Prevention of Occupational Respiratory Symptoms Among Certified Safe Farm Intervention Participants

A systematic review of the effectiveness of dust control measures adopted to reduce workplace exposure

The recent increase in silicosis cases in several countries casts doubt on dust control practices and their effectiveness in preventing respirable crystalline silica (RCS) exposure. Apart from silicosis, RCS may lead to other illnesses, health-related quality of life losses for workers and their families, and economic losses for companies. Thus, this systematic literature review examined the effectiveness of interventions employed to prevent exposure to RCS and increase the use of dust control measures. The review used keywords related to dust control interventions to search seven databases. Search results were screened and extracted for synthesis. The narrative synthesis showed the extent of research investment in China. In several designs and combinations, the interventions utilized water, surfactant, foam, and air currents to reduce dust exposure. These interventions offer varying degrees of dust control effectiveness against RCS and respirable dust. Although evidence indicates that interventions significantly decrease dust concentration levels, the control measures in place may not effectively prevent workplace overexposure to RCS. The review found that education and training interventions are employed to improve dust controls and respiratory protective equipment (RPE) use. Also, marketing strategies promote the use of RPE. These interventions can increase the frequency of use of RPE and the adoption of best practice dust control measures. Interventions increase knowledge, awareness, and attitudes about RPE usage and generate positive perceptions while reducing misconceptions. However, the benefits obtained from an intervention may diminish after its implementation, indicating that the interventions may not continually motivate workers to adopt control measures or use RPE.

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.

A scoping review to identify strategies that work to prevent four important occupational diseases

BACKGROUND

Despite being largely preventable, many occupational diseases continue to be highly prevalent and extremely costly. Effective strategies are required to reduce their human, economic, and social impacts.

METHODS

To better understand which approaches are most likely to lead to progress in preventing noise-related hearing loss, occupational contact dermatitis, occupational cancers, and occupational asthma, we undertook a scoping review and consulted with a number of key informants.

RESULTS

We examined a total of 404 articles and found that various types of interventions are reported to contribute to occupational disease prevention but each has its limitations and each is often insufficient on its own. Our principal findings included: legislation and regulations can be an effective means of primary prevention, but their impact depends on both the nature of the regulations and the degree of enforcement; measures across the hierarchy of controls can reduce the risk of some of these diseases and reduce exposures; monitoring, surveillance, and screening are effective prevention tools and for evaluating the impact of legislative/policy change; the effect of education and training is context-dependent and influenced by the manner of delivery; and, multifaceted interventions are often more effective than ones consisting of a single activity.

CONCLUSIONS

This scoping review identifies occupational disease prevention strategies worthy of further exploration by decisionmakers and stakeholders and of future systematic evaluation by researchers. It also identified important gaps, including a lack of studies of precarious workers and the need for more studies that rigorously evaluate the effectiveness of interventions.

The Effect of a Knowledge-Based Intervention on the Use of Respirators in the Norwegian Smelter Industry

Introduction

The present study investigated the effect of interventions aiming to improve attitudes toward the use of respiratory protective equipment (RPE), knowledge of RPE and the use of RPE in the Norwegian smelter industry.

Method

The surveys received 567 respondents to baseline and 240 respondents 2 weeks after the intervention. Participants were invited to either a fit-testing of respirators [Group 1] or a fit-testing combined with a lecture on exposure [Group 2], health effects and RPE. The control group [Group 3] received no training. Questionnaires containing measures of subjective knowledge, attitudes and behavior regarding RPE use were assessed.

Results

Testing indicated an improvement in knowledge of RPE and a reduction in perceived inconveniences regarding the use of RPE for both intervention groups. Group 1 showed an improvement in attitudes and organizational support, while intervention Group 2 showed an improvement in subjective norms related to RPE use. Intention to use or rate of respirator use was not shown to change significantly for any group using paired testing. Regression analysis indicated that participation in either intervention influenced intention to use respirators. The effect was significant for Group 1 and was marginally significant for intervention Group 2.

Conclusion

The results indicate that interventions can increase workers’ knowledge and attitudes, and reduce perceived inconvenience regarding the use of respiratory protective equipment. However, even though some variables seemed to positively change, reported respirator use did not improve for either groups participating in the study. It may be that physical barriers with regards to using RPE, such as fogging of protective goggles, sweating, breathing and communication issues outweigh individual attitudes, intentions and social pressure to use respirators.

