NIOSH Economic Research Projects:
Extramural

Table of Contents

Adult Asthma as a Predictor of Work Loss and Disability

Investigator(s): Paul Blanc

Affiliation: University of California
(415) 476–7377

Keywords: social/economic consequences, asthma, risk factors, labor force participation

Research Summary:
Asthma is common and costly among adults at peak ages of labor force participation. The risk factors for adverse impacts or the factors promoting better occupational outcomes are not well delineated. In addition to illness severity, demographic and psychosocial factors and the nature of working conditions (work exposures, physical demands, job structure) have an impact on work disability. The proposed study will provide statistically powerful estimates of the occupational impacts of asthma among adults of working age and the factors associated with productivity, wage, and work loss.

A random sample of pulmonary and allergy internist specialists initially enrolled 601 persons with asthma identified in patient visit logs. This established panel has completed 45-minute baseline and followup computer-assisted telephone interviews. A supplemental sampling frame of persons with asthma identified from family practitioners is in progress (target baseline n=180). The interviews assess disease severity and other covariables using established survey instruments; work factors are assessed both by interview and by linking to established job factor matrix schemes. The study will carry out an extended longitudinal followup study of this cohort. The analysis will test predictive models for productivity, wage loss, and work disability among adults with asthma.

Causes and Effects of Compliance with OSHA Standards

Investigator(s): John Mendeloff

Affiliation: University of Pittsburgh
(412) 648–2651

Keywords: OSHA, compliance costs, productivity, regulation

Research Summary:
This project will provide new insights into the determinants of compliance with OSHA standards and into the effects of compliance on the total factor productivity and capital investment at inspected establishments. This information can, in turn, be used to estimate the costs of compliance. All of these contribute to our understanding of the OSHA enforcement process, which is arguably the central public policy intervention addressing occupational injuries and illnesses. The knowledge gained can also help OSHA target its enforcement efforts.

This project will create a dataset linking information about OSHA inspections from 1972 to the present with confidential establishment-level Census data, the Longitudinal Research Database, which combines economic data from the Census of Manufacturers, conducted every 5 years, and the Annual Survey of Manufacturers.

Although a similar dataset has been extensively used to study EPA enforcement over the last decade, this will be the first time it has been used to study OSHA. Until now, studies of the determinants of compliance have used only the information available in OSHA’s own inspection data system. No prior studies of the determinants of compliance have used data on plant productivity.

In addition to examining overall patterns of compliance, this research will focus on compliance with health standards, compliance with new standards, and compliance with standards that are clearly related to injury prevention.

Regression analyses will examine several different measures of compliance, adding explanatory variables on establishment characteristics (plant age, wage levels, capital investment, and productivity) and firm characteristics (size and profitability) to the variables already in the OSHA file. Regressions will also be used to examine the effects of compliance on capital spending, productivity, and other measures of the establishment’s economic performance. Adjustments to address the potential endogenity of these variables will be carried out.

The information on productivity and investment will be used to make estimates of the compliance costs entailed by the lead and cotton dust standards adopted in the late 1970s and compare them with prospective estimates of those compliance costs derived during the standard setting process.

Disability Risk in Work-Related Musculoskeletal Injuries

Investigator(s): Gary M. Franklin

Affiliation: University of Washington
(206) 685–7080

Keywords: carpal tunnel syndrome, low back disorders, long-term disability, economic consequences

Research Summary:
The vast majority of cost and lost productivity in workers’ compensation is due to work-related musculoskeletal injuries. Among injured workers with these conditions, a small proportion (5%–10%) develop long-term disability, which accounts for most (80%–85%) of the cost and lost work. In the absence of an accurate method to identify workers at risk for long-term disability, secondary prevention efforts cannot be well targeted. This is a 5-year, population-based prospective study among Washington State workers with back injuries and carpal tunnel syndrome.

The principal aim is to develop an accurate predictive model of risk for long-term disability among five key risk dimensions: employment-related factors, biomedical- and health-care-related factors, sociodemographic factors, administrative and legal factors, and psychosocial factors. To accomplish this aim, a baseline interview among approximately 3,000 eligible workers will be conducted within 2–6 weeks of workers’ compensation claim allowance. A continuous measure of disability outcome (lost time compensation) will be determined from a computerized database at one year. Additional important outcomes will be determined by a followup interview at one year (functional status, work status) and from computerized records (work status, wage status). Multivariate survival analysis within and across risk dimensions will be used to develop the principal risk models, including adjustment for injury severity. The reliability of determining severity from medical records will be determined as well.

Another aim of this study is to develop a brief risk assessment instrument for both low-back and carpal tunnel injuries, which would be useful to physicians when first treating injured workers. The main focus of these instruments would be on those risk factors that may be modifiable and that may be amenable to early intervention to prevent disability. Statistical analysis for this aim will focus on sensitivity and specificity of risk factor combinations. These risk assessment instruments will be pilot tested among physicians participating in an occupational health care quality improvement project. The last aim of this project is to determine the rate and predictors of reinjury among the original low back injury cohort 2 years after the initial injury.

Economic and Job Hazard Analysis of Sandblasting Substitutes

Investigator(s): Beth Rosenberg

Affiliation: Tufts University
(617) 636–6709

Keywords: economic impact, effectiveness research, sand, silica substitutes, sandblasting

Research Summary:
Silicosis is a disabling and often fatal lung disease that is completely preventable. The recent designation of silica as a lung carcinogen by the International Agency for Research on Cancer (IARC) makes the control of silica urgent. The connection between silica and tuberculosis is well known, and with the rise of drug-resistant tuberculosis, the need to control silica is clear.

Sandblasting results in high silica exposures. NIOSH has produced excellent research on the industrial hygiene aspects of using blasting substitutes, yet little research has been done on the health effects of substitutes not associated with chemical exposures.

With all the much needed focus on technologies to reduce silica exposure, we must be mindful that we do not introduce new hazards into the workplace. Numerous unintended consequences have resulted from well intentioned interventions because the focus has been on controlling a single hazard rather than assessing the full range of impacts in a work environment. To evaluate an intervention fully, we need an integrated approach to the workplace. Furthermore, before any research can be useful in helping contractors decide which method to choose, the economics of each technology must be assessed.

This study will address the potential health and economic impacts associated with substituting other materials for silica sand and the technologies to deliver those substitutes in abrasive blasting.

Economic Analyses of Engineering Control Interventions for
Drywall Sanding Construction Activities

Investigator(s): Joseph Ventura (Principal Investigator, United Labor Agency), Dan Ashyk (Cleveland State University), Leo M. Blade (NIOSH), Tim Bushnell (NIOSH)

Affiliation: Painters Health and Safety Fund
(404) 239–4575

Keywords: drywall finishing, engineering hazard controls, productivity, respirable particulate, crystalline silica

Research Summary:
In the first phase of this project, questionnaire-survey instruments were developed to query drywall contractors and drywall-finishing workers about practices, costs, experiences, and attitudes associated with conventional techniques and with the use of the proven engineering control devices.  The survey instruments were administered to union drywall finishers and union drywall contractors in several areas of the country in 2001. These surveys revealed that engineering controls (vacuum attachments) have been used by most respondents to protect property and other building occupants, but rarely used to protect workers. Opinions vary widely on whether and how much these controls reduce productivity, but many perceive them to be slow, awkward, and cumbersome.

