Integration of Total Worker Health ® Training for Occupational Health and Safety Professionals With Efforts to Promote Worker Health, Safety, and Well-being in Mexico.

OBJECTIVE: We sought to test whether a 2-week Total Worker Health (TWH) training mapped to TWH education competencies could be administered to a Mexican audience of occupational safety and health professionals and could lead to positive changes to knowledge and behaviors. METHODS: This study used robust program evaluation methods collected before and after each of the nine training days and at the end of the course. RESULTS: Overall course quality received a mean score of 4.6 (SD = 0.6) and 98.8% of participants agreed that their TWH knowledge increased. All participants intended to make at least one change to their professional practice, most frequently helping companies assess their organizational culture to support health, safety, and well-being. CONCLUSIONS: This TWH training was well received and led to positive self-reported increase in knowledge and abilities to influence workers' health, safety, and well-being.

Occurrence of Occupational Injuries and Within Day Changes in Wet Bulb Temperature Among Sugarcane Harvesters.

OBJECTIVE: Climate change has implications for human health worldwide, with workers in outdoor occupations in low- to middle-income countries shouldering the burden of increasing average temperatures and more frequent extreme heat days. An overlooked aspect of the human health impact is the relationship between heat exposure and increased risk of occupational injury. In this study, we examined the association between occupational injury occurrence and changes in outdoor temperatures through the workday among a cohort of Guatemalan sugarcane harvesters. METHODS: Occupational injuries recorded for the 2014/2015 to 2017/2018 harvest seasons were collected from a large agribusiness employing male sugarcane harvesters in Southwest Guatemala. Wet Bulb Globe Temperature (WBGT) for the same period was collected from the El Balsamo weather station. We used a logistic mixed effects model to examine the association between injury occurrence and (1) the average WBGT during the hour injury was recorded, (2) the average WBGT during the hour prior to the injury being recorded, and (3) the change in the hourly average WBGT prior to the injury being recorded. RESULTS: There were 155 injuries recorded during the study period. Injuries were recorded most often between 14:00 and 16:00 (n = 62, 40%) followed by 8:00 and 10:00 (n = 56, 36%). There were significant differences in the average hourly WBGT and the hour in which injuries were recorded (p-value <.001). There were no observable associations between average hourly WBGT (OR: 1.00, 95%CI: 0.94, 1.05; p-value: 0.87), lagged average hourly WBGT (OR: 1.01, 95%CI: 0.97, 1.05; p-value: 0.71), or change in average hourly WBGT (OR: 0.96, 95%CI: 0.89, 1.04; p-value: 0.35) and recorded occupational injury. CONCLUSIONS: This is the first study that has examined how changes in WBGT throughout the day are related to occupational injury among agricultural workers. Although this study did not demonstrate an association, there is a need for future research to examine how various measurements of WBGT exposure are related to occupational injury in agricultural worker populations.

Nursing Home Adoption of CDC and ASHRAE COVID-19 Built Environment Recommendations: A Characterization Study of Colorado Nursing Home Facilities.

BACKGROUND: During the COVID-19 pandemic, the Centers for Disease Control and Prevention (CDC) and ASHRAE provided infection control recommendations for the built environments and ventilation systems of nursing homes (NHs). The level of adoption of the suggested strategies is unknown, as little information has been obtained from NHs identifying the strategies that were implemented. OBJECTIVE: The primary goal of our study was to characterize the built environments of Colorado NHs during the COVID-19 pandemic to assess the level of adoption of CDC and ASHRAE recommendations. Our secondary goal was to identify opportunities and barriers that NHs face as they work to create health-protective built environments in the future. METHOD: We used the Nursing Home Built Environment survey to obtain data related to three main categories of CDC and ASHRAE recommendation for Colorado NHs: Resident Isolation, Improved Indoor Air Quality, and Staff Separation/Support. RESULTS: Key findings included: (1) On average, NHs had 34% of their beds located in single-occupancy rooms; (2) seven (9%) NHs had designated COVID-positive "neighborhoods"; (3) 14 (20%) NHs had common area ventilation systems that were utilizing filters with a minimum efficiency reporting value 13 rating, or higher. CONCLUSION: Most Colorado NHs did not fully implement the COVID-19 built environment strategies recommended by CDC and ASHRAE. While there are barriers to the adoption of many of the strategies, there are also opportunities for immediate improvements that can support the health of vulnerable NH populations as we continue to see high rates of aerosolized infectious disease spread in NH facilities.

