Background. Children working and living in agriculture production environments are at risk of agriculture related injury, but the distinction between work and non-work related injuries is not clear. This study evaluates the role of bystanding and the risk of agriculture related injury in a five-state study of agricultural households.

Methods. The RRIS-II followed 16,546 children less than 20 years of age (∼85% of eligible) from rural communities in the Midwest for two six-month recall periods in 1999 and 2001. Injury events involving children, demographic, and exposure data were collected using computer-assisted telephone interviews. A nested-case-control study of children evaluated the determinants of being a bystander in high risk agricultural environments. Child injuries were cataloged using narrative scenarios into worker and bystander categories, those being: directly work-related, indirectly work-related, non-working accomplice and non-working attendant . Multivariate logistic regression analyses were used to estimate the risk of child bystanding and agricultural injury due to bystanding, while controlling for potentially confounding variables.

Results. Among the 463 child injury events 102 were bystanders. Of the bystander-related injuries, 14 were identified as indirectly work-related, 27 non-working accomplices, and 60 non-working attendants. The reported injuries resulted in more than seven days of restricted activities for 37% of bystander injury events and 28% for working children injury events. Bystanding exposures associated with childhood agricultural injury, multivariate analyses revealed odds ratios and 95% confidence intervals of: 1.0 (0.7-1.4) - driveways; 1.5 (1.1-1.9) - used equipment; 1.4 (1.1-1.8) - stored equipment; 1.2 (0.9-1.6) - workshops ; 1.2 (0.9-1.7) - bodies of water; 1.4 (1.0-1.9) - fields/barnyards; and 1.3 (0.9-1.7) - animals. Also, important associations were identified between a parent's belief in their child's readiness to do chores, based on specific characteristics, and bystanding in several locations on the operation.

Conclusions. Although parents cannot child-proof their operations, it is important for them to understand the apparent risks of bystanding. Agriculture-related bystander injuries in children and their attendant risks are distinct from work-related injuries and thus, prevention and control may require unique strategies.