Tomato Worker Ergonomics (pilot)

Principal Investigator: Ken Silver, D.Sc., Associate Professor of Environmental Health, East Tennessee State University.

Tomato workers cultivate and harvest Tennessee’s leading fruit crop and engage in physically demanding tasks such as lifting, stooping, and carrying. This study is therefore relevant not only to workers in the field and processing facilities, but also to their employers and rural health care providers. The study aims to inform a larger epidemiological study of the burden of musculoskeletal disorders (MSDs) and pain medication (“pill”) use among migrant and seasonal tomato workers, as well as potential evaluation of ergonomic controls; e.g., such as engineered bucket lifts, truck conveyor belts, etc. Project activities from 09/30/11 through 09/29/12 were funded through the Southeast Center under NIOSH Cooperative Agreement 5 U50 OH007547.

Methods. Video footage of tomato workers engaged in picking, hoisting, packing and sorting was collected by undergraduate honors student Nicole Manz (ETSU) at the end of the 2011 growing season. Toward this end Dr. Silver and Ms. Manz worked in close cooperation with the migrant health staff of Rural Medical Services. Per the approved human subjects protection protocol for the project, the faces of workers were obscured on film to protect their identities.

In May 2012 the project team conducted its first panel evaluation of tomato worker tasks. After a half-day training session led by Dr. Nathan Fethke of the University of Iowa, the panel used the Rapid Entire Body Assessment (REBA) method to rate video segments and tasks with respect to ergonomic hazards. A language interpreter from ETSU’s Language and Culture Resource Center facilitated the participation of 3 Spanish-speaking tomato industry workers. The other panelists included 4 physicians, 2 environmental safety and health professionals, 3 cooperative extension agents, and 1 nurse, for a total of 13 panelists.The research team analyzed the data for inter- and intra-rate variation, to test the hypothesis that individuals of similar professional backgrounds are more likely to apply similar scores to ergonomic hazards. Where ratings diverge, then qualitative research methods are used to identify the sources of variability. Where ratings assigned by industry workers correlate with those of health professionals, this forms the basis of a community consensus for practical intervention research

Preliminary Results. Data collected at annual health screenings conducted on tomato farms in 2009, 2010 and 2011 provide a window into longitudinal assessment. Over these three years, 465 individuals had screening exams. Nearly all of these persons were employed in tomato harvesting, packing, staking or sorting. Longitudinal observations across two or more growing seasons were available for 31 individuals; 11 newly incident cases of MSDs were recorded in the charts of these 31 individuals. These cases did not have musculoskeletal complaints at their first screening exams. Complaints (or diagnoses) consisted of back pain (7), knee pain (2) and pain or numbness in the upper extremities (2).

Pill Burden and Pain Treatment Issues. Researchers found that approximately 15 to 20% of tomato workers were taking at least one medication at the time of screening; the most frequently prescribed for pain were acetaminophen and ibuprofen. A single case of opiate use for low back pain was recorded in 2009. Up to two workers per year were prescribed muscle relaxants.

As this pilot study has shown, an opportunity exists to foster further community-based participatory research efforts between clinical students in the 2-semester, inter-professional ETSU Rural Track class migrant section and RMS clinicians who staff the summer health screenings. Three ETSU students assisted in project activity from 2009–2012. Follow up activity, including manuscript preparation and review, has continued through 2013.

Presentations/Publications to date

Manz N, Silver K, Fethke N, Hoffman K, Loury S, Florence J. Building a consensus for tomato worker ergonomics: A community-expert panel study. 140th Annual Meeting and Exposition of the American Public Health Association. 2012 Oct 29.

Bradfield M, Florence J, Loury S. Integrating cultural competency, experiential learning into interdisciplinary education NRHA Rural Multiracial and Multicultural Health Conference; Asheville, NC; 2012 Dec 4-6.

Silver K, Hoffman K, Loury S, Fethke N, Liebman A, Manz N, et al. A campus-community partnership for farmworkers' health: an intervention for tomato workers in Tennessee. Prog Community Health Partnersh [Johns Hopkins University Press]. 2013, in review.