Residents' perception and worldview about radon control policy in Canada: A pro-equity social justice lens.

Radon is a potent indoor air pollutant, especially in radon prone areas and in countries with long winters. As the second top lung carcinogen, radon is disproportionately affecting certain population subgroups. While many provinces have taken sporadic actions, the equity issue has remained unaddressed across all policy measures. Attempts to enforce radon guidelines and enact building regulations without considering residents' views have proved ineffective. Research linking residents' radon risk perception and worldviews regarding radon control policy is lacking in Canada. We applied mixed (quantitative and qualitative) methods in a pro-equity social justice lens to examine the variations in residents' risk perception, access to risk communication messages, and worldviews about risk management across the sociodemographic strata. Triangulation of the quantitative and qualitative findings strengthened the evidence base to identify challenges and potential solutions in addressing the health risk through upstream policy actions. Enacting radon control policy requires actions from all levels of governments and relevant stakeholders to ensure equal opportunities for all residents to take the preventive and adaptive measures. Small sample size limited the scope of findings for generalization. Future studies can examine the differential impacts of radon health risk as are determined by various sociodemographic variables in a representative national cohort.

Radon in Schools: A Review of Radon Testing Efforts in Canadian Schools.

Radon, a known carcinogen, becomes a health risk when it accumulates inside buildings. Exposure is of particular concern for children, as their longer life expectancy increases their lifetime risk of developing cancer. In 2016, 5.5 million students were enrolled in Canadian elementary and secondary schools. With no national policy on radon testing in schools, children may be at risk from radon exposure while attending school and school-based programs. This study explored radon testing efforts in publicly funded Canadian schools and summarizes where testing programs have occurred. Radon testing in schools was identified through a systematic qualitative enquiry, surveying members from different levels of government (health and education) and other stakeholders (school boards, research experts, among others). Overall, this research found that approaches to radon testing varied considerably by province and region. Responsibility for radon testing in schools was often deferred between government, school boards, building managers and construction parties. Transparency around radon testing, including which schools had been tested and whether radon levels had been mitigated, also emerged as an issue. Radon testing of schools across Canada, including mitigation and clear communication strategies, needs to improve to ensure a healthy indoor environment for staff and students.

Using geographic information systems to estimate potential pesticide exposure at the population level in Canada.

Residents in close proximity to agricultural land are at risk of higher pesticide exposures. The purpose of this study was to generate national population-level exposure estimates for Canada for three commonly applied pesticides that are suspected carcinogens (2,4-dichlorophenoxyacetic acid (2,4-D), glyphosate and chlorothalonil). Using geographic information systems, pesticide exposure was estimated for every - census subdivision (CSD) in Canada (n = 5054) by combining raster-based surfaces for the distribution of crops with average crop-specific pesticide application rates data. Analyses examined all identified crops in combination with different pesticide application rates to obtain a cumulative potential total exposure. Specifically, the number of acres of particular crops were calculated for each CSD and then multiplied by the average pesticide application rates data, summed across crops, and combined with population data by CSD to provide a potential pesticide exposure estimate for each CSD. Results demonstrate that the population exposure varies greatly depending on agricultural production by CSD region. For example, in Ontario, the 2,4-D application rate was an average of 361 kg/km2, while in Saskatchewan, which primarily grows field/cereal crops, 2,4-D application rates were much higher (3810 kg/km2). The highest potential exposures to all three pesticides were in the prairie provinces (Alberta, Saskatchewan, Manitoba) along with Prince Edward Island, Southern Quebec and British Columbia. This work can be used in conjunction with other exposure assessment approaches to better understand overall pesticide exposure among Canada's general population.

The current burden of cancer attributable to occupational exposures in Canada.

