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Health Status of the Rural Elderly According to Farm

Work History: The Iowa 65+ Rural Health Study
a b b b
Charles E. Yesalis , Jon H. Lemke , Robert B. Wallace , Frank J. Kohout & Martha C.
b
Morris
a
Department of Preventive Medicine and Environmental Health
b
College of Medicine University of Iowa , Iowa City , IA
Published online: 10 Dec 2012.

To cite this article: Charles E. Yesalis , Jon H. Lemke , Robert B. Wallace , Frank J. Kohout & Martha C. Morris (1985) Health
Status of the Rural Elderly According to Farm Work History: The Iowa 65+ Rural Health Study, Archives of Environmental
Health: An International Journal, 40:5, 245-253, DOI: 10.1080/00039896.1985.10545927

To link to this article: http://dx.doi.org/10.1080/00039896.1985.10545927

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 Health Status of the Rural Elderly According to Farm Work History:
The Iowa 65 + Rural Health Study
Downloaded by [University of Glasgow] at 09:31 29 December 2014

CHARLES E. YESALIS Ill, Sc.D.

Department of Preventive Medicine
and Environmental Health
JON H. LEMKE, PH.D.
ROBERT B. WALLACE, M.D.
FRANK J. KOHOUT, Ph.D.
MARTHA C. MORRIS, M.S.
College of Medicine
University of Iowa
Iowa City, lA

ABSTRACT. In a geographically defined survey of 3,097 rural Iowans who were at least 65
yr of age, we examined the association between prior farm experience ( ~ 25 yr) and vari-
ous measures of current health status; we controlled for age, current working status, and,
where appropriate, smoking and alcohol consumption. Health status was indexed by self-
reported morbid conditions, symptoms, and physical function. After controlling for smok-
ing behavior, it was found that both men and women with previous farm exposure cur-
rently experience a greater prevalence of all nine respiratory symptoms employed in the
study relative to non-farmers. Farm men report a lower prevalence of Parkinson's disease
and prostate conditions, but report a greater prevalence of stroke and a lower level of self-
perceived health status. Women with a farm work history experience a greater level of
physical function and fewer symptoms associated with mental illness. Overall significant
benefits as well as risks associated with a history of farm work were identified. However, of
those who survived to age 65, extended exposure to farm work did not have a major im-
pact on the overall current health status of men and women.

THE FARMER'S lifestyle and its effects on health have
1
been discussed for well over a century . The literature
examining the health status of farmers relative to urban
dwellers and non-farmers reveals both risks and bene-
fits associated with farming . Lower rates of ischemic
heart disease among farmers have been observed in sev-
eral studies. 2- 5 Presumably these findings are, in part,
related to physical activity and less use of alcohol and
tobacco among farmers, a rationale supported by Reed, 6
as well as Breslow and Enstrom . 7 Relative to the general
population, cancer mortality rates are also lower for
farmers. However, certain cancers, such as leukemia,
lymphoma, and prostate, are more common .8 •9
Compared with other occupational groups, farmers
are at increased risk for accidents, certain types of respi-
ratory illness (e.g., farmer's lung), dermatoses, hearing
loss, and impairments of the spine.9 Likewise, a greater
percentage of farmers report chronic conditions involv-
ing limitation in major activity compared to the total
labor force. However, farm workers report fewer acute
conditions (including acute respiratory conditions). 10
Farm laborers report a greater than average number