Characterization of Colorado residents and radon reduction behaviors through latent class analysis and path models.

Radon is a naturally occurring radioactive gas that enters homes through cracks in the foundation where accumulated levels can cause lung cancer. Within the United States (U.S.), state level radon reduction strategies rely on education and outreach to motivate people to test and mitigate their home. Only about 5% of the housing units in Colorado, U.S. have been tested for radon. This study looks at the 2012 Behavioral Risk Factors Surveillance System (BRFSS) in Colorado to identify distinct groups of people using Latent Class Analysis, and compares radon awareness, testing, and mitigation to understand underlying differences of radon reduction behaviors using path models. Five classes were identified: 1) Wealthy Young Families, 2) Older Singles, 3) Empty Nesters, 4) Smokers, and 5) Struggling Young Families. Significant differences in responses to radon survey questions existed across groups in which Struggling Young Families were the least likely to be aware of radon, have tested their home for radon, and have their home mitigated. Average radon awareness, testing, and mitigation appeared to be influenced by financial stress. Results from this study can be used to tailor future radon interventions and policy initiatives to enhance equity of radon reduction behaviors including legal framework to ensure radon mitigation takes place in rental properties.

Wet Bulb Globe Temperature and Recorded Occupational Injury Rates among Sugarcane Harvesters in Southwest Guatemala.

As global temperatures continue to rise it is imperative to understand the adverse effects this will pose to workers laboring outdoors. The purpose of this study was to investigate the relationship between increases in wet bulb globe temperature (WBGT) and risk of occupational injury or dehydration among agricultural workers. We used data collected by an agribusiness in Southwest Guatemala over the course of four harvest seasons and Poisson generalized linear modelling for this analysis. Our analyses suggest a 3% increase in recorded injury risk with each degree increase in daily average WBGT above 30 °C (95% CI: -6%, 14%). Additionally, these data suggest that the relationship between WBGT and injury risk is non-linear with an additional 4% acceleration in risk for every degree increase in WBGT above 30 °C (95% CI: 0%, 8%). No relationship was found between daily average WBGT and risk of dehydration. Our results indicate that agricultural workers are at an increased risk of occupational injury in humid and hot environments and that businesses need to plan and adapt to increasing global temperatures by implementing and evaluating effective occupational safety and health programs to protect the health, safety, and well-being of their workers.

Evaluation of an Occupational Safety and Health Training for Cannabis Cultivation Workers.

