Kentucky farmers deal with uncontrollable stressors; there's a mental-health coalition that helps them

Sarah Jones poses for a photo a flock of her sheep at he family's Red Hill Farms, which straddles the state line in Allen County and northern Tennessee. (Photo by Austin Anthony for the Kentucky Lantern)

By Sarah Ladd

Kentucky Lantern

This story discusses suicide and mental health among farmers. If you or someone you know is contemplating suicide, please call or text the National Suicide Prevention Lifeline at 988. You can also text “KY” to 741741.

A thousand hungry mouths must be fed before farmer Sarah Jones can eat.

Seven days a week — sometimes during 100-hour work weeks — Jones and her family tend their land and animals in southern Kentucky and northern Tennessee.

They put the earth, their animals and hired hands before themselves. Finding time for self-care when your job is a 24/7 lifestyle is nearly impossible.

That’s why experts say farmers face unique mental health challenges that a coalition called Raising Hope, out of the Kentucky Department of Agriculture, is aiming to address. Staff know of at least four people who are alive today because of the coalition’s efforts. It was established in 2021.

Stressors stretch beyond the hours of labor the Jones family puts into Red Hill Farms, though finding laborers “willing to smell like a pig” and put in long hours has become more challenging with time.

The availability and affordability of land, too, is a challenge for farmers looking to start or expand. They’re often up against developers. Weather is unpredictable. Everything – from labor to feed – costs more now.

And, Jones said, it’s concerning when members of the public don’t understand what farmers do.

“That’s changed dramatically as more and more people are more and more generations removed from agriculture and the farming lifestyle,” she said. Many “really don’t understand where their food comes from.”

Elizabeth Gordon, who does marketing work with Raising Hope, said the coalition’s mission is twofold. It seeks to decrease mental health stigma and suicide rates among farmers, which may be worse than numbers show thanks to underreporting in rural areas. But it also exists to educate non-farmers about the farming lifestyle.

“It’s hard to appreciate when you don’t understand,” said Gordon.

In addition to destigmatizing mental health, she said, Raising Hope staff also try to destigmatize the farmers themselves.

“They don’t stand in a field with pitchforks,” she said. “They’re … very technologically advanced.”

 
The needs: more access to mental health resources, less stigma

In 2020, someone in America died by suicide every 11 minutes, the Centers for Disease Control and Prevention found. Rates were worse in rural areas, yet rural folks tend not to get mental health help as frequently as those in urban areas, according to the National Library of Medicine.

The University of Kentucky said in 2022 that at least 109 farmers in Kentucky died by suicide between 2004 and 2017. Farmers 64 and older were at higher risk. From 2012 to 2015, male farmers were twice as female farmers likely to take their lives.

Farms make up a massive chunk of the commonwealth’s land, according to Kentucky AgriTech.

In 2022, there were more than 73,000 farm operations in the state, according to the State Agriculture Review. Chickens, calves and cows were the biggest livestock productions reported in that data. Kentucky produces the most beef of any state east of the Mississippi River, making it a massive contributor to the food supply.

The lifestyle comes with a measure of independence, experts said, that can make reaching out difficult.

Cheryl Witt, a researcher and sixth generation farmer from central Kentucky, said stigma and cultural differences sometimes keep farmers from getting help.

“In the general population, there’s high rates of stigma seeking help for mental health,” said Witt, whose doctoral dissertation was on depression rates among female farmers in Kentucky and Tennessee.

“But when you deal with a farming population, particularly men, you have that masculine, highly independent, self-reliant, male attitude or cultural beliefs … you just don’t do that. That’s just not something you do,” she added. “You can handle it, or you’re going to handle it yourself.” 

And often, they must handle it alone because the public doesn’t understand what they face – and not all health care providers are culturally competent enough to understand their unique challenges.

Jeanne Ward, whose passion for mental health advocacy grew during her Ph.D. research into rural health disparities, said it’s crucial that health-care providers understand those specific stressors in order to best treat the whole farmer.

“When you go to the fair, you see the shiniest stuff,” the former nurse explained. “You see the beautiful animals and that happy version of farmers that we’re used to.”

But behind the scenes, in the day-to-day, she said, “farmers are really faced with a lot of uncertainty that makes the occupation more challenging.”

They are, Ward said, disproportionately affected by suicide as a result.

 
Raising Hope – one coin and conversation at a time

Raising Hope got its start in 2021 and is a holistic, multi-faceted approach to improving Kentucky farmers’ wellbeing.

Sarah Jones holds her Raising Hope challenge coin.
(Photo by Austin Anthony for the Kentucky Lantern)

Coalition members go to farming events around the state and do physical health screenings. They also educate non-farmers about farming.

