Occupational Injuries among Latino/a Immigrant Cattle Feedyard Workers in the Central States Region of the United States

Agriculture is a dangerous industry with high rates of occupational injuries. Immigrants comprise the majority of the hired agricultural workforce in the United States, and these workers may be at a higher risk for job-related injuries. This study addressed the frequency, characteristics, and risk factors of occupational injuries among Latino immigrant cattle feedyard workers. Data were collected through structured interviews with Latino immigrant cattle feedyard workers in Kansas and Nebraska (n = 243; 90.9% male). Descriptive statistics and logistic regression were used to identify risk factors for injury. Nearly three-fourths of participants (71.2%) reported having experienced one or more injuries in the past while working on a cattle feedyard. The most frequent types of reported injuries, including those not requiring medical care, were bruises/contusions (40%), cuts/lacerations (21%), and sprains/strains (12%). These injuries were mainly caused by animals/livestock (33%), chemicals (23%), falls (12%), and tools (9%). Significant risk factors for injury included male gender (OR 5.9), being over age 35 (OR 2.6), working on a large or an extra-large feedyard (OR 5.4), having 11 or more employees on the feedyard (OR 3.6), and working more than eight hours a day (OR 4.7). Having received safety training was also associated with greater risk of injury in a univariable model (OR 2.6). Cattle feedyard workers are at high risk for injury and require more effective preventive measures.


Introduction
Agriculture is a dangerous industry with high rates of occupational injuries, illnesses, and deaths reported in statistics and studies worldwide [1,2]. Agriculture is often considered a 3-D industry, one that is dangerous, demanding, and dirty. The United States (U.S.) Bureau of Labor Statistics (BLS) annual reports indicate that agriculture has had the highest rates of injuries of any major industry sector in the U.S. over the past two decades. In 2019, the incidence of fatal injuries was 23.1 injuries per 100,000 full-time equivalent (FTE) workers in agriculture compared to 3.5 per 100,000 in all other industries combined [3]. The rate of non-fatal injuries was 5.2 injuries per 100 FTE workers in agriculture and 2.8 per 100 in all other industries combined [4]. Specific subsectors of agriculture, including beef cattle production, had even higher injury rates.
Cattle feedyards are part of the beef production cycle in the U.S. A feedyard is a physical space where beef cattle typically spend between three and six months, and where they are fed a specific ration of grains and other nutrients to help them gain weight, thereby adding muscle and fat [5]. Most cattle feedyards are small operations having less than 1000 head of cattle; however, the large feedyards, representing just 7% of the industry,

Materials and Methods
This article describes injuries reported by participants in the "Health and Safety among Immigrant Cattle Feedyard Workers in the Central States Region" study, conducted between May 2017-February 2020 as part of the Central States Center for Agricultural Safety and Health (CS-CASH) and funded by Centers for Disease Control and Prevention and the National Institute for Occupational Safety and Health (NIOSH).

Participants
To be eligible to participate in this study, individuals had to be at least the age of majority in the state where the data were collected (i.e., Kansas ≥ 18 or Nebraska ≥ 19), identify as a Hispanic/Latino immigrant, and be currently employed on a cattle feedyard in either Kansas or Nebraska. Given the total feedyard employment in the two states of 5990 [7], it was estimated that there were approximately 3115 immigrant workers who would be eligible to participate in the study. A total of 264 workers were actively invited to participate in the study, and 243 workers participated, resulting in a 92% response rate.

Procedures
Latino/a cattle immigrant feedyard workers were recruited to participate in the study through multiple mechanisms including word-of-mouth, flyers posted in community locations, Facebook advertising, and through employers. There were three bilingual and bicultural field research team members who had many years of experience working with immigrant farmworkers who also recruited participants through their social networks in agriculture and ranching as well as through connections with community organizations using a snowball sampling technique. Members of the field research team visited counties with high numbers of feedyard employees to meet with community organizations who assisted in identifying both workers and the locations that workers frequent.
A total of seven members of the field research team (two men and five women) conducted interviews with workers; however, the majority of the interviews (n = 223) were conducted by two male members of the team. Team members were trained on techniques to build trust, reduce bias, and ensure the participants' understanding of the questions. Interviews were scheduled with workers who met the inclusion criteria in an agreed upon location after working hours (i.e., participants' homes, public library, or restaurant) except for 20 interviews, which were facilitated by employers at the jobsite during working hours. A bilingual and bicultural member of the field research team would travel to conduct each interview face-to-face with the workers, and informed consent was obtained from each participant prior to beginning the research interview. Interviews used a structured questionnaire that explored several health outcomes and contributing factors using questions from validated instruments. It addressed the occupational context; prevention opportunities; physical health; stress, emotional health, and social well-being; and demographics. All study materials were available in English and Spanish, and the workers could participate in the language of their choice. Interviews took approximately 75 min, and a $25 or $30 gift card was given to all participants who completed the interview. Compensation to participants was increased during the study to improve recruitment. The study was approved and considered exempt by the Institutional Review Board at the University of Nebraska Medical Center.