The next phase of this project is a field study to document drywall contractors’ and drywall-finishing workers’ practices, costs, productivity, and quality of work with and without dust-control devices. Drywall contractors and owners of properties needing drywall finishing are being enlisted to provide construction sites where field tests of drywall sanding with dust controls can be carried out alongside drywall finishing with conventional techniques. Secondary factors being evaluated during the field surveys include workers’ exposures to noise, airborne respirable particulate and crystalline silica, and other hazards. Real-time video exposure monitoring is being employed to collect data for multiple aspects of the field study. Advantages of using controls, as well as reasons for any drawbacks of using controls will be identified and documented. The findings will be disseminated to building owners, drywall finishing contractors, drywall finishers, and other interested parties.

This project will characterize and address real and perceived barriers (economic and other) to the adoption and use of proven engineering dust-control measures for the protection of the health of workers performing drywall-finishing operations in construction projects.  Findings are expected to lead to suggestions concerning marketing, training, or engineering to overcome these barriers.

Economic Impact of Occupational Injury and Illness

Investigator(s): Sue Dong

Affiliation: Center to Protect Workers’ Rights
(301) 578–8500

Keywords: economic impact, injury and illness, cost, workers’ compensation, self-employment

Research Summary:
The more than 194,000 annual lost-workday injuries and illnesses in construction result in considerable economic costs to workers, their families, employers, and society, yet little research has been done on describing and measuring these costs. Currently, information about the costs of injuries and illnesses derives mainly from workers’ compensation, but workers’ compensation does not address all costs, nor does it cover all workers. For example, little information has been available about more than 2 million self-employed workers in the construction industry.

This project is expected to accomplish the following:
• Quantify costs of occupational injury and illness and the burden on construction workers and their families, especially the costs incurred by workers not typically addressed in existing approaches to the problem
• Determine who pays the costs of occupational injury, illness, and disability according to workforce characteristics
• Estimate the costs of leading injuries and illnesses in construction

The Medical Expenditure Panel Survey (MEPS) and the National Health Interview Survey (NHIS) will be linked together for this study.

The initial investigation of the data sets has been done. Variables related to occupational injuries and medical expenditures selected from the Medical Condition File and Full-Year Consolidated Data File have been merged. Because of constraints under the confidentiality guidelines of the Agency for Healthcare Research and Quality (the agency sponsoring the survey), some MEPS data cannot be released to the public. An application for using this confidential data has been submitted and approved. Currently, the linkage file—1996 NHIS/1997 MEPS Public Use Record Linkage—has been obtained and will be used to link MEPS and NHIS for the data analysis.

Employment Impact of Workplace Injuries in Five States

Investigator(s): Leslie I. Boden

Affiliation: Boston University
(617) 638–4620

Keywords: social/economic consequences, intervention impacts, workers’ compensation, earnings differentials

Research Summary:
This study will develop standardized methods to measure the impact of workplace employment and earnings that can be used in a variety of settings where different data are available. These measures allow more effective targeting of prevention resources. The study also will quantify the impact on earnings when employers promote rehiring of injured workers, and it will measure the differential impact of workplace injuries and illnesses on men and women and on younger and older workers. Finally, it will develop methods for comparing average lost earnings among States that differ in important ways—with disparate industrial mixes, unemployment rates, and so on. This should improve our understanding of how interstate variation in laws, practices, and regulation affect consequences of workplace injuries and illnesses.

To accomplish these goals, both parametric and nonparametric statistical methods will be used that are designed to provide unbiased measures of the impacts of interventions (which, in this case are the workplace injuries and illnesses). This study will compile and analyze individual longitudinal data on more than 500,000 injured workers in 5 States. The primary data on injured workers in each state will consist of workers’ compensation administrative records on all lost-time injuries and unemployment compensation longitudinal quarterly earnings and employment data covering at least 7 consecutive years. Comparison groups will include workers with very-short-term injuries, workers with workers’ compensation claims involving only medical payments, and uninjured workers matched on preinjury employer and preinjury earnings. The sensitivity will be tested of the results to the choice of statistical method and comparison group.

Geographic Variation in Spine Care Among Injured Workers

Investigator(s): D. Rischitelli

Affiliation: Oregon Health and Science University
(503) 494–4398

Keywords: health services research, low-back pain, workers’ compensation

Research Summary:
This proposal addresses two National Occupational Research Agenda (NORA) priority areas: Health Services Research and Low-Back Pain. Back pain among workers is an enormous medical, social, and economic burden in the United States. Back disorders account for 27% of all disabling occupational injuries in the United States and the average direct cost of low-back-injury claims is more than twice that of other occupational injury claims combined. The primary goal of the study is to examine community differences in the rate and types of spinal surgery performed on injured workers, using small-area analysis. Small-area analysis is a commonly employed method in health services research, but there have been limited applications of this technique in occupational health research. Oregon, as well as a number of neighboring Western States, has elevated rates of spine surgery compared with the rest of the Nation. Significant local variation exists among communities based on prior analyses of Medicare claims data. We plan to evaluate whether a similar pattern of local variation exists for workers’ compensation claims and to evaluate factors contributing to observed variations including physician specialty, physician supply, source of payment, and the effect of managed care. This project will pilot the use of an existing comprehensive state database of workers’ compensation medical payments that provides rich opportunities for health services and outcomes research in occupational health. The methods described in this application can be applied to other geographic units or other diagnoses and thereby serves as a model for analyzing the individual, community, and provider variables that influence the treatment of work-related injuries and illnesses.

Health and Socioeconomic Consequences of
Nonspecific Building-Related Illness (NSBRI)

Investigator(s): Carrie Redlich

Affiliation: Yale University
(203) 737–2817

Keywords: socioeconomic consequences, nonspecific building-related illness, risk factors

Research Summary:
This study will determine the health and socioeconomic consequences of nonspecific building-related illness (NSBRI or sick building syndrome) in workers diagnosed with this prevalent disorder. More than half of the U. S. workforce is now employed in indoor nonindustrial environments. Various symptoms and illnesses have increasingly been reported in such nonindustrial indoor environments. NSBRI refers to a common nonspecific disorder that is usually associated with a particular building. Although objective physiologic abnormalities are generally not noted, NSBRI can be extremely unpleasant and an important cause of disability and lost work time. Despite this, NSBRI has received scant scientific attention from a clinical and economic perspective. Little progress has been made in establishing the following:
• Diagnostic criteria
• The natural history or clinical course of NSBRI
• The social and economic consequences of this common and important occupational health problem
• The predictors of adverse outcomes

Our aims are as follows:
• Identify and classify NSBRI cases using several different case definitions of NSBRI
• Determine associations between the different case definitions of NSBRI
• Characterize the natural history of NSBRI following diagnosis
• Determine which host factors (i.e. age, marital status, initial symptoms) and workplace factors (i.e., job stress, work environment) are associated with disease progression and severity
• Determine the effect of NSBRI on socioeconomic outcomes (i.e., work disability, employment status, financial status)
• Determine which host factors and workplace factors are associated with more adverse socioeconomic outcomes

The overall study design will be a retrospective longitudinal followup study of 75 patients diagnosed with NSBRI at the YOEMP Clinic from 1994 to 1999. A similar group of 75 musculoskeletal patients matched on age, gender and year of diagnosis will be used as controls for the socioeconomic analysis. Phone interviews will assess symptoms, general health, functional status, disability, stress, and socioeconomic status since diagnosis of NSBRI. This study should identify diagnostic criteria, increase our understanding of the natural history and socioeconomic consequences of NSBRI, as well as identify risk factors associated with worse outcomes. This information is critical for the development of interventions to prevent and/or ameliorate the adverse consequences of NSBRI.

