Working Safely in the Trades as Women: A Qualitative Exploration and Call for Women-Supportive Interventions.

BACKGROUND: Construction work offers women economic advancement and self-fulfillment opportunities, but multiple barriers prevent their increased representation in the industry. This study used qualitative methods to identity key physical and psychosocial safety hazards affecting tradeswomen. METHODS: Three focus groups were held in 2015 with 19 tradeswomen in Washington State. Groups discussed workplace hazards and solutions to make the trades safer for women. Discussions were recorded, transcribed, and two independent reviewers analyzed themes. RESULTS: Participants identified myriad physical and psychosocial hazards including a dangerous work environment, inadequate personal protective equipment, gender discrimination, and fear of layoff for reporting concerns. Participants identified mentorship as a potential intervention to overcome some of these barriers. CONCLUSION: Findings suggest that the industry's work environment can be hostile and unsupportive for women, contributing to tradeswomen's injury risk and psychological distress. Future research and interventions should focus on understanding the relationships between and mediating the negative impact of women's physical and psychosocial workplace hazards. Results from these focus groups inspired a randomized control trial to study the impact mentorship has on decreasing physical and psychosocial hazards for women in construction, and improving retention.

Identification of processes that mediate the impact of workplace violence on emergency department healthcare workers in the USA: results from a qualitative study.

OBJECTIVES: Violence towards emergency department healthcare workers is pervasive and directly linked to provider wellness, productivity and job satisfaction. This qualitative study aimed to identify the cognitive and behavioural processes impacted by workplace violence to further understand why workplace violence has a variable impact on individual healthcare workers. DESIGN: Qualitative interview study using a phenomenological approach to initial content analysis and secondary thematic analysis. SETTING: Three different emergency departments. PARTICIPANTS: We recruited 23 emergency department healthcare workers who experienced a workplace violence event to participate in an interview conducted within 24 hours of the event. Participants included nurses (n=9; 39%), medical assistants (n=5; 22%), security guards (n=5; 22%), attending physicians (n=2; 9%), advanced practitioners (n=1; 4%) and social workers (n=1; 4%). RESULTS: Five themes emerged from the data. The first two supported existing reports that workplace violence in healthcare is pervasive and contributes to burn-out in healthcare. Three novel themes emerged from the data related to the objectives of this study: (1) variability in primary cognitive appraisals of workplace violence, (2) variability in secondary cognitive appraisals of workplace violence and (3) reported use of both avoidant and approach coping mechanisms. CONCLUSION: Healthcare workers identified workplace violence as pervasive. Variability in reported cognitive appraisal and coping strategies may partially explain why workplace violence negatively impacts some healthcare workers more than others. These cognitive and behavioural processes could serve as targets for decreasing the negative effect of workplace violence, thereby improving healthcare worker well-being. Further research is needed to develop interventions that mitigate the negative impact of workplace violence.

Green chemistry & chemical stewardship certificate program: a novel, interdisciplinary approach to green chemistry and environmental health education.

The Green Chemistry & Chemical Stewardship Certificate Program was designed using the Community of Inquiry (COI) model as a framework for developing curriculum that engages students across the entire program to meet interdisciplinary, professional development program outcomes. The COI framework allows faculty and course developers to develop courses that consider cognitive, social, and teaching presence as equal components of successful learning experiences. In this program, students focus on systems thinking around green chemistry, business, environmental health, chemical alternative assessment tools, and social and environmental justice. They complete a capstone project that identifies a particular environmental or human health issue associated with a chemical and suggest suitable substitutions that are less harmful but equally effective. This paper describes the program's curriculum, partnerships, delivery modalities, and student feedback as a framework developing professional development opportunities that offer a rich interdisciplinary experience for learners.

Gendered Safety and Health Risks in the Construction Trades.

Objectives: Despite women's increased representation in the overall workforce, construction remains a male-dominated industry. Prior studies have noted that the hazardous workplace environment combined with a culture that can be discriminatory and openly hostile can threaten women workers' health and safety. However, little information exists about the current physical and psychosocial hazards at work affecting tradeswomen. Methods: We examined differences in workplace exposure between women and men, and the association of these exposures with self-reported stress and work injury, in order to highlight how gendered conditions of work negatively affect tradeswomen's health. A holistic view of health that included the influence of both home and work spheres as well as hazards related to women's social experience was considered. Almost 300 workers (198 tradeswomen and 93 tradesmen) throughout Washington State completed surveys. We used descriptive statistics to compare exposures between genders, and logistic regression to model the association between psychosocial exposures and injury and stress outcomes. Results: We found that women were significantly more likely than men to report high perceived stress (31 and 18%, respectively) and being injured at work in the past year (31 and 12%, respectively). Ten of the 12 work-related psychosocial exposures were found to be associated with either stress (job strain, gender and age discrimination, bullying, work/life balance, isolation, sexual harassment, safety climate, and social support) or injury (gender discrimination, bullying, overcompensation, and sexual harassment) for women. Conclusions: The industry continues to lag in supporting tradeswomen's health and safety needs. This study suggests that multiple exposures (including discrimination, overcompensation, and work/life balance) have an important impact on worker well-being. The findings underscore the complex interaction of gender, psychosocial exposures, and occupational risks, and indicate areas for intervention.

