Assault Deterrents and Educators' Risk of Physical Assault: A Case-Control Study.

The study purpose was to identify associations between assault deterrent presence in kindergarten through 12th (K-12) grade schools and physical assaults (PAs) against educators. Data collected through a two-phase study identified physical and nonphysical violent events and utilized a nested case-control study to identify PA risk/protective factors. Analyses included multivariable modeling. Adjusted analyses demonstrated a significant decreased risk of PA with routine locker searches (odds ratio [OR] = 0.49, 95% confidence interval [CI] [0.29, 0.82]). Also important, although not statistically significant, were presence of video monitors (OR = 0.72, 95% CI [0.50, 1.03]), intercoms (OR = 0.77, 95% CI [0.55, 1.06]), and required school uniforms/dress codes (OR = 0.74, 95% CI [0.52, 1.07]). These findings are integral to school nursing practice in which there is opportunity to influence application of relevant pilot intervention efforts as a first step in determining the potential efficacy of broad-based interventions that can positively impact the problem of school-related violence.

Effectiveness of Conducted Electrical Weapons to Prevent Violence-Related Injuries in the Hospital.

INTRODUCTION: Health care workers suffer higher rates of violence-related injuries than workers in other industries, with hospital security officers and ED personnel at particularly high risk for injury. Arming hospital security workers with conducted electrical weapons, such as tasers, has been suggested as an intervention to decrease violence-related injuries in the hospital. METHODS: A retrospective cohort of all security and ED nursing staff at an urban level 1 trauma center was identified from human resources data for the period 4 years before and 7 years after security workers were armed with conducted electrical weapons. A violence-related rate of injury was calculated as all violence-related injuries incurred by each employee for the numerator and the productive hours worked by each person during the study period as the denominator. RESULTS: The hospital employed approximately 30 security staff and 200 nursing staff at the time, with a total of 98 security officers and 468 nursing staff members over the 11 years of study. During the total nursing study period, 98 security officers contributed 452,901 hours; 265 registered nurses from the emergency department contributed 1,535,044 hours; and 203 health care assistants contributed 624,805 hours. Security officers' violence-related rate of injury was 13 times higher than that of the nursing staff. The risk ratio was 1.0 (95% confidence interval [CI] 0.7-1.4) between the 2 examination periods for security officers, with similar results for nurses. However, among security workers, the cost of the injuries decreased in the period after implementation. CONCLUSION: Carrying conducted electrical weapons by hospital security staff appears to have limited capacity to decrease overall rates of violence-related injury but may decrease the severity of violence-related injuries. The latter could decease costs to health care organizations as well as morbidity of injured staff. Contribution to Emergency Nursing Practice.

Effectiveness of education and individualized counseling in reducing environmental hazards in the homes of community-dwelling older women.

OBJECTIVES: To test the effectiveness of an education and counseling intervention on reducing environmental hazards in the homes of older women. DESIGN: Secondary analysis from a randomized, controlled trial with two arms: fall prevention program and health education program (control). Environmental hazards were assessed at baseline and immediately posttreatment (12-weeks). SETTING: Participants' homes. PARTICIPANTS: Two hundred seventy-two community-dwelling women aged 70 and older at risk for falling. INTERVENTION: The fall prevention program involved a comprehensive fall risk evaluation, exercise, education, individualized counseling, and referrals. The health education program included topics unrelated to fall prevention. With the exception of the fall risk evaluation conducted by a nurse practitioner, baccalaureate-prepared nurses carried out the interventions. MEASUREMENTS: Summed and individual scores for hazards related to the bathroom, floor surfaces, lighting, furniture, stairways, and storage areas. RESULTS: Environmental hazards were found in all homes, with a baseline mean+/-standard deviation of 10.7+/-2.6 total hazards and range of four to 17 hazards. Analysis of within-group changes indicated that the fall prevention group had significantly fewer bathroom, lighting, and total hazards after the intervention, whereas the health education group had significantly fewer bathroom hazards but more floor hazards. At follow-up, the fall prevention group had significantly fewer lighting hazards and total hazards than the health education group. CONCLUSION: Education and counseling have only modest effects in helping older women make recommended home modifications. To be most effective in reducing environmental hazards, fall prevention programs may need to provide and install safety devices.

Circumstances and consequences of falls in community-dwelling older women.

