Manufactured doubt and the EPA 2020 chrysotile asbestos risk assessment

While all forms of asbestos have been determined to be carcinogenic to humans by the International Agency for Research on Cancer (IARC) as well as other authoritative bodies, the relative carcinogenic potency of chrysotile continues to be argued, largely in the context of toxic tort litigation. Relatively few epidemiologic studies have investigated only a single form of asbestos; however, one study that included an asbestos textile plant located in Marshville, North Carolina that processed chrysotile asbestos was used by the United States Environmental Protection Agency (EPA) in 2020 to help inform the agency's chrysotile asbestos risk assessment. During the EPA proceedings toxic tort defense consultants submitted comments to the EPA docket and made public presentations asserting that the Marshville plant had processed amphibole asbestos types and should not be used for the chrysotile risk assessment. A detailed evaluation of defense consultant assertions and supporting information and a full assessment of the available information concerning asbestos types used at the Marshville plant was undertaken. The preponderance of evidence continues to support the conclusion that neither amosite nor crocidolite were likely to have been processed in the Marshville textile plant. Defense consultants' assertions about chrysotile use are not supported by the preponderance of evidence and constitute an example of manipulation of information to cast uncertainty and doubt rather than to seek truth and contribute to the body of scientific evidence.

Hearing impairment and tinnitus among older construction workers employed at DOE facilities

BACKGROUND

Few studies have defined the risk of hearing impairment and tinnitus after retirement. This report measures hearing impairment and tinnitus prevalence among older construction trades workers.

METHODS

The study cohort included 21,340 participants in a national medical screening program (www.btmed.org). Audiometric hearing impairment was classified according to the Global Burden of Disease Study. Tinnitus was determined by self-report. An internal subcohort of nonconstruction trades workers served as a reference group. Stratified analyses and multivariate analyses were used to measure the prevalence of hearing impairment and tinnitus by age, sex, and job category.

RESULTS

Prevalence of any hearing impairment was 55.2% (males, 57.7%; females, 26.8%) and increased rapidly with age. Construction trades workers were 40% more likely to have hearing impairment than the reference group. The overall prevalence of tinnitus was 46.52% and followed patterns similar to hearing impairment. Workers with hearing impairment were more likely to also have tinnitus, but tinnitus was frequently reported in the absence of measured hearing impairment.

CONCLUSIONS

Hearing impairment and tinnitus prevalence were much higher in this study than in previous research. A significant reason for the difference is that BTMed follows participants after they have retired. To draw conclusions about the risk for work-related chronic diseases and disorders it is important to monitor workers through their lifetimes. Also, tinnitus by itself should be given greater significance. These findings reinforce the need to promote noise reduction and hearing conservation in construction.

COPD risk among older construction workers-Updated analyses 2020

BACKGROUND

A 2010 study of construction workers participating in medical screening programs at the Department of Energy (DOE) nuclear facilities demonstrated increased chronic obstructive pulmonary disease (COPD) risk. The current study of a larger worker cohort allowed for a more nuanced analysis of COPD risk, including for employment beginning after the mid-1990s.

METHODS

Study participants included 17,941 workers with demographic and smoking data and spirometry with a minimum of three recorded expiratory efforts and reproducibility of forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV₁ ) of 0.2 L or less. COPD was defined as a FEV₁ /FVC ratio below the lower limit of normal using established prediction equations without use of bronchodilation. Stratified analyses explored COPD prevalence by demographic variables and trade. Logistic regression analyses assessed risks by trade and time periods of trade and DOE site work, controlling for age, gender, race/ethnicity, body mass index, and smoking.

RESULTS

Overall COPD prevalence was 13.4% and 67.4% of cases were classified as moderate to severe. Compared to nonconstruction workers, construction trade workers were at significantly increased risk of all COPD (OR = 1.34, 95% CI = 1.29-1.79) and even more so for severe COPD (OR = 1.61, 95% CI = 1.32-1.96). The highest risk trades were cement masons/bricklayers (OR = 2.36; 95% CI = 1.71-3.26) and roofers (OR = 2.22; 95% CI = 1.48-3.32). Risk among workers employed after 1995 was elevated but not statistically significant.

CONCLUSIONS

Construction workers are at increased COPD risk. Results support the prevention of both smoking and occupational exposures to reduce these risks. While the number of participants employed after 1995 was small, patterns of risk were consistent with findings in the overall cohort.

Lung cancer mortality among construction workers: implications for early detection

Objectives

This study examined predictors of lung cancer mortality, beyond age and smoking, among construction workers employed at US Department of Energy (DOE) sites to better define eligibility for low-dose CT (LDCT) lung cancer screening.

Methods

Predictive models were based on 17 069 workers and 352 lung cancer deaths. Risk factors included age, gender, race/ethnicity, cigarette smoking, years of trade or DOE work, body mass index (BMI), chest X-ray results, spirometry results, respiratory symptoms, beryllium sensitisation and personal history of cancer. Competing risk Cox models were used to obtain HRs and to predict 5-year risks.

Results

Factors beyond age and smoking included in the final predictive model were chest X-ray changes, abnormal lung function, chronic obstructive pulmonary disease (COPD), respiratory symptoms, BMI, personal history of cancer and having worked 5 or more years at a DOE site or in construction. Risk-based LDCT eligibility demonstrated improved sensitivity, specificity and positive predictive value compared with current US Preventive Services Task Force guidelines. The risk of lung cancer death from 5 years of work in the construction industry or at a DOE site was comparable with the risk from a personal cancer history, a family history of cancer or a diagnosis of COPD. LDCT eligibility criteria used for DOE construction workers, which includes factors beyond age and smoking, identified 86% of participants who eventually would die from lung cancer compared with 51% based on age and smoking alone.

Conclusions

Results support inclusion of risk from occupational exposures and non-malignant respiratory clinical findings in LDCT clinical guidelines.

Early detection of lung cancer in a population at high risk due to occupation and smoking

OBJECTIVE

The US National Comprehensive Cancer Network (NCCN) recommends two pathways for eligibility for Early Lung Cancer Detection (ELCD) programmes. Option 2 includes individuals with occupational exposures to lung carcinogens, in combination with a lesser requirement on smoking. Our objective was to determine if this algorithm resulted in a similar prevalence of lung cancer as has been found using smoking risk alone, and if so to present an approach for lung cancer screening in high-risk worker populations.

METHODS

We enrolled 1260 former workers meeting NCCN criteria, with modifications to account for occupational exposures in an ELCD programme.

RESULTS

At baseline, 1.6% had a lung cancer diagnosed, a rate similar to the National Lung Cancer Screening Trial (NLST). Among NLST participants, 59% were current smokers at the time of baseline scan or had quit smoking fewer than 15 years prior to baseline; all had a minimum of 30 pack-years of smoking. Among our population, only 24.5% were current smokers and 40.1% of our participants had smoked fewer than 30 pack-years; only 43.5% would meet entry criteria for the NLST. The most likely explanation for the high prevalence of screen-detected lung cancers in the face of a reduced risk from smoking is the addition of occupational risk factors for lung cancer.

CONCLUSION

Occupational exposures to lung carcinogens should be incorporated into criteria used for ELCD programmes, using the algorithm developed by NCCN or with an individualised risk assessment; current risk assessment tools can be modified to incorporate occupational risk.

Work-Related Injury and Management Strategies Among Certified Athletic Trainers

CONTEXT

  Health care workers have high rates of musculoskeletal injuries, but many of these injuries go unreported to workers' compensation and national surveillance systems. Little is known regarding the work-related injuries of certified athletic trainers (ATs).

