Impact of chlorpyrifos exposure on lung function in Egyptian adolescent agriculture workers.

Chlorpyrifos (CPF) is a widely used organophosphate insecticide that has been linked to detrimental health effects that range from neurological impacts to respiratory disease. The objective of this study was to assess respiratory symptoms associated with CPF exposure throughout the application season. Urine samples were collected from Egyptian adolescent applicators (n = 206) and non-applicators (n = 72) to assess 3,5,6-trichloro-2-pyridinol (TCPy), a biomarker for CPF exposure, along with spirometry measures to determine lung ventilatory function. Samples were collected over 7 months in 2016. Logistic regression was used to model the odds of reporting wheeze symptoms based on urinary TCPy concentrations while controlling for age and smoking in the household. Ordinal multinomial logistic regression was used to model the percent reference for forced expiratory volume in one second (rFEV1) based on urinary TCPy concentration (µg/g creatinine). Wheezing increased with increasing pesticide exposure (OR = 1.74 (1.32 - 2.31)). There was no statistically significant relationship between rFEV1 and TCPy concentration. Efforts to reduce pesticide exposure should be implemented to prevent the potential onset or exacerbation of any linked respiratory complications in adolescents.

Associations of a toenail metal mixture with attention and memory in the Gulf long-term follow-up (GuLF) study.

BACKGROUND: Research on metal-associated neurodegeneration has largely focused on single metals. Since metal exposures typically co-occur as combinations of both toxic and essential elements, a mixtures framework is important for identifying risk and protective factors. This study examined associations between toenail levels of an eight-metal mixture and attention and memory in men living in US Gulf states. METHODS: We measured toenail concentrations of toxic (arsenic, chromium, lead, and mercury) and essential (copper, manganese, selenium, and zinc) metals in 413 non-smoking men (23-69 years, 46 % Black) from the Gulf Long-Term Follow-Up (GuLF) Study. Sustained attention and working memory were assessed at the time of toenail sample collection using the continuous performance test (CPT) and digit span test (DST), respectively. Associations between toenail metal concentrations and performance on neurobehavioral tests were characterized using co-pollutant adjusted general linear models and Bayesian Kernel Machine Regression. RESULTS: Adjusting for other metals, one interquartile range (IQR) increase in toenail chromium was associated with a 0.19 (95 % CI: -0.31, -0.07) point reduction in CPT D Prime score (poorer ability to discriminate test signals from noise). One IQR increase in toenail manganese was associated with a 0.20 (95 % CI, -0.41, 0.01) point reduction on the DST Reverse Count (fewer numbers recalled). Attention deficits were greater among Black participants compared to White participants for the same increase in toenail chromium concentrations. No evidence of synergistic interaction between metals or adverse effect of the overall metal mixture was observed for either outcome. CONCLUSIONS: Our findings support existing studies of manganese-related memory deficits and are some of the first to show chromium related attention deficits in adults. Longitudinal study of cognitive decline is needed to verify chromium findings. Research into social and chemical co-exposures is also needed to explain racial differences in metal-associated neurobehavioral deficits observed in this study.

Organophosphorus pesticide exposure from house dust and parent-reported child behavior in Latino children from an orchard community.

BACKGROUND: Organophosphorus pesticide (OP) exposure is known to have adverse effects on the nervous system. Children from agricultural communities are at risk of exposure to these chemicals from their indoor environments that can lead to neurological and developmental problems, including changes in behavior. OBJECTIVE: The aim of this study is to evaluate whether the take-home pathway exposure is associated with behavioral and emotional problems in Latino Orchid Community children. METHOD: The study was implemented over a period of two years (2008-2010) in an orchard farming community with a total of 324 parents who had children between the ages of 5-12 years old. Mothers of the children were asked to complete the Child Behavior Checklist (CBCL) and dust from their carpets was collected. Emotional and behavioral deficits were assessed based on the CBCL and house dust was assessed for OP concentrations. In this study, correlations between OPs in house dust and CBCL subscales were estimated using linear regression models with total OP concentrations classified by tertiles. This study also facilitated the comparison between the agricultural and non-agricultural families in terms of behavioral deficits and house dust concentrations of pesticides. RESULTS: The data from the study shows that there was a positive association between the concentration of OP residues in house dust and internalizing behavior (ß=2.06, p=0.05) whereas the association with externalizing behavior was not significant after accounting for sociocultural covariates. Significant positive associations of OP residues with somatic problems (p=0.02) and thought problems (p=0.05) were also found. CONCLUSION: The data support a potential role of OP exposure in childhood development, with a specific focus on internalizing behavior. Future work focused on longitudinal studies may uncover the long-term consequences of OP exposure and behavior.

