Bystander injury evaluation of children from midwestern agricultural operations.
BACKGROUND
With more than a million youth living on agricultural operations, it is important for parents to understand the consequences of bystander injuries that children experience in these environments. We identified the childhood injuries for bystander status and compared the severity of these injuries to the working children in the Regional Rural Injury Study-II (RRIS-II).


METHODS
RRIS-II followed 16,546 children ( approximately 85% of eligible) from rural communities in the Midwest for two six-month recall periods in 1999 and 2001. Demographic, injury, and exposure data were collected through comprehensive computer-assisted telephone interviews. Child injuries were cataloged using narrative scenarios into four categories: (a) directly work-related; (b) indirectly work-related; (c) non-working accomplice; and (d) non-working attendant; the latter three all being bystander categories. Poisson regression modeling was used to calculate rates of bystander injuries. Frequencies were used for comparison of severity measures.


RESULTS
Among the 463 child injuries (aged <20yrs), 102 were bystander injuries. Of the bystander-related injuries, 14 were identified as indirectly work-related (working bystanders), 27 as non-working accomplice (passengers/tag-alongs), and 60 as non-working attendant (playing on the operation). The overall rate of bystander injuries was 6.4 per 1,000 people, 95% CI (5.0, 8.1). Males, compared with females, had more than twice the injury rate (8.7; 95% CI 6.4-11.8, and 3.9; 95% CI 2.7-5.7, per 1,000 people, respectively). Bystanders in this population had more severe injuries with 4% having life-threatening circumstances; of these, 4% of the accomplices and 2% of the attendants subsequently died.


CONCLUSIONS
Children who live or work on agricultural operations are vulnerable to many hazards. Therefore, this study examined child injuries and found a clear difference in the consequences of these injuries between working-related and bystanding-related injuries.


CONCLUSIONS
Unlike occupations such as construction and mining, where laws and organizations have been created for the protection of bystanders, agricultural bystanders have remained unprotected and have had to face the consequent injury and death outcomes. As public health professionals considering these risks, it is necessary that we work to develop more intervention studies and continue to propose suggestive guidelines for child safety in these environments so as to challenge family traditions and possibly spark public policies that will give further protection to this population.
Williams
Quintin L
QL
University of Illinois at Chicago, Environmental and Occupational Health Sciences, School of Public Health (MC 922), 2121 West Taylor Street, Chicago, Illinois 60612-7260, USA. qwilli1@uic.edu
Alexander
Bruce H
BH
Gerberich
Susan G
SG
Nachreiner
Nancy M
NM
Church
Timothy R
TR
Ryan
Andrew
A
D000062:Accidents, Occupational / Q000706:statistics & numerical data*; D000293:Adolescent; D000383:Agriculture / Q000706:statistics & numerical data*; D002648:Child; D002669:Child Welfare / Q000706:statistics & numerical data; D016001:Confidence Intervals; D004781:Environmental Exposure / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D015146:Midwestern United States; D016272:Occupational Health / Q000706:statistics & numerical data*; D012307:Risk Factors; D014481:United States; D055815:Young Adult