Injury Outcome and Descriptors
The present analysis is derived from questions within the occupational context, prevention opportunities, and demographic sections of the questionnaire. To identify injury occurrences, respondents were asked, "Have you ever been injured at work on a cattle feedlot?" If participants responded "no", a follow-up question was asked, "Are you sure you have never cut, bruised, or hurt your back at work? Even if you did not go to a doctor, these are still considered injuries." If participants responded that they had been injured at work on a cattle feedlot then additional questions were asked to describe the injuries that they had experienced. These questions included the date of the injury, the type of injury, the body part that was injured, the cause of the injury, a description of tasks that the worker was engaged in when the injury occurred, the severity of pain or discomfort from the injury, whether first aid was used or medical care was sought out, lost time related to the injury, and if the injury was reported to their employer. Further, respondents could report if they had a second and third injury, with the same follow-up questions. Information from the three repeated injury question sets were stacked for each respondent. Thus, the injury outcome counted for regression modeling could have a value of 0 (no injuries), 1, 2, or 3 injuries.

Potential Contributing Factors to Injury
The potential predictors for injury were also derived the occupational context, prevention opportunities, and demographic sections of the questionnaire. Injury predictors are described in more detail below.
Sex was recorded as male or female, recognizing that few in this worker population are female. Worker age was recorded as a continuous variable (in years) and dichotomized into over age 35 and 35 or under for the present analyses. English proficiency was assessed, and the four response options were dichotomized into "not at all" and "a little" (limited English proficient) and "somewhat" and "well" (English proficient). The number of hours worked on average per day and the number of days worked on average per week were recorded as continuous variables.
Workers were asked how many cattle were on the feedyard. Based off of their response, the feedyard size was categorized as small (less than 1,000 head of cattle), medium (between 1,000-7,999 head of cattle), large (8,000-32,000 head of cattle), or extra-large (over 32,000 head of cattle) [18]. Participants were asked about the type of work they did at the feedyard (e.g., cowboy/pen rider, processing, mill, feed delivery, equipment and yard maintenance, etc.). They were asked whether they had received work-related training and if so, what type of training had been provided (e.g., in-person training, video, written materials, etc.). They were also asked whether they received any personal protective equipment (PPE) needed for their job from their employer, and if so, what specific types of PPE were provided. Finally, workers were asked about the number of other workers on the feedyard. Although this was recorded as a continuous variable, it was later dichotomized into 11 or more workers or 10 or less workers. This distinction is important because farms that employ 11 or more people may be subject to the enforcement of Occupational Safety and Health Act (OSH Act) standards [19].

Demographic Characteristics
Additional demographic characteristics of participants were recorded, including country of origin, length of time in the U.S. (in years), formal education completion (i.e., elementary, high school, college, etc.), current location (i.e., Kansas or Nebraska), and tenure in agriculture, feedyard work, and with their current employer (in years).

Data Analysis
All data were analyzed using SPSS Version 25 (IBM Corp., Armonk, NY, USA). Descriptive data on injuries were categorized and tabulated. Distributions of potential predictor variables were tabulated for respondents reporting 0, 1, 2, and 3 injuries. Through crosstab statistics in SPSS, odds ratios (OR) and their respective 95% confidence intervals (CI) were calculated. Variables with multiple categories were dichotomized for risk factor analysis. Unadjusted (crude) ORs were calculated to identify risk factors for injury. Predictors that were significant at the p < 0.05 level were entered into multivariable analysis, and the final model was constructed using the stepwise (forward) selection process.

