Challenges in residential fall prevention: insight from apprentice carpenters

Are plumbing apprentice graduates safer than their non-apprentice peers? Workers' compensation claims among journey level plumbers by apprenticeship participation

INTRODUCTION

Apprenticeships combine mentored on-the-job training with related instruction to develop a workforce with the skills sought by employers. Workplace safety is an important component of apprenticeship training. Whether that training results in fewer work injuries, however, is largely unknown.

METHOD

We linked Washington's registered apprenticeship data, plumber certification (licensing) data, employment data, and workers' compensation claims to compare claim rates among journey level plumbers (JLP) by apprenticeship participation. We used negative binomial regression models to estimate rates of total claims, wage replacement/disability claims, acute injuries, and musculoskeletal disorders (MSD), adjusted for worker characteristics.

RESULTS

Among JLP certified between 2000 and 2018, rates among JLP with no apprenticeship training were 46% higher for total workers' compensation claims (adjusted Rate Ratio (aRR) = 1.46, 95% CI: 1.26-1.69) and 60% higher for wage replacement/disability claims (aRR = 1.60, 95% CI: 1.22-2.11), compared to rates among JLP who completed a plumbing apprenticeship. Apprentice graduates experienced a greater decline in the rate of total claims between the 5 years preceding JLP certification and the years after certification (55.3% vs. 41.4% among JLP with no apprenticeship training). Greater rate reductions among JLP apprentice graduates were also observed for acute injuries and MSD, although the decline in MSD was not significantly different from the decline among JLP with no apprenticeship training.

CONCLUSIONS

Successful completion of a plumbing apprenticeship program is associated with fewer work injuries throughout the career of a JLP. Apprenticeships appear to play a key role in reducing work injuries among JLP, especially acute injuries.

PRACTICAL APPLICATIONS

Apprenticeships are an effective model for reducing workplace injuries. The mechanisms by which apprenticeship training improves workplace safety should be identified to better inform injury prevention efforts among apprentices as well as among workers outside of a formal apprenticeship arrangement.

Formation Mechanism and Dynamic Evolution Laws About Unsafe Behavior of New Generation of Construction Workers Based on China's Construction Industry: Application of Grounded Theory and System Dynamics

Construction workers' unsafe behavior is a major cause of safety accidents and injuries, therefore, a profound understanding of the formation process and evolution laws about construction workers' unsafe behavior is conducive to taking measures to prevent incidents. At present, the new generation of construction workers (NGCWs) born after 1980 are gradually becoming the main force at construction sites in China. Given that generational differences of construction workers can cause the discrepancies in their thoughts and attitudes when engaging in safety-related activities, this study aims to investigate the formation mechanism and dynamic evolution laws about NGCWs' unsafe behavior based on the context of China's construction industry. From the perspective of behavior motivation, in-depth semi-structured interviews with 18 NGCWs and 7 grassroots managers were conducted, and data analysis followed a three-step coding process based on grounded theory. Through continuous comparison, abstraction and analysis, the stimulus-organism-response theory was introduced and expanded to construct a three-stage formation mechanism model. On this basis, the causal diagram and stock flow diagram were developed based on system dynamics principles to reflect the dynamic feedback relationships of the factors in the static formation mechanism model, and simulation was carried out using Vensim PLE software. The results show that three types of internal needs and three types of external incentives stimulate corresponding motivations for NGCWs' unsafe behavior. Two types of individual factors, five types of situational factors and behavior result play an influencing role in the decision-making process of externalizing motivation into behavior. Under the synergistic effect of multiple factors, the level of unsafe behavior displays a downward trend, and the rate of decrease is slow first and then fast. Furthermore, among individual factors and situational factors, safety awareness and safety management system have the most significant effect on the level of unsafe behavior, while situational factors play a more obvious role. The findings can provide theoretical support and practical references to China's construction companies and government departments for the purpose of improving NGCWs' unsafe behavior.

Development and validation of a cognitive model-based novel questionnaire for measuring potential unsafe behaviors of construction workers

The accident death rate in the construction industry is one of the highest among all occupational accidents. In order to identify the most common and direct causes of accidents, the unsafe behaviors of construction workers must be investigated, which necessities a questionnaire. Considering that safety climate research and behavior safety research barely explained the causes of unsafe behavior, this research was conducted from a cognitive model-based perspective. A new questionnaire was designed to evaluate the potentially unsafe behaviors, and a cognitive model with 11 factors was adopted. After verification by exploratory factor analysis, confirmatory factor analysis and reliability analysis, the new questionnaire showed good validity (content validity index < 0.79 and content validity ratio aaaa 0.42, average variance extracted > 0.5) and reliability (Cronbach's α > 0.7, composite reliability > 0.7), and the cognitive model fitted well. Therefore, the new questionnaire is effective and reliable in assessing the causes of unsafe behaviors of construction workers.

