Agriculture producers in the United States experience elevated rates of fatal and non-fatal injuries, evidenced by 2020 data showing 368 fatalities and an incidence rate of 18.0 deaths per 100,000 producers, contrasting sharply with the overall occupation rate of 3.4 deaths per 100,000 workers. Non-fatal injuries also present a significant concern, with 11,880 work-related injuries causing hired agriculture workers to miss work in 2020, excluding self-employed farmers and ranchers.¹ Beyond agriculture producers, those living on or visiting farms face substantial risks due to hazardous environments. In 2014, there were 7,469 youth injured on farms, with 60% of those injuries occurring outside of work conditions.² Agriculture workers encounter health hazards, including high noise levels, pesticide, and organic dust exposures.

Agriculture producers face an elevated risk of hearing loss compared to other occupations and the general population, presenting a significant occupational health concern.³ This heightened risk is attributed to prolonged exposure to high noise levels generated by tractors, electric tools, firearms, livestock, and various equipment.^3,4 These findings underscore the pervasive nature of potential hearing threats in the agricultural setting, emphasizing the need for targeted interventions to mitigate these risks.

Exposure to hazardous chemicals through the application of pesticides also poses a risk. Those involved in applying and mixing pesticides or working in areas where these chemicals have been used may inhale or carry them on their clothes and skin. Such exposure affects the producers and poses risks to those in their vicinity and household, leading to the dissemination of toxic chemicals.³ A significant association between insecticides/herbicides and lifetime allergic rhinitis and asthma in farm producers in the United States has been reported.⁵ Pesticide exposure can manifest in neurological problems, headaches and dizziness, respiratory symptoms, alterations in sleep and mood, gastrointestinal symptoms, and irritation of the skin and eyes.⁶ Personal protective equipment (PPE), including protective gloves and respirators, are important modifiers of the association between pesticides and Parkinson’s Disease. These protections may reduce the risk of Parkinson’s associated with certain pesticides.⁷

Exposure to organic dust poses a significant concern for agriculture producers, mainly when working in confined spaces such as barns and grain bins and in livestock confinement. Inhaling organic dust in these environments introduces microorganisms and toxic materials from animal waste, potentially causing respiratory damage.³ Exposure to organic dust triggers diverse immunological pathways, with repetitive exposure potentially inducing changes to immunity, fostering the development of chronic inflammation.⁸ This alteration in immune responses, particularly in the lungs, may lead to shifts in the population of immune cells, consequently predisposing individuals to lung inflammation and potential disease.⁹

In agriculture, where the potential for injury is notably high, adopting effective risk mitigation strategies is imperative for agriculture producers, and one such crucial measure is the proper utilization of PPE.¹⁰ While employing PPE occupies the lowest tier in the protection hierarchy of controls, its significance in reducing risks cannot be overstated.¹¹ It is incumbent upon agriculture producers to not rely on PPE alone, but to address and diminish risks proactively, including measures such as curtailing pesticide usage or opting for less hazardous alternatives. Despite these efforts, the pivotal role of PPE remains, particularly when encountering specific hazards in the agricultural environment.¹² The Occupational Safety and Health Administration (OSHA) mandates farms with 11 or more employees diligently assess existing hazards, provide functional and adequate PPE, and conduct comprehensive training on its proper use.^3,13 However, most farms in the U.S. fall under the classification of family farms, employing fewer than 11 workers, and consequently, they are not obliged to establish a formal PPE program.¹⁴

Required PPE varies according to the specific risks present in the agricultural working environment. Chemical PPE is essential when handling pesticides to protect against these hazardous chemicals.¹³ Reference to the Safety Data Sheet (SDS) is crucial for obtaining recommendations regarding appropriate clothing, eye protection, and respiratory safeguards. Recommended PPE may include protective gear like hats, safety goggles, chemical-resistant gloves, and full-length shirts and pants, effectively shielding agriculture workers from direct contact with harmful chemicals. Respiratory hazards during agriculture work necessitate respirators to prevent inhalation of air-borne threats.¹³ Choosing the proper respirator is essential, particularly if toxic materials become airborne and pose an inhalation risk to producers.¹⁴ Protection from noise exposure is crucial when operating loud machinery generating noise levels exceeding 85 decibels. Employing hearing protection, such as earplugs, earmuffs, or noise-reducing earbuds, significantly reduces the risk of permanent hearing loss.¹⁵

Properly fitted and tested PPE is crucial for maintaining its effectiveness in controlled work environments; however, when misused, its efficacy can fall below-recommended standards.¹² While adequate training and education are essential to ensure proper PPE use, achieving consistent adherence among agriculture producers is a significant challenge in safeguarding their well-being.

