Susan Brumby

Background: Farmers have an elevated risk of melanoma and non‐melanoma skin cancer due to their occupational exposure to high levels of ultraviolet radiation. The sun protective behaviours of farmers are poorly understood, limiting targeted interventions to this at‐risk population. Objectives: This study aimed to characterise sun protective behaviours among Victorian farmers and to assess whether demographic factors were associated with variations in sun protection uptake. Method: A cross‐sectional study of 124 Victorian farmers was completed using Health and Lifestyle Assessment data collected by the National Centre for Farmer Health. Associations between sun protective behaviours (sunscreen, sunglasses, long sleeve shirt, long trousers, broad brim hat) and demographic factors (gender, age group, rurality) were investigated with descriptive statistics and ordinal logistic regression. Results: Age group was significantly associated with sunscreen use ( p = 0.035). Participants aged 65 years and over were most likely to never use sunscreen, while those aged 50–64 years were most likely to always use it. No significant associations were found between gender or rurality and any sun protective behaviour. Overall, use of sun protection was suboptimal across all demographic groups. Conclusion: These findings suggest that Victorian farmers over 65 years of age may benefit from targeted public health messaging and education from primary care physicians and dermatologists. Further research is required to validate these results given the small sample size. A focus group of at‐risk farmers as identified in this study may be valuable to identify interventions that could increase the sun protective behaviours of Australian farmers.

The mental health of people living in farming communities has been identified as an important public health issue. Cumulative exposure to a range of situational factors contributes to heightened risk of poor mental health and suicide. Access to evidence-based psychological treatments is limited by the availability of skilled mental health professionals. The aim of this trial—co-designed by members of the farming community—is to establish the feasibility of conducting randomised controlled, trial-testing, peer-worker-delivered Behavioural Activation in the farming community. We will undertake a single-blind, parallel group, randomised controlled feasibility trial in rural Australia. People living in farming communities aged over 15 years and experiencing moderate to moderately severe depression symptoms will be included in the trial. Participants will be randomly allocated on a 1:1 ratio to 10 sessions of peer-worker-delivered behavioural activation (Back-on-Track) or a self-help workbook (Managing Stress on the Farm). Peer workers are members of the farming community that have completed training in behavioural activation and demonstrated competence. Feasibility outcomes include establishing recruitment rates, willingness to be randomised, dropout rate from trial, acceptability of peer delivered behavioural activation, and willingness to complete trial measures. The trial will contribute high quality evidence of the feasibility of undertaking a full-scale, randomised controlled trial of peer-delivered Behavioural Activation in farming communities in rural Australia.

Introduction: Farm workers are at high risk for injuries, and epidemiological data are needed to plan resource allocation.Objective: This study identified regions with high farm‐related injury rates in the Barwon South West region of Victoria, Australia, for residents aged ≥50 yr.Design: Retrospective synthesis using electronic medical records of emergency presentations occurring during 2017–2019 inclusive for Local Government Areas (LGA) in the study region. For each LGA, age‐standardised incidence rates (per 1000 population/year) were calculated.Findings: For men and women combined, there were 31 218 emergency presentations for any injury, and 1150 (3.68%) of these were farm‐related. The overall age‐standardised rate for farm‐related injury presentations was 2.6 (95% CI 2.4–2.7); men had a higher rate than women (4.1, 95% CI 3.9–4.4 versus 1.2, 95% CI 1.0–1.3, respectively). For individual LGAs, the highest rates of farm‐related emergency presentations occurred in Moyne and Southern Grampians, both rural LGAs. Approximately two‐thirds of farm‐related injuries occurred during work activities (65.0%), and most individuals arrived at the hospital by transport classified as “other” (including private car, 83.3%). There were also several common injury causes identified: “other animal related injury” (20.2%), “cutting, piercing object” (19.5%), “fall ⟨1 m” (13.1%), and “struck by or collision with object” (12.5%). Few injuries were caused by machinery (1.7%) and these occurred mainly in the LGA of Moyne (65%).Discussion and Conclusion: This study provides data to inform future research and resource allocation for the prevention of farm‐related injuries.