AIMS: To describe the circumstances and consequences of falls reported by community-dwelling older women. METHODS: This prospective study collected data for approximately 2 years for women aged>or=70 years at risk for falling who were enrolled in the Fall Evaluation and Prevention Program. RESULTS: Participants (263) completed a median of 24 months of follow-up. A total of 143 participants reported 341 falls; 70 reported 1 fall, and 73 reported 2 or more. A majority of falls (62%) occurred in/around the home, primarily during the daytime, and in living rooms or kitchens/dining rooms. Falls frequently occurred while walking, carrying objects, or reaching/leaning. Many falls did not result in injury (53%); however, 31% resulted in minor injuries, 10% in moderate injuries, and 6% in major injuries. Soft tissue injuries were common, and 5% of falls resulted in fractures. Nine falls resulted in hospitalization. CONCLUSIONS: The high rate of injurious falls seen here and the detailed information on activity at the time of the fall emphasize the need to increase awareness of behaviors and the environment to reduce fall risk. Previous studies have identified risk factors for falls, some of which cannot be modified, such as age or gender. In contrast, this study describes the activity at the time of the fall: many falls occur in the home environment, some with modifiable circumstances.

Minnesota nurses' study: perceptions of violence and the work environment.

Work-related violence is an important problem worldwide, and nurses are at increased risk. This study identified rates of violence against nurses in Minnesota, USA, and their perceptions of the work environment. A sample of 6,300 randomly selected nurses described their experience with work-related violence in the previous year. Differences in perceptions of the work environment and work culture were assessed, based on a nested case-control study, comparing nurses who experienced assault to non-assaulted nurses. Annual rates of physical and non-physical assault, per 100 nurses, were 13.2 (95% CI: 12.2-14.3), and 38.8 (95% CI: 37.4-40.4). Cases were more likely than controls to report: higher levels of work stress; that assault was an expected part of the job; witnessing all types of patient-perpetrated violence in the previous month; and taking corrective measures against work-related assault. Controls versus cases were more likely to perceive higher levels of morale, respect and trust among personnel, and that administrators took action against assault. Nurses frequently experienced work-related violence, and perceptions of the work environment differed between nurses who had experienced physical assault, and those who had not. Employee safety, morale, and retention are particularly important in light of the nursing shortage, and knowledge of nurses' perceptions will assist in tailoring interventions aimed at reducing the substantial risk of physical assault in health care settings.

Difference in work-related violence by nurse license type.

Nurses are at considerable risk for work-related violence. This study compared the experiences of work-related violence among registered nurses (RNs) and licensed practical nurses (LPNs) to quantify differences in risks and exposures and to gain insight into possible interventions. A random sample (n = 6,300) of licensed Minnesota nurses was surveyed regarding the previous 12-month period. Nurses self-reported violent events and demographic information. After adjustment for potential confounders and nonresponse, LPNs had an increased risk for both physical assault (odds ratio = 1.4; 95% confidence interval = 1.1-1.9) and nonphysical violence (odds ratio = 1.2; 95% confidence interval = 1.0-1.5) compared to RNs. Some exposures resulted in increased risks for both types of violence for RNs and LPNs: working primarily in psychiatric departments and long-term care facilities. In contrast, working in clinics resulted in decreased risks for both license types. Some risks varied by license type. Risk of physical assault was increased for LPNs working with neonatal/pediatric patients, whereas RNs' risk was decreased. RNs' risk of physical violence increased while providing care, whereas LPNs' risk increased while supervising care. A better understanding of how this problem varies by license type and work setting will assist in designing efficacious interventions.

Successful return to work for cancer survivors.

This study investigated factors associated with successful return to work for cancer survivors in accordance with the Americans with Disabilities Act. A focus group was held with seven female cancer survivors. Participants discussed return-to-work issues following a cancer diagnosis. Factors such as coworker support and job flexibility improved their experiences, whereas coworker and supervisor ignorance about cancer and lack of support made returning to work more stressful. Participants discussed personal, environmental, and cancer-related factors that influenced their experiences with returning to work following a cancer diagnosis. Knowledge of factors that support employees helps occupational health nurses ease their transition, and may improve quality of life for employees. Physicians and health care provider teams may play a critical role in the employees' positive evaluation of their recovery process. This pilot study serves as a basis for a larger, population-based study.

The National Children's Study: Early Recruitment Outcomes Using the Direct Outreach Approach.