September/October 1985 [Vol. 40, (No.5)) 245

 of work loss days, but farm owners and managers, on Table 1.-Measures of Health
average, report fewer. Finally, farmers (owners, manag-
ers, and laborers combined) assess their health as fair
or poor more often than white or blue collar workers 1. Chronic diseases*
Heart attack High blood pressure
after controlling age, income, and education. 12 Fractures
Stroke
One limitation of many of these surveys 2- 5· 10- 12 is that Cancer Glaucoma
they usually focus on individuals currently working as Emphysema Parkinson's
farmers. Thus, it is difficult to assess to what extent the Ulcers Anemia
"healthy worker" phenomenon is influential in that the Cirrhosis Phlebitis
Diabetes Asthma
health risks or benefits associated with farming may
take years to surface, and would only be noticeable on 2. Symptoms and conditionst
older individuals who were able to continue with farm Leg pains at night
Frequent indigestion
work. Many individuals suffering the long-term ill ef-
Dry or itching skin
fects of farming would likely drop out of the farm labor Bringing up phlegm
force (i .e., die, retire, or change occupations) and Chest wheezing or whistling
would not be evaluated. Thus, persons of good general Bunions, corns, or callouses on feet
health are more likely to be employed in an industry like Other foot problems
Trouble with finger or toe nails
farming, which demands significant physical activity.13 joint stiffness in the morning
The magnitude of this confounding effect may increase Trouble with kidneys or bladder
with increased exposure to the occupation and contin- Trouble with prostate gland (male}
Downloaded by [University of Glasgow] at 09:31 29 December 2014

ued "selection of the fittest" workers. Shortness of breath

Coughing
To deal in part with these issues, we investigated,
with cross-sectional analyses, a geographically defined 3. Physiologic measures
sample of rural Iowans, aged 65 yr or over, to compare Systolic blood pressure
the health status of those who had never lived or worked Diastolic blood pressure
Pulse
on a farm to those who had worked at least 25 yr on a Quetelet index (wt/ht'}
farm . To identify the magnitude of "healthy worker" ef-
fect, we controlled for current working status. 4. Self-perceived health status*
5. Limitation on activity§

METHODS 6. Physical function

Ability to:
do heavy work around the house
This study is part of an ongoing project entitled, "The walk one flight of stairs
Iowa 65 + Rural Health Study," supported by the U.S. do your own shopping
National Institute on Aging. Coordinated population walk one-half mile
studies are also being conducted in East Boston, MA, walk without help
(Harvard University) and New Haven, CT, (Yale Univer- prepare your own meals
do your own housework
sity) . This project was specifically designed to explore a
Assistance required during past 12 months:
broad range of physical, mental, and social characteris- walking across the room
tics of the rural elderly. The target population was all bathing
persons 65 years old and older living in two rural coun- dressing
ties adjacent to the county in which the University of grooming
eating
Iowa is located. Eighty percent, or 3,673 persons, of the using the toilet
target population were willing to participate in the Degree of difficulty:
study between December, 1981 and July, 1982. Of these moving large objects
3,673 persons, 576 had abbreviated, telephone, or sur- stooping, kneeling
rogate interviews, usually because of refusal of face-to- lifting over 10 lbs
face interviews, disability, or illness, and were excluded reaching above shoulder level
writing
from further analysis due to incomplete health histories. standing in one place for long periods
The remaining 3,097 subjects (1 ,942 females and 1,155 getting up from a chair
males) were surveyed in their homes by trained inter- Require special equipment or aids:
viewers using a generally closed-ended questionnaire. cane
The average interview lasted 1 \4 hours. crutches
wheel chair
To assess the impact of farm exposure on current leg brace
health status, we employed two variables: whether a artificial limb
respondent had ever worked on the farm and the dura- commode
tion of farm work. Regarding the primary lifetime oc- pacemaker
cupation of the survey respondents, less than 3% of the eyeglasses
hearing aid
farmers identified themselves as farm laborers or serv-
ice workers. Excluding farmers and housewives, 39% of
men and 31% of women were professional and techni- Continued on page 247
cal workers, 17% of men and 55% of women were in