Exposure to occupational carcinogens is often overlooked as a contributor to the burden of cancer. To estimate the proportion of cancer cases attributable to occupational exposure in Canada in 2011, exposure prevalence and levels of 44 carcinogens were informed by data from the Canadian carcinogen exposure surveillance project (CAREX Canada). These were used with Canadian Census (between 1961 and 2011) and Labour Force Survey (annual surveys between 1976 and 2013) data to estimate the number of workers ever exposed to occupational carcinogens. Risk estimates of the association between each carcinogen and cancer site were selected mainly from published literature reviews. Population attributable risks were estimated using Levin's equation and applied to the 2011 cancer statistics from the Canadian Cancer Registry. It is estimated that 15.5 million Canadians alive in 2011 were exposed, during at least one year between 1961 and 2001, to at least one carcinogen in the workplace. Overall, we estimated that in 2011, between 3.9% (95% CI: 3.1%-8.1%) and 4.2% (95% CI: 3.3%-8.7%) of all incident cases of cancer were due to occupational exposure, corresponding to lower and upper numbers of 7700-21,800 cases. Five of the cancer sites - mesothelioma, non-melanoma skin cancer, lung, female breast, and urinary bladder - account for a total of 7600 to 21,200 cancers attributable to occupational exposures such as solar radiation, asbestos, diesel engine exhaust, crystalline silica, and night shift work. Our study highlights cancer sites and occupational exposures that need recognition and efforts by all stakeholders to avoid preventable cancers in the future.

Burden of lung cancer attributable to occupational diesel engine exhaust exposure in Canada.

OBJECTIVE: To estimate the population attributable fraction (PAF) and number of incident and fatal lung cancers in Canada from occupational exposure to diesel engine exhaust (DEE). METHODS: DEE exposure prevalence and level estimates were used with Canadian Census and Labour Force Survey data to model the exposed population across the risk exposure period (REP, 1961-2001). Relative risks of lung cancer were calculated based on a meta-regression selected from the literature. PAFs were calculated using Levin's equation and applied to the 2011 lung cancer statistics obtained from the Canadian Cancer Registry. RESULTS: We estimated that 2.4% (95% CI 1.6% to 6.6%) of lung cancers in Canada are attributable to occupational DEE exposure, corresponding to approximately 560 (95% CI 380 to 1570) incident and 460 (95% CI 310 to 1270) fatal lung cancers in 2011. Overall, 1.6 million individuals alive in 2011 were occupationally exposed to DEE during the REP, 97% of whom were male. Occupations with the highest burden were underground miners, truck drivers and mechanics. Half of the attributable lung cancers occurred among workers with low exposure. CONCLUSIONS: This is the first study to quantify the burden of lung cancer attributable to occupational DEE exposure in Canada. Our results underscore a large potential for prevention, and a large public health impact from occupational exposure to low levels of DEE.

A qualitative study of the knowledge, attitudes, and behaviors of people exposed to diesel exhaust at the workplace in British Columbia, Canada.

PURPOSE: To identify exposure-related knowledge, attitudes and behaviors of individuals occupationally exposed to diesel exhaust (DE); to reveal strengths, knowledge gaps and misperceptions therein. METHODS: A Mental Models approach was used to gather information about current scientific understanding of DE exposure hazards and the ways in which exposure can be reduced. Thirty individuals in British Columbia who were regularly exposed to occupational DE were interviewed. The audio was recorded and transcribed. Data was grouped together and examined to draw out themes around DE awareness, hazard assessment and risk reduction behaviors. These themes were then compared and contrasted with existing grey and research literature in order to reveal strengths, gaps and misperceptions regarding DE exposure. RESULTS: Study participants were aware and concerned about their exposure to DE but had incomplete and sometimes incorrect understanding of exposure pathways, health effects, and effective strategies to reduce their exposures. The perceived likelihood of exposure to DE was significantly greater compared to that of other work hazards (p<0.01), whereas the difference for their perceived severity of consequences was not significant. There was no universally perceived main source of information regarding DE, and participants generally distrusted sources of information based on their past experience with the source. Most of the actions that were taken to address DE exposure fell into the area of administrative controls such as being aware of sources of DE and avoiding these sources. CONCLUSIONS: This study of the knowledge, attitude, and behavior of those occupationally exposed to DE found, most notably, that more education and training and the creation of a health effects inventory regarding DE exposure were desired.

