measure the impact of the training and its effectiveness.

The Implications of the Jones Act on Health and Safety in the Commercial Fishing Industry
The Jones Act, enacted by Congress in 1920, gives seamen who become injured or sick while employed on the vessel, the right to sue their employer for negligence. Our Fishing Technical Advisory Committee emphasized that the Act creates a highly litigious context where vessel owners, fishing corporations, and captains are often unfairly subjected to lawsuits. Because research results could be subpoenaed, there is a high degree of reluctance to allow access to data and participate in studies. Center investigators collaborated with the Policy Analysis and Program Evaluation Initiative team to summarize the history of the Jones Act and how it influences workplace health and safety in the commercial fishing industry.

• Publication List

Pilot: Older Farmers: Factors Influencing Their Retirement Decisions
Agriculture has been recognized as one of the most hazardous occupations in the United States. In an industry where a quarter of all farm operators are 65 years of age or older, age becomes a serious factor when considering potential risk for injuries. This project explored reasons influencing the retirement decisions of farmers within five counties in Eastern Washington. The research project investigated reasons why leaving farm, not participating in farm work, and transitioning farm ownership to others is so difficult for elder farmers. Areas of inquiry included economic circumstances, issues related to loss of power in transferring the farm, and the loss of place identity. Additionally, potential risk factors which contribute to increased injuries among this population (i.e. self-reported health status and prevalence of health conditions and current use of prescription medications) were explored.

Pilot: Perception of Risk among Female Workers in the Fruit Packing Industry: A Biocultural Approach
Occupational health provides an exciting context in which to examine biocultural interactions in modern society. The objective of this research project was to investigate workers’ perceptions of health and safety hazards, as well as socioeconomic and demographic constraints in work opportunities. Qualitative and quantitative research methods were used to understand the costs, constraints, and benefits of fruit packing work for Hispanic women and their families living in eastern Washington. Data collection consisted of key informant interviews with community leaders and detailed interviews with women currently working in the apple packing warehouses. Information from the interviews was used to test whether reproductive status, household resources, personal and general working conditions, and socioeconomic and cultural context predict differences in perceptions of health and safety risks and greater tolerance for workplace hazards.

• Publication List

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Research and Health Care Tools

Pilot: Finding Common Ground: Developing, Testing, and Evaluating a Narrative Based Model for Presenting Safety Information in Two Socially Diverse Farm Communities
This project is conducted through the EWU Center for Farm Safety and Health, which has compared formal and informal (through story telling) communication models used to promote safety. The two models have been tested with intergenerational family farmers and non-intergenerational farmers. The project identified the variables and allow us to test the efficacy of incorporating informal discourse into formalized, farm safety intervention strategies.

Optical Assessment of Dermal Exposure and Absorption
The work of the PNASH Center has led to improved methods of dermal exposure assessment for agricultural workers and more accurate models for dermal absorption of pesticides. Our work with the direct-reading ATR-FTIR method shows promise as a rapid and inexpensive method for determining pesticide concentrations on the skin and uptake rates.

• Publication List

Pilot: Developing, Testing an Objective Tool for Measuring Postural and Vibrational Exposures During Forestry and Agricultural Work
In response to the recommendations of the Kennedy Report, NIOSH and the Centers began to work together to develop an evaluation scheme for the various programs and projects within each Center, as well as for evaluating the Centers overall. The evaluation plans for the Center was consistent with the scheme developed by the other NIOSH-funded centers under the leadership of the High Plains Intermountain Center. Several Center projects had formal evaluation components included in the design. An expert in program evaluation, Barbara Brooner, assisted the Center in incorporating evaluation components into research and outreach projects.

Feasibility: Diagnosis of Mental Illness among Farm Workers with a Range of Literacy
With this project, PNASH developed an audiotape survey to assist in the diagnoses of farm worker patients with depression or other mental illnesses. This tool was developed for farm workers who speak Spanish and have limited literacy skills. Our study found that the self-administered, tape recorded survey was reliable for diagnosis of mental illness. These audiotapes are available for use by health care providers.

• Materials List

Icon Based Occupational History
This project sought to expand and validate an icon based occupational history questionnaire for use with Hispanic migrant and seasonal farm workers. The questionnaire was specially designed to obtain lifetime work histories from illiterate or semiliterate subjects for use in long-term exposure studies and has been well-received by both interviewers and subjects. It was adapted for use in leukemia/brain cancer studies in Costa Rica and is available for use to other researchers.

• Publication List

Pilot: Methods for Accessing Pesticide/Nitrate Environmental Exposure Databases
Agricultural use of pesticides and fertilizers has grown dramatically in the last several years. Contamination of the hydrologic system by these chemicals is an increasing concern and much effort has been made to build databases containing measurements of these chemicals in drinking water sources. These geographically-referenced data (accessible by latitude/longitude coordinates of the target residence or facility) have yet to be used in epidemiologic studies of health outcomes. This project investigated the use of Global Positioning System (GPS)-obtained coordinates for linkage of environmental exposure data (pesticide/nitrate levels in drinking water).

