Agricultural tasks and injuries among Kentucky farm children: results of the Farm Family Health and Hazard Surveillance Project.

Background: This population-based study reports the prevalent agricultural tasks and the 1-year cumulative incidence of injuries in a sample of 999 children [less than or equal to] 18 years old living on family farms in Kentucky.

Methods: Data were collected in 1994 to 1995 for the National Institute for Occupational Safety and Health Farm Family Health and Hazard Surveillance Project. A random sample of farm children in 60 Kentucky counties was selected using a cross-sectional, two-stage cluster design. Respondents, primarily mothers, completed a 30-minute telephone interview about work-related tasks and injuries experienced by their children while working on the farm.

Results: Participation in chores related to tobacco and beef cattle production was common for children aged 5 to 18 years. In a 1-year period, 29 children were injured while performing farm work, yielding a crude rate of 2.8 per 100 children (95% confidence interval, 1.7-3.8). Boys aged 16 to 18 years had the highest injury rate (9.2 per 100 children). Farm machinery, cattle and horses, falls from heights, and contact with inanimate objects were the primary external causes of nonfatal farm work injuries.

Conclusion: Rates of farm work injuries among adolescent boys may be higher than previously reported for Kentucky and other states. Injury prevention interventions targeted to chores related to tobacco and beef cattle production are particularly relevant for this population of young workers.

Key Words: agriculture, children, epidemiology, injury

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Recent national initiatives in the United States have encouraged research into the cause and design of interventions for childhood agricultural injuries. (1), (2) In the United States, there were an estimated 1,930,306 youth under the age of 20 years who lived or worked on a farm in 1998. (3) Each year, it is estimated that there are approximately 100 unintentional farm-related deaths among children aged 19 years and younger in the United States. (4) Another 22,000 children suffer nonfatal farm injuries severe enough to be seen in emergency departments; an additional 78,000 nonfatal farm injuries to children, who are either seen in other medical care facilities or are self-treated, occur each year. (4), (5)

Factors associated with childhood agricultural injury risk have been recently reviewed by several authors. (6), (7) Both case-based (fatality and hospitalized injuries) and population-based approaches to agricultural injury surveillance among farm children have been reported in the United States, Canada, Australia, and other countries. (3), (4), (8-14) These studies have documented the hazards associated with farm machinery (tractors, augers, power take-offs), farm animals (especially cattle and horses), falls from structures, and injuries from other equipment and tools. Results generally confirm the increased risk of injury for male subjects relative to female subjects.

Studies also indicate a bimodal distribution in the occurrence of farm-related injuries, with peaks at ages 3 to 4 and 13 to 14 years. Typically, the farm injuries to young children are bystander injuries associated with their play and proximity to dangerous farm equipment, animals, or falls from elevated structures on the farm. The peak at the older ages is often directly related to performing farm work that often may be age and developmentally inappropriate for young teenagers. Seasonality is another risk factor, with higher injury rates during the spring, summer, and harvest times. Most injuries occur during the late morning and in the late afternoon. (8-11)

Examining the risk of farm-related injury among children is especially pertinent in Kentucky because its 71,331 family-owned and -operated farms may use child labor to a greater degree than farms in other states. On family farms, children have traditionally provided a substantial portion of the labor, especially during school breaks and peak harvest seasons. Under the federal Fair Labor Standards Act, it is legal for children as young as 12 to work full-time in agriculture during school breaks. Furthermore, the Fair Labor Standards Act does not apply to children working on their family farm, and minors of any age may be employed by their parents to assist with farm work. (5)

We present data on the prevalent work-related tasks and the incidence of nonfatal injuries occurring over a 1-year period for children aged 18 years and younger living and working on Kentucky farms. Our primary focus was on injuries occurring while a child was performing farm work or chores. The specific objectives were 1) to estimate the prevalence of youth participation in various farm chores, especially those related to tobacco and cattle production on Kentucky farms; 2) to estimate the 1-year incidence of nonfatal farm work injuries among these children and to identify any high-risk groups for farm work injuries; 3) to calculate the proportion of all Kentucky farm children's injuries that are a consequence of their farm labor by comparing rates of farm work injuries to injuries not associated with farm work or chores; and 4) to examine the distribution of injuries by age, gender, and other injury characteristics.

Methods

Data were collected as part of the National Institute for Occupational Safety and Health-sponsored Farm Family Health and Hazard Surveillance Project, a research effort to assess the risks from work in production agriculture among farm families in Kentucky. A telephone survey, based on a two-stage cluster sample design, was used to obtain data on the work-related exposures and the 1-year incidence of non-fatal injuries among children aged 18 years and younger living on Kentucky farms. Farms were defined as any establishment from which $1,000 or more of agricultural products from livestock, crop, or specialty operations were sold or would normally be sold during a year. (15) Agricultural commodities on Kentucky farms include beef cattle, tobacco, cash grain, soybeans, and other crops. (16)

Sampling

In brief, the sampling frame for the study was constructed using a two-stage cluster sampling design. (17) At the first stage, 60 counties were selected from the 120 counties in Kentucky using probability proportional to size sampling, where size was the number of farms in each of the counties determined on the basis of the 1992 Census of Agriculture. (18) Before sampling, several counties in the eastern portion of the state were excluded because of the small number of farms in these counties that met the study definition of a farm with $1,000 or more annually of reported agricultural production and because a greater proportion of the rural residences in this part of the state do not have telephone coverage.

