THE NATIONAL OCCUPATIONAL RESEARCH AGENDA
In April 1996, NIOSH released the National Occupational Research Agenda (NORA), a national framework to guide occupational safety and health research activities into the 21st century. NORA was developed with extensive input from more than 500 organizations and individuals outside of NIOSH. These included members of the occupational safety and health community, other government organizations, universities, industry, labor and professional societies, who worked together to identify research gaps and target future research resources.
NORA includes 21 research priorities that drive coordinated national research aimed at protecting the health and safety of workers, as well as helping to reduce the heavy economic costs imposed on the United States by job-related injuries and illnesses. Examples of these priority areas include traumatic injuries, work-related allergies, special worker populations at risk, musculoskeletal disorders, reproductive abnormalities, infectious diseases, and emerging workplace technologies. Twenty teams were formed, one to address NORA implementation in each of the research priority areas (two priority areas involving musculoskeletal disorders were combined).
NIOSH held its first national conference with NORA partner organizations on July 1, 1997 at the National Academy of Sciences. The purpose of this conference was to review progress and discuss further opportunities for implementing NORA. At the event were representatives from more than 200 business, labor, government, health, and science organizations that have partnered with NIOSH to develop and implement the agenda over the past year. During the conference NIOSH issued a report describing first-year successes under NORA which included: increasing NIOSH's investments in NORA priority areas; creating systems for assessing the effectiveness of NORA in the long term; establishing new research partnerships; and using NORA working teams to stimulate projects on preventing job-related latex allergy. For a complete report of FY 1997 NORA activities, visit the NIOSH Home Page at: http://www.cdc.gov/niosh.
1997 RESEARCH ACTIVITIES
Laboratory Research
New Laboratory Opened
In October 1996, NIOSH dedicated its new laboratory facility that houses the Health Effects Laboratory Division, located in Morgantown, West Virginia. The new laboratory provides state-of-the-art facilities for conducting advanced research in key health disciplines and developing new methods to communicate health and safety information meaningfully to workers and employers. Disciplines represented at the laboratory include immunotoxicology, microbiology, and biochemistry.
History provides evidence that medical progress has not occurred without the sustained pursuit of basic science. Occupational health issues are no exception. Thus, priority was given to the hiring of talented, experienced researchers at the new laboratory who will produce information, methodologies, and tools for identifying early signs of job-related diseases, understanding the complex effects of exposures on the body's fundamental systems (including the reproductive and central nervous systems, vital organs, and skin), designing better diagnostic and warning devices, and spurring other advancements to keep pace with rapid changes in today's workplaces and working populations.
Significant Toxicological and Molecular Biological Findings
NIOSH laboratory research has identified (1) the molecular events responsible for occupational cancers caused by such metals as cadmium and arsenic; (2) the early gene environmental reactions responsible for particle induced inflammatory lung disease; and (3) a molecular biomarker for chronic arsenic exposure. These findings are being used in risk assessment and can lead to improved prevention strategies.
Time-Saving Breakthrough
Histoplasmosis is an infectious disease that affects the lungs and is caused by the inhalation of Histoplasma capsulatum spores from soil contaminated by avian or bat excreta. NIOSH researchers developed a polymerase chain reaction (PCR) method that reduces the time needed to detect soil contamination from two months to two days. This method is a potential breakthrough for both the agricultural and construction industries, where workers often risk exposure to Histoplasma capsulatum.
Home Tests for Pesticide Exposures
NIOSH developed a direct-reading kit for determining the level of agricultural chemicals in urine. The kit does not require instrumentation and is simple enough to be used by persons without laboratory training. It is the first kit which permits workers to determine their own pesticide level. In the future, the use of this testing procedure may be combined with other interventions, such as the use of protective clothing, to determine the effectiveness of the intervention.
Assessing Workers' Risks
During FY 1997, NIOSH conducted risk assessments that supported work within NIOSH as well as other agencies, such as the Occupational Safety and Health Administration (OSHA), the Mine Safety and Health Administration (MSHA), and the Environmental Protection Agency (EPA). Risk assessment projects were conducted in the following areas: 1,3-butadiene, chrysotile asbestos, diesel exhaust, electromagnetic frequencies, noise, safety hazards, and silica.
The purpose of these projects is to measure the relationship between exposure levels and disease development. Results of the diesel exhaust risk assessment described the risk of lung cancer associated with varying levels of diesel exposures. The risk assessment of asbestosis provides evidence of a significant risk for lung cancer and nonmalignant respiratory disease at the previous OSHA standard (1 fiber/cc) and supports OSHA's recent lowering of the standard (0.1 fibers/cc) for all forms of asbestos. The results of these projects have been published in the scientific literature.