Applying the Worker Well-Being Framework to Identify Factors that Impact Turnover Among Long-Haul Truck Drivers.

BACKGROUND: Drivers in the long-haul trucking industry have chronic health conditions, engage in unhealthy behaviors, and leave the industry at high rates. Previous work has not considered the health and safety outcomes resulting from the conditions of work in the trucking industry and their role in turnover. The goal of this study was to understand the expectations of an incoming workforce, explore how work conditions impact their well-being, and identify strategies for retention. METHODS: Semi-structured interviews were conducted among current long-haul drivers and supervisors at trucking companies, and students and instructors at trucking schools (n = 33). Participants were asked about why they decided to enter the industry, their health challenges related to being in the trucking industry and whether these challenges were related to turnover, and strategies for retention. FINDINGS: Health conditions, differences in job expectations, and work demands were associated with leaving the industry. Workplace policies and culture (e.g., lack of supervisor support, schedules that limited home time, company size, and lack of benefits) were associated with workers' intention to leave an organization. Strategies identified to improve retention included integrating health and wellness into onboarding, creating realistic job expectations for those entering the industry, establishing relationships with drivers and dispatchers, and developing policies to limit time away from family. CONCLUSION/APPLICATION TO PRACTICE: Turnover in the trucking industry is a persistent problem and leads to a shortage of skilled workers, increases the workload, and reduces productivity. Understanding the relationship between the conditions of work and well-being provides a more holistic approach to address the health, safety, and well-being of long-haul truck drivers. Health conditions, differences in job expectations, and work demands were associated with leaving the industry. Workplace policies and culture (e.g., supervisor support, schedules that limited home time, lack of benefits) were associated with workers' intention to leave an organization. These conditions provide an opportunity for occupational health interventions to promote the physical as well as psychological health of long-haul truck drivers.

Evaluating how occupational exposure to organophosphates and pyrethroids impacts ADHD severity in Egyptian male adolescents.

BACKGROUND: Attention Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by deficits in attention and hyperactivity/impulsivity that cause impairments to daily living. An area of long-standing concern is understanding links between environmental toxicants, including pesticides, and the development or worsening of ADHD. OBJECTIVES: The present study evaluated associations between occupational pesticide exposure, specifically organophosphate (OP) pesticides, chlorpyrifos (CPF) and the pyrethroids (PYR) alpha-cypermethrin (αCM) and lambda-cyhalothrin (λCH), and symptoms of ADHD in a longitudinal study among Egyptian adolescent males. METHODS: Participants (N = 226, mean age = 17) were Egyptian adolescent males who either applied pesticides or were non-applicators. Urinary trichloro-2-pyridinol (TCPy) was measured as a specific metabolite biomarker of exposure to chlorpyrifos. Urinary 3-phenoxybenzoic acid (3-PBA) was measured as a general metabolite biomarker of exposure to pyrethroids, while urinary cis-3-(2,2- dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid (cis-DCCA) was measured as a specific biomarker of exposure to αCM and lambda cyhalothric acid (λCH acid) measured as a specific biomarker of exposure to λCH. Ordinal logistic regression models controlling for age were used to determine the likelihood of ADHD development (measured via parent-reported ADHD symptoms) as the level of biomarkers of pesticide exposure increased. RESULTS: Cis-DCCA was the only biomarker associated with higher likelihood ADHD symptoms (> 0.60 vs. 0-0.17 µg/g creatinine; OR = 2.82, 95% CI: 1.29-6.14). All participants reported clinical levels of ADHD symptoms when compared to national norms used in the United States. TCPy, trans-DCCA and λCH acid were not associated with risk of ADHD symptoms after controlling for levels of cis-DCCA. No other metabolites were associated with the number of ADHD symptoms. There were no interaction effects found for exposure to both OPs and Pyrethroids. DISCUSSION: The results suggest that exposure to the pyrethroid αCM is associated with more ADHD symptoms. Methodological and cultural considerations in need of further study are discussed.