A Pilot Application of Cholinesterase Monitoring of Pesticide Applicators in Washington State
This study evaluated the accuracy of cholinesterase determinations performed on the EQM Testmate Kit™ in field conditions as compared to those conducted in a laboratory. It also examined whether a field-based kit provides advantages in promptness of worker removal. Seventy-five orchard workers with regular exposure to Guthion, Diazinon, and several other organophosphate and N-methyl carbamate pesticides had samples of their blood and urine taken during the growing season. Samples were also obtained from five unexposed workers. Both the Testmate Kit and conventional venous laboratory testing for plasma and erythrocyte cholinesterase measurements were performed on the samples. Urinary metabolites confirmed that exposure was occurring in the exposed group but no significant mean cholinesterase changes were noted with either laboratory or field based methods. Preliminary findings indicated relatively good performance of the Testmate Kit under field conditions as compared to the laboratory.

Pilot: Validation of Sampling and Analytic Techniques for Fungi and Bacteria in Agricultural Organic Dust Exposure
Researchers characterized the relationships between various bioaerosol-related assays during composting operations using agricultural wastes. The assays included were standard microbiological assays (high and low temperature incubation for fungi and bacteria) on samples taken on filter cassettes, 1-3 b d glucan, possibly 1-6 b d glucan, and an extracellular polysacharride (EPS) specifically associated with aspergillus and penicillium species. Sampling was conducted during both winter and spring/summer conditions at a variety of operations composting yard waste, biosolids, agricultural waste (including fruit pulp and mint sludge), and dairy manure.

Pilot: Validation of an Asthma Questionnaire in Spanish
The main goal was to develop a validated questionnaire for the detection of asthma in community-based studies of Spanish-speaking Mexican populations in Washington State. A secondary goal was to collect pilot prevalence data on asthma in the Yakima Valley Hispanic population. Asthma, now recognized as one of the most common occupational lung diseases, is associated with many differing agricultural exposures. The Spanish-speaking migrant and seasonal farm worker population represents a large percentage of Region X and the U.S. agricultural workforce, but relatively little is known about asthma in this population. One major reason is the absence of a sensitive and specific asthma questionnaire. This project assembled a single translated respiratory symptom questionnaire from previously applied respiratory symptom surveys, translated and back translated and applied by an interviewer to 50 asthmatics and 50 non-asthmatics recruited from the Toppenish Farm Worker Clinic. Then, 10 teams of graduate students applied the questionnaire among more than 100 middle Yakima Valley residents in a pilot survey to obtain a crude prevalence estimate of asthma to be used as preliminary data for a future larger application.

Washington State Cholinesterase Monitoring Rule Evaluation:Medical Monitoring Education, Informed Consent for Handlers
In 2004, the state of Washington began requiring the medical monitoring of farm workers who work frequently with high toxicity pesticides. Washington follows only California in adopting this type of policy, presenting the opportunity for creating a model program. PNASH will help the state build the program by ensuring that there are well-developed and evaluated: training programs for the medical providers who will work with employees and employers; informed consent procedures for participating workers, many with low literacy.

These efforts will build upon interagency partnerships, informational interviews, and focus groups; draw on the experience of California’s monitoring program; and adapt their materials for use in Washington.

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Community Partnership Research/Interventions

Interventions to Minimize Worker and Family Pesticide Exposures
This field-based study tests and disseminates best workplace practices brainstormed by a team of industry experts that includes managers, workers, and pesticide safety educators.

Our underlying principles for this project are that pesticide handlers and orchard managers are the experts, as they use and implement the interventions and that workplace chemicals should stay at the workplace and not be inadvertently taken home to families. We base this on PNASH’s research and review of current information about pesticide exposure and health effects which show:

• There are opportunities to reduce handler's pesticide epsore and the transmission of pesticides off the work site.
• There is growing evidence that some pesticides, such as OP pesticides, may have long-term health effects on adults and children.

Direct community involvement is a key element of the project. The participation of experts in the day-to-day aspects of production, including orchard managers, pesticide handlers, and pesticide safety educators, and agricultural safety professionals, supports selecting solutions that a practical to use and implement. Together as the Expert Working Group we will look at innovations in equipment, education, and work practices.

