Effectiveness of OSHA Outreach Training on carpenters' work-related injury rates, Washington State 2000-2008

Forty-year trends in fatal occupational injuries in North Carolina

BACKGROUND

We describe progress in the control of deaths on-the-job due to fatal occupational injury in North Carolina over the period 1978-2017.

METHODS

Forty years of information on fatal occupational injuries in North Carolina has been assembled from medical examiners' reports and death certificates, supplemented by newspaper and police reports. Cases were defined as unintentional fatal occupational injuries among adults. Annual estimates of the population at risk were derived from US Census data, and rates were quantified using Poisson regression methods.

RESULTS

There were 4434 eligible deaths. The unintentional fatal occupational injury rate at the beginning of the study period was more than threefold the rate at the end of the study. The fatal occupational injury rate among men declined from 9.6 per 100,000 worker-years in the period 1978-1982 to 3.1 per 100,000 worker-years in the period 2013-2017. The fatal occupational injury rate among women declined from 0.3 per 100,000 worker-years in the period 1978-1981 to 0.1 per 100,000 worker-years in the period 2013-2017. Declines in rates were observed for young adults as well as older workers and were observed across all major industry categories. Average annual declines in rates were greatest in those industries and occupations that had the highest fatal injury rates at the start of the study period.

CONCLUSIONS

The substantial decline in fatal injury rates underscores the importance of injury prevention and demonstrates the ability to make meaningful reductions in unintentional fatal injury.

Injury inequalities among U.S. construction workers

This study explores racial/ethnic inequalities in work-related injuries among U.S. construction workers. Data from the 2004-2017 National Health Interview Survey were used to estimate work-related injuries by race/ethnicity in construction. Disparities in demographic, socioeconomic, and injury status among construction workers were examined by race/ethnicity. Injury differences were also evaluated in multiple logistic regression analyses controlling for potential confounders. Compared to white, non-Hispanic workers, minority workers were more likely to have lower socioeconomic statuses (e.g., lower educational attainment, lack of health insurance coverage, and family income below the poverty level), which considerably increased the likelihood of work-related injuries. The odds of work-related injuries were 70% higher among racial/ethnic minorities than white, non-Hispanics in construction. Injuries were also more severe among minorities than white, non-Hispanic workers. Among workers with a work-related injury, nearly 85% of Hispanics reported missing at least one workday due to injury, 45.6% higher than the proportion of 57.9% for their white, non-Hispanic counterparts. After adjusting for major demographic and socioeconomic factors, the work-related injury difference between race/ethnicity was no longer statistically significant. However, the odds of work-related injury remained significantly higher among workers who were younger (35-54 years vs. ≥ 55 years: aOR = 2.2, 95% CI: 1.3-3.6); male (aOR = 5.3, 95% CI: 2.9-9.8); not college-educated (aOR = 1.5, 95% CI: 1.0-2.2); had a family income below the poverty threshold (aOR = 1.8, 95% CI: 1.2-2.8); or held a blue-collar occupation (aOR = 2.0, 95% CI: 1.2-3.4). These findings suggest that the injury differences between race/ethnicity were strongly associated with demographics and socioeconomic inequalities in these worker groups. The identified injury disparities should be reduced or eliminated, following the hierarchy of controls paradigm.

In Search of Concrete Outcomes-A Systematic Review on the Effectiveness of Educational Interventions on Reducing Acute Occupational Injuries

Education is a common strategy used to prevent occupational injuries. However, its effectiveness is often measured using surrogate measures instead of true injury outcomes. To evaluate the effectiveness of workplace educational interventions, we selectively analyzed studies that reported injury outcomes (PROSPERO ID: CRD42019140631). We searched databases for peer-reviewed journal articles and sources of grey literature such as abstracts, registered trials, and theses published between 2000 and 2019. Studies on educational interventions that reported fatal or non-fatal occupational injury outcomes were selected. Two reviewers independently and in duplicate screened the studies, extracted data, and assessed risk of bias. Heterogeneity in the data precluded meta-analysis, and the results were reviewed narratively. In total, 35 studies were included. Of which, 17 found a significant reduction in injuries, most of which featured a multifaceted approach or non-didactic education. The remaining studies either described equivocal results or did not report statistical significance. Overall, interventions in the manufacturing industry were more effective than those in the construction sector. Risk of bias among included studies was moderate to high. In conclusion, educational interventions could be an effective part of multifaceted injury prevention programs. However, over-reliance on didactic education alone is not advised.

Understanding the Factors and the Corresponding Interactions That Influence Construction Worker Safety Performance from a Competency-Model-Based Perspective: Evidence from Scaffolders in China

Purpose: Construction workers' reactions to safety-related issues during operation vary from person to person due to their different occupational levels, which can be attributed to various influencing factors and their correspondingly complicated interactions. This research aims to propose an integrated framework to combine the concepts of these factors and provide a holistic interpretation of the interrelationship among them. Methods: Based on items that were mainly extracted from competency theory, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to identify the critical factors from the data collected from 243 scaffolders on Wuhan Metro construction sites. The interactions among the identified factors were then analyzed, and the safety competency model was thus established with the use of structural equation modeling (SEM). Results: A total of 17 items were identified as critical to workers' safety competency, and these were further tested and attributed to four factors: (1) individual character and inclination; (2) self-adjustment and adaptability; (3) working attitudes; (4) safety-related operation qualification. Subsequent analysis showed that all the factors significantly contributed to one's safety competency, and individual character and inclination contributed most to the formation of one's ability, while the intermediating effects of self-adjustment and adaptability should not be neglected both in theoretical and practical terms. The resultant safety competency model consisting of these four factors was revealed to share a hierarchical structure with the classical competency model. Significance: This study provided an integrated theoretical framework and a set of modeling approaches to combine the related concepts and facilitate a greater understanding of construction safety in terms of workers' characteristics and behaviors. Practical implications: This study presented a tentative approach for assessing construction workers' safety competency, as well as emphasized to the managers and professionals the necessity of developing training systems to ensure workers are integrated into a crew in an appropriate and smooth manner. Limitations and Future Work: The volume and the scope of samples impeded the study from achieving a more generalized result and a more cost-efficient data collection approach is in need of development for a comprehensive and in-depth investigation.