IntroductionFarmers face a range of factors that negatively influence their mental health and suicide risk, yet have limited access to appropriate support. Behavioural activation (BA) is an evidence-based therapy that can be effectively delivered by nonclinical workers. Working with members of farming communities to deliver BA to their peers has the potential to overcome many well-established barriers to mental health help-seeking and improve outcomes for this at-risk group. ObjectiveThis paper describes the findings of a co-design phase informing the development of a peer (farmer)-led approach for delivering BA for farmers living with depression or low mood. DesignThis qualitative study used a co-design approach involving members of the target community. Focus groups were transcribed and analysed using Thematic Analysis and the Framework approach. FindingsTen online focus groups with 22 participants were held over 3 months. Four overarching, interlinked themes were identified: (i) filling the gap in rural mental health support; (ii) alignment with the farming context-tailoring how, where and when we engage about mental health; (iii) the 'messenger' is as important as the message; and (iv) sustainability, governance and support. DiscussionFindings suggest BA could be a contextually appropriate model of support for the farming community-given its practical and solution-focused approach-and could help improve access to support. Having peer workers deliver the intervention was viewed as appropriate. Ensuring governance structures are developed to support peers to deliver the intervention will be essential to facilitate effectiveness, safety and sustainability. ConclusionInsights gained through co-design have been critical to the success of developing this new model of support for members of farming communities experiencing depression or low mood.

A significant portion of on-farm deaths and injuries in Australia occur among young people working on the farm. Since most Australian farms are still family owned and operated, young people are an integral part of everyday operations and the farm is a place where these young people live, work and play. This paper describes how the international Gear Up for Ag Health and Safety™ program, originally developed in North America, was further developed for a younger Australian audience (ages 12–19) enrolled in agricultural programs at secondary or vocational schools. In addition, we share insight on demographics, self-reported farm safety behaviours, and the most common farm tasks being performed by program participants utilising a pre-survey originally developed for program customisation. Of particular importance were the most common farming tasks reported by this group. The most common tasks performed on Australian farms included a large variety of vehicle use (farm vehicles, motorbikes, and quadbikes) and handling livestock. Females reported operating vehicles and other farm equipment at the same rates as males. Males were more likely to be working with large heavy machinery and driving trucks, while females were more likely to be working with livestock and using horses for stockwork. Both males and females reported low use of PPE and poor safety habits. In future Australian programs, it will be important to address the conspicuous use of motor vehicles, quadbikes, motor bikes and machinery at early ages, and to target gender-specific tasks to reduce risks on the farm.

Heat kills more Australians than any other natural disaster. Previous Australian research has identified increases in Emergency Department presentations in capital cities; however, little research has examined the effects of heat in rural/regional locations. This retrospective cohort study aimed to determine if Emergency Department (ED) presentations across the south-west region of Victoria, Australia, increased on high-heat days (1 February 2017 to 31 January 2020) using the Rural Acute Hospital Data Register (RAHDaR). The study also explored differences in presentations between farming towns and non-farming towns. High-heat days were defined as days over the 95th temperature percentile. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) codes associated with heat-related illness were identified from previous studies. As the region has a large agricultural sector, a framework was developed to identify towns estimated to have 70% or more of the population involved in farming. Overall, there were 61,631 presentations from individuals residing in the nine Local Government Areas. Of these presentations, 3064 (5.0%) were on days of high-heat, and 58,567 (95.0%) were of days of non-high-heat. Unlike previous metropolitan studies, ED presentations in rural south-west Victoria decrease on high-heat days. This decrease was more prominent in the farming cohort; a potential explanation for this may be behavioural adaption.