Research will be directed towards practical workplace based solutions that are acceptable to pesticide handlers and orchard managers. Solutions may include equipment, practices, pesticide safety training, and chemical protective clothing. This five year project takes place in the Pacific Northwest and focuses on airblast pesticide application on tree fruit and other crops such as hops and grapes. In collaboration with national safety and industry partners, we will distribute these materials on best practices for pesticide handling across the country

Idaho Partnership for Hispanic Health (NIOSH/CDC 2005-2008)
This partnership with the Idaho Mountain States Group is addressing health disparities among Idaho Hispanics. We are advising on community-based participatory research methodologies and will provide research and health care expertise to help communities address safety and health interests.

Community Health Interventions with Yakima Ag Workers “El Proyecto Bienestar”
(NIOSH/CDC 2003-2007)
At the heart of this project are the Yakima Valley agricultural workers and their families. A community advisory board that includes 13 different constituencies guide the project. The University of Washington and three partners serve as catalysts, educators, and resources for the community: Northwest Communities Education Center/Radio KDNA; Heritage College; Yakima Valley Farm Workers Clinic/Northwest Community Action Center.

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Educational Interventions

Pilot: Point-of-View Video Analysis of the Impact of a Faller Safety Training Program (NIOSH/CDC, 2006-2008)
Oregon Health and Sciences University researchers will conduct a video observation study of loggers at work, concentrating on fallers, using video equipment attached to a hardhat for a first-person point of view.

Pilot: Skills Retention in Commercial Fishing Training (NIOSH/CDC, 2008)
Conducted by the Alaska Marine Safety Education Association, this project will inform federal policy on how often refresher training is need for survival equipment and emergency drill conductors.

Reality Tales: Storytelling to Translate Agricultural Health and Safety Research
‘Reality tales,’ uses Northwest workers’ heat illness and ladder injury experiences to teach critical prevention strategies.

• Resource List

Pilot: Skills Retention in Commercial Fishing Safety Training
Conducted by the Alaska Marine Safety Education Association, this project will inform federal policy on how often refresher training is need for survival equipment and emergency drill conductors.

An Incentive Intervention Program to Encourage Ergonomic Behavior in Latino Farm Workers (2004–2007)
Eastern Washington University’s Center for Farm Health and Safety used videotaped Spanish language theater, hands-on demonstrations and practice, and photonovela handouts to train workers on sound ergonomic practices. More than 200 migrant and seasonal orchard and packinghouse workers and their supervisors were trained in Washington. For copies of training videos visit: http://www.ewu.edu/x14663.xml.

Animal Handling and Safety: Developing a Marker for Program Evaluation
The Magic Valley SAFE KIDS Coalition, based in Twin Falls, Idaho, collaborated with Center investigators to evaluate the effectiveness of the animal handling component of their Farm Safety Day Camps. The project identified observable and measurable safe animal handling behavior, tested the pilot evaluation tool for reliability, and refined the tool.

Pilot: Evaluation of the WPS Train-the-Trainer Pilot
PNASH was invited by the EPA and the Council of Agricultural Science and Technology (CAST) to evaluate a Worker Protection Standard train-the-trainer model curriculum; to determine its feasibility for use throughout the country; to ensure that master trainers obtain the necessary skills, tools, and knowledge to train others; and to impart knowledge to trainers. PNASH developed the instruments used to evaluate the trainers, including those with low literacy.

Farm Safety for Teens
The Skagit County Cooperative Extension office and their community sponsors have developed an annual Safety Workshop to train young workers on tractor and farm machine safety. They invited PNASH to evaluate its effectiveness. We developed a child-relevant safe behavior self-assessment tool; composed additional farm safety and environmental health curriculum to complement the Safety Workshop; assessed parental attitudes about farm health and safety; and evaluated the needs of underserved Hispanic youth in Skagit County.

Pilot: Literacy and Safety description

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Use of Theater to Introduce Health and Safety Information in Hispanic Communities
The EWU Center for Farm Health and Safety developed a successful program that uses Spanish-language theater to provide farm workers with information on health hazards and prevention strategies. Based on data gathered from health and safety literature, key informant interviews, and a farm worker focus group, it was apparent that health and safety education must be sensitive to the literacy and language constraints of this worker population. Theater was selected as a method of providing farm health and safety education because it does not require a high level of literacy. The most urgent health and safety needs of Hispanic farm workers and their families were identified through a series of focus groups. The information gathered in the needs assessment was used to develop four one-act plays written and presented in Spanish.

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Outreach and Professional Education

Nurse Murf/Enferma Elena (NIOSH 2006-2011)
PNASH’s own Helen Murphy, Director of Outreach, is known in Northwest agriculture as ‘Nurse Murf’ or “Enferma Elena.” She provides concise reviews on farm safety topics, sharing the state-of-the-science and injury and illness prevention strategies.

