Occupational Exposure of Canadian Nail Salon Workers to Plasticizers Including Phthalates and Organophosphate Esters.

Personal exposure of nail salon workers to 10 phthalates and 19 organophosphate esters (OPEs) was assessed in 18 nail salons in Toronto, Canada. Active air samplers (n = 60) and silicone passive samplers, including brooches (n = 58) and wristbands (n = 60), were worn by 45 nail salon workers for ∼8 working hours. Diethyl phthalate (median = 471 ng m-3) and diisobutyl phthalate (337 ng m-3) were highest in active air samplers. Most abundant OPEs in active air samplers were tris(2-chloroisopropyl)phosphate or TCIPP (303 ng m-3) and tris(2-chloroethyl)phosphate or TCEP (139 ng m-3), which are used as flame retardants but have not been reported for use in personal care products or nail salon accessories. Air concentrations of phthalates and OPEs were not associated with the number of services performed during each worker's shift. Within a single work shift, a combined total of 16 (55%) phthalates and OPEs were detected on passive silicone brooches; 19 (66%) were detected on wristbands. Levels of tris(2-chloroisopropyl)phosphate, tris(1,3-dichloro-2-propyl)phosphate or TDCIPP, and triphenyl phosphate or TPhP wristbands were significantly higher than those worn by e-waste workers. Significant correlations (p < 0.05) were found between the levels of some phthalates and OPEs in silicone brooches and wristbands versus those in active air samplers. Stronger correlations were observed between active air samplers versus brooches than wristbands. Sampler characteristics, personal characteristics, and chemical emission sources are the three main factors proposed to influence the use of passive samplers for measuring semi-volatile organic compound exposure.

Diesel Engine Exhaust Exposure in the Ontario Civil Infrastructure Construction Industry.

OBJECTIVES: Diesel engine exhaust (DEE) is a known lung carcinogen and a common occupational exposure in Canada. The use of diesel-powered equipment in the construction industry is particularly widespread, but little is known about DEE exposures in this work setting. The objective of this study was to determine exposure levels and identify and characterize key determinants of DEE exposure at construction sites in Ontario. METHODS: Elemental carbon (EC, a surrogate of DEE exposure) measurements were collected at seven civil infrastructure construction worksites and one trades training facility in Ontario using NIOSH method 5040. Full-shift personal air samples were collected using a constant-flow pump and SKC aluminium cyclone with quartz fibre filters in a 37-mm cassette. Exposures were compared with published health-based limits, including the Dutch Expert Committee on Occupational Safety (DECOS) limit (1.03 µg m-3 respirable EC) and the Finnish Institute of Occupational Health (FIOH) recommendation (5 µg m-3 respirable EC). Mixed-effects linear regression was used to identify determinants of EC exposure. RESULTS: In total, 149 EC samples were collected, ranging from <0.25 to 52.58 µg m-3 with a geometric mean (GM) of 3.71 µg m-3 [geometric standard deviation (GSD) = 3.32]. Overall, 41.6% of samples exceeded the FIOH limit, mostly within underground worksites (93.5%), and 90.6% exceeded the DECOS limit. Underground workers (GM = 13.20 µg m-3, GSD = 1.83) had exposures approximately four times higher than below grade workers (GM = 3.56 µg m-3, GSD = 1.94) and nine times higher than above ground workers (GM = 1.49 µg m-3, GSD = 1.75). Training facility exposures were similar to above ground workers (GM = 1.86 µg m-3, GSD = 4.12); however, exposures were highly variable. Work setting and enclosed cabins were identified as the key determinants of exposure in the final model (adjusted R2 = 0.72, P < 0.001). The highest DEE exposures were observed in underground workplaces and when using unenclosed cabins. CONCLUSIONS: This study provides data on current DEE exposure in Canadian construction workers. Most exposures were above recommended health-based limits, albeit in other jurisdictions, signifying a need to further reduce DEE levels in construction. These results can inform a hazard reduction strategy including targeted intervention/control measures to reduce DEE exposure and the burden of occupational lung cancer.

