Occupational injuries among adolescents in Washington State, 1988-1991

Assessing disabling and non-disabling injuries and illnesses using accepted workers compensation claims data to prioritize industries of high risk for Oregon young workers

INTRODUCTION

Young workers are especially vulnerable to occupational injuries and illnesses. There is a continued need to investigate injury burden among young workers across demographics and industry to inform targeted interventions. Workers compensation (WC) claims are important for quantifying work-related injuries and illnesses, however published studies have focused on disabling claims. This study extended previous research on Oregon young workers by including the most recent WC claims data to identify patterns of injury and high risk industries.

METHODS

We obtained all accepted disabling claims (N = 13,360) and a significant portion of non-disabling claims (N = 24,660) on workers aged 24 years and under from 2013 to 2018. Claim count, rate and cost were calculated by year, age, gender, industry, and injury type. A prevention index (PI) method was used to rank industries in order to inform prevention efforts.

RESULTS

Average annual disabling and non-disabling claim rates were 111.6 and 401.3 per 10,000 young workers. Workers aged 19-21 (disabling: 119.0 per 10,000 and non-disabling: 429.3) and 22-24 years (115.7 and 396.4) and male workers (145.3 and 509.0) had higher claim rates than workers aged 14-18 (80.6 and 297.0) and female workers (79.8 and 282.9). The most frequent injury types were "struck by/against" (35.6%) and "work-related musculoskeletal disorders (WMSDs)" (19.5%). High risk industries included agriculture, construction, and manufacturing for both genders combined. For female young workers, the highest risk industry was healthcare.

CONCLUSIONS

This study demonstrated the added value of non-disabling WC claims data. Using both disabling and non-disabling data and PI method, agriculture, construction, manufacturing and healthcare industries were identified as priority workplaces to prevent common and costly injuries among Oregon young workers. Practical Applications: While the industries identified are considered hazardous for all workers, findings in this study can guide targeted research and prevention efforts specific to young workers.

Incident Surveillance in New Jersey Career and Technical Education Programs, 1999 to 2008

Through school-sponsored career and technical education programs in New Jersey, students work part-time during or after school in paid and unpaid structured learning experiences regulated by the New Jersey Department of Education. Schools submit information on “reportable incidents,” injury or illness resulting in physician treatment. Incidents including reported use of personal protective equipment (PPE) were assessed; 1,600 incident reports (1999 to 2008) were received. Attributes such as type and severity, body parts affected, and PPE use for incidents occurring at school among students grades 9 to 12 or labeled as “adults” during school hours ( n = 285) were analyzed. Older teens incurred more injuries. PPE use was consistently low across age and gender. Students most frequently experienced knife injuries involving fingers and hands. Results identified potential injury determinants and training and intervention topics such as PPE, and support development of an enhanced reporting form.

Injuries and Seasonal Risks among Young Workers in West Virginia—A 10-Year Retrospective Descriptive Analysis

This study used workers' compensation data to examine seasonal trends of compensable injuries among workers 14 to 24 years old during a 10-year period. These workers had higher rates of occupational injuries in major classes of industry (e.g., service, manufacturing, and agriculture) during summer and non-summer months. The overall rate of occupational injury was significantly higher for male workers than female workers in all age groups ( p & .001). Young workers experienced occupational injuries within less than 3 hours of starting a shift. Among males, injury rates were highest in the manufacturing industry for those 14 to 18 years old and in the service industry for those 22 to 24 years old for both seasons. These results indicate that preventing injuries among young workers should be a primary concern of education and health and safety professionals and parents.

Nurse Practitioners' Comfort in Treating Work-Related Injuries in Adolescents

This study examined nurse practitioners' (NPs) previous experiences and comfort levels in treating adolescents with work-related injuries in two states where NPs have statutory authority to treat work-related injuries. The authors surveyed all actively licensed NPs in Washington and Oregon (N = 4,849). Factors associated with NPs' previous experiences and comfort in treating adolescents with work-related injuries were identified using modified Poisson regression. Less than a quarter of respondents (21.1%, n = 225) reported having ever treated an adolescent for a work-related injury. Nearly half (43.6%) of respondents reported being uncomfortable or very uncomfortable in treating adolescents with work-related injuries. Previous experience and male gender were associated with greater likelihood of feeling comfortable (p < .01). Nurse practitioners serve as primary care providers for adolescents who may experience work-related injuries. This study documents the need for developing educational and outreach efforts to better prepare NPs to treat adolescents' work-related injuries.

Perceptions of Supervision Among Injured and Non-Injured Teens Working in the Retail or Service Industry

According to the National Institute for Occupational Safety and Health (NIOSH), a teen is injured every 9 minutes at work. Workplace supervision may affect whether teens are injured on the job. Because research on workplace supervision among teens is limited, the objectives of this study were to characterize the perceptions of supervision among injured and non-injured teen workers and assess the characteristics and perceptions of supervisors that may be associated with work-related injuries. In 2011, a cross-sectional survey was conducted among high school students. Teens who worked in retail or service industries (n= 270) were included in the sample. Non-injured teens were more likely to have reported that their supervisors cared about their safety, were helpful, listened well, and ensured that teen workers understood workplace safety. Most teens (70%) did not feel comfortable talking about safety issues with their supervisors. The importance of supervision and how supervisors are perceived in the workplace may be significant in creating a safety culture that leaves a lasting impression.

