AMERICAN JOURNAL OF INDUSTRIAL MEDICINE 58:886–896 (2015)
Keeping Workers Safe: Does Provision of Personal Protective Equipment Match Supervisor Risk Perceptions? Jessica M. Clouser,
MPH,
1
Jennifer E. Swanberg,
2 PhD,
and Henry Bundy, MA3
Background Although farm management may understand agriculture’s risks, they may not provide personal protective equipment (PPE). This study describes thoroughbred farm management’s risk perceptions, provision of PPE, and factors that influence its provision. Methods Thirty-five representatives from 26 farms participated in a 1–4hr semistructured interview covering perceived risks associated with horse work and perspectives and provision of PPE. Interviews were audio-recorded, transcribed, entered into ATLAS. ti, and analyzed by three coders. Results Management cited horse-related tasks as most dangerous, yet horse-related PPE as least provided because of 1) differences in farm context, 2) the belief that workers were most important agents in their safety, 3) lack of confidence in its effectiveness, and 4) the perception that risk could never be eliminated. Conclusions PPE provision was limited by management’s poor perceptions of its efficacy relative to other factors. Future research should explore workers’ perceptions and PPE’s effectiveness in averting horse-related injury. Am. J. Ind. Med. 58:886–896, 2015. ß 2015 Wiley Periodicals, Inc.
KEY WORDS: Occupational safety and health; animal agriculture; personal protective equipment; equine workers; organizational policies
BACKGROUND The Hazards of Horse Work While horse breeding is dangerous—sharing many hazards with other large animal operations (e.g., Lindahl et al., 2012)—the literature on horse-related injuries is primarily concerned with those sustained while riding. A common injury profile found in the literature is of a young female amateur rider who has fallen from a horse, often
1
College of Public Health, University of Kentucky, Lexington, KY Baltimore School of Social Work, University of Maryland School of Social Work, Baltimore, MD 3 Department of Anthropology, University of Kentucky, Lexington, KY Correspondence to: Jessica Miller Clouser, MPH, 151Washington Ave, 346 Bowman Hall, Lexington, KY 40506. E-mail: [email protected] 2
Accepted 27 March 2015 DOI 10.1002/ajim.22464. Published online 29 April 2015 in Wiley Online Library (wileyonlinelibrary.com).
ß 2015 Wiley Periodicals, Inc.
while riding without a helmet [Ghosh et al., 2000; Ueeck et al., 2004; Thomas et al., 2006; Loder, 2008; Hawson et al., 2010; Eckert et al., 2011]. With some exceptions demonstrating the prevalence of head, chest, and upper extremity injuries to thoroughbred farmworkers [Iba et al., 2001; Swanberg et al., 2013] and a few studies noting the hazards of grooming for un-mounted riders [Exadaktylos et al., 2002; Ng and Chung, 2004], less is known about the injuries or illnesses suffered by workers on horse farms. Thoroughbred breeding is hands-on and requires constant interactions with the animals, particularly because live breeding—as opposed to artificial insemination—is required [The Jockey Club, 2013]. In addition to continual human–horse interactions that could lead to injury, other common hazards on horse farms include dust from mucking stalls [Kimbell-Dunn et al., 1999; Gallagher et al., 2007] medicines [Swanberg et al., 2012; Clouser, 2013], landscaping work, and farm equipment [Clouser, 2013; Swanberg et al., 2013].
Supervisor Risk Perception and Provision of PPE
Personal Protective Equipment Despite the hazards inherent in horse work, horserelated personal protective equipment (PPE), is rarely used while carrying out un-mounted horse-related tasks. In fact, studies of horse-related injuries reveal that few grooms or riders wear PPE while grooming horses [Thompson and Von Hollen, 1996; Reed et al., 1998; Ng and Chung, 2004; Eckert et al., 2011], despite the fact that grooming may result in serious injuries that could be mitigated by its use [Chitnavis et al., 1996; Exadaktylos et al., 2002; Ball et al., 2007]. Not only are many thoroughbred farms high-risk environments, they also tend to be small: a recent survey of thoroughbred farms in one southeastern state found nearly 75% of farms employed fewer than 10 employees [Nutt et al., 2011]. Organizations with fewer than ten employees are exempt from reporting illnesses and injuries to OSHA [DoL, 2005]. As a result, the safety climate on thoroughbred farms is not well understood. Work organization dynamics of small workplaces influence safety practices, including the provisioning and use of PPE [Eakin 1992; Eakin and MacEachen, 1998]. Consequently, safety practices of small farms may vary, dictated not by employer policy but by the experience and attitudes of managers or owners [Carpenter et al., 2002].
Risk Perception and PPE Extant literature reveals that the inherent risks of agriculture, one of the leading industries for occupational illness/injury [BLS, 2013], may be understood by farm operators, but safety behaviors may not follow [Elkind, 1993; Sorensen et al., 2006; Sorensen et al., 2008]. Specifically, numerous studies have found farmers’ PPE use to be sub-optimal [Carpenter et al., 2002]. Possible reasons behind this disconnect between risk perception and safety behavior include that farmers operate in a risksaturated environment and/or view risk through a costbenefit lens [Sorenson et al., 2008]. For example, when assessing whether and to what degree a situation involves risk, other factors such as weather, scheduling, and economic considerations may influence whether a farmer takes the time and expense to behave safely [Elkind, 2007; Sorenson et al., 2008]. However, this reasoning may change when the decision is not whether to wear safety equipment oneself, but whether to provide it or mandate it for workers. Studies conducted in North Carolina found that while farmers were aware of pesticide hazards, they tended to minimize the risk workers faced [Quandt et al., 1998; Rao et al., 2004]. However, to our knowledge, few studies have looked at the relationship of management’s risk perception and subsequent provision of PPE [see
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Eakin, 1992 for an exception], particularly among large animal operations. In fact, little is known about attitudes toward PPE in animal handling, as most of this literature is concerned with chemical, respiratory, or tractor safety [Quandt et al., 2006; Reed et al., 2006; Sorensen et al., 2006; MacFarlane et al., 2008; Vitali et al., 2008]. PPE use and provision with large animals is important to understand as animal handling not only features different risks and challenges [Lindahl et al., 2012] than other sectors of agriculture, but it also has the highest non-fatal injury rate [BLS, 2013]. This study had three main objectives: 1) to describe the risk perceptions of thoroughbred farm management representatives, 2) to describe their provision of and attitudes toward PPE, and 3) to explore the factors that influence farms’ PPE provision.
METHODS Recruitment and Sample A detailed description of the study’s methodology is described elsewhere [Swanberg et al., 2013]. Briefly, a sampling frame of 82 thoroughbred farms in one southeastern state was compiled by the study’s industry advisory council1. The sampling frame was constructed to approximate the industry’s distribution of small, medium, and large farms [Nutt et al., 2011] and each farm’s size was confirmed in the interview. Farms were eligible if they (1) engaged in thoroughbred breeding/boarding as their primary function; (2) employed at least one Latino worker; (3) were located in one southeastern state2. Management representatives were eligible if they were at least 18 years old and held a position of farm owner, manager, or personnel administrator at the recruited farm. All 82 farms were called by the study’s project manager and 20 were deemed ineligible: five had disconnected phone lines, nine were no longer operational, five no longer hired workers, and one hired no Latino workers. Thirty-two farms participated in a 20-minute telephone-administered survey (52%) and 26 participated in a 1–4 hr in-depth, face-to-face interview at the participant’s farm (42%). Of the farms that consented to the phone survey but not the in-depth interview, 1
2
The industry advisory council was comprised of eight highly engaged community and employer key stakeholders including the head of a regional thoroughbred owners and breeders association, the human resource manager at a large thoroughbred farm, the president of a regional thoroughbred farm managers’ club, the director of an organization that provides outreach to thoroughbred farmworkers, the director of a health clinic that provides health care to thoroughbred farmworkers, and several small thoroughbred farm owners. To protect the anonymity and confidentiality, participating employers, the specific location is not disclosed.
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one needed permission from a business partner, three did not have time, and two gave no reason. We settled on the attained sample size because on-going data analysis concluded that saturation was achieved.
Data Collection Both the telephone survey and the in-depth interview were conducted by the project manager who also obtained oral consent from phone participants and written consent from interview participants. The interviewer had six years of experience in qualitative research prior to conducting interviews and additionally completed three 2-hour training sessions in qualitative interview techniques prior to data collection. The semi-structured interview protocol covered topics such as farm characteristics, workforce demographics, work organization (e.g., job tasks, scheduling practices), and perceived risks associated with horse work. All study procedures were approved by the University of Kentucky’s Institutional Review Board. All interviews were audio-recorded and often accompanied by a farm tour in which the interviewer asked participants to show her areas that may pose challenges to worker health and safety. Interviews lasted an average of two hours (Range ¼ 1–4) and were completed between October 2012–April 2013. If an office/administrator was the main contact, a second interview was performed with the farm manager to gain an “on-the-ground” perspective. In all, 35 individuals representing 26 farms participated. On six farms, two to four people were interviewed. A checklist of horse farm PPE was constructed based on data from a pilot study of Latino horse farm workers [Clouser, 2013] and edited through advisory board feedback. This list was further modified through two pilot interviews conducted with management representatives. Finally, farms were asked to add PPE that were provided but not listed. This checklist was completed by all participants and later corroborated with interviews transcripts. All PPE referenced by participants were credited to that farm.