Field Research
Protecting Workers in Marion, Indiana
At the request of workers, NIOSH evaluated potential exposures to nitrosamines at an automotive rubber sealant plant in Marion, Indiana. A suspected human carcinogen, nitrosamines bind or attach to DNA, leading to the formation of DNA adducts, which, if left unrepaired, may result in a genetic mutation. NIOSH measured DNA adducts in workers' blood and urine. Results revealed that workers exposed to nitrosamines were more likely to have a specific DNA adduct in their blood than those with no nitrosamine exposure. This data will help the company evaluate the need for changes in the ventilation of the plant to reduce nitrosamine air levels and will help prevent similar exposures in other plants using nitrosamines.
NIOSH Improves Transportable Equipment
NIOSH scientists redesigned a piece of laboratory equipment, the gas chromatograph/mass spectrometer (GC/MS), for use in field industrial hygiene studies. The GC/MS units presently available are fairly large and heavy, weighing approximately 210 pounds, and are best described as "transportable" rather than "portable." Both the weight and volume of the redesigned GC/MS were reduced by 50%, resulting in a weight of approximately 100 pounds for the new instrument. The size reduction was accompanied by increased performance capabilities compared to other portable units. This instrument was used to help reduce exposures to printing solvents at a vinyl printing company in Ohio. The NIOSH instrument has been granted two patents, and two articles describing its utility have been published in the scientific literature.
A Formula for Low Back Pain Prevention
The NIOSH lifting equation is a scientifically-derived mathematical equation designed to identify lifting jobs that could place workers at risk for low back pain (LBP). The formula takes into account a variety of conditions for a lifting event as it provides the "lifting index" for a specific task. The formula has been revised and a 50-job study was conducted to evaluate its utility. Analysis of the data revealed that as the lifting index increased, so did the amount of LBP experienced by the workers. The study concluded that the NIOSH lifting equation is effective in identifying jobs with increased risk of LBP and for identifying changes in lifting practices that will help prevent future injuries.
New Technologies
A Medical Diagnostic Tool
NIOSH researchers at the Health Effects Laboratory Division (HELD) developed a system to accurately record the sound pressure waves created when an individual coughs. Coughs are associated with over 100 different pulmonary diseases, and the NIOSH technique for cough analysis has the potential to become a useful non-invasive tool for screening large populations of workers to obtain information concerning their pulmonary function. In a preliminary study, results showed agreement between the cough sound index and the clinical pulmonary diagnosis.
NIOSH Develops Long Sought-After Method to Measure Fibers
Asbestos fibers have demonstrated potential for causing asbestosis, lung cancer, and mesothelioma, with the dimensions of these fibers serving as a major determining factor in causing these diseases. Before the Fiber Length Classifier was developed by NIOSH, there had been no useful way of separating commercial fibers according to their length. Laboratory studies involving length-classified fibers using this new technology confirm the role of fiber length on cellular damage in the lungs and may have implications for future standards on fibers.
NIOSH Develops a Life-Saving Carbon Monoxide Sensor
NIOSH researchers developed a new application for a chemical sensor to monitor worker exposures to toxic gases and vapors, specifically, carbon monoxide. The sensor is designed to be used with small gasoline-powered engines. The sensor mechanism is linked to the engine, and when the sensor "sees" a predetermined quantity of carbon monoxide it causes the engine to shut down. A patent application has been submitted for this instrument and it has been described in the scientific literature.
Helping Health Care Facilities Detect TB Bacteria Early
NIOSH researchers have developed a technique that incorporates a sensitive DNA analysis with indoor air monitoring. The resulting technology will have the ability to quickly detect a small number of tuberculosis bacteria in the air and will enable health care facilities to monitor and control the spread of tuberculosis from infected patients. In addition, the efficacy of environmental control measures, such as increased ventilation and negative pressure rooms, could be monitored with this technology.
EXTRAMURAL RESEARCH GRANTS and COOPERATIVE AGREEMENTS
NIOSH sponsors innovative extramural research that complements and supplements its intramural research program. Through a competitive process, proposals judged to be scientifically sound and related to program priorities are supported through a network of research grants and cooperative agreements.
In FY 1997, NIOSH supported an extramural grants program of approximately $17.5 million. With these funds, NIOSH supported 94 grants in laboratory and field studies. NIOSH receives research grant applications through the Division of Research Grants in the National Institutes of Health. Major categories of research grants include investigator-initiated (R01 grants), Small Business Innovative Research, and targeted requests for proposals in health services research, construction, agriculture, and child agriculture.
Cooperative agreements permit NIOSH to arrange collaborative surveillance and research opportunities with state health departments, universities, labor unions, and nonprofit organizations. In FY 1997, NIOSH awarded $27.6 million for 128 cooperative agreements in 35 states and four international organizations. These funds supported research efforts primarily in agriculture, construction, fatal and nonfatal occupational injury, and surveillance of adult blood lead levels. In the area of agricultural research, NIOSH awarded $9.2 million to 34 cooperative agreements in 15 states and, in construction, NIOSH awarded $5 million in cooperative agreements. In occupational radiation and energy-related health research, NIOSH awarded $1.6 million to six cooperative agreements.
