Brick kiln pollution and its impact on health: A systematic review and meta-analysis.

Brick kiln emissions adversely affect air pollution and the health of workers and individuals living near the kilns; however, evidence of their impacts remains limited. We conducted a systematic review of brick kiln pollution (emissions, source contributions and personal exposures) and its effects on health. We extracted articles from electronic databases and through manual citation searching. We estimated pooled, sample-size-weighted means and standard deviations for personal exposures by job type; computed mean emission factors and pollutant concentrations by brick kiln design; and meta-analyzed differences in means or proportions for health outcomes between brick kiln workers and controls or for participants living near or far away from kilns. We identified 104 studies; 74 were conducted in South Asia. The most evaluated pollutants were particulate matter (PM; n = 48), sulfur dioxide (SO2; n = 24) and carbon monoxide (CO; n = 22), and the most evaluated health outcomes were respiratory health (n = 34) and musculoskeletal disorders (n = 9). PM and CO emissions were higher among traditional than improved brick kilns. Mean respirable silica exposures were only measured in 4 (4%) studies and were as high as 620 µg/m3, exceeding the NIOSH recommended exposure limit by a factor of over 12. Brick kiln workers had consistently worse lung function, more respiratory symptoms, more musculoskeletal complaints, and more inflammation when compared to unexposed participants across studies; however, most studies had a small sample size and did not fully describe methods used for sampling or data collection. On average, brick kiln workers had worse health outcomes when compared to unexposed controls but study quality supporting the evidence was low. Few studies reported silica concentrations or personal exposures, but the few that did suggest that exposures are high. Further research is needed to better understand the relationship between brick kiln pollution and health among workers, and to evaluate exposure mitigation strategies.

Career readiness: Finding a place for health and safety education.

BACKGROUND: Studies have identified gaps in health and safety knowledge and work practices of vocational students in the United States and abroad. Little is known about what, how, when, or if health and safety are taught and if the teaching that takes place is effective. Faculty skilled in their technical area may lack knowledge related to health and safety and pedagogy. This knowledge gap is compounded by a deficiency or absence of high-quality safety and health resources for vocational and technical college faculty, the use of outdated and often inaccurate information, and lack of any standardized assessment of knowledge and skills. METHODS: To identify these knowledge gaps, we conducted group interviews with auto body collision technology and machine tool technology faculty at two colleges. RESULTS: Most instructors reported a rapid transition from technical trade worker or business owner into their faculty role, with little support or education related to teaching. No instructor used a defined health and safety curriculum and materials or could describe the breadth safety skills required for their profession. Instructors tested and evaluated health- and safety-related skills on an ad hoc basis and said that workers and employers were ultimately responsible for job health and safety. CONCLUSIONS: Standardized health and safety training is needed nationally and should be progressive and integrated with career-specific educational programs. It should ensure that students obtain knowledge and understanding of how to apply the principles of safety and health and communicate with employers about health- and safety-related issues.

Self-audit of lockout/tagout in manufacturing workplaces: A pilot study.

BACKGROUND: Occupational health and safety (OHS) self-auditing is a common practice in industrial workplaces. However, few audit instruments have been tested for inter-rater reliability and accuracy. METHODS: A lockout/tagout (LOTO) self-audit checklist was developed for use in manufacturing enterprises. It was tested for inter-rater reliability and accuracy using responses of business self-auditors and external auditors. RESULTS: Inter-rater reliability at ten businesses was excellent (κ = 0.84). Business self-auditors had high (100%) accuracy in identifying elements of LOTO practice that were present as well those that were absent (81% accuracy). Reliability and accuracy increased further when problematic checklist questions were removed from the analysis. CONCLUSIONS: Results indicate that the LOTO self-audit checklist would be useful in manufacturing firms' efforts to assess and improve their LOTO programs. In addition, a reliable self-audit instrument removes the need for external auditors to visit worksites, thereby expanding capacity for outreach and intervention while minimizing costs.

Analysis of workers' compensation claims data for machine-related injuries in metal fabrication businesses.

