Incident chronic obstructive pulmonary disease associated with occupation, industry, and workplace exposures in the Health and Retirement Study.

BACKGROUND: Chronic health effects from accumulated occupational exposures manifest as the workforce ages. The Health and Retirement Study (HRS), a panel survey of U.S. adults nearing/in retirement, allows assessment of associations among industry and occupation (I/O), workplace exposures, and incident chronic obstructive pulmonary disease (COPD). METHODS: The study population comprised respondents from the 1992 HRS cohort employed in 1972 or later and not diagnosed with COPD as of initial interview. We examined associations with incident COPD through 2016 and: (1) broad and selected detailed I/O, (2) workplace exposures, and (3) exposures within I/O. Given the cohort's baseline age (50-62), we calculated subhazard ratios (SHRs) for COPD accounting for competing risk of death. RESULTS: SHRs for COPD were significantly elevated for several industries: mining; blast furnaces, steelworks, rolling and finishing mills; groceries and related products; and automotive repair shops. Occupations with significantly elevated SHRs were maids and housemen; farmworkers; vehicle/mobile equipment mechanics and repair workers; material moving equipment operators; and nonconstruction laborers. Significantly elevated COPD SHRs were observed for specific I/O-exposure pairs: blast furnace/steelworks/rolling/finishing mills and asbestos; automotive repair shops and aerosol paints; farmworkers and pesticide exposures; and both material moving equipment operators and nonconstruction laborers exposed to dust and ash. CONCLUSIONS: Certain jobs and occupational exposures are associated with increased risk for developing COPD in late preretirement and during retirement. Given the disability and economic costs of COPD, these findings support focusing exposure prevention and medical monitoring resources on groups of workers at increased risk.

Pesticide use, allergic rhinitis, and asthma among US farm operators.

OBJECTIVE: The objective of the study is to examine associations between use of specific pesticides and lifetime allergic rhinitis and current asthma in US primary farm operators. METHODS: The 2011 Farm and Ranch Safety Survey data from 11,210 primary farm operators were analyzed. Pesticide use on the farm was determined using an affirmative response to the question of whether the operator ever mixed, loaded, or applied pesticides on their farm in the 12 months prior to the interview. Operators who answered "yes" were further asked about the specific trade name and formulation identifiers of the product they used and personal protective equipment (PPE) used. Data were weighted to produce national estimates. Adjusted prevalence odds ratios (PORs) were calculated using logistic regression. The referent group included operators who did not use any pesticides in the 12 months prior to the interview. RESULTS: Of an estimated 2.1 million farm operators, 40.0% used pesticides, 30.8% had lifetime allergic rhinitis, and 5.1% had current asthma. Insecticide and herbicide use were significantly associated with lifetime allergic rhinitis and current asthma. The use of 2,4-dichlorophenoxyacetic acid (POR = 1.5; 95% CI 1.2-1.9) and carbaryl (POR = 2.3; 1.4-3.7) was significantly associated with lifetime allergic rhinitis. Of operators using pesticides, 64.9% used PPE the last time they mixed, loaded, or applied pesticides. CONCLUSIONS: Pesticide use was associated with lifetime allergic rhinitis and current asthma among farm operators. Further studies are needed to clarify the dose-response relationship between pesticide use and adverse respiratory health effects.

Acute Illnesses and Injuries Related to Total Release Foggers - 10 States, 2007-2015.

Total release foggers (TRFs) (also known as "bug bombs") are pesticide products often used indoors to kill insects. After an earlier report found that TRFs pose a risk for acute illness (1), the Environmental Protection Agency required improved labels on TRFs manufactured after September 2012 (2). To examine the early impact of relabeling, the magnitude and characteristics of acute TRF-related illness were evaluated for the period 2007-2015. A total of 3,222 TRF-related illnesses were identified in 10 participating states, based on three data sources: Sentinel Event Notification System for Occupational Risk-Pesticides (SENSOR) programs, the California Department of Pesticide Regulation (CDPR) program, and poison control centers (PCCs) in Florida, Texas, and Washington. No statistically significant decline in the overall TRF-illness incidence rate was found. Failure to vacate treated premises during application was the most commonly reported cause of exposure. To reduce TRF-related illness, integrated pest management strategies (3) need to be adopted, as well as better communication about the hazards and proper uses of TRFs. Redesigning TRFs to prevent sudden, unexpected activation might also be useful.

Elevated Blood Lead Levels Among Employed Adults - United States, 1994-2013.

CDC's National Institute for Occupational Safety and Health (NIOSH) and state health departments collect data on laboratory-reported adult blood lead levels (BLLs). This report presents data on elevated BLLs among employed adults (defined as persons aged ≥16 years) in the United States for 1994-2013. This report is a part of the Summary of Notifiable Noninfectious Conditions and Disease Outbreaks - United States, which encompasses various surveillance years but is being published in 2016 (1). The Summary of Notifiable Noninfectious Conditions and Disease Outbreaks appears in the same volume of the Morbidity Mortality Weekly Report (MMWR) as the annual Summary of Notifiable Infectious Diseases (2).

Indoor firing ranges and elevated blood lead levels - United States, 2002-2013.