The Molecular Design Research Network.

Herein, we provide an overview of a research network that is aimed at fostering interdisciplinary collaboration between chemists and toxicologists with the goal of rationally designing safer commercial chemicals. The collaborative is the Molecular Design Research Network (MoDRN) that was created in 2013 with funding from the EPA-National Science Foundation Networks for Sustainable Molecular Design and Synthesis (NSMDS) program. MoDRN is led by 4 universities, Baylor University, University of Washington, The George Washington University, and Yale University. The overarching goal of the network is to enable and empower the design of safer chemicals based on the fourth Principle of Green Chemistry that states, "chemical products should be designed to preserve efficacy of function while minimizing toxicity."

Toward the Design of Less Hazardous Chemicals: Exploring Comparative Oxidative Stress in Two Common Animal Models.

Sustainable molecular design of less hazardous chemicals presents a potentially transformative approach to protect public health and the environment. Relationships between molecular descriptors and toxicity thresholds previously identified the octanol-water distribution coefficient, log D, and the HOMO-LUMO energy gap, ΔE, as two useful properties in the identification of reduced aquatic toxicity. To determine whether these two property-based guidelines are applicable to sublethal oxidative stress (OS) responses, two common aquatic in vivo models, the fathead minnow (Pimephales promelas) and zebrafish (Danio rerio), were employed to examine traditional biochemical biomarkers (lipid peroxidation, DNA damage, and total glutathione) and antioxidant gene activation following exposure to eight structurally diverse industrial chemicals (bisphenol A, cumene hydroperoxide, dinoseb, hydroquinone, indene, perfluorooctanoic acid, R-(-)-carvone, and tert-butyl hydroperoxide). Bisphenol A, cumene hydroperoxide, dinoseb, and hydroquinone were consistent inducers of OS. Glutathione was the most consistently affected biomarker, suggesting its utility as a sensitivity response to support the design of less hazardous chemicals. Antioxidant gene expression (changes in nrf2, gclc, gst, and sod) was most significantly (p < 0.05) altered by R-(-)-carvone, cumene hydroperoxide, and bisphenol A. Results from the present study indicate that metabolism of parent chemicals and the role of their metabolites in molecular initiating events should be considered during the design of less hazardous chemicals. Current empirical and computational findings identify the need for future derivation of sustainable molecular design guidelines for electrophilic reactive chemicals (e.g., SN2 nucleophilic substitution and Michael addition reactivity) to reduce OS related adverse outcomes in vivo.

Differences in the prevalence of musculoskeletal symptoms among female and male custodians.

BACKGROUND: The prevalence of musculoskeletal symptoms among custodians is high. We sought to compare musculoskeletal symptoms between female and male custodians and to explore how task might affect this relationship. METHODS: A cross-sectional study was performed among 712 custodians who completed a survey assessing upper extremity, back, and lower extremity musculoskeletal symptoms and exposure to cleaning tasks. Chi-square tests and logistic regression analyses were used to test for associations between gender, cleaning tasks, and musculoskeletal symptoms. RESULTS: Gender was significantly (P < 0.05) associated with musculoskeletal symptoms in χ(2) tests and multivariate analyses. The prevalence ratio of symptoms among women was roughly 50% higher than men, regardless of the tasks that workers performed. CONCLUSIONS: The prevalence of musculoskeletal symptoms differed for female and male custodians and appeared to be consistent across a range of job tasks. Am. J. Ind. Med. 59:841-852, 2016. © 2016 Wiley Periodicals, Inc.

Proactive Risk Assessment for Ebola-Infected Patients: A Systematic Approach to Identifying and Minimizing Risk to Healthcare Personnel.

Performing patient care while wearing high-level personal protective equipment presents risks to healthcare providers. Our failure mode effects analysis identified 81 overall risks associated with providing hygienic care and linen change to a patient with continuous watery stool. Implementation of checklists and scheduled pauses could potentially mitigate 76.5% of all risks. Infect Control Hosp Epidemiol 2016;37:867-871.