BACKGROUND: Metal fabrication workers are at high risk for machine-related injury. Apart from amputations, data on factors contributing to this problem are generally absent. METHODS: Narrative text analysis was performed on workers' compensation claims in order to identify machine-related injuries and determine work tasks involved. Data were further evaluated on the basis of cost per claim, nature of injury, and part of body. RESULTS: From an initial set of 4,268 claims, 1,053 were classified as machine-related. Frequently identified tasks included machine operation (31%), workpiece handling (20%), setup/adjustment (15%), and removing chips (12%). Lacerations to finger(s), hand, or thumb comprised 38% of machine-related injuries; foreign body in the eye accounted for 20%. Amputations were relatively rare but had highest costs per claim (mean $21,059; median $11,998). CONCLUSIONS: Despite limitations, workers' compensation data were useful in characterizing machine-related injuries. Improving the quality of data collected by insurers would enhance occupational injury surveillance and prevention efforts. Am. J. Ind. Med. 59:656-664, 2016. © 2016 Wiley Periodicals, Inc.

Two-year follow-up of the Collision Auto Repair Safety Study (CARSS).

This paper presents an evaluation of the sustainability of health and safety improvements in small auto collision shops 1 year after the implementation of a year-long targeted intervention. During the first year (active phase), owners received quarterly phone calls, written reminders, safety newsletters, and access to online services and in-person assistance with creating safety programs and respirator fit testing. During the second year (passive phase), owners received up to three postcard reminders regarding the availability of free health and safety resources. Forty-five shops received an evaluation at baseline and at the end of the first year (Y1). Of these, 33 were evaluated at the end of the second year (Y2), using the same 92-item assessment tool. At Y1, investigators found that between 70 and 81% of the evaluated items were adequate in each business (mean = 73% items, SD = 11%). At Y2, between 63 and 89% of items were deemed adequate (mean = 73% items, SD = 9.5%). Three safety areas demonstrated statistically significant (P < 0.05) changes: compressed gasses (8% improvement), personal protective equipment (7% improvement), and respiratory protection (6% decline). The number of postcard reminders sent to each business did not affect the degree to which shops maintained safety improvements made during the first year of the intervention. However, businesses that received more postcards were more likely to request assistance services than those receiving fewer.

The Collision Auto Repair Safety Study (CARSS): a health and safety intervention.

BACKGROUND: Collision repair employs approximately 205,500 people in 33,400 shops. Workers are exposed to a diverse array of chemical, physical, and ergonomic hazards. METHODS: CARSS was based on a random and purposeful sample. Baseline and one baseline and one-year evaluations consisted of 92 questions addressing issues, such as Right-to-Know, fire protection, painting-related hazards, ergonomics, electrical safety, and personal protective equipment. Owners received a report and selected at least 30% of items found deficient for remediation. In-person and web-based services were provided. RESULTS: Forty-nine shops were evaluated at baseline and 45 at follow-up. At baseline, 54% of items were present. This improved to 71% at follow-up (P < 0.0001). Respiratory protection improved 37% (P < 0.0001) and Right-to-Know training increased 30% (P < 0.0001). Owners completed 61% of items they selected for remediation. CONCLUSIONS: Small businesses' interventions should address the lack of personnel and administrative infrastructure. Tailored information regarding hazards and easy-to-use training and administrative programs overcome many barriers to improvement.

National Machine Guarding Program: Part 1. Machine safeguarding practices in small metal fabrication businesses.

BACKGROUND: Metal fabrication workers experience high rates of traumatic occupational injuries. Machine operators in particular face high risks, often stemming from the absence or improper use of machine safeguarding or the failure to implement lockout procedures. METHODS: The National Machine Guarding Program (NMGP) was a translational research initiative implemented in conjunction with two workers' compensation insures. Insurance safety consultants trained in machine guarding used standardized checklists to conduct a baseline inspection of machine-related hazards in 221 business. RESULTS: Safeguards at the point of operation were missing or inadequate on 33% of machines. Safeguards for other mechanical hazards were missing on 28% of machines. Older machines were both widely used and less likely than newer machines to be properly guarded. Lockout/tagout procedures were posted at only 9% of machine workstations. CONCLUSIONS: The NMGP demonstrates a need for improvement in many aspects of machine safety and lockout in small metal fabrication businesses.