Skin Exposure to Acrylates in Nail Salons.

OBJECTIVES: The nail salon industry has seen significant growth in recent years. Nail technicians provide manicures, pedicures and apply artificial nails; tasks that expose them to chemicals, including acrylates that are known skin and respiratory sensitizers. This paper reports on potential skin exposure to acrylates among nail technicians in Toronto, Canada. METHODS: Hand skin wipes were collected after (i) the application of artificial nails, (ii) the application of ultraviolet cured gel nail polish, and (iii) deliberate contact with nail polish. Surface wipes were collected from work areas and surfaces contaminated with known products. Wipe samples were analysed for eight acrylates: methyl acrylate (MA), ethyl acrylate (EA), methyl methacrylate (MMA), ethyl methacrylate (EMA), 2-hydroxyethyl acrylate (HEA), 2-hydroxyethyl methacrylate (HEMA), 2-hydroxypropyl methacrylate (HPMA), and ethylene glycol dimethacrylate (EGDMA) by gas chromatography with mass spectrometry. RESULTS: Thirty-five wipe samples were collected. No acrylates were detected in skin samples (n = 8) or work surfaces (n = 6). However, MMA, EMA, EA, HEMA, and HPMA were detected in the samples of surfaces contaminated with known products. MMA was detected in 28% of products tested. HEMA and HPMA were detected where deliberate contact with nail polish occurred. CONCLUSIONS: These results confirm that acrylates are present in nail products. However, no acrylates were detected in skin wipes. MMA, a chemical prohibited for use in cosmetics in Canada, was detected in nail polishes. Nail technicians should continue to employ safe work practices that reduce the probability of skin contact with acrylates and other chemicals.

Career fire hall exposures to diesel engine exhaust in Ontario, Canada.

Firefighters are potentially exposed to many carcinogens while at fires. There is also concern that firefighters may be at risk of exposure to carcinogens at other times, such as exposure to diesel engine exhaust (DEE) within fire halls. The study objective was to evaluate DEE levels in career fire halls in Ontario, Canada. Twelve career fire halls from six cities across the province of Ontario, Canada were recruited. In each hall, 24-hr DEE area samples were collected using NIOSH method 5040 (modified) for respirable elemental carbon in three locations (vehicle bay, dormitory, living quarters). Sampling was conducted in both the summer and winter to assess seasonal differences. Factors that may influence DEE exposures were also collected including presence of local exhaust ventilation (LEV), emergency run data, vehicle bay design, and age of fire apparatus. LEV was assessed using a thermo-anemometer during both campaigns. Of the 69 samples collected, 16% had detectable elemental carbon concentrations, where all but one was taken within the vehicle bay (range: <0.5 µg/m3-2.7 µg/m3). The data indicates vehicle bay exposures may be higher in halls with LEV units, those that respond to more emergencies, have a back-in vehicle bay design compared to drive-through design, and during the summer season. Three samples (4.3%) exceeded the 1.03 µg/m3 proposed Dutch occupational exposure limit; however, the estimated exceedance fraction of the underlying vehicle bay exposure distribution was 17%. Eight halls had LEV units, where performance ranged from 3.6% to 85.3% (median = 54%) when compared to manufacturer recommendations. The results show that firefighters may be at an increased risk of exposure to DEE when in fire halls and that LEV units should be assessed regularly for efficiency. Although no occupational exposure limit for DEE is currently available for industrial/non-industrial workplaces in Ontario, fire departments should continue to implement DEE control strategies to reduce exposures to mitigate potential health risks. Additional exposure studies are recommended to better understand DEE exposure in fire halls.

Industry and geographic patterns of use and emission of carcinogens in Ontario, Canada, 2011-2015.