The physical screenings are important because poor physical health can contribute to poor mental health – and many in rural communities live far from primary care. Driving to a doctor may take too long, causing a to-do list to grow even longer. Telehealth helps, but isn’t always possible or applicable.

Staff also distribute mental health challenge coins and have passed out more than 1,300 since Raising Hope launched.

The coins are small, physical tokens meant to remind farmers that they and their work are appreciated. They also encourage them to reach out for help when they need it. 

Jones keeps her challenge coin in her wallet. It is, she said, “a continuous reminder that … I’m not alone. That there is somebody that understands and … has an appreciation … to what I might be experiencing.”

Beyond individual help, the coins can help build connectedness among farmers, which Ward said is a “protective factor against suicide.”

“Self compassion is really important too. We want people to understand that we’re all imperfect, and everybody has mental health challenges,” she said. “We want to normalize it and get people talking about it versus facing these problems alone, which often doesn’t have a very good ending.”

On top of the coins, the coalition puts out ads about mental health and sets up booths at farming events. The digital side of the coalition is huge, Ward said.

“With the stigma of suicide and mental health issues, not everybody wants to come up to us at a booth at an event,” she explained. “So that’s why these digital campaigns are so powerful, because we are actually able to confidentially serve farmers and the farm communities.”

Witt, the researcher, said primary coping mechanisms for farmers that she’s found include faith, prayer and social interaction with likeminded people.

Staff will also distribute small bluetooth speakers for farmers whose trucks or tractors don’t have radios, Gordon said.

A good podcast or music can “free their mind a little bit so they don’t just worry all the time,” she said. 
Other interventions include teaching nursing students how to interact with and treat farmers in a culturally competent way, as well as providing farmers the option when calling 988 to identify as a farmer and get specialized help.

These interventions take money, which is why Raising Hope staff want to move toward forming a nonprofit. Doing so would allow it to accept donations.

A health care workforce that understands farming is important, though. Without it, Jones said, stigma worsens.

“We make up such a small percentage of the population. There are very, very few people that can even fathom the stress and the workload that I have,” she said.

Talking about it is nothing to be ashamed of, she said.

“Farmer mental health is an issue and it’s not something to keep a secret. It’s okay to share,” she said. “It’s normal for farmers to feel stress…it’s normal for farmers to feel defeated. And so if you’re having those thoughts, there are other people that have had those thoughts too.”

Just “take care of those thoughts,” she said. And: Have a conversation with someone about how you’re feeling. You’re not alone.

UK Extension program to address farmer suicide and other mental-health issues expands to include young people and nurses

Farmer Dinner Theater helps farm families discuss mental health and suicide issues, through dramatic performances by local youth. (Photo by Steve Patton, UK Agriculture Communications)

An initiative that was originally designed to address farmer suicide has expanded to address mental health issues and suicide among young people and nurses, Jordan Strickler reports for the University of Kentucky. The initiative is called BARN, for "Bring Action Right Now." 

The initiative includes the Farmer Dinner Theater, initially designed to bring farm families together to discuss mental-health issues affecting their communities through dramatic presentations starring local community youth. The program encourages an open dialogue about mental health and reassures farmers and their families that it is OK to seek treatment if needed, Strickler reports.

“The BARN program delivered in Kentucky has helped increase awareness about mental health challenges, farm stress and suicide prevention in Kentucky,” said Paul Norrod, extension specialist for rural health and farm safety and instructor in the UK College of Nursing, told Strickler. “Dinner theater attendees have stated that mental health challenges can affect anyone and that it is important to talk about them in the community to help prevent suicide.”

The theater offers reenactments based on real-life situations that farm families may have faced and exposes farmers and their families to a variety of proven mental-health interventions, ranging from basic suicide intervention resources to breathing techniques.

Male farmers died by suicide at rates twice as high as the national average in 17 states studied by the Centers for Disease Control and Prevention in 2012-15. That may be an understatement, Strickler writes, because the study didn't include some agricultural states.

In Kentucky, 109 Kentucky farmers died by suicide from 2004 to 2017, with those over 64 most at risk, Strickler reports. 

The BARN program is a joint program of UK's nursing college and the College of Agriculture, Food and Environment. It expanded in 2021 after a Kentucky Nurses Action Coalition innovation award allowed it to address mental-health issues and suicide among young people, with participation of 100 school nurses. The same training and tools will be used to address nurses' well-being. 

