title: Child bystanding: A risk factor for injury and identifying its' determinants on midwestern agricultural operations.
abstract: BACKGROUND
  Agriculture is considered among the most dangerous occupations and has consistently ranked among the top three. Production processes, associated with this occupation, place at risk not only workers but also others who live on the operations. We evaluated the incidence and determinants of associated bystander injuries in the Regional Rural Injury Study-II (RRIS-II).
  
  
  METHODS
  The RRIS-II followed 32,601 people ( approximately 85% of eligible) from rural communities in the Midwest for 1999 and 2001, using six-month recall periods, and identified their injury events. Demographic, injury, and exposure data were collected through comprehensive and case-control computer-assisted telephone interviews. Multivariate logistic regression analyses were used to estimate the risk of child bystanding and agricultural injury, while controlling for potentially confounding variables.
  
  
  RESULTS
  Nearly 60% of all 425-child injury cases (<20 years) responded to sometimes/frequently bystanding in six out of seven different agricultural environments (e.g., workshops, animal areas, etc.) Multivariate regression analyses, with odds ratios and 95% confidence intervals, showed increased odds of injury for bystanding near used (1.5; 1.1, 1.9) or stored (1.4; 1.1, 1.8) machinery, and near fields and barnyards (1.4; 1.0, 1.9). Further, multivariate analyses revealed increased odds of bystanding for parental beliefs, such as: child age (1.4; 1.0, 2.0) near stored equipment. Parental levels of strictness were also evaluated and showed decreased odds of bystanding when the parents were not strict about the child's wearing a seatbelt near used equipment (0.5; 0.3, 1.0). Households with only one child had decreased odds of bystanding for five of the exposures while there was an increased odds of bystanding near animals for households with five or more children.
  
  
  CONCLUSIONS
  Although parents cannot child-proof their operations, it is important for them to understand the apparent odds of and risks associated with bystanding. Children can have injury odds similar to adults in this environment; therefore, it is necessary to examine parental factors that may be associated with children's likelihood of bystanding in high-risk work environments.
authors.affiliation: University of Illinois at Chicago, Environmental and Occupational Health Sciences, School of Public Health (MC 922), 2121 West Taylor Street, Chicago, IL 60612-7260, USA. qwilli1@uic.edu
authors.forename: Quintin L
authors.initials: QL
authors.lastname: Williams
authors.forename: Bruce H
authors.initials: BH
authors.lastname: Alexander
authors.forename: Susan G
authors.initials: SG
authors.lastname: Gerberich
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Nachreiner
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Church
authors.forename: Andrew
authors.initials: A
authors.lastname: Ryan
mesh_terms: D000059:Accidents / Q000706:statistics & numerical data*; D000293:Adolescent; D000383:Agriculture; D000822:Animal Husbandry; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D015146:Midwestern United States; D016487:Parenting; D012307:Risk Factors; D012423:Rural Health; D014947:Wounds and Injuries / Q000453:epidemiology*; D055815:Young Adult