Indoor firing ranges are a source of lead exposure and elevated blood lead levels (BLLs) among employees, their families, and customers, despite public health outreach efforts and comprehensive guidelines for controlling occupational lead exposure. There are approximately 16,000-18,000 indoor firing ranges in the United States, with tens of thousands of employees. Approximately 1 million law enforcement officers train on indoor ranges. To estimate how many adults had elevated BLLs (≥10 µg/dL) as a result of exposure to lead from shooting firearms, data on elevated BLLs from the Adult Blood Lead Epidemiology and Surveillance (ABLES) program managed by CDC's National Institute for Occupational Safety and Health (NIOSH) were examined by source of lead exposure. During 2002-2012, a total of 2,056 persons employed in the categories "police protection" and "other amusement and recreation industries (including firing ranges)" had elevated BLLs reported to ABLES; an additional 2,673 persons had non-work-related BLLs likely attributable to target shooting. To identify deficiencies at two indoor firing ranges linked to elevated BLLs, the Washington State Division of Occupational Safety and Health (WaDOSH) and NIOSH conducted investigations in 2012 and 2013, respectively. The WaDOSH investigation found a failure to conduct personal exposure and biologic monitoring for lead and also found dry sweeping of lead-containing dust. The NIOSH investigation found serious deficiencies in ventilation, housekeeping, and medical surveillance. Public health officials and clinicians should ask about occupations and hobbies that might involve lead when evaluating findings of elevated BLLs. Interventions for reducing lead exposure in firing ranges include using lead-free bullets, improving ventilation, and using wet mopping or high-efficiency particulate air (HEPA) vacuuming to clean.

Characterization of lead in US workplaces using data from OSHA's integrated management information system.

BACKGROUND: Lead hazards continue to be encountered in the workplace. OSHA's Integrated Management Information System (IMIS) is the largest available database containing sampling results in US workplaces. METHODS: Personal airborne lead sampling results in IMIS were extracted for years 1979-2008. Descriptive analyses, geographical mapping, and regression modeling of results were performed. RESULTS: Seventy-nine percent of lead samples were in the manufacturing sector. Lead sample results were highest in the construction sector (median = 0.03 mg/m(3) ). NORA sector, year, OSHA region, number of employees at the worksite, federal/state OSHA plan, unionization, advance notification, and presence of an employee representative were statistically associated with having a lead sample result exceed the PEL. CONCLUSIONS: Lead concentrations within construction have been higher than any other industry. Lead hazards have been most prevalent in the north and northeastern US. IMIS data can be useful as a surveillance tool and for targeting prevention efforts toward hazardous industries.

Case report: three farmworkers who gave birth to infants with birth defects closely grouped in time and place-Florida and North Carolina, 2004-2005.

CONTEXT: There is little evidence linking adverse reproductive effects to exposure to specific pesticides during pregnancy. CASE PRESENTATION: In February 2005, three infants with congenital anomalies were identified in Collier County, Florida, who were born within 8 weeks of one another and whose mothers worked for the same tomato grower. The mothers worked on the grower's Florida farms in 2004 before transferring to its North Carolina farms. All three worked during the period of organogenesis in fields recently treated with several pesticides. The Florida and North Carolina farms were inspected by regulatory agencies, and in each state a large number of violations were identified and record fines were levied. DISCUSSION: Despite the suggestive evidence, a causal link could not be established between pesticide exposures and the birth defects in the three infants. Nonetheless, the prenatal pesticide exposures experienced by the mothers of the three infants is cause for concern. Farmworkers need greater protections against pesticides. These include increased efforts to publicize and comply with both the U.S. Environmental Protections Agency's Worker Protection Standard and pesticide label requirements, enhanced procedures to ensure pesticide applicator competency, and recommendations to growers to adopt work practices to reduce pesticide exposures. RELEVANCE TO PROFESSIONAL PRACTICE: The findings from this report reinforce the need to reduce pesticide exposures among farmworkers. In addition, they support the need for epidemiologic studies to examine the role of pesticide exposure in the etiology of congenital anomalies.

Acute illnesses associated with pesticide exposure at schools.

CONTEXT: Pesticides continue to be used on school property, and some schools are at risk of pesticide drift exposure from neighboring farms, which leads to pesticide exposure among students and school employees. However, information on the magnitude of illnesses and risk factors associated with these pesticide exposures is not available. OBJECTIVE: To estimate the magnitude of and associated risk factors for pesticide-related illnesses at schools. DESIGN, SETTING, AND PARTICIPANTS: Analysis of surveillance data from 1998 to 2002 of 2593 persons with acute pesticide-related illnesses associated with exposure at schools. Nationwide information on pesticide-related illnesses is routinely collected by 3 national pesticide surveillance systems: the National Institute for Occupational Safety and Health's Sentinel Event Notification System for Occupational Risks pesticides program, the California Department of Pesticide Regulation, and the Toxic Exposure Surveillance System. MAIN OUTCOME MEASURES: Incidence rates and severity of acute pesticide-related illnesses. RESULTS: Incidence rates for 1998-2002 were 7.4 cases per million children and 27.3 cases per million school employee full-time equivalents. The incidence rates among children increased significantly from 1998 to 2002. Illness of high severity was found in 3 cases (0.1%), moderate severity in 275 cases (11%), and low severity in 2315 cases (89%). Most illnesses were associated with insecticides (n = 895, 35%), disinfectants (n = 830, 32%), repellents (n = 335, 13%), or herbicides (n = 279, 11%). Among 406 cases with detailed information on the source of pesticide exposure, 281 (69%) were associated with pesticides used at schools and 125 (31%) were associated with pesticide drift exposure from farmland. CONCLUSIONS: Pesticide exposure at schools produces acute illnesses among school employees and students. To prevent pesticide-related illnesses at schools, implementation of integrated pest management programs in schools, practices to reduce pesticide drift, and adoption of pesticide spray buffer zones around schools are recommended.