Eliminating Take-Home Exposures: Recognizing the Role of Occupational Health and Safety in Broader Community Health

An intersectional analysis of the health status, work conditions, and nonwork conditions of the U.S. working-classed across class, sex, race, and nativity identities

BACKGROUND

Classism, sexism, racism, and nativism intersect to create inequitable conditions and health outcomes based on workers' social identities. This study describes the health status, work conditions, and nonwork conditions of the United States (U.S.) working-classed at the intersections of class, sex, racial, and nativity identities.

METHODS

Descriptive statistics (e.g., frequencies, percentages) were calculated from the 2015 National Health Interview Survey data for the total working classed sample (N = 11,884) and 16 intersectional groupings. General and psychosocial health status, work factors, and access to resources outside of work were examined.

RESULTS

Intersectional analysis revealed divisions in work and nonwork conditions despite the majority of each grouping reporting very good/excellent health. The majority of the female Latine born-outside-U.S. grouping (60%) reported not having paid sick leave. The majority of the male Latine born-outside-U.S. grouping reported having neither paid sick leave (62%) nor health insurance (55%). The majority of the female Latine (53%), male Latine (60%), and male Black (55%) born-outside-U.S. groupings reported workplaces as less safe. The majority of the female Latine born-outside-U.S. grouping (53%) was the only grouping to report being moderately/very worried about being able to afford housing costs.

CONCLUSION

The health status and precarity of work and nonwork conditions of the U.S. working classed may be shaped by intersecting systems of power across class, sex, racial, and nativity identities. Intersectional analysis increases our purview to see who is most affected, how, and where, which can inform future opportunities to mitigate worker health inequities.

Creating Shared Perspectives for Worker Well-being: A Community Health-Focused Certificate in Total Worker Health®

OBJECTIVES

This study aimed to highlight the utility of a new certificate program in Total Worker Health ® (TWH) designed for health professionals in other community health settings (OCHS).

METHODS

Stakeholder needs assessment, priority setting, and comparison with existing core competencies in TWH approaches were performed to identify learning objectives and curricular threads in alignment with adult learning principles. Faculty-student pairings were conducted for content and assessment development.

RESULTS

A free six-module training course that prepares OCHS professionals to collaborate with occupational safety and health (OSH) professionals.

CONCLUSIONS

TWH can be advanced through collaboration between OSH and OCHS professionals. In service of shared ground, OCHS professionals should articulate the influence of work on health, TWH principles, and OSH vocabulary and concepts. Such training is a necessary step toward facilitating groups for the benefit of all work and workers.

Industrial Hog Operation Workers' Perspectives on Occupational Exposure to Zoonotic Pathogens: A Qualitative Pilot Study in North Carolina, USA

Industrial hog operation (IHO) workers face a range of occupational hazards, including exposure to zoonotic pathogens such as livestock-associated antimicrobial-resistant Staphylococcus aureus and swine-origin influenza viruses with epidemic or pandemic potential. To better understand this population's occupational exposure to zoonotic pathogens, we conducted a community-driven qualitative research study in eastern North Carolina. We completed in-depth interviews with ten IHO workers and used thematic analysis to identify and analyze patterns of responses. Workers described direct and indirect occupational contact with hogs, with accompanying potential for dermal, ingestion, and inhalation exposures to zoonotic pathogens. Workers also described potential take-home pathways, wherein they could transfer livestock-associated pathogens and other contaminants from IHOs to their families and communities. Findings warrant future research, and suggest that more restrictive policies on antimicrobials, stronger health and safety regulations, and better policies and practices across all IHOs could afford greater protection against worker and take-home zoonotic pathogen exposures.

Implementation of an Awareness Level Training to Prepare the Workforce for Future Infectious Disease Outbreaks

OBJECTIVE

The COVID-19 pandemic underscores the need for workforce awareness-level training for infectious disease outbreaks. A training program was created and evaluated to provide strategies for emergency preparedness as well as worker health and safety during a disease outbreak.

METHODS

Participants (N = 292) completed instructor-led synchronous online training modules between January 2022 and February 2023. Training covered 5 areas: vaccine awareness, infectious disease transmission and prevention, pandemic awareness, and inapparent infections, as well as workplace controls to reduce or remove hazards. Participants completed a survey before and after training to assess knowledge change in the five areas. Chi-square analyses assessed how predictors were related to knowledge change.