At the second stage, a systematic sample of farms in the 60 counties was selected from a listing maintained by the Kentucky Agricultural Statistics Service. Details of the geographic coverage provided by Kentucky Agricultural Statistics Service are provided elsewhere. (17) In brief, farms were selected if they were family-owned and -operated establishments with $1,000 or more annually of agricultural production and had working telephones. The result was a sample of approximately 125 farm households per county. A short telephone survey (Farm Hazard and Demographic Enumeration Survey) was conducted to enumerate children aged 18 years and younger residing in the selected households. A total of 8,271 households were enumerated, producing a sample frame of 4,499 eligible children. This sample was then stratified by county, and within each county a simple random sample of children living on farms was selected, yielding 1,189 children eligible for the 30-minute telephone survey. The only restriction in the selection process was that no more than two eligible children from the same household could be selected for the interview.

Data Collection

A 30-minute telephone survey (Farm Health Interview Survey) was administered to proxy respondents (primarily mothers) of the children in the sample. The survey included questions on work tasks and agricultural exposures, injury incidence, risk factors for the injury, and demographic characteristics of the child and of the farm household. Standard questions from the National Health Interview Survey were used extensively. (19-22) Data were collected between June 1994 and September 1995 by the Survey Research Center at the University of Kentucky, using a computer-assisted telephone interviewing system. Interviewer training emphasized agricultural terms and questions. Confidentiality was ensured for all individuals who contributed data to this study, and all study protocols were reviewed and approved by the Institutional Review Board of the University of Kentucky.

Definition of Study Variables

Variables related to work patterns and exposures were examined by age and gender groups and are reported in this study for children aged 5 to 18 years, given that few children under 5 years were assigned farm chores and tasks. Proxy-reported injuries occurring in the 12 months before the interview were categorized into two classes: 1) injuries that occurred on the farm as a result of doing farm work or farm chores ("farm work" injuries); and 2) injuries not related to farm work or chores ("nonfarm work" injuries). This classification was used to quantify that portion of the total injury profile that was a consequence of the child's work-associated activities on the farm. The 1-year cumulative incidence rate of injury among the children was calculated with the number of injured children as the numerator and the total population of children surveyed as the denominator. (23) For children who reported multiple injuries within a 1-year period, the analyses were based on the most recent injury.

To classify external cause of injury, we considered responses to questions about how the injury occurred and what the child was doing at the time of the injury. The primary external causes of farm work injuries included machinery, falls from high places, animals, and contact with inanimate objects. Severity was assessed from questions addressing whether a medical professional was consulted and whether the child lost more than 4 hours from work (or school) as a result of the injury.

Data Management and Analysis

A single-stage stratified design was used in the analysis, with the 60 counties composing the strata and a simple random sample without replacement selected within each stratum. This approach was chosen because of the necessity of excluding certain counties from the sample in the first stage of the sample design. Therefore, the target population was restricted to children living on farms within the 60 counties selected in the first stage of the sampling; parameter estimates (rates, proportions) apply to this target population of farm children. Weighted analyses, based on the single-stage stratified design, were performed in accordance with traditional survey analysis procedures. (24), (25)

Age- and gender-specific prevalence estimates are presented for children's participation in farm tasks. Crude injury rates and age- and gender-specific rates were calculated by injury classification (farm work and nonfarm work), and by external cause, body location, type of injury, and other characteristics of the injury event. All descriptive statistics were design-adjusted. Data management and analysis were performed using the SAS (SAS Institute, Inc., Cary, NC) and SUDAAN (RTI International, Research Triangle Park, NC) software systems. (26), (27) For the estimates, 95% confidence intervals were calculated in accordance with standard procedures, accounting for the complex sample design. (27)

Results

From the sampling frame of 1,189 eligible children, 999 interviews were completed, yielding a response rate of 84%. Results from a comparison of the farm population enumerated in the Farm Hazard and Demographic Enumeration Survey and the farm population from the 1992 Kentucky Census of Agriculture indicated that our sample was representative of the population of farm households in the state. (17)

Demographic characteristics of the children are given in Table 1. Distributions across age groups for both boys and girls were similar. Ninety-nine percent of the children in the sample were white, and 90% of the children were reported to have very good to excellent health. A majority of the children lived on farms with a gross annual household income in excess of $30,000; however, 6.3% were from households with an income less than $20,000 per year. Mothers were the proxy respondents for data collected in 92% of the interviews. Other proxy respondents were grandparents or other guardians (5%) and fathers (3%). Fifty-one percent of the proxy respondents were employed full-time outside the home; 39% did not work outside the home, and the remaining 11% worked part-time outside the home.