246 Archives of Environmental Health

 sales and clerical work, and 42% of the men and 14%
Table 1.-Continued of women were craftsmen and operators.
Respondents were asked if they ever worked on a
Vision: farm of at least 10 acres. If yes, they were asked to re-
When wearing eyeglasses can you see well enough to:
recognize a friend (at various distances)
port their age when they first worked and last worked
read an ordinary newspaper on a farm (because the meaning of "working on the
read only large print farm" was left to the respondent, it is possible that
Hearing: significant differences in interpretation existed,
family's perception of level of hearing loss especially between men and women). Individuals who
self-perception of level of hearing loss said they lived but did not work on the farm were ex-
situation-specific hearing loss
cluded from the analysis (31 men, 670 women). The
7. Mental health
distribution of length of exposure to farm work was
Memory/cognitive/ function
bimodal with a median of 50 yr (men) and 1st quartile
a. Metamemory assessment scale
Self-perception of memory of 25 yr (men). The first modal group primarily repre-
Self-perception of changes in memory since age 30 sented people who began work on the farm at very early
Concern about forgetting things ages and then left the farm in their teens or twenties for a
Duration of memory problem career other than farming. Since this duration of expo-
Specific problem (i .e., names, faces, keys, etc.)
sure was not extensive and the mean time since expo-
b. Word recall list
sure was substantial, we eliminated the individuals with
c. Mental status#
less than 25 yr of exposure from the analysis (261 men,
Downloaded by [University of Glasgow] at 09:31 29 December 2014

Date today
Day of the week 264 women). We also lost to analysis 21 men and 38
Telephone number women whose farm history was not known. Elimination
President of the U .S. of the above individuals left us with very distinct contrast
President before him groups: those who had never lived or worked on a farm
Mother's maiden name
(146 men, 379 women) and those who have had at least
Mood/anxiety
25 yr of exposure to farm work (696 men, 591 women).
a. I did not feel like eating./!
I felt depressed . Of those who had never lived or worked on the farm,
I felt that everything I did was an effort. 28.1% of the men and 15% of the women were cur-
My sleep was restless. rently working at a "paying" job. Similarly, for farm ex-
I was happy. posure groups, 20.7% men and 12.0% women were
I felt lonely.
People were unfriendly.
currently working at a "paying" job. We recognize,
I enjoyed life. however, that it is not uncommon for an elderly person
I felt sad. to continue working on the family farm without pay.
I felt that people disliked me. Some of the health status variables used in our analy-
I could not " get going." sis were dichotomous and some were continuous.
I lacked companionship.
I felt nervous, tense, and jittery. When dichotomous, logistic regression models were
I felt calm and relaxed. fit; when continuous, multiple regression models were
I felt left out. used. Self-weighted adjusted means were reported
I was worried. from the multiple linear regression analysis and self-
I felt cross and cranky.
I felt secure and content.
weighted prevalence rates from the logistic analysis.
There were people I could talk to . Both were adjusted to the median age 75, and where
I felt that I was part of a group of friends. appropriate, to non-smokers and non-drinkers.
b. Self-perception of anxiety Age was used as a continuous variable. In the analy-
Medical behavior associated with anxiety episodes sis of the prevalence of selected chronic diseases and of
Symptoms associated with episode chronic respiratory symptoms, two dummy variables
Difficulty in dealing with family, friends
or social acquaintances (current smoker: yes/no; previous smoker: yes/no)
Loss of interest in hobbies were used for smoking and one dummy variable (alco-
Difficulty in sitting still hol in the past month : yes/no) plus the number of
c. Worries: drinks per month were used for alcohol consumption.
Things that worry you Education, as measured by years of schooling, was not
Changes in the amount of worry over
past few years
used in the final analysis because the selection of farm-
ing as a career usually curtailed education. However,
education as well as other measures of socioeconomic
• Respondents were asked whether a physician had ever told them
they had one or more of the diseases listed above. status, were introduced into preliminary analyses. Even
t Respondents were asked, " In the past year have you had ... ?" though they may have had a significant effect on sev-
:t Respondents were asked, " Compared to other people your own eral measures of health status, they did not importantly
age, would you say that your general health is excellent, good, affect the results. In addition, although desirable,
fair, poor, or very poor?"
§ Respondents were asked how many days during the past two dietary history was not included in the survey and
weeks did they: (a) stay in bed and/or (b) limit their usual activity. could not be controlled.
# Respondents were asked who/what is/was. The dependent variables in this study are self-re-
I! Respondents were asked, " During the past week . .. ": Hardly ported measures of current health status, defined by
ever, some of the time, most of the time, don't know.
seven major categories: chronic disease, selected

