Linking environmental injustices in Detroit, MI to institutional racial segregation through historical federal redlining.

OBJECTIVES: To identify the most pervasive environmental exposures driving environmental disparities today associated with historical redlining in Detroit. METHODS: We overlaid Detroit's 1939 Home Owners' Loan Corporation (HOLC) shapefile from the Mapping Inequality project onto the EPA EJScreen and the DOT National Transportation Noise maps to analyze differences in current demographic and environmental indicators between historically redlined (D-grade) and non-redlined neighborhoods using simple linear regression and a boosted classification tree algorithm. RESULTS: Historically redlined neighborhoods in Detroit experienced significantly higher environmental hazards than non-redlined neighborhoods in the form of 12.1% (95% CI: 7.2-17.1%) higher levels of diesel particulate matter (PM), 32.2% (95% CI: 3.3-69.3%) larger traffic volumes, and 65.7% (95% CI: 8.6-152.8%) higher exposure to hazardous road noise (LEQ(24h) >70 dBA). Historically redlined neighborhoods were situated near 1.7-times (95% CI: 1.4-2.1) more hazardous waste sites and twice as many (95% CI: 1.5-2.7) risk management plan (RMP) sites than non-redlined neighborhoods. The lifetime cancer risk from inhalation of air toxics was 4.4% (95% CI: 2.9-6.6%) higher in historically redlined communities, and the risk of adverse respiratory health outcomes from air toxics was 3.9% (95% CI: 2.1-5.6%) higher. All factors considered together, among the environmental hazards considered, the most pervasive hazards in historically redlined communities are proximity to RMP sites, hazardous road noise, diesel PM, and cancer risk from air pollution. CONCLUSIONS: Historically redlined neighborhoods may have a disproportionately higher risk of developing cancer and adverse respiratory health outcomes from air toxics. Policies targeting air and noise pollution from transportation sources, particularly from sources of diesel exhaust, in historically redlined neighborhoods may ameliorate some of the impacts of structural environmental racism from historical redlining in Detroit.

Retrospective assessment of the association between noise exposure and nonfatal and fatal injury rates among miners in the United States from 1983 to 2014.

BACKGROUND: Mining is a significant economic force in the United States but has historically had among the highest nonfatal injury rates across all industries. Several factors, including workplace hazards and psychosocial stressors, may increase injury and fatality risk. Mining is one of the noisiest industries; however, the association between injury risk and noise exposure has not been evaluated in this industry. In this ecological study, we assessed the association between noise exposure and nonfatal and fatal occupational injury rates among miners. METHODS: Federal US mining accident, injury, and illness data sets from 1983 to 2014 were combined with federal quarterly mining employment and production reports to quantify annual industry rates of nonfatal injuries and fatalities. An existing job-exposure matrix for occupational noise was used to estimate annual industry time-weighted average (TWA, dBA) exposures. Negative binomial models were used to assess relationships between noise, hearing conservation program (HCP) regulation changes in 2000, year, and mine type with incidence rates of injuries and fatalities. RESULTS: Noise, HCP regulation changes, and mine type were each independently associated with nonfatal injuries and fatalities. In multivariate analysis, each doubling (5 dB increase) of TWA was associated with 1.08 (95% confidence interval: 1.05, 1.11) and 1.48 (1.23, 1.78) times higher rate of nonfatal injuries and fatalities, respectively. HCP regulation changes were associated with 0.61 (0.54, 0.70) and 0.49 (0.34, 0.71) times lower nonfatal injury and fatality rates, respectively. CONCLUSION: Noise may be a significant independent risk factor for injuries and fatalities in mining.

Health Assessment of Electronic Waste Workers in Chile: Participant Characterization.

Little research has been done to evaluate the occupational health of electronic waste (e-waste) recycling workers in Latin America. The objective of this study was to complete comprehensive health evaluations on e-waste recycling workers in Chile and to compare those that work in informal (i.e., independent) to those that work in formal (i.e., established company) settings. A cross-sectional study in the summer of 2017 recruited 78 informal recycling workers from two cities and 15 formal e-waste recycling workers from a single recycling facility to assess exposures and health outcomes. Participants completed a health questionnaire and underwent a full health assessment. Herein, only health questionnaire data are reported. Participants were primarily male, middle-aged, married with children, and had worked in e-waste recycling for an average of 12 years. Participants generally reported good health status, and their prevalence of chronic diseases was comparable to national rates. Workers frequently reported exposures to several occupational stressors, including noise and insufficient income, as well as other mental health stressors. Occupational injuries were commonly reported and use of safety equipment was low. Only a few significant differences, generally of a rather small magnitude, were found between informal and formal workers. In conclusion, from survey data, we did not identify major risks to health among e-waste workers, and only minor differences between workers in informal and formal settings.