Development of migrant workers in construction based on machine learning and artificial intelligence technology

Artificial intelligence technology has been widely used in all aspects of our life. Similarly, the application of artificial intelligence in the field of construction engineering is a necessary trend in the development of engineering industry, especially in the traditional construction engineering department. Under the background of the times, from the perspective of knowledge, artificial intelligence technology has appeared a huge development, which may have an impact on the employment of Chinese labor force, may create new jobs, or replace traditional jobs. This effect on employment is essential. From the perspective of machine learning and artificial intelligence, this paper reviews the transformation prospects of engineering industry and the development of agricultural industry in construction industry, and examines the intellectual transformation of individual human capital in Chinese labor force.

A National Survey of Health and Safety Knowledge and Beliefs Among Technical Vocational Faculty in Autobody Collision Repair Technology

OBJECTIVES

Career technical education (CTE) programs prepare new generations of technicians in a variety of trades. Even though occupational safety and health (OSH) ought to be included as an essential part of CTE curricula it is frequently absent or inadequately taught.

METHODS

OSH knowledge and beliefs were assessed in a national sample of 125 secondary and post-secondary faculty in autobody collision repair technology.

RESULTS

Over 50% of faculty thought at least 75% of OSH knowledge was learned at school, and 9% felt that safety was primarily learned on the job. Knowledge scores ranged from 22% to 78%. Overall knowledge scores were significantly lower high school than post-secondary instructors (42% vs 50%, P ≤ 0.001) and in two categories: hazard recognition (44% vs 54%, P ≤ 0.05) and hazard control and shop equipment (30% vs 37%, P ≤ 0.05).

CONCLUSIONS

There are substantial gaps in OSH knowledge among secondary and post-secondary CTE instructors. CTE programs should address these gaps by providing trade-specific safety and health education to their instructors upon hiring.

Career readiness: Finding a place for health and safety education

BACKGROUND

Studies have identified gaps in health and safety knowledge and work practices of vocational students in the United States and abroad. Little is known about what, how, when, or if health and safety are taught and if the teaching that takes place is effective. Faculty skilled in their technical area may lack knowledge related to health and safety and pedagogy. This knowledge gap is compounded by a deficiency or absence of high-quality safety and health resources for vocational and technical college faculty, the use of outdated and often inaccurate information, and lack of any standardized assessment of knowledge and skills.

METHODS

To identify these knowledge gaps, we conducted group interviews with auto body collision technology and machine tool technology faculty at two colleges.

RESULTS

Most instructors reported a rapid transition from technical trade worker or business owner into their faculty role, with little support or education related to teaching. No instructor used a defined health and safety curriculum and materials or could describe the breadth safety skills required for their profession. Instructors tested and evaluated health- and safety-related skills on an ad hoc basis and said that workers and employers were ultimately responsible for job health and safety.

CONCLUSIONS

Standardized health and safety training is needed nationally and should be progressive and integrated with career-specific educational programs. It should ensure that students obtain knowledge and understanding of how to apply the principles of safety and health and communicate with employers about health- and safety-related issues.

Understanding the Social Contagion Effect of Safety Violations within a Construction Crew: A Hybrid Approach Using System Dynamics and Agent-Based Modeling

Previous research has recognized the importance of eliminating safety violations in the context of a social group. However, the social contagion effect of safety violations within a construction crew has not been sufficiently understood. To address this deficiency, this research aims to develop a hybrid simulation approach to look into the cognitive, social, and organizational aspects that can determine the social contagion effect of safety violations within a construction crew. The hybrid approach integrates System Dynamics (SD) and Agent-based Modeling (ABM) to better represent the real world. Our findings show that different interventions should be employed for different work environments. Specifically, social interactions play a critical role at the modest hazard levels because workers in this situation may encounter more ambiguity or uncertainty. Interventions related to decreasing the contagion probability and the safety–productivity tradeoff should be given priority. For the low hazard situation, highly intensive management strategies are required before the occurrence of injuries or accidents. In contrast, for the high hazard situation, highly intensive proactive safety strategies should be supplemented by other interventions (e.g., a high safety goal) to further control safety violations. Therefore, this research provides a practical framework to examine how specific accident prevention measures, which interact with workers or environmental characteristics (i.e., the hazard level), can influence the social contagion effect of safety violations.