September/October 1985 [Vol. 40, (No.5)] 247

 symptoms and conditions, physiological measures, self-
perceived health status (SPHS) , limitation in activity,
physical function , and mental health. The components
of these categories are detailed in Table 1.
The various measures of physical function were com-
bined to form three different indices, as follows:
Physical Function I. This is an idex of three dichoto-
mous items that measure a respo ndent's ability to per-
form fairly strenuous activities. Possibles scores range
from 0 to 3 and a low score represents greater physical
dependence. The items were selected from a larger scale
developed by Rosow and Breslow and widely used to
measure functional status in the elderly. 14 This index
has a reliability of alpha = 0.71.
Physical Function II. Thi s is a five-item index of
physical independence originally developed by Shanas
and modified by Jette and Branch. 15• 16 The index has
good reliability (alpha = 0.78) and a factor analysis in-
dicated that it is unidimensional . The possible scale
Downloaded by [University of Glasgow] at 09:31 29 December 2014
scores range from 5 to 25 with a high score represent-
ing greater functional difficulty.
Physical Function Ill. This is a version of an index
developed by Katz (modified by Jette and Bran ch. 16 · 17 )
to measure a person's dependence in activities of daily
living. Internal consistency is high (alpha = 0.92) and it
is unidimensional. Possible scores range from 0 to 28.
The higher the score, the greater the degree of func-
tional dependency.
As with functional status, measures of mental health
were combined to form indices of depression and anxiety:
Depression.The depression-symptoms index used in
this study is an abbreviated version of a 20-item CES-D
index developed by the National Institute of Mental
Health Center for Epidemiological Studies for use in
large-scale surveys. 18 Our abbreviated index contains
only 11 of the original 20 items, which were chosen to
represent all four orthogonal factors identified by
Radloff through factor analysis. 18 The psychometric

Table 2.-Adjusted Prevalences of Chronic Diseases According to Work History

Adjusted Means (%) Statistical Significance

Farm Non-Farm Farm/- Work!-
Chronic Disease Sex Retired Work ing Retired Working Non-Farm• Retiredt

Diabetes:f Males 12 .6 10.3 11.7 9.5

Females 9.9 6.7 12.9 8.8
Fractures:f Males 19.1 18.1 15.0 14.2
Females 26.7 29.1 30.4 33.1
Cataracts:f Males 25 .9 23 .6 30.8 28.2 I
Females 33 .3 27.4 35.5 29.5
Glaucoma:f Males
Females
5.1
6.5
4.2
1.6
5.5
8.5
4.5
2.1 § I
Parkinson's Disease:f Males 0.9 0.4 5.8 2.8 #
Females 1.0 1.1 0 .7 0.8
Anemia:f Males 5.4 7.5 2.4 3.3
Females 18.5 16.2 19.1 16.7
Phlebitis:f Males 9.0 7.5 7.5 6.3
Females 18.6 19.0 16.6 16.9
Asthma:f Males 11.3 2.1 9.3 1.7 #
Females 7.3 4.9 6.5 4.4
Heart attacks# Males 23.1 17.7 16.9 12.8
Females 7.7 6.4 8.8 7.4
Stroke# Males 7.9 5.1 2.8 1.8 §
Females 5.7 1.1 7.0 1.3
Cancer# Males 16.6 14.2 17.7 15.2
Females 16.8 12.5 17.4 13 .0
High blood pressure# Males 33.5 33 .0 36.1 35.6
Females 50.0 53 .1 48.7 51.8
Emphysema # Males 6.7 3.6 7.5 4.0
Females 5.5 5.3 4.4 4.3
Ulcers# M ales 24.3 23.3 21.1 20.1
Females 14.1 4.2 12.3 18.0 • • Interaction(§)
Cirrhosis# Males 4.5 1.3 4.2 1.2
Females 1.9 2.8 1.1 1.6

• Controlling for current working statu s.

t Controlling for farm work history.
:f Standardized for age 75 usi ng individual logistic regression model s.
§ P ~ .OS.
# p < .001.
#Sta ndardized for age 75 , non-smoker, non-drinker, using individual logistic regression model s.
• • For women , there is significant interaction showing a " healthy worker" effect for only those with fa rm exposure.

