Dissemination and Evaluation of an Opioid Hazard Awareness Training for Stone, Sand, and Gravel Miners.

OBJECTIVE: In response to elevated risk factors, an opioid hazard awareness training for the sand, stone, and gravel mining sector was developed and embedded in annual safety training. METHODS: After positive results from a prior study among Massachusetts workers, a revised training was disseminated across the United States. Two hundred post-training surveys were obtained and compared with results from the Massachusetts cohort. RESULTS: Participants' knowledge about opioid-based medications, confidence in talking to a doctor about opioids and/or to a coworker about their own use of opioids, and ability to refer struggling coworkers to resources improved. Massachusetts respondents had slightly more favorable responses. Both cohorts had strong positive views of the training. CONCLUSIONS: These results highlight the feasibility and effectiveness of opioid hazard prevention training for a high-risk worker population.

Total Worker Health® Employer Preparedness: A Proposed Model and Survey of Human Resource Managers' Perceptions.

OBJECTIVE: Recent disasters have demonstrated gaps in employers' preparedness to protect employees and promote their well-being in the face of disruptive events. Our objective was to develop a useful strategy for advancing comprehensive employer preparedness and to assess employer preparedness in a sample of employers. METHODS: A Total Worker Health Employer Preparedness Model was developed to include seven domains: planning, human resources policies, hazard reduction, training, staffing, communications, and resources for resilience. A Survey and scoring Index based upon the Model were administered to human resources professionals in the northeast United States. RESULTS: Seventy-six responded, representing diverse employment sectors. The mean Index score was 8.8 (out of 23), which is a moderate level of preparedness. Nine scored over 15, indicating greater preparedness. Thirteen scored 0. Employers were most prepared for severe weather events and least prepared for acts of violence. There were no significant differences by sector, size, or reach, although the health-care sector reported higher scores. CONCLUSIONS: This unique attempt to assess TWH Employer Preparedness can serve as the basis of important further study that strengthens the empirical basis of the construct. Additionally, the Model, Survey, and Index can assist employers in advancing their preparedness for all hazards.

Preventing Opioid-Related Harms in the Construction Industry.

The construction sector has been hit hard by the opioid crisis. We describe CPWR-The Center for Construction Research and Training's recent efforts to address the challenges of opioid use in the construction industry. With support and guidance from the North America's Building Trades Unions Opioid Task Force, CPWR undertook three projects to promote prevention and best practices for struggling construction workers. The first project focused on recommendations for communications that reframe stigmatizing narratives into effective messages about prevention solutions. The second project refined and distributed a one-hour construction worker opioid hazard awareness training module. The third project assessed opportunities and barriers for the expansion and improvement of existing union peer support programs to support workers through treatment and recovery. Additional resources, such as opioid hazard tool box talks, to help reverse the impact on the sector are also described.

Promoting Opioid Awareness Through a Union-Based Peer Training Model.

Work factors, including physical job demands, appear to be risk factors for opioid overdoses. We collaborated with unions representing workers in high-risk occupations and offered resources to develop tailored educational interventions for their members. An ironworkers' local, a statewide nurses' union, and a Teamsters local union participated, at levels higher than we had anticipated. The three unions trained 285 workers, including apprentices, stewards, and those nearing retirement. Short surveys assessed pre- and post-training knowledge, attitudes, confidence in helping others, and related domains. Seventy percent of respondents reported heavy or very heavy physical demands at work, and one-half had experienced work-related pain. After training, participants reported more knowledge about opioids, less concern about stigma related to help-seeking, and more ability to provide help to a co-worker struggling with opioids. Peers with recovery experience provided a unique contribution to training. Tailored job-specific and peer-delivered educational interventions may be able to reduce the potential impact of opioids on working people.

Work Environment Factors and Prevention of Opioid-Related Deaths.

Opioid use disorder (OUD) and opioid overdose deaths (OODs) are prevalent among US workers, but work-related factors have not received adequate attention as either risk factors or opportunities for OOD prevention. Higher prevalence of OOD in those with heavy physical jobs, more precarious work, and limited health care benefits suggest work environment and organizational factors may predispose workers to the development of OUD.Organizational policies that reduce ergonomic risk factors, respond effectively to employee health and safety concerns, provide access to nonpharmacologic pain management, and encourage early substance use treatment are important opportunities to improve outcomes. Organizational barriers can limit disclosure of pain and help-seeking behavior, and opioid education is not effectively integrated with workplace safety training and health promotion programs.Policy development at the employer, government, and association levels could improve the workplace response to workers with OUD and reduce occupational risks that may be contributing factors.

Occupational Exposure and Ventilation Assessment in New York City Nail Salons.

