A Cohort Study of Injuries in Migrant Farm Worker Families in South Texas SHARON P. COOPER, PHD, KEITH E. BURAU, PHD, RALPH FRANKOWSKI, PHD, EVA M. SHIPP, MS, DEBORAH J. DEL JUNCO, PHD, RYAN E. WHITWORTH, MPH, ANNE M. SWEENEY, PHD, NANCY MACNAUGHTON, MPH, NANCY F. WELLER, DRPH, AND CRAIG L. HANIS, PHD PURPOSE: This cohort study estimated the frequency of and risk factors for work injuries among migrant farmworker families over a two-year period. METHODS: The cohort consisted of 267 families. Bilingual interviewers asked mothers to respond for their family soliciting demographic, psychosocial, employment, and work-related injury information. Cox regression was used to examine risk factors for first injury events. RESULTS: Of the 267 families, nearly 60% migrated and 96% of these completed the follow-up interviews. These families represented about 310 individuals each year who had participated in farmwork on average 6 days a week, 10 hours a day, for 2.7 months in the past year. Twenty-five work-related injuries were reported with an overall rate of 12.5/100 FTE (95% C.I., 8.6–19.0). Working for a contractor increased the hazard ratio, and use of car seat belts and working for more than one employer during the season decreased it. CONCLUSIONS: If person-time at risk for injuries is taken into account the reported injuries are substantial. Because the injuries were quite diverse, specific interventions may have to focus on improved working conditions (physical and economic), ergonomic modifications, and enhanced enforcement of existing regulations. Ann Epidemiol 2006;16:313–320. Ó 2006 Elsevier Inc. All rights reserved. KEY WORDS: Farm work, Youth, Texas, Hispanics, Injury, Migrant Workers, Family, Surveillance. BACKGROUND Very little is known about occupational injuries, either fatal or nonfatal, in agriculture in general and in agriculture involving migrant farmworkers in particular. The reasons for the paucity of data include incomplete surveillance, inconsistencies in the definition of work, the absence of legal injury-reporting requirements for small farms (! 11 employees), self-employed farmers and unpaid family work- ers, and difficulties in defining injuries in this population (1–8). It is estimated that 85% of migrant and seasonal farmworkers work on farms with fewer than 11 employees (9). However, sufficient data exist to document agriculture as a hazardous work environment for children and adults in the United States and in Texas (2, 3, 10–17). Agriculture is the second most hazardous industry in the United States in terms of death rates (18), and it is tied for third highest among eight major industry classifications for nonfatal injuries (19). Further, many of the studies relate to farm owner and operators and their families and not farm workers (7, 20–24), and the majority of these data relate to adults. Injury prevention efforts have been hindered by a lack of data on specific work patterns and risk factors for injuries in farm worker families. The objective of this cohort study was to use a school-based tracking system for migrant farm- worker students as a sampling frame to identify migrant farmworker families in order to estimate the incidence of and risk factors for occupational injuries over a 2-year period. Only one cohort study of injuries among farmworker From the Department of Epidemiology and Biostatistics, Texas A&M School of Rural Public Health, Bryan, TX (S.P.C., E.M.S., D.J.D.J., R.E.W., A.M.S.); Division of Biostatistics, The University of Texas School of Public Health, Houston, TX (K.E.B., R.F.); the Division of Environmental and Occupational Health, The University of Texas School of Public Health, Houston, TX (E.M.S.); Division of Epidemiology, The University of Texas School of Public Health, Houston, TX (E.M.S., N.M., C.L.H.); the Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX (N.F.W.). Address correspondence to: Sharon P. Cooper, Ph.D., Texas A&M School of Rural Public Health, 3000 Briarcrest, Suite 300, Bryan, TX 77802. Tel: (979) 845-2387; fax: (979) 862-8371. E-mail: spcooper@srph. tamhsc.edu. This article was supported in part by NIOSH R01 OH04041 and Cooperative Agreement No. U50 OH07541 to the Southwest Center for Agricultural Health at The University of Texas Health Center at Tyler from CDC/NIOSH. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC/NIOSH. Received March 21, 2005; accepted April 8, 2005. Ó 2006 Elsevier Inc. All rights reserved. 1047-2797/06/$–see front matter 360 Park Avenue South, New York, NY 10010 doi:10.1016/j.annepidem.2005.04.004