248 Archives of Environmental Health

 Table 3.-Age-Adjusted Prevalences• of General Symptoms According to Work History

Adjusted Means (%) Statistical Significance

Farm Non-Farm Farm/- Work/-
General Symptoms Sex Retired Working Retired Working Non-Farm Retired

Leg pains Males 55.3 54.6 51.6 50.8

Females 58.4 64.1 52.2 58.0
Indigestion Males 29.3 26.1 32.0 28.6
Females 31.2 22 .9 29.2 43 .0 :t Interaction (t)
Dry skin Males 37.9 30.5 46.0 37.9
Females 47.5 43 .2 37 .5 33 .5 §
Joint pains Males 67.7 69.7 63.3 65 .5
Females 64.4 64.7 65.5 65 .9
Stiff joints A.M. Males 52.9 46.9 48.2 42.2
Females 51.4 49.8 51.4 49.9

• Standardized for age 75 using individual logistic regression models.

t P s .OS .
:t For women, there is significant interaction showing a " healthy worker" effect for only those with farm exposure.
Downloaded by [University of Glasgow] at 09:31 29 December 2014

§ p < .005 .

properties of the index have been assessed with data
from the present study as well as from a large sample of
urban elderly. In both cases, factor analysis of the ab-
breviated index yielded a fairly simple structure of four
factors, which closely paralleled that of the original ver-
sion. Also, the CES-D retained an acceptable level of in-
ternal consistency, as indicated by Cronbach's Alpha
values ranging from 0.7S-0.81. 19 A low score indicates
fewer symptoms of depression.
Anxiety. This is an index of five self-reported items de-
signed to measure anxiety symptoms that a respondent
might have experienced during the past week. The items
were adopted from previously validated scales and cast
in the same format as the CES-D, to which they were ap-
pended on the interview protocol. A factor analysis in-
dicated that the index is unidimensional and an item
analysis indicated that it has good internal consistency
(alpha - 0.71). The higher the score the greater the
prevalence of symptoms associated with anxiety.
The level of significance of P ~ .OS was employed in
our statistical analysis. Due to the large number of
statistical tests undertaken, some may argue that signifi-
cant cutoffs well below the .OS level should have been
selected. We view this as a screening study, however, in
that it is an initial attempt at examining the effects of ex-
tended exposure to farm labor on health by focusing on
a study population which is, for the most part, retired .
Thus, our primary objective is to detect relationships that
should be explored more fully in subsequent research .
RESULTS
Chronic disease. The associations between the self-
reported prevalence of major chronic diseases and
farm work exposure are presented in Table 2. Few sig-
nificant differences were observed. Male farm workers
did have a more frequent history of stroke but a lower
prevalence of Parkinson's disease.
Symptoms and conditions. There were few signifi-
cant differences according to farm exposure in the re-
porting of symptoms and conditions by men and wo-
men over 6S (Tables 3 and 4). With farm work ex-
posure, women were more likely to complain of dry
skin, while men experienced fewer prostate problems
and flat feet.
The most consistent trend observed was the associa-
tion between farm work exposure and the increased
presence of respiratory problems in farm men and
women (TableS). Regardless of individual statistical sig-
nificance and controlling for alcohol and tobacco con-
sumption, a greater percentage of farmers currently ex-
perience respiratory symptoms in each category
relative to non-farmers.
Physical measures. Other than farm women having
greater relative weights and farm men having higher
diastolic blood pressure, none of the measures of cur-
rent physiological health were significantly associated
with a history of farm exposure (Table 6). Non-farm
males ranked their current health status significantly
higher than males who had worked on the farm over 2S
yr. The incidence of days where major activity was
limited or the person was confined to bed do not ap-
pear to be associated with exposure to farm work
(Table 6).
Generally, persons with a history of farm exposure ex-
hibit a greater degree of functional independence than
those in the non-farm group. However, only with wo-
men do these differences reach statistical significance
(Table 6). A greater prevalence of hearing and vision prob-
lems among farmers was not detected in this research.
Mental health. Men and women with farm exposure
reported fewer symptoms of anxiety and depression.
However, only the scores for symptoms of depression
in women are statistically significant. Differences in
memory function according to farm experience were
not observed (Table 7).
"Healthy worker" effect. After controlling for the
effects of age, previous farm exposure, and where ap-
propriate, smoking and alcohol consumption, individu-

