Extreme Heat and Occupational Health Risks.

Climate change poses a significant occupational health hazard. Rising temperatures and more frequent heat waves are expected to cause increasing heat-related morbidity and mortality for workers across the globe. Agricultural, construction, military, firefighting, mining, and manufacturing workers are at particularly high risk for heat-related illness (HRI). Various factors, including ambient temperatures, personal protective equipment, work arrangements, physical exertion, and work with heavy equipment may put workers at higher risk for HRI. While extreme heat will impact workers across the world, workers in low- and middle-income countries will be disproportionately affected. Tracking occupational HRI will be critical to informing prevention and mitigation strategies. Renewed investment in these strategies, including workplace heat prevention programs and regulatory standards for indoor and outdoor workers, will be needed. Additional research is needed to evaluate the effectiveness of interventions in order to successfully reduce the risk of HRI in the workplace.

California cannabis cultivation and processing workers: A qualitative analysis of physiological exposures and health effects.

INTRODUCTION: Cannabis is a multi-billion-dollar California industry, but little is known about the occupational hazards or health experiences of cannabis cultivation workers. Respiratory and dermal exposures, musculoskeletal hazards, and other agricultural hazards have been identified in previous research. Even in a post-legalization framework, cannabis work is stigmatized and most cannabis is still produced illegally. Qualitative research is essential for establishing rapport with cannabis workers to understand their experiences and concerns. METHODS: We conducted semi-structured discussions with four focus groups including 32 cannabis workers total, and 9 key informants who were workers, industry experts, and business owners or managers. Transcribed results were analyzed to identify key themes on physiological exposures and health effects. RESULTS: The majority (81.3%) of focus group participants were seasonal migrant cannabis trimmers. Themes emerged of respiratory and dermal exposures and outcomes, musculoskeletal disorders, and physical hazards including living conditions. Workers reported respiratory symptoms and rashes from exposure to cannabis, mold, and pesticides. Musculoskeletal pain was ubiquitous due to inadequate seating and long shifts performing repetitive tasks. Seasonal workers experienced chronic exposure to cold conditions and unsanitary housing. Management-level interviewees and other industry stakeholders described concerns and experiences that differed from those of workers. DISCUSSION: The results were consistent with existing research on cannabis worker health, with workers reporting respiratory and dermal exposure and symptoms, musculoskeletal hazards, and physical hazards associated with agricultural work. In addition, we found that workers were affected by substandard living conditions, remote and isolated work environments, and an absence of training.

Evaluating an owner-to-worker training intervention in California nail salons using personal air monitoring.

BACKGROUND: Chemicals in nail products have been linked to numerous health concerns. METHODS: We recruited Vietnamese-American nail salon owners and workers in California and randomized salons into an intervention or control group. Owners in the intervention group received training and then provided education to workers in their salons on best practices to reduce workplace chemical exposures. Methyl methacrylate (MMA), toluene, and total volatile organic compounds (TVOCs) were measured using personal air monitors worn by workers during the work-shift. RESULTS: We enrolled 77 salons (37 intervention and 40 control) and 200 workers. There was no significant intervention effect between the two groups. However, MMA and TVOCs were higher for workers who used gel polish and acrylic nails as well as in busy salons. CONCLUSIONS: Although the intervention did not show reductions in chemical levels, identifying worker tasks and salon characteristics that predict chemical levels can inform future interventions to reduce exposures.

Acquired Color Vision Defects and Hexane Exposure: A Study of San Francisco Bay Area Automotive Mechanics.