The Impact of Coworkers' Safety Violations on an Individual Worker: A Social Contagion Effect within the Construction Crew

This research developed and tested a model of the social contagion effect of coworkers’ safety violations on individual workers within construction crews. Both situational and routine safety violations were considered in this model. Empirical data were collected from 345 construction workers in China using a detailed questionnaire. The results showed that both types of safety violations made by coworkers were significantly related to individuals’ perceived social support and production pressure. Individuals’ attitudinal ambivalence toward safety compliance mediated the relationships between perceived social support and production pressure and both types of individuals’ safety violations. However, safety motivation only mediated the effects of perceived social support and production pressure on individuals’ situational safety violations. Further, this research supported the differences between situational and routine safety violations. Specifically, we found that individuals were more likely to imitate coworkers’ routine safety violations than their situational safety violations. Coworkers’ situational safety violations had an indirect effect on individuals’ situational safety violations mainly through perceived social support and safety motivation. By contrast, coworkers’ routine safety violations had an indirect effect on individuals’ routine safety violations mainly through perceived production pressure and attitudinal ambivalence. Finally, the theoretical and practical implications, research limitations, and future directions were discussed.

Safety Climate Among Nontraditional Workers in Construction: Arguing for a Focus on Construed External Safety Image

Safety climate, employees' perceptions of work-related safety, ¹ has been promoted as a leading indicator of workplace safety in construction. ^{2 , 3} While research has primarily examined internal organizational sources (e.g., manager attitudes, formal organizational policies) on these perceptions, external sources of information might be more relevant to construction workers in nontraditional jobs who work for a limited time and/or have limited interaction with other employees. This paper argues for the future development of a construed external safety image scale to measure employees' perceptions about how external groups view their organization's safety. ⁴ The construed external safety image would capture the external sources that nontraditional workers use to assess safety climate and will allow public health researchers to identify and change dangerous workplaces while more effectively communicating information about safe workplaces to workers. The public health relevance of safety climate and construed external safety image for monitoring and communicating safety to nontraditional workers require examination.

Foremen's intervention to prevent falls and increase safety communication at residential construction sites

BACKGROUND

This research aimed to improve residential construction foremen's communication skills and safety behaviors of their crewmembers when working at heights.

METHODS

Eighty-four residential construction foremen participated in the 8-hr fall prevention and safety communication training. We compared pre- and post-intervention surveys from foremen and their crewmembers to measure the effect of training.

RESULTS

Foremen and crewmembers' ratings showed improvements in fall prevention knowledge, behaviors, and safety communication and were sustained 6-months post-training, with emphasized areas demonstrating larger increases. Ratings were similar between foremen and crewmembers, suggesting that the foremen effectively taught their crew and assigned accurate ratings. Based upon associations between safety behaviors and reported falls observed in prior research, we would expect a 16.6% decrease in the one year cumulative incidence of self-reported falls post-intervention.

CONCLUSIONS

This intervention improved safety knowledge and behaviors of a large number of workers by training construction foremen in fall prevention and safety communication skills. Am. J. Ind. Med. 59:823-831, 2016. © 2016 Wiley Periodicals, Inc.

Promoting adoption of fall prevention measures among Latino workers and residential contractors: formative research findings

BACKGROUND

Falls from heights remain a concern in construction, particularly for foreign-born Latino construction workers employed by small residential contractors. The social ecological model provides a framework to assess the individual and contextual factors influencing the risk for falls.

METHODS

Five focus groups and thirteen in-depth interviews with workers, small residential contractors, and key informants were conducted in 2012 in San Francisco and Philadelphia. Data were analyzed with qualitative methods.

RESULTS

Economic conditions in residential construction, coupled with a lack of enforcement and vulnerabilities of the foreign-born workforce, are principal contributors to risk for falls. Small contractors perceive strong economic disincentives for implementation of fall protection and foreign-born Latino workers experience a variety of social, cultural and occupational pressures impeding its use.

CONCLUSIONS

Increased adoption of fall protection cannot be accomplished solely by targeting Latino construction workers. Research is needed on incentives to influence contractor behavior and facilitate adoption of fall protection measures.

Preventing falls in residential construction: Effectiveness of engaging partners for a national social marketing campaign

BACKGROUND

Falls are the leading cause of fatalities in construction. The Safety Pays, Falls Cost campaign aims to prevent falls in residential construction. A critical component of our social marketing approach was to involve 70 partners in reaching target audiences.

METHODS

We assessed partner engagement April 2012-August 2013 through: (1) baseline partnership quality interviews (eight partners); (2) pre-/post-partner "market" readiness in-depth interviews (three partners); (3) a pre-/post- (29/31 partners) online partner engagement survey; and (4) standardized metrics to measure partner activity.