September/October 1985 [Vol. 40, (No.5)) 249

 Table 4.-Age-Adjusted Prevalences• of General Conditions According to Work History

Adjusted Means (%) Statistical Significance

Farm Non-Farm Farm/- Work/-
General Symptoms Sex Retired Working Retired Working Non-Farm Retired

Flat feet Males 17.7 19.8 25 .3 28.0 t

Females 21.7 20.6 19.5 18.5
Bunions, corns Males 24.4 22 .7 30.2 28.4
Females 48.6 53 .1 49.2 53 .8
Other foot problems Males 19.0 20.9 24.7 26.9
Females 19.5 22.6 21.7 25 .0
Nail trouble Males 20.4 14.5 24.7 17.8
Females 27.6 31 .6 23 .3 26.9
Arthritis Males 72 .2 65 .3 67 .0 59.6
Females 72 .0 73.4 73.2 74.6
Kidney trouble Males 29.9 27.4 34.7 32 .1
Females 29.0 28.7 25 .7 25.4
Prostate condition Males 22.1 23 .5 30.4 32 .1 t
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• Standardized for age 75 using individual logistic regression models.

t p s .05 .

Table 5.-Adjusted Prevalences• of Respiratory Symptoms According to Work History

Adjusted Means (% ) Statistical Significance

General Farm Non-Farm Farm/- Work/-
Respiratory Symptoms Sex Retired Working Retired Working Non-Farm Retired

Shortness of breath (Gen) Males 32 .5 22 .2 26.9 17.9 t

Females 28.3 21.8 25.4 19.3
Shortness of breath Males 5.4 2.2 4.0 1.6 II
(lying) Females 4.8 1.6 3.4 1.1
Severe Shortness of Males 4.1 2.2 2.8 1.4
breath (sleep) Females 2.2 1.9 2.1 1.8
Morning cough Males 13.1 10.6 10.5 8.4
Females 12.9 14.9 8.7 10.1 II
Day cough Males 10.9 7.6 9.8 6.8
Females 11 .7 3.2 8.4 11.2 ; Interaction(+)
Morning phlegm Males 24.7 18.9 19.7 14.9
Females 12.9 12.1 12 .6 11.9
Day phlegm Males 21.5 14.4 15.9 10.4 II
Females 9.2 3.7 4.6 9.8 ; Interaction (t)
Chest wheezing Males 14.2 7.6 9.5 4.9 §
Females 10.8 9.9 6.0 5.5 t
Wheezing-shortness of Males 12.8 4.6 3.9 1.3 § #
breath Females 8.8 1.8 5.2 1.0 t t

• Standardized for age 75, non-smoker and non-drinker, using individual logistic regression models.
t p < .01.
; For the women , there are significant interactions showing a " health worker" effect for only the women with farm exposure.
§ p < .005.
# p < .001.
11Ps .05.

als over 65 yr of age who are currently working appear
healthier than retired individuals (Tables 2-7) . It is ob-
vious that this relationship is not distributed equally
over all measures of health status. The most outstand-
ing differences involve respiratory symptoms, asthma,
self-perceived health status, physical function, and
mental health, with those over 65 yr of age and who
work reporting a more favorable health status. In addi-
tion , the relationship appears to be more consistent and
stronger for men than for women. For the women there
were four significant interactions between farm status
and current working status: day cough , day phlegm,
ulcers, and indigestion . There was only a " healthy
worker" effect for the women with farm exposure.