Data Analysis Interviews were transcribed verbatim, entered into ATLAS.ti, and analyzed by three coders: two primary and one reviewer. A code list was agreed upon after coding 2-3 interviews. Coders then parsed the data, looking for similarities and differences in management risk perception, PPE provision, and factors influencing the latter. A process of constant comparative analysis was utilized to ground emergent themes in the transcripts. During weekly meetings, themes and codes were discussed. Researchers entered PPE survey data into Statistical Analysis Software (SAS) and performed univariate analyses.
TABLE I. Demographics of Farm Representatives, N ¼ 35*
Gender Male Female Race/Ethnicity Non-Hispanic White Non-Hispanic Black Hispanic White Position on farm Manager/Divisional Manager Owner/Manager HR/office administrator
N
%
26 9
74 26
33 1 1
94 3 3
17 12 6
49 34 17
* In 5 cases multiple people were interviewed separately from the same farm. In 3 cases multiple people participated in a single interview.
TABLE II. Distribution of Farm Size in Sample, N ¼ 26 Farm size
N
%
Small (10 workers) Medium (11-25 workers) Large (>25 workers)
11 8 7
42 31 27
RESULTS Sample Demographics Participants were mostly non-Hispanic White males (See Table I). Nearly half were general managers, a third were owner-managers, and less than one-fifth were office/ personnel administrators. Farm sizes ranged from 1–230 employees with a plurality (42%) having 10 or fewer workers (See Table II).
Management Risk Perceptions Risks discussed by participants fell into one of two categories: horse-related—involving direct contact with the horse—and non-horse related—including farm equipment, overexertion, etc.
Horse-related hazards Participants almost unanimously agreed that working directly with horses was the most dangerous aspect of thoroughbred farm work. Horse work is hands-on and hazardous due to the animal’s weight and unpredictable nature. Although all horses were characterized as dangerous, yearlings—being large, energetic, and unaccustomed to being handled—were often considered the most threatening.
Supervisor Risk Perception and Provision of PPE
A yearling horse or a horse that’s in the beginning of its racing training, a young horse is like a teenage boy; they’re insane [L-05MGR]3. A good friend of mine was killed several years ago by a yearling.…The horse developed a habit of trying to break away from whoever would be handling it and…he tried to teach it not to and it tried to get away and bolted on him one day and ended up dragging him. He couldn’t let go and the horse kicked out to the side and kicked him in the chest and it killed him. So, I’d say the yearlings are pretty much the toughest [S-11OWN]. When asked to identify jobs with the most potential for worker illness or injury, participants consistently cited horserelated chores. In fact, four participants noted that anything related to working with horses was the most dangerous farm endeavor: Leading one in, picking feet [hooves], everything…. the number one most dangerous job is working with the horses [S-04OWN]. We find a lot of injuries when they’re grooming the horse. It could be what they call ‘picking’ the horse’s feet; they have to pick up the hoof and clean it underneath and something can spook the horse [L-03OFF]. However, the task most commonly cited as dangerous was also one of the most routine: leading horses, or walking them from one place to another. R1: Far and away, the most injuries occur when somebody’s on the end of a shank leading a horse… R2: The horse will take off and kick out and kick one of the employees or they’re stepped on… I’ve known people that have got killed in this situation when a horse gets out the end of a shank because typically when you’re leading [horses]…you have their head. As long as you’ve got that head, they can still do things to you but it’s usually not too serious. When they get out the end of the shank, then you’re in [kicking] range and that’s when you get serious injuries [M-02OWN].
One of the more dangerous things that we do is bringing horses in and out because, you know, four or five mares at the gate, two people bringing them in, one bully wants to wheel and kick the other ones when they’re all up there crowded at the gate and it’s a dangerous spot [L-06MGR]. Another hazardous task was breaking yearlings (training a young horse to be ridden for the first time), as well as riding horses for exercise. However, these tasks were often contracted out: You can never predict that a horse, a young horse, is not going to blow up and buck a rider off… you can’t predict it, but you can minimize the chance for that by doing it slowly, by not scaring them. But it can happen. But that is the most high risk job. And for that, they have to have protective clothing, protective helmet, and that’s pretty much all you can do. You know, riding by its very nature is somewhat dangerous [M-01MGR]. Well you’re asking [horses] to do something they’ve never done, you know. So the first few days when you get on them, they can buck and some of them will buck hard and they’ll throw you off. So just a fall from a bucking horse would be pretty dangerous [S-03OWN]. A final hazardous task was working in the breeding shed, where farms brought their mares to mate with another farm’s stallion. This requires very close contact with horses in a charged environment. R: When you have two 1,300–1,400 pound animals in there, there’s always potential for problems. Anytime there’s something going on in the breeding shed, I’m always worried something could go wrong because a lot of people have been severely hurt in the breeding sheds around here historically. I: Have any of those translated into injuries? R: Had several…One was here in the breeding shed about 2 years ago. Had a person who got pinned up against the wall when the horse jumped on them, broke a collarbone… I: What happened? Could you describe it?
3
Each interviewee was assigned a unique identification tag (e.g. S-02OWN). The first letter of the tag indicates their farm’s size and is followed by a unique identification number and suffix which indicates if the interviewee was the manager (MGR), owner (OWN), or office manager (OFF). For example, S-02-OWN is the owner of a small farm.
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R: When we have breeding going on, obviously male/female, the mare who is the female is restrained. We put a device called a twitch which is a restraint that goes on their nose. We also will
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pick up and put a strap around her front leg holding that front leg up so that they’re on three legs rather than four. If you hold up a front leg, hopefully they can’t kick with the back leg. It doesn’t always work that way but sometimes it does. We’re trying to protect our stallion. The stallion is the most important and most valuable animal here on our [farm] so we do everything you can and this is standard procedure…Anyway, this lady had the mare’s leg held up with the leather strap and I don’t know whether the mare was just startled…whatever the impetus was, the mare jumped in the air. When the mare jumped up in the air, her shoulder hit her and pinned her up against the wall [S-05MGR].
masks and stuff sometimes, and we have those if they want them, but sometimes they just know they need those on their own [L-03OFF]. I think it’s something that you almost get used to and you don’t realize it but dust is terrible in the barns; that’s probably the biggest deal and we try to build our barns and position them so we can open up and get more air flow through there whenever we can. But I’d say that is, that is our biggest complaint from the guys [M-08MGR]. Finally, administering medicines to horses represented a threat which was perceived quite differently across farms. On many farms, workers often administered a range of medicines to horses, though the perception of risk was mixed.
Non horse-related hazards
DMSO5 you can, you don’t even have to wear gloves; it just smells like rotten eggs. DMSO is great… you can drink it and it’s not going to hurt you. It’s not going to taste very good, but it’s not going to hurt you [S-04OWN]
Farm equipment—such as hay balers, mowers, and tractors—were mentioned as a distant second to horserelated hazards, though a small minority of representatives cited them as the greatest threat to workers’ safety. Tasks such as “weed-eating” (i.e., string trimming) were also considered dangerous.
DMSO liquid now mixes with a lot of other liquids and it’ll help penetrate [the skin]…So it’s a very, very valuable drug but you know it’s controversial. It’s supposed to be a cancer link drug I think in humans. [S-01MGR]
Equipment’s dangerous. You know you’re dealing with 85–90 horsepower tractors with PTO4 which is by far the most dangerous. I mean more people are killed by PTO, the Power Take Off, you know, and that’s extremely dangerous[S-10OWN] The potential for injuries resulting from heavy lifting of feed, hay, or muck or falling from high locations such as a hay loft were other common hazards. As L-05MGR noted, workers “need to be physically strong enough to lift probably 30–50 pounds routinely. They need to be able to stand and scoop and move their body … sometimes people could strain or do stuff like that. I mean it’s always a risk, lifting, you know. It always will be.” Another manager told of a man falling from a hayloft: “…he lost his balance and grabbed the tobacco rail but it was not attached so it just slid… So he fell out of a loft and broke his feet” [L-01MGR]. Working with hay or straw may also lead to exposure to respiratory hazards, though few participants believed it to be of great concern.
Supposedly Furacin6 can cause cancer. I didn’t know that and used it for years when I was [farm manager]. [L-01OFF]. I don’t know that it requires gloves for Furacin but I mean most people don’t want that all over their hands, so they wear gloves [M-04OWN]. While most participants believed that medicines warranted gloves, fewer knew exactly why. As a result, associated safety practices were often relaxed. For example, altrenogest (Regu-Mate) and chloramphenicol, drugs that suppress estrus in mares, were commonly considered dangerous for women, but likely safe for men. As a result, minimal precautions were taken among male workers. Only men are allowed to use Regu-Mate period. Like when my wife helps out occasionally, she doesn’t… touch Regu-Mate; you don’t touch any part of where the Regu-Mate is. We’re fairly lax now because we don’t have any women around so we
Sometimes working in the barn I’ve had people tell me that the dust and the little hay particles or straw particles get stirred up. I’ll see them use the allergy
4
Power Take Off (PTO) is a mechanical means of transferring power that is used in a variety of farm equipment, including tractors, and poses risk of entanglement to the operator.
5 6
Dimethyl sulfoxide (DMSO) is a solvent used with other medicines to aid their absorption into the skin. Nitrofurazone (Furacin) is an antibacterial ointment used for wounds.
Supervisor Risk Perception and Provision of PPE
don’t have to worry about that, but only men can give Regu-Mate period [S-04OWN]. Chloramphenicol. That is a hazardous type medicine… something that contact to the skin is detrimental so, and it smells awful so that’s, grooms and myself will give it but instructions are you must have gloves on with it so and they do have gloves on to do so. I know that much [S-06MGR]. Supposedly Regu-Mate can alter a woman’s cycles and affect her ovaries and stuff. I didn’t know that for years and used it for years [as farm manager] because when they first came out with it, nobody knew [L-01OFF, also a female].
