Recommendations from the NIOSH Child Labor Working Team

NIOSH Projects Focused on Children and Adolescents

Most NIOSH research and activities have implications for children and adolescents. For example, the FACE Program investigates certain types of deaths and injuries of children and adolescents, and the Dirty Dozen Project (which conducts hazard surveys in selected workplaces) has investigated health hazards in vocational education programs. Programs supported by the Agricultural Safety Promotion System affect children as well as adults in agricultural communities. Workplace designs that deter robbery and robbery related homicide affect youths as well as older workers. And control technologies that minimize or reduce exposures to hazardous substances benefit all potentially exposed workers, regardless of age.

The NIOSH projects described in this section were in progress as of July 1, 1996. These projects have a particular focus on children and adolescents and take into account the unique characteristics and needs of this worker population as well as unique opportunities for prevention. The impacts of these projects will not be restricted to working children and adolescents. Control measures that reduce hazardous exposures to children will also protect older workers with similar exposures. Evaluation of community-based educational efforts can guide similar efforts for other worker groups. Also, providing children and adolescents with occupational safety and health knowledge and skills may reduce injury and illness rates in our future workforce.

Occupational Injuries in Children and Adolescents

A number of existing injury databases have unfulfilled potential for closing information gaps about occupational injuries in adolescents and children. Databases with the potential to advance our knowledge about this problem include the SOII, the National Hospital Ambulatory Medical Care Survey, hospital discharge databases, CFOI, NTOF, and NEISS. These and other databases will be evaluated to determine their potential to (1) supplement knowledge about the size of the problem, (2) provide detailed information about circumstances or risks that could promote prevention efforts and research, (3) provide information about the impact of the injuries on young lives and futures, and (4) evaluate changes in the patterns or incidence of injuries over time.

Promising analyses are pursued and findings are disseminated through the Child Labor Working Team, presentations at meetings, and publication in peer-reviewed journals and health education documents. The Child Labor Working Team has successfully encouraged the use of available data in intervention and research activities -- both by NIOSH and other stakeholders such as the Wage and Hour Division of the DOL and the School-to-Work Program.

Hazard Surveillance and Injury Investigation of Paper Baling Machinery

Recent congressional activities may result in the relaxation of restrictions on the current child labor regulation that prohibits the use of paper balers by children under age 18. NIOSH and others are concerned that this shift in policy may result in substantial numbers of disabling injuries and deaths among working adolescents. This project has initiated active surveillance to identify injuries that occur in adolescents and to collect information about the circumstances of baler-related injuries. The case surveillance involves (1) review of data as they come into NIOSH from the NEISS and FACE projects, (2) notification by DOL investigators (Wage and Hour Division) of injuries to minors, (3) notification by the NIOSH-supported Sentinel Event Notification System for Occupational Risks (SENSOR) Program of serious work injuries to minors, (4)notification by the SENSOR Program of amputations, (5) notification by the Maryland FACE program of cases identified through review of workers compensation data, (6) notification by a network of medical examiners and coroners of the deaths of minors, and (7) notification by a newspaper clipping service of deaths and injuries of minors. Investigations based on the FACE model will be conducted for fatal and nonfatal injuries.

Hazard Control Evaluation of the Safety Device Technology for Cardboard Paper Balers

Evidence indicates a need to improve the maintenance technology for hydraulic interlock safeguarding in paper baling equipment. The need has been suggested in a NIOSH report to the DOL Wage and Hour Division with regard to their standards for protecting workers aged 16 and 17. The project objective is to provide a hazard control assistance report to users of cardboard baling equipment. The report will (1) describe the range of hydraulic interlock (gate-type) safeguard technology being used on cardboard balers in the United States, (2) provide the results of a safety analysis of types that have not been previously reviewed by NIOSH, and (3) recommend gate-type, hydraulic interlock safeguards whose effectiveness should be tested in the laboratory.