Hospital support services and the impacts of outsourcing on occupational health and safety.

BACKGROUND: Outsourcing labor is linked to negative impacts on occupational health and safety (OHS). In British Columbia, Canada, provincial health care service providers outsource support services such as cleaners and food service workers (CFSWs) to external contractors. OBJECTIVES: This study investigates the impact of outsourcing on the occupational health safety of hospital CFSWs through a mixed methods approach. METHODS: Worker's compensation data for hospital CFSWs were analyzed by negative binomial and multiple linear regressions supplemented by iterative thematic analysis of telephone interviews of the same job groups. RESULTS: Non-significant decreases in injury rates and days lost per injury were observed in outsourced CFSWs post outsourcing. Significant decreases (P < 0.05) were observed in average costs per injury for cleaners post outsourcing. Outsourced workers interviewed implied instances of underreporting workplace injuries. CONCLUSIONS: This mixed methods study describes the impact of outsourcing on OHS of healthcare workers in British Columbia. Results will be helpful for policy-makers and workplace regulators to assess program effectiveness for outsourced workers.

Outdoor Workers' Use of Sun Protection at Work and Leisure.

BACKGROUND: Outdoor workers are at risk of high ultraviolet radiation exposure, and may have difficulty using sun protection. The objectives were to determine the prevalence of sun protection behaviors in a sample of outdoor construction workers, and to assess which factors predict better sun protection practices. METHODS: Participants were recruited via construction unions. Workers answered a questionnaire on demographics, skin cancer risk, sun protection behaviors, and job. Sun protection behavior scores (from questions on sunscreen use, sleeved shirt, hat, shade seeking, sunglasses) were calculated by converting Likert-scale answers to scores from 0 to 4, and taking the mean (separately for work and leisure). Determinants of sun protection behavior scores were examined for work and leisure using generalized linear models. RESULTS: Seventy-seven workers had complete questionnaire data (participation 98%). Sun protection behaviors used most often were hats (79% often/always) and sleeved shirts (82% often/always); least prevalent were shade-seeking (8% often/always) and sunscreen (29% often/always). For both work and leisure scores, the strongest predictor was skin type, with fairer-skinned individuals having higher sun protection behavior scores. Workers had higher scores at work than on weekends. Workplaces that required hats and sleeved shirts for safety purposes had higher protection behavior scores. CONCLUSION: This high-participation rate cohort helps characterize sun protection behaviors among outdoor workers. Workers practiced better sun protection at work than on weekends, suggesting that workplace policies supportive of sun protection could be useful for skin cancer prevention in the construction industry.

Occupational exposure to solar ultraviolet radiation and the risk of prostate cancer.

OBJECTIVES: Preventable risk factors for prostate cancer are poorly understood; sun exposure is a possible protective factor. The goal of this study was to investigate prostate cancer risk in outdoor workers, a population with high sun exposure. METHODS: Prostate cancer cases and controls from a large study (conducted between 1994 and 1997) were used for this analysis. A job exposure matrix (JEM) was used to assign solar ultraviolet radiation (UVR) at work as moderate (2 to <6 hours outside/day) or high (≥6 hours). Average daily satellite UV-B measures were linked to the latitude/longitude of the residences of each participant. Several other exposure metrics were also examined, including ever/never exposed and standard erythemal dose by years (SED×years). Logistic regression was used to evaluate the association between solar UVR exposure and the odds of prostate cancer. RESULTS: A total of 1638 cases and 1697 controls were included. Men of Indian and Asian descent had reduced odds of prostate cancer (ORs 0.17 (0.08 to 0.35) and 0.25 (0.15 to 0.41), respectively) compared with Caucasian men, as did single men (OR 0.76 (0.58 to 0.98)) compared with married men. Overall, no statistically significant associations were observed between sun exposure and prostate cancer with 1 exception. In the satellite-enhanced JEM that considered exposure in high category jobs only, prostate cancer odds in the highest quartile of cumulative exposure was decreased compared with unexposed men (OR 0.68 (0.51 to 0.92)). CONCLUSIONS: This study found limited evidence for an association with prostate cancer, with the exception of 1 statistically significant finding of a decreased risk among workers with the longest term and highest sun exposure.