Limited data exist on PPE usage rates among U.S. agriculture producers, but studies indicate potentially low rates. Farmers in midwestern states had low PPE usage rates despite satisfactory availability. Notably, 78% rarely or never wore earmuffs in conditions requiring elevated vocal effort, and 72% rarely or never used earplugs. Chemical-related tasks saw frequent glove use but infrequent utilization of other PPE. A survey of midwestern farmers indicated a need for information regarding hazard sources, consequences, and proper PPE use.¹⁶ Factors contributing to lower PPE usage included a history of smoking and a diminished health assessment.¹⁷ A survey of California farmers revealed that, in dusty conditions, only 24.4% of producers used respiratory protection regularly, 22.8% used hearing protection in loud conditions, and 56.3% rarely or never used any hearing protection.¹⁸ Concerning gender and PPE use, a survey of women working in the dairy industry in Pennsylvania found infrequent use of PPE on a regular basis.¹⁹

Enhancing the effectiveness of interventions necessitates adaptation and a targeted educational focus on workers less inclined to use PPE. However, there needs to be more research on characteristics associated with PPE use among farmers and ranchers in the Midwestern region of the U.S. This study aimed to identify associations between demographic and farm characteristics with chemical, hearing, and respiratory PPE in Midwestern farmers. Data on PPE usage were collected from bi-annual surveillance surveys conducted by the Central States Center for Agricultural Safety and Health (CS-CASH) among agricultural producers in a seven-states region. The analysis explored relationships between worker age, gender, farm type, farm size, state of residence, and percentage of time working on the farm or ranch with the use of respiratory, hearing, and chemical PPE. Associations between PPE use and self-reported hearing loss, respiratory disease, and skin conditions were also explored. It was hypothesized that an association would be found between workers who self-reported lower rates of PPE use and higher rates of hearing loss, respiratory disease, and skin conditions.

The 2018 and 2020 combined FRHSS response rate was approximately 16%. The survey response varied by state with the highest rate of respondents located in Nebraska (22.4%), followed by Iowa (17.0%), South Dakota (14.3%), Minnesota (13.4%), North Dakota (11.6%), Kansas (11.5%), and Missouri (9.8%). Ten observations were removed from the analysis due to having PPE usage percentages above 100%. Respondent demographics and farm/ranch information are presented in Table 1. Among the 7,905 operators included in the final analysis dataset, 1,208 were female (15.3%), 6,611 (83.6%) were male, and 86 (1.1%) were missing gender information. The quartile age groups showed that over 75% of operators were older than 50. Less than 1% of responses were missing age. Most responses were from Nebraska (22.3%), followed by Iowa (17.0%), and South Dakota (14.3%). About 39.1% of farms or ranches had both grain and livestock raised. Only 7.3% of farms or ranches had only livestock. Most of the responses were from the primary occupation type of farm (76.2%). Over 75% of operators spent more than 50% working on farms or ranches.

PPE usage is shown in Table 1, with 6,417 (81.2%) operators indicating they used at least one type of PPE. Fewer than 50% of respondents used either hearing PPE or respiratory PPE. However, more than 61% of operators used chemical PPE. As the ages of the operators increased, their likelihood of using any PPE diminished. Figure 1 illustrates a crosstabulation of the farm or ranch, highlighting its products and presenting the percentage of PPE usage across the three types. Operators exclusively engaged in livestock operation on farms or ranches exhibited notably low usage of all three types of PPE. The usage of chemical PPE is highest among the three types. The utilization of hearing PPE and respiratory PPE varied based on the type of operations and the products being produced.

