Characteristics of effective health and safety committees: survey results.

BACKGROUND: Although perhaps the most common worker-management structure, there has been surprisingly little research on describing and evaluating the characteristics of health and safety committees. METHODS: A survey of 380 health and safety committee members from 176 manufacturing workplaces was supplemented with administrative data and compared with reported workers' compensation rates. Survey respondents also reported perceptions of overall safety, committee, effectiveness, committee activities, and "best practices." RESULTS: Extensive descriptive data is presented, including a mean of 8.7 members per committee spending 1,167 hr per year on committee business for an estimate of $40,500 worth of time per committee. Higher speed to correct action items, a focus on ergonomics, and planning for safety training was associated with lower injury rates. The discrepancy between managers and hourly committee members in estimating overall safety was strongly positively associated with injury rates. CONCLUSIONS: Communications and worker involvement may be important to address discrepancy issues. Prospective studies are needed to distinguish directionality of associations.

Human health risk assessment of synthetic turf fields based upon investigation of five fields in Connecticut.

Questions have been raised regarding possible exposures when playing sports on synthetic turf fields cushioned with crumb rubber. Rubber is a complex mixture with some components possessing toxic and carcinogenic properties. Exposure is possible via inhalation, given that chemicals emitted from rubber might end up in the breathing zone of players and these players have high ventilation rates. Previous studies provide useful data but are limited with respect to the variety of fields and scenarios evaluated. The State of Connecticut investigated emissions associated with four outdoor and one indoor synthetic turf field under summer conditions. On-field and background locations were sampled using a variety of stationary and personal samplers. More than 20 chemicals of potential concern (COPC) were found to be above background and possibly field-related on both indoor and outdoor fields. These COPC were entered into separate risk assessments (1) for outdoor and indoor fields and (2) for children and adults. Exposure concentrations were prorated for time spent away from the fields and inhalation rates were adjusted for play activity and for children's greater ventilation than adults. Cancer and noncancer risk levels were at or below de minimis levels of concern. The scenario with the highest exposure was children playing on the indoor field. The acute hazard index (HI) for this scenario approached unity, suggesting a potential concern, although there was great uncertainty with this estimate. The main contributor was benzothiazole, a rubber-related semivolatile organic chemical (SVOC) that was 14-fold higher indoors than outdoors. Based upon these findings, outdoor and indoor synthetic turf fields are not associated with elevated adverse health risks. However, it would be prudent for building operators to provide adequate ventilation to prevent a buildup of rubber-related volatile organic chemicals (VOC) and SVOC at indoor fields. The current results are generally consistent with the findings from studies conducted by New York City, New York State, the U.S. Environmental Protection Agency (EPA), and Norway, which tested different kinds of fields and under a variety of weather conditions.

Synthetic turf field investigation in Connecticut.

The primary purpose of this study was to characterize the concentrations of volatile organic compounds (VOC), semivolatile organic compounds (SVOC), rubber-related chemicals such as benzothiazole (BZT) and nitrosamine, and particulate matter (PM(10)) in air at synthetic turf crumb rubber fields. Both new and older fields were evaluated under conditions of active use. Three types of fields were targeted: four outdoor crumb rubber fields, one indoor facility with crumb rubber turf, and an outdoor natural grass field. Background samples were collected at each field on grass. Personal air sampling was conducted for VOC, BZT, nitrosamines, and other chemicals. Stationary air samples were collected at different heights to assess the vertical profile of release. Air monitoring for PM(10) was conducted at one height. Bulk samples of turf grass and crumb rubber were analyzed, and meteorological data were recorded. Results showed that personal concentrations were higher than stationary concentrations and were higher on turf than in background samples for certain VOC. In some cases, personal VOC concentrations from natural grass fields were as high as those on turf. Naphthalene, BZT, and butylated hydroxytoluene (BHT) were detected in greater concentration at the indoor field compared to the outdoor fields. Nitrosamine air levels were below reporting levels. PM(10) air concentrations were not different between on-field and upwind locations. All bulk lead (Pb) samples were below the public health target of 400 ppm. More research is needed to better understand air quality at indoor facilities. These field investigation data were incorporated into a separate human health risk assessment.

Training health and safety committees to use control banding: lessons learned and opportunities for the United States.

