Review of Health Effects Research - Agriculture Forestry and Fishing Research at NIOSH - page 85

The activities addressed some of the most important exposures in AFF work-
sites. However, when reviewing the array of outputs described in the evidence
package, the committee noted some gaps and uneven emphases. For example, sleep
deprivation and the effects of nightshift work have not been extensively explored,
workplace violence has received little attention, the health impact of volatile organic
chemicals and solvents that are ubiquitous in AFF worksites remains unknown,
infectious disease has received little exploration, and reproductive health effects
have received only sporadic support in both the intramural and extramural parts
of the AFF Program. The study of gene-environment interactions is a nascent
program; it has become clear that research in this field requires large numbers of
subjects to generate useful results, so there is a need to conduct well-organized
multicenter studies with careful exposure assessment and characterization of dis-
ease phenotypes. The AFF Program has given substantial attention to respiratory
disease and traumatic injury, some cancer end points, childhood exposure, hear-
ing loss, selected dermatoses, and some neurological conditions. Program efforts
have also been devoted, through the extramural Ag Centers, to employed workers
(as distinct from owners or managers) in all three AFF sectors. The Agricultural
Health Study is an important collaborative prospective cohort study—cosponsored
with the National Cancer Institute (NCI), the National Institute of Environmental
Health Sciences (NIEHS), and the U.S. Environmental Protection Agency (EPA)—
of nearly 90,000 farmers and their wives to explore the potential causes of cancer
and other diseases (National Cancer Institute, 2007). In addition, other epidemio-
logical studies conducted through the Ag Centers serve as valuable program-wide
resources. Emphases on AFF sex-specific exposure, common disease end points,
and serious health consequences have been noted, but the evidence presented to
the committee suggests limited reach.
Evidence of AFF stakeholder input into research activity varied. Beginning
with the Surgeon General's Conference on Agricultural Safety and Health in 1991
(for the agricultural sector), the FACE-based logging initiative in five key industry
states (for the forestry sector), and an interagency working group (for the Alaska
fishing sector), stakeholder input appears to have been consistently sought by
NIOSH scientists. Indeed, that may be one of the AFF Program's strengths. Some
rural populations represented by, for example, voluntary agricultural organiza-
tions initially declined to participate in NIOSH initiatives, believing them to be
programmatic extensions of the nation's occupational safety and health regulatory
mechanism. Other populations, such as employed workers, appear to have been
underrepresented in advisory structures convened by NIOSH to secure stake-
holder input. To its credit, NIOSH has recently convened an AFF-sector advisory
mechanism; it could profit from more thorough representation of AFF employed
worker domains.