RESULTS

We found a high level of interest and engagement that increased with the addition of prompting to action through regular communication and new resources from organizers and formation of local partnerships that were able to tailor their activities to their own communities or regions.

CONCLUSION

It is feasible to leverage government-labor-management partnerships that enjoy trust among target audiences to widely disseminate campaign materials and messages.

Occupational fall injuries presenting to the emergency department

OBJECTIVES

This study was performed to evaluate occupational and fall injuries presenting to the ED, the risk factors associated with falls among all occupational injuries, and factors affecting prognosis.

METHODS

Data from ED-based Occupational Injury Surveillance System were analysed to investigate the occupational injuries. The 2147 occupational injury subjects were divided into two groups: fall (n = 213, 9.9%) and non-fall (n = 1934, 90.1%). Data including baseline and clinical characteristics were compared between the groups.

RESULTS

The mean age was older in the fall group (46 vs 42 years old). The rate of construction site-related injury was 32% in the fall group and only 8% in the non-fall group. Injury occurrence during regular working hours (09.00 hours to 18.00 hours) was 70% in the fall group and 57% in the non-fall group. Injury severity using the Excess Mortality Ratio-adjusted Injury Severity Score (EMR-ISS) was more severe in the fall group than in the non-fall group, and days away from work were longer in the fall group than the non-fall group. Older age, compared with an age <29 years old and presence in a construction area during regular working hours were factors associated with fall injuries. Factors affecting prolonged absence for work were older age, higher EMR-ISS, fall injury and poor workplace environmental conditions.

CONCLUSION

Risk factors associated with fall-related occupational injuries include older age and being at a construction area during regular working hours. Falls among occupational injuries are more severe than other injuries and result in longer work loss.

Fatal falls in the U.S. residential construction industry

BACKGROUND

Falls from heights remain the most common cause of workplace fatalities among residential construction workers in the United States.

METHODS

This paper examines patterns and trends of fall fatalities in U.S. residential construction between 2003 and 2010 by analyzing two large national datasets.

RESULTS

Almost half of the fatalities in residential construction were from falls. In the residential roofing industry, 80% of fatalities were from falls. In addition, about one-third of fatal falls in residential construction were among self-employed workers. Workers who were older than 55 years, were Hispanic foreign-born, or employed in small establishments (1-10 employees) also had higher proportions of fatal falls in residential construction compared to those in nonresidential construction.

CONCLUSIONS

The findings suggest that fall safety within the residential construction industry lags behind commercial construction and industrial settings. Fall prevention in residential construction should be enhanced to better protect construction workers in this sector.

Occupational safety issues in residential construction surveyed in Wisconsin, United States

Residential construction is a high-risk industry in the U.S. due to the exposure to work-related safety hazards and fall injuries. This study aimed to examine the safety training and safe work practices of construction workers within the small residential construction industry. In order to achieve the study objectives, a survey was designed and sent to approximately 200 Wisconsin based residential construction contractors. About one third of the respondents stated that they did not have any form of safety programs. The study indicated that the most common types of work-related injuries in residential construction were slips/trips/falls and cuts/lacerations. The survey findings also suggested that the residential construction contractors needed to increase the utilization of fall protection safety equipment. Further education and subject matter expert training could provide benefits to improve occupational safety and health of the small business workforce in the residential construction industry.

How well are we controlling falls from height in construction? Experiences of union carpenters in Washington State, 1989-2008

BACKGROUND

Falls from height (FFH) continue to cause significant morbidity and mortality across the construction industry.

METHODS

By linking data on work hours with workers' compensation records, rates of work-related injuries resulting from FFH and associated days away from work were evaluated among a large cohort (n = 24,830) of union carpenters in Washington State from 1989 to 2008. Using Poisson regression we assessed rates of FFH over the 20-year period while adjusting for temporal trend in other work-related injuries. Patterns of paid lost days (PLDs) were assessed with negative binomial regression.

RESULTS

Crude rates of FFH decreased 82% over the 20-year period. Reductions were more modest and without demonstrable change since 1996 when adjusting for the temporal reduction in other injuries. Younger workers had higher injury rates; older workers lost more days following falls. Rates of PLDs associated with falls decreased over time, but there was not a consistent decline in mean lost days per fall.

CONCLUSION

These patterns are consistent with decreased FFH for several years surrounding state (1991) and then federal (1994) fall standards; the decline during this time period exceeded those seen in injury rates overall in this cohort. While crude rates of FFH have continued to decline, the decline is not as substantial as that seen for other types of injuries. This could reflect a variety of things including more global efforts designed to control risk (site planning, safety accountability) and changes in reporting practices.

