摘要：Objectives. We assessed whether active dissemination of the North American Guidelines for Children’s Agricultural Tasks (NAGCAT) reduced childhood agricultural injuries. Methods. In this randomized controlled trial, lay educators visited intervention farms to review NAGCAT. New York State farms with resident or working children were randomized. Control farms were visited only to collect baseline data. Data on childhood injuries, tasks, and hours worked were obtained quarterly for 21 months. Injury rates per farm were compared between the treatment and control groups, along with time span to occurrence of an injury and to violation of NAGCAT age guidelines. Results . Intervention farms were less likely than control farms to violate NAGCAT age guidelines in the areas of all-terrain-vehicle use and tractor and haying operations. Cox proportional hazards regression models showed a significant protective effect of the intervention on preventable injuries after adjustment for important covariates. Conclusions. Our results showed that dissemination of NAGCAT reduced rates of work-related childhood agricultural injuries. A comprehensive public health approach is needed to reduce non–work-related childhood injuries. Annual rates of agricultural injuries among children living or working on farms are high, on the order of about 1.7 injuries per 100 farms. 1 , 2 For example, among young people less than 20 years of age, the rate of farm injuries requiring an emergency department visit increased 10% between the period spanning 1979 to 1983 (1551 per 100 000 child farm residents) and the period spanning 1990 to 1993 (1717 per 100 000). 3 Because hours worked is a proxy for exposure to agricultural injuries and young people often work part time, injury rates related to agricultural work can be expressed as injury incidents per 100 full-time equivalents (FTEs). Between 1995 and 1997, farm workers aged 15 to 17 years had an injury rate of 1.8 per 100 FTEs. 4 In an attempt to reduce childhood agricultural injuries, and at the request of farm parents, the National Children’s Center for Rural and Agricultural Health and Safety in Marshfield, Wis, created the North American Guidelines for Children’s Agricultural Tasks (NAGCAT). 5 These guidelines (available online at http://www.nagcat.org ), developed by a team of agricultural safety professionals, child development experts, farm parents, and adolescents using a job hazard analysis framework, consensus development methodology, and child development principles, are specifically designed to assist parents in matching a child’s physical, mental, and psychosocial abilities with the requirements of certain farm jobs. Targeting young people aged 7 to 16 years, the 62 guidelines address 7 categories of routine jobs: animal care, manual labor, haying operations, implement operations, specialty production, tractor fundamentals, and general activities. Each guideline includes color illustrations of the job, a description of primary hazards and safety equipment and recommendations for supervision, adult responsibilities regarding workplace safety, and a flow chart assessment of the child’s ability to do the job. A review of nonfatal childhood agricultural injury incidence and disability underscores the paucity of data available for evaluating efforts to prevent such injuries. 6 A systematic review of farm safety interventions revealed only 3 studies, none including children, in which injury incidence was used as an outcome. 7 The effectiveness of NAGCAT in reducing childhood agricultural injury has not been assessed. We evaluated the effect of active dissemination of NAGCAT on the incidence of childhood agricultural injuries as well as several intermediate outcomes.