Assessing Hearing Conservation Program Effectiveness: Results of a Multisite Assessment.

OBJECTIVES: Noise-induced hearing loss (NIHL) remains one of the most prevalent occupational diseases. Occupational hearing conservation programs (HCPs) can reduce the risk of NIHL, but there remains no consensus on assessing HCP effectiveness. We conducted a multisite, mixed-method assessment of HCP programs. METHODS: At 13 manufacturing plants, we performed assessments, including interviews with program staff and worker focus groups and surveys. We analyzed the association between these assessments and age-corrected NIHL rates. RESULTS: Only a few items from the HCP staff interviews correlated with NIHL rates. For the employee survey, management commitment to NIHL prevention and being counseled about NIHL were strongly associated with NIHL rates. CONCLUSION: Management commitment and counseling of workers about NIHL may be key factors in program effectiveness. A combination of qualitative and quantitative methods appears to be useful for assessing HCPs.

Costs and effectiveness of hearing conservation programs at 14 US metal manufacturing facilities.

OBJECTIVE: This study characterised overall and specific costs associated with hearing conservation programmes (HCPs) at US metal manufacturing sites, and examined the association between these costs and several noise-induced hearing loss (NIHL) outcomes. DESIGN: We interviewed personnel and reviewed records at participating facilities. We also measured noise for comparison to the ten-year average of measurements made by each facility. NIHL outcomes assessed included rates of standard threshold shifts (STS) and high-frequency hearing loss, as well as prevalence of hearing impairment, for each participating facility. We used linear regression to identify per-person HCP costs that best predicted the NIHL outcomes. STUDY SAMPLE: We evaluated 14 US metal manufacturing facilities operated by a single company. RESULTS: Annual HCP costs ranged from roughly $67,000 to $397,000 (average $308 ± 80 per worker). Our full-shift noise measurements (mean 83.1 dBA) showed good agreement with the facilities' measurements (mean 82.6 dBA). Hearing impairment prevalence was about 15% overall. Higher expenditures for training and hearing protector fit-testing were significantly associated with reduced STS prevalence. Higher training expenditures were also related to lower hearing impairment prevalence and high-frequency hearing loss rates. CONCLUSIONS: HCP costs were substantial and variable. Increased workplace spending on training and fit-testing may help minimise NIHL.

Economic Impact of Hearing Loss and Reduction of Noise-Induced Hearing Loss in the United States.

Purpose: Hearing loss (HL) is pervasive and debilitating, and noise-induced HL is preventable by reducing environmental noise. Lack of economic analyses of HL impacts means that prevention and treatment remain a low priority for public health and environmental investment. Method: This article estimates the costs of HL on productivity by building on established estimates for HL prevalence and wage and employment differentials between those with and without HL. Results: We estimate that HL affects more than 13% of the working population. Not all HL can be prevented or treated, but if the 20% of HL resulting from excessive noise exposure were prevented, the economic benefit would be substantial-we estimate a range of $58 billion to $152 billion annually, with a core estimate of $123 billion. We believe this is a conservative estimate, because consideration of additional costs of HL, including health care and special education, would likely further increase the benefits associated with HL prevention. Conclusion: HL is costly and warrants additional emphasis in public and environmental health programs. This study represents an important first step in valuing HL prevention-in particular, prevention of noise-induced HL-where new policies and technologies appear promising.

Health seeking behaviours among electronic waste workers in Ghana.

