Traumatic injuries among Alaska's young workers: Linking cases from four data systems.

BACKGROUND: Young workers (aged 15-24 years) experience higher rates of job-related injury compared with workers aged 25-44 years in the United States. Young workers may have limited or no prior work experience or safety training, which can contribute to their injury risk. In 2018, Alaska had the second highest work-related fatality rate and 14th highest non-fatal injury rate in the United States. This study aimed to characterize nonfatal and fatal occupational injuries among young workers in Alaska. METHODS: To describe injury patterns among Alaska young workers from 2014-2018, we used data from four datasets: Alaska Workers' Compensation, Alaska Occupational Injury Surveillance System, Alaska Trauma Registry, and Alaska Fishermen's Fund. The datasets were merged two at a time and filtered by the worker characteristics (e.g., age and sex) and incident characteristics (e.g., date of injury). Duplicates were then manually identified between the datasets using the variables above. The injury narrative and Occupational Injury and Illness Classification System codes were used last to verify true duplicates. Descriptive analyses were performed after the duplicates were merged. RESULTS: During the 5-year study period 2014-2018, young workers experienced 20 fatal and 12,886 nonfatal injuries. Residents of Alaska comprised 85% of nonfatal and 70% of fatal injuries. The top three major occupation groups with the highest number of injuries were production (1,391, 14%), food preparation (1,225, 12%), and transportation/material moving (1,166, 11%). The most common events leading to injuries were struck by object or equipment (2,027, 21%), overexertion involving outside sources (1,385, 14%), and struck against object or equipment (905, 9%). The most common nature of injuries were sprains/strains/tears (3,024, 29%), cuts/lacerations (1,955, 19%), and bruises/contusions (1,592, 15%). CONCLUSION: Although progress has been made in reducing worker injuries, Alaskan young workers still experience injuries and fatalities frequently. Based on findings, there is a clear need for employers, researchers, public health professionals, parents, and young workers to prioritize young worker safety through an integrated approach, from education and training to adequate workplace supervision and support.

Anti-Racist Violence Prevention: Partnering With Black Youth to Identify Intervention Priorities.

In this study, academic researchers partnered with Black youth to engage in critical analysis of the intersection between racism and community violence to promote anti-racist social action that advances health equity. Through youth participatory action research, we examined perspectives and experiences of Black youth to develop a shared understanding of how to approach community violence prevention with an anti-racist lens. Thirteen youth from Kansas City and Atlanta who identified as Black or African American participated in a photovoice project to explore the intersection of racism and community violence. Youth generated photo assignments, took photos that reflected the assignment, shared their photos as a group, and chose one photo to explore in depth each week using a structured method to guide photo-discussion. Qualitative analysis of youth photo-discussions identified themes related to Black youth's experiences of racism at multiple levels and identified suggestions for anti-racist interventions, including promoting Black history knowledge and nurturing Black mentoring relationships. Grounded in these findings, we propose an anti-racist approach to community violence prevention among Black youth that engages Black youth as equitable partners to build from their expertise and strengths in developing comprehensive solutions.

Youth Empowered Advocating for Health (YEAH): Facilitating Partnerships Between Prevention Scientists and Black Youth to Promote Health Equity.

Structural racism inflicts a disproportionate burden of stress and trauma within Black communities, resulting in physical and mental health inequities that impact Black youth. Yet few multilevel interventions exist to address these deeply rooted inequities from a preventive standpoint, and even fewer are informed by the participatory input of the impacted communities. To bridge these gaps, we developed a community-based prevention strategy that promotes agency and active resistance to structural racism, Youth Empowered Advocating for Health (YEAH), and implemented it across various settings. We outline the development, implementation, and expansion of YEAH as a tool for promoting optimal health among Black communities. Lastly, we discuss lessons learned and offer a framework outlining key principles for prevention scientists to partner with Black youth and engage them in translational science to address structural racism. This framework is aimed at driving policies, practices, and procedures that promote equitable and sustainable change for and with Black communities.

Persistent and emerging hazards contributing to work-related fatalities in Alaska.