OBJECTIVE: In 2009, the National Children's Study (NCS) Vanguard Study tested the feasibility of household-based recruitment and participant enrollment by using a birth rate probability sample. In 2010, the NCS Program Office launched 3 alternative recruitment methods. We tested whether direct outreach (DO) recruitment could be a more efficient strategy to recruit women of child-bearing age. METHODS: The NCS DO recruitment approach recruited women, 18 to 49 years, who were pregnant or trying to conceive using passive recruitment methods emphasizing broad community outreach and engagement to create study awareness. Study mailings to listed households included a pregnancy screening questionnaire to identify potentially eligible women from selected neighborhoods to contact the study center. Unique features of this recruitment approach included the following: (1) expansion of selected neighborhoods to maximize potential participant recruitment and enrollment while minimizing in-person participant contact and (2) offering 2 levels of study participation distinguished by data collection intensity. RESULTS: Ten study centers listed 255 475 geographically eligible households for contact representing, on average, 3.3% of households per Primary Sampling Unit. A total of 19 354 women were identified for screening, and 17 421 completed a pregnancy screener representing 6.8% of eligible households. Study-eligible pregnant women were older, more educated, and less likely to be Hispanic than the general population. Only 16% (2786) of 17 421 screened women were study-eligible, and 81.1% of these 2786 women consented to participate. CONCLUSIONS: Although feasible, the DO approach recruited a sample of study-eligible pregnant women significantly different from the population. This recruitment approach was labor intensive for the yield of enrolled women.

The Experience of Direct Outreach Recruitment in the National Children's Study.

OBJECTIVE: Few studies have reported the outcome of direct outreach methods for recruitment of research participants in population-based samples. We describe the relationship of outreach strategies that are tailored to specific community factors to recruitment and consent outcomes in 10 National Children's Study direct outreach study locations (all were single counties). METHODS: Each study center collected data from a target population of women who resided in selected county segments that were sampled based on a geographic area probability sampling design. Based on county characteristics of the 10 study locations, each study center used site-specific marketing approaches (direct mail, mass media, provider referrals, social networking) to recruit study participants. Recruitment success was measured by the number of recruited women as well as by a qualitative assessment of the effectiveness of various recruitment methods. RESULTS: The number of women who consented varied from 67 to 792. The majority of women were pregnant at the time of consent. Community awareness varied from <1% to 70%. Although no significant associations were found between community characteristics and recruitment success, we found that certain types of outreach strategies enhanced recruitment. CONCLUSIONS: In a small sample of 10 US counties, recruitment success was not associated with community characteristics. It was, however, associated with certain types of outreach strategies that may be more effective in close-knit communities.

Establishing the value of occupational health nurses' contributions to worker health and safety: a pilot test of a user-friendly estimation tool.

Occupational health nurses use their knowledge and skills to improve the health and safety of the working population; however, companies increasingly face budget constraints and may eliminate health and safety programs. Occupational health nurses must be prepared to document their services and outcomes, and use quantitative tools to demonstrate their value to employers. The aim of this project was to create and pilot test a quantitative tool for occupational health nurses to track their activities and potential cost savings for on-site occupational health nursing services. Tool developments included a pilot test in which semi-structured interviews with occupational health and safety leaders were conducted to identify currents issues and products used for estimating the value of occupational health nursing services. The outcome was the creation of a tool that estimates the economic value of occupational health nursing services. The feasibility and potential value of this tool is described.

Case-control study of student-perpetrated physical violence against educators.

PURPOSE: Although prior research focused primarily on student-on-student school violence, educators are also at risk. This study was designed to identify risk factors for assaults against educators. METHODS: Kindergarten-grade 12 educators (n = 26,000), randomly selected from a state license database, were screened for eligibility (6,469, eligible) by mailed questionnaire. Phase 1 (12-month recall) identified eligible assault cases (n = 372) and controls (n = 1,116), June 2004 to December 2005; phase 2 (case-control study; response, 78%) enabled identification of exposures through 1-month recall before student-perpetrated assaults (cases) and randomly selected months (controls). Directed acyclic graphs enabled confounder selection for multivariable logistic regression analyses; reweighting adjusted for potential biases. RESULTS: Risks (odds ratios, 95% confidence intervals) increased for working in: Special Education (5.84; 4.07-8.39) and School Social Work (7.18; 2.72-18.91); kindergarten to second grade (1.81; 1.18-2.77); urban (1.95; 1.38-2.76) schools; schools with less than 50 (8.40; 3.12-22.63), 50-200 (3.67; 1.84-7.34), 201-500 (2.09; 1.32-3.29), and 501-1000 (1.94; 1.25-3.01) students versus more than 1000; schools with inadequate resources always/frequently (1.62; 1.05-2.48) versus infrequently/never; inadequate building safety always/frequently (4.48; 2.54-7.90) versus infrequently/never; and environments with physical barriers (1.50; 1.07-2.10). Risks decreased with routine locker searches (0.49; 0.29-0.85) and accessible exits (0.36; 0.17-0.74). CONCLUSIONS: Identification of assault risk factors provides a basis for further investigation and interventions.