Safety Measures, Pesticide Concerns and Resources Utilized among Young Adult Workers: A Brief Report.

INTRODUCTION: Resources on pesticide information are widely available; however, little is known about the concerns young agricultural workers have about pesticides, whether they use existing resources to find information about pesticides, and how these resources influence safety behaviors such as personal protective equipment (PPE) use. OBJECTIVES: To examine demographic characteristics, safety measures, concerns about pesticide use and resources for pesticide information. METHODS: Young agricultural workers were recruited through three collegiate agricultural programs and completed an online questionnaire related to pesticide safety and use. RESULTS: Most participants who applied pesticides reported always wearing gloves (60.5%), using a tractor with an enclosed cab (68.4%), and always wearing long pants (76.3%). Among all participants, pesticide drift to crops (65.1%) and water contamination (62.3%) were the biggest concerns among young agricultural workers. The internet was the most utilized source to locate information about pesticides (76.4%), with the most common internet resources being online materials from universities or colleges (71.6%), the government (69.1%), or pesticide companies (66.7%). Accessibility (90.6%) and speed (78.3%) were the most common reasons for using the internet for information. Misinformation was the most common barrier (80.2%). CONCLUSIONS: Future studies should examine the accuracy and accessibility of pesticide information available on the internet since young adult workers rely on these resources for pesticide information.

Organizational Resources and Social Support Influences on Stress and Depression: A Comparison among Cooperative and Non-Cooperative Farmers.

BACKGROUND: Farmers are disproportionally affected by depression and suicide. Social connectedness has been shown to reduce depression and suicide among the general population but its impact on farmers is less well-known. Our previous research indicated that farmers who had cooperative resources and social support reported decreased symptoms of depression. However, it was unclear whether farmers who were not cooperative members or utilized resources from non-cooperative organizations differed from cooperative farmers in mental health. METHODS: A survey consisted of online self-completion and phone interviews was conducted among 307 participants (197 co-op, 110 non-co-op) to examine whether Midwest (north central United States) cooperative and non-cooperative farmers differ in perceived stress and symptoms of depression and whether potential differences were impacted by program use, program satisfaction, and social support. RESULTS: Cooperative farmers reported lower perceived stress and symptoms of depression than non-cooperative farmers and the difference was statistically significant for perceived stress. Use of educational programs, such as training and mentorship, was associated with decreased perceived stress but not symptoms of depression. Satisfaction with programs and social support were associated with decreased perceived stress and symptoms of depression. Program satisfaction was observed to have more associations with decreased perceived stress and symptoms of depression than program use. CONCLUSIONS: Results reveal that organizational resources and social support can mitigate mental health risks among farmers. This study highlighted an opportunity for future investigation of social connectedness in addressing farmers' mental health.

Interventions to Reduce Pesticide Exposure from the Agricultural Sector in Africa: A Workshop Report.

Despite the fact that several cases of unsafe pesticide use among farmers in different parts of Africa have been documented, there is limited evidence regarding which specific interventions are effective in reducing pesticide exposure and associated risks to human health and ecology. The overall goal of the African Pesticide Intervention Project (APsent) study is to better understand ongoing research and public health activities related to interventions in Africa through the implementation of suitable target-specific situations or use contexts. A systematic review of the scientific literature on pesticide intervention studies with a focus on Africa was conducted. This was followed by a qualitative survey among stakeholders involved in pesticide research or management in the African region to learn about barriers to and promoters of successful interventions. The project was concluded with an international workshop in November 2021, where a broad range of topics relevant to occupational and environmental health risks were discussed such as acute poisoning, street pesticides, switching to alternatives, or disposal of empty pesticide containers. Key areas of improvement identified were training on pesticide usage techniques, research on the effectiveness of interventions targeted at exposure reduction and/or behavioral changes, awareness raising, implementation of adequate policies, and enforcement of regulations and processes.

Residence in an Area with Environmental Exposure to Heavy Metals and Neurobehavioral Performance in Children 9-11 Years Old: An Explorative Study.

