Implications of Social and Legal Status on Immigrants' Health in Disaster Zones.

This commentary highlights how immigrants who are linguistically isolated, have limited social networks, and lack legal immigration status experience unique health risks in disaster zones. Research on immigrants and disasters tends to focus on immigrants with these characteristics who are residents of disaster-affected areas, disaster recovery workers, or both. We review the sparse research literature and provide examples of innovative but underresourced programs that reduce immigrants' exposure to disaster-related health hazards and economic exploitation in the recovery. We conclude with recommendations for advancing these initiatives while, simultaneously, addressing the anti-immigrant policies that contribute to these disaster-related inequities.

Managers' perceptions of the value and impact of HAZWOPER worker health and safety training.

BACKGROUND: Worker training is a core component of the OSHA Hazardous Waste Operations and Emergency Response (HAZWOPER) standard, but few studies have considered what motivates managers to provide HAZWOPER training to employees or what they value in that training. METHODS: In 2012, four university-based programs conducted an exploratory survey of managers who sent employees to HAZWOPER courses. Results from 109 respondents were analyzed. RESULTS: Forty-two percent of respondents cited regulations as the most important reason to provide HAZWOPER training; many indicated they would provide less training if there were no standard in place. Three-quarters (74%) reported training had improved workplace conditions. Fewer than half said they were likely to involve trained employees in aspects of the organization's H&S program. DISCUSSION: Compliance with regulatory requirements is an important factor shaping managers' training delivery decisions. Managers recognize positive impacts of training. These impacts could be enhanced by further leveraging employee H&S knowledge and skills.

Promoting integrated approaches to reducing health inequities among low-income workers: applying a social ecological framework.

BACKGROUND: Nearly one of every three workers in the United States is low-income. Low-income populations have a lower life expectancy and greater rates of chronic diseases compared to those with higher incomes. Low- income workers face hazards in their workplaces as well as in their communities. Developing integrated public health programs that address these combined health hazards, especially the interaction of occupational and non-occupational risk factors, can promote greater health equity. METHODS: We apply a social-ecological perspective in considering ways to improve the health of the low-income working population through integrated health protection and health promotion programs initiated in four different settings: the worksite, state and local health departments, community health centers, and community-based organizations. RESULTS: Examples of successful approaches to developing integrated programs are presented in each of these settings. These examples illustrate several complementary venues for public health programs that consider the complex interplay between work-related and non work-related factors, that integrate health protection with health promotion and that are delivered at multiple levels to improve health for low-income workers. CONCLUSIONS: Whether at the workplace or in the community, employers, workers, labor and community advocates, in partnership with public health practitioners, can deliver comprehensive and integrated health protection and health promotion programs. Recommendations for improved research, training, and coordination among health departments, health practitioners, worksites and community organizations are proposed.

Musculoskeletal disorders among clerical workers in Los Angeles: a labor management approach.

BACKGROUND: Musculoskeletal disorders (MSDs) persist among clerical workers despite ergonomic advances. METHODS: A cross-sectional survey among 2,310 clerical workers investigated MSD cases, defined as musculoskeletal discomfort and seeking treatment for that discomfort in the past 12 months. A modified Poisson regression model was adopted to assess the association between work and individual factors and the risk of MSDs. RESULTS: Over half of respondents reported musculoskeletal discomfort. The prevalence of MSD cases was: 37.2% neck/shoulders, 21.7% upper extremities, 18% lower extremities, and 34.3% back region. Elevated risk of MSDs was associated with less workstation adjustability; work schedule, gender, age, and BMI were also significant. Positive trends were observed between computer use and MSDs for the neck/shoulder region and the effect was amplified among those reporting insufficient workstation adjustability and lacking computer ergonomics training. CONCLUSIONS: Results demonstrate the need to limit continuous computer use and to improve the human-machine interface through adjustable workstations and worker training to enhance use of adjustable features.

Worker Injuries in Southern California's Warehousing Industry: How to Better Protect Workers in This Burgeoning Industry?