Background: Farming is physically and psychologically hazardous. Farmers face many barriers to help seeking from traditional physical and mental health services; however, improved internet access now provides promising avenues for offering support. Objective: This study aims to co-design with farmers the content and functionality of a website that helps them adopt transferable coping strategies and test its acceptability in the broader farming population. Methods: Research evidence and expert opinions were synthesized to inform key design principles. A total of 18 farmers detailed what they would like from this type of website. Intervention logic and relevant evidence-based strategies were mapped. Website content was drafted and reviewed by 2 independent mental health professionals. A total of 9 farmers provided detailed qualitative feedback on the face validity of the draft content. Subsequently, 9 farmers provided feedback on the website prototype. Following amendments and internal prototype testing and optimization, prototype usability (ie, completion rate) was examined with 157 registered website users who were (105/157, 66.9%) female, aged 21-73 years; 95.5% (149/156) residing in inner regional to very remote Australia, and 68.2% (107/157) “sheep, cattle and/or grain farmers.” Acceptability was examined with a subset of 114 users who rated at least module 1. Interviews with 108 farmers who did not complete all 5 modules helped determine why, and detailed interviews were conducted with 18 purposively sampled users. Updates were then made according to adaptive trial design methodology. Results: This systematic co-design process resulted in a web-based resource based on acceptance and commitment therapy and designed to overcome barriers to engagement with traditional mental health and well-being strategies—ifarmwell. It was considered an accessible and confidential source of practical and relevant farmer-focused self-help strategies. These strategies were delivered via 5 interactive modules that include written, drawn, and audio- and video-based psychoeducation and exercises, as well as farming-related jokes, metaphors, examples, and imagery. Module 1 included distress screening and information on how to speak to general practitioners about mental health–related concerns (including a personalized conversation script). Modules were completed fortnightly. SMS text messages offered personalized support and reminders. Qualitative interviews and star ratings demonstrated high module acceptability (average 4.06/5 rating) and suggested that additional reminders, higher quality audio recordings, and shorter modules would be useful. Approximately 37.1% (52/140) of users who started module 1 completed all modules, with too busy or not got to it yet being the main reason for non-completion, and previous module acceptability not predicting subsequent module completion. Conclusions: Sequential integration of research evidence, expert knowledge, and farmers’ preferences in the co-design process allowed for the development of a self-help intervention that focused on important intervention targets and was acceptable to this difficult-to-engage group. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12617000506392; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372526

Purpose: Research examining psychological well‐being associated with COVID‐19 in rural/regional Australia is limited. This study aimed to assess the extent of psychological distress, fear of COVID‐19, and coping strategies among the attendees in COVID‐19 screening clinics at 2 rural Victorian settings.Methods: A cross‐sectional study was conducted during July 2020 to February 2021 inclusive. Participants were invited to fill in an online questionnaire. Kessler Psychological Distress Scale (K‐10), Fear of COVID‐19 Scale, and Brief Resilient Coping Scale were used to assess psychological distress, fear of COVID‐19, and coping, respectively.Findings: Among 702 total participants, 69% were females and mean age (±SD) was 49 (±15.8) years. One in 5 participants (156, 22%) experienced high to very high psychological distress, 1 in 10 (72, 10%) experienced high fear, and more than half (397, 57%) had medium to high resilient coping. Participants with mental health issues had higher distress (AOR 10.4, 95% CI: 6.25‐17.2) and fear (2.56, 1.41‐4.66). Higher distress was also associated with having comorbidities, increased smoking (5.71, 1.04‐31.4), and alcohol drinking (2.03, 1.21‐3.40). Higher fear was associated with negative financial impact, drinking alcohol (2.15, 1.06‐4.37), and increased alcohol drinking. Medium to high resilient coping was associated with being ≥60 years old (1.84, 1.04‐3.24) and completing Bachelor and above levels of education.Conclusion: People who had pre‐existing mental health issues, comorbidities, smoked, and consumed alcohol were identified as high‐risk groups for poorer psychological well‐being in rural/regional Victoria. Specific interventions to support the mental well‐being of these vulnerable populations, along with engaging health care providers, should be considered.