Cancer and treatment effects on job task performance for gynecological cancer survivors.

BACKGROUND: Over 91,000 new cases of gynecological cancers are expected to be diagnosed in 2013 in the US alone. As cancer detection technology and treatment options improve, the number of working-age cancer survivors continues to grow. OBJECTIVE: To describe US gynecological cancer survivors' perceptions of the effects of cancer and treatment on their job tasks. PARTICIPANTS: 104 adult gynecological cancer survivors who were working at the time of their cancer diagnosis, treated at a University-based women's health clinic, diagnosed in the previous 24 months, and spoke English. METHODS: Women completed written surveys to describe their work experiences following diagnosis. Clinical characteristics were obtained through medical record review. Descriptive statistics and cross tabulations were performed to describe characteristics and associations. RESULTS: Fifteen percent of women had chemotherapy and radiation treatment; 48% had only chemotherapy, 9% only radiation therapy, and 28% had neither. Survivors described the frequency of performing seven job tasks, such as 'intense concentration', 'analyzing data', and 'lifting heavy loads.' Women who had undergone radiation treatment were more likely to indicate limitations for physical tasks; women undergoing chemotherapy were more likely to report limitations in more analytic tasks. Only 29% of women noted an employer-based policy facilitated their return-to-work process. CONCLUSIONS: Cancer and treatment have important effects on job performance and may vary by type of treatment. Employer-based policies focusing on improved communication and work accommodations may improve the return to work process.

Work-related violence against educators in Minnesota: rates and risks based on hours exposed.

PROBLEM: Violence is a major occupational problem; yet, rigorous studies focused on educators to address this problem are limited. The objective was to identify educators' potential risks for physical assault (PA) and nonphysical violence (NPV), based on hours exposed. METHODS: A total of 4,731 licensed kindergarten through grade 12 Minnesota educators, identified from the Minnesota Department of Education database, participated. Specially designed mailed questionnaires (12-month recall) enabled data collection. Calculated PA and NPV rates, per 100,000 working hours, used Poisson regression. Directed acyclic graphs identified confounders for multivariable analysis, adjusted for non-response and unknown eligibility. RESULTS: The total PA rate was 5.3; PA risks increased for educators who: were non-married versus married; held master's degrees, or education specialist degrees, versus associate/bachelor's degrees; worked in public alternative and various school types, versus public schools; worked as social workers, in special education or multiple activities, versus standard classroom teaching; worked with <10, versus 10 to <25 students in the class. The total NPV rate was 26.4; subcategory rates were: threat (34.8); sexual harassment (7.6); verbal abuse (55.5); bullying (19.6). Increased risks for NPV included: 30-39 and 60-79, versus 50-59years of age; non-married versus married; working in public alternative versus public schools; working part-time or substitute, versus full-time; teaching in special education or multiple activities, versus standard classroom teaching; teaching in class sizes <10 and ≥25, versus 10-24 students; teaching in grades 3-12 and multiple grades, versus kindergarten to second grade. The investigated results for PA and NPV were similar, with a few exceptions. DISCUSSION AND IMPACT ON INDUSTRY: Results from this study provided information about factors associated with increased and decreased risks for violence against educators, based on hours worked. In addition, they provided a basis for further investigations to reduce violence against educators in the school environment.

Risk of physical assault against school educators with histories of occupational and other violence: a case-control study.

A case-control study design was used to investigate risks of work-related physical assault (PA) associated with a history of violent victimization among educators. A total of 6,469 state-licensed educators (Kindergarten - Grade 12) worked in the previous 12~months and were eligible to participate. Exposure data were collected from cases (reporting a PA event in previous 12 months, n=290) for the month before PA, and from controls (no work-related PA in previous 12 months; n=867) for a randomly selected working month. Odds ratios and 95% confidence intervals identified increased risks for educators with any prior history of work-related (17.3, 11.4-26.3) or non-work-related PA (2.0, 1.2-3.5). In addition, PA risk in the previous twelve months increased with the number of previous victimizations, and risk also increased for educators with histories of non-physical violence (work- and non work-related). The results present a compelling case for targeted interventions and further research.