Occupational exposure to solvents, including n-hexane, has been associated with acquired color vision defects. Blue-yellow defects are most common and may be due to neurotoxicity or retinal damage. Acetone may potentiate the neurotoxicity of n-hexane. We present results on nonhexane solvent and hexane exposure and color vision from a cross-sectional study of 835 automotive repair workers in the San Francisco Bay Area, California (2007-2013). Cumulative exposure was estimated from self-reported work history, and color vision was assessed using the Lanthony desaturated D-15 panel test. Log-binomial regression was used to estimate prevalence ratios for color vision defects. Acquired color vision defects were present in 29% of participants, of which 70% were blue-yellow. Elevated prevalence ratios were found for nonhexane solvent exposure, with a maximum of 1.31 (95% confidence interval (CI): 0.86, 2.00) for blue-yellow. Among participants aged ≤50 years, the prevalence ratio for blue-yellow defects was 2.17 (95% CI: 1.03, 4.56) in the highest quartile of nonhexane solvent exposure and 1.62 (95% CI: 0.97, 2.72) in the highest category of exposure to hexane with acetone coexposure. Cumulative exposures to hexane and nonhexane solvents in the highest exposure categories were associated with elevated prevalence ratios for color vision defects in younger participants.

Using multiple data sets for public health tracking of work-related injuries and illnesses in California.

BACKGROUND: Research suggests the U.S. Bureau of Labor Statistics Survey of Occupational Injuries and Illnesses underestimates the magnitude of workplace injuries and illnesses. Enumerating workplace injuries and illnesses may be improved by utilizing multiple state-based data sources. METHODS: Using California-based datasets (workers' compensation claims, health care facility data, and physician reports), we enumerated unique cases of amputations and carpal tunnel syndrome (2007-2008), and evaluated the datasets for usefulness in occupational health tracking by performing record linkage across all datasets and calculating match rates between them. RESULTS: 6,862 amputation and 39,589 carpal tunnel syndrome (CTS) cases were identified. Match rates between the datasets ranged from 34.0% to 45.6% (amputations) and 3.0% to 43.5% (CTS). Enumerated amputation and CTS cases from state-based sources were about five and ten times greater than the BLS SOII estimates (1,390 and 3,720). CONCLUSIONS: Successful demonstration of this state level approach has broad implications for improving federal and state efforts to track and prevent work-related injuries and illnesses.

Stress, Mental Health, and Coping Among Workers in the Northern California Cannabis Industry: A Qualitative Descriptive Analysis.

California is home to a multibillion-dollar cannabis (marijuana) industry, but little is known about the occupational health and safety hazards faced by cannabis workers and even less of the stress, mental health, and coping mechanisms among these workers. Previous research has been based on long-term workers at legal businesses, but most California cannabis is produced and sold unlawfully. There are many seasonal workers whose experiences have not been studied. A qualitative study based on focus group discussions and key informant interviews was performed to understand cannabis workers' experiences, knowledge, and perceptions of occupational hazards. Participants reported sources of stress including production pressure and isolation, and mental health outcomes such as depression and mental fatigue. They described primarily maladaptive coping mechanisms. Unique characteristics of the cannabis industry, including criminalization and isolated, remote farms, make interventions challenging. However, policy approaches that involve community organizations could promote worker health.

A Pilot Study of Respiratory and Dermal Symptoms in California Cannabis Cultivation Workers.

Cannabis (Cannabis sativa, marijuana) is the largest cash crop in California. While it is difficult to characterize the size of the industry, the total production is estimated at 15 to 16 million pounds per year, with total revenues exceeding $10 billion per year. Despite the huge size and rapid growth of the industry, there has been little research on the health and safety of cannabis workers. The goal of this pilot study was to explore the feasibility of collecting cannabis worker health data with a self-administered survey and to analyze the first systematically collected data on occupational health symptoms among California cannabis cultivation workers. We performed a cross-sectional survey of demographic and job characteristics as well as eye, nasal, respiratory, and dermal symptoms among 29 workers at two cannabis farms in the Sacramento area, California. Most participants were men aged less than 30 years, with 48% of participants self-identifying as non-Hispanic white and 58% reporting at least some college education. The most frequently reported work-related symptom was nasal irritation, and 38% of the participants reported symptoms suggestive of asthma. The participants had a demographic makeup distinct from traditional California agricultural workers, and a very high prevalence of current use of cannabis (93%). The high proportion of respondents with symptoms suggestive of asthma raises concern; sensitization to the cannabis plant has been reported among cannabis workers and users and there are many well-documented agricultural exposures causing asthma and asthma-like syndrome.