Levels of Occupational Exposure to Solar Ultraviolet Radiation in Vancouver, Canada.

INTRODUCTION: Outdoor workers are at high risk of exposure to solar ultraviolet radiation (UVR), a known human carcinogen. In Canada, no objective measures of UVR exposure are available for occupational settings. METHODS: The Outdoor Workers Project collected UVR exposure data among outdoor workers in Vancouver, Canada during the summer of 2013. Objective measures of exposure were taken for one week using calibrated electronic UVR dosimeters. Additional data was collected from workers on skin cancer risk factors, family history of skin cancer, and job type; as well as meteorological data for sampling days. Marginal models were constructed to examine the worker, job and meteorological determinants of UVR exposure levels, as measured in standard erythemal dose (SED). RESULTS: Seventy-eight workers were recruited, of which 73 had at least 1 day of measured UVR exposure for this analysis. Participants were mostly male, young and Caucasian. Mean exposure (corrected for repeated measures) was 1.08 SED. Exposure measures were highly variable even in the same workplace, ranging from 0.01 SED to 19.2 SED. Younger age, working in land-based construction, and sunnier weather forecasts led to higher levels of UVR exposure. CONCLUSIONS: Exposure levels capable of causing sunburn were common in this study of outdoor workers, in a location not typically associated with high sun exposure.

Geographic variation in radon and associated lung cancer risk in Canada.

OBJECTIVE: Radon is an important risk factor for lung cancer. Here we use maps of the geographic variation in radon to estimate the lung cancer risk associated with living in high radon areas of Canada. METHODS: Geographic variation in radon was estimated using two mapping methods. The first used a Health Canada survey of 14,000 residential radon measurements aggregated to health regions, and the second, radon risk areas previously estimated from geology, sediment geochemistry and aerial gamma-ray spectrometry. Lung cancer risk associated with living in these radon areas was examined using a population-based case-control study of 2,390 lung cancer cases and 3,507 controls collected from 1994-1997 in eight Canadian provinces. Residential histories over a 20-year period were used in combination with the two mapping methods to estimate ecological radon exposures. Hierarchical logistic regression analyses were used to estimate odds ratios for lung cancer incidence, after adjusting for a comprehensive set of individual and geographic covariates. RESULTS: Across health regions in Canada, significant variation in average residential radon concentrations (range: 16-386 Bq/m3) and in high geological-based radon areas (range: 0-100%) is present. In multivariate models, a 50 Bq/m3 increase in average health region radon was associated with a 7% (95% CI: -6-21%) increase in the odds of lung cancer. For every 10 years that individuals lived in high radon geological areas, the odds of lung cancer increased by 11% (95% CI: 1-23%). CONCLUSIONS: These findings provide further evidence that radon is an important risk factor for lung cancer and that risks are unevenly distributed across Canada.

Occupational exposures to antineoplastic drugs and ionizing radiation in Canadian veterinary settings: findings from a national surveillance project.

OBJECTIVES: Although veterinary workers may encounter various occupational health hazards, a national characterization of exposures is lacking in Canada. This study used secondary data sources to identify veterinary exposure prevalence for ionizing radiation and antineoplastic agents, as part of a national surveillance project. METHODS: For ionizing radiation, data from the Radiation Protection Bureau of Health Canada were used to identify veterinarians and veterinary technicians monitored in 2006. This was combined with Census statistics to estimate a prevalence range and dose levels. For antineoplastic agents, exposure prevalence was estimated using statistics on employment by practice type and antineoplastic agent usage rates, obtained from veterinary licensing bodies and peer-reviewed literature. RESULTS: In 2006, 7,013 (37% of all) Canadian veterinary workers were monitored for ionizing radiation exposure. An estimated 3.3% to 8.2% of all veterinarians and 2.4% to 7.2% of veterinary technicians were exposed to an annual ionizing radiation dose above 0.1 mSv, representing a total of between 536 and 1,450 workers. All monitored doses were below regulatory limits. For antineoplastic agents, exposure was predicted in up to 5,300 (23%) of all veterinary workers, with an estimated prevalence range of 22% to 24% of veterinarians and 20% to 21% of veterinary technicians. CONCLUSION: This is the first national-level assessment of exposure to ionizing radiation and antineoplastic agents in Canadian veterinary settings. These hazards may pose considerable health risks. Exposures appeared to be low, however our estimates should be validated with comprehensive exposure monitoring and examination of determinants across practice areas, occupations, and tasks.