BACKGROUND: Electronic waste workers are prone to various illnesses and injuries from numerous hazards thus the need for them to seek health care. The aim of this study was to describe health-seeking behavior, and social and other factors affecting this behavior, among electronic waste workers at Agbogbloshie, Accra, Ghana. METHODS: In-depth interviews were conducted and analyzed qualitatively from a grounded theory perspective. RESULTS: Workers experienced various kinds of ailments. These included physical injuries, chest and respiratory tract associated symptoms, malaria, headaches, body pains and stomach discomfort. They reported seeking health care from multiple sources, and the main determinants of health seeking behaviour were severity of illness, perceived benefit of treatment, accessibility of service, quality of service, ease of communication with service provider and cost of health care. CONCLUSION: Multiple sources of health care were used by the e-waste workers. As cost was a major barrier to accessing formal health care, most of the workers did not subscribe to health insurance. Since enrollment in health insurance is low amongst the workers, education campaigns on the need to register with the National Health Insurance Scheme would facilitate access to formal health care and could result in improved health outcomes among e-waste workers.

Integrated assessment of artisanal and small-scale gold mining in Ghana--part 1: human health review.

This report is one of three synthesis documents produced via an integrated assessment (IA) that aims to increase understanding of artisanal and small-scale gold mining (ASGM) in Ghana. Given the complexities surrounding ASGM, an IA framework was utilized to analyze economic, social, health, and environmental data, and co-develop evidence-based responses with pertinent stakeholders. The current analysis focuses on the health of ASGM miners and community members, and synthesizes extant data from the literature as well as co-authors' recent findings regarding the causes, status, trends, and consequences of ASGM in Ghana. The results provide evidence from across multiple Ghanaian ASGM sites that document relatively high exposures to mercury and other heavy metals, occupational injuries and noise exposure. The work also reviews limited data on psychosocial health, nutrition, cardiovascular and respiratory health, sexual health, and water and sanitation. Taken together, the findings provide a thorough overview of human health issues in Ghanaian ASGM communities. Though more research is needed to further elucidate the relationships between ASGM and health outcomes, the existing research on plausible health consequences of ASGM should guide policies and actions to better address the unique challenges of ASGM in Ghana and potentially elsewhere.

Valuing Quiet: An Economic Assessment of U.S. Environmental Noise as a Cardiovascular Health Hazard.

INTRODUCTION: Environmental noise pollution increases the risk for hearing loss, stress, sleep disruption, annoyance, and cardiovascular disease and has other adverse health impacts. Recent (2013) estimates suggest that more than 100 million Americans are exposed to unhealthy levels of noise. Given the pervasive nature and significant health effects of environmental noise pollution, the corresponding economic impacts may be substantial. METHODS: This 2014 economic assessment developed a new approach to estimate the impact of environmental noise on the prevalence and cost of key components of hypertension and cardiovascular disease in the U.S. By placing environmental noise in context with comparable environmental pollutants, this approach can inform public health law, planning, and policy. The effects of hypothetical national-scale changes in environmental noise levels on the prevalence and corresponding costs of hypertension and coronary heart disease were estimated, with the caveat that the national-level U.S. noise data our exposure estimates were derived from are >30 years old. RESULTS: The analyses suggested that a 5-dB noise reduction scenario would reduce the prevalence of hypertension by 1.4% and coronary heart disease by 1.8%. The annual economic benefit was estimated at $3.9 billion. CONCLUSIONS: These findings suggest significant economic impacts from environmental noise-related cardiovascular disease. Given these initial findings, noise may deserve increased priority and research as an environmental health hazard.

Street-level noise in an urban setting: assessment and contribution to personal exposure.

BACKGROUND: The urban soundscape, which represents the totality of noise in the urban setting, is formed from a wide range of sources. One of the most ubiquitous and least studied of these is street-level (i.e., sidewalk) noise. Mainly associated with vehicular traffic, street level noise is hard to ignore and hard to escape. It is also potentially dangerous, as excessive noise from any source is an important risk factor for adverse health effects. This study was conducted to better characterize the urban soundscape and the role of street level noise on overall personal noise exposure in an urban setting. METHODS: Street-level noise measures were obtained at 99 street sites located throughout New York City (NYC), along with data on time, location, and sources of environmental noise. The relationship between street-level noise measures and potential predictors of noise was analyzed using linear and logistic regression models, and geospatial modeling was used to evaluate spatial trends in noise. Daily durations of street-level activities (time spent standing, sitting, walking and running on streets) were estimated via survey from a sample of NYC community members recruited at NYC street fairs. Street-level noise measurements were then combined with daily exposure durations for each member of the sample to estimate exposure to street noise, as well as exposure to other sources of noise. RESULTS: The mean street noise level was 73.4 dBA, with substantial spatial variation (range 55.8-95.0 dBA). Density of vehicular (road) traffic was significantly associated with excessive street level noise levels. Exposure duration data for street-level noise and other common sources of noise were collected from 1894 NYC community members. Based on individual street-level exposure estimates, and in consideration of all other sources of noise exposure in an urban population, we estimated that street noise exposure contributes approximately 4% to an average individual's annual noise dose. CONCLUSIONS: Street-level noise exposure is a potentially important source of overall noise exposure, and the reduction of environmental sources of excessive street- level noise should be a priority for public health and urban planning.