How Does Environmental Temperature Affect Farmworkers' Work Rates in the California Heat Illness Prevention Study?

OBJECTIVE: Estimate the association between environmental temperature (wet bulb globe temperature [WBGT]) and work rate over the course of a workday. METHODS: Repeated-measures regression was used to identify characteristics impacting work rate in a cross-sectional study of Latino farmworkers. Minute-by-minute work rate (measured by accelerometer) and WBGT were averaged over 15-minute intervals. RESULTS: Work rate decreased by 4.34 (95% confidence interval [CI], -7.09 to -1.59) counts per minute per degree Celsius WBGT in the previous 15-minute interval. Cumulative quarter hours worked (2.13; 95% CI, 0.82 to 3.45), age (-3.64; 95% CI, -4.50 to -2.79), and dehydration at the end of workday (51.37; 95% CI, 19.24 to 83.50) were associated with counts per minute as were gender, pay type (piece rate vs hourly) and body mass index ≥25 kg/m 2 . The effects of pay type and body mass index were modified by gender. CONCLUSION: Increased temperature was associated with a decrease in work rate.

Development of a Data Visualization Tool for Occupational Exposure to Chemicals of Concern for Breast Cancer Among California Working Women, 2010-2014.

We identified the occupations that employ California women and a list of chemicals of concern for breast cancer. We evaluated the likelihood of on-the-job exposure to the categories of chemicals by occupation among formally and informally employed women. We selected 145 occupations representing more than 6.6 million women (85% of California working women), along with an additional sixteen occupations for informal workers only. We organized 1012 chemicals (including mammary gland carcinogens, developmental toxicants, and endocrine-disrupting chemicals) into twenty-five categories. More than 80 percent of occupations investigated had possible or probable exposure to at least one category of chemicals. This is the first categorization of occupational exposure to chemicals of concern for breast cancer among California working women. Our investigation revealed significant data gaps, which could be improved by policy changes resulting in enhanced collection of data on occupation and chemical exposure.

Evaluation of respiratory protection programs and practices in California hospitals during the 2009-2010 H1N1 influenza pandemic.

BACKGROUND: Emergence of the novel 2009 influenza A H1N1 virus in California led to an evaluation of hospital respiratory protection programs (RPPs) and practices by the California Department of Public Health during the 2009-2010 influenza season. METHODS: Onsite evaluation of 16 hospitals consisted of interviews with managers and health care workers about RPPs and practices, review of written RPPs, and limited observations of personnel using respirators. Data were analyzed using descriptive statistics. RESULTS: All hospitals had implemented policies requiring the minimum use of N95 filtering facepiece respirators when working with patients with H1N1 virus infection; 95.5% of health care workers (n = 199) reported they would wear at least this level of protection when in close contact with a patient with confirmed or suspected H1N1 virus infection. However, evaluation of written RPPs indicated deficiencies in required areas, most commonly in recordkeeping, designation of a program administrator, program evaluation, employee training, and fit testing procedures. CONCLUSIONS: Health care workers were aware of respiratory protection required when providing care for patients with confirmed or suspected H1N1 virus infection. Hospitals should improve written RPPs, fully implement written procedures, and conduct periodic program evaluation to ensure effectiveness of respirator use for health care worker protection. Increased accessibility of resources tailored for hospital respirator program administrators may be helpful.

The role of state public health agencies in national efforts to track workplace hazards and the relevance of state experiences to nanomaterial worker surveillance.

OBJECTIVE: This essay examines the role state public health agencies could play in the surveillance of emerging workplace hazards including nanotechnology. METHODS: This essay describes existing state occupational health surveillance programs in order to demonstrate their potential applicability, and limitations, in regards to nanomaterial worker surveillance. RESULTS: State public health agencies have access to information and an ability to put surveillance information to use in ways that complement those of industry, academia, regulatory agencies, and federal partners. CONCLUSIONS: Some state public health agencies have significant experience with occupational health surveillance and are therefore valuable partners in the development and implementation of nanotechnology worker surveillance programs. Including states in emerging hazard surveillance enhances surveillance activities and builds state capacity to help workers.