Practical Applications

The tailored course and practical training in RPE use in the current intervention can be applied in the smelting industry to provide up to date information on dust exposure, health effects and protective equipment. Some adjustments may be warranted for the content to fit specific risks and exposures of other industries. However, the general pedagogical framework of the educational material regarding health effects and RPE should be useful for most heavy industries.

Educational Interventions to Improve Safety and Health Literacy Among Agricultural Workers: A Systematic Review

Health and safety education for farmers has the potential to increase the level of health, safety literacy, and thereby improve farmers’ health and quality of life. The aim of this paper is to provide a systematic review of the published literature documenting different educational interventions for agricultural workers that have the improvement of health and/or safety literacy as an outcome. A systematic search was conducted in PubMed, Embase, Scopus and PsycINFO databases for articles focusing on educational interventions for farmers’ health and safety. From the 3357 initial hits, 36 unduplicated records met the inclusion criteria. The articles included in the review used educational interventions for farmers with the purpose of preventing farm-induced diseases and injuries, increasing the health and well-being of farmers, and promoting good manufacturing practices. The educational approaches considered varied from lectures, videos, newsletters, games, and community fairs, to involving the community in designing the intervention and training farmers to deliver the intervention to the community. Interventions that used evidence-based theories, which took into account cultural aspects and individual factors, used biomarkers as a behavior change measurement, and involved the community in the development of the intervention had the best results in terms of behavior change. The strategies of educational interventions identified in this review that produced good results have the potential to inform future researchers and policy makers in the design and implementation of public health interventions, programs and policies to improve the health of farmers and their families.

Health Indicators of a Cohort of Midwest Farmers: Health Outcomes of Participants in the Certified Safe Farm Program

Occupational illness, injury, and fatality rates for those working in production agriculture are higher than in any other industry. A potential risk factor contributing to occupational injuries across all industries is acute or chronic co-morbidity (e.g., obesity, high blood pressure, high cholesterol), and related health issues that increase the risk for an occupational injury or illness. These chronic health conditions have been associated not only with increased risk for injuries, but also higher health-care costs, and greater absenteeism. Certified Safe Farm (CSF) is a comprehensive intervention program aimed to reduce occupational health and safety hazards and to promote general health among farmers. Prior publications have described CSF program efforts to reduce hazardous exposures, disabling injuries, organic dust toxic syndrome, occupational health-care costs, and to increase positive occupational health behaviors. This paper reports on the general health indicators of a cohort of 438 Iowa farm owner/operators enrolled in the CSF program. Overall, this study found that the farming population in Iowa has higher body mass index (BMI), but lower total cholesterol, low-density lipoprotein (LDL), and lower prevalence of hypertension compared to the general population. There was evidence that the combination of high blood pressure, cholesterol, and BMI were related to increased injury rates. Poor self-reported health status was also related to increased injuries but was not related to clinical health indicators. The CSF intervention led to improvements on health outcomes, particularly among those in the 35 to 49 age group. Little research has focused on the individual's general health status as a predictor of risk of occupational injury. This study suggests the need for additional research and interventions integrating occupational safety and health prevention along with health promotion.

Utah Regional Differences in Respirator Use and Fit Testing among Pesticide Applicators

The purpose of this study was to determine regional differences within Utah in response to piloting a mobile respirator training and fit assessment program for pesticide applicators. The objectives were to describe worker perceptions of respirator use and training experiences. Pilot trainings were offered in two southern counties and two northern counties of Utah. A total of 141 individuals completed the post-training questionnaire regarding use and fit testing experience with respirators as well as perceptions of the benefits to protecting respiratory health. The majority of respondents were male (95.7%, f = 112). The proportion of participants in the southern counties who had respirator training experience (61.0%, f = 25) was not significantly higher (2 = 3.763, df = 1, p = 0.05) than the proportion of participants in the northern counties (43.0%, f = 43). Three-fourths (73.5%, f = 72) of participants in the northern counties agreed that they expect to wear a respirator in dusty conditions, while two-thirds (61.0%, f = 25) of participants in the southern counties agreed that they expect to wear a respirator in dusty conditions. The results indicated that more training should be done to improve perceptions and beliefs about using respirators. A high priority for this population will be identification of comfortable respirator options as well as communicating the importance of proper fit testing.

