Reaching "hard to reach" workers: Evaluating approaches to disseminate worker safety information via the Mexican consular network.

Mexican immigrants suffer a disproportionately large number of work-related injuries and deaths given their share of the workforce. Barriers of language, culture, and mistrust are often cited as factors that complicate efforts to reach these workers with occupational safety and health (OSH) interventions. By partnering with the Mexican government and its consulate network in the United States, researchers from the National Institute for Occupational Safety and Health were able to assess the impact of four different information dissemination approaches (posters, passively distributed brochures, actively distributed brochures, and video kiosks) in Spanish in a five-phase study. Exit interviews conducted with Mexicans seeking consular services indicated that while nearly all respondents considered OSH to be of importance, significant differences in impact measures, such as noticing the materials and liking of content, were found when comparing the different approaches. Despite these differences, even the least effective approaches were noticed by large numbers of individuals and significantly increased their stated behavioral intentions regarding OSH. Considering all materials together, significantly more participants reported liking the materials (p < 0.001) than did not, learning something new (p < 0.01), trusting the information (p < 0.05), intending to seek out additional OSH information (p < 0.01), and intending to speak to their bosses about OSH (p < 0.05). These findings contribute to building an evidence base for moving research knowledge into practice, which is an essential, but often overlooked, element of occupational safety and health research, particularly among workers from underserved communities.

Heart Attacks, Bloody Noses, and Other "Emotional Problems": Cultural and Conceptual Issues With the Spanish Translation of Self-Report Emotional Health Items.

This article examines how respondents understood items in the Spanish versions of the Short-Form 36 (SF-36v2). Cognitive interviews of the SF-36 were conducted in 2 phases with 46 Spanish speakers living in the United States. Roughly one-third (17/46) of respondents had difficulty understanding the Role Emotional items upon their initial reading, and almost half (21/46) provided examples that were inconsistent with the intended meaning of the items. The findings of this study underscore the importance of conducting cognitive testing to ensure conceptual equivalence of any instrument regardless of how well validated it appears to be.

Work experiences of Latino building cleaners: An exploratory study.

BACKGROUND: There are roughly 3.8 million cleaning workers in the United States. The cleaning workforce is largely composed of women, immigrants, and ethnic minorities who receive low wages and have low education levels. They are exposed to physical, chemical, biological, and psychosocial hazards. METHODS: Qualitative methodology was used to investigate how Latino immigrants experience work as building cleaners. A grounded theory coding approach was used to analyze focus group data from 77 participants. RESULTS: Three major themes were identified: economic vulnerability, psychosocial stressors, and health and safety effects. Although workers are aware of the safety hazards associated with their jobs, they believe their immigration status limits employment opportunities leading them to accept poor working conditions. They work through injuries and cope psychologically through minimizing negative health impacts and normalizing work-related injuries and illnesses. CONCLUSIONS: The findings suggest that interventions for these workers should recognize the hostile organizational and psychosocial contexts within which immigrants often work.

Evaluation of toolbox safety training in construction: The impact of narratives.

BACKGROUND: Construction is a dangerous industry with a large number of small businesses. Because they require minimal resources to deliver, toolbox talks may be an ideal training format for small construction contractors. METHODS: Eight toolbox talks were developed, each with two versions. One version of each toolbox talk was standard and one version included a narrative and discussion questions. Participants were randomly assigned to receive the standard or the narrative version. Pre- and post-intervention surveys measured demographics, workplace safety climate, and knowledge. The post-intervention survey also measured training impact. RESULTS: Including narratives with discussion questions significantly increased knowledge gain and led to increased training impact. Less experienced workers were more likely to gain knowledge and training impact compared to more experienced workers. There were no significant changes in workplace safety climate. CONCLUSIONS: The results suggest that including a narrative and discussion questions increases toolbox talk effectiveness.

Exploring workplace TB interventions with foreign-born Latino workers.

BACKGROUND: Persons born outside the United States are more likely to be diagnosed with tuberculosis disease (TB) than native-born individuals. Foreign-born Latinos at risk of TB may be difficult to reach with public health interventions due to cultural and institutional barriers. Workplaces employing large concentrations of foreign-born Latinos may be useful locations for TB interventions targeting this high-risk population. METHOD: This study used a two-phase approach to investigate the feasibility of workplace TB interventions. The first phase investigated employer knowledge of TB and receptiveness to allowing TB interventions in their businesses through 5 structured interviews. The second phase investigated foreign-born workers' knowledge of TB and their receptiveness to receiving TB interventions in their places of employment through 12 focus groups stratified by gender and education. RESULTS: Phase 1: Only 1 of the 5 employers interviewed had a high level of knowledge about TB, and three had no knowledge other than that TB was a disease that involved coughing. They were receptive to workplace TB interventions, but were concerned about lost productivity and customers finding out if an employee had TB. Phase 2: There was no observed differences in responses between gender and between the bottom two education groups, so the final analysis took place between a gender-combined lower education group and higher education group. The higher education group tended to have knowledge that was more accurate and to view TB as a disease associated with poverty. The lower education group tended to have more misconceptions about TB and more often expressed concern that their employers would not support worksite interventions. CONCLUSIONS: The results from both phases indicate that more TB education is needed among both foreign-born Latino workers and their employers. Obstacles to implementing workplace TB interventions include knowledge, potential productivity loss, employer liability, and perceived customer response.