OBJECTIVES: As the commercial cannabis industry grows, there is an increased need to characterize potentially hazardous workplace exposures and provide training to workers to mitigate these exposures with the goal of reducing accidents and injuries from cannabis cultivation, processing, and manufacturing. Public health and safety stakeholders in Colorado developed a worker-focused training designed to improve hazard awareness, recognition, and controls related to commercial cannabis cultivation. This paper describes the evaluation of this training. METHODS: The training was a full day, in-person educational experience directed to workers in the cannabis cultivation industry. Training topics included an overview of occupational safety and health hazards, chemical exposures, slip, trips, and falls, repetitive motion, the application of the hierarchy of control including lockout/tagout, machine guarding, personal protective equipment, among others. Evaluation surveys assessed attendee demographics, perceived job hazards, confidence to change workplace practices, knowledge, training relevancy and quality, intent to change behavior, as well as barriers and resources. RESULTS: A total of 208 people attended the safety trainings. One hundred and thirty-four participants (64%) completed the pre-training survey and 107 (51%) completed the post-training survey. Respondents provided high ratings for the quality and relevance of the training, with 91.3% of respondents rating the training very good or excellent. Before the training, the attendees listed their most concerning safety and health issues as exposure to pesticides and other chemicals (65.7%), absorbing chemicals through the skin (56.7%), slips, trips, and falls (52.2%), and respiratory hazards (50.7%). After the training, they reported the most concerning hazards to be slips, trips, and fall hazards (65.4%), ergonomic problems (64.5%), and respiratory issues (61.7%). There was a statistically non-significant increase in knowledge scores from 67.1% correct to 76.0% correct. Finally, 88.5% of respondents felt extremely or very confident that they could change their own health and safety practices at work. CONCLUSIONS: The training successfully reached cannabis employees in cultivation, compliance, and management. Survey respondents felt that the training was of high quality and addressed gaps in their knowledge related to safety and health hazards in the cannabis industry. The workplace safety and health concerns shifted from pre- to post-training. There was a statistically non-significant increase in knowledge. Additional follow-up of training attendees would be beneficial to measure sustained impact of training.

Cannabis in homes with children: use and storage practices in a legalised state.

Our objective was to examine the prevalence of cannabis in homes with children and temporal trends in storage practices among caregivers. Caregivers of children ages 1-14 in Colorado, identified through a representative population-based telephone survey, participated in a repeated telephone survey from 2014 to 2017. Representing 79 805 households in Colorado with children, 8.6% (95% CI 7.3 to 10.0) of caregivers reported cannabis in the home. From 2014 to 2017, the prevalence of reporting cannabis in the home increased significantly from 6.9% to 11.2% (p=0.02). Among caregivers who reported cannabis in the home, 91.4% reported storage locations inaccessible to children, such as 'out of reach'. Fewer, 67.0%, caregivers reported storage in a locked container, such as a cabinet, drawer or safe. In a state with recreational cannabis, an increasing number of children live in homes where cannabis is present. Public health practitioners should promote messages to caregivers about safe cannabis storage practices.

Current Marijuana Use by Industry and Occupation - Colorado, 2014-2015.

The effects of marijuana use on workplace safety are of concern for public health and workplace safety professionals. Twenty-nine states and the District of Columbia have enacted laws legalizing marijuana at the state level for recreational and/or medical purposes. Employers and safety professionals in states where marijuana use is legal have expressed concerns about potential increases in occupational injuries, such as on-the-job motor vehicle crashes, related to employee impairment. Data published in 2017 by the Colorado Department of Public Health and Environment (CDPHE) showed that more than one in eight adult state residents aged ≥18 years currently used marijuana in 2014 (13.6%) and 2015 (13.4%) (1). To examine current marijuana use by working adults and the industries and occupations in which they are employed, CDPHE analyzed data from the state's Behavioral Risk Factor Surveillance System (BRFSS) regarding current marijuana use (at least 1 day during the preceding 30 days) among 10,169 persons who responded to the current marijuana use question. During 2014 and 2015, 14.6% of these 10,169 Colorado workers reported current marijuana use, with the highest reported prevalence among workers in the Accommodation and Food Services industry (30.1%) and Food Preparation and Serving (32.2%) occupations. Understanding the industries and occupations of adults with reported marijuana use can help direct and maximize impact of public health messaging and potential safety interventions for adults.

Mental Health-related Emergency Department Visits Associated With Cannabis in Colorado.

