Occupational particle exposure and chronic kidney disease: a cohort study in Swedish construction workers.

OBJECTIVES: Increasing epidemiological and experimental evidence suggests that particle exposure is an environmental risk factor for chronic kidney disease (CKD). However, only a few case-control studies have investigated this association in an occupational setting. Hence, our objective was to investigate associations between particle exposure and CKD in a large cohort of Swedish construction workers. METHODS: We performed a retrospective cohort study in the Swedish Construction Workers' Cohort, recruited 1971-1993 (n=286 089). A job-exposure matrix was used to identify workers exposed to nine different particulate exposures, which were combined into three main categories (inorganic dust and fumes, wood dust and fibres). Incident CKD and start of renal replacement therapy (RRT) were obtained from validated national registries until 2021 and analysed using adjusted Cox proportional hazards models. RESULTS: Exposure to inorganic dust and fumes was associated with an increased risk of CKD and RRT during working age (adjusted HR for CKD at age <65 years 1.15, 95% CI 1.05 to 1.26). The elevated risk did not persist after retirement age. Exposure to cement dust, concrete dust and diesel exhaust was associated with CKD. Elevated HRs were also found for quartz dust and welding fumes. CONCLUSIONS: Workers exposed to inorganic particles seem to be at elevated risk of CKD and RRT. Our results are in line with previous evidence of renal effects of ambient air pollution and warrant further efforts to reduce occupational and ambient particle exposure.

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).

Workplace bullying among Nigerian artisans in building and construction industry.

ABSTRACT: Bullying is a growing problem in the workplace. This study investigated the bullying experience of building and construction industry artisans.We employed a cross-sectional analytic design to study 240 artisans in respect of workplace bullying (WPB) experience using a self-report questionnaire. Percentage, mean and standard deviation were used for data analysis and interpretation.According to the study, a significant percentage (96.1%) of the artisans perceived themselves as victims of WPB within the past 6 months and these experiences also occurred once or more times weekly.WPB is a considerable problem among building and construction industry artisans in Nigeria. Further studies that can influence the construction industry to create valuable programs to minimize bullying among artisans are required.

Coercive pressure as a moderator of organizational structure and risk management: Empirical evidence from Malaysian construction industry.

INTRODUCTION: The construction industry in Malaysia has been bedevilled by myriads of risk issues that have hampered its smooth operations in recent times. This paper is an empirical assessment that aims to examine the effect of coercive pressure on the relationship between organizational structure and construction risk management among construction industry in Malaysia. METHOD: Based on the proposed model, a quantitative method was employed to obtain data from G7 construction industry operating within the peninsular Malaysia. Out of the 180 copies of questionnaire, 165 copies were properly filled, returned, and used for the analysis. PLS-SEM was used to analyze the obtained data. RESULTS: The findings of the study affirmed that specialization, centralization, and management of risk by the construction industry had positive correlation. CONCLUSIONS: As anticipated, coercive pressure had positive moderating correlation with both formalization and the management of risk by the construction industry. Similarly, it was also found that in the course of carrying out construction activities, coercive pressure made significant interactive influence on formalization, specialization, and centralization. Practical Applications: Coercive pressure reduced the frequency of accidents among workers in the process of carrying out construction works.

The evolution of built-up areas in Ghana since 1975.

We use high resolution satellite data on the proportion of buildings in a 250x250 meter cell to study the evolution of human settlement in Ghana over a 40 year period. We find a strong increase in built-up area over time, mostly concentrated in the vicinity of roads, and also directly on the coast. We find strong evidence of agglomeration effects both in the static sense-buildup in one cell predicts buildup in a nearby cell-and in a dynamic sense-buildup in a cell predicts buildup in that cell later on and an increase in buildup in nearby cells. These effects are strongest over a 3 to 15 Km radius, which corresponds to a natural hinterland for a population without mechanized transportation. We find no evidence that human settlements are spaced more or less equally either over the landscape or along roads. This suggests that arable land is not yet fully utilized, allowing rural settlements to be separated by areas of un-farmed land. By fitting a transition matrix to the data, we predict a sharp increase in the proportion of the country that is densely built-up by the middle and the end of the century, but no increase in the proportion of partially built-up locations.