Teen worker safety training: methods used, lessons taught, and time spent

Safety training is strongly endorsed as one way to prevent teens from performing dangerous tasks at work. The objective of this mixed methods study was to characterize the safety training that teenagers receive on the job. From 2010 through 2012, focus groups and a cross-sectional survey were conducted with working teens. The top methods of safety training reported were safety videos (42 percent) and safety lectures (25 percent). The top lessons reported by teens were "how to do my job" and "ways to spot hazards." Males, who were more likely to do dangerous tasks, received less safety training than females. Although most teens are getting safety training, it is inadequate. Lessons addressing safety behaviors are missing, training methods used are minimal, and the time spent is insignificant. More research is needed to understand what training methods and lessons should be used, and the appropriate safety training length for effectively preventing injury in working teens. In addition, more research evaluating the impact of high-quality safety training compared to poor safety training is needed to determine the best training programs for teens.

Epidemiology of work-related traumatic brain injury: a systematic review

OBJECTIVE

This systematic review aimed to describe the burden and risk factors of work-related traumatic brain injury (wrTBI) and evaluate methodological quality of existing literature on wrTBI.

METHODS

A search of electronic databases (MEDLINE, EMBASE, PsycINFO, and CINAHL) was conducted to identify articles published between 1980 and 2013 using a combination of terms for work, TBI, and epidemiology, without geographical limitations.

RESULTS

Ninety-eight studies were included in this review, of which 24 specifically focused on wrTBI. In general, male workers, those in the youngest and oldest age groups, and those working in the primary (e.g., agriculture, forestry, mining) or construction industries were more likely to sustain wrTBI, with falls being the most common mechanism of injury.

CONCLUSIONS

This review identified workers at highest risk of wrTBI, with implications for prevention efforts. Future research of better methodological quality is needed to provide a more complete picture of the epidemiology of wrTBI.

Reduced sleep duration and history of work-related injuries among Washington State adolescents with a history of working

BACKGROUND

The relationship between sleep and occupational injury risk has not been adequately explored for working adolescents.

METHODS

Data were analyzed from the 2010 Washington State Healthy Youth Survey of 8th, 10th, and 12th grade public school students. Teens reported average school and weekend night sleep hours and history of work-related injury that received medical treatment. Multivariable logistic regression evaluated the association between sleep duration and occupational injury.

RESULTS

Of 4,144 working teens, 6.4% reported ever having an occupational injury. Teens who sleep ≤5 hr/school night had greater odds of a history of occupational injury than those sleeping 8 hr (OR:2.91, 95% CI:1.85-4.57). No significant association was observed for weekend night sleep duration.

CONCLUSIONS

Reduced school night sleep was associated with increased odds of work-related injury in adolescents. Long hours and late night schedules may contribute to decreased sleep time and potentially have other health and developmental impacts for youth.

Workplace injuries and risk reduction practices in Malaysia

INTRODUCTION

This study on workplace injuries and risk reduction practices was part of the Malaysia National Health Morbidity Survey III (NHMS III) conducted in 2006.

METHODS

This cross-sectional population-based survey was conducted to determine the incidence of workplaces injuries and assess the magnitude of some important risk reduction practices among workers. Data were gathered through face-to-face household interviews using a pre-coded questionnaire.

RESULTS

Of the 22 880 eligible respondents, 88·2% (20 180) responded. The incidence rate for injuries at the workplace was 4·9 per 100 (95% CI: 4·6-5·2). The overall proportion of workers who had received occupational safety and health (OSH) training before or within 1 month of starting work was 33·6%. Among respondents who perceived that personal protective equipment (PPE) was required at their workplace, only 38·9% (95% CI: 37·8-39·4) were provided with it by their employers.

DISCUSSION

Further studies are urgently needed to identify reasons for and management of the low uptake of risk reduction practices. This issue needs to be addressed to ensure the safety and health of our working population.

Working for mom and dad: are teens more likely to get injured working in family-owned businesses?

Recent controversy regarding the issue of children working in family-owned businesses has come to the forefront, pitting safety and health versus parent's right to teach their children the family trade. While studies have characterized injury among working teens, no studies have assessed work and injury among teens employed in family-owned businesses. This study is the first to examine teenagers working in family-owned businesses and to compare the experiences of teens working in family-businesses to the experiences of other working teens. A questionnaire was distributed to 8,085 teens in high schools throughout the five public health regions of Wisconsin. A total of 6, 810 teens responded (84%). Overall 2,858 high school teens aged 14-17 reported working (42%); of which 963 (34%) worked in a family-business. Teens working in family-businesses were more likely to report that their injury was severe, affecting their activities for more than three days, compared with other working teens (33% vs. 21%, P = 0.05). The percentage of teens working in family-businesses that reported broken bones or crushed body parts was 17% compared to only 5% of other-working teens. Additionally, teens employed in family-businesses were more likely to file for workers' compensation (28% vs. 12%, P = 0.005). Teens working in family-owned businesses may be at a greater risk for more severe injury based on the jobs and tasks they are doing. Teens working in family-owned businesses were more likely to report engaging in dangerous tasks, including some that are illegal under the Hazardous Occupation Orders. More research is needed to assess the dynamics that exist for teens working in family-owned businesses.

Assessing occupational health and safety of young workers who use youth employment centers

BACKGROUND

Adolescents and young adults who are out of school are at elevated risk for a work injury.

METHODS

To obtain more information on this "high risk" group of young workers, young people at youth employment centers across Ontario were asked through an online survey about training, unsafe work conditions, work injuries and safety knowledge.

RESULTS

The 1,886 youth who completed the survey reported a medically attended work injury rate of 14.45 per 100 FTEs. Also, the most common unsafe work conditions were dust/particles, trip hazards and heavy lifting. In addition, many young workers reported using much of their income for living essentials (e.g., rent).

CONCLUSIONS

Though not a representative sample, it appears that youth using employment centers experience many unsafe work conditions and work injuries. While many report safety training, the nature and effectiveness of this training remains to be determined. The large portion of young workers out of school and working for living essentials included in this sample suggest that youth employment centers should be considered in future prevention efforts targeting this vulnerable subgroup of workers.