Janie Heath, president of the coalition and dean of the College of Nursing, told Strickler that anyone looking to improve their mental health and wellness can use strategies highlighted in the BARN programming, including: 

• Staying focused on what can be controlled: For example, one cannot control the weather, but one can control how we react to or prepare for the weather.
• Breathing: Focusing on breathing and practicing breathing exercises is a proven method for combating stress and refocusing your mind away from stressors.
• Practicing gratitude: Take time each day to identify something to be thankful for, as this helps promote positive thinking and perspective. For example, being thankful for a sunny day, talking with a friend or spending time with a pet. 
• Prioritizing time for ourselves: Prioritize “me time” at least once a day by taking the time to do something beneficial for yourself, such as reading, exercising or watching a favorite TV program.
• Embracing resources: Use free and/or paid professional counseling, mental-health apps or other treatment that helps your mental wellness, especially if in a crisis situation. For example, call the new mental-health crisis hotline at 988 or the National Suicide Prevention Lifeline at 1-800-273-8255. Both are free and available 24/7. 

September is Suicide Prevention Month. In 2020, the Kentucky legislature declared the Wednesday of each National Farm Safety Week "Farmer Suicide Prevention Day," which was Sept. 21 this year.

Kentucky is investing in several initiatives to address farmer suicide; National Suicide Prevention Day is Wednesday

By Melissa Patrick
Kentucky Health News

Kentucky is investing in efforts to prevent farmer suicide, including a program to teach people in farming communities how to recognize warning signs of suicide and how to head it off; expanding the state's suicide-prevention call center; funding to collect more data; and an initiative that asks people to reach out to someone if they are feeling "down-and-out, lonesome or blue."

National Suicide Prevention Day is Wednesday, Sept. 22. 

Dale Dobson, farm and home safety program administrator with the state Department of Agriculture, told legislators at the Sept. 16 Tobacco Settlement Agreement Fund Oversight Committee about the "challenge coin initiative" that he said was instigated by youth who are part of the Dixie Ag Safety Team, located in the Hardin and LaRue counties. 

The program involves a handshake, a coin and a pledge made by the person accepting the coin to reach out to someone if they are depressed or have suicidal ideation. Calling the coin an icebreaker, Dobson said he is training young people across the state to share these coins and its message. 

Screenshot of Sen. Robin Webb, D-Grayson, taking
the "challenge coin initiative" from Dale Dobson 

Several lawmakers came forward to take the pledge. It was emotional at times, as Dobson shook their hands and said if they accepted the coin, then they would need to give him their word that if they ever felt "down-and-out, lonesome or blue" that they would find a friend or call somebody. 

"This is your coin to keep, but not to take to your grave," he said. "This is how we are going to save lives. One person at a time." 

Another initiative, led by the Southeast Center for Agricultural Health and Injury Prevention in partnership with the state, is a program to provide suicide-prevention training to a diverse group of community members who largely interact with farmers. The trained community members then go back into their communities and train others. 

The training is called Agricultural Community QPR, which stands for "question, persuade, refer" and is designed to teach people how to recognize the warning signs of suicide, how to offer hope and how to get help for that person. The agricultural focus of the program involves information specific to the culture of farming as a way to help people understand the stressors unique to farmers and their families and provides customized resources. 

University of Kentucky professor Joan Mazur, deputy director of the center, explained some of the many stressors that come with farming, many of them involving "the unpredictability of multiple factors." 

"The unpredictability of the weather, the unpredictability of the crop yields, the unpredictability of the markets, financial losses that can accrue. . . . The whole idea of loss is it's very prominent, you know,  in causing depression and just hopelessness," she said. 

Mazur stressed how important it is for people who work with farmers' finances, like those at Farm Credit, to take QPR training because they are often the first outsiders to know that a farm is in financial trouble.

The initial phase of the program supported the training for 17 trainers, who went on to train 415 others from last fall to March 2021, said Carolyn Oldham, who is director of continuing education for the Central Appalachian Regional Education and Research Center and works with Mazur. She said the trainings took place across the nation and in Kentucky.

More recently, she said state appropriations have allowed 40 more Kentuckians to get trained and that this cohort has already initiated 300 more trainings. "And they are just getting started, she said.  

In addition to the trainings, the latest state appropriations will be used to train more QPR trainers and to develop a peer-to-peer mobile app for farmers, said Mazur. 

Kentucky appropriated $500,000 in each of the last two budgets from its Tobacco Settlement Fund for a mental-health and suicide prevention program aimed at farmers.

Mazur praised the support of the agriculture department and the General Assembly. "Not every state enjoys this kind of support from state offices and state legislature," she said. "So I think it's unique and I think it's very forward thinking and a real tribute to a legislature that understands they are representing a largely rural state." 

Dave Morris, the deputy executive director of marketing for the department, told the oversight committee that the state has received a $500,000 grant from the U.S. Department of Agriculture that will be used to supplement the initiative, called "Raising Hope." 