BACKGROUND: Cannabis legalization in Colorado resulted in increased cannabis-associated health care utilization. Our objective was to examine cooccurrence of cannabis and mental health diagnostic coding in Colorado emergency department (ED) discharges and replicate the study in a subpopulation of ED visits where cannabis involvement and psychiatric diagnosis were confirmed through medical review. METHODS: We collected statewide ED International Classification of Diseases, 9th Revision, Clinical Modification diagnoses from the Colorado Hospital Association and a subpopulation of ED visits from a large, academic hospital from 2012 to 2014. Diagnosis codes identified visits associated with mental health and cannabis. Codes for mental health conditions and cannabis were confirmed by manual records review in the academic hospital subpopulation. Prevalence ratios (PRs) of mental health ED discharges were calculated to compare cannabis-associated visits to those without cannabis. Rates of mental health and cannabis-associated ED discharges were examined over time. RESULTS: Statewide data demonstrated a fivefold higher prevalence of mental health diagnoses in cannabis-associated ED visits (PR = 5.35, 95% confidence interval [CI], 5.27-5.43) compared to visits without cannabis. The hospital subpopulation supported this finding with a fourfold higher prevalence of psychiatric complaints in cannabis attributable ED visits (PR = 4.87, 95% CI = 4.36-5.44) compared to visits not attributable to cannabis. Statewide rates of ED visits associated with both cannabis and mental health significantly increased from 2012 to 2014 from 224.5 to 268.4 per 100,000 (p < 0.0001). CONCLUSIONS: In Colorado, the prevalence of mental health conditions in ED visits with cannabis-associated diagnostic codes is higher than in those without cannabis. There is a need for further research determining if these findings are truly attributed to cannabis or merely coincident with concurrent increased use and availability.

Spatial Surveillance of Childhood Lead Exposure in a Targeted Screening State: An Application of Generalized Additive Models in Denver, Colorado.

CONTEXT: The targeted nature of Colorado's childhood lead screening program presents several analytical issues that complicate routine epidemiologic surveillance. OBJECTIVES: To analyze spatial patterns of childhood lead exposure among children younger than 6 years, identifying areas of increased risk along with associated covariates. METHODS: We analyzed a spatial case-control data set of childhood lead poisoning using generalized additive models. Incident cases were represented by the residential locations of children younger than 6 years with confirmed elevated blood lead levels (EBLL) of 5 µg/dL or more recorded between calendar years 2010 and 2014, and controls were sampled from the population at risk. We modeled the effect of spatial location, adjusting for potential spatial confounders. We also adjusted for a number of covariates previously identified in the childhood lead poisoning literature to understand the ecologic-level drivers of spatial variation in risk. MAIN OUTCOME MEASURE(S): Crude and adjusted spatial odds ratios describing the relative frequency of lead poisoning among different locations in Denver, Colorado. RESULTS: We found evidence of statistically significant spatial clustering in incident cases of lead poisoning even after adjustment for age, sex, year, season, and spatially smoothed screening rate. Spatial confounder-adjusted odds ratios in the Denver study area ranged from 0.22 to 2.7. Adjusting for additional ecologic-level covariates effectively accounted for the observed spatial variation. We found that ecologic-level indicators of low socioeconomic status, Hispanic ethnicity, Asian race, and older housing age were all positively and significantly associated with an increased EBLL risk. CONCLUSION: Housing and socioeconomic factors continue to be the primary ecologic risk factors associated with childhood lead exposure and can be used to predict risk at a fine spatial resolution in the Denver study area. Our analysis demonstrates how other targeted screening states can be proactive about childhood lead surveillance within their major population centers and enhance the spatial specificity of lead mitigation efforts.

Lessons learned after three years of legalized, recreational marijuana: The Colorado experience.

In November 2012 Colorado voters approved legalized recreational marijuana. On January 1, 2014 Colorado became the first state to allow legal sales of non-medical marijuana for adults over the age of 21. Since that time, the state has been monitoring potential impacts on population health. In this paper we present lessons learned in the first three years following legal sales of recreational marijuana. These lessons pertain to health behaviors and health outcomes, as well as to health policy issues. Our intent is to share these lessons with other states as they face the prospect of recreational marijuana legalization.