In 2015, New York State enacted new ventilation regulations to protect employees and clients from exposure to chemicals used in nail salons. This study measured common air pollutants found in nail salons and assessed compliance with ventilation requirements. Area sampling was conducted in 12 nail salons located in New York City for three consecutive days (Thursday, Friday, and Saturday) to measure total volatile organic compounds (TVOCs), methyl methacrylate, toluene, and ethyl acetate concentrations and estimate ventilation rates. Salon characteristics were determined through a walkthrough inspection and survey administered to the manager. The average daily concentration of carbon dioxide and TVOCs across all salons was 1070 ppm [standard deviation (SD) = 440 ppm] and 29 ppm (SD = 25 ppm), respectively. Chemical-specific air sampling showed low to non-detectable levels of the three measured chemicals. Seventy-five percent of the nail salons did not meet general minimum outdoor airflow requirements. Little temporal variation was observed in day-to-day average concentrations of contaminants within salons, indicating uniform exposure during high customer count days. Salons that met the outdoor airflow requirements had twice the average daily customers (83 versus 42) and half the TVOC concentrations compared with salons that did not (33 versus 16 ppm). Nail salons not meeting ventilation requirements tended to have fewer customers and managers that did not understand the essential components of the ventilation system. Data from this study can be used as evidence of reduction in exposure due to compliance with the ventilation requirements.

Improving Boston Nail Salon Indoor Air Quality Through Local Public Health Regulation, 2007-2019.

In 2011, following years of outreach and training, Boston, Massachusetts, enacted regulations to improve health and safety in nail salons. These were amended in 2013 to require mechanical ventilation, including dedicated exhaust for each manicure and pedicure station. As of June 2019, 185 of 190 salons have satisfied the regulatory requirements. Regulations can help ensure that environmental health benefits are widespread and that small businesses' investment in occupational health does not result in a competitive disadvantage.

Opioid-related overdose deaths by industry and occupation-Massachusetts, 2011-2015.

BACKGROUND: Thousands of people in the United States continue to die from opioid overdoses every year. Work-related injuries and other factors associated with work may increase exposure to opioids and, subsequently, opioid-related overdose deaths (OROD). This study sought to determine whether OROD rates differed by industry and occupation and explored work-related factors that might contribute to these differences. METHODS: We coded industry and occupation information on death certificates for all OROD among Massachusetts residents from 2011 to 2015. We estimated rates of OROD by industry and occupation using Massachusetts employment data. National survey data were used to explore whether work-related factors known to vary by occupation (occupational injury and illness, job insecurity, and paid sick leave) correlate to observed differences in OROD. RESULTS: Several industries and occupation groups had rates of OROD that were significantly higher than the rates for other workers. Construction workers and fishing workers stood out for having OROD rates many times higher than the average for all workers. Occupation groups with high rates of occupational injuries and illnesses, high job insecurity, and low availability of paid sick leave had higher rates of OROD. CONCLUSIONS: These findings underscore the need for policy and educational interventions to reduce OROD tailored to the needs of high rate worker populations. Interventions should address workplace hazards that cause injuries for which opioids are prescribed, as well as best practices in medical management and return to work following injury, safer prescribing, enhanced access to treatment for opioid use disorders, and overdose prevention education.

Engaging Small Residential Construction Contractors in Community-Based Participatory Research to Promote Safety.

Construction is a large employment sector with a high prevalence of small businesses. Despite the high injury rates reported for employees of small construction firms, these firms are under-represented in occupational safety research studies. Such studies are needed to understand barriers experienced by these firms and to examine ways to overcome them. However, challenges accessing and recruiting this hard-to-reach population are frequently reported. Traditional approaches of recruiting through unions or workers' compensation insurers may not be appropriate or effective for small construction businesses. Previous studies have demonstrated the value of academic collaborations with community-based organizations for recruiting participants from hard-to-reach populations for research studies. In accordance with the principles of Community-Based Participatory Research (CBPR), we formed a recruitment team comprised of staff from a local union, a community organization, and a community outreach team to recruit small construction contractors in Lawrence, MA. Media marketing strategies, participation in community events, exploring neighborhoods in search of ongoing residential projects, and partnership with vocational training institutions and building trade associations were some of the strategies implemented during this project. We recruited 118 contractors, supervisors, and foremen from more than 50 construction firms across the Greater Lawrence area to participate in an intervention project to reduce falls and silica exposure. The CBPR approach facilitated the development and implementation of recruitment strategies that resulted in the participation of a significant number of hard-to-reach small construction contractors.

Without Warning: Worker Deaths From Heat 2014-2016.

