Applying a Health Equity Lens to Work-Related Motor Vehicle Safety in the United States.

Motor vehicle crashes (MVCs) are the leading cause of fatal work-related injuries in the United States. Research assessing sociodemographic risk disparities for work-related MVCs is limited, yet structural and systemic inequities at work and during commutes likely contribute to disproportionate MVC risk. This paper summarizes the literature on risk disparities for work-related MVCs by sociodemographic and employment characteristics and identifies worker populations that have been largely excluded from previous research. The social-ecological model is used as a framework to identify potential causes of disparities at five levels-individual, interpersonal, organizational, community, and public policy. Expanded data collection and analyses of work-related MVCs are needed to understand and reduce disparities for pedestrian workers, workers from historically marginalized communities, workers with overlapping vulnerabilities, and workers not adequately covered by employer policies and safety regulations. In addition, there is a need for more data on commuting-related MVCs in the United States. Inadequate access to transportation, which disproportionately affects marginalized populations, may make travel to and from work less safe and limit individuals' access to employment. Identifying and remedying inequities in work-related MVCs, whether during the day or while commuting, will require the efforts of industry and multiple public sectors, including public health, transportation, and labor.

Risky driving behaviors and employer motor vehicle safety policies among U.S. oil and gas extraction workers.

INTRODUCTION: Over half of fatal occupational injuries in the oil and gas extraction (OGE) industry are due to transportation incidents. While driving for work is common in this industry and risky driving behaviors have been identified as contributing factors to fatal crashes among OGE workers, limited information is available on the frequency of risky driving behaviors and employer policies to reduce these behaviors. METHODS: Researchers conducted a cross-sectional survey of OGE workers in three states. Responses from 363 OGE workers who drive as a part of their work duties were analyzed to evaluate relationships between self-reported risky driving behaviors (i.e., speeding, cell phone use, and driving unbelted) and awareness of motor vehicle safety policies by their employers. RESULTS: Hands-free cell phone use was the most common risky driving behavior among participants (59.8%), while a hands-free cell phone ban was the least commonly reported employer motor vehicle safety policy (34.7%). Multiple logistic regression results identified longer work and commuting hours, lack of employer motor vehicle safety policies, having ever been in a work crash, and being employed by an operator to be significantly associated with risky driving behaviors. CONCLUSIONS: Workers whose employers lacked motor vehicle safety policies were more likely to engage in risky driving behaviors. PRACTICAL APPLICATIONS: Results of this survey support the implementation of motor vehicle safety interventions such as bans on texting and handheld and hands-free cell phone use, speed management, and in-vehicle monitoring systems by OGE employers as well as research focusing on the effectiveness of these interventions in OGE. Additional research could examine worker driving behaviors through self-reported data in combination with objective measures.

Self-reported exposure to hazards and mitigation strategies among oil and gas extraction workers in three U.S. states.

Numerous health and safety hazards exist at U.S. onshore oil and gas extraction worksites. Higher fatal injury rates have been reported among drilling and servicing companies, which are more likely to employ workers in construction and extraction occupations, compared to operators that employ more workers in management and office and administrative support roles. However, there is little information describing the extent to which workers encounter these hazards, are provided hazard mitigation strategies by their employers, or use personal protective equipment (PPE). A cross-sectional survey of 472 U.S. oil and gas extraction workers was conducted to identify and characterize factors related to on-the-job fatalities, injuries, and illnesses and determine workers' health and safety concerns. Workers were employed by servicing companies (271/472, 57.4%), drilling contractors (106/472, 22.5%), and operators (95/472, 20.1%). The likelihood of contact with hazardous substances varied by substance and company type. Drilling and servicing employees had significantly higher odds of self-reported contact with pipe dope (ORdrilling = 10.07, 95% CI: 1.74-63.64; ORservicing = 5.95, 95% CI: 2.18-18.34), diesel exhaust (ORdrilling = 2.28, 95% CI: 1.15-5.05; ORservicing = 4.93, 95% CI: 2.73-10.32), and drilling mud (ORdrilling = 24.36, 95% CI: 4.45-144.69; ORservicing = 3.48, 95% CI: 1.24-12.20), compared to operators. Safety policies, programs, and trainings were commonly reported by workers, although substance-specific training (e.g., respirable crystalline silica hazards) was less common. Differences in self-reported employer PPE requirements and worker use of PPE when needed or required for safety highlight a need for novel strategies to improve the use of PPE. Overall, this study highlights differences in work conditions by company type and uncovers gaps in employer administrative controls and PPE use.

On the road again: A cross-sectional survey examining work schedules, commuting time, and driving-related outcomes among U.S. oil and gas extraction workers.