OBJECTIVE

  To determine the 12-month incidence and prevalence of work-related injuries and describe injury-reporting and -management strategies.

DESIGN

  Cross-sectional study.

SETTING

  Population-based online survey.

PATIENTS OR OTHER PARTICIPANTS

  Of the 29 051 ATs currently certified by the Board of Certification, Inc, who "opted in" to research studies, we randomly selected 10 000. Of these, 1826 (18.3%) ATs currently working in the clinical setting were eligible and participated in the baseline survey.

MAIN OUTCOME MEASURE(S)

  An online survey was e-mailed in May of 2012. We assessed self-reported work-related injuries in the previous 12 months and management strategies including medical care, work limitations or modifications, and time off work. Statistics (frequencies and percentages) were calculated to describe injury rates per 200 000 work hours, injury prevalence, injury characteristics, and injury-reporting and -management strategies.

RESULTS

  A total of 247 ATs reported 419 work-related injuries during the previous 12 months, for an incidence rate of 21.6 per 200 000 hours (95% confidence interval = 19.6, 23.7) and injury prevalence of 13.5% (95% confidence interval = 12.0%, 15.1%). The low back (26%), hand/fingers (9%), and knee (9%) were frequently affected body sites. Injuries were most often caused by bodily motion/overexertion/repetition (52%), contact with objects/equipment/persons (24%), or slips/trips/falls (15%). More than half of injured ATs (55.5%) sought medical care, 25% missed work, and most (77%) did not file a workers' compensation claim for their injury. Half of injured ATs were limited at work (n = 125), and 89% modified or changed their athletic training work as a result of the injury.

CONCLUSIONS

  More than half of AT work-related injuries required medical care or work limitations and were not reported for workers' compensation. Understanding how ATs care for and manage their work-related injuries is important given that few take time off work.

Work-related illness and injury claims among nationally certified athletic trainers reported to Washington and California from 2001 to 2011

BACKGROUND

Little is known about the work-related injury and illnesses experienced by certified athletic trainers (AT).

METHODS

The incidence and characteristics of injury/illness claims filed in two workers' compensation systems were described from 2001 to 2011. Yearly populations at risk were estimated from National Athletic Trainers' Association membership statistics. Incidence rate ratios (IRR) were reported by job setting.

RESULTS

Claims were predominantly for traumatic injuries and disorders (82.7%: 45.7% sprains/strains, 12.0% open wounds, 6.5% bruises) and at these body sites (back 17.2%, fingers 12.3%, and knee 9.6%) and over half were caused by body motion and overexertion (51.5%). Compared with school settings, clinic/hospital settings had modestly higher claim rates (IRR = 1.29, 95% CI: 1.06-1.52) while other settings (e.g., professional or youth sport, nursing home) had lower claim rates (IRR = 0.63, 95% CI: 0.44-0.70).

CONCLUSIONS

These first known estimates of work-related injuries/illnesses among a growing healthcare profession help identify occupational tasks and settings imposing injury risk for ATs. Am. J. Ind. Med. 59:1156-1168, 2016. © 2016 Wiley Periodicals, Inc.

Hospital workers bypass traditional occupational injury reporting systems when reporting patient and visitor perpetrated (type II) violence

BACKGROUND

Under-reporting of type II (patient/visitor-on-worker) violence by workers has been attributed to a lack of essential event details needed to inform prevention strategies.

METHODS

Mixed methods including surveys and focus groups were used to examine patterns of reporting type II violent events among ∼11,000 workers at six U.S. hospitals.

RESULTS

Of the 2,098 workers who experienced a type II violent event, 75% indicated they reported. Reporting patterns were disparate including reports to managers, co-workers, security, and patients' medical records-with only 9% reporting into occupational injury/safety reporting systems. Workers were unclear about when and where to report, and relied on their own "threshold" of when to report based on event circumstances.

CONCLUSIONS

Our findings contradict prior findings that workers significantly under-report violent events. Coordinated surveillance efforts across departments are needed to capture workers' reports, including the use of a designated violence reporting system that is supported by reporting policies. Am. J. Ind. Med. 59:853-865, 2016. © 2016 Wiley Periodicals, Inc.

An urgent need to understand and address the safety and well-being of hospital "sitters"

BACKGROUND

Hospital sitters provide continuous observation of patients at risk of harming themselves or others. Little is known about sitters' occupational safety and well-being, including experiences with patient/visitor-perpetrated violence (type II).

METHODS

Data from surveys, focus groups, individual interviews at six U.S. hospitals were used to characterize the prevalence of and circumstance surrounding type II violence against sitters, as well as broader issues related to sitter use.

RESULTS

Sitter respondents had a high 12-month prevalence of physical assault, physical threat, and verbal abuse compared to other workers in the hospital setting. Sitters and other staff indicated the need for clarification of sitters' roles regarding patient care and sitter well-being (e.g., calling for assistance, taking lunch/restroom breaks), training of sitters in personal safety and de-escalation, methods to communicate patient/visitor behaviors, and unit-level support.

CONCLUSIONS

The burden of type II violence against hospital sitters is concerning. Policies surrounding sitters' roles and violence prevention training are urgently needed.

Physical assault, physical threat, and verbal abuse perpetrated against hospital workers by patients or visitors in six U.S. hospitals

BACKGROUND

An elevated risk of patient/visitor perpetrated violence (type II) against hospital nurses and physicians have been reported, while little is known about type II violence among other hospital workers, and circumstances surrounding these events.

METHODS

Hospital workers (n = 11,000) in different geographic areas were invited to participate in an anonymous survey.

RESULTS

Twelve-month prevalence of type II violence was 39%; 2,098 of 5,385 workers experienced 1,180 physical assaults, 2,260 physical threats, and 5,576 incidents of verbal abuse. Direct care providers were at significant risk, as well as some workers that do not provide direct care. Perpetrator circumstances attributed to violent events included altered mental status, behavioral issues, pain/medication withdrawal, dissatisfaction with care. Fear for safety was common among worker victims (38%). Only 19% of events were reported into official reporting systems.

CONCLUSIONS

This pervasive occupational safety issue is of great concern and likely extends to patients for whom these workers care for.

IARC monographs: 40 years of evaluating carcinogenic hazards to humans

BACKGROUND

Recently, the International Agency for Research on Cancer (IARC) Programme for the Evaluation of Carcinogenic Risks to Humans has been criticized for several of its evaluations, and also for the approach used to perform these evaluations. Some critics have claimed that failures of IARC Working Groups to recognize study weaknesses and biases of Working Group members have led to inappropriate classification of a number of agents as carcinogenic to humans.

OBJECTIVES

The authors of this Commentary are scientists from various disciplines relevant to the identification and hazard evaluation of human carcinogens. We examined criticisms of the IARC classification process to determine the validity of these concerns. Here, we present the results of that examination, review the history of IARC evaluations, and describe how the IARC evaluations are performed.

DISCUSSION

We concluded that these recent criticisms are unconvincing. The procedures employed by IARC to assemble Working Groups of scientists from the various disciplines and the techniques followed to review the literature and perform hazard assessment of various agents provide a balanced evaluation and an appropriate indication of the weight of the evidence. Some disagreement by individual scientists to some evaluations is not evidence of process failure. The review process has been modified over time and will undoubtedly be altered in the future to improve the process. Any process can in theory be improved, and we would support continued review and improvement of the IARC processes. This does not mean, however, that the current procedures are flawed.

CONCLUSIONS

The IARC Monographs have made, and continue to make, major contributions to the scientific underpinning for societal actions to improve the public's health.