Behavioural interventions to promote workers' use of respiratory protective equipment

BACKGROUND

Respiratory hazards are common in the workplace. Depending on the hazard and exposure, the health consequences may include: mild to life-threatening illnesses from infectious agents, acute effects ranging from respiratory irritation to chronic lung conditions, or even cancer from exposure to chemicals or toxins. Use of respiratory protective equipment (RPE) is an important preventive measure in many occupational settings. RPE only offers protection when worn properly, when removed safely and when it is either replaced or maintained regularly. The effectiveness of behavioural interventions either directed at employers or organisations or directed at individual workers to promote RPE use in workers remains an important unanswered question.

OBJECTIVES

To assess the effects of any behavioural intervention either directed at organisations or at individual workers on observed or self-reported RPE use in workers when compared to no intervention or an alternative intervention.

SEARCH METHODS

We searched the Cochrane Work Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 07), MEDLINE (1980 to 12 August 2016), EMBASE (1980 to 20 August 2016) and CINAHL (1980 to 12 August 2016).

SELECTION CRITERIA

We included randomised controlled trials (RCTs), controlled before and after (CBA) studies and interrupted time-series (ITS) comparing behavioural interventions versus no intervention or any other behavioural intervention to promote RPE use in workers.

DATA COLLECTION AND ANALYSIS

Four authors independently selected relevant studies, assessed risk of bias and extracted data. We contacted investigators to clarify information. We pooled outcome data from included studies where the studies were sufficiently similar.

MAIN RESULTS

We included 14 studies that evaluated the effect of training and education on RPE use, which involved 2052 participants. The included studies had been conducted with farm, healthcare, production line, office and coke oven workers as well as nursing students and people with mixed occupations. All included studies reported the effects of interventions as use of RPE, as correct use of RPE or as indirect measures of RPE use. We did not find any studies where the intervention was delivered and assessed at the whole organization level or in which the main focus was on positive or negative incentives. We rated the quality of the evidence for all comparisons as low to very low. Training versus no trainingOne CBA study in healthcare workers compared training with and without a fit test to no intervention. The study found that the rate of properly fitting respirators was not considerably different in the workers who had received training with a fit test (RR 1.17, 95% Confidence Interval (CI) 0.97 to 1.10) or training without a fit test (RR 1.16, 95% CI 0.95 to 1.42) compared to those who had no training. Two RCTs that evaluated training did not contribute to the analyses because of lack of data. Conventional training plus additions versus conventional training aloneOne cluster-randomised trial compared conventional training plus RPE demonstration versus training alone and reported no significant difference in appropriate use of RPE between the two groups (RR 1.41, 95% CI 0.96 to 2.07).One RCT compared interactive training with passive training, with an information screen, and an information book. The mean RPE performance score for the active group was not different from that of the passive group (MD 2.10, 95% CI -0.76 to 4.96). However, the active group scored significantly higher than the book group (MD 4.20, 95% CI 0.89 to 7.51) and the screen group (MD 7.00, 95% CI 4.06 to 9.94).One RCT compared computer-simulation training with conventional personal protective equipment (PPE) training but reported only results for donning and doffing full-body PPE. Education versus no educationOne RCT found that a multifaceted educational intervention increased the use of RPE (risk ratio (RR) 1.69, 95% CI 1.10 to 2.58) at three years' follow-up when compared to no intervention. However, there was no difference between intervention and control at one year's, two years' or four years' follow-up. Two RCTs did not report enough data to be included in the analysis.Four CBA studies evaluated the effectiveness of education interventions and found no effect on the frequency or correctness of RPE use, except in one study for the use of an N95 mask (RR 4.56, 95% CI 1.84 to 11.33, 1 CBA) in workers. Motivational interviewing versus traditional lecturesOne CBA study found that participants given motivational group interviewing-based safety education scored higher on a checklist measuring PPE use (MD 2.95, 95% CI 1.93 to 3.97) than control workers given traditional educational sessions.

AUTHORS' CONCLUSIONS

There is very low quality evidence that behavioural interventions, namely education and training, do not have a considerable effect on the frequency or correctness of RPE use in workers. There were no studies on incentives or organisation level interventions. The included studies had methodological limitations and we therefore need further large RCTs with clearer methodology in terms of randomised sequence generation, allocation concealment and assessor blinding, in order to evaluate the effectiveness of behavioural interventions for improving the use of RPE at both organisational and individual levels. In addition, further studies should consider some of the barriers to the successful use of RPE, such as experience of health risk, types of RPE and the employer's attitude to RPE use.

Feedback on Measured Dust Concentrations Reduces Exposure Levels Among Farmers

BACKGROUND

The high burden of exposure to organic dust among livestock farmers warrants the establishment of effective preventive and exposure control strategies for these workers. The number of intervention studies exploring the effectiveness of exposure reduction strategies through the use of objective measurements has been limited.