Results
Of the total of 243 feedyard workers who participated in the study, over 60% were working in Nebraska and the remainder were working in Kansas. Most participants (90.9%) were male, and most were from Mexico, followed by Guatemala, and El Salvador.
Most participants (62%) performed work tasks associated with two or more feedyard departments such as processing, cowboy/pen riding, yard and equipment maintenance, feed delivery, feed milling, hospital pen, or administration and security. Further, 23.1% of the participants worked tasks in five or more departments (Figure 1). More than one in four workers (26.3%) had not received any type of safety training while 59.6% had received up to three types of safety training (e.g., in-person training, videos, shadowing another worker, hands-on training, and written materials) ( Figure 2). Only a few workers (6.2%) had not been provided with any PPE, while nearly one-third (32.9%) had access to five or more types of PPE (e.g., sun protection/sunscreen, sunglasses, gloves, long sleeve shirt, long pants, boots, hearing protection, and face mask).
scriptive data on injuries were categorized and tabulated. Distributions of potential predictor variables were tabulated for respondents reporting 0, 1, 2, and 3 injuries. Through crosstab statistics in SPSS, odds ratios (OR) and their respective 95% confidence intervals (CI) were calculated. Variables with multiple categories were dichotomized for risk factor analysis. Unadjusted (crude) ORs were calculated to identify risk factors for injury. Predictors that were significant at the p <.05 level were entered into multivariable analysis, and the final model was constructed using the stepwise (forward) selection process.

Results
Of the total of 243 feedyard workers who participated in the study, over 60% were working in Nebraska and the remainder were working in Kansas. Most participants (90.9%) were male, and most were from Mexico, followed by Guatemala, and El Salvador.
Most participants (62%) performed work tasks associated with two or more feedyard departments such as processing, cowboy/pen riding, yard and equipment maintenance, feed delivery, feed milling, hospital pen, or administration and security. Further, 23.1% of the participants worked tasks in five or more departments (Figure 1). More than one in four workers (26.3%) had not received any type of safety training while 59.6% had received up to three types of safety training (e.g., in-person training, videos, shadowing another worker, hands-on training, and written materials) (Figure 2). Only a few workers (6.2%) had not been provided with any PPE, while nearly one-third (32.9%) had access to five or more types of PPE (e.g., sun protection/sunscreen, sunglasses, gloves, long sleeve shirt, long pants, boots, hearing protection, and face mask).   All data were analyzed using SPSS Version 25 (IBM Corp., Armonk, NY, USA). Descriptive data on injuries were categorized and tabulated. Distributions of potential predictor variables were tabulated for respondents reporting 0, 1, 2, and 3 injuries. Through crosstab statistics in SPSS, odds ratios (OR) and their respective 95% confidence intervals (CI) were calculated. Variables with multiple categories were dichotomized for risk factor analysis. Unadjusted (crude) ORs were calculated to identify risk factors for injury. Predictors that were significant at the p <.05 level were entered into multivariable analysis, and the final model was constructed using the stepwise (forward) selection process.

Results
Of the total of 243 feedyard workers who participated in the study, over 60% were working in Nebraska and the remainder were working in Kansas. Most participants (90.9%) were male, and most were from Mexico, followed by Guatemala, and El Salvador.
Most participants (62%) performed work tasks associated with two or more feedyard departments such as processing, cowboy/pen riding, yard and equipment maintenance, feed delivery, feed milling, hospital pen, or administration and security. Further, 23.1% of the participants worked tasks in five or more departments (Figure 1). More than one in four workers (26.3%) had not received any type of safety training while 59.6% had received up to three types of safety training (e.g., in-person training, videos, shadowing another worker, hands-on training, and written materials) (Figure 2). Only a few workers (6.2%) had not been provided with any PPE, while nearly one-third (32.9%) had access to five or more types of PPE (e.g., sun protection/sunscreen, sunglasses, gloves, long sleeve shirt, long pants, boots, hearing protection, and face mask).    Table 1 shows the frequency of reported occupational injuries (range: 0 (none) to 3 injuries) among feedyard workers by their demographic characteristics. Overall, the proportion of workers with one or more injuries was high (71.2%). A higher proportion of male workers (75.6%) had injuries compared to female workers (27.3%). Injuries were more frequently reported by workers older than 35 years (80%) compared to younger workers (61.1%). The injury distributions were similar for workers from Mexico and Guatemala, while the numbers of workers from other countries were small. Those speaking English 'well' had a lower incidence of injuries (56.5%) compared to less proficient English speakers. Education did not make a clear difference in the distribution of injuries. Over 70% of the participants had been in the U.S. for more than 5 years, but the majority of participants had five years or less of work experience in the cattle feedyard sector (61.8%) and at their current feedyard employer (85.4%). Generally, the proportion of participants ever having an injury in feedyard work increased with the duration of employment in agriculture and feedyard work (Table 1).  Table 2. The most frequent types of reported injuries were bruises and contusions (40%), cuts/lacerations (21%), and muscle sprains or strains (12%), which together represented nearly three quarters of the injuries. Injuries were most commonly to the legs/knees/hips (23%), fingers (22%), and hands/wrists (14%). Animals/livestock (33%), tools/equipment (23%), and falls (12%) were the top three causes of injury (Table 2). Regression analysis of risk factors for injury (Table 3) showed that male workers had much greater adjusted odds (ORa) of being injured (ORa 5.86) compared to female workers. Workers aged 35 years and older had a higher likelihood of injury compared to younger workers (ORa 2.55). Workers on large to extra-large size feedyards had greater odds of being injured (ORa 5.39), compared to small to medium size feedyards. The risk of injury was greater on feedyards with 11 or more employees (ORa 3.56), compared to operations with fewer workers. The risk of injury was greater among participants who worked more than five days a week (vs. fewer days) (ORc 4.58) and among those working eight hours or more per day (vs. fewer hours) (ORa 4.73). Safety training had an adverse association with injury in crude analysis (ORc 2.64). When predictors that were significant in crude analyses at the p < 0.05 level were entered into multivariable analysis, the covariates including sex, age, feedyard size, employee count, and work hours per day were significant at the p < 0.05 level. English proficiency, number of different jobs performed on the feedyard, and provision of PPE had no significant association with injury. The "-" denotes that there was no significant effect at p < 0.05 level. ORc: Crude Odds Ratio. ORa: Adjusted Odds Ratio.