BACKGROUND: Workers in Alaska have an elevated risk of dying on the job compared to workers in the rest of the United States. The purpose of this study was to measure and describe the trend in fatalities during the 15-year period 2004 to 2018, and to identify lingering and emerging hazards that result in fatalities. METHODS: Data on fatal work-related injuries in Alaska during 2004 to 2018 were obtained from the Alaska Occupational Injury Surveillance System. Descriptive statistics were calculated to identify fatality characteristics. Fatality rates were expressed as the number of deaths per 100 000 workers, and Poisson regression was used to measure the trend during the study period. RESULTS: During 2004 to 2018, there were 517 work-related fatalities in Alaska. The average annual risk of fatalities during the 15-year period was 9.6 per 100 000 workers, with no significant trend. The leading events or exposures resulting in fatal injuries to workers in Alaska during 2004 to 2018 were water vehicle incidents (145, 28.0%), aircraft incidents (105, 20.3%), and suicides (46, 8.9%). The number of suicides and homicides at work increased substantially during the 15-year period. CONCLUSIONS: While deaths due to water vehicle incidents have substantially decreased, they still represent a major component of Alaska's work-related fatality profile. Aviation safety continues to be an area of concern in Alaska. Unintentional drug overdoses at work, as well as workplace violence in the form of suicides and homicides, represent emerging issues that need the attention of Alaskan occupational safety stakeholders. These findings can inform and direct fatality prevention research and practice.

Injury and illness among onshore workers in Alaska's seafood processing industry: Analysis of workers' compensation claims, 2014-2015.

BACKGROUND: Alaska's onshore seafood processing industry is economically vital and hazardous. METHODS: Accepted Alaska workers' compensation claims data from 2014 to 2015 were manually reviewed and coded with the Occupational Injury and Illness Classification System and associated work activity. Workforce data were utilized to calculate rates. RESULTS: 2,889 claims of nonfatal injuries/illnesses were accepted for compensation. The average annual claim rate was 63 per 1000 workers. This was significantly higher than Alaska's all-industry rate of 44 claims per 1000 workers (RR = 1.42, 95%CI = 1.37-1.48). The most frequently occurring injuries/illnesses, were by nature, sprains/strains/tears (n = 993, 36%); by body part, upper limbs (1212, 43%); and by event, contact with objects/equipment (1020, 37%) and overexertion/bodily reaction (933, 34%). Incidents associated with seafood processing/canning/freezing (n = 818) frequently involved: repetitive motion; overexertion while handling pans, fish, and buckets; and contact with fish, pans, and machinery. CONCLUSIONS: Ergonomic and safety solutions should be implemented to prevent musculoskeletal injuries/illnesses in seafood processing.

Fatal Falls Overboard in Commercial Fishing - United States, 2000-2016.

Commercial fishing is one of the most dangerous jobs in the United States, with a 2016 work-related fatality rate (86.0 deaths per 100,000 full-time equivalent workers) 23 times higher than that for all U.S. workers (3.6) (1). Sinking vessels cause the most fatalities in the industry; however, falling from a fishing vessel is a serious hazard responsible for the second highest number of commercial fishing-associated fatalities (2,3). CDC's National Institute for Occupational Safety and Health (NIOSH) analyzed data on unintentional fatal falls overboard in the U.S. commercial fishing industry to identify gaps in the use of primary, secondary, and tertiary prevention strategies. During 2000-2016, a total of 204 commercial fishermen died after unintentionally falling overboard. The majority of falls (121; 59.3%) were not witnessed, and 108 (89.3%) of these victims were not found. Among 83 witnessed falls overboard, 56 rescue attempts were made; 22 victims were recovered but were not successfully resuscitated. The circumstances, rescue attempts, and limited use of lifesaving and recovery equipment indicate that efforts to reduce these preventable fatalities are needed during pre-event, event, and post-event sequences of falls overboard. Vessel owners could consider strategies to prevent future fatalities, including lifeline tethers, line management, personal flotation devices (PFDs), man-overboard alarms, recovery devices, and rescue training.

Work-related mortality in the US fishing industry during 2000-2014: New findings based on improved workforce exposure estimates.

