The purpose of this study was to determine regional differences within Utah in response to a pilot mobile respirator training and fit assessment program for agricultural workers. The objective was to describe the workers’ perceptions of respirator use and their training experiences.

The speed and success in implementing the OSHA respiratory protection standard requirements cannot be evaluated at present, but both the goal and challenge is to improve the health and safety of agricultural workers by reducing their exposure to pesticides. In summary, changes to the EPA’s WPS will require additional training to assist with compliance, especially for respirator standards. Continued efforts are necessary to advance programs that are judged by the level of information comprehension rather than just attendance. Participants will need to receive the training and demonstrate comprehension of the information.

This project was reviewed and approved by Utah State University (USU) Human Subjects IRB (Protocol No. 4819). An approved letter of information was provided to participants and reviewed with the principal investigator to provide details about the research program. The training program was piloted in two southern counties and two northern counties of Utah. The geographic region was established using Salt Lake City as the boundary line separating northern and southern counties. Participants were attendees of Utah State University Extension Pesticide Applicator workshops during 2013 and 2014. The training included information on OSHA respiratory standard compliance, including medical clearance and fit testing. The training was guided by frequently asked questions regarding respirators from pesticide applicators who had previously attended Extension trainings in Utah (table 1). These questions were developed from applicators’ inquiries to clarify recommendations provided by SDS and EPA-approved pesticide labels (Beard et al., 2014).

Additional training focused on hazard assessment, including the use of MSDS and pesticide labels. Proper selection using the NIOSH classification and labeling system was discussed and demonstrated. Training on respirator care and maintenance was presented at the conclusion of the workshop. Samples of various brands of N95 facemasks and elastomeric facemasks with P100 filters were provided for demonstrations of face-seal checks with agricultural producers. Agricultural employers and employees were instructed to review and complete the 3M medical clearance online questionnaire. Immediate results of this medical evaluation questionnaire were provided by a physician or other licensed healthcare professional. If an individual’s medical questionnaire needed further evaluation, a notification was sent, and fit testing did not proceed until clearance was provided by a physician or other licensed healthcare professional. Participants were asked to provide contact information to schedule a respirator fit test at a convenient location, either at a local USU Extension office or in a climate-controlled building at their worksite.

Data collection was conducted through use of a questionnaire following the training session. The questionnaire requested information about participants’ use of respirators, perceived barriers and facilitators of respirator use, as well as training and fitting experience. A portion of the questionnaire is provided in figure 1. Additional demographic data were gathered on contact information, age, gender, education, and production operation. Data were entered into SPSS (ver. 20).

Data analysis was completed to compare northern and southern counties. The state was divided into northern and southern regions based on a geographic reference line along Interstate 80. The justification for comparing northern and southern counties was based on the geographic and demographic characteristics of Utah. Counties located north of the Great Salt Lake are characterized by factors such as higher crop sales and higher population estimates within counties (USDA-NASS, 2012; U.S. Census Bureau, 2016). Northern counties are also closer to the main campus of Utah’s Land Grant Agricultural College and Extension service. Within Utah, there are variations of climatic features. Precipitation rates have been noted to range from less than 12.7 cm to 101.6 cm (WRCC, 2016). Areas of southern Utah below elevations of 1219.2 m (4,000 ft) typically receive less than 25.4 cm of moisture annually, while northwestern areas of Utah at higher elevations receive more perception due to normal storm tracks (WRCC, 2016). Additionally, lower air quality con-ditions, in the form of smoke and haze accumulations, are experienced due to anticyclones settling over Utah for extended periods of time (WRCC, 2016).

We hypothesized that the northern counties would have greater experience with respirator training due to their location and the higher number of crop production operations in the region. Crop production operations would be more familiar with EPA worker protection standards. Individuals in northern counties with more respirator training experience as well as higher respirator use would have a greater perceived value of respirators.

Descriptive statistics including frequencies and percentages were used to summarize the quantitative data. The chi-square test of association was used to test for differences between participants in the northern and southern counties on the nominal dependent variable and previous respirator training experience (yes or no). Using the effect size descriptors proposed by Rea and Parker (1992, p. 203), the magnitude of the phi coefficient was used to indicate the level of association between variables. Fisher’s exact test was used for analyses with expected cell counts of less than 5. An alpha level of 0.05 was set a priori for all tests for significance. Written responses from participants were open-coded by the principal investigator.