Cheryl Witt, assistant professor at the University of Louisville School of Nursing and the project manager for the pilot, told the lawmakers that the program had prioritized its areas of focus by applying a formula based on the number of farmers in a county, the suicide-attempt and suicide rate, resulting in 56 Kentucky counties being included in the pilot. 

Oldham said that talking about suicide is not something most people are comfortable doing and said the QPR training helps with that, noting that a "Willingness to Intervene Survey" that is done both pre- and post-training found that individuals said they were twice as willing to intervene as a result of the program. 

One of the many trainers is Kristie Guffey, an assistant professor and a graduate coordinator for the Hutson School of Agriculture at Murray State University. 

Guffey said she was first asked to be part of this training to bring the program to the western part of the state, but it has since become something she is "called to do" after the March suicide of a "very prominent farmer" that she had known for more than 20 years and her families experience with a nephew who is a suicide survivor. 

"In our farm communities, we have to do something," she said. "We have to step up and we have to speak up and we've got to talk about a topic that no one wants to talk about. And if we don't rip the band aid off, then we're going to continue to visit funeral homes throughout the commonwealth and throughout our farming communities. . . . It's a stigma that we don't want to talk about, but if we don't talk about it, nothing will ever change." 

Guffey said she had received a "phenomenal" response from this grassroots effort from her trainees, many of whom said that before the training they thought they couldn't talk to people about suicide because it might give them the idea to do so. She said  research has proven that this is not true. 

"My message of hope is pretty much that I want individuals to take this seriously," she said. "I want them to understand that they don't have to be a licensed practitioner and they do not have to be a board certified counselor or anything like that, all they have to be is a concerned friend that wants to help them through a tough time and so everybody can do that."  

Knowing exactly how many farmers die by suicide is a challenge because farming is so dangerous and what may look like an accident could sometimes be a suicide, said Mazur. 

A 2020 Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention looked at 2016 suicide rates by industry and occupation in 32 states and found that the suicide rate among male farmers and ranchers was 43.2 per 100,000, compared to 27.4 per 100,000 among working-age men in all occupations.

In an effort to collect better data, when a person calls the suicide prevention hotline in Kentucky, which is a national hotline but is answered by someone in Kentucky, they are asked if they are a farmer or a member of a farm family.

Witt added that the state pilot increased the call centers capacity, which has seen an 8% increase in calls from January 2019 to June 21. Further, she said the pilot has funded a data-collecting system that allows it to obtain weekly data from hospitals on rural suicide attempts at both a state and county level and in working with its partners has been able to "clean up" existing data. 

"And that results in more accurate information for our statewide database," she said. "And Kentucky is also one of the,  amongst the very few states in our nation utilizing this data for behavioral health." 

Suicide is the 11th leading cause of death in Kentucky, with an average of one person dying by suicide every 11 hours in the state, according to the American Foundation for Suicide Prevention.

Kentucky is home to about 76,000 farms, and most are small. The average farm in Kentucky has 171 acres, much smaller than the national average of 444 acres. In Kentucky, the industry is dominated by small family farms and about 50,000, or two-thirds, have annual sales of less than $10,000.
 

To get involved with the Agriculture Community QPR program, go to www.uky.edu/scahip or reach out via e-mail to Oldham at carolynoldham@uky.edu or Mazur at jmazur@uky.edu. 

National Farm Safety and Health Week is Sept. 19 through Sept. 25. Click here for a list of daily AgriSafe webinars, including one Wednesday, Sept. 22 at 1 p.m. Eastern Daylight Time (all times on the graphic are Central Daylight Time) titled "Developing and Implementing a Pilot Agricultural Community Suicide Prevention Program for Farmers and Farm Families." 

The Southeast Center has created a video for the National Center for Ag Safety's Farmer Health and Safety Week that features the impact of the Agriculture Community QPR trainings.

If you or someone you know may be considering suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255.

Ky. efforts at farmer suicide prevention are a national model, UK professor says; Farmer Suicide Prevention Day is Wed., Sept. 23

By Melissa Patrick
Kentucky Health News

Kentucky farmers, like those across the nation, work tirelessly to stay afloat amid plummeting farm incomes, market instabilities, extreme weather conditions, few safety nets and now, a global pandemic. And sometimes those stressors add up, leading some to consider suicide, and others to die by it.

To bring awareness to this issue, the General Assembly passed House Bill 59, sponsored by Rep. Brandon Reed, R-Hodgenville, during the last legislative session to designate the Wednesday of National Farm Safety and Health Week, which is the third week of September, as "Farmer Suicide Prevention Day." This year that date falls on Sept. 23.   