Compared with girls, boys between the ages of 5 and 18 years spent more days per year participating in farm work or chores. Overall, 54.9% (95% confidence interval [CI], 50.3-59.4%) of boys aged 5 to 18 spent at least 180 days per year participating in farm work, compared with 37.6% (95% CI, 32.9-42.5%) of same-aged girls (P < 0.001). Of the boys aged 16 to 18 years, 63.8% participated in farm chores at least 180 days or more per year.

The age and gender distribution of children's participation in farm chores within the past year is given in Table 2. Overall, 81% of children aged 5 to 18 were involved in handling and caring for livestock; the feeding and care of livestock was the farm task that parents/guardians reported that children performed most often. Undertaking chores related to tobacco production (66% of all children) was also common; however, boys tended to participate in greater proportions in tasks related to the topping, harvesting and cutting, and hanging of tobacco compared with similar age girls. In addition, a significantly greater proportion of boys were involved in operating a tractor alone, driving a tractor on a public road, and working within 10 feet of a power take-off compared with girls of the same age.

Crude injury rates for farm work, nonfarm work, and total injuries are given in Table 3. Of the 999 children, 163 sustained at least one injury in the previous year; 133 children were injured once, 18 twice, and 12 children had three or more injuries, yielding a total of 231 reported injuries. Because few multiple injuries were reported, "injured children" was chosen as the unit of analysis. The rate of children injured at least once was 15.8 per 100 (95% CI, 13.2-18.4).

Nearly 20% of all injured children (n = 29) sustained their injuries during the performance of farm work or farm chores. Farm work injury rates increased with the child's age, regardless of gender. Farm work injury rates for boys were more than three times higher than rates for girls. Boys aged 16 to 18 years had the highest farm work injury rate of 9.2 per 100 children per year; 37% of all boys in this age group were injured while doing farm work. There were no farm work injuries reported among children aged 1 to 4 years. The proportion of all injuries that were a consequence of farm work was nearly equal for boys and girls aged 10 to 15 years (16% and 18%, respectively, of all injuries).

Nonfarm work injury rates were consistently higher than farm work injury rates across all age and gender strata. Rates of nonfarm work injury ranged from approximately 1.7 to 9 times the rate of farm work injuries. Nonfarm work injury rates were higher among boys than girls within all age categories except 16- to 18-year-olds. The highest nonfarm work injury rate for both sexes (16.6 injured children per 100 children per year) occurred in the 16- to 18-year-old age group. Boys aged 1 to 4 years had the highest nonfarm work injury rate, primarily from falls, among all the age and gender strata.

Characteristics of farm work injuries for the 29 injured children are given in Table 4. The leading external cause was contact with an inanimate object (24%) (eg, injuries to the eyes from rocks, sticks, and hay, and also injuries to the extremities from hand tools and barbed wire). Machine-related injuries (17% of all farm work injuries), injuries due to animals (12%), and injuries from falls (12%) constituted the majority of the farm work injuries. The machine-related injuries included fractures and contusions from crashes of allterrain vehicles, motorbikes, and tractors, and cuts sustained while hitching farm equipment. Animal-related injuries were primarily from cattle kicks and crushes. Most falls resulting in injury were from heights in tobacco barns or from farm equipment, such as the tobacco setter. The majority of the farm work injuries were sustained in the upper and lower extremities, occurred during the summer months on the farm of residence, happened under the supervision of an adult, and required the care of a medical professional.

The majority of the nonfarm work injuries were from sports (34%, summarized across all sports categories) and falls (29%) (Table 5). Approximately three-fourths of the nonfarm work injuries occurred in the spring and the summer, with slightly more than one-fourth occurring at school. A medical professional was consulted for 81% of the injuries. Although farm work injuries were more often to the upper extremities, injuries to the head and the neck and to the lower extremities were more prevalent among the nonfarm work injuries.

Discussion

A high proportion of farm youth in Kentucky are involved in the care and feeding of livestock, particularly beef cattle. The prevalence estimates associated with handling and feeding of animals for Kentucky children are higher than those reported by Marlenga et al (28) for farms in the midwestern and western United States and the province of Ontario, Canada. A majority of farm children in Kentucky are engaged in tobacco-related chores each year. Although the unique hazards (eg, green tobacco sickness, tobacco spear injuries) remain poorly documented for children, our surveillance data provide evidence of tobacco harvest-associated injuries in children including falls from heights in the tobacco barn and from the tobacco setter during planting.

