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Objectives: Certified Safe Farm (CSF) is a multimodal intervention composed of four components: safety, health, education, and economic incentive. North Carolina has conducted the largest implementation of CSF outside of the Midwestern United States where it was developed. This paper describes the Efficacy dimension of the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework for the implementation of CSF in North Carolina during 2009-2012 on 113 farms in a three-county, highly productive and diverse agricultural area. Methods: Using descriptive statistics, analysis of variance, correlational analyses, and logistic regression, quantitative data were examined from on-farm safety reviews, as well as primary operators’ use of cost-share funds as an economic incentive (34% participation) to make identified safety and health improvements on the farm. Results: Overall farm safety review scores were generally high (96% passing rate). Category scores revealed hazards in seven key categories: Chemical Storage; Tractors; Machine Shop, Repair Area; Gravity Flow, Auger, and Forage Wagons; Portable Augers; Dairy and Beef Structures; and Swine and Poultry Structures. The cost-share economic incentive component was utilized in addressing hazards in five of these categories, as well as in nine others. The average per farm cost-share reimbursement was $3,276, with a median of $1,615. In total, an investment of $255,307 (farmer investment plus incentive) was made in safety and health improvements on farms (n = 38). Correlation and logistic regression analyses revealed no significant relationships among scores, cost-share investments, and selected farm demographics. Conclusion: Findings suggest the 50% cost-share for safety and health improvements is a promising economic incentive model for CSF implementation. [ABSTRACT FROM AUTHOR]

Certified Safe Farm (CSF) is a multimodal safety and health program developed and assessed through multiple controlled intervention studies in Iowa. Although developed with the intent to be broadly applicable to agriculture, CSF has not been widely implemented outside the midwestern United States. This article describes the CSF implementation process in North Carolina (NC), as piloted on a large-scale in three agriculturally diverse and productive counties of NC, and reports its effectiveness using the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. Implementation involved (1) capacity building through safety and health training, (2) adaptation of components of Iowa's CSF model to NC agriculture, (3) marketing and recruitment, and (4) formative evaluation, including an online survey and focus group discussion. From 2009 to 2012, 113 farms participated in at least one component of the CSF intervention, representing a NC farm participation rate of 3.1% in the study area. A major adaptation of NC implementation was the utilization of NC Cooperative Extension as the local driver of implementation in contrast to local AgriSafe clinics in Iowa. The most innovative adaptation to CSF components was the development of a defined economic incentive in the form of a cost-share program. The RE-AIM framework was found to be useful and relevant to the field of agricultural health and safety translational research. This study provides effectiveness measures and implementation alternatives useful for those considering implementing CSF. It informs current efforts to move CSF from research to practice through the National Sustainable Model CSF Program initiative. [ABSTRACT FROM AUTHOR]