Health Disparities Among Health Workers

Investigator(s): Craig Slatin

Affiliation: University of Massachusetts
(978) 934–3291

Keywords: socioeconomic determinants, health care workers, physical and social functional capacity

Research Summary:
Socioeconomic position (class, gender, and ethnicity) is correlated (associated) with risk of morbidity and mortality due to various conditions. Some of these risks or health outcomes are not immediately life threatening but have a major impact on health-related quality of life and affect the physical and social functional capacity of a substantial proportion of the population. Health outcomes include musculoskeletal disorders, various types of acute injury (both intentional and unintentional), and mental health conditions. All three of these have been associated with environmental conditions in the workplace, which themselves show a marked socioeconomic gradient because of widespread occupational segregation. We propose to examine the work environment as a primary mediator of the effect of socioeconomic position on population health. The study will involve a combination of quantitative and qualitative data and will support a contextual analysis set within a broader ecological and political theoretical framework. Multiple data sources will be used to evaluate job features such as physical load (e.g., heavy lifting), shift work, high psychological job demands coupled with low decision autonomy, threat of interpersonal violence, and facility characteristics such as adequacy of staffing, management commitment to occupational health and safety programs, and policies concerning gender and racial discrimination and sexual harassment. Morbidity will be assessed by survey instrument as well as from facility records of absenteeism, work-related injury and illness, and compensation claims. In a series of three panel surveys, we will seek to maximize the number of subjects responding more than once to permit longitudinal analysis. An outcomes sub-study will sample employees reporting health problems at baseline; additional information about their health and employment status will be sought about two years later. By conducting the study in multiple facilities and job groups, it will be possible to compare the effects of job and individual exposures as well as the effect of different management policies and workplace climates that have the potential to determine the magnitude and impact of hazardous exposures. The study will be conducted in the health care industry, which employs a large proportion of the working population in Massachusetts (and nationally) and is an increasingly important employer of minority workers. This workforce has substantial variability in socioeconomic status, gender, and ethnicity and is exposed to a variety of known health and safety hazards at work. This setting should provide an adequate multidimensional range of facts to permit a meaningful examination of physical and social/behavioral risks and the complex pathways that produce disparities in population health status.

Impacts of Demanding Work Schedules: National Survey Findings

Investigator(s): Allard E. Dembe

Affiliation: University of Massachusetts
(508) 856–6162

Keywords: occupational stressor, circadian rhythm, injury prevention, shift work, occupational disease/disorder

Research Summary:
The study will use data from the National Longitudinal Survey of Youth (NLSY) to analyze the impact of demanding work schedules on employee safety and health. The NLSY contains extensive information about worker’s employment history, job experiences, occupational injuries and illnesses, along with a variety of social, economic, vocational, and disability outcomes. Using these data, we will be able to categorize work schedules according to the type of shift work performed (day, evening, night, split, rotating), overtime work, extended hours per week (60+), and extended hours per day (12+). The longitudinal nature of the NLSY will allow us to retrospectively track work experiences over a 13-year observation period (1987–2000). Our analysis will answer the following questions:
• Does shift work and irregular schedules increase the likelihood of suffering occupational injuries and illnesses?
• Does overtime and extended work hours increase the likelihood of suffering occupational injuries and illnesses?
• What types of shift work, overtime, and extended hours schedules are most hazardous? and
• Does working a demanding schedule increase the severity of the social, economic, vocational, and disability consequences of occupational injuries and illnesses?

Our study has several important design features that will significantly advance scientific understanding in this important area of research, including large sample sizes, a wide range of industries covered, a relatively long period of observation to examine the time dependencies between events, the ability to control for important covariates, and an extremely large array of significant outcome measures. To conduct this study, we have assembled a highly qualified research team with experts in work organization and the analysis of large databases from the University of Massachusetts Medical School, the RAND Institute, and Applied Epidemiology, Inc. Our study will result in policy-relevant publications and reports that will include research-based recommendations for practical interventions to prevent or minimize risk from these exposures.

Injuries and Cost Shifting in the Construction Industry

Investigator(s): Cleve J. Waddoups

Affiliation: University of Nevada, Las Vegas
(702) 895–3497

Keywords: uncompensated care, workers’ compensation insurance, cost shifting, health insurance coverage

Research Summary:
Conventional measures of the incidence of health insurance coverage are correlated with employment in construction and other industries. Analysis of Current Population Survey data demonstrates that compared with workers in most other industries, construction workers and their dependents generally have a lower incidence of health insurance coverage. Regression analysis using data from a large public safety-net hospital demonstrates that patients employed in the construction sector are more likely to be found in the uncompensated care (bad debt) files, after holding other variables constant. Thus it may be argued that the institutional configuration of the construction industry causes the costs of health care for its workers to be shifted to public safety-net health care facilities, paying patients, companies that offer insurance to their workers, and to the public through higher taxes.

Analysis of the data also suggest that a substantial number of injuries among construction workers appear to be job-related, yet are still being treated without compensation. When work-related injuries fall into uncompensated care accounts at the public safety-net hospital, then perhaps employers are not purchasing the requisite workers’ compensation insurance, injured workers feel it is to their advantage to avoid financing their injuries with workers’ compensation insurance, or injured workers do not understand their rights to file workers’ compensation claims. Without such financing, they often become self-pay patients and tend to amass bills that cannot be paid.

This project will establish a link between uncompensated care at public health facilities and employment in the construction industry. Particular emphasis is placed on the potential for avoidance of workers’ compensation insurance to finance workplace injuries in favor of uncompensated care at public safety-net hospitals.

Job-Related Arthritis and Disability in Retirement

Investigator(s): J. Paul Leigh

Affiliation: University of California
(530) 754–8605

Keywords: low back pain, lost productivity, cost of injury, functional disability

Research Summary:
Two widely shared medical views motivate the proposed study:
• Injuries to joints at some time in life can produce osteoarthritis in those joints later in life.
• Perhaps the best predictor of future low-back pain is prior low-back pain.

For our purposes, the time dimension is important. The initial injury or pain could occur on the job, whereas the subsequent osteoarthritis or pain could occur much later, perhaps during retirement years. These subsequent osteoarthritis and pain events will generate direct costs (doctor visits, hospitalizations, drugs) and indirect costs (lost productivity on the job and in the home). The first aim is to estimate the costs of job-related osteoarthritis. Current estimates of all job-related injuries and illnesses ignore these costs. The second aim is to investigate the connection between employment in injury-producing jobs before retirement and functional disability after retirement.

Costs of job-related osteoarthritis and functional disability in retirement are important for at least three reasons. First, ignoring them leads to a significant underestimate of the overall costs of job-related injuries and illnesses. Second, these costs are largely borne by victims, families, and taxpayers, not by workers’ compensation systems.