OBJECTIVES: The goal of this study was to leverage data from two environmental regulatory initiatives, Ontario's Toxics Reduction Act (TRA) and Canada's National Pollutant Release Inventory (NPRI), to assess their ability to monitor trends in the use and emission of carcinogens by industry sector in Ontario. METHODS: Data reported to the TRA and NPRI by industrial facilities in Ontario were retrieved from 2011 to 2015. Twenty-six known and suspected carcinogens were identified (IARC) and the trends in the use and emission were evaluated by industry sector. The locations of industrial facilities that used and released carcinogens were mapped by Public Health Unit (PHU). RESULTS: Chemical manufacturing and primary metal manufacturing sectors accounted for 84% of all reported industrial use of carcinogens during the period 2011-2015. The largest source of carcinogen emissions came from facilities in the primary metal manufacturing and paper manufacturing sectors. The largest number of industrial facilities that reported the use and release of carcinogens were located in the City of Toronto and Peel Region PHUs. Overall, the use of carcinogens across all sectors appeared to decrease by 8%, while emissions increased by about 2%. CONCLUSION: The results of this study show the need to reduce the use and emission of select carcinogens in priority industry sectors. Environmental reporting programs, such as the TRA and NPRI, can serve as important tools in cancer prevention by tracking potential carcinogen exposures in the environment and in the workplace.

Recent trends in the industrial use and emission of known and suspected carcinogens in Ontario, Canada.

BACKGROUND: In 2010, Ontario, Canada's most populous province, implemented its Toxics Reduction Act, Ontario Regulation 455/09 (TRA), which requires four major manufacturing and mineral processing industry groups that already report releases of pollutants federally to the National Pollutant Release Inventory to additionally track, account and report their use and creation. The TRA was modeled after the Massachusetts Toxics Use Reduction Act of 1989, which has been very successful and reported significant reduction in toxic use and carcinogen release. METHODS: Data from the TRA were retrieved, and the trends in the use and release of 17 known and suspected carcinogens associated with the seven most prevalent cancers diagnosed in Ontario and reported by industrial facilities in Ontario from 2011 to 2015 were examined using methodology adapted from (Jacobs MM, Massey RI, Tenney H, Harriman E. Reducing the use of carcinogens: the Massachusetts experience. Rev Environ Health 2014;29(4):319-40). RESULTS: Carcinogens associated with lung cancers, leukemia and lymphomas were observed as the most used and released carcinogens in Ontario by amount. Overall, for 2011-2015, there was an observed reduction in the industrial use of carcinogens, except among breast carcinogens, which increased by 20%. An increase in the industrial releases of carcinogens was observed across all cancer sites, except among lung carcinogens, which decreased by 28%. CONCLUSION: The results of this study highlight the potential for reducing the cancer burden by reducing the use and release of select carcinogens associated with particularly prevalent cancers. Toxics use reduction programs can support cancer prevention initiatives by promoting targeted reductions in exposures to industrial carcinogens.

From awareness to action: Sudbury, mining and occupational disease in a time of change.