Discounting the value of safety: effects of perceived risk and effort

INTRODUCTION

Although falls from heights remain the most prevalent cause of fatalities in the construction industry, factors impacting safety-related choices associated with work at heights are not completely understood. Better tools are needed to identify and study the factors influencing safety-related choices and decision making.

METHOD

Using a computer-based task within a behavioral economics paradigm, college students were presented a choice between two hypothetical scenarios that differed in working height and effort associated with retrieving and donning a safety harness. Participants were instructed to choose the scenario in which they were more likely to wear the safety harness. Based on choice patterns, switch points were identified, indicating when the perceived risk in both scenarios was equivalent.

RESULTS

Switch points were a systematic function of working height and effort, and the quantified relation between perceived risk and effort was described well by a hyperbolic equation.

CONCLUSION

Choice patterns revealed that the perceived risk of working at heights decreased as the effort to retrieve and don a safety harness increased.

IMPACT ON INDUSTRY

Results contribute to the development of computer-based procedure for assessing risk discounting within a behavioral economics framework. Such a procedure can be used as a research tool to study factors that influence safety-related decision making with a goal of informing more effective prevention and intervention strategies.

More than training: Community-based participatory research to reduce injuries among hispanic construction workers

BACKGROUND

Workplace mortality and severe injury are disproportionately distributed among foreign born and Hispanic construction workers. Worker Centers (WCs) provide services and advocacy for low-wage workers and a way for investigators to reach them. The goal of this project is to prevent occupational injuries by increasing awareness of hazards and self-efficacy among foreign born, Hispanic construction workers and by expanding the agenda of WCs to include occupational health and safety (H&S).

METHODS

Investigators partnered with eight WCs in seven cities to train worker leaders to deliver a modified OSHA 10-hr curriculum to their peers.

RESULTS

Thirty-two worker leaders trained 446 workers over 3 years. There was a demonstrated improvement in knowledge, hazard identification, self-efficacy, and sustainable H&S activities.

CONCLUSIONS

This study provides evidence for successful implementation of a training intervention for low wage, low literacy Hispanic construction workers using a community-based participatory research approach.

Identifying fall-protection training needs for residential roofing subcontractors

Falls remain the leading cause of injuries and fatalities in the small residential roofing industry and analogous investigations are underrepresented in the literature. To address this issue, fall-protection training needs were explored through 29 semi-structured interviews among residential roofing subcontractors with respect to recommendations for the design of fall-protection training. Content analysis using grounded theory was conducted to analyze participants' responses. Results of the analysis revealed six themes related to the design of current fall-protection training: (1) barriers to safety training; (2) problems of formal safety-training programs; (3) recommendations for training implementation; (4) important areas for fall-protection training; (5) training delivery means; and (6) design features of training materials. Results of the study suggest the need for informal jobsite safety training to complement what had been covered in formalized safety training. This work also provides recommendations for the design of a more likely adopted fall-protection training program.

Fall prevention and safety communication training for foremen: report of a pilot project designed to improve residential construction safety

PROBLEM

Falls from heights account for 64% of residential construction worker fatalities and 20% of missed work days. We hypothesized that worker safety would improve with foremen training in fall prevention and safety communication.

METHOD

Training priorities identified through foreman and apprentice focus groups and surveys were integrated into an 8-hour training. We piloted the training with ten foremen employed by a residential builder. Carpenter trainers contrasted proper methods to protect workers from falls with methods observed at the foremen's worksites. Trainers presented methods to deliver toolbox talks and safety messages. Results from worksite observational audits (n=29) and foremen/crewmember surveys (n=97) administered before and after training were compared.

RESULTS

We found that inexperienced workers are exposed to many fall hazards that they are often not prepared to negotiate. Fall protection is used inconsistently and worksite mentorship is often inadequate. Foremen feel pressured to meet productivity demands and some are unsure of the fall protection requirements. After the training, the frequency of daily mentoring and toolbox talks increased, and these talks became more interactive and focused on hazardous daily work tasks. Foremen observed their worksites for fall hazards more often. We observed increased compliance with fall protection and decreased unsafe behaviors during worksite audits.

DISCUSSION

Designing the training to meet both foremen's and crewmembers' needs ensured the training was learner-centered and contextually-relevant. This pilot suggests that training residential foremen can increase use of fall protection, improve safety behaviors, and enhance on-the-job training and safety communication at their worksites.