250 Archives of Environmental Health

 Table 6.-Adjusted Mean Values of Physical Health According to Work History

Adjusted Means Statistical Significance

Farm Non-Farm Farm/- Work/-
Health Measures Sex Retired Working Retired Working Non-Farm Retired

Physiologic Measures
Pulse• (beats/min) Males 71.40 70.14 72 .83 71 .57
Females 75 .97 72.68 75.29 72.00 t
Systolic BP* (mm Hg) Males 137.24 136.49 139.24 138.48
Females 138.57 136.16 139.43 137.01
Diastolic BP* (mm Hg) Males 72.61 72.62 70.05 70.05 t
Females 72.72 71 .38 71.59 70.25
Quetelet index• Males 3.76 3.63 3.58 3.54
Females 3.62 3.63 3.49 3.51 :j:

Self-perceived health • Males 2.20 1.92 2.02 1.75 t §

status Females 2.16 1.91 2.11 1.86 :j:

Limitation in Activity•
Disability days Males 0.10 0.05 0.09 0.05
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Females 0.16 0.12 0.17 0.13

Limited activity days Males 0.48 0.13 0.33 0.00
Females 0.49 0.34 0.44 0.29
Physical Function II
I# Males 2.42 2.71 2.38 2.67 §
Females 2.42 2.62 2.22 2.43 § t
II** Males 7.91 6.85 7.57 6.51 §
Females 8.97 8.13 9.27 8.43 t
II Itt Males 0.26 0.14 0.41 0.29
Females 0.31 0.20 0.52 0.40 t
Vision II§§ Males 5.83 5.92 5.83 5.92
Females 5.83 5.88 5.76 5.80
HearingiiH Males 9.90 9.16 9.46 8.72 :j:
Females 8.50 8.28 8.52 8.29

• Standardized for age 75, non-smoker and non-drinker, using individual analysis of covariance models.
t P s .OS .
:j: p < .005.
§ p < .001.
# A low score represents greater dependence.
11 Standardized for age 75, using individual analysis of covariance models.
•• A high score represents greater functional difficulty.
tt A high score represents greater functional dependence.
H A high score represents increased hearing problems.
§§ A low score represents increased vision problems.

DISCUSSION
The results indicate that, of those who survived to be
surveyed, extended exposure ( 2:25 yr) to farm work
does not have a major impact on the overall current
health status of elderly men and women as we defined
it. That is, in some ways they are healthier and in others
they are less healthy. However, detected differences in
health status associated with farm work history involv-
ing certain physical and mental functions and the prev-
alence of chronic respiratory problems deserve addi-
tional comment.
The Physical Function I index is comprised of rela-
tively strenuous activities (i.e., the ability to do heavy
housework, walk a flight of stairs, and walk a half-mile)
and showed that women (statistically significant) and
men with farm exposure currently had a greater degree
of functional independence. The other indices deal
with activities that are generally less taxing and, thus,
they may be less sensitive to functional differences in a
generally healthy, non-institutionalized population .
Moreover, as time on the farm increased, it is not un-
expected that a more functionally fit workforce was se-
lected. It might also follow that this group would sus-
tain greater functional independence over time than
the group that dropped out of the farm labor force
before 25 yr had elapsed-perhaps due to chronic ill-
ness or disability.
The greater functional independence enjoyed by ex-
farmers may also be related in part to this group's experi-
encing fewer symptoms of anxiety and depression, al-
though the individual relationships for the most part
were not statistically significant. In addition, farmers ex-
perience, on average, a more physically active lifestyle
than non-farmers (this is particularly true of this study
group whose farm work was far less mechanized than