Photo from Talk Business & Politics

"There are significant stress factors across rural America and it's important to know that it's okay for farmers to ask for help," said state Agriculture Commissioner Ryan Quarles. "And one of the more unfortunate issues here is that the farm community is one of the last communities to reach out for help and so we've got to make sure that farmers know that there are resources available if they need to talk with someone."

Quarles pointed to several stressors that are unique to the farming community, including the extended stress that comes with only getting one or two paychecks a year, working under risky market conditions, and not having access to benefits or health insurance through an employer.   

Farmers also worry about losing the family farm, said University of Kentucky professor Joan Mazur. She is deputy director of the Southeast Center for Agricultural Health and Injury Prevention, which has received a $48,000 federal grant to work on suicide prevention.

"No farmer wants to be the person that loses the multi-generational farm, sometimes in the family for decades and decades," Mazur said. "And that can cause huge depression. . . .  Nobody would want  to lose their home, but the additional burden on a farm family ... really can be catastrophic. "

Deborah Reed, a professor of nursing and agricultural health at UK, added that she knows anecdotally and through her own research that farmers also feel "very unappreciated and persecuted by the public."  

One goal of suicide awareness is to reduce the stigma of asking for help, Mazur said: "We know it's hard to ask for help. People talk about physical complaints all the time but it's very difficult for them to talk about any mental health issues that they are having." 

But even though it's hard, she urged anyone thinking about suicide to seek help. 

"Suicide is preventable, it's not inevitable," Mazur said. "That message has to get out to the general public and it has to get out to the farming community as well, and to  farm families so that people can get the help that they need. That's the point of the USDA grant that we have." 

She added, "We can't keep ignoring this. Stress, mental health, depression, suicide are real issues nationwide, and in particular in our farming community, which is our focus." 

2018 Farm Bill spurs action

Mazur said the 2018 Farm Bill has been instrumental to addressing mental health in agriculture, because for the first time it had money included to address the issue. The bill appropriated $50 million over five years for mental-health work with people in agriculture-related occupations, but the impact went beyond money.

"It said to all the farming community, this is a conversation we can have," she said. "You can't overstate enough how important it was that there were mental health components in that 2018 Farm Bill. That was huge." 

Kentucky has also appropriated $500,000 from its Tobacco Settlement Fund for a mental-health and suicide-prevention program. The pilot program brings together a wide range of agencies to focus on increasing awareness of resources, increasing behavioral health care providers in rural areas, increasing  intervention training in communities, and increasing surveillance. It will also create and disseminate a Kentucky farmer cultural humility training for healthcare providers. 

"The concerted effort in Kentucky is remarkable," Mazur said, adding later, "This is really unprecedented nationally to have a state that is so committed to this kind of an issue, to preventing farmer suicide and farmer mental health issues. . . . It's really a model, a national model for how to address an issue."  

Farmer suicide prevention in Kentucky

With its Farm and Ranch Stress Assistance Network grant, Mazur said, the center has created a pilot program to provide suicide-prevention training to a diverse group of community members who largely interact with farmers, such as people from Farm Credit, ministers, Extension agents and their families. The trained community members then go back into their communities and train others. 

The training is called QPR, which stands for "question, persuade, refer," and is designed to teach people how to recognize the warning signs of suicide, how to offer hope and how to get help and save a life. 

Joan Mazur (UK photo)

Mazur said they have enhanced the QPR program with information specific to the culture of farming to help people understand the stressors unique to farmers, their families and their workers. 

As of Aug. 1, she said in the center's annual report, 18 people had completed the training and made a commitment to deliver at least two trainings. She said they expect 100 people to be trained by mid-November.

Mazur said the center is also working with the Suicide Prevention Hotline to help its workers better understand the culture of farming. 

For example, she said, if someone calls the hotline and says it's been a rainy spring and they couldn't plant their crops, the person on the other end of that hotline needs to understand the full implications of what that means to a farmer: "That can be financially devastating and provoke the kinds of situations that cause depression and stress and lead to, that are run-ups to suicide."

Quarles also spoke to the importance of making sure hotline workers understand the "lingo of agriculture" since a farmer's message may get lost in the translation. 

Reed said it's also a problem when health-care providers don't understand farming, because that is who a farmer is likely to see first, given the poor access to mental-health care in most rural areas. 

Reed said farmers have told her "over and over again" that when they actually decide to seek help for their depression or anxiety or mental-health issue, the provider doesn't understand their world: They can't take medicine that makes them sleepy and also work on farm equipment, and can't take time off for therapy. Mazur said efforts are in motion to also work on educating providers about farm culture. 

Prior to the pandemic, Reed said she offered evidence-based community theater programs across Kentucky that focused on health and agriculture safety, including mental health. 