Airborne fiber size characterization in exposure estimation: Evaluation of a modified transmission electron microcopy protocol for asbestos and potential use for carbon nanotubes and nanofibers

BACKGROUND

Airborne fiber size has been shown to be an important factor relative to adverse lung effects of asbestos and suggested in animal studies of carbon nanotubes and nanofibers (CNT/CNF).

MATERIALS AND METHODS

The International Standards Organization (ISO) transmission electron microscopy (TEM) method for asbestos was modified to increase the statistical precision of fiber size determinations, improve efficiency, and reduce analysis costs. Comparisons of the fiber size distributions and exposure indices by laboratory and counting method were performed.

RESULTS

No significant differences in size distributions by the ISO and modified ISO methods were observed. Small but statistically-significant inter-lab differences in the proportion of fibers in some size bins were found, but these differences had little impact on the summary exposure indices. The modified ISO method produced slightly more precise estimates of the long fiber fraction (>15 μm).

CONCLUSIONS

The modified ISO method may be useful for estimating size-specific structure exposures, including CNT/CNF, for risk assessment research.

Impact of hospital type II violent events: use of psychotropic drugs and mental health services

BACKGROUND

While violence can adversely affect mental health of victims, repercussions of violence against workers is not as well characterized.

MATERIALS AND METHODS

We explored relationships between workplace violent events perpetrated by patients or visitors (Type II) against hospital employees and the employee use of psychotropic medications or mental health services using a data system that linked violent events with health claims.

RESULTS

Significant associations were observed between reported Type II workplace violent events and employee prescription claims for anti-depressants and anxiolytics combined (RR = 1.45, 95% CI = 1.01-2.33) and anti-depressants alone (RR = 1.65, 95% CI = 1.10-2.48). No significant association between reported violent events and health claims for treatment of depression or anxiety was observed.

CONCLUSIONS

Type II violence experienced by hospital workers may lead to increased use of psychotropic drugs, particularly anti-depressants but also anxiolytics. Our results suggest an important role of employee assistance programs in mitigating the psychological consequences of workplace violent events.

The steps to health employee weight management randomized control trial: rationale, design and baseline characteristics

BACKGROUND

The workplace can be an important setting for addressing obesity. An increasing number of employers offer weight management programs.

PURPOSE

Present the design, rationale and baseline characteristics of the Steps to Health study (STH), a randomized trial to evaluate the effectiveness of two preexisting employee weight management programs offered at Duke University and Medical Center.

METHODS

550 obese (BMI ≥30) employee volunteers were randomized 1:1 to two programs. Baseline data, collected between January 2011 and July 2012, included height/weight, accelerometry, workplace injuries, health care utilization, and questionnaires querying socio-cognitive factors, perceptions of health climate, physical activity, and dietary intake. In secondary analyses participants in the two programs will also be compared to a non-randomized observational control group of obese employees.

RESULTS

At baseline, the mean age was 45 years, 83% were female, 41% white, and 53% black. Mean BMI was 37.2. Participants consumed a mean of 2.37 servings of fruits and vegetables per day (in the past week), participated in 11.5 min of moderate-to-vigorous physical activity, and spent 620 min being sedentary.

CONCLUSION

STH addresses the need for evaluation of worksite interventions to promote healthy weight. In addition to having direct positive effects on workers' health, worksite programs have the potential to increase productivity and reduce health care costs.

Increased lung cancer mortality among chrysotile asbestos textile workers is more strongly associated with exposure to long thin fibres

BACKGROUND

Animal data and physical models suggest that the carcinogenicity of asbestos fibres is related to their size and shape.

OBJECTIVES

To investigate the influence of fibre length and diameter on lung cancer risk in workers at asbestos textile mills in North Carolina and South Carolina, USA.

METHODS

Men and women (n=6136) who worked ≥30 days in production and were employed between 1940 and 1973 were enumerated and followed for vital status through 2003. A matrix of fibre size-specific exposure estimates was constructed using determinations of fibre numbers and dimensions through analysis of 160 historical dust samples by transmission electron microscopy. Associations of lung cancer mortality with metrics of fibre exposure were estimated by Poisson regression with adjustment for age, sex, race and calendar year.

RESULTS

Exposure to fibres throughout the range of length and diameter was significantly associated with increased risk of lung cancer. Models for fibres >5 μm long and <0.25 μm in diameter provided the best fit to the data, while fibres 5-10 μm long and <0.25 μm in diameter were associated most strongly with lung cancer mortality (log rate about 4% per IQR, p<0.001). When indicators of mean fibre length and diameter were modelled simultaneously, lung cancer risk increased as fibre length increased and diameter decreased.

CONCLUSIONS

The findings support the hypothesis that the occurrence of lung cancer is associated most strongly with exposure to long thin asbestos fibres. The relationship of cancer risk and fibre dimensions should be examined in cohorts exposed to other types of fibres.

Musculoskeletal injuries among hospital patient care staff before and after implementation of patient lift and transfer equipment

OBJECTIVE

Using an observational research design and robust surveillance data, we evaluated rates of musculoskeletal (MS) injuries, days away from work, and restricted work days among patient care staff at a medical center and community hospital in the United States over 13 years, during which time a "minimal manual lift" policy and mechanical lift equipment were implemented.

METHODS

Workers' compensation claims data were linked to human resources data to define outcomes of interest and person-time at risk to calculate rates. Poisson and negative binomial regression with lagging were used to compare outcome rates in different windows of time surrounding the intervention. Patterns of MS injuries associated with patient-handling were contrasted to patterns of other MS injuries that would not be affected by the use of mechanical lift equipment.

RESULTS

At the medical center, no change in the patient-handling MS injury rate followed the intervention. A 44% decrease was observed at the community hospital. At both hospitals, the rate of days away declined immediately - before it was reasonable for the intervention to have been adopted.

CONCLUSIONS

Institutional-level changes at the time of the intervention likely influenced observed results with findings only partially consistent with an intervention effect. Observational studies can be useful in assessing effectiveness of safety interventions in complex work environments. Such studies should consider the process of intervention implementation, the time needed for intervention adoption, and the dynamic nature of work environments.

Estimates of historical exposures by phase contrast and transmission electron microscopy for pooled exposure--response analyses of North Carolina and South Carolina, USA asbestos textile cohorts

OBJECTIVES

To develop pooled size-specific asbestos fiber exposure estimates for North Carolina and South Carolina asbestos textile plants.

METHODS

Airborne sample data and prior exposure estimates by phase-contrast microscopy (PCM) for the two cohorts were reviewed and compared. Estimates by transmission electron microscopy (TEM) for 160 membrane filter samples from all plant were pooled. Poisson regression models were developed to predict bivariate diameter/length airborne fiber size distributions based on independent categorical variables for fiber diameter, fiber length, plant, and exposure zone. The model predicted bivariate diameter/length distributions were expressed as the proportion of fibers in 28 size-specific cells and these data were used to calculate PCM to TEM adjustment factors in order to estimate fiber size-specific exposures for the pooled cohort.

RESULTS

Exposure levels in the North Carolina plants were in excess of 50 f/cc for many operations through about 1955 owing to lack of dust control measures in early years whereas levels in the South Carolina plant were generally less than 10 f/cc by about 1950. The Poisson regression models found covariates for plant department to be a stronger predictor of bivariate size proportions than plant; however, a plant effect was observed. The final Poisson models demonstrated good fit to the observed data.

CONCLUSIONS

Consistent with early studies, fiber exposures in the North Carolina plants were much higher than in South Carolina plant. Use of the predicted size-specific TEM exposures by plant and department based on the Poisson model predictions should reduce exposure.