Occupational injuries to Oregon workers 24 years and younger: An analysis of workers' compensation claims, 2000-2007

BACKGROUND

Occupational injuries to adolescents and young adults are a known public health problem. We sought to describe and estimate rates of occupational injuries to workers younger than 25 years of age in Oregon during an 8-year period.

METHODS

Oregon workers' compensation disabling claims data (n = 23,325) and one commercial insurance carrier's non-disabling claims data (n = 16,153) were analyzed. Total employment from the Local Employment Dynamics of the U.S. Census Bureau and the Oregon Labor Market Information System was used as a denominator for rates.

RESULTS

Injuries were more frequent among 22-24 year olds and among males, though females accounted for a higher proportion of claims in the youngest age group. The most common injury type was a sprain or strain, but lacerations and burns were more frequently reported in the 14-18 year olds. When non-disabling claims were included, the rate of injury for 14-18 year olds doubled. The overall rate of injury was 122.7/10,000 workers, but was higher in the construction, manufacturing, and transportation sectors, and in the agriculture, forestry, fishing, and hunting sector for older teens and young adults.

CONCLUSIONS

Young workers continue to be at risk for occupational injuries. Our results show that specific interventions may be needed for older teen and young adult workers to reduce their rate of injury.

Occupational injuries in children and adolescents in emergency services of Aracaju, Brazil

BACKGROUND

The incidence of occupational injuries among children and adolescents is not well known in Brazil. This study aims to identify occurrences and characteristics of occupational injuries in children and adolescents at the two major public emergency hospitals in Aracaju, Brazil.

METHODS

In a cross sectional study, all children and adolescents (5-17 years) attending the services because of accidents of external cause in October-November 2006 and May-June 2007 were evaluated. The patients and their responsibles were interviewed to obtain information about the injury, family and patient characteristics and relation to work in the last 7 days. Data were analysed in number and percentages using descriptive statistics and chi-squared and Fisher's exact tests.

RESULTS

There were 917 patients with injuries of external cause in the period studied. Seventy-one (8%) had worked in the last 7 days and in 40 (4%) the injury was related to work, with 2 (0.21%) deaths. Occupational injuries occurred more frequently in boys (95%); in the 14- to 17-year-old age group (77%); in agricultural (46%) and commercial activities (18%); to help with family budget (54%); without any safety training (73.5%) and not using personal protective equipment (94%). Main mechanisms of injuries were transportation incidents (42.5%) and contact with tools and equipment (27.5%). Injuries were mostly fractures (37.5%) and lacerations (22.5%). Upper extremities were injured in 49% of cases and the lower extremities in 26.5%. Comparison between the two groups (accident related or not related to labour) shows that there were significant differences for gender, age group, the main mechanism of injury and the part of the body injured, but not for the nature of injury.

CONCLUSION

Working children and adolescents have been injured during their occupational activities and work-related injuries represent 4% of injuries of external causes in the emergency departments of Aracaju with 5% lethality.

The effects of age and type of carrying task on lower extremity kinematics

The purpose of this study was to determine the effects of age, load amount and load symmetry on lower extremity kinematics during carrying tasks. Forty-two participants in four age groups (8-10 years, 12-14 years, 15-17 years and adults) carried loads of 0%, 10% and 20% body weight (BW) in large or small buckets unilaterally and bilaterally. Reflective markers were tracked to determine total joint range of motion and maximum joint angles during the stance phase of walking. Maximum hip extension, hip adduction and hip internal rotation angles were significantly greater for each of the child/adolescent age groups as compared with adults. In addition, maximum hip internal rotation angles significantly increased when carrying a 20% BW load. The observation that the 8-10-year-old age group carried the lightest absolute loads and still displayed the highest maximum hip internal rotation angles suggests a particular necessity in setting carrying guidelines for the youngest children. STATEMENT OF RELEVANCE: Bucket-carrying tasks were analysed as a function of age group, load amount and load symmetry. Hip joint rotations significantly increased when carrying 20% BW loads and in children as compared to adults, which suggests a particular necessity in setting carrying guidelines for the youngest age group (8-10 year olds).

Time trends and predictive factors for safety perceptions among incoming South Australian university students

PROBLEM

Young workers are over-represented in injury statistics. In order to develop injury prevention strategies, this study investigated time trends and predictive factors relating to safety skills, confidence, and attitudes.

METHOD

Annual surveys were conducted from 2006-2009 among incoming students at the University of Adelaide. The questions addressed safety training, injury experience, and health and safety perceptions.

RESULTS

Time trends in training, perceived safety skills, confidence, and attitudes were not significant. In terms of skills and confidence, the most important correlate was safety training outside of high school (odds ratio=1.6), especially when repeated, assessed, or in face to face mode. Feeling strongly about safety issues was best predicted by injury experience (OR=1.7) and gender.

DISCUSSION

These results emphasize the value of assessed training, but they are also consistent with published U.S. data, indicating no improvement over time. It is suggested that there be a more integrated approach in safety education, involving schools and workplaces.

IMPACT ON INDUSTRY

By developing an understanding of student safety perceptions and experiences, this research aims to target strategies to reduce the excess injury rate for young workers. Workplaces should be more aware of the limitations of school-based safety education and a more integrated and evidence-based approach should be developed, involving schools and workplaces.