Provision of Personal Protective Equipment Horse-related equipment Equipment to protect workers from the horse (i.e., helmets, padded vests) was neither widely available nor mandated. The most common horse-related PPE—helmets —was only available at ten farms. Approximately one quarter of farms offered padded vests (See Table III). On several farms, horse-related PPE was only considered necessary when riding horses or working in the breeding shed, not for day-to-day horse work: “Nobody is going to have a flak jacket (padded vest) on when they groom a horse” [M-03OWN]. Of the six farms that offered padded vests, five were large farms that housed stallions and conducted breeding operations. On these farms, vests were mandatory only in the breeding shed. Several farms provided boots, though only one farm provided steel-toe boots. One manager stated that although he believed boots were necessary, they neither provided nor recommended them: [Workers] don’t wear work boots, they don’t wear steel-toe shoes…there need to be better footwear and we don’t provide that for employees but…you know some stuff can be prevented if you’re not wearing tennis shoes. That’s my soapbox issue [L-05MGR]. The same manager later noted that “truly at the income level that most of our people are at, to have to go out and buy a pair of boots doesn’t make the job worthwhile.”
Non-horse related equipment The provision of PPE for non-horse related hazards was more prevalent than that for the horse. Latex gloves and safety glasses were the most common and most often
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mandated. In addition, about half of farms provided masks/ respirators, cold weather jackets, and hearing protection. Safety glasses were required for tasks such as operating equipment, using chemicals, or repairing fences. Some managers would terminate employees caught using equipment without this PPE. While rubber or latex gloves were available at every farm to protect against medicines/chemicals or to prevent the spread of disease among horses, less than half required their use. Farms also differed on which medicines/chemicals required gloves. As a result, some farms mandated gloves when applying all or certain medicines, others recommended it, and still others deferred to workers. In all, little direct education about glove use was provided. Well [gloves are] there and if they see me using it then they’ll use them. But if they don’t it’s not a big deal. Like, Furacin and stuff where you put it on the leg and then put a bandage over the top, but I always use a rubber glove. And if they see me doing it, they’ll do it [S-05OWN]. Masks, used both when working in stables and handling chemicals, were often provided. However, while some farms mandated masks when working with chemicals, mowing, or painting, no farms required them when mucking stalls. In some cases, participants observed workers improvising when masks were unavailable: “Occasionally you’ll see them wear a bandana or something over their nose if they feel like it’s something dusty” [S-11OWN]. Overall, respiratory hazards were not considered particularly dangerous and breathing complaints were often attributed to allergies. L-03OFF, for example, referred to respirators as “allergy masks.”
Factors That Influence Farms’ Provision of PPE Differences in farm context Some farms noted farm size and income as barriers to PPE provision. Owners/managers of small “working” farms were aware of the industry’s disparities in farm size/income and the associated constraints. I see a lot of other farms that can probably afford a lot of practices that I’m just simply financially unable to, but you know I try, since I’m pretty much a hands-on owner/manager [S-11OWN]. Although influential, only three farms cited farm size or affluence as a limiting factor for PPE. As one example, the owners at M-08MGR’s farm provided college tuition assistance to workers’ children and clothing such as insulated boots, cold weather jackets, and uniforms. However, they did
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TABLE III. Personal Protective Equipment Provided and Mandated, N ¼ 26 PPE Type Horse-Related Helmets
# Farms Provided (%)
# Farms Mandate for certain tasks (%)
Examples of tasks mandated for
10(38.5)
7(26.9)
Riding horses, Breeding horses, Using chainsaws, Being in stalls (1 farm) Breeding horses, Riding horses No tasks given
*
Padded vests Steel-toe boots Non-Horse Related Latex gloves
7(26.9) 1(3.9)
6(23.1) 1(3.9)
26 (100)
11(42.3)
Eye protection
24(92.3)
16(61.5)
15(57.7) 13(50) 10(38.5) 8(30.8) 2(7.7) 3(11.5) 1(3.9)
5(19.2) 6(23.1) 5(19.2) 2(7.7) 1(3.9) 1(3.9) 0(0)
Administering medicines, Applying chemicals String trimming, Pressure washing, Fence repair, Applying chemicals, Using chain saws, Operating equipment Applying Chemicals, Mowing String trimming,Operating equipment Foaling horses, Breeding horses Fence repair, Painting, Handling hay Applying chemicals Mowing/string trimming along road X-rays
15(57.7) 12(46.2) 12(46.2) 11(42.3) 8(30.8) 6(23.1)
3(11.5) 0(0) 1(3.9) 2(7.7) 2(7.7) 0(0)
No tasks given Not mandated When raining No tasks given Breeding horses Not mandated
Masks/Respirators Hearing protection Other boots (work or rubber) Cut-resistant gloves Paper suit/Coverall Reflective vests Lead vests Clothing, Other equipment provided Cold weather jackets Cold weather gloves Rain Jackets Breathable t-shirts Overalls Ear muffs *
Horse-Related refers to equipment that protects one against the horse. Non-horse related refers to equipment that protects from any other mechanism of injury or illness.
not provide helmets, padded vests, or steel-toe boots to workers. Farms that did not engage in certain activities (i.e., standing stallions7) did not believe that certain PPE was relevant at their farm. As S-04OWN explained “I mean we don’t have helmets because we don’t have stallions; we don’t have flak jackets [padded vests] because we don’t have stallions.” Further, because riders were often contract workers, they often brought their own helmets and vests to ensure a proper fit, and therefore many farms did not purchase them.
7
Not “having stallions“ means that breeding does not occur on this farm because breeding takes place at the farms where stallions are housed. Owners or boarders of mares will bring those horses to the farms with stallions, and it is the workers at the host farm that manage the breeding process.
Workers as most important agents in their safety Several participants believed that even if PPE was provided, workers would not wear it because it was uncomfortable, taxing, or a hassle. These participants noted that safety glasses were forgotten, managers were not informed when disposable PPE ran low, and work gear was taken home for personal use. You know [for workers] it’s kind of like, ‘Do I really need to stick those earplugs in? Do I really need to go and get them? Because it is so much easier to just pick up the blower and just start blowing.’[L03OFF]. I took a kid out to weed-eat. I said, ‘Well, why don’t you work on this fence line there. You got all your stuff?’ ‘Yeah.’ I said, ‘You got your safety glasses?’
Supervisor Risk Perception and Provision of PPE
‘No.’ I mean he knew he was supposed to have them. ... But then I said, ‘Okay I’ll go get them, I’ll be right back.’ So then he starts weed-eating while I’m gone. I’m gone 5 minutes. I come back. He’s got something in his eye. I gotta take him to the doctor. Unbelievable [M-02OWN].
You could probably arm yourself with a suit of armor if you wanted but it’s impractical so you just have to be careful and calculating throughout your day… If you watch a horse, if you’re careful around them and respect them, then you’re not going to have any injuries [S-08OWN].
The next day [after an eye injury] I did go up there and I’m angry and … I can’t find [the safety glasses], ‘Where are they? This is where they are supposed to be, right where the weed-eater is. I just bought five pair.’ So that’s pretty much how safety is [M-05OFF].
So we don’t have the vests or the helmets whereas I know some stallion complexes do. But most all of our grooms [have] been breeding horses for ten years or longer. I mean they’re very experienced [L03OFF].
Other participants believed that if workers wanted or needed PPE they would request it. They could [wear masks] if they wanted to. If they wanted to, we would supply it, but no one has ever asked for one [M-02OWN]. If they ask for [masks], that’s fine. I mean if you leave masks in a barn, the mice eat them … I mean you can’t just leave stuff in the barn for people to use. If they don’t use it for a while, then you know… if they need something, they just have to tell us [M04OWN]. If somebody comes down in complex and all of a sudden said, ‘You know I want to start wearing a vest down there’… we’d certainly get it for them [L-07MGR].
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Occasionally you’ll hear about somebody that got hurt pretty bad and usually it’s a matter of somebody not paying attention or doing something they shouldn’t have been doing … if farms thought helmets and vests were really needed or preventative, I think more farms would do it [L-07MGR]. According to some managers, helmets, vests, and work gloves could be hot and limited movement. Steel-toe boots were described as uncomfortable and inflexible and posed the risk of severing or crushing toes if stepped on by a horse. R: We do not recommend steel toes because I’ve known people to actually (get) stepped on and the toes, the steel goes down on their toes and they have to have the boot cut out so they can be almost too dangerous. I: So you’ve known people that have actually had that happen to them?
Some farms might provide PPE, but deferred to workers on whether to use it. I mean if somebody wants to go give Regu-Mate without gloves on, that’s their prerogative… [Worker name] has 20, 30…40 years’ experience with horses and the rest of them have college degrees and I don’t have to tell them to read a label on something precautionary. I mean they see it [M-03OWN]. Those that left PPE practices up to employee discretion often felt they had little power to enforce its use. “I mean you can’t make somebody use earplugs” M-04OWN noted. However, other managers disagreed and sent employees home or threatened termination if workers didn’t comply.
R: Not here but I’ve heard of it happening [L-01MGR]. There is a theory that the steel-toed boots that if a 2,000lb horse steps on it then it is going to crush your toe even with the steel toe, so I kind of go back and forth with these guys on what is really needed there. It goes both ways. They say, well, you know they’re more quick and agile if they just have a good boot with good tread and not have to worry about a heavy boot and stuff like that [L-03OFF].
Perception that risk could never be eliminated
Lack of confidence in its effectiveness Many representatives believed that attention, common sense, and a good understanding of horse behavior were more important than PPE for preventing horse-related injury.