AGRICULTURE
The agriculture industry in the United States employs approximately 3.5 million workers; when including part-time help, about 8 million individuals work in agriculture. According to data from the National Traumatic Occupational Fatalities (NTOF) surveillance system, the agriculture industry has the second highest rate of occupational fatalities in the country. Farmers are at high risk for fatal and nonfatal injuries, work-related lung diseases, noise-induced hearing loss, skin diseases, and certain cancers associated with chemical use and prolonged sun exposure. Farmers also experience chronic diseases such as cardiovascular disease, hypertension, hearing loss, and asthma.
In addition to the safety and health of adults working on farms, NIOSH is also concerned with occupational safety and health issues surrounding child farmworkers. Farming is one of the few industries in which the families (who often share the work and live on the premises) are also at risk for injuries, illness, and death. Every year approximately 100 children are killed in farmwork-related incidents, and another 100,000 are injured. More than 900,000 children under the age of 15 years and 346,000 children 15-19 years of age lived on U.S. farms and ranches in 1991. Another 800,000 are children of farmworkers, including migrants and hired laborers, and may be exposed to hazards that are carried home or may themselves work in a farm setting.
Agricultural Research and Prevention Centers
The eight Centers, funded by NIOSH at $5.1 million in FY 1997, provide a multi-disciplinary approach to agricultural safety and health through a network of regional centers throughout the United States. Agricultural Research and Training Centers are located in California, Colorado, Iowa, Kentucky, New York, Texas, Washington, and Wisconsin.
Agricultural Child Research Grants
NIOSH distributes an additional $2.7 million to independent researchers to study the prevention of agricultural injuries in children. Research grants were funded in California, Illinois, Indiana, Iowa, Kentucky, Minnesota, Mississippi, Missouri, Ohio, Oregon, Washington, and Wisconsin.
Community Partners for Healthy Farming
NIOSH funded $1.9 million in FY 1997 for community-based programs that include both action-oriented surveillance and intervention research projects. This set of projects is built on the strengths of the former Occupational Health Nurses in Agricultural Communities. Community Partners projects include migrant and seasonal workers in their study populations, and involve collaboration between researchers and stakeholders in the communities. Community Partners funded surveillance projects and intervention research projects in nine and six states, respectively.
Farm Family Health and Hazard Surveys
Farm Family Health and Hazard Surveys assessed the health status and hazards faced by farmers and farm families in California, Colorado, Iowa, Kentucky, New York, and Ohio. Field surveys are completed, and the data collected are being analyzed by state survey teams for state and local uses. Using the data, several publications were completed in FY 1997 on topics including prevalence of respiratory symptoms in Colorado, analyses of depression and stress-related injuries in Iowa, and prevalence of tractor and machinery hazards in New York.
The National Center for the Prevention of Childhood Agricultural Injuries
In FY 1997, NIOSH implemented recommendations for the prevention of childhood agriculture injury which included the establishment of a national center dedicated to the prevention of childhood agricultural injuries. NIOSH awarded a cooperative agreement to the National Farm Medicine Center in Marshfield, Wisconsin, to establish this Center which will serve as a national resource for raising awareness of childhood agricultural injuries and coordinating prevention efforts. Activities will include health communications campaigns, outreach to stakeholders and partners, and training of health and safety professionals.
CONSTRUCTION
There are almost eight million construction workers in the U.S., of whom 1.5 million are self-employed. Ninety percent of the 636,000 construction companies employ less than 50 workers, and few construction companies have formal health and safety programs. According to data from the National Traumatic Occupational Fatalities (NTOF) surveillance system for the years 1980-1993, the construction industry had the highest number of fatalities in the country. In 1995, 1,000 workers were killed on the job, more than in any other industry. Construction injuries are responsible for 15% of all workers' compensation costs. NIOSH is collaborating with the construction industry and unions to develop new strategies to reduce worker injuries and illnesses. In FY 1997, NIOSH funded $1.2 million in research grants for the study of construction safety and health.
Collaborations With Labor
Scientists from NIOSH have worked extensively with several labor unions to study the health hazards faced by construction workers. NIOSH collaborated with unions representing carpenters, electrical workers, sheet metal workers, and bricklayers. Results of these projects have been presented to workers and scientists at national conferences and have been published for scientific, technical, and lay audiences. These findings will further be used to develop educational materials and to conduct focus groups for intervention/prevention programs.