National Machine Guarding Program: Part 2. Safety management in small metal fabrication enterprises.

BACKGROUND: Small manufacturing businesses often lack important safety programs. Many reasons have been set forth on why this has remained a persistent problem. METHODS: The National Machine Guarding Program (NMGP) was a nationwide intervention conducted in partnership with two workers' compensation insurers. Insurance safety consultants collected baseline data in 221 business using a 33-question safety management audit. Audits were completed during an interview with the business owner or manager. RESULTS: Most measures of safety management improved with an increasing number of employees. This trend was particularly strong for lockout/tagout. However, size was only significant for businesses without a safety committee. Establishments with a safety committee scored higher (55% vs. 36%) on the safety management audit compared with those lacking a committee (P < 0.0001). CONCLUSIONS: Critical safety management programs were frequently absent. A safety committee appears to be a more important factor than business size in accounting for differences in outcome measures.

Understanding safety climate in small automobile collision repair shops.

BACKGROUND: In the United States, approximately 236,000 people work in 37,600 auto collision-repair businesses. Workers in the collision-repair industry may be exposed to a wide range of physical and chemical hazards. METHODS: This manuscript examines the relationship of safety climate as reported by collision repair shop workers and owners to: (1) an independent business safety assessment, and (2) employee self-reported work practices. The study was conducted in the Twin Cities metropolitan area. RESULTS: A total of 199 workers from 49 collision shops completed a survey of self-reported work practices and safety climate. Surveys were completed by an owner or manager in all but three shops. In general, self-reported work practices were poor. Workers' scores on safety climate were uniformly lower than those of owners. For workers, there was no correlation between how well the business scored on an independent audit of business safety practices and the safety climate measures they reported. For owners, however, there was a positive correlation between safety climate scores and the business safety assessment. For workers, safety rules and procedures were associated with improved work practices for those engaged in both painting-related and body technician-related activities. CONCLUSIONS: The enforcement of safety rules and procedures emerged as a strong factor positively affecting self-reported work practices. These findings identify a simple, cost effective path to reducing hazards in small workplaces.

A comparison of owner and expert evaluation of health and safety in small collision repair shops: a pilot study.

BACKGROUND: Workplace evaluation is one of the first steps in reducing the risk of injuries and illnesses, and is part of several programs that promote a participatory approach to occupational health among small business owners. The usefulness of written safety evaluations is contingent upon non-safety professionals obtaining accurate and reliable results. OBJECTIVES: The purpose of this study was to better understand auto body shop owners' ability to correctly identify occupational health and safety issues within their businesses. METHODS: In this study, 11 auto body shop owners used a 25-question checklist, developed specifically for this industry, to identify key safety and health problems. Owner results were compared with those of an industrial hygienist (IH) experienced in using the assessment form. RESULTS: The average number of safety problems identified by the IH was twice as large as the number identified by business owners (P = 0.02). The average percentage agreement of answers between owners and the IH was 81% (SD = 21%). Shop owners were more accurate in assessing the presence of written safety programs and records than the presence of unsafe work conditions. Overall, owners' sensitivity (ability to correctly identify a safety-deficient item) was low (0.22). CONCLUSIONS: Collision shop owners had some difficulty correctly identifying many unsafe/non-compliant items or situations in their facility. Naïve users' ability to correctly identify potentially hazardous situations--sensitivity--should be the metric of concern for the validity of safety assessments, and efforts should be directed at bringing this number as close to one as feasible.

A qualitative evaluation of owner and worker health and safety beliefs in small auto collision repair shops.

BACKGROUND: About 223,000 people are employed in approximately 34,500 auto collision repair businesses. In general, employees and owners in these establishments lack knowledge of health and safety practices and do not have the technical expertise to make their place of work safer. METHODS: Three employee and three owner focus groups were conducted. The goal of these focus groups was to characterize health and safety beliefs of owners and employees and to determine the best methods for motivating safety improvements in collision repair shops. RESULTS: A total of 11 owners and 19 workers participated in these focus groups. Employees and owners were aware of a wide range of hazards. Both groups noted difficulty in staying informed. Employers were hesitant to set and enforce safety and health rules. Employees perceive owners to be unwilling to dedicate the resources to make the workplace safer and provide personal protective equipment. Both groups felt insurance reimbursement practices placed undue pressure on employees. CONCLUSIONS: Focus groups provide important insights into intervention development in very small enterprises in general and auto collision shops in specific. Employers were conflicted about allowing employees a certain level of independence while also maintaining a safe workplace. From the employee perspective, owners frequently fail to provide adequate personal protective equipment and make improvements needed to ensure safe work. The unique managerial needs of very small enterprises must be accounted for if health and safety programs are to be implemented in these establishments.

