Pain and Prescription Opioid Use Among US Construction Workers: Findings From the 2011‒2018 Medical Expenditure Panel Survey.

Objectives. To examine prescription opioid and nonopioid analgesic use among US construction workers and their associations with pain conditions and sociodemographic factors. Methods. We analyzed data for about 9000 (weighted 11.5 million per year) construction workers who responded to the Medical Expenditure Panel Survey from 2011 to 2018. We applied both descriptive statistics and multiple logistic regression procedures in the analyses. Results. An estimated 1.2 million (10.0%) of construction workers used prescription opioid analgesics annually. The adjusted odds of prescription opioid use were significantly higher for workers suffering from work-related injuries (adjusted odds ratio [AOR] = 3.82; 95% confidence interval [CI] = 2.72, 5.37), non‒work-related injuries (AOR = 3.37; 95% CI = 2.54, 4.46), and musculoskeletal disorders (AOR = 2.31; 95% CI = 1.80, 2.95) after we controlled for potential confounders. Adjusted odds of prescription opioid use were also higher among workers with poorer physical health (AOR = 1.95; 95% CI = 1.42, 2.69) or mental health disorders (AOR = 1.95; 95% CI = 1.41, 2.68). Conclusions. Work- and non‒work-related injuries and musculoskeletal disorders significantly increased prescription opioid use among construction workers. To prevent opioid use disorders, multipronged strategies should be approached. (Am J Public Health. 2022;112(S1):S77-S87. https://doi.org/10.2105/AJPH.2021.306510).

Preventing Opioid-Related Harms in the Construction Industry.

The construction sector has been hit hard by the opioid crisis. We describe CPWR-The Center for Construction Research and Training's recent efforts to address the challenges of opioid use in the construction industry. With support and guidance from the North America's Building Trades Unions Opioid Task Force, CPWR undertook three projects to promote prevention and best practices for struggling construction workers. The first project focused on recommendations for communications that reframe stigmatizing narratives into effective messages about prevention solutions. The second project refined and distributed a one-hour construction worker opioid hazard awareness training module. The third project assessed opportunities and barriers for the expansion and improvement of existing union peer support programs to support workers through treatment and recovery. Additional resources, such as opioid hazard tool box talks, to help reverse the impact on the sector are also described.

What strategies are appropriate for monitoring children outside of family care and evaluating the impact of the programs intended to serve them?

OBJECTIVES: To strengthen the evidence-base for policy and practice for support of children outside of family care requires effective, efficient and sustainable mechanisms for monitoring and evaluation. Toward that end, two core questions guided a systematic review of evidence: What strategies are appropriate for monitoring the needs and circumstances of children outside of family care? What strategies are suitable for evaluating the impact of the programs intended to serve such children? METHODS: A structured document search and review process was implemented within the context of the U.S. Government Evidence Summit on Protecting Children Outside of Family Care of December 2011. Through successive review phases, initially using structured screening criteria, followed by thematic review by an expert panel, 73 documents were identified for analysis. RESULTS: Analysis of models and strategies indicates that: (1) tools are available for assessment of children's needs, but require refining to accommodate contextual demands; (2) well-designed evaluations are able to identify the influence of assistance; (3) long-term follow-up is crucial to developing a strong evidence-base on effective strategies; and (4) insights into systems-wide monitoring mechanisms are emerging. In addition to describing key components of monitoring and evaluation strategies, findings draw attention to the evaluation of children's resiliency and protective factors, community based monitoring and the role of caregivers, as well as concerns over the stigmatization of children (through data collection methodologies encouraging the 'labeling' of children) and the importance of children's participation. CONCLUSIONS: Fostering a stronger evidence-base to improve protection for vulnerable children requires evaluations that are integrated into program development, use context-appropriate methodologies able to assess intervention scalability and employ more longitudinal designs to explore children's trajectories. Further, future programming will benefit from systems-wide data coordination and international comparisons, research that emphasizes coping and resilience mechanisms, and children's participation in monitoring and evaluation.

National Prevention through Design (PtD) Initiative.

INTRODUCTION: The most effective means of preventing and controlling occupational injuries, illness, and fatalities is to "design out" hazards and hazardous exposures from the workplace. There is a long history of designing for safety for the general public and to a lesser degree for workers. METHOD: We now have the experience and insight from thoughtful, previous efforts to call for a comprehensive national strategy to implement a Prevention through Design (PtD) Initiative. RESULTS: This paper describes that initiative in terms of four overarching areas where action can be directed: practice, policy, research, and education. To obtain stakeholder input for issues in these four areas and to focus implementation efforts, eight sector divisions of the economy will be addressed. A seven year strategy is envisioned.

Reduction of respirable silica following the introduction of water spray applications in Indian stone crusher mills.

Respirable crystalline silica dust generated during stone crushing operations has been linked to chronic lung disease and increased risk of tuberculosis. In India, most stone crushing mills operate without any dust control or containment systems. This investigation in the Khurda District of Orissa demonstrated a reduction in respirable particulate mass following the application of a fine mist of water. Average respirable quartz and cristobalite levels declined 82% and 69%, respectively, after water spray controls were installed. This finding suggests that relatively inexpensive modifications that are available in the local market can be effective at reducing silica exposures. Although average exposure levels, particularly during the dry season, may exceed the Permissible Exposure Limit for silica, the overall reductions observed were substantial. Widespread adoption of this simple control technology by stone crushers in India could have a positive public health impact.

Laboratory evaluation of a potential diesel fuel interference in the determination of polycyclic aromatic compounds on dermal samplers.

Road pavers are exposed to asphalt fumes through dermal contact, inhalation, or ingestion. These fumes contain polycyclic aromatic compounds (PACs), a class of compounds including polycyclic aromatic hydrocarbons (PAHs). The PAHs include compounds such as pyrene and benzo(a)pyrene and a large number of other compounds of known or suspected carcinogenicity. To estimate dermal deposition of asphalt fume particulate matter, polypropylene sampling patches can be worn on a worker's inside wrist. Diesel fuel used for cleaning can splash onto the dermal sampler. Exposed dermal patches were solvent extracted and PACs estimated in the extract using a modification of NIOSH Method 5800. The final solution was analyzed by high pressure liquid chromatography (HPLC) with a fluorescence detector using an excitation wavelength of 270 nanometers and an emission wavelength of 415 nanometers. The PACs were concentrated on a C-18 reverse phase guard column but not separated so that they could be measured expediently as a group. In this study we examined whether deposited diesel fuel interferes with the HPLC determination of PACs. We characterized the effect of diesel fuel contamination over broad ranges of both analyte and interferent. Two drops, or approximately 100 microL, of diesel fuel on the dermal samplers caused an overestimation of the concentration of polycyclic aromatic compounds (PACs). In the range of PACs determined in our field study (0 to 54 microg per sample), these errors could have exceeded 100%. Because 100 microL of deposited diesel fuel produced a clear visual "wetness," this observation can serve as one of the criteria for sample rejection. Sampling media must be examined carefully for visible contamination to prevent bias in the measurement of PACs deposited from asphalt fume.