COPD risk among older construction workers-Updated analyses 2020.

BACKGROUND: A 2010 study of construction workers participating in medical screening programs at the Department of Energy (DOE) nuclear facilities demonstrated increased chronic obstructive pulmonary disease (COPD) risk. The current study of a larger worker cohort allowed for a more nuanced analysis of COPD risk, including for employment beginning after the mid-1990s. METHODS: Study participants included 17,941 workers with demographic and smoking data and spirometry with a minimum of three recorded expiratory efforts and reproducibility of forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1 ) of 0.2 L or less. COPD was defined as a FEV1 /FVC ratio below the lower limit of normal using established prediction equations without use of bronchodilation. Stratified analyses explored COPD prevalence by demographic variables and trade. Logistic regression analyses assessed risks by trade and time periods of trade and DOE site work, controlling for age, gender, race/ethnicity, body mass index, and smoking. RESULTS: Overall COPD prevalence was 13.4% and 67.4% of cases were classified as moderate to severe. Compared to nonconstruction workers, construction trade workers were at significantly increased risk of all COPD (OR = 1.34, 95% CI = 1.29-1.79) and even more so for severe COPD (OR = 1.61, 95% CI = 1.32-1.96). The highest risk trades were cement masons/bricklayers (OR = 2.36; 95% CI = 1.71-3.26) and roofers (OR = 2.22; 95% CI = 1.48-3.32). Risk among workers employed after 1995 was elevated but not statistically significant. CONCLUSIONS: Construction workers are at increased COPD risk. Results support the prevention of both smoking and occupational exposures to reduce these risks. While the number of participants employed after 1995 was small, patterns of risk were consistent with findings in the overall cohort.

Smoking, occupational exposures, and idiopathic pulmonary fibrosis among Swedish construction workers.

BACKGROUND: Cigarette smoking and occupational exposures each have been reported to increase the risk of idiopathic pulmonary fibrosis (IPF), a disease previously considered of unknown origin. We investigated the risk of IPF mortality associated with combined smoking and occupational exposures. METHODS: A registry study of Swedish construction workers (N = 389,132), linked baseline smoking and occupational data with registry data on cause of death and hospital care diagnoses. Occupation was classified by the likelihood of exposure to vapors, gases, dusts, or fumes using a job-exposure matrix. Those likely exposed to asbestos or silica were excluded from the analysis. Age-adjusted relative risks [RRs] were calculated using Poisson regression. Follow-up observation began at age 40 and ended at age 89. RESULTS: Heavy smokers at baseline who were exposed to inorganic dusts during their working life had an increased risk of IPF mortality (RR 1.70; 95% confidence interval [CI] 1.11-2.60), while there was no statistically increased risk in the other exposure groups. There were dose-response relationships between smoking at baseline and IPF mortality among both unexposed and dust exposed workers, with similar risk for dust exposed and unexposed, except among baseline heavy smokers, where workers exposed to inorganic dust manifested the highest risk (RR 4.22; 95% CI 2.69-6.60). Excluding workers with chronic obstructive pulmonary disease or emphysema did not affect the results substantively. CONCLUSION: A clear dose-response relationship was seen between smoking at baseline and IPF, supporting a causal relationship. Occupational exposure to inorganic dusts, excluding silica and asbestos, was associated with increased risk of IPF in baseline heavy current smokers.

Predictors of long-term opioid use and opioid use disorder among construction workers: Analysis of claims data.