Exposures to tractor operations were significantly more common for boys than for girls; the proportion of boys aged 16 to 18 who live on farms and drive a tractor (84%) is more than twice (38%) that of similar age girls who operate a tractor. The risks associated with the operation of tractors, especially those without rollover protective equipment, has been documented in several investigations. (3), (4), (10), (29) The use of all-terrain vehicles on the farm by children was also reported at a high prevalence across all age and gender groups; the use of all-terrain vehicles has been documented in other studies for increasing the risk of injuries to children living on farms. (7), (30)

Boys aged 16 to 18 were at the greatest risk for farm work injuries on family farms in Kentucky. The farm work injury rate for these boys (9.2 injured children per 100 children per year) was greater than that reported previously for Kentucky, for other states, and for the nation among this age and gender group. (3), (4), (11), (31) This rate is comparable to full-time male farmers aged 55 years and older in Kentucky and indicates that this particular group of children should be targeted for injury control programs. (17)

Our overall rate for children performing farm chores was 2.8 injured children per 100 children per year. With the exception of our elevated rate for 16- to 18-year-old boys, our nonfatal farm work injury rates were similar to those reported in several national studies of agricultural injuries in children. (3-5) The significant gender difference in rates of farm work injuries (ie, higher rates for boys) reported in our study confirms previous research. (3), (11), (13), (31), (32) Within Kentucky, the elevated farm work injury rate among adolescent boys may be partially explained by our finding that, compared with girls of similar age, boys on Kentucky farms are more likely to engage in farm work or chores, perform farm work more days per year, undertake more tasks with farm machinery and other equipment, and more likely to perform tasks without supervision. (29), (33)

Machinery, animals, contact with inanimate objects, and falls were the primary external causes of nonfatal farm work injuries reported in this study. A report from the Occupational Health Nurses in Agricultural Communities project corroborated this finding with machinery (27%), animals (17%), falls (16%), and hand tools (15%) as the primary external causes of injury among hospitalized Kentucky farm children. (34) Our study also identified injuries not requiring medical attention, including a number of minor injuries from contact with inanimate objects. A substantial number of these injuries could have been prevented through the use of simple personal protective equipment, including protective eyewear, hard-toed shoes, and appropriate clothing.

We estimate that 20% of all injuries sustained annually for children living on family-operated farms in Kentucky were due to the performance of farm work or chores. The finding of higher rates of injuries not related to farm work (eg, sports-related injuries, falls) compared with farm work injuries among youth is confirmed by other studies. (30)

Methodologically, the comparison of farm work injury rates between various studies is problematic and depends on several factors, especially the definition of a farm work injury. Our classification of farm work injuries provides a conservative estimate of the proportion of work-related injuries to children living on farms. Other authors have discussed the difficulties inherent in the classification of farm work and bystander injuries for children in an agricultural environment. (14), (35) Children's work and play often overlap--for example, riding horses while doing farm chores or playing in the barn while feeding animals. For this reason, we do not see the bimodal injury distribution that is often reported because the injury classification adopted in this study focused on farm work injuries. Our definition was intended to quantify the singular contribution of farm work to all reported injuries sustained by children living on family farms in Kentucky and indicates that one in five injuries to these children is related to the performance of farm work or chores.

The response rate (84%) for our telephone survey was impressive, especially for a population that is characteristically difficult to reach for survey research. Our population of farm families reflected the demographics of the typical family -operated farm in Kentucky. However, the data from this study are not generalizable to very small farming operations (ie, "hobby farms" or marginal farming operations with annual agricultural incomes less than $1,000) given the definition of a farm used in our sampling frame. The study population was predominantly white; consequently, we were unable to examine any potential racial or ethnic differences. The rates do not include injuries to migrant children or children who were visiting but not living on the family farm. However, other research conducted in Wisconsin indicated that 95% of farm injuries among children were to those in the immediate farm family. (11)

Several of the limitations regarding the methods used in the design and analysis of the Kentucky Farm Family Study have been discussed in detail elsewhere. (17) These include the potential for underestimation of injury rates due to poor recall from proxy respondents and underestimation of injury rates based on our classification of farm work injuries. Indeed, because the majority of the proxy respondents were mothers, who typically are not involved in assigning and overseeing farm chores, potential for underestimation of some minor injuries may have been present.

The data indicate that the recall of injuries over the 1-year time period focused primarily on injuries requiring medical attention. Because self-treated injuries were less likely to be reported, the data probably underestimate the overall injury rate but capture the most serious of the injuries. Recall of injuries may also differ by the age of the child. Furthermore, our rate denominators did not account for the person-time of exposure, nor did they adjust for the time since injury. Finally, the relatively small number of farm work injuries (n = 29) reported in this study preclude a meaningful multivariate analysis of the potential risk factors, including age, gender, hours of exposure, safety training, and supervision, which likely influence the risk of injuries related to children's performance of farm work.

Conclusion

Approximately 2 million children and adolescents aged 19 years and younger live on farms in the United States. (3) Recent national data indicate that nonfatal injury rates among children living and working on farms have risen approximately 10% in the past 10 years. (4) We estimate that there are approximately 38,840 children aged 18 years and younger living and working on family-owned and -operated farms in Kentucky. The application of our injury rate data suggests that each year approximately 1,088 of these children experience a nonfatal injury as a result of their performance of farm work. An estimated 740 of these children will need to consult with a medical professional concerning a farm-related injury.