Prevalence and costs of osteoarthritis will be estimated with primary data from the National Health Interview Surveys, National Center for Health Statistics, the Bureau of Labor Statistics, and the Agency for Healthcare Research and Quality and with secondary data from published studies. We will present a range of estimates under clearly stated assumptions so readers can select the scenario they find most reasonable.

The connection between employment in injury-producing jobs and subsequent functional disability will be investigated with the National Health and Nutrition Examination Survey III (NHANES III). The NHANES III has information on the functional disability (activities of daily living) of retirees, as well as information on subjects’ longest held jobs before retirement.

Low Back Pain: Physical and Psychosocial Job Factors

Investigator(s): Niklas Krause

Affiliation: University of California, San Francisco (510) 231–9540

Keywords: backache, ergonomics, functional ability, occupational psychology, work site clinical research

Research Summary:
This project will prospectively examine the role of physical and psychosocial job factors in the development of occupational low-back pain during successive phases:
• The pre-disability symptom phase
• The pre-disability formal injury report phase
• Three disability phases:
—acute
—subacute
—chronic, which is defined by increasing durations of lost work time

It is hypothesized that both physical and psychosocial job factors are independent predictors of low-back pain at all five phases and that their relative effect sizes change across phases. The main objective is to determine phase-specific risk factor profiles with particular focus on the relative impact of psychosocial and biomechanical risk factors. The long-term goal is to yield useful information for the design of workplace interventions which combine organizational and ergonomic job redesign to prevent low back injuries and work disability. This project combines the resources of two existing data sets - two prospective cohorts of San Francisco urban transit operators (n = 1,449, n = 1,640). These two longitudinal studies provide workers’ compensation data with 3 to 5 years of follow-up, allowing for the study of each phase of the disability process, including the chronic disability phase (greater than 90 days off work), which accounts for 80 percent of the costs associated with work-related low back injuries. Both studies provide comparable information on job-related, sociodemographic, injury, medical legal, and economic factors. Primary analyses will examine the independent and combined effects of physical and psychosocial job factors, including psychological and physical job demands, job control, job strain and social support at work. In addition, unique data on job stress, measured by independent observers with an innovative job analysis instrument, will be used for agreement analyses with self-reported measures to evaluate the predictive validity of survey instruments used in large epidemiological studies of occupational low-back pain.

Occupational Fatality Trends: A Contextual Analysis

Investigator(s): Dana Loomis

Affiliation: University of North Carolina (919) 966–7433

Keywords: labor-force factors, economic factors, traumatic injuries, surveillance, fatalities

Research Summary:
The rate of fatal occupational injuries in the United States has been declining since the 1970s. At the same time, the structure of the economy has undergone profound changes that affect worker safety and health and the ability to monitor and ensure them through public health interventions. We propose an epidemiologic study of the relationship of long-term trends in fatal occupational injury to economic and labor-force factors at national and regional levels. The overall goal of the research is to examine the context of trends in fatal injury rates. We will consider differences among industrial sectors, worker groups, and geographic regions. We will examine potential causes, focusing on structural changes in the economy and the workforce. Specifically, we seek to answer the following research questions:
• What was the average annual change in the rate of fatal occupational injury from 1980 to 1994 for the Nation, for its principal geographic regions, and for specific sectors of industry, major occupational groups, and worker groups defined by sex, age, and race?
• Did characteristics of States and regions, including compensation levels, population mobility, the proportion of women and minorities in the labor force, educational attainment, the power of labor relative to capital and regulatory climate, predict differences in occupational fatality trends between 1980 and 1994?
• Was the relative decline in fatal occupational injury rates from 1980 to 1994 equal for potentially vulnerable groups of workers and for other worker groups with greater historical advantages?
• Would the overall rate of fatal occupational injury observed toward the middle of the 1990s have been the same as the rate in the early 1980s if there had been no restructuring of the labor force?
• How are trends modified by the interplay of factors on regional, industry, and individual levels of organization?

To address these questions, we will conduct a contextual analysis using data collected by U.S. government agencies. In evaluating regional patterns, we will devote attention to the South as a region that has led some current trends. The research has the potential both to produce greater knowledge of the relationship of worker safety to larger trends beyond the workplace, and to identify steps that can be taken to maintain or improve safety as other conditions of work change.

On-the-Job Injury: Employment History and Hidden Losses

Investigator(s): Monica Galizzi

Affiliation: University of Massachusetts (978) 934–2790

Keywords: social/economic consequences, labor force participation, occupational injury, workers’ compensation

Research Summary:
This research project will test the hypothesis that a worker’s personal characteristics and pre-injury labor market experience, together with employers’ characteristics, behaviors, and working conditions, will determine the long lasting social and economic consequences of workplace injuries. The study aims are as follows:
• Estimate the effect of a job-related injury or illness on the worker’s future employment given information on workers' preinjury labor force participation, employment relations, and working conditions
• Determine the factors that may explain recurrent episodes of work-related injury and illness
• Estimate the effect of a job-related injury/illness on future earnings and on other hidden economic consequences (such as loss of fringe benefits and the need to rely on government assistance programs)
• Evaluate the effect of an injury on the families of injured workers (in terms of changes in spouses' employment and children’s well-being)
• Measure variation in outcomes among workers who receive or do not receive workers' compensation benefits

To study these topics, the research will use several probability models and models describing the variation of continuous dependent variables over time.

Organizational Predictors of Successful Return to Work

Investigator(s): Benjamin C. Amick, III

Affiliation: University of Texas (713) 500–9496

Keywords: job performance, income insurance, job satisfaction, quality of life, socioeconomics

Research Summary:
The long-term goal of this research is to identify organizational practices and policies that effectively support the injured worker’s return to a productive work role. The research has two aims:
• To determine the relationship between organizational practices and policies and successfully returning to work and reduced work disability
• To examine the validity and reliability of workers reported organizational practices and policies

This research builds on an ongoing cohort study of 250 physician-reported carpal tunnel syndrome cases in Maine funded by the Arthritis Foundation that follows workers at baseline, 2, 6, and 12 months post surgery. Information is collected about worker, job, and economic factors that predict work disability and return to work. Augmentation of worker-level health data with employer-level data on organizational practices and policies creates an opportunity to examine heretofore unanswered research questions. The investigators will interview 80 key organizational informants (representing 80 different employers) to collect employer-level data on eight organizational practices and policies (people-oriented culture, active safety leadership, safety diligence, safety training, standard ergonomics practices, disability case monitoring, proactive return to work, and labor-management safety and health committees) and use the employer-level data to predict return to work, lost work days, and work disability (carpal tunnel syndrome symptoms, paid and unpaid work functioning incidents). The investigators hypothesize that organizational practices and policies will be associated with fewer lost work days, a quicker return to work, improved work, and unpaid work role functioning and fewer carpal tunnel syndrome symptoms. They will also compare employer with worker organizational practices and policies reports. Additional hypotheses are that worker reports of organizational practices and policies will significantly co-vary with employer reports of organizational practices and policies; and workers of organizational practices and policies will predict fewer total lost work days, earlier return to work, improved paid and unpaid work functioning and fewer carpal tunnel syndrome symptoms. Employer interviews will be conducted as an additional step with the purpose of demonstrating that worker self-reports are valid and reliable and will provide new measurement tools heretofore unavailable in occupational health research. In addition, the investigators will collect workers’ compensation data from employers and OSHA reportable data to replicate research conducted among Michigan employers. A second unique feature of the proposed research is the use of new measures of successful return to work that measure more than the fact of returning. In summary, this research will validate a critical new instrument (worker assessment of organizational practices and policies), and by defining the association between organizational practices and policies and health outcomes, open avenues for interventions to enhance the well being of injured workers.