"We're trying to start to move the conversations to where the farm communities themselves will talk about this issue. I think we're having some success," she said, noting that farmers showing up at Extension events that focus on stress, and she is often asked to talk to farm groups about it. 

"What I've seen working with our farmers across the nation, and particularly ones in Kentucky, is they have become much more receptive," she said. "They will attend programs on stress and how to manage their behavioral or mental stress, if you will, now where before they they would not have done that." 

Reed also noted the value of letting farmers know they are appreciated, pointing to the "Heart to Heart Program" at UK where students write letters to farmers expressing their gratitude for what they do. 

"We hear farmers actually say, 'Well, I'd like to get one of those letters,'" she said. "Everybody wants to be thanked so that's an easy step that everyone can do."

"We're really a lot more active on this issue than we have been in years past and I think that is a good thing," said Quarles. 

More data needed

Another challenge is the need for more information about farmer suicides. 

"We don't really understand what the baseline is, that we still are trying to better understand exactly what Kentucky's farmers in rural areas are experiencing right now," Quarles said. 

Mazur said farm suicides are often listed as an accident on death certificates, and reporting systems differ among states. She said through the grant, a doctoral student is working to get better data, including possible factors that contributed to suicide, to guide intervention.  

"We do know that suicide rates have increased among working-age people from 2000 to 2016 by 34 percent," she said. "And rural areas in states with high agricultural populations and small farms like Kentucky are over-represented in that sample."

A 2020 Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention looked at 2016 suicide rates by industry and occupation in 32 states and found that the suicide rate among male farmers and ranchers was 43.2 per 100,000, compared to 27.4 per 100,000 among working-age men in all occupations. 

Ty Borders, director of the Rural and Underserved Health Research Center, along with fellow University of Kentucky faculty member Kathi Harp, recently published a study that found, nationwide, rural residents experienced suicide ideation, planning and attempts at a higher rate than those in urban areas.

The study also found that the risk of dying by suicide is greater among lesser educated farmers and at times of economic depression, especially in rural areas that are heavily dependent on a single industry, like farming. Death by suicide is also higher among men.

Borders said that when worked at the federal level on this issue, it became clear that for decades, the national government has needed a better plan to address rural suicide because most suicide-prevention programs have been designed for urban communities and may not be applicable to rural communities. 

The Borders-Harp study calls for new suicide prevention interventions targeted to the unique needs of rural residents.  

Suicide is the 11th leading cause of death in Kentucky, with an average of one person dying by suicide every 12 hours in the state, according to the American Foundation for Suicide Prevention. 

Kentucky is home to about 76,000 farms, and most are small. The average farm in Kentucky has 171 acres, much smaller than the national average of 444 acres. In Kentucky, the industry is dominated by small family farms and about 50,000, or two-thirds, have annual sales of less than $10,000.

If you’re thinking about suicide, are worried about a friend or loved one, or would like support, the Suicide Prevention Lifeline is available 24/7 at 1-800-273-8255.

Webinar Friday at 10 a.m. ET will explore a Kentucky farmer's response to the pandemic, food justice and community health

Kentucky farmer Michelle Howell will share her work on covid-19 responses, including delivery of medically tailored meals for patients and farmers' market safety, in a free webinar at 10 a.m. Friday, July 10. Howell will discuss areas that require a creative response such as farm to school, home deliveries, chronic hunger, and food justice. To register, click here.

Nathan and Michelle Howell of Need More Acres Farm in Scottsville met at Western Kentucky University where they pursued degrees in agriculture. Nathan had grown up on a farm in Hart County, where he and his family grew corn, wheat, cattle. Michelle's food story began when experiencing hunger motivated her to consider ways a community could feed itself. After college the University of Kentucky hired them to help tobacco farmers transition to fruit and vegetable production.

In April 2013 Nathan and Michelle, along with their four children, began farming full time and they are currently growing fruits and vegetables, combining them with meat, milk, cheese, eggs and bread from other farms to provide a multi-farm Community Supported Agriculture service, co-founding Community Farmers Market in Bowling Green, selling to schools, food pantries and restaurants.

Nathan and Michelle want to combine their love for Kentucky farms with the realization that our food system didn't change overnight. With grace and patience, they are working towards a healthier lifestyle for their own family and hope to do the same for others. Community organizing, public speaking, policy change and storytelling is now weaved through their everyday life on the farm.

For questions about registration, contact Rachelle Seger at rseger@healthy-ky.org.

Workshop offers tips to keep kids safe on farms; biggest injury-causers are falls (often from tractors), animals and machinery

By Melissa Patrick
Kentucky Health News

Growing up on a farm gives children the opportunity to play in ways that few others get to experience, and gain a set of useful skills, but agricultural safety experts caution that farm life also comes with safety challenges that all too often can result in injury or even death.