Dangerous conditions and worker injuries in the rapidly growing warehousing industry have gained attention in recent years, with accounts typically drawing on worker reports and investigative journalism. We analyzed workers' compensation injury claims and California Division of Occupational Safety and Health (Cal/OSHA) citations in Southern California's large warehousing sector. Claims increased from 2014 to 2018, with a majority of injuries caused by repetitive motion, lifting and other ergonomic risk factors. Cal/OSHA cited employers for violating standards to protect workers from unsafe vehicle operations, dangerous machinery and equipment, and falls; and for failing to implement injury prevention programs. These citations address the causes of some worker injuries; however, no Cal/OSHA citations were issued for violating the state's Repetitive Motion Injuries prevention standard. Nor do enforcement activities address the underlying causes highlighted by workers-high production quotas and a relentless work pace-that characterize the industry. We discuss the value and limitations of our approach and the implications of our results.

Risk Amid Recovery: Occupational Health and Safety of Latino Day Laborers in the Aftermath of the Gulf Coast Hurricanes.

After Katrina, the Bush administration suspended Department of Labor workplace regulations throughout the Gulf, a move consistent with their general emphasis on voluntary workplace protection programs rather than government oversight. This approach left many workers in hurricane reconstruction jobs unprotected, especially Latino immigrant day laborers who, facing language barriers and legal constraints, were least able to negotiate workplace safety or other labor conditions. Fifty-three immigrant workers and 28 key informants from community, union, church, and relief organizations in Louisiana and Mississippi were interviewed at job hiring sites and relief organizations using an inductive, exploratory approach. In this multihazard and changing work environment with a new and fluctuating workforce, enforceable policies mandating worker protection and education were sorely lacking. Free market conditions, driven by incentives to work as fast as possible, and the preponderance of unregulated small contractors and individual home owners as employers contributed to the unsafe environment. Although workers and home owners attempted to take precautions, they usually lacked adequate education about hazards, access to protective equipment, and training in its proper use. However, the labor conditions during the hurricane recovery in the Gulf Coast are likely to be duplicated throughout the country in workplaces employing Latino day laborers unless workers' health is given greater priority by regulatory agencies.

Mortality and Morbidity during Extreme Heat Events and Prevalence of Outdoor Work: An Analysis of Community-Level Data from Los Angeles County, California.

Heat is a well-recognized hazard for workers in many outdoor settings, yet few investigations have compared the prevalence of outdoor work at the community level and rates of heat-related mortality and morbidity. This analysis examines whether heat-related health outcomes occur more frequently in communities with higher proportions of residents working in construction, agriculture, and other outdoor industries. Using 2005-2010 data from Los Angeles County, California, we analyze associations between community-level rates of deaths, emergency department (ED) visits, and hospitalizations during summer heat events and the prevalence of outdoor work. We find generally higher rates of heat-related ED visits and hospitalizations during summer heat events in communities with more residents working outdoors. Specifically, each percentage increase in residents working in construction resulted in an 8.1 percent increase in heat-related ED visits and a 7.9 percent increase in heat-related hospitalizations, while each percentage increase in residents working in agriculture and related sectors resulted in a 10.9 percent increase in heat-related ED visits. The findings suggest that outdoor work may significantly influence the overall burden of heat-related morbidity at the community level. Public health professionals and healthcare providers should recognize work and employment as significant heat risk factors when preparing for and responding to extreme heat events.

Fostering youth leadership to address workplace and community environmental health issues: a university-school-community partnership.

Many communities of color are disproportionately exposed to workplace and community environmental hazards. This article presents the results of a pilot project designed by a university-school-community partnership to develop youth leadership to confront these exposures. Using a popular empowerment education approach, students applied peer education, research, and organizing skills learned in the classroom to community-based internships in a service-learning model. Evaluation results from pretests and posttests, focus groups, and in-depth interviews demonstrated that students shared what they learned about young workers' rights and environmental justice with family and friends. They developed a critical analysis of environmental inequities, created a citywide youth coalition that advocates around legal, educational, and environmental issues affecting youth, and implemented campaigns to enforce child labor laws and to prevent school construction on contaminated land. This multifaceted model can serve as an important foundation to develop youth leaders to influence environmental policies in a variety of communities.

Work-related risk factors for neck pain in the US working population.