The project team is composed of NIOSH and external personnel with appropriate control technology skills. Project methods involve site visits to evaluate the safe-guarding of paper baling equipment, laboratory reviews of safe-guarding methods, and task team development of a comprehensive equipment survey report and recommendations. During the current project year, the team identified areas that need to be reviewed to assure safer hydraulic equipment such as balers. These areas include the actual and required structural strength of safeguard components (such as support structures, fasteners, and barrier material areas), development of interlocking for gate-type safeguards that responds to structural indications of jammed equipment, and laboratory evaluation of machine components for safely starting and stopping machine motion. The Team plans a workshop to examine the review area and recommend priorities for effective research on preventing machine related injuries.

Hazards of Youth Work

This project was funded by NIOSH as a research grant to the North Carolina Injury Prevention Research Center through the National Center for Injury Prevention and Control. The following description of the project is based on a draft progress report [Runyan 1996]. The study is one of the first in the Nation to seek information about exposures of adolescents to workplace hazards. The goal of this interdisciplinary project is to describe the following: hazards to which adolescents are exposed in the workplace, protective practices used by adolescents in specific jobs, adolescent perceptions and reactions to workplace hazards, and knowledge of adolescent workers about hazards, protective strategies, and child labor restrictions. This study includes a telephone survey of a Statewide sample of 572 working youths aged 14 to 17 and a survey of a Statewide purposive sample of 323 youths aged 14 to 17 involved in a 4H program via self-administered questionnaire. The project includes a follow up survey of youths interviewed in 1995 and focus groups of selected youths working in targeted industries (food service, grocery stores, and other retail trades). This project lays the foundation for a national study of exposures to work-related hazards among youths.

Massachusetts SENSOR -- Serious Occupational Injuries to Youths

In a cooperative agreement with NIOSH, the Massachusetts Department of Public Health is working to develop and evaluate a Statewide, case based surveillance and intervention system for occupational injuries to youths under age 18. At the core of this system are departmental regulations requiring physicians and hospitals to report work-related injuries of youths under age 18 to the Department. The Department is conducting active outreach to hospital emergency departments to solicit reports and to explore the use of computerized emergency department or billing data to generate reports. Workers compensation claims for minors, hospital discharge data, Massachusetts Burn Registry data, and CFOI data are also used to determine cases. Interviews are conducted with youths having serious injuries and with those having less serious injuries in selected occupations. Memoranda of understanding have been signed with the DOL Region I Wage and Hour Division and OSHA to facilitate referrals. The Massachusetts Department of Public Health is working with other agencies on a variety of educational interventions.

A new component was added to this project in FY96 to begin filling information gaps about work-related health hazards that may cause short or long-term health effects. The project industrial hygienist arranges workplace visits, makes observations, and interviews employers, supervisors, and working youths. The industrial hygienist observes work tasks performed by youths and identifies hazardous exposures or conditions. Protective measures are noted, including ventilation, personal protective equipment, training, and supervision. A special focus in the upcoming year will be hazards in vocational schools. A summary report will include recommendations for future health hazard research.

Missouri Agricultural Safety Promotion System

The Agricultural Safety Promotion System is designed to stimulate the development and implementation of agricultural safety and health intervention programs to reduce agricultural injuries and exposures to safety hazards. The primary emphasis is to assess the effectiveness of proposed intervention programs. The program is intended to (1) reduce the incidence of agricultural injuries and fatalities by implementing intervention projects immediately, and (2) provide practitioners with useful information about the effectiveness of the intervention programs. The Missouri Agricultural Safety Promotion System aims at preventing youth injuries through peer education. The University of Missouri at Columbia is therefore developing a peer approach to educating youths about agricultural safety. A multi disciplinary team of adult leaders is being trained to develop youth safety programs for FFA members. These members are instructed to teach agricultural safety (safety hazards, prevention measures, and concepts) to younger children. The premise is that children learn more readily from other children. One curriculum has been developed for use by FFA members, and another is being developed for classroom use by FFA instructors. This approach requires adequately trained adults to support the instructors. The primary target audience is FFA members, and the secondary target audience is rural elementary students. The program effectiveness will be evaluated by assessing the behavioral intentions of the target populations. Pre and post-testing will provide data to evaluate whether behavioral intentions were measurably improved in both FFA instructors and students. College courses in agricultural safety will also be developed.