IMPACT ON INDUSTRY

Construction workers' training should target safety communication and mentoring skills with workers who will lead work crews. Interventions at multiple levels are necessary to increase safety compliance in residential construction and decrease falls from heights.

Fatal falls from roofs among U.S. construction workers

INTRODUCTION

This study examined trends and patterns of fatal falls from roofs in the U.S. construction industry over an 18-year period (1992-2009), with detailed analysis for 2003-2009.

METHODS

Two large national datasets were analyzed: the U.S. Bureau of Labor Statistics' Census of Fatal Occupational Injuries and the Current Population Survey.

RESULTS

Roof fatalities accounted for one-third of fatal falls in construction in 1992-2009. A disproportionately high percentage (67%) of deaths from roof falls occurred in small construction establishments (1-10 employees). Roofers, ironworkers, workers employed with roofing contractors, or working at residential construction sites, had a higher risk of roof fatalities. A higher rate of roof fatalities was also found among younger (<20years) and older (>44years) workers, Hispanics, and immigrant workers.

CONCLUSION

Roof fatalities corresponded with economic cycles and differed among construction subgroups and worksites.

IMPACT ON INDUSTRY

Prevention strategies should target high-risk worker groups and small establishments.

Fatal falls among older construction workers

OBJECTIVE

This study examines recent trends and patterns in fall fatalities in the U.S. construction industry to determine whether fatal falls among older workers are different from younger workers in this industry.

BACKGROUND

Falls are the leading cause of fatalities in the U.S. construction industry. Given the increasingly aging workforce in construction, it is important to assess the risk of falls among older construction workers.

METHODS

Fatality data were obtained from the Census of Fatal Occupational Injuries for the years 1992 through 2008. Denominators for death rates were estimated from the Current Population Survey. Stratified and multivariate analyses were performed to examine whether there are differences in fatal falls between older workers (> or = 55 years) and younger workers (16-54 years). Fatal falls in nonconstruction industries were excluded from this study.

RESULTS

Older workers had higher rates of fatal falls than younger workers; results were significant in 11 of 14 construction occupations. Regression analysis indicated that older decedents had a higher likelihood that work-related death was caused by a fall, after controlling for major demographic and employment factors (odds ratio = 1.50, confidence interval [1.30, 1.72]). Falls from roofs accounted for one third of construction fatal falls, but falls from ladders caused a larger proportion of deadly falls in older decedents than in younger decedents.

CONCLUSION

Older workers have a higher likelihood of dying from a fall. Roofs and ladders are particularly risky for older construction workers.

APPLICATION

As the construction workforce ages, there is an urgent need to enhance fall prevention efforts, provide work accommodations, and match work capabilities to job duties.

Objective measures of adoption of patient lift and transfer devices to reduce nursing staff injuries in the hospital setting

BACKGROUND

Interventions to reduce patient-handling injuries in the hospital setting are often evaluated based on their effect on outcomes such as injury rates. Measuring intervention adoption could address how and why observed trends in the outcome occurred.

METHODS

Unit-level data related to adoption of patient lift equipment were systematically collected at several points in time over 5 years on nursing units at two hospitals, including hours of lift equipment use, equipment accessibility, and supply purchases and availability.

RESULTS

Various measures of adoption highlighted the adoption process' gradual nature and variability by hospital and between units. No single measure adequately assessed adoption. Certain measures appear well-correlated.

CONCLUSION

Future evaluation of primary preventive efforts designed to prevent patient-handling injuries would be strengthened by objective data on intermediate measures that reflect intervention implementation and adoption.

A framework of task demand factors for residential framing

In the USA, framing contractors consistently have the highest rate of non-fatal injuries of all speciality contractors. Residential framing contractors face additional challenges, partly due to the exception of ‘residential type’ activities from fall protection regulations. This study investigated residential framing accidents with a focus on the task features that affect the task difficulty of the residential framing activities and consequently the likelihood of errors and accidents. The study analysed 654 safety incidents that occurred over a period of 5 years 6 months in a large residential framing company. Accident analysis and interviews with safety and production experts identified the high-risk tasks, the errors that lead to incidents and the task elements that increase the likelihood of errors. The study identified five task factors that increase the task difficulty of residential framing activities and consequently the likelihood of accidents: (a) support conditions; (b) body posture constraints; (c) load-handling requirements; (d) tool accuracy requirements; and (e) external forces. The combination of these factors generates high task demands that can lead to errors and accidents. Reducing the task difficulty (independent of the hazards) is an important safety strategy that can reduce the likelihood of accidents while at the same time it can increase productivity.