Exposure assessment in auto collision repair shops.

Workers in auto collision shops are exposed to a variety of chemical and physical hazards. Previous studies have focused on measuring levels of isocyanates, but little is known about exposures to dust, noise, and solvents. In preparation for an intervention effectiveness study in small collision repair businesses, sampling was conducted on 3 consecutive days in four representative businesses with three to seven employees. Full-shift and task-specific exposures were measured for dust and solvents (for operations other than painting and spray gun cleaning). Full-shift personal exposures and tool-specific noise levels were also evaluated. Samples of banded earplugs were distributed to employees and feedback was collected after 1 week of wear time. Dust and solvent exposures did not exceed the OSHA PELs. Noise exposure doses were below the OSHA PEL; however, 4 of the 18 measurements were in excess of the ACGIH® threshold limit value. The majority of tools generated noise levels above 85 dBA. Air guns, wrenches, cutoff wheels, and air drills generated noise levels with the 5th percentile above 90 dBA. Mean noise levels generated by hammers, grinders, and ratchets were also above 95 dBA. Three pairs of banded earplugs had the best reviews in terms of comfort of use. This study was conducted during a time when all shops reported relatively low production levels. Noise exposure results suggest that it is likely that technicians' 8-hr time-weighted average exposures may be in excess of 85 dBA during periods of higher production, but exposures to dust and solvents are unlikely to approach OSHA exposure limits. These pilot test results will be useful when developing recommendations and technical assistance materials for health and safety interventions in auto collision repair businesses.

Outcomes of a Safety and Health Educational Intervention in Auto Body and Machine Tool Technologies Vocational College Programs: The Technical Education Curricula for Health and Safety (TECHS) Study.

Technical Education Curricula for Health and Safety (TECHS) is a research collaboration between safety and health professionals and vocational instructors in three Minnesota colleges. Curriculum materials, including full and refresher modules with of classroom presentations, lab activities, homework, and quizzes, were developed for auto body collision technology (ABCT) and machine tool technology (MTT) programs. Curricula were implemented during the 2015-2018 academic years. Graduates' safety-related knowledge, skills, work practices, and workplace safety climate were assessed 1 year postgraduation using an electronic survey. Responses were received from 71 ABCT and 115 MTT graduates. Classroom presentations were used consistently throughout the study. Instructors cited a lack of time as the main barrier to using other materials (lab activities, homework, and quizzes). Graduates with TECHS instruction had significantly greater safety-related knowledge overall (both trades) as well as in two topic areas: eye and respiratory protection (ABCT) and hearing protection and machine guarding (MTT). Our data confirm that nearly all graduates consistently engage in practices such as use of safety glasses, hearing protection, and respirators, use of machine guards, material handling strategies. At 1 year postgraduation, MTT graduates' work practices related to machine guarding improved significantly. Graduates with TECHS instruction had improved in about half of the work practices, but statistical significance was not achieved. Graduates' self-reported work practices were not significantly correlated with their knowledge or skills. Work practices variability was best explained by graduates' attitudes toward safety rules and their rating of the workplace safety climate. TECHS findings confirm that classroom instruction alone has little impact on graduates' work practices. We propose institutions formalize their commitment to safety and health education by ear-marking teaching time for this subject and providing assistance to instructors to facilitate curricula integration. Instructors would benefit from learning more about trade-specific safety and health, and adult education teaching methods. Additional research is needed to understand how students' attitudes toward safety change during vocational college attendance and the first year of employment in the trade, explore implementation supports and barriers at institutional and instructor levels, and assess educational effectiveness beyond the end of the academic program. The entire curricula are available on the study website www.votechsafety.net.