Our data confirm the importance of designing and evaluating programs targeted to the high risk of farm work injuries among boys aged 16 to 18 years. State-based surveillance data of farm injuries is important because the risk of injury, to a degree, is a function of the farm commodity base in the state. Injuries related to the production of beef cattle and tobacco in Kentucky are particularly important. (36) Injury control interventions targeted to machinery-related hazards should be directed to preventing injury among these boys, especially before they become engaged in the operation of farm machinery. The prevention of animal-related injuries is appropriate for children of all ages, especially younger children.

The National Committee for Childhood Agricultural Injury Prevention recommends a multifaceted approach to the prevention of farm injuries to children and adolescents. (1) The collection of state-based surveillance data is a first step in this process. The opportunity to engage in farm work has much to offer children and is a benefit to their parents. Although farm work injuries account for a sizable portion of the total injury risk experienced by children living on farms, the substantial benefits associated with participation in farm work must also be considered. The role of injury prevention research is to allow for a child's continued, developmentally appropriate participation in farm work while identifying the important risk factors and evaluating the effectiveness of interventions designed to minimize childhood agricultural injuries.

It is good to be children sometimes, and never better than at Christmas.

--Charles Dickens

Table 1. Demographic characteristics of farm children
(aged 1-18 yr) in Kentucky: The Farm Family Health
and Hazard Surveillance Project

                                Children
                               in sample
Characteristic                 No.   %    Weighted % (a)

Gender/age (yr)

  Male                         532  53.3      51.5
   0-4                          60  11.3      12.0
   5-9                         102  19.2      19.1
   10-15                       207  38.9      38.0
   16-18                       163  30.6      30.9

  Female                       467  46.7      48.5
    0-4                         60  12.8      11.8
    5-9                         98  21.0      21.1
    10-15                      185  39.6      37.1
    16-18                      124  26.6      30.0

Race
  White                        987  98.8      98.7
  Black                          3   0.3       0.3
  American Indian                3   0.3       0.2
  Other                          6   0.6       0.7

Health status (b)
  Excellent                    706  70.7      70.0
  Very good                    194  19.4      19.5
  Good/fair/poor                99   9.9      10.5

Gross annual household income
  <$10,000                      12   1.2       1.2
  $10,000-19,999                64   6.4       5.1
  $20,000-29,999               166  16.6      18.1
  $30,000-49,999               316  31.6      31.4
  $50,000                      335  33.5      33.9
  Don't know/refused           106  10.6      10.2

Type of farm
  Beef cattle                  287  28.7      29.8
  Beef and tobacco             120  12.0      12.0
  Tobacco                      270  27.0      26.9
  Other                        322  32.2      31.2

(a) Weighted percentage reflects the distribution expected in the
60-county population.
(b) Proxy-reported health status for target child.

Table 2. Participation of Kentucky farm children (aged 5-18 yr) in
select chores, by gender and age group (a)

                                 5-9 yr                10-15 yr
                             Male       Female      Male      Female
Farm chore/task             No.  % (b)  No.  %     No.  %     No.  %

Animal related

  Handle/touch livestock     79   86.3   72  81.9  162  79.8  138  76.8

  Feed farm animals          81   82.1   73  69.4  167  80.6  142  76.2

Tobacco related

  Work with tobacco          24   59.4   18  45.8  137  67.7  108  63.8

   Set                       18   75.6    9  49.3  115  86.3   82  73.3

   Top                        6   21.6    0   0.0   70  53.7   23  22.8

   Strip                     21   83.8   13  68.8  120  86.0   78  70.8

   Harvest/cut                4   10.5    2  12.3   80  58.7   17  18.3

   Hang                       2    4.0    0   0.0   58  40.2   15  13.1

Machinery related

  Drive tractor on farm       4    7.2    0   0.0  109  55.5   45  26.5
  alone

  Drive tractor on public     0    0.0    0   0.0   37  34.5    3   4.1
  road

  Drive ATV                  20   25.8   12  16.5  108  51.6   66  35.0

  Work within 10 ft of PTO   26   25.0   18  19.5  109  51.1   53  31.6

                                16-18 yr
                             Male      Female
Farm chore/task             No.  %     No.  %

Animal related

  Handle/touch livestock    136  85.6  81  79.3

  Feed farm animals         140  85.9  76  65.8

Tobacco related

  Work with tobacco         122  74.5  74  64.8

   Set                      104  81.5  69  94.9

   Top                      102  83.8  38  56.5

   Strip                    106  82.6  57  80.6

   Harvest/cut              104  84.0  29  41.8

   Hang                     110  89.6  24  38.3

Machinery related

  Drive tractor on farm     130  84.0  43  37.9
  alone

  Drive tractor on public    77  63.0  11  29.6
  road

  Drive ATV                 103  61.2  55  42.3

  Work within 10 ft of PTO  111  70.5  36  28.9

(a) ATV, all-terrain vehicle; PTO, power take-off.
(b) Prevalence estimates (%) are weighted to account for the complex
sampling design. No. refers to the number of children who responded
affirmatively to each question regarding participation in the selected
farm chore in the past year.