According to the National Ag Safety Database, 33 children sustain agriculture-related injuries every day, and every three days a child dies from an agriculture-related incident.

"A lot of these ag-related injuries, work-related injuries in ag, are related to the fact that children are doing work that does not match their capabilities or their abilities," youth agricultural safety specialist Marsha Salzwedel said at the Child Agricultural Injury Prevention Workshop in Lexington Aug. 6-7.

The three most common causes of non-fatal injuries are falls, animals and machinery, such as tractors; and the top three causes of fatal injuries are machinery, other vehicles and drowning.

Salzwedel, of the National Children's Center for Rural and Agricultural Health and Safety, added that advances in technology are changing the types of farm injuries found in children. She told the story of a child who lost an eye after being hit by a drone.

Page from guidelines book; for a larger version, click on the image.

Salzwedel suggested that parents use the Agricultural Youth Work Guidelines to help determine whether a youth has the physical and cognitive abilities to safely perform a job.

The guidelines have a checklist for 51 ag-related jobs detailing what youth between 7 and 16 need to perform a job safely. The list also gives adult responsibilities, suggestions for the level of adult supervision, and hazards and protective strategies.

Salzwedel noted that tractors are the leading cause of fatalities for youth and children, but added that all-terrain vehicles and skid-steer loaders "are coming up fast behind them."

The National Children's Center for Rural and Agricultural Health and Safety reports that tractors are responsible for more than 40% of unintentional farm-injury deaths of children under 15. It also reports that four out of five farm children regularly ride on them.

Tractors are notorious for turning over, but CultivateSafety.org says there are many ways a rider can fall and be injured while riding on a tractor, including "sudden stops, driving over holes, stumps and debris, or a sharp turn." It adds that tractors with cabs are no guarantee of injury prevention, because children have fallen out cabs after hitting a door than then opened.

The Childhood Agricultural Safety Network, a 60-member coalition that includes the American Farm Bureau Federation, has launched a "Keep Kids Away from Tractors" campaign with the message: "It's easier to bury a tradition than a child."

Dennis Murphy, a professor emeritus at Penn State University, said ATVs present a number of safety challenges when it comes to keeping kids safe on farms. For example, he noted that all too often young children are at risk of getting hurt on them because they are driving a machine that is too big for them, riding with passengers, not wearing helmets, operating on paved roads, which they are not designed for, or driving on slopes and uneven ground.

He added that a recent survey shows that upwards of 90% of youth say they drive an adult-sized machine and that another study found that 90% of kids have never received any training on ATV use.

Murphy also noted that 60% of child ag-related injuries happen to children who are not working, including infants, toddlers and pre-schoolers. He stressed that "childcare is the best option" to keep children safe on farms, but said when this isn't possible it's important to provide a "safe play area."

The National Children's Center for Rural and Agricultural Health and Safety offers an online book that shows how to create safe play areas on farms. Suggestions include making sure the area has designated physical boundaries and is away from traffic and machinery; age-appropriate equipment for the children using it; and competent supervision.

Several speakers noted that some obstacles to a safer farming culture for children is that parents and farm supervisors often underestimate the risk of injury or assume that decisions about safety are "obvious" or are "common sense," and believe "It will happen to someone else."

Joe Grzywacz, a Florida State University professor who has researched immigrant farmworkers and their families, told the workshop attendees, "Families don't think of this as an occupational risk; they are thinking about this as . . . this is the way we live our lives."

3 children die, 33 are injured per day in accidents on U.S. farms; prevention workshop to be held in Lexington Aug. 6-7

The National Children's Center for Rural and Agricultural Health and Safety will host a workshop will be held in Lexington Aug. 6-7 on preventing injuries of children on farms and ranches.

The workshop website says, "Learn how you can help safeguard children and youth who live, work and play on farms and ranches. This information can be used to develop and enhance childhood agricultural safety strategies for your organization. Interactive sessions will be facilitated by safety experts and leaders in the field of childhood agricultural injury prevention."

Registration is limited to 60 participants. Registration is $249. Click here for more information or to register.  Another workshop will be held in Hershey, Pa., Sept. 17-18.

Joan Mazur of the University of Kentucky, who is helping with the Lexington workshop, attended an earlier one in Iowa, and The Rural Blog asked her to write about it and her work. Here's her report:

By Joan Mazur
     I have been at the University of Kentucky College of Education since 1993 and have been associated with the Southeast Center for Agricultural Health & Injury Prevention with continual federal funding since 1994. The interdisciplinary nature of this center, housed at the UK College of Public Health, as well as its focus on solving real-world issues on family farms, has supported my research interests at the intersection of public education and public health. My husband and I also own a 70-acre farm in Washington County, Kentucky, so my interests in farm safety and health are also personal.