Many participants believed that risk on the farms could never be mitigated entirely, regardless of one’s experience or skill: “you could be the best horseman in the world,” L04MGR noted, “and one [horse] could get on top of you. It’s
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happened to me and it’s probably happened to anybody that’s been in the business very long.” To them, injuries were inevitable, “It’s not if you’re going to get hurt,” said S09OWN, “it’s when you’re going to get hurt.” They noted that the continuous risk could cause employees to become complacent about safety. And what happens a lot when people get hurt is when you take a shortcut you know … 999,990 times out of 100,000 you get away with it and it’s just that one time…Everybody that I’ve known that’s gotten serious injuries… usually did something that they knew they shouldn’t have done…Even with all the training and experience in the world, you can still put yourself in a very dangerous position [M02OWN]. A lot of times they’ll just walk into a stall and say, ‘Well the horse is real docile and has never been a problem before’ and well this is the time that the horse rears up and kicks you in the head. So you know, sometimes [workers] get a little too complacent with their work duties [L-03OFF].
DISCUSSION This paper examined the risk perceptions of thoroughbred farm management and their provision of and attitudes toward PPE. Unlike other research that has assessed safety behavior and/or risk perception of farmers, this study focused on management practices over a high-risk worker group. Many studies have observed that economic and other stressors influence farmers’ safety behaviors, but these have chiefly focused on a farmer’s behavior to protect him/ herself (e.g., wearing PPE when applying pesticides or retrofitting a tractor with rollover bars) [Sorensen et al., 2008; DellaValle et al., 2012]. A key difference in this study is that the end behavior is an organizational policy (i.e., providing helmets to workers) that impacts others through a calculated versus spontaneous decision. Nonetheless, despite the near consensus on horses being the most hazardous part of the farm, PPE policies tended to be informal, with PPE for horse-related tasks least likely to be provided. We discuss several possible reasons why horse and non-horse related PPE were treated differently. First, is the role of risk perception. As other studies note, safety behavior does not always follow from an awareness of risk [Elkind, 1993; Elmore and Arcury, 2001]. Research suggests that constant exposure to risk may lead to “habituation,” a learned tolerance of elevated danger [Lindahl, 2012]. This may explain why common tasks— such as leading horses and working with yearlings—are cited as more dangerous, and yet do not elicit PPE provision/use.
Another possible explanation is the relativization of risk, whereby a risk that is considered to be less extreme than another is minimized [Carpenter et al., 2002; Sorensen et al., 2008; Lindahl et al., 2012; Rabinowitz et al., 2013]. Because working in the breeding shed or riding horses are discreet events for which injury potential is high, the daily act of leading a horse may seem too mundane to warrant protection. This finding corroborates other research and may explain why individuals wear helmets during certain risky horse activities, but not others [Reed et al., 1998]. Second, horse-related PPE (e.g., helmets and flak jackets) are more expensive than gloves, masks, and glasses. Researchers have posited that farmers may view the costsavings associated with risk-taking to outweigh the cost of potential injury [Sorensen et al., 2008; Lindahl et al., 2012]. Although equipment cost was discussed as an obstacle by only three representatives, the most prevalent PPE on farms were also among the least expensive: gloves, safety glasses, masks/respirators. Provision of PPE when it is cheap, but not when it is expensive mirrors other studies’ findings [Sorenson et al., 2008]. A third finding concerns social norms associated with horse and non-horse PPE. Non-horse activities were considered to have predictable, yet preventable dangers. Equipment, chemicals, and medicines come with user manuals, warning labels, and other “cues to action” [Janz and Becker, 1984] which may prompt the use of PPE to mitigate risk. Despite the mixed perceptions on how dangerous certain horse-related medicines could be, latex gloves were universally supplied by farms in our sample. Horses carry no such labels or manuals, and thus social norms may follow that PPE is discretionary, not mandatory. Further, many non-horse hazards, such as equipment and chemicals, are present in other industries and thus may have more widely adopted social norms regarding PPE. Another potential reason for the lower adoption of PPE for horse-related tasks is that representatives did not believe PPE was the most effective means of protection against horses. Helmets, vests, and steel-toe boots were sometimes cited as cumbersome, limiting mobility. Steel-toe boots were roundly criticized for their potential to exacerbate injury, though no one had witnessed this, nor could this be substantiated in the literature. As the extant research on PPE use in large animal operations is sparse, future research should explore its efficacy in protecting workers. Experience, according to interviewees, was more important in protecting workers from animal-related injury, a perspective which was shared among a sample of Swedish dairy farmers [Lindahl et al., 2012]. However, not only was experience hard-won through injuries and close calls, but research suggests that inexperience is rarely a factor in horserelated injuries [Exadaktylos et al., 2002; Ng and Chung, 2004; Ball et al., 2007; Eckert, 2011]. In fact, risk of serious injury appears to be a function of cumulative exposure to
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horses, rather than level of expertise [Kriss & Kriss 1997; Ball et al., 2007; Loder, 2008; Lucas et al., 2009]. Finally, some participants believed that workers did not desire and would not use PPE, for they never requested it. However, studies conducted with Latino farmworkers, who comprised half the workforce on these farms [Swanberg et al., 2013], warn that they may be reticent to vocalize work-related concerns, particularly if they believe it might endanger their job [Elmore & Arcury 2001; Rao et al., 2004]: A recent study of Latino horse workers found that nearly a quarter (24%) “Almost always” worried about losing their jobs [Swanberg et al., 2012]. Consequently, supervisors may benefit from initiating conversations with workers about desires for PPE rather than waiting for workers to initiate these conversations.
ACKNOWLEDGMENTS
Limitations
REFERENCES
This study has several limitations which should be considered when interpreting its results. First, due to its small sample size, convenience sampling, and qualitative methodology, its results are not generalizable to all farms or even all thoroughbred farms. Rather, its findings provide context and understanding of farms’ decisions about whether or not to provide PPE to workers. Also, as information was self-reported rather than directly observed, it is possible that farms’ reports were not accurate depictions of what was available or mandated. Similarly, because the role of the representative may have varied from farm to farm, it is possible that the interviewee may not be aware of how policies are implemented. However, the team interviewed multiple people (office manager, farm manager) on several farms to avoid this limitation.
Ball CG, Ball JE, Kirkpatrick AW, Mulloy RH. 2007. Equestrian injuries: incidence, patterns, and risk factors for 10 years of major traumatic injuries. Am J Surg 193:636–640.
CONCLUSIONS This is one of the first studies of thoroughbred farm management’s risk perceptions and PPE use/provision. Findings suggest that farm representatives perceived great risk in working with horses, but also that horse-related PPE was not effective in mitigating that risk. Other barriers, such as perception of worker adherence and cost of equipment, prevented PPE from being a widely accepted solution. Future research is needed to understand workers’ perception of PPE and risks associated with thoroughbred farm work as well as communication dynamics between managers and non-native workers. It should also explore the use of horse-related PPE for tasks beyond the breeding shed and track. Finally, research should incorporate community-based participatory principles to engage thoroughbred management in developing and evaluating strategies to reduce risk on horse farms.
We would like to thank the representatives of the farms who took the time to share their perspectives—this was a time intensive interview process, and we appreciate their patience. We would also like to thank the active members of the industry and the community advisory councils that have supported and informed this project. The work presented in this paper was supported by the Southeast Center for Agricultural Health and Injury Prevention, University of Kentucky College of Public Health, under CDC/NIOSH Cooperative Agreement 5U54OH007547-13. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of CDC/ NIOSH.
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Gallagher LM, Crane J, Fitzharris P, Bates MN. 2007. Occupational respiratory health of New Zealand horse trainers. Int Arch Occup Environ Health 80:335–341.
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Reed DB, Browning SR, Westneat SC, Kidd P. 2006. Personal protective equipment use and safety behaviors among farm adolescents: Gender differences and predictors of work practices. J Rural Health 22:314–320.
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Schenker MB, Orenstein MR, Samuels SJ. 2002. Use of protective equipment among California farmers. Am J Ind Med 42:455–464.
Kimbell-Dunn M, Bradshaw L, Slater T, Erkinjuntti-Pekkanen R, Fishwick D, Pearce N. 1999. Asthma and allergy in New Zealand farmers. Am J Ind Med 35:51–57.
Sorensen JA, May JJ, Jenkins PL, Jones AM, Earle-Richardson G. 2006. Risk perceptions, barriers, and motivators to tractor ROPS retrofitting in the New York State Farm Community. J Agri Saf Health 12:215–226.