Undocumented status as a social determinant of occupational safety and health: The workers' perspective.

BACKGROUND: Undocumented immigration to the United States has grown dramatically over the past 25 years. This study explores undocumented status as a social determinant of occupational health by examining its perceived consequences on workplace safety of Latino immigrants. METHODS: Guided by the Theory of Work Adjustment, qualitative analysis was conducted on transcripts from focus groups and individual interviews conducted with a convenience sample of Latino immigrant workers. RESULTS: Participants reported that unauthorized status negatively impacted their safety at work and resulted in a degree of alienation that exceeded the specific proscriptions of the law. Participants overwhelming used a strategy of disengagement to cope with the challenges they face as undocumented immigrants. CONCLUSION: This study describes the complex web of consequences resulting from undocumented status and its impact on occupational health. This study presents a framework connecting the daily work experiences of immigrants, the coping strategy of disengagement, and efforts to minimize the impact of structural violence.

Immigration, Work, and Health: A Literature Review of Immigration Between Mexico and the United States.

Understanding the influence someone's job or career has on their health goes beyond the physical, emotional and social hazards, risks and conditions that they face at work. One's job or career also exerts a significant influence over other aspects of life that contribute or detract from their health and that of their family. Work is the major incentive for Latin American migration to the United States. Latino immigrants experience increasingly poorer outcomes for physical health and chronic diseases the longer they remain in the U.S. The strong link between work and immigration suggests that, for many Latin Americans, immigration can be understood as a career path which puts them, and their family members, in situations that can change their physical, emotional, and social health as a condition of their employment. Given the large number of Latin Americans who emigrate for work, it is essential that the unique physical, mental and social impacts of emigration are accounted for when working with clients impacted by emigration at the individual, family and community level as well as those social workers practicing at the system level. This paper is a literature review that explores the impact that emigrating for work has on the health of those that emigrate and their family members that stay behind.

Improving occupational safety and health among Mexican immigrant workers: a binational collaboration.

Latino immigrants are 50% more likely than all workers in the United States to experience a fatal injury at work. Occupational safety and health (OSH) organizations often find that the approaches and networks they successfully use to promote OSH among U.S.-born workers are ineffective at reaching Latino immigrants. This article describes the collaboration between the National Institute for Occupational Safety and Health (NIOSH) and the Mexican Ministry of Foreign Affairs (Secretaría de Relaciones Exteriores) to promote OSH among Mexican immigrant workers. The Ministry of Foreign Affairs operates 50 consulates throughout the U.S. that provide four million discrete service contacts with Mexican citizens annually. The focus of this ongoing collaboration is to develop the internal capacity of Mexican institutions to promote OSH among Mexican immigrants while simultaneously developing NIOSH's internal capacity to create effective and sustainable initiatives to better document and reduce occupational health disparities for Mexican immigrants in the U.S.

Applying the Theory of Work Adjustment to Latino Immigrant Workers: An Exploratory Study.

Blustein mapped career decision making onto Maslow's model of motivation and personality and concluded that most models of career development assume opportunities and decision-making latitude that do not exist for many individuals from low income or otherwise disadvantaged backgrounds. Consequently, Blustein argued that these models may be of limited utility for such individuals. Blustein challenged researchers to reevaluate current career development approaches, particularly those assuming a static world of work, from a perspective allowing for changing circumstances and recognizing career choice can be limited by access to opportunities, personal obligations, and social barriers. This article represents an exploratory effort to determine if the theory of work adjustment (TWA) might meaningfully be used to describe the work experiences of Latino immigrant workers, a group living with severe constraints and having very limited employment opportunities. It is argued that there is significant conceptual convergence between Maslow's hierarchy of needs and the work reinforcers of TWA. The results of an exploratory, qualitative study with a sample of 10 Latino immigrants are also presented. These immigrants participated in key informant interviews concerning their work experiences both in the United States and in their home countries. The findings support Blustein's contention that such workers will be most focused on basic survival needs and suggest that TWA reinforcers are descriptive of important aspects of how Latino immigrant workers conceptualize their jobs.

Work Experiences of Latina Immigrants: A Qualitative Study.

