NIOSH
Economic Research Projects:
Extramural |
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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