Kimbell-Dunn MR, Fishwick RD, Bradshaw L, Erkinjuntti-Pekkanen R, Pearce N. 2001. Work-related respiratory symptoms in New Zealand Farmers. Am J Ind Med 39:292–300. Kriss TC, Kriss VM. 1997. Equine-related neurosurgical trauma: A prospective series of 30 patients. J Trauma 43:97–99. Lindahl C, Lundqvist P, Norberg AL. 2012. Swedish dairy farmers’ perceptions of animal-related injuries. J Agromedicine 17:364–376. Loder R. 2008. The demographics of equestrian-related injuries in the United States: Injury patterns, orthopedic specific injuries, and avenues for injury prevention. J Trauma 65:447–460. Lucas M, Day L, Fritschi L. 2009. Injuries to Australian veterinarians working with horses. Vet Rec 164:207–209. MacFarlane E, Chapman A, Benke G, Meaklim J, Sim M, McNeil J. 2008. Training and other predictors of personal protective equipment use in Australian grain farmers using pesticides. Occup Environ Med 65:141–146. Mazan M, Svatek J, Maranda L, Christiani D, Ghio A, Nadeau J, Hoffman A. 2009. Questionnaire assessment of airway disease symptoms in equine barn personnel. Occup Med 59:220–225. National Thoroughbred Racing Association Safety and Integrity Alliance, NTRA 2014. Code of Standards. Retrieved from http:// www.ntra.com/media/8539193/2014%20Code%20of%20Standards% 20-%20Draft%20-%20Final.pdf. Ng CP, Chung CH. 2004. Horse-related injuries: A local scene. Hong Kong J Emerg Med 11:133–141. Nutt P, Clark M, Graycarek R, Hall CT, Roenker J. 2011. The Kentucky Thoroughbred Breeding Industry and State Programs That Assist the
Sorensen JA, May JJ, Paap K, Purschwitz MA, Emmeline M. 2008. Encouraging farmers to retrofit tractors: A qualitative analysis of risk perceptions among a group of high-risk farmers in New York. J Agri Saf Health 14:105–117. Swanberg J, Clouser JM, Westneat S. 2012. Work organization and occupational health among Latino farmworkers: Perspectives from Latinos employed on crop and horse breeding farms. J Ind Med 55:714– 728. Swanberg J, Clouser JM, Westneat S, Marsh MW, Reed D. 2013. Occupational injuries on thoroughbred horse farms: A description of Latino and Non-Latino workers’ experiences. Int J Environ Res Public Health 10:6500–6516. Swanberg JE, Clouser JM, Gan W, Mannino D, Flunker JC. 2015. Individual and occupational characteristics associated with respiratory symptoms among Latino horse farm workers. Am J Ind Med. Submitted manuscript. The Jockey Club 2013. The American Stud Book. Principal Rules and Requirements. Retrieved from http://www.registry.jockeyclub.com/ RegistryIncludes/pdfs/rule_book.pdf. Thomas KE, Annest JL, Gilchrist J, Bixby-Hammett DM. 2006. Nonfatal horse related injuries treated in emergency departments in the United States, 2001–2003. Br J Sports Medi 40:619–626. Thompson J, VonHollen B. 1996. Causes of horse-related injuries in a rural western community. Can Fam Physician 42:1103–1109. Vitali M, Protano C, Del Monte A, Ensabella F, Maurizio G. 2009. Operative modalities and exposure to pesticides during open field treatments among a group of agricultural subcontractors. Arch Environ Contam Toxicol 57:193–202.
Keeping Workers Safe: Does Provision of Personal Protective Equipment Match Supervisor Risk Perceptions? Jessica M. Clouser,
MPH,
1
Jennifer E. Swanberg,
2 PhD,
and Henry Bundy, MA3
Background Although farm management may understand agriculture’s risks, they may not provide personal protective equipment (PPE). This study describes thoroughbred farm management’s risk perceptions, provision of PPE, and factors that influence its provision. Methods Thirty-five representatives from 26 farms participated in a 1–4hr semistructured interview covering perceived risks associated with horse work and perspectives and provision of PPE. Interviews were audio-recorded, transcribed, entered into ATLAS. ti, and analyzed by three coders. Results Management cited horse-related tasks as most dangerous, yet horse-related PPE as least provided because of 1) differences in farm context, 2) the belief that workers were most important agents in their safety, 3) lack of confidence in its effectiveness, and 4) the perception that risk could never be eliminated. Conclusions PPE provision was limited by management’s poor perceptions of its efficacy relative to other factors. Future research should explore workers’ perceptions and PPE’s effectiveness in averting horse-related injury. Am. J. Ind. Med. 58:886–896, 2015. ß 2015 Wiley Periodicals, Inc.
KEY WORDS: Occupational safety and health; animal agriculture; personal protective equipment; equine workers; organizational policies
BACKGROUND The Hazards of Horse Work While horse breeding is dangerous—sharing many hazards with other large animal operations (e.g., Lindahl et al., 2012)—the literature on horse-related injuries is primarily concerned with those sustained while riding. A common injury profile found in the literature is of a young female amateur rider who has fallen from a horse, often
1
College of Public Health, University of Kentucky, Lexington, KY Baltimore School of Social Work, University of Maryland School of Social Work, Baltimore, MD 3 Department of Anthropology, University of Kentucky, Lexington, KY Correspondence to: Jessica Miller Clouser, MPH, 151Washington Ave, 346 Bowman Hall, Lexington, KY 40506. E-mail: [email protected] 2
Accepted 27 March 2015 DOI 10.1002/ajim.22464. Published online 29 April 2015 in Wiley Online Library (wileyonlinelibrary.com).
ß 2015 Wiley Periodicals, Inc.
while riding without a helmet [Ghosh et al., 2000; Ueeck et al., 2004; Thomas et al., 2006; Loder, 2008; Hawson et al., 2010; Eckert et al., 2011]. With some exceptions demonstrating the prevalence of head, chest, and upper extremity injuries to thoroughbred farmworkers [Iba et al., 2001; Swanberg et al., 2013] and a few studies noting the hazards of grooming for un-mounted riders [Exadaktylos et al., 2002; Ng and Chung, 2004], less is known about the injuries or illnesses suffered by workers on horse farms. Thoroughbred breeding is hands-on and requires constant interactions with the animals, particularly because live breeding—as opposed to artificial insemination—is required [The Jockey Club, 2013]. In addition to continual human–horse interactions that could lead to injury, other common hazards on horse farms include dust from mucking stalls [Kimbell-Dunn et al., 1999; Gallagher et al., 2007] medicines [Swanberg et al., 2012; Clouser, 2013], landscaping work, and farm equipment [Clouser, 2013; Swanberg et al., 2013].
Supervisor Risk Perception and Provision of PPE
Personal Protective Equipment Despite the hazards inherent in horse work, horserelated personal protective equipment (PPE), is rarely used while carrying out un-mounted horse-related tasks. In fact, studies of horse-related injuries reveal that few grooms or riders wear PPE while grooming horses [Thompson and Von Hollen, 1996; Reed et al., 1998; Ng and Chung, 2004; Eckert et al., 2011], despite the fact that grooming may result in serious injuries that could be mitigated by its use [Chitnavis et al., 1996; Exadaktylos et al., 2002; Ball et al., 2007]. Not only are many thoroughbred farms high-risk environments, they also tend to be small: a recent survey of thoroughbred farms in one southeastern state found nearly 75% of farms employed fewer than 10 employees [Nutt et al., 2011]. Organizations with fewer than ten employees are exempt from reporting illnesses and injuries to OSHA [DoL, 2005]. As a result, the safety climate on thoroughbred farms is not well understood. Work organization dynamics of small workplaces influence safety practices, including the provisioning and use of PPE [Eakin 1992; Eakin and MacEachen, 1998]. Consequently, safety practices of small farms may vary, dictated not by employer policy but by the experience and attitudes of managers or owners [Carpenter et al., 2002].
Risk Perception and PPE Extant literature reveals that the inherent risks of agriculture, one of the leading industries for occupational illness/injury [BLS, 2013], may be understood by farm operators, but safety behaviors may not follow [Elkind, 1993; Sorensen et al., 2006; Sorensen et al., 2008]. Specifically, numerous studies have found farmers’ PPE use to be sub-optimal [Carpenter et al., 2002]. Possible reasons behind this disconnect between risk perception and safety behavior include that farmers operate in a risksaturated environment and/or view risk through a costbenefit lens [Sorenson et al., 2008]. For example, when assessing whether and to what degree a situation involves risk, other factors such as weather, scheduling, and economic considerations may influence whether a farmer takes the time and expense to behave safely [Elkind, 2007; Sorenson et al., 2008]. However, this reasoning may change when the decision is not whether to wear safety equipment oneself, but whether to provide it or mandate it for workers. Studies conducted in North Carolina found that while farmers were aware of pesticide hazards, they tended to minimize the risk workers faced [Quandt et al., 1998; Rao et al., 2004]. However, to our knowledge, few studies have looked at the relationship of management’s risk perception and subsequent provision of PPE [see
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Eakin, 1992 for an exception], particularly among large animal operations. In fact, little is known about attitudes toward PPE in animal handling, as most of this literature is concerned with chemical, respiratory, or tractor safety [Quandt et al., 2006; Reed et al., 2006; Sorensen et al., 2006; MacFarlane et al., 2008; Vitali et al., 2008]. PPE use and provision with large animals is important to understand as animal handling not only features different risks and challenges [Lindahl et al., 2012] than other sectors of agriculture, but it also has the highest non-fatal injury rate [BLS, 2013]. This study had three main objectives: 1) to describe the risk perceptions of thoroughbred farm management representatives, 2) to describe their provision of and attitudes toward PPE, and 3) to explore the factors that influence farms’ PPE provision.
METHODS Recruitment and Sample A detailed description of the study’s methodology is described elsewhere [Swanberg et al., 2013]. Briefly, a sampling frame of 82 thoroughbred farms in one southeastern state was compiled by the study’s industry advisory council1. The sampling frame was constructed to approximate the industry’s distribution of small, medium, and large farms [Nutt et al., 2011] and each farm’s size was confirmed in the interview. Farms were eligible if they (1) engaged in thoroughbred breeding/boarding as their primary function; (2) employed at least one Latino worker; (3) were located in one southeastern state2. Management representatives were eligible if they were at least 18 years old and held a position of farm owner, manager, or personnel administrator at the recruited farm. All 82 farms were called by the study’s project manager and 20 were deemed ineligible: five had disconnected phone lines, nine were no longer operational, five no longer hired workers, and one hired no Latino workers. Thirty-two farms participated in a 20-minute telephone-administered survey (52%) and 26 participated in a 1–4 hr in-depth, face-to-face interview at the participant’s farm (42%). Of the farms that consented to the phone survey but not the in-depth interview, 1
2
The industry advisory council was comprised of eight highly engaged community and employer key stakeholders including the head of a regional thoroughbred owners and breeders association, the human resource manager at a large thoroughbred farm, the president of a regional thoroughbred farm managers’ club, the director of an organization that provides outreach to thoroughbred farmworkers, the director of a health clinic that provides health care to thoroughbred farmworkers, and several small thoroughbred farm owners. To protect the anonymity and confidentiality, participating employers, the specific location is not disclosed.