Surveillance of nail gun injuries by journeymen carpenters provides important insight into experiences of apprentices

Experienced journeymen conducted detailed surveillance interviews with injured apprentice carpenters (n = 413). Nail gun injuries commonly occurred due to inadvertent discharge, ricocheting or projectile nails, and penetration of the wood surface. Framing nailers with contact trip triggers were most often involved; these triggers allow nail discharge anytime the trigger and nose piece are both depressed including following recoil of the tool after firing. Injured workers made concrete and practical suggestions for prevention. Scenarios were identified where changes in work practice, safer triggers, and thoughtful training could prevent injuries. Most injuries were not reported through workers' compensation; this was often due to perceived lack of injury severity, but also involved subtle as well as overt pressures on apprentices not to report. These case-based analyses are consistent with reports that many injuries from nail guns could be prevented with existing safer trigger mechanisms and training. Efforts should also focus on improved injury reporting.

Changes in fall prevention training for apprentice carpenters based on a comprehensive needs assessment

PROBLEM

Falls from heights in residential construction are common, especially among inexperienced workers.

METHODS

We conducted a comprehensive needs assessment to determine gaps in the school-based apprentice carpenters' fall prevention training. A team of carpenter instructors and researchers revised the fall prevention training to fill these gaps. Apprentice evaluation and feedback guided ongoing curricular improvements.

RESULTS

Most apprentice carpenters performed work tasks at heights prior to training and fall protection techniques were not commonly used at residential construction sites. Priorities of the revised school-based training included safe ladder habits, truss setting, scaffold use, guarding floor openings, and using personal fall arrest systems. New apprentices were targeted to ensure training prior to exposure at the workplace. We used adult learning principles to emphasize hands-on experiences. A framed portion of a residential construction site was fabricated to practice fall protection behaviors in a realistic setting. The revised curriculum has been delivered consistently and apprentice feedback has been very favorable.

CONCLUSIONS

Integration of needs assessment results was invaluable in revising the school-based carpenters apprentice fall prevention curriculum. Working closely with the instructors to tailor learning experiences has provided preliminary positive results.

IMPACT ON INDUSTRY

The fall safety of the residential construction industry continues to lag behind commercial construction and industrial settings. The National Occupational Research Agenda includes a Strategic Goal to strengthen and extend the reach of quality training and education in the construction industry via mechanisms such as construction safety and health training needs assessments. This study demonstrates how a structured process can be used to identify and remedy gaps and improve training effectiveness. We encourage others to take steps to assess and increase the impact of training efforts directed at all residential construction professionals; including both union and non-union workers. The implications are even greater in the non-union sector where most U.S. residential work is done.

Nonfatal tool- or equipment-related injuries treated in US emergency departments among workers in the construction industry, 1998-2005

BACKGROUND

Individuals in the construction industry are exposed to a variety of tools and pieces of equipment as they work.

METHODS

Data from the National Institute for Occupational Safety and Health (NIOSH) occupational supplement to the National Electronic Injury Surveillance System (NEISS-Work) were used to characterize tool- and equipment-related injuries among workers in the construction industry that were treated in US emergency departments between 1998 and 2005. Based on a national stratified probability sample of US hospitals with 24 hr emergency services, NEISS-Work allows calculation of national injury estimates.

RESULTS

Over the 8-year period between 1998 and 2005, we estimated 786,900 (95% CI 546,600-1,027,200) ED-treated tool- or equipment-related injuries identified by the primary or secondary source of injury code. These injuries accounted for a quarter of all ED-treated construction industry injuries. Although over 100 different tools or pieces of equipment were responsible for these injuries, seven were responsible for over 65% of the injury burden: ladders, nail guns, power saws, hammers, knives, power drills, and welding tools in decreasing order.

CONCLUSIONS

Current injury estimates and their severity, marked by the proportion of cases that were not released after ED treatment, indicate interventions are particularly needed to prevent injuries associated with use of ladders as well as nail guns and power saws. Attention should focus on design and guarding to more efficiently prevent these injuries rather than simply calling for the training of workers in how to safely use a dangerous tool or piece of equipment.

The impact of a peer-led participatory health and safety training program for Latino day laborers in construction

BACKGROUND

Immigrant Latino day laborers working in residential construction are at particularly high risk of fatal and non-fatal traumatic injury and benefit from targeted training.

OBJECTIVE

To understand the impact of a participatory, peer-facilitated health and safety awareness training customized to the needs of Latino day laborers.