STUDY DESIGN: This study uses the Taylor linearized variance estimation method to compute weighted unadjusted and adjusted prevalence of neck pain by occupation, with a cross-section data set from the 2009 to 2012 National Health Interview Survey. OBJECTIVE: The goal of this study was to explore occupational patterns of neck pain and the relationship between long work hours and neck pain in the working population in the United States. SUMMARY OF BACKGROUND DATA: The past research has demonstrated that specific occupations have a high prevalence of neck pain. However, occupational patterns of neck pain in the United States have been understudied. METHODS: Risk of neck pain was estimated using univariate and multivariate logistic regression with odds ratios (ORs) with 95% confidence interval (CI) as measures of association. RESULTS: After controlling for demographic, socioeconomic status, and behavior-related factors and compared with workers in architecture and engineering occupation group, the top 5 occupational groups with significantly higher relative prevalence of neck pain included: military specific (OR, 2.50; 95% CI, 1.17-5.35); arts, design, entertainment, sports, and media (OR, 1.70; 95% CI, 1.34-2.17); life, physical, and social science (OR, 1.67; 95% CI, 1.33-2.11); health care support (OR, 1.55; 95% CI, 1.23-1.97); and installation, maintenance, and repair (OR, 1.54; 95% CI, 1.21-1.96). Compared with those who worked 40 hours, people who worked 46 to 59 hours (OR, 1.20; 95% CI, 1.10-1.30) and 60 or more hours of work per week (OR, 1.35; 95% CI-1.21, 1.51) were more likely to report neck pain. CONCLUSION: This study adds to the evidence that an individual's occupation and work hours affect workers' risk for neck pain. This study indicates a need for new research efforts and public policies targeted to workers who are susceptible to neck pain in the United States. LEVEL OF EVIDENCE: 1.

Health status, job stress and work-related injury among Los Angeles taxi drivers.

BACKGROUND: Taxi drivers work long hours for low wages and report hypertension, weight gain, and musculoskeletal pain associated with the sedentary nature of their job, stressful working conditions, and poor dietary habits. They also experience a high work-related fatality rate. OBJECTIVE: The objective of this study is to examine the association of taxi drivers' health status and level of job stress with work-related injury and determine if a potential interaction exists. METHODS: A survey of 309 Los Angeles taxi drivers provides basic data on health status, job stress, and work-related injuries. We further analyzed the data using a Modified Poisson regression approach with a robust error variance to estimate the relative risk (RR) and the 95% confidence intervals (CI) of work-related injuries. Focus group results supplemented and helped interpret the quantitative data. RESULTS: The joint effect of good health and low job stress was associated with a large reduction in the incidence of injuries, consistent with the hypothesis that health status and stress levels modify each other on the risk of work-related injury. CONCLUSIONS: These results suggest that the combination of stress reduction and health management programs together with changes in the stressful conditions of the job may provide targeted avenues to prevent injuries.

A legacy of struggle: the OSHA ergonomics standard and beyond, Part I.

In November 2000, the Occupational Safety and Health Administration (OSHA) issued an ergonomics standard to prevent debilitating work-related musculoskeletal disorders (WMSDs). It was rescinded by Congress within four months. We explore how this story unfolded over two decades of collaboration and conflict. Part I provides an overview of the historical context of the struggle for a standard, followed by interviews with key players from labor, academia and government. They provide a snapshot of the standard; discuss the prevalence of WMSDs in the context of changing work organization; give insight into the role of unions and of scientific debate within the context of rulemaking; and uncover the basis for the groundbreaking OSHA citations that laid the foundation for a standard. Part II interviews further explore the anti-regulatory political landscape of the 1990s that led to repeal of the standard, discuss the impact of the struggle beyond the standard, and describe creative approaches for the future.

A legacy of struggle: the OSHA ergonomics standard and beyond, Part II.

The OSHA ergonomics standard issued in 2000 was repealed within four months through a Congressional resolution that limits future ergonomics rulemaking. This section continues the conversation initiated in Part I, documenting a legacy of struggle for an ergonomics standard through the voices of eight labor, academic, and government key informants. Part I summarized important components of the standard; described the convergence of labor activism, research, and government action that laid the foundation for a standard; and highlighted the debates that characterized the rulemaking process. Part II explores the anti-regulatory political landscape of the 1990s, as well as the key opponents, power dynamics, and legal maneuvers that led to repeal of the standard. This section also describes the impact of the ergonomics struggle beyond the standard itself and ends with a discussion of creative state-level policy initiatives and coalition approaches to prevent work-related musculoskeletal disorders (WMSDs) in today's sociopolitical context.

