摘要：Objectives. Although eye injuries are common among citrus harvesters, the proportion of workers using protective eyewear has been negligible. We focused on adoption of worker-tested safety glasses with and without the presence and activities of trained peer-worker role models on harvesting crews. Methods. Observation of 13 citrus harvesting crews established baseline use of safety eyewear. Nine crews subsequently were assigned a peer worker to model use of safety glasses, conduct eye safety education, and treat minor eye injuries. Safety eyewear use by crews was monitored up to 15 weeks into the intervention. Results. Intervention crews with peer workers had significantly higher rates of eyewear use than control crews. Intervention exposure time and level of worker use were strongly correlated. Among intervention crews, workers with 1 to 2 years of experience (odds ratio [OR] = 2.89; 95% confidence interval [CI] = 1.11, 7.55) and who received help from their peer worker (OR = 3.73; 95% CI = 1.21, 11.57) were significantly more likely to use glasses than were other intervention crew members. Conclusions. Adaptation of the community health worker model for this setting improved injury prevention practices and may have relevance for similar agricultural settings. Agricultural work is one of the most dangerous occupational fields. 1 Although many injuries are preventable, barriers to safe practices exist. These barriers are especially evident in the citrus harvesting industry and include a piece-rate pay scale that fosters a rapid and potentially hazardous pace of work; a crew leader system that obscures employer–worker relationships; language and literacy barriers that impede safety training; cultural barriers that contribute to entrenched resistance to using safety equipment; an illegal work status that encourages hazardous job employment; and a dearth of occupational safety and health enforcement. 2 Florida's $1 billion citrus harvest is almost entirely handpicked. Harvesters use 20-foot ladders and canvas bags weighing up to 90 pounds when full to pick about 3 tons of fruit daily. 3 , 4 Environmental conditions are challenging. During picking season, the groves are typically wet and humid in the morning and hot and dusty in the afternoon. Harvesters confront eye injuries from tree branches, dust, chemical residues, biting insects, sunlight, and falls. 5 – 11 Citrus industry managers recognize that eye injuries are the most frequent causes of clinic visits, and that transportation, lost time, and paperwork contribute significantly to harvesting costs. More than 90% of eye injuries are preventable by protective eyewear. 12 However, use of safety glasses requires availability, a monetary outlay, adoption by reluctant workers, 13 and a change in workplace safety culture that is difficult to influence and measure. 14 , 15 Although most companies provide harvesters with free glasses, use is deterred by fears that they impede efficiency and productivity, resulting in lower wages. The workers also believe glasses are uncomfortable, too hot to wear in warmer months, require breaks for cleaning or adjusting, come into contact with tree branches, and distort vision, thereby increasing risk of falls. Thus, the proportion of workers wearing safety glasses is negligible (∼2%). 11 One method of encouraging behavior change that has not been widely disseminated at the worksite is the use of community health workers (CHWs). 16 Whereas CHWs have been used extensively throughout Latin America, Africa, and Asia, 17 , 18 their activities are usually limited to home visits. In the United States, most CHWs are women serving as cultural bridges between health care providers and members of economically disadvantaged communities. 19 The CHW approach has been useful in reaching Hispanic populations in rural areas where English usage is uncommon. 20 Because they know local norms, CHWs can make personal connections more effectively than traditional health care providers can, as well as disseminate health information. 21 Relevant worksite health promotion interventions are beneficial in that they offer the possibility of combining policy, organizational, and individual behavior change strategies, thereby increasing intervention potency. 22 – 25 Moreover, ongoing interactions among workers provide social support that may enhance intervention effect by motivating persons who might otherwise not participate. 26 Lastly, beyond adoption of desired health behaviors, worksite interventions can increase morale and productivity. 27 , 28 We assessed the utility of a CHW approach for increasing the acceptance and use of safety glasses among citrus harvesters.