The majority of participants were male (95.7%, f = 112, n = 117). There were 24 individuals who did not respond to the question regarding gender identification. There were four individuals from the southern counties who identified as female, and only one individual from the northern counties who identified as female. The average age of participants in the northern counties was 51.6 (SD = 16.46), while the average age of participants in the southern counties was 48.1 (SD = 14.4). Overall, the average age of participants responding to the questionnaire was 50 (SD = 15.5). The difference in participant age between northern and southern counties was not statistically significant (t = 1.132(116), p = 0.260). A total of 100 (70.9%) participants from northern counties and 41 participants from southern counties (29.1%) completed the questionnaire. A total of 232 individuals attended the presentations in the two northern counties. The response rate for the northern counties was 43.1%. A total of 101 individuals attended the presentations in the two southern counties. The response rate for the southern counties was 39.8%.

Participants were asked to indicate their primary occupation using an open response. The open responses were coded as production agriculture (e.g., farmer), agriculture support industry (e.g., custom sprayer operator), or non-agriculture (e.g., city maintenance worker). The highest proportion (59.0%, f = 46) of participants from northern counties indicated production agriculture as their primary occupation. The highest proportion (50.0%, f = 18) of participants from southern counties indicated non-agricultural primary occupations. The differences in primary occupation between regions was statistically significant (x² = 16.754, df = 2, p = 0.000, Φ = 0.383). There were no cells with expected counts less than 5. There were 22 individuals from northern counties and five individuals from southern counties who chose not to answer the question.

Table 2 provides comparisons between northern and southern counties on education level. A total of 57 individuals from northern counties (72.2%) had attained a two-year college degree or higher. There were 28 participants from southern counties (73.7%) who had attained a two-year college degree or higher.

All participants were asked to indicate their perceptions of having to use a respirator during agricultural work using a 7-point Likert scale ranging from extremely burdensome to extremely helpful. Table 3 provides a comparison of the distribution of responses from the northern and southern counties. There were 20 participants (48.8%) from southern counties who perceived that respirators were slightly helpful to extremely helpful. A total of 60 participants (61.9%) from northern counties perceived that respirators were slightly helpful to extremely helpful. The combined majority (57.9%, f = 80) of all participants indicated that wearing a respirator during agricultural work was slightly helpful to extremely helpful.

All participants were asked to indicate if wearing a respirator while working was pleasant using a 7-point Likert scale. Table 4 provides a comparison of the frequency and distribution of responses from northern and southern counties. A total of 37 participants from northern counties (44.1%) indicated that wearing a respirator while working was slightly unpleasant to extremely unpleasant. There were 21 individuals from southern counties (52.5%) who indicated that wearing a respirator while working was slightly unpleasant to extremely unpleasant. A combined total of 58 respondents (46.7%) indicated that wearing a respirator while working was slightly unpleasant to extremely unpleasant. Participants were asked to provide written comments on what they believed were the advantages and disadvantages of using a respirator during agricultural work. The advantages commonly stated by the participants focused on clean air, health protection, prolonged lung function, reduced likelihood of chronic and acute exposure, and safety. Disadvantages commonly stated by the participants focused on comfort, convenience, and vision obstruction. Several comments indicated that respirators were in the way or caused the participant to get hot when working. Other comments indicated that respirators took extra time and were cumbersome to wear.

Participants were asked to indicate if they agreed that they wear a respirator while working in dusty conditions using a 7-point Likert scale (strongly disagree to strongly agree). Table 5 provides a comparison of the distribution and frequencies of responses between northern and southern counties on participants’ agreement that they wear a respirator while working in dusty conditions. The responses were collapsed into three categories (agree, neutral, or disagree) for chi-square analysis. Responses were classified “agree” if the participants indicated either slightly agree, agree, or strongly agree. Responses were classified as “disagree” if the participants indicated slightly disagree, disagree, or strongly disagree. There were 72 (72%) participants from northern counties who agreed that they wear a respirator while working in dusty conditions and 25 (61%) participants from southern counties who agreed that they wear a respirator while working in dusty conditions. The difference between northern and southern counties was not statistically significant (x² = 2.140, df = 2, p = 0.343, Φ = 0.124). There were no cells with expected counts less than 5.

Participants were asked to indicate if they had received previous respirator training prior to the workshop. Table 6 shows a comparison between northern and southern counties on previous training experience. The proportion of participants from northern counties who had respirator training experience was 43.0% (f = 43). For southern counties, 25 participants (61.0%) had previous respirator training experience. Although a higher proportion of participants from southern counties had previous respirator training experience, this was not a statistically significant difference (x² = 3.763, df = 1, p = 0.05, Φ = 0.163). There were no cells with expected counts less than 5.

Participants were asked if they had been fit-tested for a respirator prior to the workshop. Table 7 provides the frequency and distribution comparison between northern and southern counties on fit testing experience. A higher proportion of participants from southern counties (53.7%, f = 22) had completed a respirator fit test than the proportion for participants from northern counties (34.0%, f = 34). This difference was statistically significant (x² = 4.694, df = 1, p = 0.030, Φ = 0.182). There were no cells with expected counts less than 5.