Predictors of lost time from work among nursing personnel who sought treatment for back pain

OBJECTIVE

To examine possible predictors of lost workdays among nurses and nurses' aides who sought treatment for work-related back pain.

PARTICIPANTS

Nursing staff employed at a tertiary care medical center over a 13-year time period (1994 through 2006).

METHODS

We used existing data from clinic surveys administered to nursing personnel during their initial treatment visit to the hospital's occupational health clinic. Predictors of losing ≤ 7 and ≥ 8 workdays was examined.

RESULTS

589 of 708 (83%) nursing personnel with complaints of work-related back pain completed the survey, with 31% resulting in lost workdays. Experiencing sudden onset of pain (RR:1.9; 95% CI: 1.1, 3.1), a combination of severe pain with numbness and tingling in the back/legs (RR: 7.4; 95% CI: 2.9, 18.6), severe pain only (RR: 4.4; 95% CI: 1.8, 11.1), numbness and tingling in the back/legs only (RR: 3.5; 95% CI: 1.0, 12.2), and working < 5 years at the hospital (RR: 2.3; 95% CI: 1.2, 4.7) were predictive of losing ≥ 8 workdays. Job title, work demands, work conflicts, and most psychosocial factors were not predictive.

CONCLUSIONS

Severe pain, neurologic symptoms and sudden onset of pain were predictive of delayed return-to-work; however, these symptoms alone should not be considered indicators of poor outcomes given that most workers who reported these symptoms returned to work in less than 8~days. Among these health care workers, lost workdays appear to be related to more severe pathology rather than workplace characteristics.

Surveillance of nail gun injuries by journeymen carpenters provides important insight into experiences of apprentices

Experienced journeymen conducted detailed surveillance interviews with injured apprentice carpenters (n = 413). Nail gun injuries commonly occurred due to inadvertent discharge, ricocheting or projectile nails, and penetration of the wood surface. Framing nailers with contact trip triggers were most often involved; these triggers allow nail discharge anytime the trigger and nose piece are both depressed including following recoil of the tool after firing. Injured workers made concrete and practical suggestions for prevention. Scenarios were identified where changes in work practice, safer triggers, and thoughtful training could prevent injuries. Most injuries were not reported through workers' compensation; this was often due to perceived lack of injury severity, but also involved subtle as well as overt pressures on apprentices not to report. These case-based analyses are consistent with reports that many injuries from nail guns could be prevented with existing safer trigger mechanisms and training. Efforts should also focus on improved injury reporting.

Continued progress in the prevention of nail gun injuries among apprentice carpenters: what will it take to see wider spread injury reductions?

PROBLEM

Nail guns are a common source of acute, and potentially serious, injury in residential construction.

METHOD

Data on nail gun injuries, hours worked and hours of tool use were collected in 2008 from union apprentice carpenters (n=464) through classroom surveys; this completed four years of serial cross-sectional data collection from apprentices. A predictive model of injury risk was constructed using Poisson regression.

RESULTS

Injury rates declined 55% from baseline measures in 2005 with early training and increased use of tools with sequential actuation. Injury rates declined among users of tools with both actuation systems, but the rates of injury were consistently twice as high among those using tools with contact trip triggers. DISCUSSION AND IMPACT: Nail gun injuries can be reduced markedly through early training and use of tools with sequential actuation. These successful efforts need to be diffused broadly, including to the non-union sector.

Physical assault among nursing staff employed in acute care

Hospital workers are known to be at risk of physical assault. The objective of this study is to characterize injuries resulting from physical assault among hospital nursing staff and to identify associated risk factors. Workers' compensation reports linked to human resources data were used to identify a cohort of aides and nurses employed in acute care units at a major healthcare system from 1997 to 2004 and their reported physical assault events. Poisson regression methods were used to estimate rates and rate ratios (RR) by occupation, gender, race, age, tenure, and hospital unit. During the study period 220 assaults were reported; the overall incidence rate was 1.65 (95% CI: 1.45-1.89) per 100 full-time-equivalent employees (FTEs). Assault risk was higher among those with shorter tenure (< 5 years vs. 15 or more) (RR=1.35, 95% CI: 0.83-2.19) and younger workers (under age 30 vs. 50 or older) (RR=1.30, 95% CI: 0.78-2.19), and lower among Black workers (vs. non-Blacks) (RR=0.63, 95% CI: 0.45-0.90). Incidence rates were highest in Psychiatry (12.65, 95% CI: 8.90-17.99), Neurology (4.43, 95% CI: 3.17-6.20) and Rehabilitation (3.63, 95% CI: 1.51-8.71) units. Interventions targeting Psychiatry, Neurology, and Rehabilitation units, and younger and newly hired staff are warranted. More detailed data are needed to develop targeted interventions.

Airways obstruction among older construction and trade workers at Department of Energy nuclear sites

BACKGROUND

A study of chronic obstructive pulmonary disease (COPD) among 7,579 current and former workers participating in medical screening programs at Department of Energy (DOE) nuclear weapons facilities through September 2008 was undertaken.

METHODS

Participants provided a detailed work and exposure history and underwent a respiratory examination that included a respiratory history, respiratory symptoms, a posterior-anterior (P-A) chest radiograph classified by International Labour Office (ILO) criteria, and spirometry. Statistical models were developed to generate group-level exposure estimates that were used in multivariate logistic regression analyses to explore the risk of COPD in relation to exposures to asbestos, silica, cement dust, welding, paints, solvents, and dusts/fumes from paint removal. Risk for COPD in the study population was compared to risk for COPD in the general US population as determined in National Health and Nutrition Examination Survey (NHANES III).

RESULTS

The age-standardized prevalence ratio of COPD among DOE workers compared to all NHANES III data was 1.3. Internal analyses found the odds ratio of COPD to range from 1.6 to 3.1 by trade after adjustment for age, race, sex, smoking, and duration of DOE employment. Statistically significant associations were observed for COPD and exposures to asbestos, silica, welding, cement dusts, and some tasks associated with exposures to paints, solvents, and removal of paints.

CONCLUSIONS

Our study of construction workers employed at DOE sites demonstrated increased COPD risk due to occupational exposures and was able to identify specific exposures increasing risk. This study provides additional support for prevention of both smoking and occupational exposures to reduce the burden of COPD among construction workers.

Who is paying the bills? Health care costs for musculoskeletal back disorders, Washington State Union Carpenters, 1989-2003

OBJECTIVE

Factors associated with private health insurance payment rates for musculoskeletal back disorders were examined among a 15-year cohort of union carpenters. Payment patterns were contrasted with work-related back injury rates over time.

METHODS

Negative binomial regression was used to assess payment rates; generalized estimated equations accounted for multiple observations per person and cost correlation within subjects.

RESULTS

Payment rates increased after work-related injury and with the number of injuries. Increasing private payments and deductibles (inflation-adjusted and discounted) were observed in contrast with a marked decline in reported work-related injuries.

CONCLUSIONS

Private insurance payments do not appear to be independent of work-related back injury. Findings suggest cost-shifting from workers' compensation to the union-provided health insurance and to the worker; they also provide a warning regarding reliance on workers' compensation statistics for surveillance of work-related disorders or disease.

Occupational injuries among aides and nurses in acute care

BACKGROUND

Occupational injuries are common among nursing personnel. Most epidemiologic research on nursing aides comes from long-term care settings. Reports from acute care settings often combine data on nurses and aides even though their job requirements and personal characteristics are quite different. Our objective was to assess risk of work-related injuries in an acute care setting while contrasting injuries of aides and nurses.