We explored the association between residence in an area polluted with metals and neurobehavioral performance in children aged 9 to 11. A cross-sectional study was conducted with thirty boys and thirty girls aged 9 to 11 from public schools in a heavily industrialized area, matched by age (±4 months) and gender with 15 boys and 15 girls from public schools in cities without relevant industrial activity. Neurobehavioral performance was assessed with the Behavioral Assessment and Research System. Linear regression models were used, adjusting for age, sex, social class and multimedia activities to predict each of the neurobehavioral outcome variables. No differences in neurobehavioral performance were found when all children with residence in areas with environmental exposure to metals were classified as exposed and the children from the other provinces as unexposed. However, when we compared children living <1 km from an industrial area with respect to those living more than 1 km away, significant differences were found. Children living <1 km away had lower scores on Finger Tapping (p = 0.03), Symbol-Digit (p = 0.07) and Continuous Performance (p = 0.02) than those living farther away. Our results support the hypothesis that residing close to an area with industrial activity (<1 km) is associated with deficits in neurobehavioral performance among children aged 9 to 11.

Protecting Young Agricultural Workers: The Development of an Online Supervisor Training.

Adolescents and young adults working in agriculture are at greater risk of injury. We describe the development of an online safety and health training for people who hire, teach, or supervise young agricultural workers. The online training targeted specific skills supervisors can use to effectively supervise, train, and communicate with young workers about health and safety hazards that impact injury risk. Consistent with NIOSH's evidence-based Total Worker Health® approach, the training integrated safety and health promotion and was also informed by behavioral change theories. An iterative approach was used to develop and evaluate the training. A content review provided feedback on topics and organization of material. Safety and health experts assessed the revised training content and rated the training topics on clarity, accuracy, and completeness. Finally, a pilot study with employers and health and safety professionals was used to evaluate the training materials. The content review suggested ways to reorganize the material to improve flow and reduce redundancy. Ratings of clarity, accuracy, and completeness were high, ranging from 5 to 7 (mean ratings from 5.8 to 7.0) on a scale of 1 ("does not do this at all") to 7 ("does this very well"). The pilot study led to changes in wording and items used to assess knowledge. A theoretically-informed approach was used to develop an online supervisor training to increase awareness and build skills. An iterative process that included expert review, evaluation of learning competencies, and a pilot study with the end-users is described.

Agricultural Cooperatives in Mental Health: Farmers' Perspectives on Potential Influence.

Agricultural cooperatives are formed to promote farmers' economic, social, and legislative interests. Their role in influencing mental health is less known. We characterized farmers' experiences with cooperatives and identified the potential impact of cooperatives in promoting mental health. Semi-structured interviews were conducted in Wisconsin with 12 participants, including farmers, cooperative professionals, and agricultural extension educators. Participants were asked about stress among farmers; cooperative structures and services provided to farmers, and farmers' interactions with the cooperatives; and the role cooperatives play in reducing stress among farmers. Three main themes were developed: stress farmers were experiencing, available resources from cooperatives, and the role of cooperatives in promoting farmers' mental health. Stress farmers were experiencing was elucidated through the subthemes: increased stress, depression, and suicide and stressors involving finances, occupational pressure, relationships, isolation, and loneliness. Available resources from cooperatives were described in subthemes: cooperative characteristics, services, and engagement activities. The role of cooperatives in promoting farmers' mental health was discussed through subthemes: responder, community, facilitator, and divergent views on whether co-ops can protect farmers' mental health. Cooperatives provide members market stability, services, and opportunities for decision-making, social interaction, and civic engagement. These resources create a community where farmers feel a sense of belonging and retain a level of control. As rural communities continue to struggle with mental health resource shortages, identifying and evaluating community-based resources such as those offered by the cooperatives is imperative.

Dissemination and Implementation Science Approaches for Occupational Safety and Health Research: Implications for Advancing Total Worker Health.

Total Worker Health® (TWH), an initiative of the U.S. National Institute for Occupational Safety and Health, is defined as policies, programs, and practices that integrate protection from work-related health and safety hazards by promoting efforts that advance worker well-being. Interventions that apply the TWH paradigm improve workplace health more rapidly than wellness programs alone. Evidence of the barriers and facilitators to the adoption, implementation, and long-term maintenance of TWH programs is limited. Dissemination and implementation (D&I) science, the study of methods and strategies for bridging the gap between public health research and practice, can help address these system-, setting-, and worker-level factors to increase the uptake, impact, and sustainment of TWH activities. The purpose of this paper is to draw upon a synthesis of existing D&I science literature to provide TWH researchers and practitioners with: (1) an overview of D&I science; (2) a plain language explanation of key concepts in D&I science; (3) a case study example of moving a TWH intervention down the research-to-practice pipeline; and (4) a discussion of future opportunities for conducting D&I science in complex and dynamic workplace settings to increase worker safety, health, and well-being.