An Injury Prevention Strategy for Teen Restaurant Workers

High levels of youth employment, workplace hazards, and characteristics unique to adolescents contribute to a relatively high incidence of injuries among teens in the restaurant industry. This article discusses the ProSafety model of injury prevention among teen restaurant workers. Through integration with an existing career and technical education program, the ProSafety project seeks to prevent occupational injuries among the teen worker population through classroom safety education and internship skills reinforcement. ProSafety is the product of an innovative collaboration with occupational health nurses, business professionals, educators, and government. Its approach is derived from Social Cognitive Theory, is consistent with key values and strategies of occupational health nurses, and provides lessons for practitioners seeking to reduce occupational injuries in food service or among other populations of adolescent workers.

An injury prevention strategy for teen restaurant workers. Washington State's ProSafety project

High levels of youth employment, workplace hazards, and characteristics unique to adolescents contribute to a relatively high incidence of injuries among teens in the restaurant industry. This article discusses the ProSafety model of injury prevention among teen restaurant workers. Through integration with an existing career and technical education program, the ProSafety project seeks to prevent occupational injuries among the teen worker population through classroom safety education and internship skills reinforcement. ProSafety is the product of an innovative collaboration with occupational health nurses, business professionals, educators, and government. Its approach is derived from Social Cognitive Theory, is consistent with key values and strategies of occupational health nurses, and provides lessons for practitioners seeking to reduce occupational injuries in food service or among other populations of adolescent workers.

Supervising structured learning experiences for students in New Jersey: training teachers in school-based occupational health and safety practice

This article describes the structured learning experience (SLE) supervisory training curriculum coordinated by the New Jersey Safe Schools Program, a project supported by the New Jersey Department of Education, Office of Career and Technical Education. The New Jersey SLE supervisory training program comprises training courses and resources for teachers who supervise secondary school minors (students aged 16 to 18 years and special needs students up to age 21) enrolled in various programs--college preparatory, general education, career and technical education, career academies, and special education. One goal of the program is to enhance knowledge and awareness of legal and scientific occupational safety and health principles to ensure safe, rewarding work experiences inside and outside classrooms. This article describes our experiences and data available from November 2005 to January 2008. We summarize relevant federal and state laws and agencies; potential exposure agents and microenvironments of concern; stakeholders and training partners; process and immediate impact data from SLE supervisory trainings; and lessons learned to inform states that may adopt similar strategies or regulations.

Work exposures, injuries, and musculoskeletal discomfort among children and adolescents in dairy farming

Little research is available about the specifics of child or adolescent work on dairy farm operations. The objective of this study was to investigate work performed by children and adolescents on these operations. The authors administered mail questionnaires to a community-based, age- and operation size-stratified sample of individuals aged 6 to 18 (n = 240) who worked on dairy operations in Wisconsin. Data were collected in 1999. The 197 children and adolescents reported averaging 567 hours of dairy farm work in the last year (10.9 hours/week) and completed over 1/3 of all calf feeding, 1/5 of the milking, 1/5 of cow feeding, and 1/10 of tractor operation hours on their farm during the weeks they worked. Some of these young workers reported accomplishing duties also judged by some experts as hazardous work, including nearly half of the 9- to 11-year-olds driving tractors. Six nonfatal injuries were reported that required stopping work (14.6 per 100 full time equivalents per year), including those that required medical attention. Musculoskeletal discomfort and disability reports were unremarkable compared to existing studies of general and working populations. Wisconsin dairy farm youth appeared to be working no more hours per week than their peers in other studies of agricultural populations. Adolescents and some children largely performed the same range of tasks and often the same scope of work as adults, including some performing hazardous work. There is a need for further investigations with larger samples of dairy youth to confirm these findings. The exposures of very young workers to hazardous tractor driving and tower silo tasks suggest that there is an urgent need for improved and validated interventions to reduce these exposures.

Characteristics of occupational burns in Oregon, 2001-2006

BACKGROUND

Occupational burns are known to be a serious public health concern. This article describes work-related burns in Oregon between 2001 and 2006.

METHODS

Oregon Workers' Compensation (WC) burn claims were analyzed; data from a commercial insurance carrier (CIC) was used to characterize non-disabling burn claims. To ensure that our primary data source (WC) captures as many burn cases as possible, we compared hospitalized cases to a regional burn center (RBC) and Oregon hospital discharge index (HDI) data.

RESULTS

The WC burn injury rate ranged from a high of 1.8 per 10,000 workers in 2001 to a low of 1.4 per 10,000 in 2004. We identified 2,165 accepted burn claims in CIC data, of which 85% were non-disabling. We matched data from a regional burn center to a subset of hospitalized claims from WC data and found an additional 44 cases of occupational hospitalized burns representing a 3% increase in total cases captured.

CONCLUSIONS

Occupational burns continue to be a problem for working Oregonians, and the use of additional data sources outside of WC augments our surveillance system.

Adolescent occupational injuries and workplace risks: an analysis of Oregon workers' compensation data 1990-1997

PURPOSE

Injuries to adolescents from occupational activities has been recognized as a significant public health concern. The objective of this study was to quantify adolescent injury rates, analyze risk factors, and measure the severity of injuries sustained using Oregon workers' compensation data.

METHODS

From 1990-1997, a total of 8060 workers' compensation claims, submitted by claimants 16-19 years old, were accepted by Oregon and used in these analyses. Data from the Bureau of Labor Statistics were used to derive injury rates.

RESULTS

An overall estimated claim rate of 134.2 (95% confidence interval [CI] 124.9-143.6) per 10,000 adolescent workers was found, with males having over twice the rate of females. The total average annual claim cost was $3,168,457, representing $3145 per claim. The average total temporary disability period per claim was 22.3 days. Precision production workers had the highest claim rate of 296.2 (95% CI 178.9-413.4) and highest associated costs ($8266) for all occupations, whereas those in the farming/fishing/forestry occupation had the longest average periods of indemnification with 31.6 days. Day shift workers had the highest claim rates and most severe injuries relative to other shifts.