BACKGROUND: Commercial fishing is a global industry that has been frequently classified as high-risk. The use of detailed surveillance data is critical in identifying hazards. METHODS: The purpose of this study was to provide updated statistics for the entire US fishing industry during 2010-2014, generate fleet-specific fatality rates using a revised calculation of full-time equivalent estimates, and examine changes in the patterns of fatalities and in risk over a 15-year period (2000-2014). RESULTS: During 2010-2014, 188 commercial fishing fatalities occurred in the United States. Vessel disasters and falls overboard remain leading contributors to commercial fishing deaths. The Atlantic scallop fleet stands out for achieving substantial declines in the risk of fatalities over the 15-year study period. However, fatality rates ranged from 21 to 147 deaths per 100 000 FTEs, many times higher than the rate for all US workers. CONCLUSIONS: Although the number of fatalities among commercial fishermen in the United States has generally declined since 2000, commercial fishing continues to have one of the highest occupational fatality rates in the United States. The sustainable seafood movement could assist in improving the health and safety of fishing industry workers if worker well-being was integrated into the definition of sustainable seafood.

Work-related injuries in the Alaska logging industry, 1991-2014.

BACKGROUND: Although loggers in Alaska are at high risk for occupational injury, no comprehensive review of such injuries has been performed since the mid-1990s. We investigated work-related injuries in the Alaska logging industry during 1991-2014. METHODS: Using data from the Alaska Trauma Registry and the Alaska Occupational Injury Surveillance System, we described fatal and nonfatal injuries by factors including worker sex and age, timing and geographic location of injuries, and four injury characteristics. Annual injury rates and associated 5-year simple moving averages were calculated. RESULTS: We identified an increase in the 5-year simple moving averages of fatal injury rates beginning around 2005. While injury characteristics were largely consistent between the first 14 and most recent 10 years of the investigation, the size of logging companies declined significantly between these periods. CONCLUSIONS: Factors associated with declines in the size of Alaska logging companies might have contributed to the observed increase in fatal injury rates.

Work-related traumatic injuries onboard freezer-trawlers and freezer-longliners operating in Alaskan waters during 2001-2012.

BACKGROUND: Workers onboard freezer-trawl (FT) and freezer-longline (FL) vessels in Alaska may be at high risk for fatal and non-fatal injuries. METHODS: Traumatic occupational injuries onboard vessels in the FT and FL fleets were identified through two government data sources. RESULTS: The annual risk of fatal injuries was 125 per 100,000 FTEs in the FT fleet, and 63 per 100,000 FTEs in the FL fleet. The annual risk of non-fatal injuries was 43 per 1,000 FTEs in the FT fleet and 35 per 1,000 FTEs in the FL fleet. The majority of injuries in the FT fleet occurred in the factories and freezer holds, whereas the most common injuries in the FL fleet occurred on deck while working the fishing gear. CONCLUSIONS: The findings confirmed that workers in those fleets were at high risk for work-related injuries. Injury prevention should focus on removing hazards in the work processes injuring the most workers.

Relationship of personal, situational, and environmental factors to injury experience in commercial fishing.

INTRODUCTION: Commercial fishing work involves a variety of activities and is hazardous. While much is understood to mitigate fatalities in this industry, research must further explore nonfatal injury characteristics, factors related to injury, and potential injury prevention strategies. This paper determines if fishing experience is associated with injury risk and explores common work activities associated with injury. METHOD: Key informant interviews and a survey of fishermen were conducted to refine work activity codes and collect injury experiences. Independent sample t-tests compared the means of the years fishing by injury incident for all crab fishermen then stratified by position. Descriptive statistics explored the nature of injury in relation to work activity. RESULTS: The level of experience was significantly lower for injured fishermen compared to fishermen who reported no injuries, but when stratified by position at the time of the injury, the association of injury to experience was only significant for owners. This stratified result demonstrates that the work activity, rather than experience, drives the apparent relationship of experience to injury. Being tired (24%) and weather (26%) were indicated as contributing factors at the time of injury. CONCLUSION: Modifying the work environment to better control hazards would benefit all fishermen, regardless of their experience, age, or position. Further work into effective interventions that fishermen would adopt is needed to reduce injury risk. Any formal or informal training of new fishermen should focus on the most hazardous activities, but more experienced fishermen would also benefit. Additionally, effective training or interventions for fatigue management, and decision support tools for weather- and navigation-related decisions would further reduce risk of at sea injuries. PRACTICAL APPLICATIONS: Injury prevention training, for all fishermen, regardless of their position and years of experience, should cover the most hazardous tasks, fatigue risk management strategies, and weather decisions.