Promoting Safety and Health in Vocational, Technical, and Industrial Programs: Guidelines and Curricula

The immediate goal of this project is to increase the safety awareness and education of the Nations vocational school teachers and administrators so that they can pass this information to students before they enter the work environment. The ultimate goal is to produce students (future American workers) knowledgeable in occupational safety and health. Industries will thus be provided with employees informed about occupational safety and health issues. Toward these goals, this project will develop training materials to help students recognize safety and health hazards in vocational shops, employ safe work practices, and eliminate hazards. The 1981 edition of Safety & Health for Industrial/Vocational Education will be revised and updated. The training materials in the manual will be evaluated through a pilot test and revised before a mass printing of the manual. Training materials could be developed in a CD-ROM or CD-interactive format and displayed on the NIOSH Home Page on the Internet. NIOSH will collaborate with the American Vocational Association, the Vocational Industrial Clubs of America, State vocational directors, and the U.S. Department of Education to develop or disseminate recommended curricula and policy for occupational safety and health in all vocational schools. A secondary objective is to expand the program to colleges that graduate teachers for vocational schools.

Enhancing Young Workers Safety and Health Through Community Education Efforts

In FY96, the NIOSH Education and Information Division embarked on three 2-year community health education projects to enhance young workers occupational safety and health. The partners in this effort are (1) the Massachusetts Department of Health (and the Brockton Public Schools, Brockton, Massachusetts), (2) the University of California at Berkeley (and the Oakland Unified School District, Oakland, California), and (3) the University of California at Los Angeles (and the Los Angeles Unified School District). These projects attempt to arouse a community response to young workers safety and health issues and thereby stimulate a variety of education and awareness efforts by community members. A project advisory group has been established in each community. This group broadly represents community interests such as labor, education, business, government, public health, parents, young workers, etc.

The early months of the projects have been spent collecting formative data about (1) employment patterns of young workers, (2) knowledge and attitudes about young worker safety and health issues, and (3) health education and peer counseling services that now exist for youths within the communities. A survey of knowledge and attitudes was administered to a convenient sample of students in each community and to a sample of students in North Carolina (administered by the University of North Carolina, Injury Prevention and Research Center). These data can be used to compare baseline knowledge and attitudes across communities.

Health educators on the staffs of the three partner public health organizations are working with community members to devise materials for use in awareness sessions in community groups and school classrooms. The early phases of the projects emphasize creating an awareness of the issues. The second year emphasizes establishing an ongoing effort to educate students and other community members. These health educators have already developed innovative approaches such as risk analysis games, risk-mapping exercises, and photo novella vignettes, which they are testing in the communities.

Two types of evaluation data are being collected: process and outcome. Process evaluation data allow analysis of the community intervention effort at the community level. The life of each community project (its successes and failures, the timing of events, participation, etc.) will be assessed to provide administrative guidance for future efforts in other communities. Outcomes will be evaluated primarily using individuals as units of analysis. Knowledge and behavior changes will be assessed to identify the education strategies that worked best. From these data, a community education handbook (precise medium to be determined) will be developed for other communities to undertake similar efforts.

Adverse Neurobehavioral Effects in Children of Farm Workers

The University of California Center for Agricultural Research, Education, and Disease and Injury Prevention (one of eight such centers funded by NIOSH) is conducting a study to determine the risk of adverse neurobehavioral effects in the children of farm workers. Researchers at this Center are evaluating children' exposure to organophosphate pesticides, which may occur through their parents agricultural field work. Exposed children may be more likely to show adverse neurobehavioral effects than children whose parents do not work in agriculture. This study focuses on the prevalence of organophosphate pesticide exposures in infants and preschoolers, the prevalence of neurobehavioral problems that might result from such exposures, and parental occupation as a potential source of the children exposure.

Support of Farm Safety 4 Just Kids

The eight NIOSH supported Centers for Agricultural Research, Education, and Disease and Injury Prevention support chapters of the national organization Farm Safety 4 Just Kids. Established by a farm mother as a result of her 12-year-old sons death, this organization alerts parents and children to the hazards of farm work. The network of chapters in the United States is growing -- partly as a result of their collaboration with the staff at the NIOSH-funded Centers, who share health education materials and tools for increasing participation among farm children.