Violence against educators: a population-based study.

OBJECTIVE: Identify the magnitude and risk factors for occupational physical assault (PA) and nonphysical violence (NPV) against Minnesota educators. METHODS: Among 26,000 randomly selected licensed kindergarten to grade 12 educators, 6469 eligible educators reported whether they experienced PA or NPV during the prior year. Multiple logistic regression models were based on directed acyclic graphs. RESULTS: Respective PA and NPV annual rates per 100 educators were 8.3 and 38.4. Work changes resulted among PA (13% to 20%) and NPV (22%) victims. Risks increased for master's prepared or education specialists who worked in public alternative schools and special education. Risks decreased for those working for more than 20 years, part time, and in private schools. Physical assault risk decreased when teaching grades 3 to 12 (vs kindergarten to grade 2), but NPV risk increased. CONCLUSION: Targeted efforts on specific violence risk and protective factors are essential to improve educators' work environments.

Written violence policies and risk of physical assault against Minnesota educators.

Few research studies on school violence policies use quantitative methods to evaluate the impact of policies on workplace violence. This study analyzed nine different written violence policies and their impact on work-related physical assault in educational settings. Data were from the Minnesota Educators' Study. This large, nested case control study included cases (n=372) who reported physical assaults within the last year, and controls (n=1116) who did not. Multivariate logistic regression analyses, using directed acyclic graphs, estimated risk of assault. Results of the adjusted multivariate model suggested decreased risks of physical assault were associated with the presence of policies regarding how to report sexual harassment, verbal abuse, and threat (OR 0.53; 95 per cent CI: 0.30-0.95); assurance of confidential reporting of events (OR 0.67; 95 per cent CI: 0.44-1.04); and zero tolerance for violence (OR 0.70; 95 per cent CI: 0.47-1.04).

Child bystanding: A risk factor for injury and identifying its' determinants on midwestern agricultural operations.

BACKGROUND: Agriculture is considered among the most dangerous occupations and has consistently ranked among the top three. Production processes, associated with this occupation, place at risk not only workers but also others who live on the operations. We evaluated the incidence and determinants of associated bystander injuries in the Regional Rural Injury Study-II (RRIS-II). METHODS: The RRIS-II followed 32,601 people ( approximately 85% of eligible) from rural communities in the Midwest for 1999 and 2001, using six-month recall periods, and identified their injury events. Demographic, injury, and exposure data were collected through comprehensive and case-control computer-assisted telephone interviews. Multivariate logistic regression analyses were used to estimate the risk of child bystanding and agricultural injury, while controlling for potentially confounding variables. RESULTS: Nearly 60% of all 425-child injury cases (<20 years) responded to sometimes/frequently bystanding in six out of seven different agricultural environments (e.g., workshops, animal areas, etc.) Multivariate regression analyses, with odds ratios and 95% confidence intervals, showed increased odds of injury for bystanding near used (1.5; 1.1, 1.9) or stored (1.4; 1.1, 1.8) machinery, and near fields and barnyards (1.4; 1.0, 1.9). Further, multivariate analyses revealed increased odds of bystanding for parental beliefs, such as: child age (1.4; 1.0, 2.0) near stored equipment. Parental levels of strictness were also evaluated and showed decreased odds of bystanding when the parents were not strict about the child's wearing a seatbelt near used equipment (0.5; 0.3, 1.0). Households with only one child had decreased odds of bystanding for five of the exposures while there was an increased odds of bystanding near animals for households with five or more children. CONCLUSIONS: Although parents cannot child-proof their operations, it is important for them to understand the apparent odds of and risks associated with bystanding. Children can have injury odds similar to adults in this environment; therefore, it is necessary to examine parental factors that may be associated with children's likelihood of bystanding in high-risk work environments.

Bystander injury evaluation of children from midwestern agricultural operations.