Worker deaths from heat exposure are unlike heat deaths in the general population; workers tend to be outside in variable temperatures and younger than sixty-five years. Climate change will increase the frequency, duration, and variability of hot temperatures. Public health warning systems, such as the Heat Index of the National Weather Service, do not generally account for workers' greater likelihood of exposure to direct sunlight or exertion. Only 28% of the 79 worker heat-related fatalities during 2014-2016 occurred on days when the National Weather Service warning would have included the possibility of fatal heat stroke. Common heat illness prevention advice ignores workers' lack of control over their ability to rest and seek cooler temperatures. Additionally, acclimatization, or phased-in work in the heat, may be less useful given temperature variability under climate change. Workers' vulnerability and context of heat exposure should inform public health surveillance and response to prevent heat illness and death.

Assessing indoor air quality in New York City nail salons.

Nail salons are an important business and employment sector for recent immigrants offering popular services to a diverse range of customers across the United States. However, due to the nature of nail products and services, salon air can be burdened with a mix of low levels of hazardous airborne contaminants. Surveys of nail technicians have commonly found increased work-related symptoms, such as headaches and respiratory irritation, that are consistent with indoor air quality problems. In an effort to improve indoor air quality in nail salons, the state of New York recently promulgated regulations to require increased outdoor air and "source capture" of contaminants. Existing indoor air quality in New York State salons is unknown. In advance of the full implementation of the rules by 2021, we sought to establish reliable and usable baseline indoor air quality metrics to determine the feasibility and effectiveness of the requirement. In this pilot study, we measured total volatile organic compounds (TVOC) and carbon dioxide (CO2) concentrations in 10 nail salons located in New York City to assess temporal and spatial trends. Within salon contaminant variation was generally minimal, indicating a well-mixed room and similar general exposure despite the task being performed. TVOC and CO2 concentrations were strongly positively correlated (ρ = 0.81; p < 0.01) suggesting that CO2 measurements could potentially be used to provide an initial determination of acceptable indoor air quality for the purposes of compliance with the standard. An almost tenfold increase in TVOC concentration was observed when the American National Standards Institute/American Society of Heating, Refrigerating and Air-Conditioning Engineers (ANSI/ASHRAE) target CO2 concentration of 850 ppm was exceeded compared to when this target was met.

The Extractive Industries: Asserting Their Place in Global Health Pedagogy.

The extractive industries play a central role in determining the social determinants of global health yet may not be a core subject of global health studies. This article describes how an undergraduate seminar in global health takes on questions and examples related to the "causes of causes" and challenges instructors to find a place for discussion of extraction of wealth, development, and health in their curricula.

Latency attention deficit: Asbestos abatement workers need us to investigate.

Little is known of the impact of asbestos on the health of the workers in the United States who have removed or abated asbestos from buildings following recognition of its adverse effects on health. The United States does not have a national occupational health surveillance network to monitor asbestos-related disease and, while the United States Occupational Health and Safety Administration has a strong and detailed asbestos standard, its enforcement resources are limited. A significant proportion of asbestos abatement workers are foreign-born, and may face numerous challenges in achieving safe workplaces, including lack of union representation, economic vulnerability, and inadequate training. Public health surveillance and increased and coordinated enforcement is needed to monitor the health and exposure experiences of asbestos-exposed workers. Alarming disease trends in asbestos removal workers in Great Britain suggest that, in the United States, increased public attention will be necessary to end the epidemic of asbestos-related disease.

Results of a community-based survey of construction safety climate for Hispanic workers.

BACKGROUND: Hispanic construction workers experience high rates of occupational injury, likely influenced by individual, organizational, and social factors. OBJECTIVES: To characterize the safety climate of Hispanic construction workers using worker, contractor, and supervisor perceptions of the workplace. METHODS: We developed a 40-item interviewer-assisted survey with six safety climate dimensions and administered it in Spanish and English to construction workers, contractors, and supervisors. A safety climate model, comparing responses and assessing contributing factors was created based on survey responses. RESULTS: While contractors and construction supervisors' (n = 128) scores were higher, all respondents shared a negative perception of safety climate. Construction workers had statistically significantly lower safety climate scores compared to supervisors and contractors (30·6 vs 46·5%, P<0·05). Safety climate scores were not associated with English language ability or years lived in the United States. CONCLUSIONS: We found that Hispanic construction workers in this study experienced a poor safety climate. The Hispanic construction safety climate model we propose can serve as a framework to guide organizational safety interventions and evaluate safety climate improvements.

Mesothelioma and employment in massachusetts: analysis of cancer registry data 1988-2003.