METHODS

A retrospective cohort of aides (n = 1,689) and nurses (n = 5,082) working in acute care at a large healthcare system between 1997 and 2004 were identified via personnel records. Workers' compensation filings were used to ascertain occupational injuries. Poisson regression was used to estimate rate ratios (RR) and 95% confidence intervals (95% CI).

RESULTS

Aides had higher overall injury rates than nurses for no-lost work time (RR = 1.2, 95% CI: 1.1-1.3) and lost work time (RR = 2.8, 95% CI: 2.1-3.8) injuries. The risk of an injury due to lifting was greater among aides compared to nurses for both non-lost work time and lost work time injuries. Injury rates among aides were particularly high in rehabilitation and orthopedics units. Most of the injuries requiring time away from work for both groups were related to the process of delivering direct patient care.

CONCLUSIONS

Our findings illustrate the importance of evaluating work-related injuries separately for aides and nurses, given differences in injury risk profiles and injury outcomes. It is particularly important that occupational safety needs of aides be addressed as this occupation experiences significant job growth.

Mortality of older construction and craft workers employed at Department of Energy (DOE) nuclear sites

BACKGROUND

The U.S. Department of Energy (DOE) established medical screening programs at the Hanford Nuclear Reservation, Oak Ridge Reservation, the Savannah River Site, and the Amchitka site starting in 1996. Workers participating in these programs have been followed to determine their vital status and mortality experience through December 31, 2004.

METHODS

A cohort of 8,976 former construction workers from Hanford, Savannah River, Oak Ridge, and Amchitka was followed using the National Death Index through December 31, 2004, to ascertain vital status and causes of death. Cause-specific standardized mortality ratios (SMRs) were calculated based on US death rates.

RESULTS

Six hundred and seventy-four deaths occurred in this cohort and overall mortality was slightly less than expected (SMR = 0.93, 95% CI = 0.86-1.01), indicating a "healthy worker effect." However, significantly excess mortality was observed for all cancers (SMR = 1.28, 95% CI = 1.13-1.45), lung cancer (SMR = 1.54, 95% CI = 1.24-1.87), mesothelioma (SMR = 5.93, 95% CI = 2.56-11.68), and asbestosis (SMR = 33.89, 95% CI = 18.03-57.95). Non-Hodgkin's lymphoma was in excess at Oak Ridge and multiple myeloma was in excess at Hanford. Chronic obstructive pulmonary disease (COPD) was significantly elevated among workers at the Savannah River Site (SMR = 1.92, 95% CI = 1.02-3.29).

CONCLUSIONS

DOE construction workers at these four sites were found to have significantly excess risk for combined cancer sites included in the Department of Labor' Energy Employees Occupational Illness Compensation Program (EEOCIPA). Asbestos-related cancers were significantly elevated.

Compensation costs of work-related back disorders among union carpenters, Washington State 1989-2003

BACKGROUND

We measured resources used to provide medical care and to estimate lost productivity represented by payments for lost work time or impairment for work-related back injuries among a large cohort of union carpenters over 15 years.

METHODS

Using administrative data we identified a cohort of carpenters, their hours worked, their workers' compensation claims and associated costs. After adjustment for inflation and discounting to 2006 dollars, yearly costs for injuries and payment rates based on hours worked were calculated. Using negative binomial regression, dollars paid per claim were modeled based on age, gender, union tenure, and predominant type of work of the carpenter and whether the injury resulted from overexertion or acute trauma.

RESULTS

Workers' compensation costs for back injuries exceeded $128 million dollars between 1998 and 2003, representing payments of $0.97 for each hour of work. Costs per hour of work declined substantively over time due largely to declining overexertion injury rates. Traumatic injuries, though less common than overexertion injuries, were more expensive. Costs increased with the number of prior back injuries and with increasing age, beginning as early as age 30.

CONCLUSIONS

Increasing costs even among relatively young carpenters likely reflect the heavy nature of their work rather than simply the effects of biological aging. Musculoskeletal back problems remain a common, and consequently costly, source of injury among these carpenters that needs to be addressed through engineering modifications; there are also clearly needs for prevention of the often more costly back injuries associated with acute trauma.

Systematic reviews of workplace injury interventions: what are we missing?

BACKGROUND

There are pitfalls associated with applying a biomedical model with its emphasis on experimental designs to the evaluation of workplace injury interventions.

OBJECTIVES

Evaluation over enough time is essential in occupational safety when interventions are expected to have a latent effect as well as to assess sustained effects. Controlled trials are not well-suited to this task and are not even possible in circumstances where a policy change, such as legislative action, affects a population of workers simultaneously. Social context influences occupational injury interventions, their evaluation and the wider generalization of findings but is lost in the pooling of data for meta-analyses. Some of these issues can be addressed through recognition of the contribution of diverse observational methodologies in intervention evaluation, improvement and maintenance of robust surveillance systems, and inclusion of qualitative methodologies not typically embraced by epidemiologists or medical researchers.

METHODS

Through consideration of an evaluation of a legislative effort to prevent falls from height in construction, we demonstrate lack of flexibility in current methods used for evaluating time series analyses in systematic reviews of occupational injury intervention effectiveness.

DISCUSSION AND CONCLUSIONS

These include the manner in which downward change in slope is assessed and the call to demonstrate a significant initial downward change in level. We illustrate essential contextual detail regarding this intervention that is lost in the pooling of data from multiple studies into a combined measure of effect. This reduction of occupational injury intervention evaluation to one of pure statistical significance is ill-conceived, irresponsible, and should be stopped.

Musculoskeletal injuries resulting from patient handling tasks among hospital workers

BACKGROUND

The purpose of this study was to evaluate musculoskeletal injuries and disorders resulting from patient handling prior to the implementation of a "minimal manual lift" policy at a large tertiary care medical center. We sought to define the circumstances surrounding patient handling injuries and to identify potential preventive measures.

METHODS

Human resources data were used to define the cohort and their time at work. Workers' compensation records (1997-2003) were utilized to identify work-related musculoskeletal claims, while the workers' description of injury was used to identify those that resulted from patient handling. Adjusted rate ratios were generated using Poisson regression.

RESULTS

One-third (n = 876) of all musculoskeletal injuries resulted from patient handling activities. Most (83%) of the injury burden was incurred by inpatient nurses, nurses' aides and radiology technicians, while injury rates were highest for nurses' aides (8.8/100 full-time equivalent, FTEs) and smaller workgroups including emergency medical technicians (10.3/100 FTEs), patient transporters (4.3/100 FTEs), operating room technicians (3.1/100 FTEs), and morgue technicians (2.2/100 FTEs). Forty percent of injuries due to lifting/transferring patients may have been prevented through the use of mechanical lift equipment, while 32% of injuries resulting from repositioning/turning patients, pulling patients up in bed, or catching falling patients may not have been prevented by the use of lift equipment.

CONCLUSIONS

The use of mechanical lift equipment could significantly reduce the risk of some patient handling injuries but additional interventions need to be considered that address other patient handling tasks. Smaller high-risk workgroups should not be neglected in prevention efforts.

Lung cancer mortality and fibre exposures among North Carolina asbestos textile workers

OBJECTIVE

To describe mortality among workers exposed to chrysotile asbestos and evaluate the relationship between lung cancer and asbestos fibre exposure.

METHODS

Workers employed for at least 1 day between 1 January 1950 and 31 December 1973 in any of four plants in North Carolina, USA that produced asbestos textile products were enumerated. Vital status was ascertained through 31 December 2003. Historical exposures to asbestos fibres were estimated from work histories and 3578 industrial hygiene measurements taken in 1935-1986. Mortality of the cohort was compared with that of the national population via standardised mortality ratios (SMRs). Exposure-response relationships for lung cancer were examined within the cohort using Poisson regression to compute adjusted mortality rate ratios.