Have you met Angus? Development and evaluation of a social marketing intervention to improve personal flotation device use in commercial fishing.

INTRODUCTION: Drowning is the leading cause of death among commercial fishermen in the United States. Approximately 30% of all commercial fishing fatalities are attributed to falls overboard. One of the simplest and most affordable ways to prevent these fatalities is for crewmembers to wear personal flotation devices (PFDs) while on deck. An examination of over 200 fatal falls overboard in the U.S. fishing industry revealed that none of the victims were wearing PFDs when they died. PFDs are not required to be worn by commercial fishermen in the United States, so this study was designed to encourage behavior change using targeted health communication and social marketing. METHODS: This study developed, implemented, and evaluated a multi-media social marketing campaign featuring a fictitious, culturally-relevant spokesman designed to look, talk, and act like the target audience. The messages were crafted to address common barriers to PFD adoption and misconceptions about fleet-specific risks for fatalities from falls overboard. The campaign was evaluated over two seasons of fishing to look at message retention and intent toward action following exposure to the campaign materials. RESULTS: Survey respondents indicated overall positive opinions about the spokesman and the messages. Results also show a reported change in behavior related to using PFDs while working on deck. DISCUSSION: Targeted multi-media messaging can influence behavior of workers in high-risk occupations in remote locations. Safety message development should focus on occupational culture to create valid and authentic communication products for workers in high-risk industries.

Linking Datasets to Characterize Injury and Illness in Alaska's Fishing Industry.

Limited research has characterized nonfatal injury/illness in Alaska's hazardous fishing industry. This study aimed to determine (a) the utility of linking datasets to conduct surveillance, and (b) injury/illness patterns during 2012-2016. Data were obtained from the Alaska Trauma Registry (ATR), Fishermen's Fund (FF), and US Coast Guard (USCG). Datasets were coded to identify patterns in injury/illness characteristics and circumstances. Probabilistic linkage methods were utilized to identify unique incidents that appeared in more than one dataset. After linking datasets, 3,014 unique injury/illness cases were identified. By dataset, 2,365 cases appeared only in FF, 486 only in USCG, 110 only in ATR, 25 in ATR and FF, 15 in ATR and USCG, 10 in USCG and FF, and 3 in all datasets. FF mainly captured claims submitted by small, independently-owned vessels in Southcentral and Southeastern Alaska. In contrast, USCG mainly captured reports from large, company-owned vessels in Western Alaska. By nature, cases were most frequently sprains, strain, and tears (27%), cuts (15%), and fractures (11%). Across fleets, injuries/illnesses most frequently resulted from contact with objects and equipment (41%), overexertion and bodily reaction (27%), and slips, trips, and falls (20%). Work processes associated with traumatic injuries were most frequently hauling gear (18%) and walking, climbing, and descending (18%). Half of all injuries were of moderate severity (53%). Linking datasets, which capture different segments of Alaska's fishing industry, provides the most comprehensive understanding of nonfatal injury/illness to date. These results, stratified by fleet and severity, will inform prevention strategies.

Drowning in Alaska: progress and persistent problems.

OBJECTIVES: The purpose of this study is to evaluate and describe the current problem of drowning in Alaska, measure changes in the rates since earlier studies have been done and compare occupational and non-occupational drowning characteristics. STUDY DESIGN: This is a descriptive observational study, using existing records obtained from several sources to describe and compare drowning victims and event characteristics. METHODS: Drowning fatality data were collected from death certificates, law-enforcement reports and news articles. Descriptive statistics and risk ratios were calculated to compare levels of risk based on incident and victim characteristics. RESULTS: During 2000-2006, 402 unintentional drowning deaths, 108 of them occupational, occurred in Alaska, with an average annual fatality rate of 8.9 deaths per 100,000 Alaskans. The victim population was 86% male and 44% Alaska Native; 40% drowned in the south-west region of Alaska. For non-occupational cases with alcohol use documented, 33% were associated with alcohol consumption, as were 78% of those involved with all-terrain vehicle crashes. Only 17% of non-occupational victims who drowned while boating wore a Personal Flotation Device (PFD). CONCLUSIONS: The drowning rate in Alaska during 2000-2006 was 8.9 drowning deaths per 100,000 population. This shows a decrease from the rate reported in a 1996 study, but several problems persist. Males and Alaska Natives had elevated risks for drowning. A substantial portion of fatalities were associated with alcohol consumption. PFD use remains low, and child drowning rates were unchanged from earlier studies. Increased data on water temperature and immersion time may help demonstrate the benefits of PFD use to those at risk. Social marketing efforts should be adapted for at-risk populations.