Discussion
This study explored the frequency, characteristics, and risk factors of injuries among Latino/a immigrant cattle feedyard workers in the Central States region of the United States. We found that a high percentage of workers (71.2%) reported being injured while working at a feedyard. Few studies have reported injury rates for immigrant workers in agriculture. One study reported 7.9-11.7 injuries per 100 full-time equivalent (FTE) workers among New York and Maine migrant and seasonal farmworkers [20]. In our study, feedyard work experience varied and ranged from less than a year to more than 25 years, and we could not construct similar FTE-based injury rate estimates retrospectively. In a retrospective analysis of insurance records, 52.9% of Finnish farmers had been injured during their work time, which ranged up to 26 years [21]. Reported injury rates among self-employed farmers have varied greatly, ranging from 0.5-42 injuries per 100 farmers a year [22,23]. Recent national statistics on work-related injuries highlight that the beef cattle industry (including feedyards) has nearly double the number of injuries compared to the "all industries" rate (5.3 injuries/100 FTE vs. 2.8/100 FTE in 2019) [4], and this study clearly demonstrates that there are a significant number of injuries in this line of work. Similar to earlier studies of agricultural injuries, the most frequently reported injuries in our study were bruises, cuts, and muscle strains and sprains. The main causes of these injuries included livestock handling, chemicals, falls, and tools.
Previous studies have identified reasons why immigrant workers are vulnerable and at increased risk of illness and injury at work. These concerns include limited host country language proficiency, low literacy, limited formal education completion and job-related training, immigration legal status, risk perceptions, stress, economic challenges and a need to maximize work hours and earnings, limited knowledge of work-related rights, difficult manual labor, working with animals, precarious living conditions, limited access to medical care, and lack of enforcement of safety regulations in agriculture [24][25][26][27][28]. Significant risk factors for injury in our study included male gender, being over age 35, working on a large or extra-large feedyard, having 11 or more employees on the feedyard, and working more than eight hours a day. A systematic review of risk factors for agricultural injury also found male gender, a higher number of workers, and a larger farm size were among risk factors for injury while the association of injury with age and safety training were inconclusive from the results of several studies [29,30]. The association of work time, in hours per day or days per week, has not been well established in agriculture, likely due to the complexities of enumerating working hours for self-employed farmers. However, a recent study of agricultural machine operators in Italy found that work hours were positively associated with unsafe behaviors, leading to near misses, and ultimately, safety incidents [31]. Feedyard employers should consider hiring sufficient workers to be able to meet operational needs so that working beyond a standard shift is not a necessity or a consistent expectation.
Stronger oversight into daily operating procedures on the feedyard is needed. Feedyard employers could ensure greater enforcement of safety protocols and promote safety coaching between supervisors and workers. Regulatory bodies such as the Occupational Safety and Health Administration (OSHA) have a responsibility to enforce and promote worker safety. OSHA has tools, such as the local emphasis program, which is intended to address industries and hazards that pose risks to workers' safety and health. It uses outreach to industry leaders and employers as well as unannounced inspections to promote and enforce compliance with safety regulations [32]. This program has been used with the dairy industry and focused on the "dairy dozen" (i.e., 12 common dairy safety concerns) [33]. If injury rates in the cattle feedyard sector do not decrease, it is possible that OSHA could establish a local emphasis program focused on feedyards that do not meet the small farm exemption.
Although this study did not address the history of prior injury or sleep deprivation, these may be additional risk factors for occupational injuries. Numerous studies and systematic reviews have reported on the negative effects of fatigue, shift work, and sleep deprivation [34][35][36]. Daily sleep and weekly working hours have been established as risk factors for injury in many studies, including the U.S. National Health Interview Survey [37], and recently, NIOSH established the Center for Work and Fatigue Research to expand the understanding of sources of fatigue such as physically and mentally demanding work, comorbidities, and environmental concerns [38]. Future research should explore the impact of fatigue and non-standard work on reported agricultural injuries and near misses.
Counter-intuitively, we found that having received safety training was associated with more reports of injuries. However, earlier studies have shown conflicting results as well [29,39]. Safety training focused on increasing knowledge may not be sufficient to bring about changes to behaviors [40]. A systematic review of interventions to prevent injuries in agriculture found no significant effect from educational interventions [41]. The authors speculated that educational interventions such as training may not be strong enough to bring about change unless combined with other behavioral incentives such as financial benefits or legislative requirements. Further, educational intervention trials may suffer from biases favoring control due to non-blinded designs, leaking of educational intervention, and better awareness and willingness to report outcomes among intervention subjects. In our study, it is possible that having received training sensitized workers to be able to recognize and report injuries. Such recognition and reporting may be beneficial to the feedyard industry, as it could lead to a greater understanding of the common conditions and risks experienced by workers, which may result in stronger, more relevant preventive actions over the long term. In our study, this counterintuitive finding of safety training being associated with more injuries may also have been the result of a reactionary approach to safety, including training, where safety measures were implemented after injury incidents had already occurred. Regardless, occupational safety and health training should be provided to all workers at the time of hire and at regular intervals during employment [42]. Training should incorporate best practices for fostering adult learning through engaging, participatory, culturally, and linguistically relevant approaches [43][44][45][46]. Training may also have an added spillover benefit of reducing occupational stress, another potential risk factor for injury [47].
Immigrant farmworkers are a growing worker segment, particularly in animal agriculture, but there is limited data on this population. Published government statistics from the Bureau of Labor Statistics on occupational injuries are likely undercounts [17,48,49]. A recent study conducted by RAND concluded that developing definitions of populations at risk for occupational exposure and profiling them by agricultural commodity, demographic factors, work organization patterns, and worksite tasks should be prioritized [50]. Additional studies are needed to more fully understand occupational risks, injuries, and potential preventive measures across the agricultural industry, but especially among immigrant farmworkers engaged in livestock production.