The Public Health Framework of Legalized Marijuana in Colorado.

On January 1, 2014, Colorado became the first state in the nation to sell legal recreational marijuana for adult use. As a result, Colorado has had to carefully examine potential population health and safety impacts as well as the role of public health in response to legalization. We have discussed an emerging public health framework for legalized recreational marijuana. We have outlined this framework according to the core public health functions of assessment, policy development, and assurance. In addition, we have discussed challenges to implementing this framework that other states considering legalization may face.

Adding industry and occupation questions to the behavioral risk factor surveillance system: new opportunities in public health surveillance.

OBJECTIVES: Industry and occupation variables are overlooked in many public health surveillance efforts, yet they are useful for describing the burden and distribution of various public health diseases, behaviors, and conditions. This study is the first ever analysis of the Colorado Behavioral Risk Factor Surveillance System (BRFSS) to describe chronic conditions and risk behaviors by occupation. It is intended to provide a new perspective on this existing data source and demonstrate the value of occupation as a core demographic variable for public health research, policy, and practice. METHODS: Two standardized employment questions were included in the 2012 Colorado BRFSS survey and administered to eligible survey respondents who were employed, self-employed, or out of work for less than one year. Occupation data were coded using the National Institute for Occupational Safety and Health (NIOSH) Industry and Occupation Computerized Coding System. We analyzed health behaviors and conditions by major occupation groups. We calculated prevalence estimates and 95% confidence intervals (CIs). RESULTS: The prevalence of chronic conditions, health statuses, and risk behaviors (e.g., smoking and seatbelt use) varied significantly by occupation. For example, compared with all workers (93.6%, 95% CI 92.7, 94.5), significantly fewer workers in farming, forestry, fishing and construction, extraction jobs (87.0%, 95% CI 82.0, 92.0) reported always or nearly always wearing a seatbelt while driving. Additionally, significantly more office and administrative support workers (27.5%, 95% CI 22.5, 32.4) compared with all workers (20.6%, 95% CI 19.3, 22.0) were obese. Further observation and research is needed to understand the effects of occupation on health outcomes and behaviors. CONCLUSION: There are no other Colorado state-level datasets that link health behaviors and chronic conditions with occupation. This study shows that the prevalence of chronic conditions and risk behaviors varies substantially by occupation. Other states conducting the BRFSS may choose to adopt the NIOSH industry and occupation module and add other questions to further investigate health issues by occupation.

Private well water in Colorado: collaboration, data use, and public health outreach.

As a result of participating in the Centers for Disease Control and Prevention's Private Well Initiative and Environmental Public Health Tracking Network (Tracking), the Colorado Department of Public Health and Environment was able to inventory private well water quality data, prioritize potential health concerns associated with drinking water from these wells, and create a Web portal for sharing public health information regarding private well water. The Colorado Department of Public Health and Environment collaborated with a local health department to pilot the project prior to a public implementation. Approximately 18 data sets were identified and inventoried. The Colorado Department of Public Health and Environment also participated in development and pilot testing of best practices for display of well water quality data with other Tracking states. Available data sets were compiled and summarized, and the data made available on the Colorado Tracking portal using geographic information system technology to support public health outreach regarding private wells.

Methamphetamine residue dermal transfer efficiencies from household surfaces.