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one needed permission from a business partner, three did not have time, and two gave no reason. We settled on the attained sample size because on-going data analysis concluded that saturation was achieved.
Data Collection Both the telephone survey and the in-depth interview were conducted by the project manager who also obtained oral consent from phone participants and written consent from interview participants. The interviewer had six years of experience in qualitative research prior to conducting interviews and additionally completed three 2-hour training sessions in qualitative interview techniques prior to data collection. The semi-structured interview protocol covered topics such as farm characteristics, workforce demographics, work organization (e.g., job tasks, scheduling practices), and perceived risks associated with horse work. All study procedures were approved by the University of Kentucky’s Institutional Review Board. All interviews were audio-recorded and often accompanied by a farm tour in which the interviewer asked participants to show her areas that may pose challenges to worker health and safety. Interviews lasted an average of two hours (Range ¼ 1–4) and were completed between October 2012–April 2013. If an office/administrator was the main contact, a second interview was performed with the farm manager to gain an “on-the-ground” perspective. In all, 35 individuals representing 26 farms participated. On six farms, two to four people were interviewed. A checklist of horse farm PPE was constructed based on data from a pilot study of Latino horse farm workers [Clouser, 2013] and edited through advisory board feedback. This list was further modified through two pilot interviews conducted with management representatives. Finally, farms were asked to add PPE that were provided but not listed. This checklist was completed by all participants and later corroborated with interviews transcripts. All PPE referenced by participants were credited to that farm.
Data Analysis Interviews were transcribed verbatim, entered into ATLAS.ti, and analyzed by three coders: two primary and one reviewer. A code list was agreed upon after coding 2-3 interviews. Coders then parsed the data, looking for similarities and differences in management risk perception, PPE provision, and factors influencing the latter. A process of constant comparative analysis was utilized to ground emergent themes in the transcripts. During weekly meetings, themes and codes were discussed. Researchers entered PPE survey data into Statistical Analysis Software (SAS) and performed univariate analyses.
TABLE I. Demographics of Farm Representatives, N ¼ 35*
Gender Male Female Race/Ethnicity Non-Hispanic White Non-Hispanic Black Hispanic White Position on farm Manager/Divisional Manager Owner/Manager HR/office administrator
N
%
26 9
74 26
33 1 1
94 3 3
17 12 6
49 34 17
* In 5 cases multiple people were interviewed separately from the same farm. In 3 cases multiple people participated in a single interview.
TABLE II. Distribution of Farm Size in Sample, N ¼ 26 Farm size
N
%
Small (10 workers) Medium (11-25 workers) Large (>25 workers)
11 8 7
42 31 27
RESULTS Sample Demographics Participants were mostly non-Hispanic White males (See Table I). Nearly half were general managers, a third were owner-managers, and less than one-fifth were office/ personnel administrators. Farm sizes ranged from 1–230 employees with a plurality (42%) having 10 or fewer workers (See Table II).
Management Risk Perceptions Risks discussed by participants fell into one of two categories: horse-related—involving direct contact with the horse—and non-horse related—including farm equipment, overexertion, etc.
Horse-related hazards Participants almost unanimously agreed that working directly with horses was the most dangerous aspect of thoroughbred farm work. Horse work is hands-on and hazardous due to the animal’s weight and unpredictable nature. Although all horses were characterized as dangerous, yearlings—being large, energetic, and unaccustomed to being handled—were often considered the most threatening.
Supervisor Risk Perception and Provision of PPE
A yearling horse or a horse that’s in the beginning of its racing training, a young horse is like a teenage boy; they’re insane [L-05MGR]3. A good friend of mine was killed several years ago by a yearling.…The horse developed a habit of trying to break away from whoever would be handling it and…he tried to teach it not to and it tried to get away and bolted on him one day and ended up dragging him. He couldn’t let go and the horse kicked out to the side and kicked him in the chest and it killed him. So, I’d say the yearlings are pretty much the toughest [S-11OWN]. When asked to identify jobs with the most potential for worker illness or injury, participants consistently cited horserelated chores. In fact, four participants noted that anything related to working with horses was the most dangerous farm endeavor: Leading one in, picking feet [hooves], everything…. the number one most dangerous job is working with the horses [S-04OWN]. We find a lot of injuries when they’re grooming the horse. It could be what they call ‘picking’ the horse’s feet; they have to pick up the hoof and clean it underneath and something can spook the horse [L-03OFF]. However, the task most commonly cited as dangerous was also one of the most routine: leading horses, or walking them from one place to another. R1: Far and away, the most injuries occur when somebody’s on the end of a shank leading a horse… R2: The horse will take off and kick out and kick one of the employees or they’re stepped on… I’ve known people that have got killed in this situation when a horse gets out the end of a shank because typically when you’re leading [horses]…you have their head. As long as you’ve got that head, they can still do things to you but it’s usually not too serious. When they get out the end of the shank, then you’re in [kicking] range and that’s when you get serious injuries [M-02OWN].
One of the more dangerous things that we do is bringing horses in and out because, you know, four or five mares at the gate, two people bringing them in, one bully wants to wheel and kick the other ones when they’re all up there crowded at the gate and it’s a dangerous spot [L-06MGR]. Another hazardous task was breaking yearlings (training a young horse to be ridden for the first time), as well as riding horses for exercise. However, these tasks were often contracted out: You can never predict that a horse, a young horse, is not going to blow up and buck a rider off… you can’t predict it, but you can minimize the chance for that by doing it slowly, by not scaring them. But it can happen. But that is the most high risk job. And for that, they have to have protective clothing, protective helmet, and that’s pretty much all you can do. You know, riding by its very nature is somewhat dangerous [M-01MGR]. Well you’re asking [horses] to do something they’ve never done, you know. So the first few days when you get on them, they can buck and some of them will buck hard and they’ll throw you off. So just a fall from a bucking horse would be pretty dangerous [S-03OWN]. A final hazardous task was working in the breeding shed, where farms brought their mares to mate with another farm’s stallion. This requires very close contact with horses in a charged environment. R: When you have two 1,300–1,400 pound animals in there, there’s always potential for problems. Anytime there’s something going on in the breeding shed, I’m always worried something could go wrong because a lot of people have been severely hurt in the breeding sheds around here historically. I: Have any of those translated into injuries? R: Had several…One was here in the breeding shed about 2 years ago. Had a person who got pinned up against the wall when the horse jumped on them, broke a collarbone… I: What happened? Could you describe it?
3
Each interviewee was assigned a unique identification tag (e.g. S-02OWN). The first letter of the tag indicates their farm’s size and is followed by a unique identification number and suffix which indicates if the interviewee was the manager (MGR), owner (OWN), or office manager (OFF). For example, S-02-OWN is the owner of a small farm.
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R: When we have breeding going on, obviously male/female, the mare who is the female is restrained. We put a device called a twitch which is a restraint that goes on their nose. We also will
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pick up and put a strap around her front leg holding that front leg up so that they’re on three legs rather than four. If you hold up a front leg, hopefully they can’t kick with the back leg. It doesn’t always work that way but sometimes it does. We’re trying to protect our stallion. The stallion is the most important and most valuable animal here on our [farm] so we do everything you can and this is standard procedure…Anyway, this lady had the mare’s leg held up with the leather strap and I don’t know whether the mare was just startled…whatever the impetus was, the mare jumped in the air. When the mare jumped up in the air, her shoulder hit her and pinned her up against the wall [S-05MGR].
masks and stuff sometimes, and we have those if they want them, but sometimes they just know they need those on their own [L-03OFF]. I think it’s something that you almost get used to and you don’t realize it but dust is terrible in the barns; that’s probably the biggest deal and we try to build our barns and position them so we can open up and get more air flow through there whenever we can. But I’d say that is, that is our biggest complaint from the guys [M-08MGR]. Finally, administering medicines to horses represented a threat which was perceived quite differently across farms. On many farms, workers often administered a range of medicines to horses, though the perception of risk was mixed.
Non horse-related hazards
DMSO5 you can, you don’t even have to wear gloves; it just smells like rotten eggs. DMSO is great… you can drink it and it’s not going to hurt you. It’s not going to taste very good, but it’s not going to hurt you [S-04OWN]
Farm equipment—such as hay balers, mowers, and tractors—were mentioned as a distant second to horserelated hazards, though a small minority of representatives cited them as the greatest threat to workers’ safety. Tasks such as “weed-eating” (i.e., string trimming) were also considered dangerous.