METHODS

Baseline surveys exploring exposures, PPE use, attitudes, work practices and work-related injuries were collected from more than 300 New Jersey Latino day laborers in construction prior to their participation in a one day (minimum of six hour) Spanish language health and safety training class. The classes, led by trained worker trainers, engaged participants in a series of tasks requiring teamwork and active problem solving focused on applying safe practices to situations they encounter at their worksites. Follow-up surveys were difficult to obtain among mobile day laborers, and were collected from 70 men (22% response rate) 2-6 months following training. Chi-square analysis was used to compare pre- and post-intervention PPE use, self protective actions, and self-reported injury rates. Focus groups and in-depth interviews addressing similar issues provided a context for discussing the survey findings.

RESULTS

At baseline, the majority of day laborers who participated in this study reported great concern about the hazards of their work and were receptive to learning about health and safety despite limited influence over employers. Changes from baseline to follow-up revealed statistically significant differences in the use of certain types of PPE (hard hats, work boots with steel toes, safety harnesses, and visible safety vests), and in the frequency of self-protective work practices (e.g., trying to find out more about job hazards on your own). There was also a suggestive decrease in self-reported injuries (receiving an injury at work serious enough that you had to stop working for the rest of the day) post-training based on small numbers. Sixty-six percent of workers surveyed post-training reported sharing information from their safety workbook with friends and co-workers. Focus groups and interview results generally confirmed the quantitative findings.

CONCLUSIONS

Participatory, peer led training tailored to the needs of construction day laborers may have a positive effect on Latino immigrant workers' attitudes, work practices, and self reported injury rates, but major changes would require employer engagement.

IMPACT ON INDUSTRY

Health and safety researchers have identified reducing the number of traumatic injuries among the immigrant construction workforce as an increasingly important priority. This project provides one model for collaboration between university-based researchers, a union, and a community-based organization. The specific elements of this project-participatory curriculum customized to the needs of day laborers in residential construction, training day laborers to facilitate training classes, and involving peer leaders in outreach and research-could be adapted by other organizations. The findings of this study suggest that the Latino day laborers have a strong interest in and some ability to act on health and safety information. Widespread implementation of this type of training, especially if supported with cooperation from residential contractors, could lead to reduced rates of traumatic injury in the residential construction industry.

An Intervention Effectiveness Study of Hazard Awareness Training in the Construction Building Trades

Objective.

We evaluated knowledge, attitudes, and self-reported work practices among apprentice and journeyman trainees in two construction trades at baseline and three months after participation in two training sessions as part of a 10-hour Occupational Safety and Health Administration hazard awareness training program. We developed preliminary assessment of prior and current training impact, accounting for demographics, trade, and construction site safety climate.

Methods.

Participants were recruited prior to union-delivered safety training, self-completed a baseline survey prior to class, and completed a follow-up interviewer-administered telephone survey three months later. Discrimination (D) testing evaluated knowledge questions, paired t-tests examined differences in pre- and post-intervention knowledge, and attitude responses were tested with the Wilcoxon signed rank test. Linear regression analysis and logistic regression were used to assess the contribution of different categorical responses to specific sub-questions.

Results.

Of 175 workers completing the baseline survey, 127 were born in the U.S. and 41 were born in Mexico; 40% of those who reported ethnicity were Hispanic. Follow-up surveys were completed by 92 (53%) respondents and documented significant increases in both fall safety and electrical safety knowledge. The most recent safety climate was associated with improvement in fall safety attitudes (slope = 0.49, p<0.005) when adjusted by country of birth (slope = 0.51, p<0.001). Workers born in Mexico had less formal education than U.S.-born workers and lower baseline knowledge scores, but more positive attitude scores at baseline and greater improvements in attitude at follow-up.

Conclusion.

Knowledge and attitude improvement following a one-hour safety class was measurable at three months in both U.S.-born and Mexican-born construction workers.

Development of the St. Louis audit of fall risks at residential construction sites

We describe the development and pilot testing of the St. Louis Assessment of Fall Risks, a worksite audit to assess fall prevention safety practices on residential construction sites. Surveillance data and feedback from carpenters and safety instructors regarding work tasks associated with falls from heights were used to develop the audit instrument. The audit focuses on the framing process, including general safety climate/housekeeping, floor joist/sub-floor installation, walking surfaces/edges, wall openings, truss setting, roof sheathing, ladders, scaffolds, and personal fall arrest equipment. The audit was tested at sixteen residential construction sites, documenting excellent inter-rater reliability (kappa = 0.93). Results suggest that the audit has good face and content validity and is a reliable instrument for measuring fall safety risks at residential construction sites. It is practical, easy, and safe to administer, making it a potentially useful instrument for field research as well as regular safety monitoring by foremen and crew.