Methamphetamine contamination from illegal production operations poses a potential health concern for emergency responders, child protective services, law enforcement, and children living in contaminated structures. The objective of this study was to evaluate dermal transfer efficiencies of methamphetamine from contaminated household surfaces. These transfer efficiencies are lacking for methamphetamine, and would be beneficial for use in exposure models. Surfaces were contaminated using a simulated smoking method in a stainless steel chamber. Household surfaces were carpet, painted drywall, and linoleum. Dermal transfer efficiencies were obtained using cotton gloves for two hand conditions, dry or saliva moistened (wet). In addition, three contact scenarios were evaluated for both hand conditions: one, two, or three contacts with contaminated surfaces. Dermal transfer efficiencies were calculated for both hand conditions and used as inputs in a Stochastic Human Exposure and Dose Simulation model (SHEDS-Multimedia, Office of Research and Development, United States Environmental Protection Agency, Research Triangle Park, N.C.). Results of this study showed that average dermal transfer efficiencies of methamphetamine ranged from 11% for dry hands to 26% for wet hands. There was a significantly higher wet transfer as compared to dry transfer for all surfaces. For wet hands, dermal transfer depended on surface type with higher transfer from carpet and linoleum as compared to drywall. Based on our estimates of dermal transfer efficiency, a surface contamination clearance level of 1.5 µg/100 cm(2) may not ensure absorbed doses remain below the level associated with adverse health effects in all cases. Additional dermal transfer studies should be performed using skin surrogates that may better predict actual skin transfer.

Potential exposures associated with indoor marijuana growing operations.

We entered a total of 30 indoor marijuana grow operations (IMGO) with law enforcement investigators in order to determine potential exposures to first responders. Samples for airborne fungal spores, volatile organic compounds, carbon dioxide, carbon monoxide, and delta-9-tetrahydrocannabinol (THC) were obtained as well as the identification of chemicals utilized in the IMGO. The chemicals utilized within the IMGOs were primarily pesticides and fertilizers with none showing high toxicity. Although several of the IMGOs had CO2 enrichment processes involving combustion, CO levels were not elevated. THC levels were identified on surfaces within the IMGOs and on the hands of the investigators. Surface levels ranged from <0.1 µg /100 cm(2) to 2000 µg /100 cm(2) with a geometric mean of 0.37 µg /100 cm(2). THC levels on the hands of officers ranged from <0.10 µg /wipe to 2900 µg /wipe with a geometric mean of 15 µg /wipe. These levels were not considered to be elevated to the point of causing a toxic exposure to responders. A total of 407 fungal spore samples were taken using both slit impactor plates and 400-hole impactors. Both methods identified elevated fungal spore levels, especially during the removal of plants from some of the IMGOs. After plant removal, spore counts increased to levels above 50,000 spores/m(3) with one sample over 500,000 spores/m(3). In addition, we found that there was a shift in species between indoor and outdoor samples with Cladosporium sp. the predominant outdoor species and Penicillium sp. the predominant indoor species. We concluded that the potential increase in fungal spore concentrations associated with the investigation and especially removal of the marijuana plants could potentially expose responders to levels of exposure consistent with those associated with mold remediation processes and that respiratory protection is advisable.

Decontamination of clothing and building materials associated with the clandestine production of methamphetamine.

This study was designed to determine how easily methamphetamine can be removed from clothing and building materials, utilizing different cleaning materials and methods. The study also addressed the penetration of methamphetamine into drywall and the ability of paints to encapsulate the methamphetamine on drywall. Clothing and building materials were contaminated in a stainless steel chamber by aerosolizing methamphetamine in a beaker heater. The amount of methamphetamine surface contamination was determined by sampling a grid pattern on the material prior to attempting to clean the materials. After cleaning, the materials were again sampled, and the degree of decontamination noted. We found that household clothing and response gear worn by first responders was easily decontaminated using a household detergent in a household washing machine. A single wash removed over 95% of the methamphetamine from these materials. The study also indicated that methamphetamine-contaminated, smooth non-porous surfaces can be easily cleaned to below detectable levels using only mild cleaners. More porous surfaces such as plywood and drywall were unlikely to be decontaminated to below regulatory levels even with three washes using a mild cleaner. This may be due to methamphetamine penetration into the paint on these surfaces. Evaluation of methamphetamine contamination on drywall indicated that approximately 40% of the methamphetamine was removed using a wipe, while another 60% remained in the paint layer. Stronger cleaners such as those with active ingredients including sodium hypochlorite or quaternary ammonia and commercial decontamination agents were more effective than mild detergent-based cleaners and may reduce methamphetamine contamination to below regulatory levels. Results from the encapsulation studies indicate that sprayed on oil-based paint will encapsulate methamphetamine on drywall and plywood surfaces up to 4.5 months, while latex paints were less effective.