A multilevel multinomial logistic analysis of factors associated with PPE usage is shown in Table 2. Males were more significantly likely to use Chemical PPE OR = 1.26, 95% CI :1.08–1.47 and Respiratory PPE OR = 1.34, 95% CI: 1.18–1.52. Farmers (grain only) were more significantly likely to use chemical, hearing and respiratory PPE compared to livestock type of operations OR = 1.60, 95% CI: 1.19–2.15; OR = 1.51, 95% CI: 1.28–1.79; and OR = 2.16, 95% CI: 1.81–2.57 respectively. Similarly, those characterizing themselves as farmers were more likely to use chemical and respiratory PPE compared to ranchers, except for hearing PPE (chemical PPE OR = 1.26, 95% CI: 1.10–1.43; hearing PPE OR = 0.97, 95% CI: 0.81–1.17; respiratory PPE OR = 1.19, 95% CI: 0.99–1.44). Operators who spent less time working on farm or ranch were less likely to use PPE (50%–74%) percent work time group: chemical PPE OR = 1.52, 95% CI: 1.04–2.20; hearing PPE OR = 1.33, 95% CI: 1.06–1.65; respiratory PPE OR = 1.42, 95% CI: 1.13–1.79.

Producers were asked whether they had been diagnosed by a physician with respiratory disease, hearing loss, and skin disease. Results are shown in Table 3. Table 4 presents the multinomial logistic regression for self-reported skin disease, hearing loss, and respiratory disease. Medium usage of PPE resulted in 1.17 times the risk of respiratory disease (95% CI: 1.01–1.36) compared to those who reported high PPE use. However, the low PPE usage group showed a similar risk to those who reported high PPE use. Operators who spent 25%–49% of the time on the farm or ranch reported 1.41 times the risk of hearing loss (95% CI: 1.17–1.70) and 1.31 times the risk of respiratory disease (95% CI: 1.06–1.62

This study aimed to better understand the correlation between the use of PPE by agricultural workers in the Midwest U.S. and their personal demographics and farm/ranch status. Using surveillance and United States Department of Agriculture farm survey data from Midwestern farmers and ranchers, this study examined links between PPE use and age, gender, location (state), commodities raised, type of farm, and percentage of time working on the farm. In addition, associations between PPE use and self-reported skin disease, hearing loss, and respiratory disease were also examined.

This study contributes valuable insights into some of the determinants for PPE use by midwestern farmers and ranchers. Utilizing a substantial dataset from seven central U.S. states, this study shed light on potential factors linked to lower PPE usage among agricultural producers. Using data imputation in SAS enhanced the reliability of the results by addressing missing data issues. The study’s focus on previously underexplored aspects of PPE use in different farm types adds to the existing body of knowledge.

Previous research examining nonresponse bias in the Farm and Ranch Health and Safety Survey found there was scant evidence of nonresponse bias. Farm and ranch characteristics of operations responding to the mailed survey were similar to those not responding.³² Therefore, those who responded to the survey (16%) were deemed to be representative of the region’s farm and ranch operators. The finding that there was a greater response to the survey in Nebraska compared to the other six states was not surprising, as the survey originated from a well-known Nebraska institution. Name recognition of the surveyor can significantly add to the trustworthiness of a survey. People are generally more likely to trust and respond to surveys conducted by organizations or individuals they recognize and perceive as credible.

The findings are not broadly generalizable, as they are specific to the states included in the survey. Additionally, the cross-sectional design and reliance on self-reported data introduce constraints in establishing causal relationships and may be susceptible to recall bias. The analysis provides a snapshot based on data from two-time points, but a longitudinal approach would offer a more dynamic understanding of PPE usage trends over time. Future studies should aim to expand the temporal scope and include additional states for a more comprehensive assessment of PPE practices in agriculture. To better understand why some states report significantly lower PPE use, age and farm size variables should be factored in the future analysis examining state PPE usage. To assess the protective effects of PPE, a longitudinal analysis focusing on the incidence of injury rather than the prevalence would help clarify if there is reverse causality involved.

This analysis underscores the importance of understanding the nuanced factors influencing PPE usage among agricultural producers. There needs to be an emphasis on tailored training programs, outreach, and research into innovative PPE for older producers, females, livestock-oriented operations, and individuals with minimal time spent on the farm. Additional research is needed to refine these insights and comprehensively address the multifaceted dynamics of PPE usage in agriculture. Research should include longitudinal analyses and an expanded geographical scope. As the agricultural landscape undergoes continuous evolution, ongoing research and adaptive strategies remain indispensable for enhancing the effectiveness of safety measures and ensuring the well-being of those involved in this vital industry.