Prevalence of exposure to solar ultraviolet radiation (UVR) on the job in Canada.

OBJECTIVE: Over one third of all newly diagnosed cancers in Canada in 2010 were skin cancer, despite the fact that skin cancer is largely preventable by limiting ultraviolet radiation (UVR) exposure. Outdoor workers are at risk of exposure to UVR, yet the prevalence of exposure in Canada is unknown. The objective of this study was to estimate the number of outdoor workers in Canada. METHODS: Building on CAREX Canada methods, we used a combination of data in the original Finnish CAREX, an Australian skin cancer prevention workbook, career-selection websites, and published studies to flag jobs at high risk of exposure. We also created a category for moderate exposure, where workers were unlikely to spend their whole day outside. Adjustments were made for industry-driven exposure, and prevalence of exposure was assigned for all jobs. Prevalence data were linked to census data to derive the number of workers exposed to solar UVR. RESULTS: Over 1.5 million Canadian workers are exposed to solar UV at work, and approximately 897,000 of these were flagged as "high exposed" (outdoors > or =75% of the workday). The largest occupational groups were farmers, construction labourers, and landscapers. Proportions of the workforce exposed ranged by province, with 6.9% of workers exposed in Ontario, and up to 17.3% in Prince Edward Island. CONCLUSIONS: Information on solar UVR exposure prevalence is needed for primary skin cancer prevention with regard to targeting of high-risk groups, priority setting, and better risk assessment. This study showed that solar UVR exposure is occurring on a large scale in Canada.

Accuracy, comprehensibility, and use of material safety data sheets: a review.

OBJECTIVES: Material safety data sheets (MSDSs) are used in workplaces to communicate to workers the hazards of chemical products. This article describes a review of the peer-reviewed scientific literature regarding the accuracy, comprehensibility and use of MSDSs in the workplace. METHODS: Articles were retrieved via a systematic search of indexes and databases, followed by hand searching and citation index searching. Two reviewers independently read and coded the articles using an iterative matrix. RESULTS: Of the 280 unique articles retrieved, 24 fit the review criteria. Eligible articles included a range of methodologies: laboratory analyses, site audits, surveys and qualitative inquiry. Articles were grouped into three main topic categories: accuracy and completeness, awareness and use, and comprehensibility. Accuracy and completeness were found to be relatively poor, with the majority of studies presenting evidence that the MSDSs under review did not contain information on all the chemicals present, including those known to be serious sensitizers or carcinogens. Poor presentation and complex language were consistently associated with low comprehensibility among workers. Awareness and use of MSDSs was suboptimal in workplaces where these factors were studied. CONCLUSIONS: Despite the fact that these studies varied in methodology and spanned a period of more than 15 years, a number of common themes emerged regarding inaccuracies, incompleteness, incomprehensibility and overall low use of MSDSs. The results of the literature review suggest that there are serious problems with the use of MSDSs as hazard communication tools. The article concludes with recommendations for governments, regulatory bodies, and occupational health and safety personnel to seriously reassess the ways in which MSDSs are written, monitored, regulated, and used.

Communicating the risks of a new, emerging pathogen: the case of Cryptococcus gattii.