BACKGROUND: With more than a million youth living on agricultural operations, it is important for parents to understand the consequences of bystander injuries that children experience in these environments. We identified the childhood injuries for bystander status and compared the severity of these injuries to the working children in the Regional Rural Injury Study-II (RRIS-II). METHODS: RRIS-II followed 16,546 children ( approximately 85% of eligible) from rural communities in the Midwest for two six-month recall periods in 1999 and 2001. Demographic, injury, and exposure data were collected through comprehensive computer-assisted telephone interviews. Child injuries were cataloged using narrative scenarios into four categories: (a) directly work-related; (b) indirectly work-related; (c) non-working accomplice; and (d) non-working attendant; the latter three all being bystander categories. Poisson regression modeling was used to calculate rates of bystander injuries. Frequencies were used for comparison of severity measures. RESULTS: Among the 463 child injuries (aged <20yrs), 102 were bystander injuries. Of the bystander-related injuries, 14 were identified as indirectly work-related (working bystanders), 27 as non-working accomplice (passengers/tag-alongs), and 60 as non-working attendant (playing on the operation). The overall rate of bystander injuries was 6.4 per 1,000 people, 95% CI (5.0, 8.1). Males, compared with females, had more than twice the injury rate (8.7; 95% CI 6.4-11.8, and 3.9; 95% CI 2.7-5.7, per 1,000 people, respectively). Bystanders in this population had more severe injuries with 4% having life-threatening circumstances; of these, 4% of the accomplices and 2% of the attendants subsequently died. CONCLUSIONS: Children who live or work on agricultural operations are vulnerable to many hazards. Therefore, this study examined child injuries and found a clear difference in the consequences of these injuries between working-related and bystanding-related injuries. IMPACT ON INDUSTRY: Unlike occupations such as construction and mining, where laws and organizations have been created for the protection of bystanders, agricultural bystanders have remained unprotected and have had to face the consequent injury and death outcomes. As public health professionals considering these risks, it is necessary that we work to develop more intervention studies and continue to propose suggestive guidelines for child safety in these environments so as to challenge family traditions and possibly spark public policies that will give further protection to this population.

School resources, resource allocation, and risk of physical assault against Minnesota educators.

To investigate the relation between schools' resource levels (i.e., annual per student expenditures), school resource allocations, and physical assault (PA) against Minnesota's educators, a study was conducted from the two-phase Minnesota Educators' Study (MES) that incorporated school-level fiscal and demographic data from the Minnesota Department of Education (MDE). The MES examined a randomly selected cohort of employed, state-licensed kindergarten through grade 12 educators. From mailed questionnaires, response rates for both Phase I (comprehensive data collection on violent events) and Phase II (case-control) were 84%. Cases experienced a work-related PA event in the previous 12 months; controls reported no assaults. Based on the school in which they worked the most time and available MDE school-level data, together with MES questionnaire data, analyses were conducted on 238 cases and 640 controls. Multivariate analyses, using directed acyclic graphs to guide selection of confounders, suggested that increased spending (i.e. resources) was associated with decreased risk of PA. Analyses further suggested that the highest quartiles of resource allocations, compared with the lowest quartiles (referents), were associated with decreased risks of PA for: district level administration; regular instruction; special education; student activities and athletics; and pupil support services expenditures. Associations between increased resource allocations to student activities expenditures and decreased risks of PA were the strongest. For example, an allocation greater than 5% of the total annual per student expenditure to student activities programming (referent, less than 0.04%) was associated with a decreased risk of PA (OR=0.30, 95% CI: 0.12, 0.77). Results suggested that allocations of school resources (i.e., expenditures) to key program areas such as student athletics and extracurricular activities may reduce risk of work-related PA against educators. Research to further explore the nature of the relations between disparities in school resources and spending, resource allocations, and PA will be important to the continued development of relevant prevention strategies.

Graduate proficiency assessment using a competency-based learning model.

OBJECTIVE: The goal of this study was to evaluate and compare occupational health and safety graduates' perceptions of the value of and their proficiency in 29 educational competencies. METHODS: A survey was mailed to 159 students graduating between 1992 and 2005. RESULTS: Ninety-eight graduates (62% response) ranked all 29 competencies as valuable or very valuable. Graduates reported high proficiency in the competencies they most highly valued. The greatest discrepancy between value and proficiency occurred in competencies related to managing resources, programs, and personnel. Results were similar to those of a 2001 survey. Competencies identified by occupational health and safety professionals in 49 countries were very similar to those included in our set. CONCLUSIONS: We made changes in the curriculum to address graduates' reports of low proficiency in resource, program, and personnel management.