RESULTS

Follow-up of 5770 workers included in the cohort resulted in 181 640 person-years of observation, with 2583 deaths from all causes and 277 from lung cancer. Mortality from all causes, all cancers and lung cancer was significant higher than expected, with SMRs of 1.47 for all causes, 1.41 for all cancer and 1.96 (95% CI 1.73 to 2.20) for lung cancer. SMRs for pleural cancer, mesothelioma and pneumoconiosis were also elevated. The risk of lung cancer and asbestosis increased with cumulative fibre exposure (RR 1.102 per 100 fibre-year/ml, 95% CI 1.044 to 1.164, and RR 1.249 per 100 fibre-year/ml, 95% CI 1.186 to 1.316, respectively, for total career exposure).

CONCLUSIONS

This study provides further evidence that exposure to chrysotile asbestos in textile manufacturing is associated with increased risk of lung cancer, asbestosis cancer of the pleura and mesothelioma.

Demographic, clinical and occupational characteristics associated with early onset of delivery: findings from the Duke Health and Safety Surveillance System, 2001-2004

BACKGROUND

This cross-sectional study explores associations between preterm delivery and demographic, clinical and occupational characteristics of women employed within a university and health system.

METHODS

A comprehensive surveillance system linking individual-level data from Human Resources, medical insurance claims and a job-exposure matrix was used to identify women with a single live birth between 2001 and 2004 and describe maternal characteristics during pregnancy.

RESULTS

Preterm delivery occurred in 7.1% (n = 74) of the 1,040 women, a lower preterm delivery prevalence than observed in the general U.S. population. Nearly all (>99.5%) women utilized prenatal care services. Prevalence of preterm delivery was highest for inpatient nurses, nurses' aides and office staff. In multivariate analyses, preterm delivery was positively associated with several clinical conditions: placenta previa, diabetes and cardiovascular disorder/disease.

CONCLUSIONS

We observed associations between preterm delivery and several previously indicated clinical conditions. Further study of the effect of job characteristics on preterm delivery is warranted.

Prevention of traumatic nail gun injuries in apprentice carpenters: use of population-based measures to monitor intervention effectiveness

INTRODUCTION

Nail guns are responsible for a significant injury burden in residential construction. Risk, based on hours of work, is particularly high among apprentice carpenters due in part to more frequent exposure to tool use.

METHODS

Nail gun injuries were evaluated over 3 years among carpenters enrolled in two apprenticeship programs in the Midwest (2.3 million residential work hours observed) following initiation of training and a voluntary ANSI standard change calling for safer sequential triggers on framing nailers. Injury rates, based on hours of tool use, were calculated yearly. Rates and adjusted rate ratios were calculated with Poisson regression. Attributable risk percent (AR%) and population attributable risk (PAR%) were calculated yearly for modifiable independent risk factors for injury including lack of training in tool use and type of trigger mechanism on tools being used.

RESULTS

As apprentices received training and safer trigger mechanisms became more widespread, injury rates decreased significantly (31%). While school training and hands-on mentoring were both important, injury rates were lowest among apprentices who received both. Although injury rates changed over the observation period, the relative risk comparing trigger mechanisms did not; contact trip triggers consistently carried a twofold risk.

CONCLUSIONS

Although training and safer trigger use both increased, because of the relative prevalence of training and trigger exposures in this population, the engineering solution consistently had the potential to make more difference in population risk. Our findings demonstrate the utility of observational methods including measures of population-based risk in monitoring intervention effectiveness and making recommendations that lead to injury reduction.

Estimates of historical exposures by phase contrast and transmission electron microscopy in North Carolina USA asbestos textile plants

OBJECTIVES

To develop a job-exposure matrix (JEM) for fibre exposures in three asbestos textile plants and to develop estimates of fibre size-specific exposures.

METHODS

Historical dust samples from three North Carolina, USA asbestos textile plants were obtained. Plant specific samples were used to express impinger dust concentrations as fibre concentrations by phase contract microscopy (PCM). Mixed models were used to estimate PCM exposures by plant, department, job and calendar time. Archived membrane filter samples were analysed by transmission electron microscopy (TEM) to determine the bivariate diameter/length distribution of airborne fibres by plant and operation.

RESULTS

PCM fibre levels estimated from the models were very high in the 1930s, with some operations having in excess of 200 fibres/ml, and decreased appreciably over time. TEM results for 77 airborne dust samples found that only a small proportion of airborne fibres were measured by PCM (>0.25 microm in diameter and >5 microm in length) and the proportion varied considerably by plant and operation (range 2.9% to 10.0%). The bivariate diameter/length distribution of airborne fibres demonstrated a relatively high degree of variability by plant and operation. PCM adjustment factors also varied substantially across plants and operations.

CONCLUSIONS

These data provide new information concerning airborne fibre levels and characteristics in three historically important asbestos textile plants. PCM concentrations were high in the early years and TEM data demonstrate that the vast majority of airborne fibres inhaled by the workers were shorter than 5 microm in length, and thus not included in the PCM-based fibre counts.

How much time is safety worth? A comparison of trigger configurations on pneumatic nail guns in residential framing

OBJECTIVE

Nail gun injuries are among the most common in wood frame construction. Despite evidence that the majority of injuries from unintentional firings could be prevented with a sequential trigger mechanism on the tools, the safer trigger has not been embraced in the fast-paced residential construction industry. An experiment was conducted in an attempt to realistically evaluate the magnitude of productivity concerns.

METHODS

Ten journeymen carpenters built a yard shed on two occasions, using nail guns with two different trigger configurations, alternately, under controlled conditions. Mean differences in time required, nails used, and proper placement were evaluated considering the trigger used and whether the building was the carpenter's first or second project.

RESULTS

The sequential trigger tool required a mean of 10 additional minutes of active nailing time, which represented 10% of mean nailing time (97 minutes) but only 0.77% of the total mean work time (1,298 minutes) to construct each shed. No significant differences were observed in nail count or placement. The majority of the time variability was related to who was using the tool, rather than the type of tool in the person's hand.

CONCLUSIONS

Productivity concerns should focus more on improving the skill of the carpenter rather than on the trigger mechanism. Failure to place tools with the safer trigger configuration, which requires the nose piece to be depressed before the trigger is pulled, in the hands of workers does not make sense given the frequency and potential repercussions of injuries associated with the use of these tools in wood framing.

Surveillance of musculoskeletal injuries and disorders in a diverse cohort of workers at a tertiary care medical center

BACKGROUND

The purpose of this study was to investigate the incidence of work-related musculoskeletal (MSK) injuries and disorders among a dynamic cohort of health care workers, including direct care providers and support services, employed at a tertiary care medical center.

METHODS

Human resources data were used to define the cohort and time at risk. Workers' compensation (WC) records (1997-2003) were utilized to identify work-related MSK claims. Poisson regression was used to generate gender specific rate ratios and 95% confidence intervals (CI) of MSK injuries among workgroups.

RESULTS

MSK injuries resulted equally ( approximately 30% each) from lift/push/pull of equipment, patient handling, and slip/trip/falls. Injury rates and their mechanisms varied substantially by occupational group, gender, and race. Even with declining injury rates over time, black workers had rates 2.5 times higher than other workers and women had rates 1.8 times higher than men. Male and female nurses' aides, housekeepers, and radiology technicians had among the highest rates of injury, while lost workdays rates were highest for male and female nurses' aides, female housekeepers, and male patient transporters.