BACKGROUND: Cancer registries can be used to monitor mesothelioma cases and to identify occupations and industries previously and newly associated with mesothelioma-causing asbestos exposure by using standard registry data on the "usual" occupation and industry of the case. METHODS: We used the National Institute for Occupational Safety and Health's Standardized Occupational Industry Coding Software to code 564 mesothelioma cases for occupation and 543 for industry of the 1,424 incident mesothelioma in the Massachusetts Cancer Registry from 1988 to 2003. Additionally, we coded the occupation and industry of 80,184 comparison cancer cases (35% of comparison cases in our database). These were used to compute Standardized Morbidity Odds Ratios (SMORs). RESULTS: Seventeen occupations and 11 industries had statistically significant elevated SMORs for mesothelioma. Occupations and industries historically associated with mesothelioma remained elevated in these results. However, we also found statistically significant elevated SMORs for several occupations and industries for which there was previously weak or no association such as chemical engineers, machine operators, and automobile mechanics and machine manufacturing, railroads, and the U.S. Postal Service. CONCLUSIONS: Incident cases of mesothelioma do not appear to be declining in Massachusetts, as legacy exposures to asbestos continue to produce cases in individuals involved in shipbuilding and construction. Exposures in occupations and industries not previously associated with mesothelioma also contribute cases. Cancer registries, with improved data collection, should continue to be monitored for mesothelioma cases and asbestos exposures.

A qualitative investigation of Hispanic construction worker perspectives on factors impacting worksite safety and risk.

BACKGROUND: Hispanic workers have higher rates of injury and death on construction worksites than workers of other ethnicities. Language barriers and cultural differences have been hypothesized as reasons behind the disparate rates. METHODS: We conducted two series of focus groups with union and non-union Hispanic construction workers to ask them about their perceptions of the causes for the unequal rates. Spanish transcripts were translated and coded in QSR NVivo software for common themes. RESULTS: Workers reported a difficult work environment characterized by supervisor pressure, competition for jobs and intimidation with regard to raising safety concerns. Language barriers or cultural factors were not strongly represented as causative factors behind the rates. CONCLUSION: The results of this study have informed the development of an intervention trial that seeks to prevent falls and silica dust exposure by training contractors employing Hispanic construction workers in the elements of safety leadership, including building respect for their Hispanic workers and facilitating their participation in a safety program.

The Boston Safe Shops model: an integrated approach to community environmental and occupational health.

Small, immigrant-owned businesses, such as auto repair shops and nail salons, often face barriers to environmental and occupational health compliance and may be a source of neighborhood pollution complaints. The Boston Public Health Commission established the Safe Shops Project to improve safety and environmental practices in such businesses using a community partnership model that incorporates enforcement inspection findings, worker training, technical assistance, and referral to health care and business resources. This integrated technical assistance approach has led to improved occupational health and environmental conditions, adoption of pollution prevention technologies, novel problem-solving, and dozens of health screenings and insurance referrals for workers and their neighbors.

A hazardous substance exposure prevention rating method for intervention needs assessment and effectiveness evaluation: the Small Business Exposure Index.

AIMS: This paper describes the refinement and adaptation to small business of a previously developed method for systematically prioritizing needs for intervention on hazardous substance exposures in manufacturing worksites, and evaluating intervention effectiveness. METHODS: We developed a checklist containing six unique sets of yes/no variables organized in a 2 x 3 matrix of exposure potential versus exposure protection at three levels corresponding to a simplified hierarchy of controls: materials, processes, and human interface. Each of the six sets of indicator variables was reduced to a high/moderate/low rating. Ratings from the matrix were then combined to generate an exposure prevention 'Small Business Exposure Index' (SBEI) Summary score for each area. Reflecting the hierarchy of controls, material factors were weighted highest, followed by process, and then human interface. The checklist administered by an industrial hygienist during walk-through inspection (N = 149 manufacturing processes/areas in 25 small to medium-sized manufacturing worksites). One area or process per manufacturing department was assessed and rated. A second hygienist independently assessed 36 areas to evaluate inter-rater reliability. RESULTS: The SBEI Summary scores indicated that exposures were well controlled in the majority of areas assessed (58% with rating of 1 or 2 on a 6-point scale), that there was some room for improvement in roughly one-third of areas (31% of areas rated 3 or 4), and that roughly 10% of the areas assessed were urgently in need of intervention (rated as 5 or 6). Inter-rater reliability of EP ratings was good to excellent (e.g., for SBEI Summary scores, weighted kappa = 0.73, 95% CI 0.52-0.93). CONCLUSION: The SBEI exposure prevention rating method is suitable for use in small/medium enterprises, has good discriminatory power and reliability, offers an inexpensive method for intervention needs assessment and effectiveness evaluation, and complements quantitative exposure assessment with an upstream prevention focus.