DMSO liquid now mixes with a lot of other liquids and it’ll help penetrate [the skin]…So it’s a very, very valuable drug but you know it’s controversial. It’s supposed to be a cancer link drug I think in humans. [S-01MGR]
Equipment’s dangerous. You know you’re dealing with 85–90 horsepower tractors with PTO4 which is by far the most dangerous. I mean more people are killed by PTO, the Power Take Off, you know, and that’s extremely dangerous[S-10OWN] The potential for injuries resulting from heavy lifting of feed, hay, or muck or falling from high locations such as a hay loft were other common hazards. As L-05MGR noted, workers “need to be physically strong enough to lift probably 30–50 pounds routinely. They need to be able to stand and scoop and move their body … sometimes people could strain or do stuff like that. I mean it’s always a risk, lifting, you know. It always will be.” Another manager told of a man falling from a hayloft: “…he lost his balance and grabbed the tobacco rail but it was not attached so it just slid… So he fell out of a loft and broke his feet” [L-01MGR]. Working with hay or straw may also lead to exposure to respiratory hazards, though few participants believed it to be of great concern.
Supposedly Furacin6 can cause cancer. I didn’t know that and used it for years when I was [farm manager]. [L-01OFF]. I don’t know that it requires gloves for Furacin but I mean most people don’t want that all over their hands, so they wear gloves [M-04OWN]. While most participants believed that medicines warranted gloves, fewer knew exactly why. As a result, associated safety practices were often relaxed. For example, altrenogest (Regu-Mate) and chloramphenicol, drugs that suppress estrus in mares, were commonly considered dangerous for women, but likely safe for men. As a result, minimal precautions were taken among male workers. Only men are allowed to use Regu-Mate period. Like when my wife helps out occasionally, she doesn’t… touch Regu-Mate; you don’t touch any part of where the Regu-Mate is. We’re fairly lax now because we don’t have any women around so we
Sometimes working in the barn I’ve had people tell me that the dust and the little hay particles or straw particles get stirred up. I’ll see them use the allergy
4
Power Take Off (PTO) is a mechanical means of transferring power that is used in a variety of farm equipment, including tractors, and poses risk of entanglement to the operator.
5 6
Dimethyl sulfoxide (DMSO) is a solvent used with other medicines to aid their absorption into the skin. Nitrofurazone (Furacin) is an antibacterial ointment used for wounds.
Supervisor Risk Perception and Provision of PPE
don’t have to worry about that, but only men can give Regu-Mate period [S-04OWN]. Chloramphenicol. That is a hazardous type medicine… something that contact to the skin is detrimental so, and it smells awful so that’s, grooms and myself will give it but instructions are you must have gloves on with it so and they do have gloves on to do so. I know that much [S-06MGR]. Supposedly Regu-Mate can alter a woman’s cycles and affect her ovaries and stuff. I didn’t know that for years and used it for years [as farm manager] because when they first came out with it, nobody knew [L-01OFF, also a female].
Provision of Personal Protective Equipment Horse-related equipment Equipment to protect workers from the horse (i.e., helmets, padded vests) was neither widely available nor mandated. The most common horse-related PPE—helmets —was only available at ten farms. Approximately one quarter of farms offered padded vests (See Table III). On several farms, horse-related PPE was only considered necessary when riding horses or working in the breeding shed, not for day-to-day horse work: “Nobody is going to have a flak jacket (padded vest) on when they groom a horse” [M-03OWN]. Of the six farms that offered padded vests, five were large farms that housed stallions and conducted breeding operations. On these farms, vests were mandatory only in the breeding shed. Several farms provided boots, though only one farm provided steel-toe boots. One manager stated that although he believed boots were necessary, they neither provided nor recommended them: [Workers] don’t wear work boots, they don’t wear steel-toe shoes…there need to be better footwear and we don’t provide that for employees but…you know some stuff can be prevented if you’re not wearing tennis shoes. That’s my soapbox issue [L-05MGR]. The same manager later noted that “truly at the income level that most of our people are at, to have to go out and buy a pair of boots doesn’t make the job worthwhile.”
Non-horse related equipment The provision of PPE for non-horse related hazards was more prevalent than that for the horse. Latex gloves and safety glasses were the most common and most often
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mandated. In addition, about half of farms provided masks/ respirators, cold weather jackets, and hearing protection. Safety glasses were required for tasks such as operating equipment, using chemicals, or repairing fences. Some managers would terminate employees caught using equipment without this PPE. While rubber or latex gloves were available at every farm to protect against medicines/chemicals or to prevent the spread of disease among horses, less than half required their use. Farms also differed on which medicines/chemicals required gloves. As a result, some farms mandated gloves when applying all or certain medicines, others recommended it, and still others deferred to workers. In all, little direct education about glove use was provided. Well [gloves are] there and if they see me using it then they’ll use them. But if they don’t it’s not a big deal. Like, Furacin and stuff where you put it on the leg and then put a bandage over the top, but I always use a rubber glove. And if they see me doing it, they’ll do it [S-05OWN]. Masks, used both when working in stables and handling chemicals, were often provided. However, while some farms mandated masks when working with chemicals, mowing, or painting, no farms required them when mucking stalls. In some cases, participants observed workers improvising when masks were unavailable: “Occasionally you’ll see them wear a bandana or something over their nose if they feel like it’s something dusty” [S-11OWN]. Overall, respiratory hazards were not considered particularly dangerous and breathing complaints were often attributed to allergies. L-03OFF, for example, referred to respirators as “allergy masks.”
Factors That Influence Farms’ Provision of PPE Differences in farm context Some farms noted farm size and income as barriers to PPE provision. Owners/managers of small “working” farms were aware of the industry’s disparities in farm size/income and the associated constraints. I see a lot of other farms that can probably afford a lot of practices that I’m just simply financially unable to, but you know I try, since I’m pretty much a hands-on owner/manager [S-11OWN]. Although influential, only three farms cited farm size or affluence as a limiting factor for PPE. As one example, the owners at M-08MGR’s farm provided college tuition assistance to workers’ children and clothing such as insulated boots, cold weather jackets, and uniforms. However, they did
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TABLE III. Personal Protective Equipment Provided and Mandated, N ¼ 26 PPE Type Horse-Related Helmets
# Farms Provided (%)
# Farms Mandate for certain tasks (%)
Examples of tasks mandated for
10(38.5)
7(26.9)
Riding horses, Breeding horses, Using chainsaws, Being in stalls (1 farm) Breeding horses, Riding horses No tasks given
*
Padded vests Steel-toe boots Non-Horse Related Latex gloves
7(26.9) 1(3.9)
6(23.1) 1(3.9)
26 (100)
11(42.3)
Eye protection
24(92.3)
16(61.5)
15(57.7) 13(50) 10(38.5) 8(30.8) 2(7.7) 3(11.5) 1(3.9)
5(19.2) 6(23.1) 5(19.2) 2(7.7) 1(3.9) 1(3.9) 0(0)
Administering medicines, Applying chemicals String trimming, Pressure washing, Fence repair, Applying chemicals, Using chain saws, Operating equipment Applying Chemicals, Mowing String trimming,Operating equipment Foaling horses, Breeding horses Fence repair, Painting, Handling hay Applying chemicals Mowing/string trimming along road X-rays
15(57.7) 12(46.2) 12(46.2) 11(42.3) 8(30.8) 6(23.1)
3(11.5) 0(0) 1(3.9) 2(7.7) 2(7.7) 0(0)
No tasks given Not mandated When raining No tasks given Breeding horses Not mandated
Masks/Respirators Hearing protection Other boots (work or rubber) Cut-resistant gloves Paper suit/Coverall Reflective vests Lead vests Clothing, Other equipment provided Cold weather jackets Cold weather gloves Rain Jackets Breathable t-shirts Overalls Ear muffs *
Horse-Related refers to equipment that protects one against the horse. Non-horse related refers to equipment that protects from any other mechanism of injury or illness.
not provide helmets, padded vests, or steel-toe boots to workers. Farms that did not engage in certain activities (i.e., standing stallions7) did not believe that certain PPE was relevant at their farm. As S-04OWN explained “I mean we don’t have helmets because we don’t have stallions; we don’t have flak jackets [padded vests] because we don’t have stallions.” Further, because riders were often contract workers, they often brought their own helmets and vests to ensure a proper fit, and therefore many farms did not purchase them.
7
Not “having stallions“ means that breeding does not occur on this farm because breeding takes place at the farms where stallions are housed. Owners or boarders of mares will bring those horses to the farms with stallions, and it is the workers at the host farm that manage the breeding process.
Workers as most important agents in their safety Several participants believed that even if PPE was provided, workers would not wear it because it was uncomfortable, taxing, or a hassle. These participants noted that safety glasses were forgotten, managers were not informed when disposable PPE ran low, and work gear was taken home for personal use. You know [for workers] it’s kind of like, ‘Do I really need to stick those earplugs in? Do I really need to go and get them? Because it is so much easier to just pick up the blower and just start blowing.’[L03OFF]. I took a kid out to weed-eat. I said, ‘Well, why don’t you work on this fence line there. You got all your stuff?’ ‘Yeah.’ I said, ‘You got your safety glasses?’
Supervisor Risk Perception and Provision of PPE
‘No.’ I mean he knew he was supposed to have them. ... But then I said, ‘Okay I’ll go get them, I’ll be right back.’ So then he starts weed-eating while I’m gone. I’m gone 5 minutes. I come back. He’s got something in his eye. I gotta take him to the doctor. Unbelievable [M-02OWN].
You could probably arm yourself with a suit of armor if you wanted but it’s impractical so you just have to be careful and calculating throughout your day… If you watch a horse, if you’re careful around them and respect them, then you’re not going to have any injuries [S-08OWN].
The next day [after an eye injury] I did go up there and I’m angry and … I can’t find [the safety glasses], ‘Where are they? This is where they are supposed to be, right where the weed-eater is. I just bought five pair.’ So that’s pretty much how safety is [M-05OFF].
So we don’t have the vests or the helmets whereas I know some stallion complexes do. But most all of our grooms [have] been breeding horses for ten years or longer. I mean they’re very experienced [L03OFF].