Table 3. Estimated injury rates for children (aged 1-18 yr) in 60
Kentucky counties, by age, gender, and injury classification (a)

                    Farm work injuries (b)
Category         [n.sub.i]  Rate (c)  95% CI

Gender
  Male                21       4.1    2.3-5.9
  Female               8       1.3    0.4-2.2
  Total               29       2.8    1.7-3.8

Age (yr)
  1-4                  0        --      --
  5-9                  2       1.0      -- (d)
  10-15               10       2.4    0.8-4.0
  16-18               17       5.4    2.7-8.0

Gender/age (yr)
  Male
   1-4                 0        --      --
   5-9                 1       1.6      -- (d)
   10-15               5       2.6    0.2-5.0
   16-18              15       9.2    4.4-13.9

  Female
    1-4                0        --      --
    5-9                1       0.5      -- (d)
    10-1               5       2.2    0.2-4.1
    16-1               2       1.3      --

                 Nonfarm work injuries
Category         [n.sub.i]  Rate  95% CI

Gender
  Male                79    14.6  11.1-18.2
  Fema                55    11.4   8.2-14.7
  Tota               134    13.1  10.7-15.5

Age (yr)
  1-4                 15    12.9   5.6-20.8
  5-9                 22    10.8   5.8-15.9
  10-1                50    11.5   8.2-14.8
  16-1                47    16.6  11.6-21.6

Gender/age (yr)
  Male
   1-4                10    18.4   6.0-30.7
   5-9                16    14.6   6.5-22.6
   10-15              27    12.4   7.7-17.1
   16-18              26    16.0   9.2-22.8

  Female
    1-4                5     7.0   0.9-13.2
    5-9                6     7.2   1.4-13.0
    10-15             23    10.6   6.0-15.1
    16-18             21    17.1   9.5-24.7

                       Total injuries
Category         [n.sub.i]  Rate  95% CI

Gender
  Male               100    18.8  14.9-22.6
  Female              63    12.7   9.3-16.0
  Total              163    15.8  13.2-18.4

Age (yr)
  1-4                 15    12.9   5.6-20.3
  5-9                 24    11.9   6.6-17.1
  10-15               60    13.9  10.3-17.4
  16-18               64    21.9  16.6-27.3

Gender/age (yr)
  Male
   1-4                10    18.4   5.96-30.74
   5-9                17    16.2   7.73-24.39
   10-15              32    15.0   9.79-20.13
   16-18              41    25.2  17.53-32.89

  Female
    1-4                5     7.0   0.85-13.23
    5-9                7     7.7   1.84-13.60
    10-15             28    12.7   7.88-17.56
    16-18             23    18.4  10.70-26.02

(a) [n.sub.i] number of injured children in sample; CI, confidence
interval.
(b) Farm work injuries were defined as proxy-reported injuries occurring
to the children in the 12 mo before the interview that occurred on the
farm as a result of doing farm work or farm chores.
(c) Estimated number of injured children per 100 children per yr,
weighted to account for sampling design.
(d) Insufficient data to calculate a valid confidence interval.

Table 4. Distribution of farm work injuries in Kentucky children by
injury characteristics (n = 29) (a)

                                                        Distribution for
Characteristic                               [n.sub.i]    sample (%)

External cause
  Object                                         8           27.6
  Machine                                        5           17.2
  Animal                                         4           13.8
  Falls from height                              4           13.8
  Lifting                                        3           10.3
  Motor vehicle                                  1            3.4
  Other (b)                                      4           13.8

Part of body injured
  Upper extremities                             11           37.9
  Lower extremities                              8           27.6
  Torso                                          4           13.8
  Head/neck                                      4           13.8
  Multiple body parts                            2            6.9

Type of injury
  Cut                                            6           20.7
  Contusion                                      4           13.8
  Strain                                         4           13.8
  Multiple                                       2            6.9
  Fracture                                       2            6.9
  Other (d)                                     11           37.9

Season of injury
  Spring                                         8           28.6
  Summer                                        16           57.1
  Fall                                           3           10.7
  Winter                                         1            3.6

Farm type
  Beef cattle                                    5           17.2
  Beef and tobacco                               1            3.4
  Tobacco                                        6           20.7
  Other                                         17           58.6

Place injury occurred
  Farm                                          23           79.3
  Other (e)                                      6           20.7

Consulted medical professional after injury
  Yes                                           21           72.4
  No                                             8           27.6

Missed > 4 h work
  Yes                                           13           44.8
  No                                            16           55.2

Adult present at time of injury
  Yes                                           21           72.4
  No                                             8           27.6

Characteristic                               [N.sub.i]  Weighted %

External cause
  Object                                        134        23.8
  Machine                                        95        16.9
  Animal                                         69        12.3
  Falls from height                              67        11.9
  Lifting                                        61        10.9
  Motor vehicle                                  39         6.9
  Other (b)                                      97        17.3

Part of body injured
  Upper extremities                             241        42.9
  Lower extremities                             131        23.3
  Torso                                          82        14.6
  Head/neck                                      59        10.5
  Multiple body parts                            49         8.7