Psychosocial Outcomes in Working Farm Children Age 10-12

Investigator(s): Sharon J. Barton

Affiliation: Ohio State University (859) 323–6650

Keywords: socioeconomics, environmental exposure, ergonomics, psychological stressor, quality of life

Research Summary:
The goal of this program of research is to improve the health of children working on farms. Across the 2.2 million farms in the United States, nearly 1.3 million children live, play, and work. In addition to children who live on America’s farms and ranches, more than a half million children who do not reside there work as hired farm labor. Despite the popular view of farms as pastoral and serene, farmers know that the daily challenges of weather and economy make their work and home environments less than ideal. The purpose of this pilot study is to examine the physical, psychosocial and economic consequences of farm work on children aged 10–12. This proposal directly addresses the NORA priority areas of special populations at risk, social and economic consequences of work, and indirectly, traumatic injuries. The proposed study also directly addresses Objective 6 of the National Action Plan of the Childhood Agricultural Injury Prevention Initiative to “conduct research on costs, risk factors and consequences associated with children and adolescents who participate in agricultural work.” This proposal falls within the focus area of the Great Lakes Center to protect the agricultural safety and health of farm families. Specifically, this proposal will provide the center with important information to address pesticide exposure of children and to further understand acute unintentional injury and ergonomics of farm work performed by children. A cross-sectional survey of 330 children will be used to collect data on general demographics of the sample, stress and depressive symptoms, risk behaviors, previous injuries, economics, and psychosocial variables. The findings will provide the basis for developing and testing interventions to improve psychosocial outcomes of working farm children.

Sentinel Event Notification Systems for Occupational Risk (SENSOR): Oregon

Investigator(s): Michael Heumann

Affiliation: Department of Human Services (503) 731–4025

Keywords: economic costs, dermatitis, burns, priority populations, surveillance

Research Summary:
The Oregon Department of Human Services’ Environmental and Occupational Epidemiology (EOE) section will collaborate with a wide range of State and private partners to track workers’ compensation claims data and direct reports of occupational dermatitis, burns, and pesticide-related illness and injury. The sentinel and population-based data for each condition will be analyzed to characterize demographic patterns and causal factors in specific industries and occupations. Economic costs and case rates will be calculated. Particular attention will be paid to specific populations, including youth, temporary and migrant, and seasonal workers. Data for target conditions will be reviewed and selected case investigations conducted to identify underlying causes and new hazards. Results of these analyses and intervention recommendations will be shared with those stakeholders who have demonstrated interest in preventing targeted work-related illness and injury. EOE will work with partners to prioritize and pursue strategies to prevent the targeted conditions in high-risk populations. The project will be evaluated for the efficiency and usefulness of the model and its components. This evaluation will serve to improve Oregon’s surveillance system and demonstrate its reproducibility for other states. EOE’s surveillance methods, data findings, and intervention experiences will be disseminated through local publications, peer-reviewed journals, and shared with NIOSH and other States.

Sharp Instrument Injuries and Use of Clinical Services

Investigator(s): Gerardo Maupome

Affiliation: Kaiser Foundation Research Institute (503) 335–6625

Keywords: economic impact, sharp instruments injuries, health care workers, health services research

Research Summary:
The present study proposes to use detailed health records to explore links between sharp instrument injuries and exposure to blood and body fluids among health care workers and their personal use of clinical services. Such research will result in a more accurate assessment of the economic and health impacts of sharps injuries and body fluid incidents, as well as an estimation of the current systems in place to address the sequels of such incidents. By means of sophisticated electronic health information technology, detailed data will be obtained to explore the selection, design, and implementation of engineering systems, clinical protocols, and subsequent research efforts in the future. We will be using records from the Kaiser Permanente Northwest health maintenance organization clinical services, so barriers to access to care, lack of standardization of clinical/laboratory data and data entry procedures, and other confounders will be controlled for in the research design. More stringent measures than the already high standards currently in place will be employed to maintain the anonymity and confidentiality of these records during the investigation.

In the present study, we will undertake both a case-referent study and a pre-post study using electronic records of health care workers with a clinical position at Kaiser to establish and characterize whether an association exists between sharps injuries and body fluid incidents reported and the increased short- and long-term use of clinical services. We will also establish a classification of risk in terms of circumstances of sharps injuries and body fluid incidents by evaluating the relative contribution of the factors making up an employee profile (job description; mechanism of injury; purpose of offending device; and so on).

The results from this exploratory investigation will identify research opportunities to fill some of the gaps outlined in the National Occupational Research Agenda (www.cdc.gov/niosh/nora). We hope that these opportunities will lead in the future to a more accurate body of knowledge for policy makers, clinicians, and health plan administrators to ensure that timely interventions to ameliorate the effect of health hazards may be planned and implemented for at-risk employees. This study will provide important information to establish the current impact of sharps injuries and body fluid incidents in health care workers in terms of their use of clinical services and associated costs.

Social/Economic Impact of Injury/Illness in Career Roofers

Investigator(s): Laura Welch

Affiliation: Center to Protect Workers’ Rights
(301) 578–8500

Keywords: economic impacts, social impacts, roofers

Research Summary:
Standard, well developed instruments and techniques will be used to survey union construction workers at the time they leave their trade and 1 year later. Questions will include reason for leaving, nature of injury or illness if present, functional limitations at the time of leaving and after 1 year, and the social and economic consequences of their decisions. This study will focus on three groups of roofers:
• Those who leave the trade at any time in their careers before retiring
• Those who take early retirement
• Those who apply for disability retirement

A comparable group of roofers who continue to work will be interviewed also.

This project will develop a credible measure of the amount of disability, disability retirement, early retirement, and job change caused by injury, illness, and musculoskeletal disease among roofers. We will do the following:
• Determine what proportion of roofers leave the union before retirement age, retire early, or apply for disability retirement because of a work-related injury, work-related disease, or chronic medical condition
• Determine what proportion of roofers who continue to work in the trade have chronic symptoms from a work-related injury, work-related disease, or chronic medical condition
• Describe the social and economic impact of a work-related injury, illness, or premature retirement caused by a medical condition
• Evaluate changes in the social and economic status over time in roofers who leave the union, retire early, or take disability retirement
• Assess and describe the impact of work-related conditions and aging on the ability of roofers to remain employed in their trade

Social Inequalities in Occupational Health and Health Safety

Investigator(s): Allard E. Dembe

Affiliation: University of Massachusetts
(508) 856–6162

Keywords: occupational disease/disorder, racial/ethnic difference, socioeconomics, occupational health