Other participants believed that if workers wanted or needed PPE they would request it. They could [wear masks] if they wanted to. If they wanted to, we would supply it, but no one has ever asked for one [M-02OWN]. If they ask for [masks], that’s fine. I mean if you leave masks in a barn, the mice eat them … I mean you can’t just leave stuff in the barn for people to use. If they don’t use it for a while, then you know… if they need something, they just have to tell us [M04OWN]. If somebody comes down in complex and all of a sudden said, ‘You know I want to start wearing a vest down there’… we’d certainly get it for them [L-07MGR].
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Occasionally you’ll hear about somebody that got hurt pretty bad and usually it’s a matter of somebody not paying attention or doing something they shouldn’t have been doing … if farms thought helmets and vests were really needed or preventative, I think more farms would do it [L-07MGR]. According to some managers, helmets, vests, and work gloves could be hot and limited movement. Steel-toe boots were described as uncomfortable and inflexible and posed the risk of severing or crushing toes if stepped on by a horse. R: We do not recommend steel toes because I’ve known people to actually (get) stepped on and the toes, the steel goes down on their toes and they have to have the boot cut out so they can be almost too dangerous. I: So you’ve known people that have actually had that happen to them?
Some farms might provide PPE, but deferred to workers on whether to use it. I mean if somebody wants to go give Regu-Mate without gloves on, that’s their prerogative… [Worker name] has 20, 30…40 years’ experience with horses and the rest of them have college degrees and I don’t have to tell them to read a label on something precautionary. I mean they see it [M-03OWN]. Those that left PPE practices up to employee discretion often felt they had little power to enforce its use. “I mean you can’t make somebody use earplugs” M-04OWN noted. However, other managers disagreed and sent employees home or threatened termination if workers didn’t comply.
R: Not here but I’ve heard of it happening [L-01MGR]. There is a theory that the steel-toed boots that if a 2,000lb horse steps on it then it is going to crush your toe even with the steel toe, so I kind of go back and forth with these guys on what is really needed there. It goes both ways. They say, well, you know they’re more quick and agile if they just have a good boot with good tread and not have to worry about a heavy boot and stuff like that [L-03OFF].
Perception that risk could never be eliminated
Lack of confidence in its effectiveness Many representatives believed that attention, common sense, and a good understanding of horse behavior were more important than PPE for preventing horse-related injury.
Many participants believed that risk on the farms could never be mitigated entirely, regardless of one’s experience or skill: “you could be the best horseman in the world,” L04MGR noted, “and one [horse] could get on top of you. It’s
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happened to me and it’s probably happened to anybody that’s been in the business very long.” To them, injuries were inevitable, “It’s not if you’re going to get hurt,” said S09OWN, “it’s when you’re going to get hurt.” They noted that the continuous risk could cause employees to become complacent about safety. And what happens a lot when people get hurt is when you take a shortcut you know … 999,990 times out of 100,000 you get away with it and it’s just that one time…Everybody that I’ve known that’s gotten serious injuries… usually did something that they knew they shouldn’t have done…Even with all the training and experience in the world, you can still put yourself in a very dangerous position [M02OWN]. A lot of times they’ll just walk into a stall and say, ‘Well the horse is real docile and has never been a problem before’ and well this is the time that the horse rears up and kicks you in the head. So you know, sometimes [workers] get a little too complacent with their work duties [L-03OFF].
DISCUSSION This paper examined the risk perceptions of thoroughbred farm management and their provision of and attitudes toward PPE. Unlike other research that has assessed safety behavior and/or risk perception of farmers, this study focused on management practices over a high-risk worker group. Many studies have observed that economic and other stressors influence farmers’ safety behaviors, but these have chiefly focused on a farmer’s behavior to protect him/ herself (e.g., wearing PPE when applying pesticides or retrofitting a tractor with rollover bars) [Sorensen et al., 2008; DellaValle et al., 2012]. A key difference in this study is that the end behavior is an organizational policy (i.e., providing helmets to workers) that impacts others through a calculated versus spontaneous decision. Nonetheless, despite the near consensus on horses being the most hazardous part of the farm, PPE policies tended to be informal, with PPE for horse-related tasks least likely to be provided. We discuss several possible reasons why horse and non-horse related PPE were treated differently. First, is the role of risk perception. As other studies note, safety behavior does not always follow from an awareness of risk [Elkind, 1993; Elmore and Arcury, 2001]. Research suggests that constant exposure to risk may lead to “habituation,” a learned tolerance of elevated danger [Lindahl, 2012]. This may explain why common tasks— such as leading horses and working with yearlings—are cited as more dangerous, and yet do not elicit PPE provision/use.
Another possible explanation is the relativization of risk, whereby a risk that is considered to be less extreme than another is minimized [Carpenter et al., 2002; Sorensen et al., 2008; Lindahl et al., 2012; Rabinowitz et al., 2013]. Because working in the breeding shed or riding horses are discreet events for which injury potential is high, the daily act of leading a horse may seem too mundane to warrant protection. This finding corroborates other research and may explain why individuals wear helmets during certain risky horse activities, but not others [Reed et al., 1998]. Second, horse-related PPE (e.g., helmets and flak jackets) are more expensive than gloves, masks, and glasses. Researchers have posited that farmers may view the costsavings associated with risk-taking to outweigh the cost of potential injury [Sorensen et al., 2008; Lindahl et al., 2012]. Although equipment cost was discussed as an obstacle by only three representatives, the most prevalent PPE on farms were also among the least expensive: gloves, safety glasses, masks/respirators. Provision of PPE when it is cheap, but not when it is expensive mirrors other studies’ findings [Sorenson et al., 2008]. A third finding concerns social norms associated with horse and non-horse PPE. Non-horse activities were considered to have predictable, yet preventable dangers. Equipment, chemicals, and medicines come with user manuals, warning labels, and other “cues to action” [Janz and Becker, 1984] which may prompt the use of PPE to mitigate risk. Despite the mixed perceptions on how dangerous certain horse-related medicines could be, latex gloves were universally supplied by farms in our sample. Horses carry no such labels or manuals, and thus social norms may follow that PPE is discretionary, not mandatory. Further, many non-horse hazards, such as equipment and chemicals, are present in other industries and thus may have more widely adopted social norms regarding PPE. Another potential reason for the lower adoption of PPE for horse-related tasks is that representatives did not believe PPE was the most effective means of protection against horses. Helmets, vests, and steel-toe boots were sometimes cited as cumbersome, limiting mobility. Steel-toe boots were roundly criticized for their potential to exacerbate injury, though no one had witnessed this, nor could this be substantiated in the literature. As the extant research on PPE use in large animal operations is sparse, future research should explore its efficacy in protecting workers. Experience, according to interviewees, was more important in protecting workers from animal-related injury, a perspective which was shared among a sample of Swedish dairy farmers [Lindahl et al., 2012]. However, not only was experience hard-won through injuries and close calls, but research suggests that inexperience is rarely a factor in horserelated injuries [Exadaktylos et al., 2002; Ng and Chung, 2004; Ball et al., 2007; Eckert, 2011]. In fact, risk of serious injury appears to be a function of cumulative exposure to
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horses, rather than level of expertise [Kriss & Kriss 1997; Ball et al., 2007; Loder, 2008; Lucas et al., 2009]. Finally, some participants believed that workers did not desire and would not use PPE, for they never requested it. However, studies conducted with Latino farmworkers, who comprised half the workforce on these farms [Swanberg et al., 2013], warn that they may be reticent to vocalize work-related concerns, particularly if they believe it might endanger their job [Elmore & Arcury 2001; Rao et al., 2004]: A recent study of Latino horse workers found that nearly a quarter (24%) “Almost always” worried about losing their jobs [Swanberg et al., 2012]. Consequently, supervisors may benefit from initiating conversations with workers about desires for PPE rather than waiting for workers to initiate these conversations.
ACKNOWLEDGMENTS
Limitations
REFERENCES
This study has several limitations which should be considered when interpreting its results. First, due to its small sample size, convenience sampling, and qualitative methodology, its results are not generalizable to all farms or even all thoroughbred farms. Rather, its findings provide context and understanding of farms’ decisions about whether or not to provide PPE to workers. Also, as information was self-reported rather than directly observed, it is possible that farms’ reports were not accurate depictions of what was available or mandated. Similarly, because the role of the representative may have varied from farm to farm, it is possible that the interviewee may not be aware of how policies are implemented. However, the team interviewed multiple people (office manager, farm manager) on several farms to avoid this limitation.
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CONCLUSIONS This is one of the first studies of thoroughbred farm management’s risk perceptions and PPE use/provision. Findings suggest that farm representatives perceived great risk in working with horses, but also that horse-related PPE was not effective in mitigating that risk. Other barriers, such as perception of worker adherence and cost of equipment, prevented PPE from being a widely accepted solution. Future research is needed to understand workers’ perception of PPE and risks associated with thoroughbred farm work as well as communication dynamics between managers and non-native workers. It should also explore the use of horse-related PPE for tasks beyond the breeding shed and track. Finally, research should incorporate community-based participatory principles to engage thoroughbred management in developing and evaluating strategies to reduce risk on horse farms.
We would like to thank the representatives of the farms who took the time to share their perspectives—this was a time intensive interview process, and we appreciate their patience. We would also like to thank the active members of the industry and the community advisory councils that have supported and informed this project. The work presented in this paper was supported by the Southeast Center for Agricultural Health and Injury Prevention, University of Kentucky College of Public Health, under CDC/NIOSH Cooperative Agreement 5U54OH007547-13. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of CDC/ NIOSH.
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