Predicting commercial fishing vessel disasters through a novel application of the theory of man-made disasters.

INTRODUCTION: Vessel disasters (e.g., sinkings, capsizings) are a leading contributor to fatalities in the U.S. commercial fishing industry. Primary prevention strategies are needed to reduce the occurrence of vessel disasters, which can only be done by developing an understanding of their causes and risk factors. If less serious vessel casualties (e.g., loss of propulsion, fire, flooding) are predictors of future disasters, then reducing vessel casualties should in turn reduce vessel disasters and the accompanying loss of life. METHOD: This case-control study examined the association between vessel casualties and disasters using fishing vessels in Alaska during 2010-2015. RESULTS: The findings show that vessels that experienced casualties within a preceding 10-year period were at increased odds of disaster. Other significant predictors included safety decal status and hull material. Practical Applications: The results of this analysis emphasize the importance of implementing vessel-specific preventive maintenance plans. At an industry level, specific prevention policies should be developed focusing on high-risk fleets to identify and correct a wide range of safety deficits before they have catastrophic and fatal consequences.

Using Workers' Compensation Claims Data to Describe Nonfatal Injuries among Workers in Alaska.

BACKGROUND: To gain a better understanding of nonfatal injuries in Alaska, underutilized data sources such as workers' compensation claims must be analyzed. The purpose of the current study was to utilize workers' compensation claims data to estimate the risk of nonfatal, work-related injuries among occupations in Alaska, characterize injury patterns, and prioritize future research. METHODS: A dataset with information on all submitted claims during 2014-2015 was provided for analysis. Claims were manually reviewed and coded. For inclusion in this study, claims had to represent incidents that resulted in a nonfatal acute traumatic injury, occurred in Alaska during 2014-2015, and were approved for compensation. RESULTS: Construction workers had the highest number of injuries (2,220), but a rate lower than the overall rate (34 per 1,000 construction workers, compared to 40 per 1,000 workers overall). Fire fighters had the highest rate of injuries on the job, with 162 injuries per 1,000 workers, followed by law enforcement officers with 121 injuries per 1,000 workers. The most common types of injuries across all occupations were sprains/strains/tears, contusions, and lacerations. CONCLUSION: The successful use of Alaska workers' compensation data demonstrates that the information provided in the claims dataset is meaningful for epidemiologic research. The predominance of sprains, strains, and tears among all occupations in Alaska indicates that ergonomic interventions to prevent overexertion are needed. These findings will be used to promote and guide future injury prevention research and interventions.

Workers' compensation injury claims of aviation industry worker injuries in Alaska, 2014-2015.

Aviation operations in Alaska often occur in remote locations and during inclement weather. Limited infrastructure and staff in some locations often requires aviation workers to perform tasks outside of their specific job descriptions. Researchers identified workers' compensation claims as a valuable data source to characterise nonfatal injuries among Alaskan aviation workers. Keyword searches of injury claim narrative fields and industry codes were used to identify potentially aviation-related workers' compensation claims during 2014-2015. These claims were manually reviewed to verify whether aviation related and manually coded according to the US Bureau of Labour Statistics' Occupational Injury and Illness Classification System. There were 875 aviation-related injury claims accepted during 2014-2015. Ramp/baggage/cargo agents incurred the most injuries (35%), followed by mechanics/maintenance workers (15%). Among all workers, Overexertion and Bodily Reaction (40%) was most often cited as the injury event, followed by Contact with Objects and Equipment (28%), and Falls, Slips, Trips (22%). Sprains, strains, tears were the most frequent nature of injury (55%). Cargo/freight/luggage was the most frequent source of injury (24%). The 3 most frequently identified injury event types were responsible for over 90% of all injuries, which indicates that preventive interventions should be directed towards tasks rather than occupational groups.

Reducing commercial fishing deck hazards with engineering solutions for winch design.