Characterization of Urinary Phthalate Metabolites Among Custodians.

Phthalates, a ubiquitous class of chemicals found in consumer, personal care, and cleaning products, have been linked to adverse health effects. Our goal was to characterize urinary phthalate metabolite concentrations and to identify work and nonwork sources among custodians using traditional cleaning chemicals and 'green' or environmentally preferable products (EPP). Sixty-eight custodians provided four urine samples on a workday (first void, before shift, end of shift, and before bedtime) and trained observers recorded cleaning tasks and types of products used (traditional, EPP, or disinfectant) hourly over the work shifts. Questionnaires were used to assess personal care product use. Four different phthalate metabolites [monoethyl phthalate (MEP), monomethyl phthalate (MMP), mono (2-ethylhexyl) phthalate (MEHP), and monobenzyl phthalate (MBzP)] were quantified using liquid chromatography mass spectrometry. Geometric means (GM) and 95% confidence intervals (95% CI) were calculated for creatinine-adjusted urinary phthalate concentrations. Mixed effects univariate and multivariate modeling, using a random intercept for each individual, was performed to identify predictors of phthalate metabolites including demographics, workplace factors, and personal care product use. Creatinine-adjusted urinary concentrations [GM (95% CI)] of MEP, MMP, MEHP, and MBzP were 107 (91.0-126), 2.69 (2.18-3.30), 6.93 (6.00-7.99), 8.79 (7.84-9.86) µg g(-1), respectively. An increasing trend in phthalate concentrations from before to after shift was not observed. Creatinine-adjusted urinary MEP was significantly associated with frequency of traditional cleaning chemical intensity in the multivariate model after adjusting for potential confounding by demographics, workplace factors, and personal care product use. While numerous demographics, workplace factors, and personal care products were statistically significant univariate predictors of MMP, MEHP, and MBzP, few associations persisted in multivariate models. In summary, among this population of custodians, we identified both occupational and nonoccupational predictors of phthalate exposures. Identification of phthalates as ingredients in cleaning chemicals and consumer products would allow workers and consumers to avoid phthalate exposure.

Traditional and environmentally preferable cleaning product exposure and health symptoms in custodians.

BACKGROUND: We investigated the associations between traditional and environmentally preferable cleaning product exposure and dermal, respiratory, and musculoskeletal symptoms in a population of custodians. METHODS: We analyzed associations between symptoms and exposure to traditional and environmentally preferable cleaning product exposure among 329 custodians. RESULTS: We observed increased odds of dermal (P < 0.01), upper (P = 0.01) and lower respiratory (P = 0.01), and upper extremity (P < 0.01), back (P < 0.01), and lower extremity (P = 0.01) musculoskeletal symptoms associated with increased typical traditional cleaning product exposure. We observed significant trends for increased odds of dermal (P = 0.03) and back (P = 0.04) and lower (P = 0.02) extremity musculoskeletal symptoms associated with increased typical environmentally preferable cleaning product exposure. CONCLUSIONS: Fewer positive associations and reduced odds of health symptoms associated with environmentally preferable cleaning product exposure suggest that these products may represent a safer alternative to traditional cleaning products.

Exposure to volatile organic compounds in healthcare settings.

OBJECTIVES: To identify and summarise volatile organic compound (VOC) exposure profiles of healthcare occupations. METHODS: Personal (n=143) and mobile area (n=207) evacuated canisters were collected and analysed by a gas chromatograph/mass spectrometer to assess exposures to 14 VOCs among 14 healthcare occupations in five hospitals. Participants were volunteers identified by their supervisors. Summary statistics were calculated by occupation. Principal component analysis (PCA) was used to reduce the 14 analyte inputs to five orthogonal factors and identify occupations that were associated with these factors. Linear regressions were used to assess the association between personal and mobile area samples. RESULTS: Exposure profiles differed among occupations; ethanol had the highest geometric mean (GM) among nursing assistants (∼4900 and ∼1900 µg/m(3), personal and area), and 2-propanol had the highest GM among medical equipment preparers (∼4600 and ∼2000 µg/m(3), personal and area). The highest total personal VOC exposures were among nursing assistants (∼9200 µg/m(3)), licensed practical nurses (∼8700 µg/m(3)) and medical equipment preparers (∼7900 µg/m(3)). The influence of the PCA factors developed from personal exposure estimates varied by occupation, which enabled a comparative assessment of occupations. For example, factor 1, indicative of solvent use, was positively correlated with clinical laboratory and floor stripping/waxing occupations and tasks. Overall, a significant correlation was observed (r=0.88) between matched personal and mobile area samples, but varied considerably by analyte (r=0.23-0.64). CONCLUSIONS: Healthcare workers are exposed to a variety of chemicals that vary with the activities and products used during activities. These VOC profiles are useful for estimating exposures for occupational hazard ranking for industrial hygienists as well as epidemiological studies.