CONCLUSION

The injury rates found among adolescent workers demonstrates that continued safety interventions and increased training are needed. Because of high claim rate and injury severity, particular attention should be focused on adolescents in food service, manufacturing, and agricultural occupations. Understanding the differences of adolescent circadian rhythm patterns in establishing work schedules and supervisory practices could also prove valuable for decreasing injury risk.

Understanding the ergonomic risk for musculoskeletal disorders in the United States agricultural sector

INTRODUCTION

Farming is a very large industry in the United States. Understanding the risks for injuries and more specifically musculoskeletal disorders in this industry poses a challenge for health officials.

METHODS

A review was conducted of the existing peer-reviewed publications prior to December 2006 about injuries and musculoskeletal disorders for farmers and farm workers. The aim was to review existing knowledge concerning: (1) the prevalence, types, and causes of farm-related injuries, paying particular attention to musculoskeletal disorders and the special populations within the agricultural sector, and (2) interventions that have been developed to reduce risk factors associated with farm-related injuries.

RESULTS

Farmers and farm workers experience high rates of low back, shoulder, and upper extremity disorders. Musculoskeletal disorders may disproportionately affect farm youth and migrant workers due to the types of farm tasks performed. There is an urgent need for improved and validated interventions to reduce exposures and to improve the health of farmers and farm workers.

DISCUSSION

Future farm-related musculoskeletal disorder research should emphasize: (1) better identification of exposures for special populations, (2) development of interventions for diverse farm populations, and (3) identification of additional exposures for musculoskeletal disorders. Inadequate understanding of musculoskeletal disorders in farming impedes efforts to prevent this common and important type of occupational injuries on farms.

An ecological study of regional variation in work injuries among young workers

BACKGROUND

The investigation of geographic variation in occupational injuries has received little attention. Young workers 15 to 24 years are of particular concern because they consistently show elevated occupational injury rates compared to older workers. The present study sought to: (a) to describe the geographic variation of work injuries; (b) to determine whether geographic variation remained after controlling for relevant demographic and job characteristics; (c) to identify the region-level factors that correlate with the geographic variation.

METHODS

Using workers compensation claims and census data, we estimated claim rates per 100 full-time equivalents for 15 to 24 year olds in 46 regions in Ontario. A total of 21 region-level indicators were derived primarily from Census and Labour Force Survey data to reflect social and material deprivation of the region as well as demographic and employment characteristics of youth living in those areas.

RESULTS

Descriptive findings showed substantial geographic variation in young worker injury rates, even after controlling for several job and demographic variables. Region-level characteristics such as greater residential stability were associated with low work injury rates. Also, regions with the lowest claim rates tended to have proportionally fewer cuts and burns than high-claim-rate regions.

CONCLUSION

The finding of substantial geographic variation in youth claim rates even after controlling for demographic and job factors can aid in targeting prevention resource. The association between region-level indicators such as residential stability and youth work injury suggests that work injury prevention strategies can be integrated with other local economic development measures. The findings partially support the notion that work safety measures may be unevenly distributed with respect to regional socio-economic factors.

Work-related hazards and workplace safety of US adolescents employed in the retail and service sectors

OBJECTIVE

Our goal was to examine the hazard exposures, work experiences, and workplace safety training of adolescents employed in retail and service jobs in the United States.

METHODS

This was a cross-sectional telephone survey among working adolescents, 14 to 18 years old, in the continental United States. Data were collected in 2003. Survey items measured self-reported hazard exposures, training, and supervision experiences of working adolescents.

RESULTS

Teens reported working an average of 16.2 hours per week during the school year, including working an average of 2.9 times per week after 7 PM on school nights and 2.6 nights per week after 9 PM. Thirty-seven percent of those under age 16 reported working after 7 PM on a school night, indicating employer violation of federal law. Teens typically perform multiple kinds of tasks in a given job. Higher proportions of females than males are involved in cash handling (84% vs 61%), whereas males are more likely than females to be involved in physically challenging tasks, such as lifting heavy objects (57% vs 22%) or working at heights (35% vs 17%). Despite federal regulations prohibiting teens under 18 from using certain types of dangerous equipment (eg, slicers, dough mixers, box crushers, paper balers) or serving or selling alcohol in places where it is consumed, 52% of males and 43% of females reported having performed > or = 1 prohibited task. Although more males reported receiving safety training, they were also more likely to report working without supervision than their female counterparts.

CONCLUSIONS

Teens are exposed to multiple hazards, use dangerous equipment despite federal prohibitions, and work long hours during the school week. They also lack consistent training and adult supervision on the job. It is important for adolescent medicine practitioners to become involved in prevention efforts through both anticipatory guidance and policy advocacy.

Severe back pain among farmworker high school students from Starr County, Texas: baseline results

PURPOSE

This cohort study is among the first to estimate the prevalence of and examine potential risk factors for severe back pain (resulting in medical care, 4+ hours of time lost, or pain lasting 1+ weeks) among adolescent farmworkers. These youth often perform tasks requiring bent/stooped postures and heavy lifting.

METHODS

Of 2536 students who participated (response rate across the three public high schools, 61.2% to 83.9%), 410 students were farmworkers (largely Hispanic and migrant). Students completed a self-administered Web-based survey including farm work/nonfarm work and back-pain items relating to a 9-month period.

RESULTS

The prevalence of severe back pain was 15.7% among farmworkers and 12.4% among nonworkers. The prevalence increased to 19.1% among farm workers (n = 131) who also did nonfarm work. A multiple logistic regression for farmworkers showed that significantly increased adjusted odds ratios for severe back pain were female sex (4.59); prior accident/back injury (9.04); feeling tense, stressed, or anxious sometimes/often (4.11); lifting/carrying heavy objects not at work (2.98); current tobacco use (2.79); 6+ years involved in migrant farm work (5.02); working with/around knives (3.87); and working on corn crops (3.40).