Essential Elements for Effective Safety and Health Education in Postsecondary Construction Career Technical Education

Because Career Technical Education (CTE) programs at the community/technical college level are among the few places new construction workers receive training or preparation, they are an important vehicle for educating new and young workers about occupational health and safety (OSH). We developed recommendations for (1) OSH "core competencies" that all postsecondary construction students should achieve and (2) "essential elements" for OSH education in construction training programs. Based on a review of the literature, subject matter expert focus groups, and iterative engagement with an expert advisory group, we identified fourteen core competencies and a list of essential supporting elements at the school, program, and instructor levels. Knowledge and recognition of the importance of effective safety and health management systems served as the foundation for elements and competencies. Findings provide an important starting point for systematically improving the preparation of construction CTE students that can help keep them safe on the job.

Interventions to prevent injuries in construction workers

BACKGROUND

Construction workers are frequently exposed to various types of injury-inducing hazards. There are a number of injury prevention interventions, yet their effectiveness is uncertain.

OBJECTIVES

To assess the effects of interventions for preventing injuries in construction workers.

SEARCH METHODS

We searched the Cochrane Injuries Group's specialised register, CENTRAL (issue 3), MEDLINE, Embase and PsycINFO up to April 2017. The searches were not restricted by language or publication status. We also handsearched the reference lists of relevant papers and reviews.

SELECTION CRITERIA

Randomised controlled trials, controlled before-after (CBA) studies and interrupted time-series (ITS) of all types of interventions for preventing fatal and non-fatal injuries among workers at construction sites.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies, extracted data and assessed their risk of bias. For ITS studies, we re-analysed the studies and used an initial effect, measured as the change in injury rate in the year after the intervention, as well as a sustained effect, measured as the change in time trend before and after the intervention.

MAIN RESULTS

Seventeen studies (14 ITS and 3 CBA studies) met the inclusion criteria in this updated version of the review. The ITS studies evaluated the effects of: introducing or changing regulations that laid down safety and health requirements for the construction sites (nine studies), a safety campaign (two studies), a drug-free workplace programme (one study), a training programme (one study), and safety inspections (one study) on fatal and non-fatal occupational injuries. One CBA study evaluated the introduction of occupational health services such as risk assessment and health surveillance, one evaluated a training programme and one evaluated the effect of a subsidy for upgrading to safer scaffoldings. The overall risk of bias of most of the included studies was high, as it was uncertain for the ITS studies whether the intervention was independent from other changes and thus could be regarded as the main reason of change in the outcome. Therefore, we rated the quality of the evidence as very low for all comparisons.Compulsory interventionsRegulatory interventions at national or branch level may or may not have an initial effect (effect size (ES) of -0.33; 95% confidence interval (CI) -2.08 to 1.41) and may or may not have a sustained effect (ES -0.03; 95% CI -0.30 to 0.24) on fatal and non-fatal injuries (9 ITS studies) due to highly inconsistent results (I² = 98%). Inspections may or may not have an effect on non-fatal injuries (ES 0.07; 95% CI -2.83 to 2.97; 1 ITS study).Educational interventionsSafety training interventions may result in no significant reduction of non-fatal injuries (1 ITS study and 1 CBA study).Informational interventionsWe found no studies that had evaluated informational interventions alone such as campaigns for risk communication.Persuasive interventionsWe found no studies that had evaluated persuasive interventions alone such as peer feedback on workplace actions to increase acceptance of safe working methods.Facilitative interventionsMonetary subsidies to companies may lead to a greater decrease in non-fatal injuries from falls to a lower level than no subsidies (risk ratio (RR) at follow-up: 0.93; 95% CI 0.30 to 2.91 from RR 3.89 at baseline; 1 CBA study).Multifaceted interventionsA safety campaign intervention may result in an initial (ES -1.82; 95% CI -2.90 to -0.74) and sustained (ES -1.30; 95% CI -1.79 to -0.81) decrease in injuries at the company level (1 ITS study), but not at the regional level (1 ITS study). A multifaceted drug-free workplace programme at the company level may reduce non-fatal injuries in the year following implementation by -7.6 per 100 person-years (95% CI -11.2 to -4.0) and in the years thereafter by -2.0 per 100 person-years (95% CI -3.5 to -0.5) (1 ITS study). Introducing occupational health services may result in no decrease in fatal or non-fatal injuries (one CBA study).

AUTHORS' CONCLUSIONS

The vast majority of interventions to adopt safety measures recommended by standard texts on safety, consultants and safety courses have not been adequately evaluated. There is very low-quality evidence that introducing regulations as such may or may not result in a decrease in fatal and non-fatal injuries. There is also very low-quality evidence that regionally oriented safety campaigns, training, inspections or the introduction of occupational health services may not reduce non-fatal injuries in construction companies. There is very low-quality evidence that company-oriented safety interventions such as a multifaceted safety campaign, a multifaceted drug workplace programme and subsidies for replacement of scaffoldings may reduce non-fatal injuries among construction workers. More studies, preferably cluster-randomised controlled trials, are needed to evaluate different strategies to increase the employers' and workers' adherence to the safety measures prescribed by regulation.