BACKGROUND: Construction workers have high rates of work-related musculoskeletal disorders, which lead to frequent opioid use and opioid use disorder (OUD). This paper quantified the incidence of opioid use and OUD among construction workers with and without musculoskeletal disorders. METHODS: We conducted a retrospective study using union health claims from January 2015 to June 2018 from 19,909 construction workers. Claims for diagnoses of chronic musculoskeletal disorders, acute musculoskeletal injuries, musculoskeletal surgery, and other conditions were linked to new opioid prescriptions. We examined the effects of high doses (≥50 morphine mg equivalents per day), large supply (more than 7 days per fill), long-term opioid use (60 or more days supplied within a calendar quarter), and musculoskeletal disorders, on the odds of a future OUD. RESULTS: There were high rates (42.8% per year) of chronic musculoskeletal disorders among workers, of whom 24.1% received new opioid prescriptions and 6.3% received long-term opioid prescriptions per year. Workers receiving opioids for chronic musculoskeletal disorders had the highest odds of future OUD: 4.71 (95% confidence interval 3.09-7.37); workers prescribed long-term opioids in any calendar quarter had a nearly 10-fold odds of developing an OUD. CONCLUSIONS: Among construction workers, opioids initiated for musculoskeletal pain were strongly associated with incident long-term opioid use and OUD. Musculoskeletal pain from physically demanding work is likely one driver of the opioid epidemic in occupations like construction. Prevention of work injuries and alternative pain management are needed for workers at risk for musculoskeletal injuries.

Early intervention mechanism for preventing electrocution in construction engineering.

The aim of this study is to establish an effective early intervention mechanism for construction engineering to prevent electrocution while improving labor safety and reducing the casualty risk. This study used narrative text analysis and the Haddon Matrix for data collection, and analyzed the causes from the 113 electrocution deaths among in the construction industry, the exhaustive chi-square automatic interaction detector algorithm was employed the segmentation of the correlations. Based on the theory of inventive problem solving, through IDEF0 (ICAM DEFinition) for function modeling was designed the early intervention mechanism. This study revealed the operating features related to electric shock hazards. Early intervention was introduced to reduce the relevant risks and establish safety mechanisms. The first contribution of this study is the determination of hazard correlations between operating features and conductive media, and entry point for the prevention of electrocutions. The second contribution is the suggestion of the establishment of inspection stations for electric tools, thereby ensuring that the portable power tools are safe. The final contribution is the joint application of TRIZ (Teoriya Resheniya Izobreatatelskikh Zadatch) and IDEF0, which establishing the pre-entry testing, strengthening safety mechanisms.

L'influence de l'identité professionnelle sur la détresse psychologique dans les métiers spécialisés des secteurs de la construction et manufacturier au Québec.

OBJECTIVE: This study explores how the structure of professional identity and its undermining are associated with symptoms of psychological distress in the skilled trades, focusing on the construction and manufacturing sectors in Quebec. One limitation of the current research is its neglect of professional identity, even though this concept is important to explaining psychological distress symptoms. METHODS: The sample includes 282 workers from four manufacturing and seven construction sites in Quebec. Data were collected for the years 2016 and 2017. Multilevel regression analysis was carried out with the statistical software Stata 13. Five variables were controlled in this study: sex, gender, age, type of team and occupational sector. RESULTS: The results of multilevel regression models, addressing variations across 54 participating teams, suggested that a low skilled trades self-esteem, a higher professional identification, a low integration of differences, heavy demands at work, and job insecurity are associated with psychological distress, as are the factors of being a woman or being a younger worker. CONCLUSION: Study results corroborate the importance of taking preventive actions on identity dimensions to reduce psychological distress symptoms. In particular, at the level of skilled trades culture, it would be beneficial to incorporate values based on a better inclusion of all workers and an open mind with regard to differences.

RéSUMé: OBJECTIF: Cette étude explore comment la structure de l'identité professionnelle et sa fragilisation s'associent aux symptômes de détresse psychologique dans les métiers spécialisés des secteurs de la construction et manufacturier au Québec. Une limitation importante dans la littérature consiste en l'omission de l'identité professionnelle, même s'il s'agit d'un concept important pour expliquer les symptômes de détresse psychologique. MéTHODE: L'échantillon se compose de 282 travailleurs de quatre établissements manufacturiers et de sept chantiers de construction au Québec. Les données ont été collectées durant les années 2016 et 2017. Des analyses de régressions multiniveaux ont été réalisées avec le logiciel statistique Stata 13. Cinq variables ont été contrôlées dans cette étude, soit le sexe, le genre, l'âge des travailleurs, ainsi que le type d'équipe et le secteur d'occupation. RéSULTATS: Les résultats des analyses multiniveaux, en considérant la variation entre les 54 équipes, ont associé une faible estime privée du métier, un fort sentiment d'identification, une faible intégration des différences, de fortes demandes au travail et de l'insécurité d'emploi à la détresse psychologique, ainsi que le fait d'être une femme et un âge moins élevé des travailleurs. CONCLUSION: Les conclusions de cette étude corroborent l'importance d'agir sur les dimensions identitaires afin de réduire les symptômes de détresse psychologique. Particulièrement, au niveau de la culture de métiers, il s'avère judicieux de privilégier les valeurs misant sur l'inclusion des travailleurs et sur une plus grande ouverture aux différences.