BACKGROUND: Oil and gas extraction (OGE) workers in the United States experience high fatality rates, with motor vehicle crashes the leading cause of death. Land-based OGE workers drive frequently to remote and temporary worksites. Limited information is available on factors that may influence crash risk for this workforce. METHODS: A cross-sectional survey of 500 land-based OGE workers examined work schedules and hours, commuting, sleep, employer policies, and their relationship to potentially harmful events while driving. RESULTS: Over 60% of participants worked 12 or more hours per day. The mean daily roundtrip commuting time was 1.82 h. Longer daily commutes, nonstandard work schedules, less sleep on workdays, and lack of employer policies were associated with one or more risky driving-related outcomes. CONCLUSIONS: Implementation and evaluation of OGE employer policies and programs to limit long work hours, reduce long daily commutes, promote sufficient sleep, and reduce drowsy driving among U.S. OGE workers are needed.

US research needs related to fatigue, sleep, and working hours among oil and gas extraction workers.

BACKGROUND: During 2003-2013, 1189 US oil and gas extraction (OGE) workers died while working, resulting in an average annual workplace fatality rate seven times that for all US workers. OGE work commonly involves long hours, shiftwork, irregular schedules, and long commutes, but effects of these factors on fatigue, occupational injury, and illness in OGE are largely unknown. METHODS: A scoping review of relevant OGE research during 2000-2019 was completed and supplemented by input from a NIOSH-sponsored Forum. RESULTS: Seventy-eight papers were identified; 76% reported only offshore research. Five themes for research needs emerged: build knowledge about the impacts of fatigue; explore interactions between on- and off-the-job risk factors; identify and evaluate interventions; assess effectiveness of technology; and increase the diffusion of fatigue risk management information. CONCLUSIONS: Further collaboration between researchers and OGE operators and contractors can lead to action-oriented recommendations to mitigate the effects of fatigue, inadequate sleep, and shiftwork.

Balance Impairments as Differential Markers of Dementia Disease Subtype.

BACKGROUND: Accurately differentiating dementia subtypes, such as Alzheimer's disease (AD) and Lewy body disease [including dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD)] is important to ensure appropriate management and treatment of the disease. Similarities in clinical presentation create difficulties for differential diagnosis. Simple supportive markers, such as balance assessments, may be useful to the diagnostic toolkit. This study aimed to identify differences in balance impairments between different dementia disease subtypes and normal aging using a single triaxial accelerometer. METHODS: Ninety-seven participants were recruited, forming four groups: cognitive impairment due to Alzheimer's disease (AD group; n = 31), dementia with Lewy bodies (DLB group; n = 26), Parkinson's disease dementia (PDD group; n = 13), and normal aging controls (n = 27). Participants were asked to stand still for 2 minutes in a standardized position with their eyes open while wearing a single triaxial accelerometer on their lower back. Seven balance characteristics were derived, including jerk (combined, mediolateral, and anterior-posterior), root mean square (RMS; combined, mediolateral, and anterior-posterior), and ellipsis. Mann-Whitney U tests identified the balance differences between groups. Receiver operating characteristics and area under the curve (AUC) determined the overall accuracy of the selected balance characteristics. RESULTS: The PDD group demonstrated higher RMS [combined (p = 0.001), mediolateral (p = 0.005), and anterior-posterior (p = 0.001)] and ellipsis scores (p < 0.002) than the AD group (AUC = 0.71-0.82). The PDD group also demonstrated significantly impaired balance across all characteristics (p ≤ 0.001) compared to the controls (AUC = 0.79-0.83). Balance differences were not significant between PDD and DLB (AUC = 0.69-0.74), DLB and AD (AUC = 0.50-0.65), DLB and controls (AUC = 0.62-0.68), or AD and controls (AUC = 0.55-0.67) following Bonferroni correction. DISCUSSION: Although feasible and quick to conduct, key findings suggest that an accelerometer-based balance during quiet standing does not differentiate dementia disease subtypes accurately. Assessments that challenge balance more, such as gait or standing with eyes closed, may prove more effective to support differential diagnosis.

Analytical observational study of nonfatal motor vehicle collisions and incidents in a light-vehicle sales and service fleet.