CONCLUSIONS

Areas for further research include ergonomic exposure assessments and examining the effects of doing farm work and nonfarm work simultaneously.

Racial and ethnic disparities in work-related injuries among teenagers

PURPOSE

No current data exist on the difference in occurrence of work-related injury among minority teens, compared with white teens. Therefore, this study investigated the differences in workplace injury among white teens, African-American teens, and Hispanic teens.

METHODS

An anonymous questionnaire was administered to teens in five Wisconsin school districts in May 2003. The questionnaire assessed work, characteristics of work, injury, characteristics of injury, and school performance.

RESULTS

There were 3574 teens who worked during the 2002-2003 school year. The distribution of jobs worked was similar among the races/ethnicities. Both Hispanic and African-American teens were more likely to report working more than 23 hours per week, compared with white teens. Both minority groups were significantly more likely to report having sustained a serious injury compared with white teenagers (adjusted odds ratio [AOR] = 3.07, 95% confidence interval [CI] = 1.86-5.04 for African-American teens; AOR = 2.27 95% CI = 1.27-4.05 for Hispanic teens).

CONCLUSIONS

Minority teens are more likely to report sustaining injuries at work. Although the jobs minority teens were working were similar to white teens, some of the characteristics of their jobs may be responsible for more hazardous working conditions, leading to a greater number of injuries.

The relationship between work permits, injury, and safety training among working teenagers

BACKGROUND

No information exists on the differences between teenagers with work permits and teenagers without work permits in regards to workplace injury, near-miss incidents, and safety training.

METHODS

In May 2003, an anonymous questionnaire was administered to 7,506 teens attending high school throughout the five public health regions of Wisconsin. All students in the participating school districts were invited to respond. The questionnaire included questions about employment, injury, safety and health training, and school performance.

RESULTS

Overall, 6,382 teens participated in the survey and 49% reported working during the school year. Seventy percent of all working teens reported having a permit. Females were more likely to have work permits compared with males (71% vs. 68%, P = 0.018). The percentages of teens with permits varied by job and ranged from 55% for teens working in tree-trimming/cutting to 85% for teens working in restaurants or fast food establishments. Teens with work permits were no less likely to be injured than those without permits (AOR = 1.07, 95% CI: 0.85-1.33) and no less likely to have a near-miss incident (AOR = 1.28, 95% CI: 0.99-1.63). However, teens with permits were significantly more likely to be given safety training than teens without permits (AOR = 2.61, 95% CI: 2.21-3.10).

CONCLUSIONS

Although teens with work permits were more likely to report receiving safety training than teens without permits, the occurrence of injury was no different among the groups.

Occupational injury among Rhode Island adolescents: an analysis of workers' compensation claims, 1998 to 2002

OBJECTIVES

We sought to examine occupational injuries sustained by adolescent workers during a 5-year period.

METHODS

Workers' compensation claims from Rhode Island were used to assess injuries of 15- to 19-year-old employees (n = 8321) from 1998 to 2002. Baseline employee population estimates were derived using the Current Population Survey.

RESULTS

The annual estimated adolescent claim rate was 6.6 per 100 workers (95% confidence interval = 6.1-7.1), with annual average costs of $614,182. Injury rates increased with employee age, hours worked, and for day and nightshift employees relative to evening shift workers. The highest proportion of claims by industry was in eating establishments, and the average indemnification duration was 13.0 days.

CONCLUSIONS

Specific emphasis should be placed on increasing safety training and preventative interventions for teenagers in hazardous occupations and for those working longer hours.

Age-related differences in work injuries: a multivariate, population-based study

BACKGROUND

Many population-based studies find that the rate of work injuries is higher among adolescent and young adult workers compared to older adults. The present study examines age-related differences in work injuries, with an emphasis on adjusting for the potential confounding effects of job characteristics.

METHODS

Age-related differences in work injuries were examined in a representative sample of 56,510 working Canadians aged 15 years and over. Respondents reported work-related injuries and job characteristics (e.g., occupation) in the past 12 months. Total hours worked in the past year were computed for each worker and accounted for in the logistic regressions. Analyses were stratified by gender.

RESULTS

For men, adjusting for job characteristics substantially reduced, but did not eliminate the elevated risk status of adolescent and young adult workers. For women, only young adult women showed an elevated risk of work injury with job characteristics controlled.

CONCLUSIONS

This is one of the few multivariate studies specifically examining contributors to age-related differences in work injuries in a population-based sample of workers. The substantial reduction in age-work injury association in the fully adjusted model suggests that differences in the types of jobs young workers hold play a critical role in their high-risk status.

Understanding work-related injuries in children: a perspective in West Virginia using the state-managed workers' compensation system

BACKGROUND/PURPOSE

Little data exist that defines the consequences of occupational injuries in children. Traditional assessment of work-related injury is coupled with disability payments based on salary, which give little insight into etiology and severity. The authors hypothesize that the risk and pattern of occupational injuries in young workers are different then adults.

METHODS

Claims from 1996 through 2000 were analyzed from the West Virginia Bureau of Workers Compensation. To define the significance of an injury, child and adult groups were subdivided into injuries that required surgery (ie, serious injuries). Current Procedural Terminology (CPT) codes for anesthesia and surgical procedures were cross referenced with the claims to ensure group designation. Relative risks (RR) were used to compare groups.