RESULTS

Overall, an increase in knowledge was observed between pre- (80.9%) and post-training (92.7%). Participants from small businesses, with less work experience, and in non-health care roles were under-informed. Knowledge of disease transmission and prevention improved for non-health care professions and workers with less experience. All participants gained knowledge in identifying and ranking safeguards to protect workers from injuries and illness at job sites.

CONCLUSIONS

Training improved employee knowledge about safe work practices and pandemic preparedness. Studies should continue to evaluate the effectiveness of preparedness training to prepare the workforce for infectious disease outbreaks and pandemics.

Para-occupational exposure to chemical substances: a systematic review

Today, many health problems related to work have overshadowed workers and their families. In the meantime, chemicals are among the risk factors that have created many problems due to para-occupational exposure. In para-occupational exposures, family members are exposed to work pollutants transferred to the home environment. This study was conducted to investigate para-occupational exposure to chemicals. To conduct this systematic review, databases such as "Web of Science", "Google Scholar", "Scopus", and "SID" were used. Relevant articles in these databases were extracted by searching keywords such as "take-home exposure", "para-occupational exposure", and "chemicals" from 2000 to 2022. To extract the required data, all parts of the articles were reviewed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA 2020). Among the 44 identified articles, 23 were selected as final articles, of which 10 were related to agriculture workers and their families, and 13 were related to other occupations. These studies mainly investigated para-occupational exposure to pesticides (14 studies) and metals (four studies). Also, contaminated work clothes, the washing place of contaminated clothes, and storage of working clothes, equipment, and chemicals were proposed as the main routes of contamination transmission. As a result of these para-occupational exposures, problems like neuro-behavioral disorders in children, end-stage renal disease, black gingival borders, and autism spectrum disorder were created or aggravated. Limiting the transmission routes and taking measures such as training and providing facilities like devoting places for washing and storing clothes in the workplaces can decrease this type of exposure.

Tackling the Lead Gremlins: A Response to Take-Home Lead Exposure in a Minnesota Industrial Facility, 2019

Lead exposure that occurs from contamination inadvertently brought home from a workplace is known as take-home exposure. Take-home exposures are a public health hazard that adversely affects health equity for families and communities. This article describes coordinated action by agencies in Minnesota to curb lead exposure among children of workers at a facility that produces fishing sinkers and battery terminals. (Am J Public Health. 2022;112(S7):S655-S657. https://doi.org/10.2105/AJPH.2022.306982).

Metals dust in workers' homes and potential for take home in the Greater Boston area: Pilot study

Toxic metals such as lead, cadmium, arsenic, are present at construction worksites. From work, metals can easily, unintentionally be transported to homes of workers, contaminating living spaces and affecting others including children, known as "take-home exposure." Focus has been given to minimizing lead take-home exposure but less is known about other metals. This pilot study aims to better understand the sources and predictors of metals in the home primarily of construction workers (n = 21), but also explore other workers potentially exposed [janitorial (n = 4) and auto repair (n = 2) jobs]. Greater Boston workers were recruited in 2018-2019 through collaboration with community-based organizations and worker unions serving low-income/immigrant workers. During a home visit, a dust vacuum sample was collected, a worker questionnaire was administered, and home observations were performed to determine factors that could affect home metals concentration. Thirty elements were analyzed in the dust via inductively coupled plasma coupled to atomic emission and mass spectrometry. We performed univariable and multivariable models, potential predictive factors, and multivariable mixed-effect regression analyses combining metals. Arsenic, chromium, copper, lead, manganese, nickel, and tin, commonly found in construction, were higher in construction workers' home dust compared to other workers, although not statistically significant. Sociodemographic/work/home-related variables affected home metals dust concentrations. Various work-related factors were associated with higher metal dust levels, for example: no work locker vs. locker (nickel ratio of means or ROM = 4.2, p < 0.05); mixing vs. no mixing work/personal items (nickel ROM = 1.6, p < 0.05); dusty vs. no dusty at work (copper ROM = 3.1, p < 0.05); not washing vs. washing hands after work (manganese ROM = 1.4, p < 0.05); not changing vs. changing clothes after work (cadmium ROM = 6.9, p < 0.05; copper ROM = 3.6, p < 0.05). Mixed effect regression confirmed statistical significance, which suggests a likelihood of metal mixtures carrying a "take-home" potential. Lead home interventions should evaluate other metals exposure reduction.

