Bystanding as a risk factor for injury of children on Midwestern agricultural operations

Background: Agriculture is considered among the most dangerous occupations and has consistently ranked among the top three. Production processes, associated with this occupation, place at risk not only workers but also others who live on the operation. We evaluated the incidence and determinants of associated injuries in the Regional Rural Injury Study - II (RRIS-II).

Methods: The RRIS-II followed 16,546 children under 20 yrs (~85% of eligible) from rural communities in the Midwest for two six-month recall periods in 1999/2001 and identified their injury events. Demographic, injury, and exposure data were collected through comprehensive and case-control computer-assisted telephone interviews.

Results: Among the 463 child injury events 102 were bystanders, where: 14 were identified as indirectly work-related (working bystanders), 27 non-working accomplices (passengers/tag-alongs), and 60 non-working attendant (playing on the operation). Inter-rater agreement among 10 raters resulted in a Fleiss Kappa = 0.74. Nearly 60% of all 425 cases responded to sometimes/frequently bystanding in six out of seven different agricultural environments (workshops, animals, etc.) Multivariate regression showed an increased odds for all of the exposures until controlling for gender, then only bystanding near used machinery OR=1.5 (1.1, 2.0) or stored machinery OR=1.4 (1.1, 1.8) showed an increased odds for injury.

Conclusions: Children are vulnerable to hazards similar to those of adults; but, they are less capable of understanding these hazards. Although parents cannot child-proof their operations, it is important for them to understand the apparent risks of bystanding. Further analysis of bystander data from RRIS-II will aid in prevention program development.