BACKGROUND: Miners work in highly hazardous environments, but surprisingly, there are more fatalities from occupational diseases, including cancers, than from fatalities from injuries. Over the last few decades, the mining environment has become safer with fewer injuries and less exposure to the toxins that lead to occupational disease. There have been improvements in working conditions, and a reduction in the number of workers exposed, together with an overall improvement in the health of miners. OBJECTIVES: This study attempted to gain a deeper understanding of the impetus for change to reduce occupational exposures or toxins at the industry level. It focuses on one mining community in Sudbury, Ontario, with a high cancer rate, and its reduction in occupational exposures. It explored the level of awareness of occupational exposures from the perspective of industry and worker representatives in some of the deepest mines in the world. Although awareness may be necessary, it is often not a sufficient impetus for change, and it is this gap between awareness and change that this study explored. It examined the awareness of occupational disease as an impetus to reducing toxic exposures in the mining sector, and explores other forces of change at the industrial and global levels that have led to an impact on occupational exposures in mining. METHODS: From 2014 and 2016, 60 interviews were conducted with individuals who were part of, or witness to the changes in mining in Sudbury. From these, 12 labour and 10 industry interviews and four focus groups were chosen for further analysis to gain a deeper understanding of industry and labour's views on the changes in mining and the impact on miners' health from occupational exposures. The results from this subsection of the data is the focus for this paper. RESULTS: The themes that emerged told a story about Sudbury. There is awareness of occupational exposures, but this awareness is dwarfed in comparison to the attention that is given to the tragic fatal injuries from injuries and accidents. The mines are now owned by foreign multinationals with a change from an engaged, albeit paternalistic sense of responsibility for the health of the miners, to a less responsive or sympathetic workplace culture. Modernization has led to the elimination, substitution, or reduction of some of the worst toxins, and hence present-day miners are less exposed to hazards that lead to occupational disease than they were in the past. However, modernization and the drop in the price of nickel has also led to a precipitous reduction in the number of unionized miners, a decline in union power, a decline in the monitoring of present-day exposures, and an increase in non-unionized contract workers. The impact has been that miners have lost their solidarity and power to investigate, monitor or object to present-day exposures. CONCLUSIONS: Although an increase in the awareness of occupational hazards has made a contribution to the reduction in occupational exposures, the improvement in health of miners may be considered more as a "collateral benefit" of the changes in the mining sector. Multiple forces at the industrial and global level have differentially led to an improvement in the working and living environment. However, with the loss of union power, the miners have lost their major advocate for miner health.

Perceptions and acceptability of mHealth interventions for improving patient care at a community-based HIV/AIDS clinic in Uganda: a mixed methods study.

Mobile technologies for health (mHealth) represents a growing array of tools being applied in diverse health care settings. mHealth interventions for improving HIV/AIDS care is a promising strategy, but its evidence base is limited. We conducted a formative research evaluation to inform the development of novel mHealth HIV/AIDS care interventions to be used by community health workers (CHWs) in Kampala, Uganda. A mixed methods formative research approach was utilized. Qualitative methods included 20 in-depth interviews (IDIs) and six focus groups with CHWs, clinic staff, and patients. Thematic analysis was performed and selected quotations used to illustrate themes. Quantitative methods consisted of a survey administered to CHWs and clinic staff, using categorical and Likert scale questions regarding current mobile phone and internet access and perceptions on the potential use of smartphones by CHWs. Qualitative results included themes on significant current care challenges, multiple perceived mHealth benefits, and general intervention acceptability. Key mHealth features desired included tools to verify CHWs' task completions, clinical decision support tools, and simple access to voice calling. Inhibiting factors identified included concerns about CHWs' job security and unrealistic expectations of mHealth capabilities. Quantitative results from 27 staff participants found that 26 (96%) did not have internet access at home, yet only 2 (7.4%) did not own a mobile phone. Likert scale survey responses (1-5, 1 = Strongly Disagree, 5 = Strongly Agree) indicated general agreement that smartphones would improve efficiency (Mean = 4.35) and patient care (4.31) but might be harmful to patient confidentiality (3.88) and training was needed (4.63). Qualitative and quantitative results were generally consistent, and, overall, there was enthusiasm for mHealth technology. However, a number of potential inhibiting factors were also discovered. Findings from this study may help guide future design and implementation of mHealth interventions in this setting, optimizing their chances for success.

Research capacity-building program for clinicians and staff at a community-based HIV clinic in Uganda: A pre/post evaluation.

Developing capacity for HIV research and clinical practice is critically needed in resource-limited countries. The purpose of this study was to evaluate a research capacity-building program for community-based participants in the preparation and conduct of mobile phone-based technology interventions. A descriptive, cross-sectional design was used. Participants completed self-report surveys at three time points. Thirty-three participated in the situational analysis, and all (100%) felt that the research training was needed. For the interim evaluation, more than 96.8% (n = 30) reported increased knowledge and confidence and attributed this to the training. Fourteen participants completed the final evaluation. Dedicated time away from work was an important factor to facilitate recruitment and data collection, followed by financial incentives to commute to data collection sites. Expertise through supervision and mentorship for participants and sustained funding for research projects are critical to the innovation needed to improve HIV prevention and care outcomes.