Management of Occupational Risk Prevention of Nanomaterials Manufactured in Construction Sites in the EU.

Currently, nanotechnology plays a key role for technological innovation, including the construction sector. An exponential increase is expected in its application, although this has been hampered by the current degree of uncertainty regarding the potential effects of nanomaterials on both human health and the environment. The accidents, illnesses, and disease related to the use of nanoproducts in the construction sector are difficult to identify. For this purpose, this work analyzes in depth the products included in recognized inventories and the safety data sheets of these construction products. Based on this analysis, a review of the recommendations on the use of manufactured nanomaterials at construction sites is performed. Finally, a protocol is proposed with the aim of it serving as a tool for technicians in decision-making management at construction sites related to the use of manufactured nanomaterials. This proposed protocol should be an adaptive and flexible tool while the manufactured nanomaterials-based work continues to be considered as an "emerging risk," despite the expectation that the protocol will be useful for the development of new laws and recommendations for occupational risk prevention management.

Implementing and evaluating novel safety training methods for construction sector workers: Results of a randomized controlled trial.

INTRODUCTION: The construction industry is regarded as one of the most unsafe occupational fields worldwide. Despite general agreement that safety training is an important factor in preventing accidents in the construction sector, more studies are needed to identify effective training methods. To address the current research gap, this study evaluated the impact of novel, participatory safety training methods on construction workers' safety competencies. Specifically, we assessed the efficacy of an immersive virtual reality (VR)-based safety training program and a participatory human factors safety training program (HFST) in construction industry workplaces. METHOD: In 2019, 119 construction sector workers from eight workplaces participated in a randomized controlled trial conducted in Finland. All the study participants were assessed using questionnaires at baseline, immediately after the intervention and at one-month follow-up. We applied generalized linear mixed modeling for statistical analysis. RESULTS: Compared to lecture-based safety training, VR-based safety training showed a stronger impact on safety motivation, self-efficacy and safety-related outcome expectancies. In addition, the construction sector workers who participated in the VR-based safety training showed a greater increase in self-reported safety performance at one-month follow-up. Contrary to our study hypotheses, we found no significant differences between the study outcomes in terms of study participants in the HFST training condition and the comparison condition without HFST training. CONCLUSION: Our study indicates that VR technology as a safety training tool has potential to increase safety competencies and foster motivational change in terms of the safety performance of construction sector workers. In the future, the efficacy of participatory human factors safety training should be studied further using a version that targets both managerial and employee levels and is implemented in a longer format. PRACTICAL IMPLICATIONS: Safety training in virtual reality provides a promising alternative to passive learning methods. Its motivating effect complements other safety training activities.

Does the potential safety risk affect whether particular construction hazards are recognized or not?