Type of injury
  Cut                                           116        20.7
  Contusion                                      83        14.8
  Strain                                         73        13.0
  Multiple                                       56        10.0
  Fracture                                       37         6.6
  Other (d)                                     196        34.9

Season of injury
  Spring                                        180        34.0
  Summer                                        282        53.3
  Fall                                           50         9.5
  Winter                                         17         3.2

Farm type
  Beef cattle                                    83        14.8
  Beef and tobacco                               20         3.5
  Tobacco                                        81        14.5
  Other                                         378        67.2

Place injury occurred
  Farm                                          436        77.6
  Other (e)                                     126        22.4

Consulted medical professional after injury
  Yes                                           381        67.9
  No                                            180        32.1

Missed > 4 h work
  Yes                                           253        45.1
  No                                            308        54.9

Adult present at time of injury
  Yes                                           405        72.2
  No                                            156        27.8

Characteristic                               95% CI

External cause
  Object                                     7.6-40.3
  Machine                                    3.4-30.4
  Animal                                     1.1-23.4
  Falls from height                          0.8-23.1
  Lifting                                    1.5-23.1
  Motor vehicle                                - (b)
  Other (b)                                  1.6-32.9

Part of body injured
  Upper extremities                          23.6-62.1
  Lower extremities                          7.7-38.9
  Torso                                      0.5-28.8
  Head/neck                                  0.03-21.0
  Multiple body parts                          - (b)

Type of injury
  Cut                                        5.2-36.0
  Contusion                                  0.9-28.7
  Strain                                       - (b)
  Multiple                                     - (b)
  Fracture                                     - (b)
  Other (d)                                  16.7-53.1

Season of injury
  Spring                                     14.3-53.8
  Summer                                     33.3-73.1
  Fall                                         - (b)
  Winter                                       - (b)

Farm type
  Beef cattle                                2.9-26.8
  Beef and tobacco                             - (b)
  Tobacco                                    2.9-26.1
  Other                                      50.6-83.8

Place injury occurred
  Farm                                       60.8-94.6
  Other (e)                                  5.4-39.2

Consulted medical professional after injury
  Yes                                        49.4-86.4
  No                                         13.6-50.6

Missed > 4 h work
  Yes                                        25.8-64.5
  No                                         35.5-74.2

Adult present at time of injury
  Yes                                        55.1-89.1
  No                                         10.8-44.9

(a) [n.sub.v] number of injured children in sample; [N.sub.v] estimated
number of injured children in population of 60 counties; CI, confidence
interval.
(b) Insufficient data to calculate an interval.
(c) Includes injuries from animal feeding chores (eg, milking), welding,
and a firearm injury.
(d) Includes dislocations, scrapes, stabs, toxic effects, and other
multiple injuries.
(e) Includes neighbor's or relative's farm or field.

Table 5. Distribution of nonfarm work injuries in Kentucky children by
injury characteristics (n = 134) (a)

                                                        Distribution for
Characteristic                               [n.sub.i]    sample (%)

External cause
  Falls                                          42           31.3
  Other sports (b)                               15           11.2
  Bicycle                                        13            9.7
  Object                                         10            7.5
  Basketball                                      9            6.7
  Vehicle                                         9            6.7
  Baseball                                        6            4.5
  Football                                        6            4.5
  Horse                                           4            3.0
  Animal                                          3            2.2
  Machine                                         1            0.7
  Other (d)                                      16           11.9

Part of body injured
  Head/neck                                      39           29.1
  Lower extremities                              43           32.1
  Upper extremities                              28           20.9
  Torso                                          12            9.0
  Multiple body parts                            12            9.0

Type of injury
  Strain                                         28           20.9
  Cut                                            19           14.2
  Contusion                                      21           15.7
  Fracture                                       27           20.1
  Multiple                                       11            8.2
  Amputation                                      1            0.7
  Other (e)                                      27           20.1

Season of injury
  Spring                                         59           44.4
  Summer                                         43           32.3
  Fall                                           23           17.3
  Winter                                          8            6.0

Place of injury
  School                                         41           30.6
  Home                                           35           26.1
  Farm                                           15           11.2
  Other (f)                                      43           32.1

Consulted medical professional after injury
  Yes                                           108           80.6
  No                                             26           19.4

Adult present at time of injury
  Yes                                            91           67.9
  No                                             43           32.1

Characteristic                               [N.sub.i]  Weighted %

External cause
  Falls                                         772        28.9
  Other sports (b)                              310        11.6
  Bicycle                                       212         7.9
  Object                                        210         7.9
  Basketball                                    202         7.6
  Vehicle                                       190         7.1
  Baseball                                       96         3.6
  Football                                       81         3.0
  Horse                                          87         3.3
  Animal                                         67         2.5
  Machine                                        37         1.4
  Other (d)                                     408        15.3

Part of body injured
  Head/neck                                     889        33.3
  Lower extremities                             804        30.1
  Upper extremities                             416        15.6
  Torso                                         356        13.3
  Multiple body parts                           207         7.7