A National Survey of Health and Safety Knowledge and Beliefs Among Technical Vocational Faculty in Autobody Collision Repair Technology.

OBJECTIVES: Career technical education (CTE) programs prepare new generations of technicians in a variety of trades. Even though occupational safety and health (OSH) ought to be included as an essential part of CTE curricula it is frequently absent or inadequately taught. METHODS: OSH knowledge and beliefs were assessed in a national sample of 125 secondary and post-secondary faculty in autobody collision repair technology. RESULTS: Over 50% of faculty thought at least 75% of OSH knowledge was learned at school, and 9% felt that safety was primarily learned on the job. Knowledge scores ranged from 22% to 78%. Overall knowledge scores were significantly lower high school than post-secondary instructors (42% vs 50%, P ≤ 0.001) and in two categories: hazard recognition (44% vs 54%, P ≤ 0.05) and hazard control and shop equipment (30% vs 37%, P ≤ 0.05). CONCLUSIONS: There are substantial gaps in OSH knowledge among secondary and post-secondary CTE instructors. CTE programs should address these gaps by providing trade-specific safety and health education to their instructors upon hiring.

A randomized, controlled intervention of machine guarding and related safety programs in small metal-fabrication businesses.

OBJECTIVES: Metal fabrication employs an estimated 3.1 million workers in the United States. The absence of machine guarding and related programs such as lockout/tagout may result in serious injury or death. The purpose of this study was to improve machine-related safety in small metal-fabrication businesses. METHODS: We used a randomized trial with two groups: management only and management-employee. We evaluated businesses for the adequacy of machine guarding (machine scorecard) and related safety programs (safety audit). We provided all businesses with a report outlining deficiencies and prioritizing their remediation. In addition, the management-employee group received four one-hour interactive training sessions from a peer educator. RESULTS: We evaluated 40 metal-fabrication businesses at baseline and 37 (93%) one year later. Of the three nonparticipants, two had gone out of business. More than 40% of devices required for adequate guarding were missing or inadequate, and 35% of required safety programs and practices were absent at baseline. Both measures improved significantly during the course of the intervention. No significant differences in changes occurred between the two intervention groups. Machine-guarding practices and programs improved by up to 13% and safety audit scores by up to 23%. Businesses that added safety committees or those that started with the lowest baseline measures showed the greatest improvements. CONCLUSIONS: Simple and easy-to-use assessment tools allowed businesses to significantly improve their safety practices, and safety committees facilitated this process.

Health and Safety Education in Auto Body Collision and Machine Tool Technology Programs in Vocational Colleges: Challenges and Opportunities.

Collision repair, machining, and metal manufacturing are industries with a large percentage of small businesses whose owners face unique challenges implementing health and safety regulatory requirements. Previous research found that 72% of collision repair technicians and 47% of machinists attended some classes or graduated from vocational colleges. Although health and safety is a mandatory part of the curricula for post-secondary vocational education, little is known about what, how, and when health and safety is taught and if teaching is effective. Surveys and discussion groups were used to evaluate health and safety education in two vocational colleges in Minnesota. Six instructors and 76 students in collision repair, and 6 instructors and 130 students in machine tool technology programs participated. Instructors had no formal training in health and safety, few teaching materials, and lacked opportunities to learn about safety in their trade. Teaching was unscripted and heavily influenced by each instructor's™ industry experience, knowledge, perceptions and attitude towards safety, with little or no guidance from school administration, or safety professionals. Student survey results show that graduates have significant gaps in safety and health knowledge. Standardized trade-specific curricula and instructor training are needed to ensure students receive adequate health and safety education.

Findings From the National Machine Guarding Program: Safety Climate, Hazard Assessment, and Safety Leadership in Small Metal Fabrication Businesses.

OBJECTIVES: This manuscript assesses safety climate data from the National Machine Guarding Program (NMGP)-a nationwide intervention to improve machine safety. METHODS: Baseline safety climate surveys were completed by 2161 employees and 341 owners or managers at 115 businesses. A separate onsite audit of safety management practices and machine guarding equipment was conducted at each business. RESULTS: Safety climate measures were not correlated with machine guarding or safety management practices. The presence of a safety committee was correlated with higher scores on the safety management audit when contrasted with those without one. CONCLUSIONS: The presence of a safety committee is easily assessed and provides a basis on which to make recommendations with regard to how it functions. Measures of safety climate fail to provide actionable information. Future research on small manufacturing firms should emphasize the presence of an employee-management safety committee.