     Over the years I have developed with colleagues many educational programs, most of which involve technology and are targeted at a high at-risk group of teenagers from 14 to 19. Narrative simulations, digital games and other online interventions for preventing injuries and fatalities have been used at schools in farming and rural communities in the Southeast.

     While many of our more horrifying statistics on youth injury and fatality and injury in agriculture are decreasing, one segment of the at-risk younger population has resisted efforts. Every day on farms in the U.S., three children die and 33 are injured. These injuries and fatalities are preventable, and there are guidelines and best practices to assure that children can take advantage of the many benefits of living or working on family farms in safe and healthy ways.
     Recently I attended a Childhood Agricultural Injury Prevention (CAIP) Workshop in Iowa hosted by the National Children’s Center for Agricultural Safety & Health, whose national mission is to prevent agricultural injuries and fatalities to children. Many of us in all fields over the years have attended workshops, even entire conferences that disappointed despite a promise of improved professional learning. However the CAIP Workshop was excellent!

     Every session was highly informative -- delivered to the entire group, with many interactive small-group components to practice and absorb the various techniques and approaches to engaging stakeholders in preventing injuries to children, whether working or non-working, on farms or even in specialized settings such as agritourism sites (orchards, farms, petting zoos etc).

     We have now scheduled a CAIP for Lexington Aug. 5-7. I hope some of you can consider going, as journalists, teachers, counselors and other educators or others such as insurance personnel, FFA, bankers or other community member in positions to influence individual families and policy makers in decision making that can promote the economic, social, educational and personal mental and physical health of rural farm families and children.
     This KY-CAIP workshop is also a partnership between the National Childrens Center for Ag Safety & Health, the North Carolina Agromedicine Institute and the Florida Coastal Center for Agricultural Safety & Health, which will be providing expertise for regional agricultural safety and health issues.

UK nurse creates Farm Dinner Theater as a way to remind farmers of safe practices; has some unexpected benefits

Deborah Reed (UK photo by
Mark Cornelison)

A University of Kentucky nursing professor has come up with a novel way to remind farmers about farm safety: dinner theater.

At Farm Dinner Theater, farmers watch each other perform funny skits with a serious message. At a recent show at the Lincoln County Extension Office in Stanford, Thelma Blair asked her husband Jack if he remembered to wear ear plugs before working on his loud farm machinery. The audience laughed as Jack yelled, "WHAT?" in response. "While they delight in Jack's feigned deafness, it serves as a reminder to use ear protection when working with machines, Hilary Brown reports for UK Now. The Blairs are respected farmers in their community, and were excited to participate in the program when their extension agent asked.

The skits may fill a need because health and safety standards don't apply to small family farms. Lectures aren't effective, and pamphlets are easy to ignore, so Reed, who grew up on a nearby farm, wanted to find another way to help farmers recognize farming hazards and practice safety measures, Brown reports.

"Based on our research, we found that farmers learned best from watching each other and stories based on real situations," Reed told Brown. "They like humor. From observing farmers and how they choose their work behavior we know they learn from an apprentice model where role modeling is so important." And a free dinner doesn't hurt.

Reed says the program has helped in ways she didn't expect, such as "how the farmers would come together and work out issues among themselves," Brown reports. "At one event, a farmer mentioned how his father, who was grappling with Alzheimer's, kept trying to get the keys to the family tractor. Their solution was to move the tractor out sight. Once they did that, he stopped trying to drive it."

Another unexpected benefit: Attendees say the program has helped relieve their stress. Farmers are under a lot of stress these days because of bad weather, the trade war, low crop prices and more, and depression and suicide among farmers has increased greatly in recent years. Farm Dinner Theater "gives farmers the opportunity to come together, discuss their situations, and to support each other," Reed told Brown. "Non-farm people in the community come to these events and have a better understanding of the stressors that farmers face and can support them better."

Brown reports, "The results of these events have been remarkable. Fifty percent of the farmers who attended reported to have incorporated changes in their habits and on their farms within two weeks. Sixty percent made changes within two months. The program was so successful, Reed, who has won numerous awards for the program and was named by Oprah Magazine as "One of Five Nurses Who Might Just Save the World", was appointed UK's first agricultural nurse, the first at a land-grant university. Her position is funded by UK's College of Agriculture, Food and Environment, and marks the beginning of a unique partnership" with the College of Nursing.

The project is funded with a grant from the National Institute for Occupational Safety and Health.