September/October 1985 [Vol. 40, (No. 5)] 251

 Table 7.-Adjusted Mean Values• of Mental Health According to Work History
Farm
Mental Health Sex Retired
Depression# Males 13.85
Females 14.19
Anxiety II Males 6.57
Females 6.70
Memory•• Males 10.34
Females 10.03
• Standardized for age 75, using individual analysis of covariance models.
t P s .OS .
* p < .001.
§ p < .005.
#A low score indicates fewer or less severe symptoms of depression.
II A low score indicates fewer or less severe symptoms of anxiety.
• • A high score represents greater functional difficulty.
Downloaded by [University of Glasgow] at 09:31 29 December 2014
tt A low score indicates fewer problems with memory.
that of farmers working today), and strenuous physical
activity has been linked with a reduction of anxiety and
depression. 20- 24
The increased prevalence of chronic respiratory prob-
lems among men and women with history of farm work
reported here is similar to the results of studies of those
currently employed on farms. 9 •25- 28 The respiratory dis-
eases characteristic of farmers are occupational
asthma; farmer's lung; and airway obstruction from ex-
posure to organic dust, a variety of chemical irritants
(such as ammonia, hydrogen sulfide, and oxides of ni-
trogen ), and certain pesticides and herbicides. 9
It appears, not surprisingly, that the " healthy
worker" effect is present in this study in that those over
65 yr of age who are currently working are generally
healthier, by our measures, than those who are retired.
Whether, in the elderly population, this is because
those who are healthy are better able to work or those
who work remain healthier due to their activity cannot
be determined here. However, both of these hypothe-
ses are supported in the literature. 29 - 31 It should be
noted that the "healthy worker" effect takes on a
somewhat different connotation in the 65 + population
since there are individuals in this age group who, per-
haps because of a favorable financial posture, choose
retirement irrespective of health status. Furthermore,
recent studies have suggested that on average, the
event of retirement does not significantly influence the
risk of deterioration of physical health .30•32 - 34 These
studies included both white and blue collar workers
and controlled for the effects of illness or disability-
related retirement. It was also noted that often retire-
ment is not a discrete event in that some level of work
continues (with or without pay).
There are several limitations in this study of which
the reader should be aware. Farming is continually
changing; thus the farm exposures of today are differ-
ent from those of yesteryear. Currently, farming is more
mechanized than in that past so the current level of
252
Adjusted Means Statistical Significance
Non-Farm Farm/- Work/-
Working Retired Working Non-Farm Retired
12 .97 13.89 13.02
13.28 14.63 13.72 t *
§
6.09 6.82 6.34 §
6.36 6.88 6.53
10.69 10.71 11.06
10.49 10.16 10.62 t
physical activity is probably lower.35 Today's farmers use
more and different types of equipment and this may alter
their risk of accidents. Modern equipment is probably
safer to operate, 36 although the farmer's exposure to
noxious chemicals has probably increased with time.9
Some may argue that, due to fluctuations in the econ-
omy and the corporatization of farming, the psychologi-
cal stress in farming is greater today than in the past.
The multivariate models were chosen for their overall
appropriateness to the health status variables we inves-
tigated. That is, the underlying assumptions of the sta-
tistical models were met. Additional explanatory varia-
bles such as time since farm exposure, and time since
retirement have potential value when used appropri-
ately with some of the individual health status meas-
ures. However, a diverse set of curvilinear trends exists
between these explanatory variables and some of the
health status measures and, therefore, made it impossi-
ble to include these predictors in a global model. Thus, if
each measure of health status was modeled individually,
one could accommodate the curvilinear relationships as
well as use different sets of explanatory variables.
Our measures of health status and exposure to farm-
ing were self-reported and were not (or could not be)
validated. Non-respondents and selective mortality or
morbidity associated with farming (and non-farming)
are potential areas of concern. That is, if exposure
resulted in death, institutionalization, or migration
from a rural area, these individuals would not have
been included in our study population. Conversely,
factors not related to etiology but which alter survival
with chronic disease (e.g., improved medical care)
might affect the prevalence of disease, conditions, or
symptoms. Nevertheless, by focusing on elderly sur-
vivors, we were able to explore the long-term effects of
exposure to farm work on the current health status of a
large, geographically defined population. This study
should provide a clearer picture of the impact of farm
work on health in later years as well as provide a refer-
Archives of Environmental Health
 ence group for comparisons of the health status of
future generations of farmers.
**********
This study was presented at the Annual Meeting of the Amer-
ican Public Health Association , November 1984, in Anaheim ,
California.
This study was supported by the National Institute on Aging,
Contract NOl-AG-0-2106, Established Populations for Epidemio-
logic Studies of the Elderly.
Submitted for publication january 20, 1985; revised; accepted
for publication May 10, 1985.
Requests for reprints should be sent to: Charles E. Yesalis Ill,
Sc.D., Department of Preventive Medicine and Environmental
Health, College of Medicine, University of Iowa, Iowa City lA
52242.
**********
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