Assessment of Noise Exposure to Children: Considerations for the National Children's Study.

Evidence has been accruing to indicate that young children are vulnerable to noise in their physical environment. A literature review identified that, in addition to hearing loss, noise exposure is associated with negative birth outcomes, reduced cognitive function, inability to concentrate, increased psychosocial activation, nervousness, feeling of helplessness, and increased blood pressure in children. While increasing attention has been given to the health effects of noise in children, research about noise exposure is sparse and often the measure of exposure is simply proximity to a noise source. The U.S. National Children's Study (NCS) provides a unique opportunity to investigate noise exposures to pregnant women and children using a number of assessment modalities at different life stages. Measurement of noise levels in homes and other environments, personal dosimetry measurements made over a period of days, and questionnaires addressing sources of noise in the environment, annoyance to noise, perceived noise level, use of head phones and ear buds, noisy activity exposures, and occupational exposures, are planned for evaluation within the NCS Vanguard pilot study. We describe the NCS planned approach to addressing noise exposure assessment in study visits over a child's lifetime.

Longitudinal assessment of noise exposure in a cohort of construction workers.

OBJECTIVES: To address questions surrounding noise-induced hearing loss (NIHL) from variable noise, we have been evaluating noise exposures and changes in hearing in a prospective cohort of construction workers (representing eight trades) and controls. In this paper, we develop and explore several long-term exposure estimates for cohort members. METHODS: We followed cohort members between 1999 and 2009 and interviewed them approximately annually to obtain a detailed work history for the previous subject-interval while also collecting tests of hearing sensitivity. Over the same period, we also collected a sample of full-shift average noise measurements and activity information. We used data from these two sources to develop various exposure estimates for each subject for specific subject intervals and for the duration of the study. These estimates included work duration, trade-mean (TM)-equivalent continuous exposure level (L(EQ)), task-based (TB) L(EQ), a hybrid L(EQ) combining TB and subjective information, and an estimate of noise exposure 'peakiness'. RESULTS: Of the 456 subjects enrolled in the study, 333 had at least 2 interviews and met several inclusion criteria related to hearing sensitivity. Depending on the metric used, between one-third and three-quarters of 1310 measured full-shift noise exposures exceeded permissible and recommended exposure limits. Hybrid and TB exposure estimates demonstrated much greater variability than TM estimates. Work duration and estimates of exposure peakiness showed poor agreement with average exposures, suggesting that these metrics evaluate different aspects of exposure and may have different predictive value for estimating NIHL. CONCLUSIONS: Construction workers in the cohort had subject-interval and study-average exposures which present a substantial potential risk of NIHL. In a subsequent paper, we will use these estimates to evaluate the exposure-response relationship between noise and NIHL.

Predictors of hearing protection use in construction workers.