The news media are an important channel for communicating public health messages, providing important information about geographic extent, symptoms, and precautionary measures. This function may be particularly important in the case of new and emerging infectious diseases, which are unfamiliar to both the public and health professionals. We conducted a content analysis of the coverage in six Canadian newspapers of two emerging infectious pathogens in British Columbia (BC), West Nile virus and Cryptococcus gattii (C. gattii), between 2001 and 2006. C. gattii was first identified in the Canadian Pacific Northwest in 1999, having previously been restricted to tropical and subtropical areas. By summer 2006, C. gattii had killed at least eight people and was responsible for over 150 hospitalizations in the province of BC, as well as significant morbidity and mortality among companion animals. West Nile virus reached Canada in 2001 and has since caused significant morbidity and mortality. It has not, to date, reached BC. Despite the much higher incidence of disease and death caused by C. gattii in BC, West Nile virus received five times more news coverage in the British Columbian and national newspapers examined. Surprisingly, the local newspaper closest to the center of the British Columbia C. gattii outbreak had a much lower proportion of coverage of the disease than other papers in the province. The article discusses possible explanations for these findings, and the implications for public health communication.

Assessment of pesticide exposure control practices among men and women on fruit-growing farms in British Columbia.

Exposure to pesticides can be reduced by wearing personal protective equipment (PPE) or by implementing alternative pest control techniques, such as Integrated Pest Management (IPM). A cross-sectional telephone survey was conducted to explore the prevalence of these practices and the factors that may be associated with them among men and women involved in fruit growing in British Columbia (BC), Canada. Survey variables were developed using a framework that incorporated aspects of farm structure, health promotion, and risk perception theories. Three hundred and eighty people took part in the survey (response rate 75%). Of those who applied pesticides (n = 119), 63% indicated that they usually wore PPE during application. Individual equipment use varied. Gloves were worn most frequently (84%), followed by a spray suit (77%) and breathing protection (75%). Peer-related factors and farm-specific characteristics such as the type of crops grown were most strongly associated with PPE use, whereas perception of pesticide risk was only weakly associated with this practice. IPM techniques had been tried on 62% of the conventional farms in the study. A range of factors was significantly associated with the use of IPM, including cultural, attitudinal, experiential, and risk-based and farm-specific variables. These results suggest that decisions to adopt exposure control practices may reflect consideration from the multiple dimensions that make up farm life, including structural characteristics of the farm as well as the attributes of the individuals who live on farms. These findings provide a better understanding of current practices and may help in the development of programs to promote pesticide exposure control practices in the BC farming community.

On-call work and health: a review.

Many professions in the fields of engineering, aviation and medicine employ this form of scheduling. However, on-call work has received significantly less research attention than other work patterns such as shift work and overtime hours. This paper reviews the current body of peer-reviewed, published research conducted on the health effects of on-call work The health effects studies done in the area of on-call work are limited to mental health, job stress, sleep disturbances and personal safety. The reviewed research suggests that on-call work scheduling can pose a risk to health, although there are critical gaps in the literature.

Assessment of exposure in an international study on cancer risks among pulp, paper, and paper product workers.

A data management system and a department-exposure matrix (PAPDEM) was designed and constructed to facilitate exposure assessment for a large multinational study on cancer risks among pulp, paper, and paper product workers. Exposure to 25 major agents was described by prevalence, P (i.e., proportion of the exposed, classified %-range), and level, L (i.e., annual mean concentration at work, classified). Some agents could be assessed only in qualitative terms. The assessment was specific to mill, work department, agent, and time period. The results of industrial hygiene measurements, information from detailed company questionnaires, and the professional judgments of the assessment team were the cornerstones of the assessment. Validity and consistency of the assessment were aimed at by setting default values for P and L prior to the assessment, accurately defining agents and exposure classes, dividing assessment work by subindustry, working in pairs, testing interrater agreement, and finalizing the estimates in a meeting. In spite of these precautions, good agreement between different assessors was difficult to reach. Exposure to chemical agents turned out to be widespread and complex with frequent multiple exposures. A computer-assisted exposure assessment system such as PAPDEM may save time and facilitate assessment in large epidemiological studies requiring complicated exposure assessment procedures. It also provides a good documentation of exposure assignments, which may be useful in the interpretation of the results and in future updates of the study.