Research Summary:
The specific aim of this study is to determine whether there are disparities in the occurrence of occupational injuries and illness and in associated medical care for work-related disorders, based on workers’ race, ethnicity, and socioeconomic status. This exploratory study will do the following:
• Advance the NORA health services research mission by illuminating socially based patterns of disease occurrence and medical care delivery
• Test a novel research methodology that employs large national health care databases to collect and analyze information about the health and health care experiences of injured workers

The proposed investigation also directly applies to the NORA focus on social and economic consequences. Social disparities in the incidence of work-related injuries and illness and inequalities in health care services are potentially a significant social impact of workplace accidents that must be considered when evaluating the overall human burden imposed on workers suffering job injuries. The study methodology is based on the use of three national population-based surveys of patients and health care providers containing information about patient sociodemographic attributes, employment experiences, and medical care services. Data sources include the National Ambulatory Medical Care Survey, the National Longitudinal Study on Youth, and the Health and Retirement Survey. Pilot studies conducted by this research team have demonstrated the usefulness of these databases in providing an innovative source of new information about this topic. The studies have provided initial evidence suggesting that blacks, Hispanics, and those of low socioeconomic status are more vulnerable to sustaining workplace injuries and receiving inferior medical care. This study will result in a descriptive analysis of work-related-cases databases and selected multivariate analyses to assess the interactive effect of patient sociodemographic characteristics with employment experiences, occupational health events, medical services, and vocational outcomes. This study has significant policy implications related to the NORA health services research objective of collecting new information about the determinants of health services for injured workers and thereby help to eliminate barriers to securing appropriate care. Eliminating social disparities in health is one of the two overarching national goals articulated in Healthy People 2010 and the focus of President Clinton’s and the Department of Health and Human Service’s national initiative, Eliminating Racial and Ethnic Disparities in Health.

Social Security Disability Insurance (SSDI) Benefit Impacts of
Occupational Injuries/Illnesses

Investigator(s): David S. Salkever

Affiliation: Johns Hopkins University
(410) 955–3141

Keywords: social security benefits, disability, workers’ compensation, economic consequences

Research Summary:
This project will explore the use of several large databases for developing national estimates of the impact of occupational injuries and illnesses on Social Security Disability Insurance benefit payments. The cost of the Insurance program has increased rapidly in the past decade and it is likely that a large portion of these benefits are attributable to occupational injuries and illnesses. The need to fund these Insurance benefits out of payroll taxes is a major concern in the national efforts to stabilize Social Security. Estimates of Insurance benefit savings that result from controlling occupational injuries and illnesses will be important for Federal health policy and priority setting.

Measurement of Social Security Disability Insurance benefit impacts requires data on individual workers covering a long enough time period to capture their progression from the onset of an occupational injury or illness to their receipt of Insurance benefits. Two data sources that capture data for large numbers of workers over a sufficiently long time period are private long-term disability claims data and large-scale panel surveys such as the Survey of Income and Program Participation. In this project, we will develop and test methods for generating national Insurance benefit impacts of occupational injuries and illnesses from both types of data. Long-term disability claims data represent the claims experience for one large insurer of policies covering approximately 500,000 workers of more than 1,400 employers during 1992–1997. Survey data will be analyzed from the 1996 Survey (a 4-year panel survey) and data from the 1992 and 1993 Surveys (including an extended followup for respondents to the Survey of Program Dynamics). Long-term disability claims data will be used to develop national estimates of Insurance benefit impacts of occupational injuries and illnesses for all U.S. workers covered by private long-term disability insurance. We will also examine variations in these estimates by diagnostic category of injury or illness, by region, and by industry. Insurance benefit impact estimates based on the Survey will cover occupational injuries and illnesses to all workers for which workers’ compensation benefits were received. We will also examine variations in these estimates by region, industry, worker demographics, and health problem category. We will examine strategies for benchmarking estimates from both Survey and long-term disability data against other national data sets. Exploratory statistical models will also be developed to explore the interaction of workers’ compensation program characteristics and Insurance benefit impacts.

Surveillance of Mortality and Morbidity in U.S. Workers

Investigator(s): Lora Fleming

Affiliation: University of Miami
(305) 243–5912

Keywords: trends of U.S. worker health and safety, morbidity and mortality, costs of injury and disease

Research Summary:
The databases available to examine national patterns and trends of U.S. worker health and safety are outdated, and in general, incomplete. The National Health Interview Survey (NHIS) is a multipurpose household survey of the U.S. civilian noninstitutionalized population conducted annually since 1957 by the National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention (CDC). NHIS has collected demographic, health, and employment data on more than 450,000 U.S. workers aged 18 and older in probability sampling of the entire U.S. population, with a mortality followup with cause of death from 1986 through 1995. Therefore, the NHIS database allows for longitudinal analysis of mortality data as a retrospective cohort study, as well as cross-sectional and trend analysis of the aggregate morbidity data collected annually from a representative sample of all U.S. workers for the past two decades. Using this uniquely representative and large database of the NHIS 1986–1994 surveys with mortality followup, the objectives of this proposed study are to evaluate the time trends for morbidity, and the longitudinal mortality associated with industry and occupation for the U.S. worker. After assembling the cohort of employed persons aged 18 and older, the investigators will examine the cause of specific mortality, and reported health and disability as summarized data for all annual NHIS interviews from 1986 to 1994, as well as the morbidity time trends by industry and occupation.

Hypotheses have been generated based on the historical literature and can be tested not only in terms of industry or occupational subgroups, but also in subgroups determined by important confounding variables such as age, gender, race/ethnic, socioeconomic status, and geographic region (depending on the subgroup sample size). The costs of injury and disease in terms of lost work time and use of medical services can be evaluated by industry or occupational subgroups. Cause-specific mortality will also be determined by industry or occupation subgroups, as well as by the same confounding variables. The investigators will create two study monographs, one on morbidity and one on mortality, to be made publicly available in a linked study Web site for researchers and the occupational health community. These data can be used to compare with prior studies, to develop new research hypotheses, and as a surveillance tool to evaluate time trends and occupational disease in the United States for the past two decades in both genders and in a variety of race-ethnic subpopulations. This study satisfies at least three NIOSH/NORA research priority areas:
• Surveillance research methods providing unique mortality and morbidity data on the entire U.S. workforce
• Unique mortality and morbidity data on older, race-ethnic, lower socioeconomic and gender-specific worker subpopulations in the United States
• Unique data on social and economic costs of workplace disease and injury

Sustained Work Indicators of Older Farmers

Investigator(s): Deborah Reed

Affiliation: University of Kentucky
(859) 257–9636

Keywords: priority populations, farmers, safety programs

Research Summary:
This prospective panel study will focus on the most rapidly aging workforce in the U.S.: the family farmer. This special population is known to suffer one of the highest rates of occupational injury and mortality. Farmers rarely retire from their vocation and work long past usual retirement age. A longitudinal design to track the sustained work patterns of aging farmers and to identify factors that influence their decision to remain in farm work will be used. The specific aims of this study are as follows:
• Identify factors that influence the sustained work of older farmers
• Develop health profiles (including physical and mental indicators) of older male and female farmers
• Develop exposure profiles for tasks related to agricultural work of older farmers
• Explore the sociocultural, family, and economic factors that influence the work practices and health of older farmers

The aims are congruent with the Healthy People 2010 objectives 20.1 and 20.2 to reduce farm worker fatalities and injuries. This study will enroll a partial sample from the Kentucky Farm Family Health and Hazard Surveillance Study (data collected 1994–1996) and their spouses (n=914) and an oversample of African American farmers and spouses (n=914), for a total of 1,828 persons enrolled from Kentucky and South Carolina. Measures on sociocultural, health and behavioral, and work environment factors will be collected through 6 waves of mailed surveys over 50 months. Hierarchical regression analysis will provide a quantitative model of the sustained work of older farmers. Descriptive and predictive analyses will be conducted by gender and race. Focus groups of male farmers, farm women, and farm couples will address items not obtainable from survey research. Attachment to farm life and the land, farm enterprise transfer, and the meaning of work will be explored in 18 focus-group sessions. Findings from the study will be used to design occupational counseling appropriate to age, gender, and race, as well as health and safety programs for aging farmers.