Winter Weather-Related Crashes during the Commute to Work: An Opportunity for Total Worker Health®.

BACKGROUND: The ways workers interface with their workplace and work are changing. These changes provide challenges and opportunities for health and safety professionals attempting to improve worker wellbeing for the future of work. For many workers, the morning commute, an activity typically outside the scope of workplace policies, is the most hazardous portion of the day. The hazard increases if workers are required to drive during winter weather or in other hazardous conditions in order to adhere to strict workplace start times. This research describes the role winter weather plays during the morning commute, demonstrating the need for organizational design and work arrangements that improve safety during the commute to work. METHODS: Crash data from the Iowa Department of Transportation for the years 2013-2017 was linked to county level characteristics from the American Community Survey. Crashes were characterized by 30-min time intervals. The likelihood of the crash involving winter weather as a contributing circumstance was compared across time-intervals. RESULTS: Winter weather was more likely to contribute to crashes during the commuting hours compared to 11:00 to 11:59 am. Winter weather was most frequently a contributing circumstance during 8:00-8:29 a.m. (OR = 2.21 95% CI: 1.93-2.52). CONCLUSIONS: Winter weather plays a role in crashes during commuting hours. Workplaces can adopt policies for flexible work start times or for telecommuting to empower workers to avoid hazardous driving conditions.

Evaluation of an Online Training for Supervisors of Young Agricultural Workers.

Adolescents and young adults (<25 years) working in agriculture are at greater risk of injury than youth working in other industries. Supervisors play an important role in protecting these young workers who lack workplace experience and whose bodies and brains are still developing. A theoretically based approach was used to develop an online training for supervisors of young agricultural workers. The training addresses an expanded view of occupational safety that not only addresses injury prevention, but also focuses on health promotion and worker well-being using a Total Worker Health approach. A pre-post/post study design was used to evaluate the training. Questionnaires included demographics, workplace characteristics, knowledge, beliefs about protecting young workers, and supervisors' communication behaviors. One-hundred-eighty-two participants completed all parts of the efficacy trial. A post-test administered immediately after completing the training, indicated that supervisors had greater understanding of the risks to young workers and at 3-month follow-up were more likely to engage in communication behaviors to protect the safety and health of young workers. Positive changes in when, how, and under what circumstances supervisors talk about safety and health occurred. Establishing patterns of protective behaviors in the workplace can have lifelong impact, particularly among young workers.

Work Organization Factors Associated with Health and Work Outcomes among Apprentice Construction Workers: Comparison between the Residential and Commercial Sectors.

There are substantial differences in work organization between residential and commercial construction sectors. This paper examined differences in work factors between construction sectors and examined the association between sector and health behaviors, health outcomes, and work outcomes. We surveyed 929 male construction apprentices (44% residential and 56% commercial) and found that residential apprentices reported fewer workplace safety policies, higher frequency of heavy lifting, and greater likelihood of reporting musculoskeletal pain compared to apprentices in commercial work. Residential apprentices reported higher job strain, lower supervisor support, more lost workdays due to pain or injury, and lower productivity related to health than commercial apprentices. Multivariate Poisson regression models controlling for multiple work factors showed that residential construction work, high job strain, heavy lifting, low coworker support, and low supervisor support were each independently associated with one or more work or health outcomes. These findings suggest that interventions should seek to improve coworker and supervisory supportive behaviors, decrease job strain, and reduce organizational stressors, such as mandatory overtime work. Our study shows disparities in health and safety between construction sectors and highlights the need for interventions tailored to the residential sector.

Acute and Cumulative Effects of Repeated Exposure to Chlorpyrifos on the Liver and Kidney Function among Egyptian Adolescents.