Modeling Clothing as a Vector for Transporting Airborne Particles and Pathogens across Indoor Microenvironments

Evidence suggests that human exposure to airborne particles and associated contaminants, including respiratory pathogens, can persist beyond a single microenvironment. By accumulating such contaminants from air, clothing may function as a transport vector and source of "secondary exposure". To investigate this function, a novel microenvironmental exposure modeling framework (ABICAM) was developed. This framework was applied to a para-occupational exposure scenario involving the deposition of viable SARS-CoV-2 in respiratory particles (0.5-20 μm) from a primary source onto clothing in a nonhealthcare setting and subsequent resuspension and secondary exposure in a car and home. Variability was assessed through Monte Carlo simulations. The total volume of infectious particles on the occupant's clothing immediately after work was 4800 μm3 (5th-95th percentiles: 870-32 000 μm3). This value was 61% (5-95%: 17-300%) of the occupant's primary inhalation exposure in the workplace while unmasked. By arrival at the occupant's home after a car commute, relatively rapid viral inactivation on cotton clothing had reduced the infectious volume on clothing by 80% (5-95%: 26-99%). Secondary inhalation exposure (after work) was low in the absence of close proximity and physical contact with contaminated clothing. In comparison, the average primary inhalation exposure in the workplace was higher by about 2-3 orders of magnitude. It remains theoretically possible that resuspension and physical contact with contaminated clothing can occasionally transmit SARS-CoV-2 between humans.

Factors affecting lead dust in construction workers' homes in the Greater Boston Area

Lead is a known reproductive, developmental, and neurological toxicant. Workers with a high likelihood of being exposed to lead at work may inadvertently transport lead home from work, known as "take-home exposure." This is concerning for many workers for whom a workplace intervention is not feasible because their worksites and employers often change, rendering centralized strategies insufficient. This study aimed to better understand the connection between lead in the home of workers living with children and work in construction (n = 23), while other occupations were used as a comparison group (janitorial n = 5, autobody n = 2). Thirty workers living in disadvantaged communities in the Greater Boston area were recruited in 2018-2019 through collaboration with non-profits and worker unions with expertise working with low-income or immigrant workers. Construction workers that performed renovations, bridge constructions, welding, metal work, and demolitions were prioritized during recruitment. During a visit to their residences, a worker questionnaire was administered, and observations and a dust vacuumed sample of the home were collected. Factors predicting lead in home dust were explored by a bivariate analysis and a multivariable regression model. We found lead in homes' dust in the range of 20-8,310 ppm. Homes of construction workers generally had higher and more variable lead dust concentrations (mean 775, max 8,300 ppm) than autobody and janitor worker homes combined (mean 296, max 579 ppm). Five of the construction workers' home lead dust concentrations exceeded US guidelines for yard soil in children's play areas of 400 ppm, and were similar to other studies of homes near lead smelters, superfund sites, or in the Boston area in the early 1990s, pointing to disparities relating to work. Results from the multivariable regression model suggest that lead dust in homes of workers was associated with sociodemographic-, home-, and work-related factors, and pointed to overlapping vulnerabilities; however, a larger sample size is needed to verify findings. Results provide evidence that work-related factors are important to consider when assessing home exposures, and that take-home exposures for workers in lead high-risk jobs such as construction may be an important source of exposure in the home prime for public health intervention at work, home, and community levels.

Overlapping vulnerabilities in workers of the electronics recycling industry formal sector: A commentary

Vulnerabilities in workers performing electronics recycling (e-recycling) in the informal sector worldwide have been well documented. However, the growing e-recycling industry in the formal sector still brings many challenges to protect the health of workers and their environment. This commentary aims to draw attention to the overlooked vulnerabilities faced by the workers of the e-recycling industry formal sector in high-income countries and discuss the potential impact on health inequalities experienced by these workers. Expanding the definition of vulnerability, not limited to the biological susceptibility to chemical and physical exposures, the demographic characteristics of workers in the e-recycling formal sector often reveal social groups known to be disadvantaged regarding occupational exposures and health effects, including young workers, immigrant or ethnic minorities, and workers with mental or physical health issues or disabilities. Overlapping structural vulnerabilities of the e-recycling industry stem from its newness, its working conditions, its conditions of employment, and the sociodemographic characteristics of its workforce. This phenomenon in high-income countries is not restricted to the e-recycling industry alone. It is rather a symptom of more generalized macro socioeconomical phenomena. The present challenges are in line with the new gig and green economies and changes in the global market, and their consequences on the solid waste sector. Continued efforts to strengthen the inclusion of social aspects of health into the complex interaction of the structural vulnerabilities met by e-recycling workers will be essential to anticipate and prevent health issues in this essential but still emerging workforce.