Motor vehicle crashes (MVCs) are a significant cause of lost-workday injuries, and consistently the leading cause of work-related fatalities in the United States for all industries combined. Prevention research has focused mainly on collisions fatal to the drivers of large trucks. This analytical observational study addresses gaps in the literature by: conducting a descriptive analysis of motor vehicle claim events involving light-vehicle drivers in a large health care industry fleet; identifying risk factors for work-related MVCs and injuries based on vehicle miles traveled; and providing details on circumstances of these events. The study examined 8068 motor vehicle events resulting in vehicle damage, property damage, or injury reported by 6680 U.S.-based drivers in a light-vehicle sales and service fleet operated by a health care company over a 4 ½-year period (January 2010 through June 2014). Thirty-three percent (n = 2660) of the events were collisions. Collisions were segmented as recoverable or non-recoverable according to whether the company could recover costs from another party, and mileage-based collision and injury rates were calculated by gender, age, tenure, and vehicle type. Differences in collision and injury rates between groups of interest (for example, tenure and age categories) were assessed with Poisson regression techniques adjusted using generalized estimating equations (GEE) for repeated observations on the same employee over time. Age, gender, and job tenure were significant collision risk factors, and risk patterns for recoverable and non-recoverable collisions were similar to those for total collisions. Collisions per million miles (CPMM) were significantly higher for drivers 21-24.9 years of age compared to drivers age 25-54.9 years (9.58 CPMM vs 4.96 CPMM, p = .025), drivers employed for less than 2 years compared to those employed 2 or more years (6.22 CPMM vs 4.82 CPMM, p < .001), for female drivers compared to male drivers (6.37 CPMM vs 4.16 CPMM, p < .001), and for drivers of passenger cars compared to all other vehicles (5.27 CPMM vs 4.48 CPMM, p < .001). Among collisions between the employee's vehicle and another vehicle in transport, those where the front of one vehicle hit another vehicle at an angle were the most likely to result in injury to the employee driver or another party (26%), followed by rear-end collisions (25%). Special attention should be given to preventing collisions among newly-hired employees, and to preventing angle and rear-end collisions, which were the most common types of collisions and also were most likely to result in injury than all other collisions combined.

Work-related fatal motor vehicle traffic crashes: Matching of 2010 data from the Census of Fatal Occupational Injuries and the Fatality Analysis Reporting System.

Motor vehicle traffic crashes (MVTCs) remain the leading cause of work-related fatal injuries in the United States, with crashes on public roadways accounting for 25% of all work-related deaths in 2012. In the United States, the Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries (CFOI) provides accurate counts of fatal work injuries based on confirmation of work relationship from multiple sources, while the National Highway Traffic Safety Administration (NHTSA) Fatality Analysis Reporting System (FARS) provides detailed data on fatal MVTCs based on police reports. Characterization of fatal work-related MVTCs is currently limited by data sources that lack either data on potential risk factors (CFOI) or work-relatedness confirmation and employment characteristics (FARS). BLS and the National Institute for Occupational Safety and Health (NIOSH) collaborated to analyze a merged data file created by BLS using CFOI and FARS data. A matching algorithm was created to link 2010 data from CFOI and FARS using date of incident and other case characteristics, allowing for flexibility in variables to address coding discrepancies. Using the matching algorithm, 953 of the 1044 CFOI "Highway" cases (91%) for 2010 were successfully linked to FARS. Further analysis revealed systematic differences between cases identified as work-related by both systems and by CFOI alone. Among cases identified as work-related by CFOI alone, the fatally-injured worker was considerably more likely to have been employed outside the transportation and warehousing industry or transportation-related occupations, and to have been the occupant of a vehicle other than a heavy truck. This study is the first step of a collaboration between BLS, NHTSA, and NIOSH to improve the completeness and quality of data on fatal work-related MVTCs. It has demonstrated the feasibility and value of matching data on fatal work-related traffic crashes from CFOI and FARS. The results will lead to improvements in CFOI and FARS case capture, while also providing researchers with a better description of fatal work-related MVTCs than would be available from the two data sources separately.

Vital signs: seat belt use among long-haul truck drivers--United States, 2010.

BACKGROUND: Motor vehicle crashes were the leading cause of occupational fatalities in the United States in 2012, accounting for 25% of deaths. Truck drivers accounted for 46% of these deaths. This study estimates the prevalence of seat belt use and identifies factors associated with nonuse of seat belts among long-haul truck drivers (LHTDs), a group of workers at high risk for fatalities resulting from truck crashes. METHODS: CDC analyzed data from its 2010 national survey of LHTD health and injury. A total of 1,265 drivers completed the survey interview. Logistic regression was used to examine the association between seat belt nonuse and risk factors. RESULTS: An estimated 86.1% of LHTDs reported often using a seat belt, 7.8% used it sometimes, and 6.0% never. Reporting never using a belt was associated with often driving ≥10 mph (16 kph) over the speed limit (adjusted odds ratio [AOR] = 2.9), working for a company with no written safety program (AOR = 2.8), receiving two or more tickets for moving violations in the preceding 12 months (AOR = 2.2), living in a state without a primary belt law (AOR = 2.1); and being female (AOR = 2.3). CONCLUSIONS: Approximately 14% of LHTDs are at increased risk for injury and death because they do not use a seat belt on every trip. Safety programs and other management interventions, engineering changes, and design changes might increase seat belt use among LHTDs. IMPLICATIONS FOR PUBLIC HEALTH: Primary state belt laws can help increase belt use among LHTDs. Manufacturers can use recently collected anthropometric data to design better-fitting and more comfortable seat belt systems.

