Review of Health Effects Research - Agriculture Forestry and Fishing Research at NIOSH - page 94

be conducted on exposures to substances associated with latent diseases (such as
cancer, hearing loss, repetitive motion injuries, and back injury) at a time of rapid
growth and cell turnover, and also on endocrine disruptors at a time of puberty.
INTERMEDIATE OUTCOMES
The intermediate outcomes span unique staff and laboratory capability for AFF
worksite exposure assessment, explicit worksite interventions and fruitful partner-
ships with AFF stakeholders, professional and clinical training at academic health
centers, and symposia and other professional career-development opportunities.
Prevention or mitigation of exposure is reflected in a hierarchy that begins with
AFF worksite exposure assessment, moves to testable interventions, continues with
stakeholder partnerships if interventions are effective, and culminates in training of
and clinical awareness in rural practitioners, agricultural extension leadership and
staff, local public health nurses, agricultural engineers, and voluntary agriculture
and forestry association staff and general membership. NIOSH public affairs staff
repeatedly rejected advice from Ag Center scientists encouraging intramural staff
to produce materials that farmers could relate to and understand.
AFF worksite exposure assessment needs to involve unique biomechanics, basic
science, and epidemiological assessment. NIOSH and the extramurally funded Ag
Centers have developed and deployed biomechanics and basic science capability.
Substantial activity has also occurred in design of rural epidemiological surveil-
lance, sometimes without NIOSH assistance or support but still able to elucidate
the epidemiology of disease states and injury of disabling conditions of interest in
agriculture and forestry populations.
NIOSH funding has been invested in AFF worksite interventions, such as de-
sign of a Certified Safe Farms initiative, tractor ROPS public policy development,
rural cancer control intervention development, ergonomic tool design, develop-
ment of respiratory and hearing personal protective equipment, organic dust re-
duction in AFF worksites through animal housing engineering, injury prevention
through redesign of worksite facilities and methods of work, design of safe play
areas for children in agricultural worksites, design of helicopter logging injury
countermeasures, and use of enhanced deck safety technologies for fishermen.
Those initiatives have generally been scientifically robust and clinically relevant and
have reflected input of AFF stakeholders whose perspective governed identification
and priority-setting of interventions and the actual deployment process. Feedback
from AFF stakeholders as varied as the National Institute for Farm Safety and the
U.S. Coast Guard about the utility of the interventions has generally been favor-
able. Other AFF stakeholders—including agricultural engineers, rural clinicians,