OBJECTIVES: Although noise-induced hearing loss is completely preventable, it remains highly prevalent among construction workers. Hearing protection devices (HPDs) are commonly relied upon for exposure reduction in construction, but their use is complicated by intermittent and highly variable noise, inadequate industry support for hearing conservation, and lax regulatory enforcement. METHODS: As part of an intervention study designed to promote HPD use in the construction industry, we enrolled a cohort of 268 construction workers from a variety of trades at eight sites and evaluated their use of HPDs at baseline. We measured HPD use with two instruments, a questionnaire survey and a validated combination of activity logs with simultaneous dosimetry measurements. With these measurements, we evaluated potential predictors of HPD use based on components of Pender's revised health promotion model (HPM) and safety climate factors. RESULTS: Observed full-shift equivalent noise levels were above recommended limits, with a mean of 89.8 +/- 4.9 dBA, and workers spent an average of 32.4 +/- 18.6% of time in each shift above 85 dBA. We observed a bimodal distribution of HPD use from the activity card/dosimetry measures, with nearly 80% of workers reporting either almost never or almost always using HPDs. Fair agreement (kappa = 0.38) was found between the survey and activity card/dosimetry HPD use measures. Logistic regression models identified site, trade, education level, years in construction, percent of shift in high noise, and five HPM components as important predictors of HPD use at the individual level. Site safety climate factors were also predictors at the group level. CONCLUSIONS: Full-shift equivalent noise levels on the construction sites assessed were well above the level at which HPDs are required, but usage rates were quite low. Understanding and predicting HPD use differs by methods used to assess use (survey versus activity card/dosimetry). Site, trade, and the belief that wearing HPD is not time consuming were the only predictors of HPD use common to both measures on an individual level. At the group level, perceived support for site safety and HPD use proved to be predictive of HPD use.

A comparison of "Train-the-Trainer" and expert training modalities for hearing protection use in construction.

BACKGROUND: Few assessments have been conducted on the impact of a "Train-the-Trainer" (T3) approach for training delivery. The present study compared the effectiveness of a noise induced hearing loss (NIHL) prevention training delivered using "Train-the-Trainer" and expert trainer modalities. METHODS: Participating construction companies were assigned to the Train-the-Trainer or expert trainer modalities. Workers were recruited from each company and then trained. The effectiveness of the modalities was assessed through the use of surveys. The accuracy of self-reported hearing protection device (HPD) use was also evaluated through on-site observation. RESULTS: Post-training scores for hearing conservation knowledge, perceived barriers, and current and intended future use of HPDs improved significantly for both training modalities. Subjects trained by T3 trainers significantly increased their beliefs regarding general susceptibility to NIHL, desire to prevent NIHL, and ability to recognize, and control hazardous noise exposures. The expert-trained groups significantly increased their beliefs regarding the benefits of HPD use and ability to ask for help with HPDs. The only changes that were significantly different between modalities were in general susceptibility to NIHL and effective use of HPDs. However, these beliefs differed significantly between subjects in the two-modality groups prior to training. Self-reported HPD use was poorly correlated with observed use, calling into question the validity of survey-based HPD use measures in this context. CONCLUSIONS: The training improved beliefs regarding HPD use, increased workers' hearing conservation knowledge, and increased self-reported HPD use. The effectiveness of the training was not found to be dependent on training modality.

Task-based assessment of occupational vibration and noise exposures in forestry workers.

Forty-two noise exposures and 164 whole-body (WBV) and hand-arm (HAV) vibration exposures were collected from 43 forestry workers in six trades employed by two forestry companies. Data were collected on 10 days over 8 weeks during various felling, logging, and log handling operations. Up to 5 volunteers were monitored for noise and vibration daily using datalogging noise dosimeters, which provided daily time-weighted averages (TWAs) and 1-min averages; and a precision sound level meter equipped to measure human vibration, which provided triaxial HAV and WBV event-weighted averages (AEQS). Workers completed a short questionnaire throughout the workday detailing the timing and number of tasks performed and equipment used. Substantial overexposures to noise and vibration were seen; for example, 60% of Occupational Safety and Health Administration (OSHA) TWAs and 83% of National Institute for Occupational Safety and Health (NIOSH) noise TWAs exceeded 85 dBA, 33-53% of the axis-specific HAV AEQS exceeded the 8-hour American Conference of Governmental Industrial Hygienists' HAV threshold limit value, and 34% of all summary weighted WBV AEQS exceeded the Commission of the European Communities' 8-hour exposure limit. The mean for 99 WBV summary weighted AEQ was 3.53 +/- 7.12 m/sec2, whereas the mean for 65 HAV summary weighted AEQ was 5.45 +/- 5.25 m/sec2. The mean OSHA TWA was 86.1 +/- 6.2 dBA, whereas the mean NIOSH TWA was 90.2 +/- 5.1 dBA. The task and tool with the highest exposure levels were unbelling chokers on landings and chain saws (noise), log processing and frontend loaders (WBV), and notching stumps and chain saws (HAV). An internal validation substudy indicated excellent agreement between worker-reported and researcher-documented tasks and tools.