Fleet Safety: Developing & Sustaining an Effective Program With ANSI/ASSE Z15.1.

Millions of U.S. workers are at risk for a work-related motor vehicle crash. Fatality data show that across all industries, motor vehicle crashes are consistently the leading cause of work-related fatalities. Of 43,025 work-related fatalities reported by BLS between 2003 and 2010, 10,202 were the result of single- or multiple-vehicle crashes of workers driving or riding in a vehicle on a public roadway, and 2,707 were pedestrian workers struck by a motor vehicle. During the same period, an additional 2,487 workers died in crashes that occurred off a public roadway or on industrial premises (BLS, 2013).

Motor vehicle fatalities among oil and gas extraction workers.

Motor vehicle crashes are the leading cause of work-related fatality in the U.S. as well as in the oil and gas extraction industry. This study describes the characteristics of motor vehicle-related fatalities in the oil and gas extraction industry using data from the U.S. Bureau of Labor Statistics' Census of Fatal Occupational Injuries. It compares the risk of dying in a motor vehicle crash in this industry to other major industries and among different types and sizes of oil and gas extraction companies. There were 202 oil and gas extraction workers who died in a work-related motor vehicle crash from 2003 to 2009. The motor vehicle fatality rate for workers in this industry was 8.5 times that of all private wage and salary workers (7.6 vs. 0.9, p<.0001). Workers from small oil and gas establishments (<20 workers) and workers from well-servicing companies were at greatest risk of dying in a motor vehicle crash. Pick-up trucks were the most frequent type of vehicle occupied by the fatally injured worker (n=104, 51.5%). Safety belt non-use was identified in 38.1% (n=77) of the cases. Increased focus on motor vehicle safety in this industry is needed, in particular among small establishments. Extraction workers who drive light duty vehicles need to be a specific focus.

Multimodal urgency coding: auditory, visual, and tactile parameters and their impact on perceived urgency.

Through a series of investigations involving different levels of contextual fidelity we developed scales of perceived urgency for several dimensions of the auditory, visual, and tactile modalities. Psychophysical ratings of perceived urgency, annoyance, and acceptability as well as behavioral responses to signals in each modality were obtained and analyzed using Steven's Power Law to allow comparison across modalities. Obtained results and their implications for use as in-vehicle alerts and warnings are discussed.

The use of electronic pharmacy data to investigate prescribed medications and fatal motor vehicle crashes in a military population, 2002-2006.

The authors examined the association between prescribed medications and fatal motor vehicle crashes (MVCs) in an active duty military population between 2002 and 2006. Using a case-control design, MVC deaths were ascertained using a military mortality registry, and an integrated health system database provided information on health system eligibility, pharmacy transactions, and medical encounters. Cases and controls were matched on comparable observation time outside periods of deployment. Among selected categories, only one, antidepressant medications, was an independent predictor of fatal MVC (odds ratio, 3.19; 95% confidence interval, 1.01-10.07). Male gender, Black race, enlisted rank, service branch (Navy and Marine Corps), and selected co-morbidities were also independent predictors. Unexpectedly, the odds of younger age quartiles (< 27 years) and history of deployment were reduced for MVC cases. Although results need to be considered in the context of data limitations, the association between prescribed antidepressants and fatal MVC may reflect unmeasured co-morbidities, such as combined effects of prescribed and over-the-counter medications and/or alcohol or other substance abuse. Younger individuals, representing new military accessions in training or returning from deployment with serious injuries, may have fewer opportunities to operate vehicles, or targeted efforts to reduce MVC following deployment may be showing a positive effect.

Nonfatal injuries to young workers in the retail trades and services industries in 1998.

We estimate the incidence and describe patterns of work-related injuries during 1998 to youth in retail trades and services industries. Data from the National Electronic Injury Surveillance System and the Current Population Survey were analyzed. The highest number of work-related injuries to youth younger than 18 years occurred in eating and drinking establishments and food stores. Injuries occurring in these industries accounted for 44% of all young worker injuries. Injury rates were similar during summer and school months. Youth continue to experience high numbers and rates of injuries in retail trades and services. Improvements in safety training and injury prevention in these industries, particularly eating and drinking establishments, food stores, and health services, need to be addressed for youth.