Control banding (CB) is a control-focused risk management model that has received international attention. CB strategies are designed to control workplace chemical exposures after the completion of a qualitative risk assessment. Connecticut was one of the first states to provide training on how to use this control-focused tool. Joint labor/management teams and individuals from 34 workplaces attended a control banding workshop and learned how to use one CB model, the United Kingdom (UK) Health and Safety Executive's Control of Substances Hazardous to Health (COSHH) Essentials Toolkit. After the initial training program the investigators used follow-up workshops, questionnaires, site visit data, and case studies to evaluate the training curriculum and assess the utility and effectiveness of this CB strategy. We found that the model is easily learned, although several areas for improvement were identified. Participants from 10 workplaces used COSHH Essentials to evaluate at least one task. The training curriculum was effective in that the agreement between the exposure variables coded by these workplaces and one of the workshop instructors, a certified industrial hygienist (CIH), were highly concordant. The training curriculum and the model promoted a discussion of risk between workers and managers and resulted in the implementation of improvements in the work environment. The model agreed with both the CIH's and the worksites' qualitative risk assessments 65% of the time, and likely over-controlled for 71% (5/7) of the cases of nonagreement. Feedback from workshop participants benefits the current dialogue on the implications of implementing CB in the United States.

Latent tuberculosis among Latino migrant farmworkers in Connecticut.

STUDY OBJECTIVE: It is estimated that the prevalence rate of latent tuberculosis infection (LTBI) for the United States general population is less than 5%. The prevalence of LTBI among Connecticut migrant workers has not been reported. This study was designed to determine the prevalence of a positive tuberculin skin test (TST), a potential measure of LTBI in migrant workers, at one Connecticut farm. METHODS: A two-step standardized TST was performed on farmworkers recruited in a migrant clinic setting. Those with negative results on the first-step were offered the second. Workers with positive results were referred to community health centers for assessment and examined by a physician investigator. RESULTS: Seventy-nine male workers were recruited from a population of approximately 200. Of these, 57 consented to the first-step TST, and 26% tested positive. Over 96% of the 57 tested workers were from Mexico. None had symptoms or signs of active tuberculosis. CONCLUSION: This study suggests that a high percentage of asymptomatic Connecticut Latino migrant farmworkers have LTBI. This finding has public health implications for TB control strategies in the state.

Cotinine levels and green tobacco sickness among shade-tobacco workers.

STUDY OBJECTIVE: Symptoms consistent with Green Tobacco Sickness (GTS) were found in 4% (13/331) to 15% (45/303) of the migrant, mostly Latino, shade-tobacco workers who sought medical care at a Connecticut clinic. The objective of this study was to determine whether or not shade-tobacco farm workers absorb nicotine from the tobacco leaves and have a corresponding increase in both salivary cotinine levels (a breakdown product of nicotine) and symptoms consistent with GTS. METHODS: The study utilized a prospective cohort design to evaluate salivary cotinine and symptoms consistent with GTS in a population of shade tobacco farm workers compared to a control group of nursery workers. The workers were assessed at two points in time, the early tobacco planting season and the harvest season. RESULTS: There was not a significant increase in salivary cotinine levels among shade-tobacco workers. Salivary cotinine levels over the work season did not significantly increase in shade-tobacco workers when compared with nursery workers. During the harvest season, none of the tobacco workers reported symptoms consistent with GTS. CONCLUSIONS: Migrant workers in Connecticut who harvest shade-tobacco appear to have a low-risk of occupational nicotine dermal absorption and a low incidence of GTS. The work practices associated with harvesting shade-tobacco, in addition to the fact that shade tobacco may actually have a lower level of nicotine than either burley or flue cured tobacco, may explain these results. Our study appears to reinforce the GTS prevention recommendations made by investigators in other tobacco growing regions, specifically the importance of minimizing close skin contact with tobacco leaves and avoiding dermal contact with the plants when they are wet.

Work-related asthma in teachers in Connecticut: association with chronic water damage and fungal growth in schools.