INTRODUCTION: Evidence from the global construction industry suggests that an unacceptable number of safety hazards remain unrecognized in construction workplaces. Unfortunately, there isn't a sufficient understanding of why particular safety hazards remain unrecognized. Such an understanding is important to address the issue of poor hazard recognition and develop remedial interventions. A recent exploratory effort provided anecdotal evidence that workers often fail to recognize safety hazards that are expected to impose relatively lower levels of safety risk. In other words, the research demonstrated that the underlying risk imposed by a safety hazard can affect whether a hazard will be recognized or not. METHOD: The presented research focused on empirically testing this preliminary finding. More specifically, the study tested the proposition that Construction workers are more likely to recognize safety hazards that impose higher levels of safety risk than those that impose relatively lower levels of safety risk. The research goals were accomplished through a number of steps. First, a set of 16 construction case images depicting a variety of construction operations that included a number of known safety hazards was presented to a panel of four construction safety experts. The experts were tasked with examining each of the known safety hazards and providing a rating of the relative safety risk that the individual hazards impose. Having obtained an estimate of the underlying safety risk, a hazard recognition activity was administered to 287 workers recruited from 57 construction workplaces in the United States. The hazard recognition activity involved the examination of a random sample of two construction case images that were previously examined by the expert panel and reporting relevant safety hazards. RESULTS: The results of the study provided support for the proposition that workers are more likely to recognize hazards that impose relatively higher levels of safety risk. Practical Applications: The findings of the study can be leveraged to improve existing hazard recognition methods and develop more robust interventions to address the issue of poor hazard recognition levels.

Impact of Work Environment and Occupational Stress on Safety Behavior of Individual Construction Workers.

This study was conducted to investigate how the work environment and psychological state influence construction workers' perceptions and safety behaviors. Structural equation modeling was developed with five factors on the working environment (i.e., job demand, job control, job support, rewards, organizational justice, lack of reward), two factors on workers' psychological condition (i.e., depression and trait anxiety), and four factors on safety perception (i.e., safety motivation, safety knowledge, and safety compliance and participation behaviors). Sample data were collected from 399 construction workers working at 29 construction sites in South Korea and analyzed the direct and indirect effects between those factors. The results showed that construction workers' safety compliance and participation behavior are related to their safety knowledge and motivation, and depression and trait anxiety were found to lower safety motivation, knowledge, and, eventually, safety behavior. Job demands, lack of job control, lack of reward, and lack of organizational justice negatively impacted safety behavior. In contrast, job support did not show a significant relationship with safety behavior.

Evaluating the Environmental Impact of Construction within the Industrialized Building Process: A Monetization and Building Information Modelling Approach.

Industrialization has been widely regarded as a sustainable construction method in terms of its environmental friendliness. However, existing studies mainly consider the single impact of greenhouse gas emissions or material consumption in the construction process of industrialized buildings, and pay less attention to ecological pollution and community interest, which leads to an insufficient understanding. There is an urgent need to systematically carry out accurate assessment of comprehensive construction environmental impact within industrialized building processes. Various methods, including face-to-face interviews, field research and building information modeling (BIM), were used for data collection. Four categories selected for the study included resource consumption, material loss, ecological pollution, and community interest. A life cycle assessment (LCA) model, namely input-process-output model (IPO), is proposed to analyze the construction environmental impact of the standard layer of industrialized buildings from four life cycle stages, namely, transportation, stacking, assembly and cast-in-place. The monetization approach of willingness to pay (WTP) was applied to make a quantitative comparison. Results reveal that the assembly stage has the largest impact on the environment at 66.13% among the four life cycle stages, followed by transportation at 16.39%, stacking at 10.29%, and cast-in-place at 7.19%. The key factors include power consumption, noise pollution, material loss, fuel consumption and component loss, which altogether account for more than 85% of the total impact. Relevant stakeholders can conduct their project using the same approach to determine the construction environmental performance and hence introduce appropriate measures to mitigate the environmental burden.

Magnitude of risky sexual practice and associated factors among big construction site daily laborers in Bahir Dar city, Amhara Region, Ethiopia.