INTRODUCTION: The majority (67%) of hospitalized injuries among Alaska commercial fishermen are associated with deck machinery. This paper describes the "Prevention Through Design" process to mitigate one serious machinery entanglement hazard posed by a capstan deck winch. METHODS: After observing that the capstan winch provides no entanglement protection and the hydraulic controls are usually out of reach of the entangled person, NIOSH personnel met with fishermen and winch manufacturers to discuss various design solutions to mitigate these hazards. RESULTS: An emergency-stop ("e-stop") system was developed that incorporated a momentary contact button that when pushed, switches a safety-relay that de-energizes the solenoid of an electro-hydraulic valve stopping the rotating winch. The vessel owners that had the e-stop installed enthusiastically recommend it to other fishermen. NIOSH entered into a Proprietary Technology Licensing Agreement with a company to develop the system for commercial use. CONCLUSIONS: This is an example of a practical engineering control that effectively protects workers from a hazardous piece of equipment by preventing injuries due to entanglement. This solution could reduce these types of debilitating injuries and fatalities in this industry.

Factors associated with crewmember survival of commercial fishing vessel sinkings in Alaska.

Occupational fatality surveillance has identified that fishing vessel disasters, such as sinkings and capsizings, continue to contribute to the most deaths among crewmembers in the US fishing industry. When a fishing vessel sinks at sea, crewmembers are at risk of immersion in water and subsequent drowning. This study examined survival factors for crewmembers following cold water immersion after the sinking of decked commercial fishing vessels in Alaskan waters during 2000-2014. Two immersion scenarios were considered separately: immersion for any length of time, and long-term immersion defined as immersion lasting over 30 minutes. Logistic regression was used to predict the odds of crewmember survival. Of the 617 crewmembers onboard 187 fishing vessels that sank in Alaska during 2000-2014, 557 (90.3%) survived and 60 died. For crewmembers immersed for any length of time, the significant adjusted predictors of survival were: entering a life-raft, sinking within three miles of shore, the sinking not being weather-related, and working as a deckhand. For crewmembers immersed for over 30 minutes, the significant adjusted predictors of survival were: wearing an immersion suit, entering a life-raft, working as a deckhand, and the sinking not being weather-related. The results of this analysis demonstrate that in situations where cold water immersion becomes inevitable, having access to well-maintained, serviceable lifesaving equipment and the knowledge and skills to use it properly are critical.

Occupational traumatic injuries among offshore seafood processors in Alaska, 2010-2015.

INTRODUCTION: The U.S. Coast Guard and Federal Occupational Safety and Health Administration have identified the Alaskan offshore seafood processing industry as high-risk. This study used Coast Guard injury reports to describe patterns of traumatic injury among offshore seafood processors, as well as identify modifiable hazards. METHODS: From the reports, we manually reviewed and abstracted information on the incident circumstances, injury characteristics and circumstances, and vessel. Traumatic injury cases were coded using the Occupational Injury and Illness Classification System, and a Work Process Classification System. Descriptive statistics characterized worker demographics, injuries, and fleets. RESULTS: One fatal and 304 nonfatal injuries among processors were reported to the Coast Guard during 2010-2015 across multiple fleets of catcher-processor and mothership vessels. The most frequently occurring injuries were: by nature of injury, sprains/strains/tears (75, 25%), contusions (50, 16%), and fractures (45, 15%); by body part affected, upper extremities (121, 40%), and trunk (75, 25%); by event/exposure resulting in injury, contact with objects and equipment (150, 49%), and overexertion and bodily reaction (76, 25%); and by source of injury, processing equipment and machinery (85, 28%). The work processes most frequently associated with injuries were: processing seafood on the production line (68, 22%); stacking blocks/bags of frozen product (50, 17%); and repairing/maintaining/cleaning factory equipment (28, 9%). CONCLUSIONS: Preventing musculoskeletal injuries, particularly to workers' upper extremities and trunks, is paramount. Some injuries, such as serious back injuries, intracranial injuries, and finger crushing or amputations, had the potential to lead to disability. PRACTICAL APPLICATIONS: Safety professionals and researchers can use the study findings to inform future intervention efforts in this industry. Hazard control measures should target: (a) overexertion from lifting and lowering objects and equipment; (b) equipment and boxes falling and striking workers; (c) workers being caught in running machinery during regular operations; and (d) slips, trips, and falls.