Strengths and Limitations
This is one of the few studies that has explored injuries among immigrant livestock production workers in the U.S.; however, there are some limitations to note, including the cross-sectional design, the reliance on self-reports of injury over a long period of time, the selection of potential risk factors, and the limited sample of only Latino immigrant workers in one part of the United States. This study represents a snapshot in time, and causality cannot be determined. Workers may have experienced recall decay, whereby injuries or training sessions further in the past were more likely to be forgotten or underreported; however, our data were based on a series of questions, thereby limiting the possibility of bias. Although our interviewers probed for job-related injuries, it is possible that workers underreported injuries that they had experienced due to self-presentation bias as well. Latino immigrant workers may face differential working conditions compared to other workers based on language and cultural differences as well as immigration legal status, thereby positioning them to work in more dangerous conditions or to complete more risky tasks. Additional studies are needed to understand the influence of these factors on jobrelated injuries in the cattle feeding industry. Moreover, it is possible that the experiences of Latino immigrant workers in other parts of the U.S., those working in other commodities, and non-Latino workers may differ. Future studies should include objective measures of injury such as those from workers' compensation claims and OSHA 300 logs [51], conduct onsite observations or use ethnographic approaches to understand injuries and near misses, explore injuries among the greater feedyard workforce, and use longitudinal designs to better understand the influence of training on injury rates and reporting.

Conclusions
Cattle feedyard work can be dangerous, and the proportion of immigrant feedyard workers reporting injuries at work was exceptionally high compared to previous studies and official published injury statistics. Significant risk factors for injury included male gender, being over age 35, working on a large or extra-large feedyard, having 11 or more employees on the feedyard, and working more than eight hours a day. Because feedyard workers are at a high risk of injury, more effective preventive measures including providing engaging, participatory, culturally, and linguistically appropriate training, greater enforcement of safety protocols, and safety coaching implemented as part of a broader approach to enhance safety culture on feedyards, are needed in addition to ensuring appropriate staffing to meet operational needs. Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.

Data Availability Statement:
The data presented in this study are available on request from the corresponding author.