OBJECTIVE

To examine whether dust exposure can be reduced by providing feedback to the farmers concerning measurements of the exposure to dust in their farm.

METHODS

The personal dust levels of farmers in 54 pig and 26 dairy cattle farms were evaluated in two measurement series performed approximately 6 months apart. Detailed information on work tasks and farm characteristics during the measurements were registered. Participating farms were randomized a priori to a control (n = 40) and an intervention group (n = 40). Shortly after the first visit, owners of intervention farms only received a letter with information on the measured dust concentrations in the farm together with some general advises on exposure reduction strategies (e.g. use of respirators during certain tasks). Relationships between measured dust concentrations and intervention status were quantified by means of linear mixed effect analysis with farm and worker id as random effects. Season, type of farming, and work tasks were treated as fixed effects. Changes in exposure over time were explored primarily at a farm level in models combined, as well as separate for pig and cattle farmers.

RESULTS

After adjustment for fixed effects, an overall reduction of 23% in personal dust exposures was estimated as a result of the intervention (P = 0.02). Exposure reductions attributable to the intervention were similar across pig and cattle farmers, but statistically significant only for pig farmers. Intervention effects among pig farmers did not depend on the individuals' information status; but among cattle farmers a significant 48% reduction in exposure was found only among individuals that reported to have been informed. No systematic differences in changes over time considering the use of respiratory protection between the intervention and control groups were observed.

CONCLUSION

The results of the present study suggest reductions between 20 and 30% in personal exposure to inhalable dust to be feasible through simple information provided to the farm owners regarding actual levels of exposure together with instructions on basic measures of prevention. The exact reasons for these effects are unclear, but likely they involve changes in behavior and working practices among intervention farmers.

Social marketing campaign promoting the use of respiratory protection devices among farmers

This article describes the formal use of marketing concepts in a systematic approach to influence farmers to voluntarily increase respiratory protective device (RPD) use. The planning process for the project incorporated six key decision or action points, each informed by formative research or health behavior theory. The planning process included developing behavior change strategies based on a 4P model (product, price, place, and promotion). The resulting campaign elements included print and e-mail messages that leveraged motivators related to family and health in order to increase farmers' knowledge about the risks of exposure to dusty environments, four instructional videos related to the primary barriers identified in using RPDs, and a brightly colored storage bag to address barriers to using RPDs related to mask storage. Campaign implementation included a series of e-mails using a bulk e-mail subscription service, use of social media in the form of posting instructional videos on a YouTube channel, and in-person interactions with members of the target audience at farm shows throughout the Central States Center for Agricultural Safety and Health seven-state region. Evaluation of the e-mail campaigns indicated increased knowledge about RPD use and intent to use RPDs in dusty conditions. YouTube analytic data indicated continuing exposure of the instructional videos beyond the life of the campaign. The project demonstrates the efficacy of a planning process that incorporates formative research and clear decision points throughout. This process could be used to plan health behavior change interventions to address other agriculture-related health and safety issues.

A comprehensive review of levels and determinants of personal exposure to dust and endotoxin in livestock farming

The respiratory health effects of livestock farming have been on debate for more than three decades. Endotoxin-contaminated organic dusts are considered as the most important respiratory hazards within livestock environments. A comprehensive review of the knowledge from studies assessing the exposure status of livestock farmers is still to be published. The present study reviews research published within the last 30 years on personal exposure of livestock farmers to organic dust and endotoxin, focusing on studies on pig, poultry and cattle farmers. Applied measurement methods and reported levels of personal exposure for the total, inhalable and respirable fractions are summarized and discussed, with emphasis on the intensity of exposure and the size and distribution of the reported exposure variability. In addition, available evidence on potential determinants of personal exposure to dust and endotoxin among these farmers are documented and discussed, taking results from exposure determinant studies using stationary sampling approaches into consideration. Research needs are addressed from an epidemiological and industrial hygiene perspective. Published studies have been heterogeneous in design, and applied methodologies and results were frequently inadequately reported. Despite these limitations and the presence of an enormous variability in personal exposure to dust and endotoxin, no clear downward trends in exposure with time were observed, suggesting that working environments within stables remains largely uncontrolled. Exposure control and prevention strategies for livestock farmers are urgently required. These should focus on the development of novel and improved methods of controlling dust and endotoxin exposure within stables based on the currently available knowledge on determinants of exposure.