Unclaimed Injuries and Workers’ Compensation Adequacy

Investigator(s): Darius N. Lakdawalla

Affiliation: Institute for Civil Justice
(310) 393–0411

Keywords: health services, injuries, economic consequences

Research Summary:
The workers’ compensation system is designed to provide health care and compensation to all American workers who suffer injuries or illnesses in the workplace, without regard to fault. However, preliminary analysis suggests that only half of injured workers file claims. In light of this fact, we propose research with two key goals:
• To understand the economic, demographic, and policy factors that cause workers with occupational injuries and illnesses not to file claims
• To reassess the adequacy of workers’ compensation wage replacement rates, in light of the fact that many workers do not file claims or receive benefits of any kind

Consideration of the first goal reveals the surprising finding that the most vulnerable workers—those with the least alternative insurance against workplace injuries and illnesses—may be the ones least likely to file for workers’ compensation. They may face higher costs of filing workers’ compensation claims. To pursue the second goal, we calculate the total wages lost over several years as a result of a workplace injury, which we will compare with the benefits paid by workers’ compensation. These calculations will include the zero benefits paid to workers who do not file claims.

We will use the National Longitudinal Survey of Youth (NLSY), a public-use database sponsored by the United States Department of Labor, to explore the economic, demographic, and policy factors that affect filing claims. Use of the NLSY breaks new empirical ground in two important ways. First, the NLSY is a nationally representative database, containing extensive information about more than 4,000 workplace injuries, while previous analyses of workers’ compensation filing have been limited to the use of site-, firm-, or region-specific data. Second, the NLSY has longitudinal data on earnings as well as unclaimed injuries, while previous analyses of the adequacy of workers’ compensation have been limited to workers who file claims.

Understanding Occupational Injury and Illness Trends

Investigator(s): Ted R. Miller

Affiliation: Pacific Institute for Research and Evaluation
(301) 935–5688

Keywords: injury, occupational disease/disorder, occupational health/safety, socioeconomics

Research Summary:
This study will conduct longitudinal and cross-sectional analyses of the striking decline in occupational injury and illness rates in the United States during the 1990s by using a richer set of controls than in prior studies. Understanding the causes and economic consequences of these changes in injury rates is critical. Are gains concentrated among establishments of certain sizes, or in specific industries? Why are restricted work cases rising? Are tools like drug testing, formal and informal workplace safety training, OSHA inspections, and changes in state workers’ compensation systems helping to improve a firm’s injury experience? How have employee assistance program existence, scope, administrative structure, and in-house versus vendor operation affected occupational injury and illness rates? What cost savings have resulted for employers and society? We will study these questions using a set of surveys conducted at the establishment level by the Bureau of Labor Statistics (BLS). Although these surveys were conducted for different purposes, establishments in them can be linked using common identification variables. This provides a unique opportunity to study a wider range of questions than could be accommodated by any single survey. The primary dataset we will use is the Annual Survey of Occupational Injuries and Illnesses during 1987–1997. Each year, the Survey samples approximately 250,000 establishments and collects information about their injury experience for that year. While the Annual Survey is not designed to be a longitudinal survey, exploratory work on 1992–1996 data leads us to expect that a sizeable number of establishments will have injury information for the 11 years from 1987 to 1997. We will conduct separate longitudinal and cross- sectional analyses after linking the establishments in the Annual Survey to BLS surveys on their safety training, anti-drug programs, employee benefits, and other characteristics, as well as to information on OSHA inspections, and the characteristics of state workers’ compensation systems.
Our analysis will improve on prior studies of injury rates in the following ways:
• Linking different surveys provides us with a richer set of establishment-level information on workplace practices and job-related benefits that can be combined with information about OSHA inspections and workers’ compensation variables to provide a more detailed study of injury rates than is generally possible.
• By assembling a longitudinal dataset both at the industry and establishment level, we can estimate fixed- and random-effects models to mitigate the biases that commonly occur in cross-sectional analyses due to unobserved heterogeneity.
• We have estimates of both employer and societal cost per diagnosis that allow us to weight different injuries by their severity and estimate the cost-savings resulting from various policy measures.
We also will pilot test use of an input-output model to assess the impact of occupational injury/illness on the economy.

Use of Health and Social Services Following Work Injury

Investigator(s): Harry S. Shannon

Affiliation: McMaster University
(905) 525–9140

Keywords: social/economic consequences, social service utilization, mental health, health service utilization

Research Summary:
The main aim of this study is to investigate the health, economic, and social consequences of workplace injury for workers and their families, with particular emphasis on mental health and social service utilization. We propose using a linked database of administrative records developed in British Columbia, that includes Workers’ Compensation Board, public insured health services, income assistance, and vital statistics records. We will investigate the use of health and social services for 5 years before and after an injury for both workers and their families. These patterns will be compared to selected control groups. The major focus of the study will involve examining the following:
• Changes and patterns over time in health and social service utilization and suicide rates for injured workers and their controls
• Changes and patterns over time in health and social service utilization, and suicide rates for families of injured workers and families of controls
• Risk factors associated with increased utilization of health and social services for injured workers
• Risk factors associated with increased utilization of health and social services for families of injured workers

Outcomes to be examined include changes in, and specific types of uses of physician services, hospital services, income assistance, prescription drugs, continuing care services, and mental health care episodes will be explored for workers, their families, and controls. Mortality data, specifically suicide as cause of death, for 1994 to 2000 will also be examined for all groups. A number of potential confounders, such as age, sex, and income will be examined for all groups. Worker characteristics such as, age, sex, income, industry or job type, time on job before injury, type of injury (acute or chronic), and Workers’ Compensation Board costs, length of claim, and occurrence of other claims will also be examined. The substantial economic and social consequences of workplace injury underscore the need to document such consequences and how injuries affect the overall quality of life of workers and their families. By identifying characteristics of workers and their families who are most at risk (increased mental health and social assistance utilization) of being severely affected by a workplace injury, specific interventions can be targeted to provide services to help vulnerable families to better cope with workplace injuries and illnesses.

World Health Organization (WHO) Global Occupational Health Programme

Investigator(s): Gregory Goldstein

Affiliation: World Health Organization (WHO)
+41 22 791 3559

Keywords: occupational injuries, economic costs, economic evaluation methods, work-related diseases, global burden of work-related disease and injuries

Research Summary:
Safe and healthful work should be a fundamental right, yet every year, millions of people worldwide are denied that right. It is estimated that occupational injuries affect more than 250 million workers, and occupational diseases affect 160 million people annually. More than one million workers lose their lives from work-related causes every year. The human and economic costs are larger in developing countries, where many workers are concentrated in the informal sector or small scale enterprises, or in traditionally dangerous industries such as agriculture, logging, fishing, and mining.