RESULTS

Between 1996 and 2000, 364,063 claims were submitted, 14,093 in workers < or =19 years of age. Two hundred seventy claims in children required surgery. Serious injuries in children occur more often in boys 2.2x mainly in the (16 to 24 hours) evening (48% v 23.13%; P <.05) and in July/August (26.5 v 18.4; P <.001). Falls were the main mechanism of injury. Proportionately fingers (1.70x) and hands (1.64x, 1.6 to 1.7) were injured in children. Lacerations (3.4x), fractures (1.4x), and amputations (3.75x) frequently resulted in general anesthetic procedures, and the RR of these injuries were increased versus adults. Service, manufacturing, construction, and agriculture were the main injury-related occupations in children.

CONCLUSIONS

For any job category, injuries in children have unique features, tend to be more serious, and require a surgical intervention proportionately more frequently than adults.

Review of the Federal Child Labor Regulations: updating hazardous and prohibited occupations

BACKGROUND

Child labor regulations are intended to protect our young and most vulnerable workers. While regulations are not the only strategy for providing a safe and healthy work environment for young workers, they are the first step in setting the community standard to protect them. The world of work has changed since the first child labor laws were issued in 1939. The U.S. Department of Labor (DOL) enlisted assistance from the National Institute for Occupational Safety and Health (NIOSH) to evaluate the current list of hazardous and prohibited occupations and to make recommendations for changes to the regulations.

METHODS

A group of national experts reviewed the recommendations made by NIOSH. The consensus review process identified areas of agreement, disagreement, and priorities for the DOL's Wage and Hour Division. Gaps in the hazardous orders not addressed in the recommendations were also identified.

RESULTS

This commentary describes the background of the Hazardous Orders under the Fair Labor Standards Act, the evaluation by NIOSH, the process used to review it, and recommendations for further action.

CONCLUSIONS

The NIOSH report is a valuable resource for anyone working to prevent occupational injuries-among adult and young workers alike. It is crucial that the DOL use the guidance provided by NIOSH and the Young Workers Safety and Health Network to improve the protections for young workers.

Work-related amputations in Michigan, 1997

BACKGROUND

Work-related amputations are of concern in Michigan and nationally. This study reports on 1 year of data on work-related amputations, which were treated in Michigan hospital emergency departments (ED) or as in-patients in Michigan.

METHODS

Michigan hospitals provided face sheets and discharge summaries of in-patient and ED visits for work-related amputations that occurred in 1997. Information was also obtained about worksite inspections associated with reported amputations from the Michigan Occupational Safety and Health Act (MIOSHA) program. Data from this study and from Michigan workers compensation were used to generate an estimate of the true numbers of work-related amputations in Michigan in 1997.

RESULTS

Three hundred thirty-nine work-related amputations were identified by hospitals. Powered saws and power presses were the leading sources of injury. MIOSHA completed 30 enforcement inspections related to these amputations. Our best estimate of the total numbers of work-related amputations in 1997 for Michigan was 693, of which 562 resulted in hospitalization or ED treatment.

CONCLUSIONS

In-patient and ED records provided information for identifying high risk groups and problem worksites in Michigan. Estimates generated from these data underscore that data on work-related amputations released by the Bureau of Labor Statistics (BLS), which reported 440 amputations in 1997, are a significant undercount--only 64%--of the true number of cases. Better integration of public health data into OSHA enforcement activity is needed.

Age related differences in work injuries and permanent impairment: a comparison of workers' compensation claims among adolescents, young adults, and adults

BACKGROUND

There is growing evidence that adolescent workers are at greater risk for work injury.

AIMS

To investigate the severity of work injuries across age groups.

METHODS

Workers' compensation records were used to examine work related injuries among adolescents (15-19 years old), young adults (20-24 years old), and adults (25+ years old) between 1993 and 2000. The incidence of compensated injuries was calculated for each age group and compared by gender, industry, and type of injury. The presence and degree of permanent impairment in each age group was also examined.

RESULTS

For males, adolescents and young adults had higher claim rates than adults. For females, adults had the highest claim rates and young adults the lowest. Rates of permanent impairment indicated that age was positively associated with severity of injury.

CONCLUSIONS

Indicators of health consequences, in particular presence of permanent impairment, provide preliminary evidence that compensated work injuries sustained by youth are not as serious as injuries sustained by adults. Nevertheless, there was evidence that some young workers sustain injuries that have long term consequences. Documenting the consequences of the injuries that young workers sustain has implications for secondary prevention efforts and health services policy.

Occupational accidents among middle and high school students of the state of São Paulo, Brazil

OBJECTIVES

To estimate the prevalence of occupational injuries and identify their risk factors among students in two municipalities.

METHODS

A cross-sectional survey was conducted in public schools of the municipalities of Santo Antonio do Pinhal and Monteiro Lobato, Brazil. A stratified probabilistic sample was drawn from public middle and high schools of the study municipalities. A total of 781 students aged 11 to 19 years participated in the study. Students attending middle and high school answered a comprehensive questionnaire on living and working conditions, as well as aspects of work injuries, and health conditions. Multiple logistic regression models were fitted to estimate risk factors of previous and present occupational injuries.

RESULTS

Of 781 students, 604 previously had or currently have jobs and 47% reported previous injuries. Among current workers (n=555), 38% reported injuries on their current job. Risk factors for work injuries with statistically significant odds ratio >2.0 included attending evening school, working as a housekeeper, waiter or brickmaker, and with potentially dangerous machines.

CONCLUSIONS

The study results reinforce the need of restricting adolescent work and support communities to implement social promotion programs.