For the question regarding respondents’ perception that wearing a respirator during agricultural work was burdensome or helpful, the 7-point Likert scale ranging from extremely burdensome to extremely helpful was collapsed into three categories (burdensome, neutral, or helpful). Chi-square analysis was performed to compare the differences between respondents who had received prior respirator training and those who had not. There were 40 individuals (59.7%) with prior respirator training who indicated that wearing a respirator was helpful and 18 individuals (26.9%) with prior respirator training who indicated that wearing a respirator was burdensome. There were 40 individuals (56.3%) without prior training who indicated that wearing a respirator was helpful, while 18 individuals (25.4%) without prior training indicated that wearing a respirator was burdensome. The difference between individuals with prior training and those without prior training was not statically significant (x² = 0.612, df = 2, p = 0.736, Φ = 0.067). There were no cells with expected counts less than 5.

For the question regarding respondents’ perception that using a respirator during agricultural work was unpleasant or pleasant, the 7-point Likert scale ranging from extremely unpleasant to extremely pleasant was collapsed into three categories (unpleasant, neutral, or pleasant). Chi-square analysis was performed to compare the differences between respondents who had received prior respirator training and those who had not. There were 24 individuals (40.0%) with prior training who indicated that using a respirator was unpleasant and 17 individuals (28.3%) with prior training who indicated that using a respirator was pleasant. There were 34 individuals (53.1%) without prior training who indicated that using a respirator was unpleasant and 19 individuals (29.7%) without prior training who indicated that using a respirator was pleasant. The difference between individuals with prior training and those without prior training was not statically significant (x² = 0.308, df = 2, p = 0.579, Φ = 0.057). There were no cells with expected counts less than 5.

For the question regarding respondents’ expectation to wear a respirator in dusty conditions, chi-square analysis was performed to compare differences between respondents who had received prior training and those who had not received prior training. There were 51 individuals (75.0%) with prior training who agreed that they expected to wear a respirator in dusty conditions and 10 individuals (10.3%) with prior training who disagreed that they expected to wear a respirator in dusty conditions. There were 46 individuals (64.8%) without prior training who agreed that they expected to wear a respirator in dusty conditions and 11 individuals (15.5%) without prior training who disagreed that they expected to wear a respirator in dusty conditions. The difference between individuals with prior training and those without prior training was not statically significant (x² = 2.575, df = 2, p = 0.276, Φ = 0.136). There were no cells with expected counts less than 5.

We acknowledge the limited response rate from the training participants. Caution should be used when generalizing the results of this study to other populations.

Based on the findings that participants from southern counties had a significantly higher rate of experience with respirator fit testing (x² = 4.694, df = 1, p = 0.030, Φ = 0.182) and a higher proportion of previous respirator training experience, approaching a statistically significant difference (x² = 3.763, df = 1, p = 0.05, Φ = 0.163), we rejected the hypothesis that participants from northern counties would have greater experience with respirator training due to their location within the state of Utah and the higher number of crop production operations in the area. We offer an alternative hypothesis that the differences in respirator fit testing and training experience are due to the respondents’ primary occupations. A higher proportion of participants from southern counties indicated a non-agricultural primary occupation (x² = 16.754, df = 2, p = 0.000, Φ = 0.383). Non-agricultural industries have greater regulatory control for protecting workers. OSHA has limited regulatory authority over production agriculture; therefore, participants from northern counties would have less experience with respirator fit testing and training. The following conclusions were drawn from the results of this study:

There was a significant difference between northern and southern counties in the percentage of participants who had received respirator fit testing. Although not statistically significant, a higher proportion of individuals with prior training rated the use of respirators as pleasant. These training experiences are helpful for individuals by identifying respirators that provide a greater level of comfort.

Respirators are one of the most specialized pieces of personal protection equipment, and they require an appropriate level of knowledge for effective use. Appropriate training on when to use and how to adjust a respirator may address concerns that respirators are inconvenient. Fewer participants from southern counties indicated having prior training or fit testing. It will be important for participants to understand the health implications of using respirators without proper fit testing. Attempts should be made to complete follow-ups with participants to determine if any changes in perceptions, behavior intentions, or respirator knowledge have occurred. A high priority for these participants will be identifying comfortable respirator options. Ensuring the health benefits associated with respirators should be maximized when agricultural workers know how to appropriately select a respirator type, identify face-seal leaks due to poor respirator fit, and perform appropriate maintenance (Lee et al., 2005; Sprince et al., 2000).