Almost half of the Latino immigrants working in the United States are women. However, studies concerning the work experiences of Latinas are almost absent in the literature. This article reports the findings from a qualitative study using eight focus groups (n = 53) of Latina immigrant workers. The focus group transcripts were analyzed using the grounded theory approach in which themes emerge from iterative readings of the transcripts by a group of investigators. This study identified themes related to excessive workload, familiar work/unfamiliar hazards, cultural tensions, lack of health care, pregnancy, sexual harassment, and family obligations/expectations. The responses of the Latina workers in this study clearly indicated that they live within a complex web of stressors, both as workers and as women. The increased economic opportunities that come with immigration to the United States are accompanied by many opportunities for exploitation, especially if they are undocumented. It is hoped that the findings of this study will raise awareness regarding these issues and spur further work in this area.

A systematic review of the effectiveness of occupational health and safety training.

OBJECTIVES: Training is regarded as an important component of occupational health and safety (OHS) programs. This paper primarily addresses whether OHS training has a beneficial effect on workers. The paper also examines whether higher engagement OHS training has a greater effect than lower engagement training. METHODS: Ten bibliographic databases were searched for pre-post randomized trial studies published in journals between 1996 and November 2007. Training interventions were included if they were delivered to workers and were concerned with primary prevention of occupational illness or injury. The methodological quality of each relevant study was assessed and data was extracted. The impacts of OHS training in each study were summarized by calculating the standardized mean differences. The strength of the evidence on training's effectiveness was assessed for (i) knowledge, (ii) attitudes and beliefs, (iIi) behaviors, and (iv) health using the US Centers for Disease Control and Prevention's Guide to Community Preventive Services, a qualitative evidence synthesis method. RESULTS: Twenty-two studies met the relevance criteria of the review. They involved a variety of study populations, occupational hazards, and types of training. Strong evidence was found for the effectiveness of training on worker OHS behaviors, but insufficient evidence was found of its effectiveness on health (ie, symptoms, injuries, illnesses). CONCLUSIONS: The review team recommends that workplaces continue to deliver OHS training to employees because training positively affects worker practices. However, large impacts of training on health cannot be expected, based on research evidence.

Translating questionnaire items for a multi-lingual worker population: the iterative process of translation and cognitive interviews with English-, Spanish-, and Chinese-speaking workers.

BACKGROUND: The increasing ethnic diversity of the US workforce has created a need for research tools that can be used with multi-lingual worker populations. Developing multi-language questionnaire items is a complex process; however, very little has been documented in the literature. METHODS: Commonly used English items from the Job Content Questionnaire and Quality of Work Life Questionnaire were translated by two interdisciplinary bilingual teams and cognitively tested in interviews with English-, Spanish-, and Chinese-speaking workers. RESULTS: Common problems across languages mainly concerned response format. Language-specific problems required more conceptual than literal translations. Some items were better understood by non-English speakers than by English speakers. De-centering (i.e., modifying the English original to correspond with translation) produced better understanding for one item. CONCLUSIONS: Translating questionnaire items and achieving equivalence across languages require various kinds of expertise. Backward translation itself is not sufficient. More research efforts should be concentrated on qualitative approaches to developing useful research tools.

Issues in neurological risk assessment for occupational exposures: the Bay Bridge welders.

The goal of occupational risk assessment is often to estimate excess lifetime risk for some disabling or fatal health outcome in relation to a fixed workplace exposure lasting a working lifetime. For sub-chronic or sub-clinical health effects measured as continuous variables, the benchmark dose method can be applied, but poses issues in defining impairment and in specifying acceptable levels of excess risk. Such risks may also exhibit a dose-rate effect and partial reversibility such that effects depend on how the dose is distributed over time. Neurological deficits as measured by a variety of increasingly sensitive neurobehavioral tests represent one such outcome, and the development of a parkinsonian syndrome among welders exposed to manganese fume presents a specific instance. Welders employed in the construction of piers for a new San Francisco-Oakland Bay Bridge in San Francisco were previously evaluated using a broad spectrum of tests. Results for four of those tests (Rey-Osterrieth Complex Figure Test, Working Memory Index, Stroop Color Word Test and Auditory Consonant Trigrams Test) were used in the benchmark dose procedure. Across the four outcomes analyzed, benchmark dose estimates were generally within a factor of 2.0, and decreased as the percentile of normal performance defining impairment increased. Estimated excess prevalence of impairment, defined as performance below the 5th percentile of normal, after 2 years of exposure at the current California standard (0.2 mg/m3, 8 h TWA), ranged 15-32% for the outcomes studied. Because these exposures occurred over a 1-2-year period, generalization to lifetime excess risk requires further consideration of the form of the exposure response and whether short-term responses can be generalized to equivalent 45-year period. These results indicate unacceptable risks at the current OSHA PEL for manganese (5.0 mg/m3, 15 min) and likely at the Cal OSHA PEL as well.