[Non-fatal work-related accidents in adolescents]

This community-based survey estimates the annual incidence of non-fatal work-related injuries in adolescents and describes their characteristics. Using a random area sampling design, 2,513 households were selected from the city of Salvador, capital of Bahia State, Northeast Brazil. The study population included 361 young people 10 to 20 years of age who answered individual questionnaires on socio-demographic, occupational, and health data. Annual incidence of non-fatal work-related injuries was 6.4%. Among females, most injuries were mild and were related to household chores; some 38.5% required medical care, and 36.4% caused permanent non-disabling lesions. Among males, work-related injuries took place mainly in public byways, and the majority (60.0%) were treated in emergency-care facilities. These results show that work-related injuries need to be considered in adolescent protection policies.

Injuries among teens employed in the homebuilding industry in North Carolina

OBJECTIVE

To describe injuries of teens employed in the residential construction industry and to assess whether their injury experiences are significantly different from those of adults in this high risk industry.

METHODS AND SETTING

North Carolina homebuilders workers' compensation data for a 41 month period were analyzed. Injuries of teens were identified and described by body part injured, nature, and cause of injury. Proportionate injury ratios were used to summarize and compare the injury experience of teens with those of adult construction workers.

RESULTS

Teens had proportionately more injuries to the eye and foot and fewer injuries to the back than adults. They had more cuts and scratches and fewer sprains and strains. They also had proportionately fewer injuries from falls from elevations and overexertion, injuries that account for a significant cost burden in construction. Consistent with these findings, teens had significantly fewer injuries resulting in medical costs or lost time costs of $1,000 or more.

CONCLUSIONS

The analyses indicate that injuries of teens are less serious than those of adults. This finding may indicate that their work exposures are less dangerous than those of adults in comparable broad categories of construction. However, the data also provide documentation of injuries to teens resulting from work at heights, use of power tools, and motor vehicles with the majority of more expensive claims involving one of these exposures. Construction is dangerous work and these results add to the documentation of the need for additional measures to prevent work related injuries among all workers-teens and adults-in this industry.

Repetitive strain injuries in youth

PURPOSE

To review the anatomic and physiologic considerations in repetitive strain injuries (RSI) in youth in relation to normal growth and development.

DATA SOURCES

Extensive review of scientific literature, laws relating to youth labor, and the authors' experience.

CONCLUSIONS

Early detection of youth at risk for RSIs is crucial for prevention and treatment. Physical maturity and size are more important than chronological age in the safe performance of work tasks or sports.

IMPLICATIONS FOR PRACTICE

Interventions that reduce injury in youth include gradually increasing training load, improving flexibility, and strength, improving biomechanics, and correcting malalignment. Assessments should include tests of flexibility, laxity, and muscle symmetry.

Nonfatal farm injury incidence and disability to children: a systematic review

OBJECTIVE

To summarize the literature on farm child nonfatal injury incidence and the subsequent disability to children.

SEARCH STRATEGY

We used a systematic process to search the following databases: MEDLINE, EMBASE, ERIC, NTIS and NIOSHTIC. The reference lists from each potentially eligible study were checked and experts in the field contacted for additional reports.

SELECTION CRITERIA

Studies for selection had to meet the following criteria: published in the last 20 years (1979-1998); located in North America; and include nonfatal farm injury cases for children under age 20.

DATA COLLECTION AND ANALYSIS

Thirty-two studies met the inclusion criteria and were examined for study design, location, sample size, injury rate, injury sources, and functional outcomes.

RESULTS

Among the 32 studies, there were 9 case series, 11 secondary analyses of administrative databases, 2 case-control studies, 6 cross-sectional surveys, one mixed-method study, 2 prospective case series reports, and 1 cohort study. Twenty-two of the studies confined the sample to agriculture, but nine of these combined children within a larger sample, creating considerable difficulty in examining only agricultural injuries to children. Only one study focused on outcome measurement. Although nearly all the reports provided some discussion about injury severity, these comments were generally limited to injury severity scores or injury type.

CONCLUSIONS

Despite increasing attention on farm-related child injury, the literature continues to report primarily descriptive studies that rely on small samples focusing on the nature of the injury event and immediate consequences. Analysis of larger databases, such as worker compensation claims, trauma registries, and agricultural injury surveillance, still lacks valid denominators; thus, incidence rates cannot be calculated. Very little was found regarding disability among children who experienced agricultural injury, even though the literature clearly proclaims the severity and seriousness of child injury on farms. To complete the portrait of the burden of this continuing problem, research must include functional outcome measures.

Adolescent occupational injuries: Texas, 1990-1996

BACKGROUND

A comprehensive surveillance system for occupational injuries to adolescents does not exist in Texas, as in most states. Therefore, the magnitude, severity, nature, and source of injuries to working adolescents have not been well described in Texas.

METHODS

The investigators used three data sources to investigate work-related injuries and deaths in Texas: (1) Texas Workers' Compensation Commission (TWCC) claims data from 1991 through April 1996; (2) 1993 TWCC/Bureau of Labor Statistics (BLS) Annual Survey of Occupational Injuries and Illnesses; and (3) work-related fatalities identified from Texas death certificates from 1990-1995.

RESULTS

There were 9,027 injuries reported to the TWCC for adolescents 14-17 years of age during slightly more than 5 years. Injuries for which indemnity payments were made (more than 7 days out of work) occurred among 21.7% of the adolescents. Based on BLS data in 1993, of 992 non-fatal injuries involving days away from work, 35% were caused by contact with objects, 27% by bodily reaction, and 24% by falls. Two-thirds of these injuries occurred while working in eating and drinking places and grocery stores. Three-quarters of the 30 deaths from 1990-1995 were accounted for equally by motor vehicle and homicide.

CONCLUSIONS

In conclusion, a substantial number of adolescents are injured or killed in the workplace each year in Texas. Although improved population-based surveillance is needed, sufficient knowledge exists to begin prevention efforts now.