Shaping the future: ten years of the occupational health internship program.

The Occupational Health Internship Program (OHIP) was initiated in 2003 to recruit a new, diverse generation of occupational safety and health (OSH) professionals and to advance OSH within union and community-based initiatives. It retains the principles of the original OCAW/Montefiore internship program while adapting to the changed landscape of the 21st-century workplace. Case studies of OHIP projects illustrate how students have contributed to key OSH policies-to regulate silica exposure among construction workers, apply principles of green chemistry with Vietnamese nail salon workers, and integrate OSH into "green" jobs in the recycling industry. They have supported innovative campaigns with immigrant workers in contingent jobs-from taxi drivers to warehouse workers. The students, in turn, have been inspired to enter the OSH arena as professionals and worker advocates with the potential to contribute new energy to an OSH movement.

From agricultural fields to urban asphalt: the role of worker education to promote California's heat illness prevention standard.

This article describes an innovative approach to reach and educate workers and worker advocates about California's outdoor heat illness prevention standard. In 2010, Cal/OSHA initiated a statewide education campaign to reduce heat-related illnesses and fatalities and increase awareness of the standard's requirements. In Southern California, the UCLA Labor Occupational Safety and Health Program (LOSH) focused on three principal strategies of community-based outreach, popular education, and organizational capacity building. Central to the LOSH approach was the integration of health promotores into core program planning and training activities and the expansion of campaign activities to a wide variety of rural and urban workers. We describe each of these strategies and analyze the possibilities and constraints of worker education to support implementation of this standard, particularly given the vulnerabilities of the impacted workforce, the often precarious nature of employment arrangements for these workers, and the resource limitations of Cal/OSHA.

The political and economic context of home care work in California.

California's primarily female, ethnically diverse home care workforce is at the intersection of the public and private spheres of work and at the front line of recurring policy and budget debates targeting government-funded long-term care services. The convening of a Home Care Research Working Group in 2001 has led to collaborative action research initiatives and advocacy for policies to improve working conditions and home care services. The study reported here demonstrates that: 1) current long-term care policy is inadequate to ameliorate home care stressors such as physical and emotional demands, schedule conflicts, financial strain, and job insecurity; 2) workers' experience of home care differs by gender and by race or ethnic group; and 3) a union that actively engages workers is a viable avenue to provide individual support and empowerment as well as collective advocacy for home care services, critical in an era of attacks against health and social service programs.

Job stress and job satisfaction: home care workers in a consumer-directed model of care.

OBJECTIVE: To investigate determinants of job satisfaction among home care workers in a consumer-directed model. DATA SOURCES/SETTING: Analysis of data collected from telephone interviews with 1,614 Los Angeles home care workers on the state payroll in 2003. DATA COLLECTION AND ANALYSIS: Multivariate logistic regression analysis was used to determine the odds of job satisfaction using job stress model domains of demands, control, and support. PRINCIPAL FINDINGS: Abuse from consumers, unpaid overtime hours, and caring for more than one consumer as well as work-health demands predict less satisfaction. Some physical and emotional demands of the dyadic care relationship are unexpectedly associated with greater job satisfaction. Social support and control, indicated by job security and union involvement, have a direct positive effect on job satisfaction. CONCLUSIONS: Policies that enhance the relational component of care may improve workers' ability to transform the demands of their job into dignified and satisfying labor. Adequate benefits and sufficient authorized hours of care can minimize the stress of unpaid overtime work, caring for multiple consumers, job insecurity, and the financial constraints to seeking health care. Results have implications for the structure of consumer-directed models of care and efforts to retain long-term care workers.

Role of work permits in teen workers' experiences.

BACKGROUND: Work permits are required for working teenagers under 18 in 41 US states, but little is known about the work experience of those with work permits compared with those without such permits. This study examines job hazards, training, and knowledge of child labor laws reported by students in a predominantly Latino high school in Los Angeles and compares the responses of those who obtained work permits with those who did not. METHODS: Student responses to a 60 item questionnaire were supplemented with information from focus groups and a survey of work permits issued by the school. RESULTS: Students without work permits were more likely to perform hazardous tasks and to use certain types of dangerous equipment and less likely to receive health and safety training than those with permits. CONCLUSION: Possible explanations for the findings and suggested areas in need of policy change or research are considered.