Findings From the National Machine Guarding Program: A Small Business Intervention: Lockout/Tagout.

OBJECTIVE: Failure to implement lockout/tagout (LOTO) procedures adversely affects the rate of work-related fatalities and serious traumatic injury and is one of the most frequently cited Occupational Safety and Health Administration standards. This study assesses the impact of a nationwide intervention to improve LOTO in small metal fabrication businesses. METHODS: Insurance safety consultants conducted a standardized and validated evaluation of LOTO programs and procedures. Businesses received a baseline evaluation, two intervention visits, and a 12-month follow-up evaluation. RESULTS: The intervention was completed by 160 businesses. The mean LOTO procedure score improved from 8% to 33% (P < 0.0001), the mean program score went from 55% to 76% (P < 0.0001), and the presence of lockable disconnects went from 88% to 92% (P < 0.0001). CONCLUSIONS: This nationwide intervention showed substantial improvements in LOTO. It provides a framework for assessing and improving LOTO.

Findings From the National Machine Guarding Program-A Small Business Intervention: Machine Safety.

OBJECTIVES: The purpose of this nationwide intervention was to improve machine safety in small metal fabrication businesses (3 to 150 employees). The failure to implement machine safety programs related to guarding and lockout/tagout (LOTO) are frequent causes of Occupational Safety and Health Administration (OSHA) citations and may result in serious traumatic injury. METHODS: Insurance safety consultants conducted a standardized evaluation of machine guarding, safety programs, and LOTO. Businesses received a baseline evaluation, two intervention visits, and a 12-month follow-up evaluation. RESULTS: The intervention was completed by 160 businesses. Adding a safety committee was associated with a 10% point increase in business-level machine scores (P < 0.0001) and a 33% point increase in LOTO program scores (P < 0.0001). CONCLUSIONS: Insurance safety consultants proved effective at disseminating a machine safety and LOTO intervention via management-employee safety committees.

Hazardous child labor: lead and neurocognitive development.

Hazardous child labor is challenging to define and quantify in the context of acute or chronic toxic exposures--either of which may cause significant disease and disability. Epidemiologic occupational studies in adults have documented many harmful outcomes secondary to exposure to toxic substances. Occupational surveillance efforts often have focused on acute injuries because they are more readily identified. Fassa has been able to compile data concerning injuries to child laborers but notes, "There is great need for studies in developing countries ... on the impact of child labour on illness." Although injuries may be underreported or undocumented among child laborers, acute injury is, at least, potentially recordable. This is in sharp contrast to toxic exposures, where exposure assessment is usually difficult and costly. This is especially true when it is done after an exposure has taken place. The outcomes of most toxic workplace exposures to children remain unknown. The Agency for Toxic Substances and Disease Registries (ATSDR) notes that in similar environments, children may have greater exposures than adults: "Pound for pound of body weight, children drink more water, eat more food, and breathe more air than adults," and "In some instances, children are less able than adults to detoxify chemicals and are thus more vulnerable." Children who begin work at an early age have many more years to develop illness than an adult doing the same work. A household survey of child laborers in Ethiopia found that a high proportion (greater than 90%) of children in both urban and rural areas of the country reported non-use of protective equipment. However, it is the experience of present author D.P. that this equipment is rarely if ever adequate, even when made available. For example, protective equipment such as respirators or impermeable gloves are designed for adults, and thus do not properly fit children. In defining hazardous child labor, the larger context of public health cannot be ignored. The study of child labor needs to take into account the baseline health of exposed individuals. In developing countries, the poorest and most vulnerable children are most often involved in work in order to earn money for survival. These children are also likely to already lack basic necessities of food and medical care, predisposing them to diarrhea, anemia, and micronutrient deficiencies. Underlying nutritional conditions may make children more susceptible to the effects of toxic substances such as lead. In addition, child laborers also may be exposed to lead and other toxic substances from their poor living conditions.