CONCLUSIONS

Differential risk associated with work tasks in highly segregated work populations can contribute to disparities in health, and the patterns we observed partly reflect the high concentration of female and black workers in occupations with increased physical demands. While the greatest public health impact will be achieved by implementing prevention strategies among large workgroups with high injury rates, public health efforts must not ignore smaller, often segregated, workgroups identified in this study as high risk.

Development of a fibre size-specific job-exposure matrix for airborne asbestos fibres

OBJECTIVE

To develop a method for estimating fibre size-specific exposures to airborne asbestos dust for use in epidemiological investigations of exposure-response relations.

METHODS

Archived membrane filter samples collected at a Charleston, South Carolina asbestos textile plant during 1964-8 were analysed by transmission electron microscopy (TEM) to determine the bivariate diameter/length distribution of airborne fibres by plant operation. The protocol used for these analyses was based on the direct transfer method published by the International Standards Organization (ISO), modified to enhance fibre size determinations, especially for long fibres. Procedures to adjust standard phase contrast microscopy (PCM) fibre concentration measures using the TEM data in a job-exposure matrix (JEM) were developed in order to estimate fibre size-specific exposures.

RESULTS

A total of 84 airborne dust samples were used to measure diameter and length for over 18,000 fibres or fibre bundles. Consistent with previous studies, a small proportion of airborne fibres were longer than >5 microm in length, but the proportion varied considerably by plant operation (range 6.9% to 20.8%). The bivariate diameter/length distribution of airborne fibres was expressed as the proportion of fibres in 20 size-specific cells and this distribution demonstrated a relatively high degree of variability by plant operation. PCM adjustment factors also varied substantially across plant operations.

CONCLUSIONS

These data provide new information concerning the airborne fibre characteristics for a previously studied textile facility. The TEM data demonstrate that the vast majority of airborne fibres inhaled by the workers were shorter than 5 mum in length, and thus not included in the PCM-based fibre counts. The TEM data were used to develop a new fibre size-specific JEM for use in an updated cohort mortality study to investigate the role of fibre dimension in the development of asbestos-related lung diseases.

Follow-up study of chrysotile textile workers: cohort mortality and exposure-response

OBJECTIVES

This report provides an update of the mortality experience of a cohort of South Carolina asbestos textile workers.

METHODS

A cohort of 3072 workers exposed to chrysotile in a South Carolina asbestos textile plant (1916-77) was followed up for mortality through 2001. Standardised mortality ratios (SMRs) were computed using US and South Carolina mortality rates. A job exposure matrix provided calendar time dependent estimates of chrysotile exposure concentrations. Poisson regression models were fitted for lung cancer and asbestosis. Covariates considered included sex, race, age, calendar time, birth cohort and time since first exposure. Cumulative exposure lags of 5 and 10 years were considered by disregarding exposure in the most recent 5 and 10 years, respectively.

RESULTS

A majority of the cohort was deceased (64%) and 702 of the 1961 deaths occurred since the previous update. Mortality was elevated based on US referent rates for a priori causes of interest including all causes combined (SMR 1.33, 95% CI 1.28 to 1.39); all cancers (SMR 1.27, 95% CI 1.16 to 1.39); oesophageal cancer (SMR 1.87, 95% CI 1.09 to 2.99); lung cancer (SMR 1.95, 95% CI 1.68 to 2.24); ischaemic heart disease (SMR 1.20, 95% CI 1.10 to 1.32); and pneumoconiosis and other respiratory diseases (SMR 4.81, 95% CI 3.84 to 5.94). Mortality remained elevated for these causes when South Carolina referent rates were used. Three cases of mesothelioma were observed among cohort members. Exposure-response modelling for lung cancer, using a linear relative risk model, produced a slope coefficient of 0.0198 (fibre-years/ml) (standard error 0.00496), when cumulative exposure was lagged 10 years. Poisson regression modelling confirmed significant positive relations between estimated chrysotile exposure and lung cancer and asbestosis mortality observed in previous updates of this cohort.

CONCLUSIONS

This study confirms the findings from previous investigations of excess mortality from lung cancer and asbestosis and a strong exposure-response relation between estimated exposure to chrysotile and mortality from lung cancer and asbestosis.

Depressive symptoms among working women in rural North Carolina: a comparison of women in poultry processing and other low-wage jobs

We report on the prevalence of self-reported depressive symptoms and associated factors among women employed in a poultry processing plant and a community comparison group of other employed women in northeastern North Carolina in the southern United States. The rural area is poor and sparsely populated with an African American majority. The largest employer of women in the area is a poultry processing plant. The goals of the analyses were 1) to evaluate whether women employed in poultry processing had a higher prevalence of depressive symptoms than other working women from the same geographic area, and 2) to evaluate factors which might be associated with depression among all of these working women, including specific characteristics of their work environment. Recruitment of participants (n=590) and data collection were by community-based staff who were also African American women. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D). Work organization factors were measured with the Job Content Questionnaire (JCQ). Log-binomial regression was used to calculate crude and adjusted prevalence ratios. The prevalence of depressive symptoms, based on a CES-D measure of sixteen or more, was 47.8% among the poultry workers and 19.7% among the other working women (prevalence ratio=2.3). After adjusting for socioeconomic variables, health-related quality of life and coping style, the prevalence of depressive symptoms remained 80% higher among the poultry workers. The prevalence of symptoms was also higher among those who perceived low social support at work, hazardous work conditions, job insecurity, and high levels of isometric load. These factors were all more common among the women employed in the poultry plant. The concentration of this low-wage industry in economically depressed rural areas illuminates how class exploitation and racial discrimination may influence disparities in health among working women.

Musculoskeletal symptoms among poultry processing workers and a community comparison group: Black women in low-wage jobs in the rural South

BACKGROUND

Poultry processing is characterized by rapid line speed and extreme division of labor. Morbidity associated with this work has been reported by scientists, journalists and workers in this fast growing industry.

METHODS

Cross-sectional data from baseline measures of a cohort of black women employed in poultry processing (n = 291) and a community comparison group (n = 299) in rural North Carolina were used to evaluate musculoskeletal symptom reports and to explore factors associated with those reports. Recruitment of participants and collection of data were performed by women in the community circumventing the need to involve employers.

RESULTS

Significant differences in musculoskeletal symptom prevalence were observed between women employed in poultry processing and those of similar economic status employed elsewhere in the same area of rural northeastern North Carolina. After adjusting for other factors independently associated with symptoms among these women including age, depression, and perceived isometric load at work, the prevalence of upper extremity and neck symptoms was 2.4 (95% CI 1.7, 3.2) times higher among women working in poultry processing.

CONCLUSIONS

The findings add to the documentation of occupational health concerns among vulnerable workers employed in poultry processing in our state; in this economically depressed area of rural northeastern North Carolina poultry processing is the largest single employer of women. On a larger scale, the potential magnitude of upper extremity morbidity among women employed in poultry processing should be viewed with the knowledge that poultry processing is a growing industry in the U.S. with work done largely by blacks and immigrants.

Obesity and Workers' Compensation

BACKGROUND

Obese individuals have increased morbidity and use of health services. Less is known about the effect of obesity on workers' compensation. The objective of this study was to determine the relationship between body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) and number and types of workers' compensation claims, associated costs, and lost workdays.