BACKGROUND: Young person's susceptibility to sexually transmitted infection has been consistently linked to intractable work places. In Ethiopia, different behavior related interventions had carried out to raise awareness of risky sexual behaviors and their consequences. However, there is still limited information on risky sexual practices. METHODS: A cross-sectional study was conducted among the big construction site daily laborers from April 1, 2019 to May 30, 2019. A pre-tested questionnaire was used for data collection, and data were entered into Epidata and transported to SPSS for analysis. Independent variables with p < 0.05 in the multivariate analysis were considered to have a statistically significant association with risky sexual practice. RESULT: Among 627 sample respondents, the magnitude of risky sexual practice was found to be 24.2%. Labor workers who had a history of an STIs (AOR = 4.29; 95% CI: 2.56, 7.19), those who enjoy in the nightclubs (AOR = 2.33; 95% CI: 1.34, 4.08), those who started sex by peer pressure (AOR = 3.42; 95% CI: 2.06, 5.68), substance users (AOR = 2.03; 95% CI: 1.08, 3.82), those who were unable to read and write (AOR = 3.65; 95% CI: 1.41, 9.67), living independently (AOR = 3.71; 95% CI: 1.78, 7.77) and living with relatives (AOR = 3.12; 95% CI: 1.06, 9.20) were statistically associated with risky sexual practice. CONCLUSION: The magnitude of risky sexual practice among big constriction daily laborers was high in Bahir Dar City likely to increase their vulnerability to HIV. The findings of this study show the need of targeted HIV prevention plan to give due attention for daily laborers who had a history of an STI, enjoy in the night clubs, peer pressure, substance users, educational status and living arrangement. The Amhara Education Bureau and the city education department have to design ways to deliver at least a high school education.

Antecedents of safety behavior in construction: A literature review and an integrated conceptual framework.

There has been no scarcity in the literature of suggested antecedents of employee safety behavior, and this paper brings together the disaggregated antecedents of safety behavior in the construction field. In total, 101 eligible empirical articles are obtained. Bibliometric and context analyses are combined to identify the influential journals, scholars, keywords, use of theory, research methods, and countries or regions of the empirical samples. The 83 factors that are identified are divided into five groups, namely (a) individual characteristics, (b) workgroup interactions, (c) work and workplace design, (d) project management and organization, and (e) family, industry, and society. This indicates that the causes of safety behavior are manifold. Various factors from different systems likely work in concert to create situations in which an individual chooses to comply with safety rules and participate voluntarily in safety activities. Given this, we propose that safety behavior is only an ostensible symptom of more complex "The Self-Work-Home-Industry/Society" systems and establish a safety behavior antecedent analysis and classification model. Based on this model, we develop a resource flow model, illustrating why, how, and when the flow of resources between the five systems-namely the self system, work system, home system, work-home interface system, and industry/society system-either promotes or inhibits safety behavior. The safety behavior antecedent analysis and classification model and resource flow model are based mainly on bioecological system theory and resources theories. Avenues for future theoretical development and method designs are suggested based on the reviewed findings and the two conceptual models. The intention with this systematic review together with the two integrated conceptual models is to advance theoretical thinking on how safety behavior can be promoted, or instead, inhibited.

Preventing fall-from-height injuries in construction: Effectiveness of a regulatory training standard.

INTRODUCTION: A regulatory training standard for construction workers using fall protection equipment became mandatory in 2015 in the province of Ontario, Canada. By the end of the transition period in 2017, 418,000 workers had been trained to the new standard. Two primary research questions were posed: (1) To what extent does the WAH training affect practices at the worksite? and (2) Has there been a change in the incidence of fall-from-height injuries coincident with the introduction of the WAH Training Standard? MATERIALS AND METHODS: A longitudinal survey of 633 learners was conducted in 2017 at one-, four- and seven-week post-training. A quasi-experiment estimated the incidence of lost-time injuries attributed to falls from heights in 2017 compared to 2012-2014 for a census of construction workers insured for work disability in Ontario, Canada. RESULTS: Learners self-reported substantial increases in knowledge of and improvements in safe work practices when working at heights. The incidence rate of lost-time claim injuries attributed to falls targeted by the training declined by 19.6% (95% CI: 10.7, -27.6), compared to corresponding declines of 2.1% (95% CI: -6.3, 9.9) for other fall injuries and 7.2% (95% CI: 1.8, 12.3) for non-fall traumatic injuries. The observed decline was largest among the smallest employers (<5 full-time equivalent employees). CONCLUSION: The evaluation findings provide consistent support for a conclusion that the mandatory training standard was effective in reducing the incidence of injuries targeted by the training. However, the effects were modest and did not eliminate the problem. Practical application: A mandatory training standard should be considered as one approach to preventing traumatic injuries. However, other approaches higher in the hierarchy of risk controls should also be considered.