Health and Safety Awareness for Working Teens in Agriculture: Curriculum Evaluation Project (WA MAAF/ NIOSH/CDC, 2005-2008)
This curriculum was developed to teach students in grades 9-12 introductory information about workplace health and safety in an agricultural work environment. The flexible five-unit curriculum addresses the unique job hazards found in an agriculture work setting. The curriculum is composed of interactive age appropriate lessons that help engage students in learning about topics such as:

• Identifying hazards in an agricultural work setting
• Child labor regulations that govern agricultural employment
• Developing solutions to reduce and eliminate hazards
• Communicating with your supervisor to solve health and safety issues
• Dealing with sexual harassment in the workplace.

For a copy, visit: http://www.uwworksafe.com/worksafe/request/.

National Tractor Safety Initiative (NIOSH/CDC, 2005-2008)
Tractors remain the leading cause of death and serious injury in US agriculture. The NIOSH Agricultural Centers are collaborating to create a national injury prevention program to address this problem.

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Pesticide Effects: Integration into Health Care Provider Curricula
The goal of this project is to improve the training of health care providers in the diagnosis, care, and prevention of pesticide poisonings among those who work with pesticides. This project will advance EPA’s goal to protect human health and address the intent of the Pesticide Registration and Improvement Act through improved poisoning reporting.

The project will develop, test and distribute innovative materials for integrating the core competencies, as outlined in National Pesticide Competency Guidelines for Medical and Nursing Education, into the curricula of medical, public health, nursing, physician assistant and advanced nurse practitioner programs. The project will enlist students and faculty in these schools to assist in the development and introduction of these modules in their respective schools, thus developing a new cadre of “champions” in this and the next generation. Additionally, the project will carefully monitor the introduction process across a broad range of curricular models in order to identify the most successful approaches to integrating these materials into the curricula. The program products will then be tested regionally in preparation for national distribution.

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Introducing a Cholinesterase (ChE) Test Kit into Clinical Practice (NIOSH/CDC 2006-2011)
The kit has been used in countries around the globe and has been reported upon in many studies in the published literature. It has shown good performance when compared to laboratory-based systems. Easy to apply in a clinician’s office, the Test-mate can substantially reduce the time necessary to detect a cholinesterase inhibitor overexposure and will speed the response of the clinician with regard to removing over-exposed workers. This project will introduce the Test-mate to clinics and work with large and small programs to facilitate the introduction by developing several "use models" based on the way the clinic conducts testing.

Once developed, these use models will be used to disseminate the technology to other clinics in the area. Monitoring workers for overexposure to pesticides is a labor and resource intensive process. This project will take a proven methodology, reconfirm its value and introduce it into the cholinesterase testing process aiming at reducing the work, cost and improving the quality of information and response time of the cholinesterase monitoring process.

Agricultural Health and Safety Communication and Education Project
The goal of this project is to provide an essential link between the research activities of the Center, agricultural workers and their families, and the safety and medical care professionals who interact with and care for them. Through this project, PNASH has developed, distributed, and evaluated educational programs and information. The major activities are the annual Western regional conference in partnership with UC Davis, continuing education courses in collaboration with partners such as Washington State University Cooperative Extension, research priority workshops, and dissemination of research findings and educational materials through traditional and new media.

Fluorescent Tracer Component for Hands-on Pesticide Handler Training (2004-2007)
We are improving education for pesticide handlers through a new hands-on training program and manual, Fluorescent Tracer Manual: An Educational Tool for Pesticide Educators. Pesticide handlers immediately see potential pesticide contamination by viewing results of proper and improper handling techniques. The training was developed and evaluated in collaboration with pesticide safety educators from the Washington State Department of Agriculture and the WSU Agricultural Extension Service. This project transfers to pesticide educators and employers a proven tool for the self-assessment of pesticide exposure, and integrates the technique into existing hands-on pesticide handler training programs. Visit our website for a copy of Fluorescent Tracer Manual: An Educational Tool for Pesticide Educators.

Development of a Community Theater Troupe: Health and Farm Safety Training for Hispanic Agricultural WorkersThe EWU Center for Farm Health and Safety developed a successful program that uses Spanish-language theater to provide farm workers with information on health hazards and prevention strategies. Based on data gathered from health and safety literature, key informant interviews, and a farm worker focus group, it was apparent that health and safety education must be sensitive to the literacy and language constraints of this worker population. Theater was selected as a method of providing farm health and safety education because it does not require a high level of literacy. The most urgent health and safety needs of Hispanic farm workers and their families were identified through a series of focus groups. The information gathered in the needs assessment was used to develop four one-act plays written and presented in Spanish.

Development of Agricultural Health and Safety Fact Sheet Publications
PNASH, working with the University of Idaho Departments of Agriculture Communications and Biological and Agricultural Engineering, Oregon State University, and Washington State University, developed a series of Agricultural Safety and Health fact sheet publications that were made available within the Pacific Northwest Region. These publications are available to potential users by CD-ROM, print copy masters, and online.

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