Variability and specificity associated with environmental methamphetamine sampling and analysis.

This study was designed to explore the efficacy of the use of wipe sampling to determine methamphetamine contamination associated with the clandestine manufacture of methamphetamine. Three laboratories were utilized to analyze wipe samples to investigate variability in reported methamphetamine concentration among samples spiked with known amounts of methamphetamine. Different sampling media, surfaces, and solvents were also utilized to determine potential differences in measured methamphetamine concentration due to different wipes, wipe solvents, and wipe contaminants. This study examined rate of false positive detection among blank samples and whether interference with common household substances would create a false positive detection of methamphetamine. Variability between the three labs-using liquid chromatography with mass spectrometry or gas chromatography with mass spectrometry for detection of a known concentration of methamphetamine-resulted in percent differences of 3-30%. Results from wipe sample analysis for methamphetamine, using methanol or isopropanol, showed no significant difference in methamphetamine contamination recovery. Dust and paint contamination on methamphetamine wipe samples with known methamphetamine spike amounts did not affect methamphetamine wipe sample recovery. This study confirmed that either methanol or isopropanol is an appropriate solvent for use in methamphetamine wipe sampling. Dust and paint contamination on wipe samples will not interfere with the wipe sample analysis for methamphetamine. False positive detection for methamphetamine was not observed in any of the blank wipe samples submitted for the study. Finally, this study determined that methamphetamine will not be detected in structures that are truly methamphetamine free at current laboratory limits of quantification.

Risk of chronic beryllium disease by HLA-DPB1 E69 genotype and beryllium exposure in nuclear workers.

RATIONALE: Beryllium sensitization (BeS) and chronic beryllium disease (CBD) are determined by at least one genetic factor, a glutamic acid at position 69 (E69) of the HLA-DPB1 gene, and by exposure to beryllium. The relationship between exposure and the E69 genotype has not been well characterized. OBJECTIVES: The study goal was to define the relationship between beryllium exposure and E69 for CBD and BeS. METHODS: Workers (n = 386) from a U.S. nuclear weapons facility were enrolled into a case-control study (70 BeS, 61 CBD, and 255 control subjects). HLA-DPB1 genotypes were determined by sequence-specific primer-polymerase chain reaction. Beryllium exposures were reconstructed on the basis of worker interviews and historical exposure measurements. MEASUREMENTS AND MAIN RESULTS: Any E69 carriage increased odds for CBD (odds ratio [OR], 7.61; 95% confidence interval [CI], 3.66-15.84) and each unit increase in lifetime weighted average exposure increased the odds for CBD (OR, 2.27; 95% CI, 1.26-4.09). Compared with E69-negative genotypes, a single E69-positive *02 allele increased the odds for BeS (OR, 12.01; 95% CI, 4.28-33.71) and CBD (OR, 3.46; 95% CI, 1.42-8.43). A single non-*02 E69 allele further increased the odds for BeS (OR, 29.54; 95% CI, 10.33-84.53) and CBD (OR, 11.97; 95% CI, 5.12-28.00) and two E69 allele copies conferred the highest odds for BeS (OR, 55.68; 95% CI, 14.80-209.40) and CBD (OR, 22.54; 95% CI, 7.00-72.62). CONCLUSIONS: E69 and beryllium exposure both contribute to the odds of CBD. The increased odds for CBD and BeS due to E69 appear to be differentially distributed by genotype, with non-*02 E69 carriers and E69 homozygotes at higher odds than those with *02 genotypes.