BACKGROUND: There is a paucity of research that tracks changes in liver and kidney function among pesticide applicators. The aim of the current study was to investigate the role of repeated seasonal exposure to the organophosphorus pesticide, chlorpyrifos, on serum measures of liver and kidney function. METHODS: Pesticide exposure was assessed by measuring the urinary concentrations of 3,5,6-trichloro-2 pyridinol (TCPy), a specific biomarker for chlorpyrifos. Chlorpyrifos exposure and 8 serum markers of liver and kidney function were measured at 15 timepoints over 3 years prior to, during, and following the end of seasonal pesticide application among adolescent applicators and non-applicators from 4 field stations in Menoufia, Egypt. RESULTS: Urinary TCPy levels showed increases during the application cycles and recovery at the end of each application season. Altered serum markers of liver and kidney function were associated with chlorpyrifos exposure, with some markers recovering 3 months after the end of exposure each year, while other measures demonstrated progressive increase up to 300% the baseline levels at the end of 3 years. CONCLUSION: The study demonstrated that frequent assessment of liver and kidney function is a sound practice to evaluate cellular injury following chronic repeated occupational and environmental exposure to chlorpyrifos.

Examination of Symptoms of Depression among Cooperative Dairy Farmers.

Farmers experience a high risk of stress, depression, and suicide. Risk factors are well documented but protective factors are seldom examined. Social support has been reported to reduce psychological distress among the general population but its effect on farmers is inconclusive. Agricultural cooperatives are typically created and owned by farmers to secure markets, access supplies and services, and participate in decision-making. It is unknown whether having cooperative resources impacts symptoms of depression. A survey was used to examine whether having access to cooperative programs and social support impacted symptoms of depression among dairy farmers. Farm bankruptcies, stress, depression, and suicide were identified as ongoing concerns. Having social support and cooperative educational opportunities and mentorship programs were associated with decreased symptoms of depression. Conversely, having cooperative policy discussions was associated with increased symptoms of depression. Results suggest that social support can potentially reduce symptoms of depression among farmers and having access to cooperative resources can reduce or increase it, depending on the type of program. Our findings identified an opportunity to further examine how programs provided by farmer-led organizations such as cooperatives can impact stress, depression, and suicide among farmers.

Evaluation of occupational pesticide exposure on Egyptian male adolescent cognitive and motor functioning.

BACKGROUND: Chronic low-level exposure to organophosphorus pesticides is associated with adverse health effects, including a decline in neurological functioning and long-term impairment. These negative effects may be more detrimental in children and adolescents due to their critical stage in development. Little work has investigated the effects of chronic exposure to pesticides, specifically chlorpyrifos (CPF) during the adolescent period. OBJECTIVES: To examine effects of CPF exposure over a year-long period within a group of male adolescents in Egypt (N = 242, mean age = 17.36), including both pesticide applicators and non-applicators. METHODS: Associations between average CPF exposure (measured via urinary metabolite levels of 3,5,6-trichloro-2-pyridinol [TCPy]) and neurobehavioral functioning were examined in a 1-year longitudinal study. Given previous literature, higher levels of TCPy were expected to be associated with worse neurobehavioral functioning. RESULTS: Using mixed effects linear regression, average TCPy exposure predicted deficits in more complex neurobehavioral tasks (Benton visual retention, digit span reverse, match to sample, serial digit learning, and alternating tapping) with estimates of effects ranging from -0.049 to 0.031. Age (effects ranging from 0.033 to 0.090) and field station (effects ranging from -1.266 to -0.278) were significantly predictive of neurobehavioral functioning over time. An interaction effect was found for field station and TCPy across several neurobehavioral domains. DISCUSSION: Results show that occupational exposure to pesticides may have particularly deleterious effects on complex neurobehavioral domains. Additionally, differences across field stations and the age at which individuals are exposed may be important factors to investigate in future research.

A Comparison of Safety, Health, and Well-Being Risk Factors Across Five Occupational Samples.

Objective: The aim of this study was to present safety, health and well-being profiles of workers within five occupations: call center work (N = 139), corrections (N = 85), construction (N = 348), homecare (N = 149), and parks and recreation (N = 178). Methods: Baseline data from the Data Repository of Oregon's Healthy Workforce Center were used. Measures were compared with clinical healthcare guidelines and national norms. Results: The prevalence of health and safety risks for adults was as follows: overweight (83.2%), high blood pressure (16.4%), injury causing lost work (9.9%), and reported pain (47.0%). Young workers were least likely to report adequate sleep (46.6%). Construction workers reported the highest rate of smoking (20.7%). All of the adult workers reported significantly lower general health than the general population. Conclusion: The number of workers experiencing poor safety, health and well-being outcomes suggest the need for improved working conditions.