Increased Mortality Among Construction Workers
NIOSH conducted a national study to investigate the mortality among 13,301 members of the International Association of Bridge, Structural and Ornamental Ironworkers. The study found that union members who had died between 1984 and 1991 experienced a higher number of deaths from falls and other injuries when compared to the U.S. population. In addition, this group of workers had higher mortality from lung cancer, mesothelioma, pneumoconiosis, and other respiratory diseases. The results are applicable to all workers in similar jobs. Additional studies need to be conducted to learn which potential exposures, such as ionizing radiation, diesel exhaust, asphalt and welding fumes, are associated with these disease risks.
Reducing Exposures to Welding Fumes
Welding operations pose safety and health risks to over 500,000 workers in a variety of industries. Metal fume fever and lung cancer are two examples of health hazards associated with exposures to welding fumes and gases. NIOSH evaluated welding operations using both walk-through surveys and in-depth field studies in California, Indiana, Iowa, Kentucky, Minnesota, Ohio, and Pennsylvania. This study provides an independent evaluation of welding control technologies, enabling employers and welders to choose the most appropriate control option for their operations.
MINING
Reorganization and Programmatic Transitions
FY 1997 witnessed the transfer of health and safety research programs from the former U.S. Bureau of Mines (Department of the Interior) to NIOSH. With the transfer, NIOSH became the new home of the Pittsburgh and Spokane Research Laboratories (PRL and SRL). The two laboratories deal with mining issues unique to their regions, with the PRL focusing on Eastern mining, particularly underground coal mining, and the SRL focusing on the Western mining industry, particularly those safety hazards found in metal/nonmetal mining and surface mining.
The reorganization of the Pittsburgh and Spokane research laboratories resulted in the establishment of four branches and two activities for research at PRL and two branches and two activities for research at SRL. SRL has an administrative support unit, while PRL has a substantial administrative and management services branch.
Associate Director of Mining Named
In October 1997, Robert L. Grayson, Ph.D., was named the first permanent Associate Director of Mining. Dr. Grayson has responsibility for activities at NIOSH's mining research laboratories in Pittsburgh and Spokane and for the coordination of mining research throughout the Institute. Prior to his appointment to NIOSH, Dr. Grayson was professor of mining engineering at the School of Mines and Metallurgy, University of Missouri at Rolla. He has also served as a professor of mining engineering at the College of Engineering and Mineral Resources, as Dean of the College of Mineral and Energy Sources, West Virginia University, and as chair of the West Virginia Mine Inspectors' Examining Board.
Protecting Miners' Hearing
NIOSH researchers, in collaboration with the Mine Safety and Health Administration (MSHA), conducted analyses of over 42,000 hearing tests obtained from 9,000 miners. The study showed that by age 50, 49% of the male miners had hearing impairment that affected daily communication, as compared to 9% of the males in the control group. This information is being used to alert miners, mine safety professionals, and the mining industry of the severe consequences of noise exposure for metal/nonmetal miners, and of the need for more diligent efforts to minimize exposures.
SMALL BUSINESS
Metal-Working Fluids in Small Businesses
Metal-working fluids (MWFs) is a generic term which applies to fluids used for cooling, flushing, and lubricating metal parts and tools during metal machining. An estimated 1.2 million workers in the United States are potentially exposed to MWFs. Exposure to MWFs has been strongly associated with dermatitis and nonmalignant respiratory health effects including asthma, hypersensitivity pneumonitis, airways irritation, and chronic bronchitis.
NIOSH and OSHA signed an interagency agreement beginning in FY 1997 to characterize MWF exposures in small businesses. Field investigations were completed in California, Illinois, Indiana, Ohio, Oregon, and Washington. The collected data will be used by OSHA to help determine the need to regulate occupational exposures to MWFs and to help determine industry-wide needs for future evaluation and control of MWFs. NIOSH is also investigating the microbial component of MWFs, the selection of air cleaners to control MWF mist exposures, and a procedure to separate MWFs from other components that may be present.
Reducing Hazards in the Dry-Cleaning Industry
There are between 30,000 and 40,000 dry-cleaning establishments and 250,000 workers employed in dry-cleaning in the United States. Seventy percent of the shops have ten or fewer employees. Perchloroethylene, used by approximately 90% of U.S. shops, is a known animal carcinogen and a suspected human carcinogen. NIOSH investigators evaluated available technology to control worker exposure to this substance. In addition to evaluating state-of-the-art machines, NIOSH investigators evaluated the effectiveness of retrofitting controls on older equipment. These studies are important because there is a tremendous impact on the community via exposures to perchloroethylene occupationally, environmentally, and even in the home. Each year in the U.S. there are about 1,500 perchloroethylene dry-cleaning machines sold, and 80% of those machines are equipped with older technology that causes extremely high worker exposures. NIOSH's control technology/intervention research has shown that state-of-the-art dry-cleaning machines can substantially reduce these high exposures. NIOSH has produced seven Hazard Control documents to provide dry-cleaning shop owners with information concerning effective, low-cost control options to reduce worker exposures.