Estimated use of industrial chemicals in Connecticut.

BACKGROUND: Chemical exposures in the workplace are poorly documented and researched, yet appear to be widespread and with significant potential for impacting worker health. There are few reporting requirements for chemical usage on a national level. METHODS: Chemical usage reports and employment data from Massachusetts were categorized by manufacturing subsector. Connecticut employment was compared to Massachusetts data, with the employment fraction used to estimate chemical usage in Connecticut. RESULTS: The chemical manufacturing sector was estimated to use 620 million pounds of chemicals annually in Connecticut, and all other manufacturing sectors combined used an estimated 50 million pounds, with approximately half listed as carcinogens or reproductive hazards. Potential health effects are presented. CONCLUSION: Widespread chemicaluse underscores the need for the development and use of safer alternatives, as well as additional documentation of potential health effects. Physicians should be aware of potential chemical exposures for patients and provide preventive advice.

Transitioning from traditional to green cleaners: an analysis of custodian and manager focus groups.

Custodians represent one of the largest occupational groups using cleaning agents, and yet their voices are infrequently heard in relation to the introduction of "green" cleaners and the laws regarding environmentally preferable products (EPP). This study reflects worker voices on use and effectiveness of chemicals, as well as incentives and obstacles for green cleaning programs. Sixty-four custodians and staff participated in 10 focus groups. Data were entered into Atlas Ti and the constant comparative method of qualitative data analysis was used to identify themes. Themes included satisfaction in a "well-done" job, more effort required for job, lack of involvement in EPP selection process, EPP's ease of use for workers with English as a Second Language (ESL), misuse of disinfectants, health complaints, and need for training. This study shows that custodians have a voice, and that improved communication and feedback among all the stakeholders are needed to make the transition to green cleaning more effective.

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.

Characterization of mold and moisture indicators in the home.

As studies increasingly support the presence of health risks associated with mold and moisture, understanding fungal concentrations and physical measurements as they relate to the microenvironment becomes more important. We conducted a cross-sectional study in the homes of 64 subjects. The primary objective of this study was to use trained inspectors' list of indicators in rooms (bathroom, bedroom, and basement) and determine whether these indicators are associated with higher fungal levels or physical measurements. A new category for combining the concentrations of fungal species, referred to as moisture indicator fungi (MIF), is used in the analysis. Our results show that basements with a musty odor, efflorescence, water sources, or mold have a two- to threefold increase in fungal concentrations over basements without these indicators. The regression model for the basement was highly predictive of indoor MIF concentrations (r2 = .446, p = .017). Basement water sources are substantial predictors of indoor total fungi, MIF, and Aspergillus/Penicillium spp. MIF concentrations are higher in homes with basement water sources, and most notably, the increase in MIF concentrations is significant in other living spaces (bathroom and bedroom) of the dwelling. Basement water sources are important moisture/mold indicators for epidemiologists to use in exposure assessments performed in residential dwellings.

Residential arsenic and lead levels in an agricultural community with a history of lead arsenate use.

Lead arsenate (PbHAsO4) was used as an insecticide in Washington fruit orchards from 1905 to 1947. We examined exposure potential for children living in an agricultural community with historic PbHAsO4 use. Soil and housedust samples were collected from 58 residences. Families were asked about land use history, age of home, and remodeling activities. Median concentrations of arsenic were higher in housedust than in soil (9.0 and 4.2 microg/g, respectively; P=0.05), as were lead concentrations (129 and 46 microg/g, respectively; P=0.0001). Significant associations were observed between indoor and outdoor levels of each metal, indicating track-in as an important exposure pathway. Homes on or near land use for pear or apple production between 1905 and 1947 had significantly higher soil (P=0.005) and housedust (P=0.004) lead, and soil arsenic (P=0.04) than did the other homes. Homes more than 30 years old had significantly higher soil and housedust lead than did newer homes (P=0.01). Homes remodeled within the past two years had significantly higher soil (P=0.01) and housedust (P=0.04) lead. Child doses extrapolated from these data indicate that 36% of homes had soil or dust arsenic levels above the minimum risk level estimated by the Agency for Toxic Substances and Disease Registry. None of the measured lead levels exceeded current US Environmental Protection Agency guidelines. Public health education programs focused on residential hygiene would be of value in areas of historic PbHAsO4 use.