PURPOSE: To review a series of 55 teachers from schools in Connecticut who presented consecutively to our clinic, and to summarize our clinical experience with work-related disease in this population, which could lead to a more formal study. METHODS: Retrospective chart review; data were abstracted concerning clinical and environmental factors and entered into a statistical spreadsheet program (JMP for Windows). RESULTS: Of the 55 educators, 22 were diagnosed with upper respiratory syndromes (rhinitis or sinusitis), three with bronchitis, and 23 with asthma. Of the 23 with asthma, 20 presented with active or symptomatic asthma, and seven of these were incident cases of occupational asthma. In addition, four cases (7%) of granulomatous lung disease (two hypersensitivity pneumonitis and two sarcoidosis) were diagnosed. Finally, three patients (5%) received only nonrespiratory diagnoses (panic disorder, sicca syndrome, and vertigo). In 33 work-places, the exposures of concern were predominantly related to ongoing "dampness" or visible mold growth. The remaining 22 work-places were "dry." Symptoms varied according to the work-place environment, with more patients from water damaged (vs dry) work-places having upper respiratory symptoms (76% vs 45%) and asthma (45% vs 23%). All seven patients with incident asthma and all four patients with interstitial lung disease worked in schools with documented water incursion. CONCLUSIONS: Work-place exposures in water damaged school buildings are risk factors for development of work-related lower respiratory disease in schoolteachers and staff. Identification of such high-risk environments can be done by a simple but thorough qualitative evaluation during a walk-through inspection, and it should not require air sampling or surface sampling protocols for microbial contaminants.

Shade tobacco and green tobacco sickness in Connecticut.

The prevalence of Green Tobacco Sickness (GTS) among shade tobacco farmworkers in Connecticut is unknown. We conducted a study to determine the prevalence of GTS in farmworkers working in shade tobacco fields who presented for clinical care at medical student-run clinics. A retrospective chart review of the tobacco workers seen at Farmworkers' Clinics during 2001 was instituted in this study. Although GTS was not clinically diagnosed in any of the patients, we found 15% diagnoses that could be attributed to possible GTS by ICD-9 code review. Using a stricter GTS case definition, the frequency rate decreased to 4%. Nonsmokers were significantly more likely than smokers to report GTS-like symptoms (P < 0.01). Isolated symptoms of headache and dizziness were significantly more frequent among nonsmokers than smokers (P < 0.05). In conclusion, cases of possible GTS were found in Connecticut shade tobacco workers. Nonsmokers were more at risk to have possible GTS than smokers.

An outbreak of hypersensitivity pneumonitis at a metalworking plant: a longitudinal assessment of intervention effectiveness.

The authors describe a longitudinal assessment of intervention effectiveness in response to an outbreak of hypersensitivity pneumonitis (HP) at a metalworking facility. Thirty-five (29%) of the plant's 120 production workers were given a clinical diagnosis of HP during the two years of the investigation. Although quantitative exposure assessment tools were of limited utility, the investigators successfully used qualitative observations and the patients' return-to-work experiences to iteratively evaluate their exposure control recommendations. Recommended interventions included improving metalworking fluid management practices, enclosing selected metalworking fluid machining operations, eliminating mist cooling, exhausting two additional water-based industrial processes, increasing general dilution ventilation, and worker training. As of November 1999, 26 months into the outbreak, 51 percent (18) of the employees with a clinical diagnosis of hypersensitivity pneumonitis had been able to return to work. The symptom onset of the 35 workers who were given a clinical diagnosis of hypersensitivity pneumonitis during the two-year study period predated the implementation of the interventions. The collaboration of a multidisciplinary team appears to have allowed for successful intervention in this setting. A specific etiological agent(s) associated with the outbreak was not confirmed during the investigation. An acid fast isolate identified as being in the Mycobacterium chelonae group was detected in only one of the submitted metalworking fluid (MWF) sump samples. Longitudinally, there was a statistically significant difference in MWF sump bacteria (X(2) = 286.4, df = 17, p <.0001) and MWF sump fungi (X(2) = 28.1, df = 7, p <.0002). Measured oil mist air levels did not exceed the Occupational Safety and Health Administration's (OSHA's) permissible exposure limit (PEL), and in fact, did not exceed 0.5 mg/m(3).

Assessing occupational and environmental exposures that cause lung disease.

The approach to hazard identification and exposure characterization presented in this article will help physicians assess the likelihood that their patients with respiratory illness have relevant exposures in their work, home, or other environments. The clinician will identify potentially important exposures and s/he will develop an estimate of the level, duration, and frequency of exposure. With experience, such histories provide information critical to the recognition of occupational and environmental lung disease. Successful identification of such exposures provides an opportunity to halt, and even reverse, lung disease that can otherwise become chronic and progressive.