In 1996 the World Health Assembly approved and endorsed the Global Strategy on Occupational Health for All. This Strategy has become the mandate of the Occupational Health Programme in the WHO Headquarters, the WHO Regional Offices, and the global Network of the WHO Collaborating Centres in Occupational Health. In 1999, following consultations with several partners, including NIOSH, it was agreed that WHO’s program on occupational health would focus its activities mostly on issues of increasing global concern, under three main areas:
• Evidence for policy, legislation, and support to decision-makers
• Capacity building
• Protection and promotion of workers’ health

Under the first area, sound information on the global burden of work-related diseases and injuries has been developed. A methodology is then developed for assessing economic impact, and that methodology is used along with the information on the global burden to estimate the economic impact of occupational illness and injury. In three countries, national plans of action will be prepared based on these analyses. Another proposal will study the impact of globalization and trade on occupational health, and develops recommendations for action. Under the second area, proposals to increase the national capacity of developing countries to strengthen occupational health by providing relevant and timely information in a usable format, and to enable members to build collaborative partnerships. Under the third area, proposals for the Regional Initiatives in Occupational Health, especially the Africa Initiative for occupational health in small-scale industries and in the informal sector, and related components of Practical Solutions, and workplace health promotion.

Workplace Safety in Atlanta’s Construction Industry:
Institutional Failure in Temporary Staffing Arrangements

Investigator(s): Chirag Mehta

Affiliation: University of Illinois
Chicago Center for Urban Economic Development
(312) 355–0744

Partner(s): Georgia Committee on Occupational Safety and Health
Atlanta/North Georgia Building and Construction Trades Council
Atlanta Labor Pool Workers’ Union
Building and Construction Trades Department, AFL-CIO

Keywords: temporary work, temporary staffing agencies, construction, workplace safety, workers’ compensation

Research Summary:
Demand for temporary workers in Atlanta’s building and construction industry is raising substantial concerns about safety conditions for this segment of the low-wage workforce. Data on workplace injuries, safety concerns, and provisions for safety equipment and job training suggest that workers supplied by temporary staffing agencies to building and construction contractors work in substandard safety conditions. Agency-supplied temporary workers cite insufficient job training and provisions for safety equipment as reasons for their safety concerns.

It is hypothesized that temporary agency workers in Atlanta’s building and construction industry experience substandard safety conditions in part because nonstandard employment arrangements between building contractors and temporary agencies undermine the efficacy of regulatory forces designed to improve workplace safety standards. Research has shown that the triangular employment arrangement between temporary workers, temporary agencies, and building contractors confounds the system of accountability successfully enforced by a system of safety-inducing incentives shaped by labor market forces, workers’ compensation insurance, and occupational safety and health regulations. Supply-side forces do not exert safety-inducing pressures on client-employers in temporary labor markets. Experience-rating workers’ compensation premiums paid by temporary agencies do not necessarily influence safety conditions at their client-employers’ job sites. Occupational safety and health regulations have only recently begun to adapt to the presence of multiemployer job sites. The result is that temporary agency workers, compared with their counterparts in standard employment arrangements, may have less access to appropriate safety equipment and more often work without proper training and supervision.

This project will examine the impact of the temporary staffing industry on workplace safety for temporary workers in the construction industry in the Atlanta metropolitan area. Particular emphasis is placed on examining how nonstandard employment arrangements undermine the system of incentives that encourage employers to adopt higher workplace safety standards.

Work-Related Motor Vehicle Crashes: Reducing the Burden

Investigator(s): Pamela Peele

Affiliation: University of Pittsburgh
(412) 624–2743

Keywords: occupational motor vehicles, municipal employee injuries, workers’ compensation

Research Summary:
Motor vehicle crashes are the single major occupational cause of death for U.S. workers. A great deal has been learned about prevention of motor vehicle crashes for the general public; much less is known about the underlying causes and effective preventive strategies for work-related motor vehicle crashes. Few studies have focused on nonfatal motor vehicle injuries in the workplace, and there is no comprehensive information about morbidity and costs of work-related motor vehicle crashes. This study represents an extension of our currently funded project Analysis of Capitated Payments in Workers’ Compensation through which we have developed a database and prospective record linking system to capture comprehensive data on the number, magnitude, and economic impact of work-related injuries for the 29,000 employees of the city of Philadelphia.

This project expands that database through additional record linking of existing databases to comprehensively analyze the nature and causes of occupational motor vehicle crashes involving city vehicles and to develop a risk factor model that accounts for morbidity and economic burden of these events. This proposal addresses the National Occupational Research Agenda (NORA) priority research areas of Traumatic Injuries; Health Services Research; Intervention Effectiveness Research; Social and Economic Consequences of Worker Illness and Injury; and Surveillance Research Methods. To achieve these goals, there are three highly focused aims:
• To create a comprehensive database of municipal employees and their work-related motor vehicle crashes—The database should be suitable for risk factor analysis using existing data on municipal workers in the city of Philadelphia. It should include a broad range of information about all city drivers and vehicles, focus on the morbidity and economic impacts of crashes, and provide the foundation for an ongoing crash surveillance system.
• To develop predictive models to define the determinants of work-related motor vehicle crashes—Models can be developed by examining risk factors related to driver characteristics, vehicle factors, and crash factors using retrospectively collected data on the city’s workforce and vehicles. Predictive models of work-related motor vehicle crashes should be tested and validated by using prospectively collected data on the city’s workforce and vehicles.
• To test and validate predictive models of work-related motor vehicle crashes by using prospectively collected data on the city’s workforce and vehicles

Work Scheduling, Overtime, and Work-Related Injuries in Construction

Investigator(s): Sue Dong

Affiliation: Center to Protect Workers’ Rights
(301) 578–8500

Keywords: economic conditions, work hours, overtime, work organizations

Research Summary:
Research has shown that work organization factors, including work schedules and working extended periods of overtime, may be detrimental to the safety and health of workers. As described in the National Occupational Research Agenda, these factors may contribute to occupational injury, work-related musculoskeletal disorders, cardiovascular disease, and other occupational health concerns. Very few studies, however, have looked at this particular work organization variable within the construction environment and identified whether it has any negative impact on the safety and health of construction workers.

This study tries to answer the following research questions:
• What are typical work schedules in construction and what differences in work scheduling exist between construction and other industries?
• How is work scheduling influenced by factors such as economic conditions, technology, demographics, and employment performance?
• How does work scheduling and overtime affect the safety and health of construction workers?

The National Longitudinal Survey of Youth (1979 cohort) was used for this study. Initial findings are as follows:
• Work scheduling in construction is different from scheduling in other industries.
• Hours worked per week and weeks worked per year increased steadily for all workers (construction and other industries) in this cohort during the study period.
• Injured workers were more likely to have worked overtime before being injured.
• Overtime was significantly associated with work-related injuries in construction, especially for construction laborers, after controlling for sex, age, occupation, employment size, and other potential confounders.

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