METHODS

Retrospective cohort study. Participants included 11 728 health care and university employees (34 858 full-time equivalents [FTEs]) with at least 1 health risk appraisal between January 1, 1997, and December 31, 2004. The main outcome measures were stratified rates of workers' compensation claims, associated costs, and lost workdays, calculated by BMI, sex, age, race/ethnicity, smoking status, employment duration, and occupational group. The body part affected, nature of the illness or injury, and cause of the illness or injury were also investigated. Multivariate Poisson regression models examined the effects of BMI, controlling for demographic and work-related variables.

RESULTS

There was a clear linear relationship between BMI and rate of claims. Employees in obesity class III (BMI >/=40) had 11.65 claims per 100 FTEs, while recommended-weight employees had 5.80; the effect on lost workdays (183.63 vs 14.19 lost workdays per 100 FTEs), medical claims costs ($51 091 vs $7503 per 100 FTEs), and indemnity claims costs ($59 178 vs $5396 per 100 FTEs) was even stronger. The claims most strongly affected by BMI were related to the following: lower extremity, wrist or hand, and back (body part affected); pain or inflammation, sprain or strain, and contusion or bruise (nature of the illness or injury); and falls or slips, lifting, and exertion (cause of the illness or injury). The combination of obesity and high-risk occupation was particularly detrimental.

CONCLUSIONS

Maintaining healthy weight not only is important to workers but should also be a high priority for their employers given the strong effect of BMI on workers' injuries. Complementing general interventions to make all workplaces safer, work-based programs targeting healthy eating and physical activity should be developed and evaluated.

Are we failing vulnerable workers? The case of black women in poultry processing in rural North Carolina

In 1989, North Carolina Occupational Safety and Health Administration (OSHA) inspectors cited two poultry processing plants in northeastern North Carolina for serious repetitive motion problems. In 1990, investigators from the National Institute for Occupational Safety and Health confirmed significant upper extremity musculoskeletal symptoms and disorders among workers. We now report on analyses of baseline data collected from a cohort of women employed in one of these plants. The plant, which is the largest employer of women in the area, is located in a sparsely populated area with a black majority where nearly one-third of the population lives below the poverty level. Conditions we report suggest failure of existing health and safety systems, both regulatory and consultative, to prevent morbidity among vulnerable women in this industry, as well as social and economic conditions that influence availability of work and use of benefits to which they are entitled.

Nail gun injuries in apprentice carpenters: risk factors and control measures

BACKGROUND

Nail guns increase residential construction productivity but their use is associated with risk of injury.

METHODS

Active surveillance data from 772 apprentice carpenters were used to document the injury risk associated with the use of nail guns and the potential impact of modifiable risk factors. Using reported work hours and nail gun injuries injury rates per 200,000 hr worked in the past year were calculated. Using estimates of hours of tool use, Poisson regression was used to calculate adjusted rate ratios for injury associated with time in the trade, trigger mechanism on the tools and training prior to injury.

RESULTS

Forty-five percent of these apprentices had sustained a nail gun injury; injury rates in the past year based on hours of work were considerably higher than previously recognized. Those with less than 1 year in the trade compared to those with more than 5 years experience (RR = 2.7; 95% CI 1.2, 5.9) and those with no training in tool use (RR = 2.9; 95% CI 1.9, 4.4) were at greatest risk. After adjusting for experience and training, the rate of injury was twice as high with tools with a contact trip trigger compared to those with a sequential trigger (RR = 2.0; 95% CI 1.2, 3.3).

CONCLUSIONS

Preventive measures should include change to the safer sequential trigger that prevents unintentional firing and early training in safe tool use. Because of the high prevalence of use of tools with contact trip triggers the greatest number of injuries among these apprentices could be prevented with an engineering solution.

Exploration of work and health disparities among black women employed in poultry processing in the rural south

We describe an ongoing collaboration that developed as academic investigators responded to a specific request from community members to document health effects on black women of employment in poultry-processing plants in rural North Carolina. Primary outcomes of interest are upper extremity musculoskeletal disorders and function as well as quality of life. Because of concerns of community women and the history of poor labor relations, we decided to conduct this longitudinal study in a manner that did not require involvement of the employer. To provide more detailed insights into the effects of this type of employment, the epidemiologic analyses are supplemented by ethnographic interviews. The resulting approach requires community collaboration. Community-based staff, as paid members of the research team, manage the local project office, recruit and retain participants, conduct interviews, coordinate physical assessments, and participate in outreach. Other community members assisted in the design of the data collection tools and the recruitment of longitudinal study participants and took part in the ethnographic component of the study. This presentation provides an example of one model through which academic researchers and community members can work together productively under challenging circumstances. Notable accomplishments include the recruitment and retention of a cohort of low-income rural black women, often considered hard to reach in research studies. This community-based project includes a number of elements associated with community-based participatory research.

Blood and body fluid exposure risks among health care workers: results from the Duke Health and Safety Surveillance System

BACKGROUND

Health care workers (HCWs) are at risk of exposures to human blood and body fluids (BBF). Needlestick injuries and splashes place HCWs at risk for numerous blood-borne infections including human immunodeficiency virus (HIV), hepatitis B (HBV), and hepatitis C (HCV). Utilizing a new comprehensive occupational health surveillance system, the objective of this research was to better define the BBF exposure risk and risk factors among employees of a large tertiary medical center.

METHODS

A population of 24,425 HCWs employed in jobs with potential BBF exposures was followed for BBF exposure events from 1998 to 2002. BBF exposure rates were calculated for strata defined by age, race, gender, occupation, work location, and duration of employment. Poisson regression was used for detailed analyses of risk factors for BBF exposure.

RESULTS

The study population reported 2,730 BBF exposures during the study period, resulting in an overall annual rate of 5.5 events/100 FTEs and a rate of 3.9 for percutaneous exposures. Higher rates were observed for males, persons employed less than 4 years, Hispanic employees, and persons less than 45 years of age. Much higher rates were observed for house staff, nurse anesthetists, inpatient nurses, phlebotomists, and surgical/operating room technicians. Poisson regression results strengthened and extended results from stratified analyses. Rates of percutaneous exposures from hollow needles were found to decrease over the study period; however, exposure rates from suture needles appear to be increasing.

CONCLUSION

While continued training efforts need to be directed toward new HCWs, our data also suggest that employees who have been in their job 1-4 years continue to be at higher risk of BBF exposures. This research also points to the need for better safety devices/products and work practices to reduce suture-related injuries.

Comparing Questionnaire-Based Methods to Assess Occupational Silica Exposure

BACKGROUND

Epidemiologic assessment of occupational exposure to silica is typically limited to long-term work in the dusty trades, primarily in jobs held by men. We compared alternative questionnaire-based methods to assess silica exposure in a recent case-control study of 265 patients with systemic lupus erythematosus (mostly women) and 355 controls randomly selected from state driver's license registries and frequency-matched by age and sex.

METHODS

In-person interviews included a job history (all jobs held at least 12 months) and checklist of silica-related jobs and tasks (work of at least 2 weeks). Three industrial hygienists reviewed job descriptions without knowing case-control status. Potential high- or moderate-intensity exposures were confirmed or revised based on follow-up telephone interviews.

RESULTS

In the full assessment including all work of at least 2 weeks, 9% of cases and 4% of controls were classified as medium or high silica exposure (odds ratio of disease = 2.9; 95% confidence interval = 1.3-6.4). In contrast, only 4% of cases and 9% of controls were identified by the standardized code groups index as having worked in silica-related industries or occupations for at least 12 months, providing a much lower risk estimate for disease (0.4; 0.2-0.9).

CONCLUSIONS

Specific task-based questions must be included to assess the full potential of occupational silica exposure. These findings highlight the limitations of using standardized code groups to define exposure or to select jobs for industrial hygienist review.