Type of injury
  Strain                                        544        20.4
  Cut                                           455        17.0
  Contusion                                     434        16.2
  Fracture                                      379        14.2
  Multiple                                      297        11.1
  Amputation                                     16         0.6
  Other (e)                                     547        20.5

Season of injury
  Spring                                      1,100        41.4
  Summer                                        958        36.0
  Fall                                          477        17.9
  Winter                                        124         4.7

Place of injury
  School                                        716        26.8
  Home                                          635        23.8
  Farm                                          296        11.1
  Other (f)                                   1,025        38.4

Consulted medical professional after injury
  Yes                                         2,175        81.4
  No                                            497        18.6

Adult present at time of injury
  Yes                                         1,662        62.2
  No                                          1,010        37.8

Characteristic                               95% CI

External cause
  Falls                                      20.0-37.8
  Other sports (b)                           4.8-18.4
  Bicycle                                    3.4-12.5
  Object                                     2.9-12.9
  Basketball                                 2.3-12.9
  Vehicle                                    2.2-12.0
  Baseball                                    0.5-6.7
  Football                                    0.6-5.5
  Horse                                        - (c)
  Animal                                       - (c)
  Machine                                      - (c)
  Other (d)                                  6.8-23.7

Part of body injured
  Head/neck                                  23.5-43.1
  Lower extremities                          21.0-39.1
  Upper extremities                          9.6-21.5
  Torso                                      5.5-21.1
  Multiple body parts                        3.0-12.5

Type of injury
  Strain                                     12.2-28.5
  Cut                                        8.9-25.2
  Contusion                                  9.2-23.3
  Fracture                                   8.7-19.7
  Multiple                                   3.8-18.4
  Amputation                                   - (c)
  Other (e)                                  12.7-28.3

Season of injury
  Spring                                     31.7-51.1
  Summer                                     26.0-46.0
  Fall                                       10.6-25.3
  Winter                                      1.4-8.0
Place of injury
  School                                     18.7-34.9
  Home                                       15.5-32.1
  Farm                                       5.3-16.9
  Other (f)                                  28.3-48.4

Consulted medical professional after injury
  Yes                                        73.6-89.2
  No                                         10.8-26.4

Adult present at time of injury
  Yes                                        52.2-72.0
  No                                         27.9-47.7

(a) [n.sub.v] number of injured children in sample; [N.sub.v] estimated
number of injured children in population of 60 counties; CI, confidence
interval.
(b) Includes weight lifting, track, soccer, and gym class.
(c) Insufficient data to calculate interval.
(d) Includes injuries from indoor/outdoor games; using tools; and
bending, twisting, or lifting.
(e) Includes dislocations, scrapes, stabs, and toxic effects.
(f) Includes neighbor's or relative's house, street, field, mall, and
other locations.

Acknowledgments

We thank the Kentucky Agricultural Statistics Service and the Survey Research Center at the University of Kentucky for their assistance in implementing the study. Dr. Helena Truszczcynska and Dr. Richard Kryscio provided statistical support and consultation throughout the study. We also thank Carol Koetke, Carl Wendt, and Susan Pollack for their review of an earlier version of the manuscript. We gratefully acknowledge and extend our appreciation to the Kentucky farmers and their families who participated in the study.

Accepted May 13, 2003.

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RELATED ARTICLE: Key Points

* Among children living on Kentucky farms, 82% were involved in the feeding and care of animals and 70% were reported to have performed work related to the production of the tobacco crop in the past year. Although there was high participation in chores related to animal care across all age and gender groups, boys were more likely to perform tractor-related chores and the harvesting of the tobacco crop compared with girls.

* The highest rates of farm work injuries occur among boys aged 16 to 18 years (9.2 injured children per 100 children per year), a rate comparable to older, male, full-time farmers. Among all children, injuries related to tractors and all-terrain vehicles, working with cattle and horses, use of farm hand-tools and barbed wire, and falls from heights (especially in barns) were the primary external causes of nonfatal farm work injuries among Kentucky children living on farms.

* Nearly 20% of all injuries to Kentucky farm children were sustained while they were performing farm work or chores. We estimate that in any given year, 1,088 children living on family farms in Kentucky will experience a nonfatal injury as a result of their performance of farm work. Interventions targeted toward reducing injuries related to tobacco and beef cattle production are especially relevant in this population of children.

Steven R. Browning, PHD, Susan C. Westneat, MA, Carol Donnelly, BA, and Deborah Reed, RNC, PHD

From the College of Nursing and the Department of Preventive Medicine and Environmental Health, University of Kentucky, Lexington, KY.

This article is based on data produced by a study funded by the National Institute for Occupational Safety and Health under Cooperative Agreements U04/CCU406090, R01/CCR414307-03, and 1 R01 OH03924-01.

Reprint requests to Steve Browning, PhD, College of Nursing, University of Kentucky, 549 Health Sciences Learning Center, Lexington, KY 40536-0232. Email: [e-mail]

Copyright [c] 2003 by The Southern Medical Association

0038-4348/03/9612-1203