Wounding the Messenger: The New Economy Makes Occupational Health Indicators Too Good to Be True

The U.S. Bureau of Labor Statistics and workers' compensation insurers reported dramatic drops in rates of occupational injuries and illnesses during the 1990s. The authors argue that far-reaching changes in the 1980s and 1990s, including the rise of precarious employment, falling wages and opportunities, and the creation of a super-vulnerable population of immigrant workers, probably helped create this apparent trend by preventing employees from reporting some injuries and illnesses. Changes in the health care system, including loss of access to health care for growing numbers of workers and increased obstacles to the use of workers' compensation, compounded these effects by preventing the diagnosis and documentation of some occupational injuries and illnesses. Researchers should examine these forces more closely to better understand trends in occupational health.

Barriers to use of workers' compensation for patient care at Massachusetts community health centers

OBJECTIVES

To examine barriers community health centers (CHCs) face in using workers' compensation insurance (WC).

DATA SOURCES/STUDY SETTING

Leadership of CHCs in Massachusetts.

STUDY DESIGN

We used purposeful snowball sampling of CHC leaders for in-depth exploration of reimbursement policies and practices, experiences with WC, and decisions about using WC. We quantified the prevalence of perceived barriers to using WC through a mail survey of all CHCs in Massachusetts.

DATA COLLECTION/EXTRACTION METHODS

Emergent coding was used to elaborate themes and processes related to use of WC. Numbers and percentages of survey responses were calculated.

PRINCIPAL FINDINGS

Few CHCs formally discourage use of WC, but underutilization emerged as a major issue: "We see an awful lot of work-related injury, and I would say that most of it doesn't go through workers' comp." Barriers include lack of familiarity with WC, uncertainty about work-relatedness, and reliance on patients to identify work-relatedness of their conditions. Reimbursement delays and denials lead patients and CHCs to absorb costs of services.

CONCLUSION

Follow-up studies should fully characterize barriers to CHC use of WC and experiences in other states to guide system changes in CHCs and WC agencies. Education should target CHC staff and workers about WC.

Results of a community-university partnership to reduce deadly hazards in hardwood floor finishing

A community-university partnership used community-based participatory research (CBPR) to design, implement, and evaluate a multi-cultural public health campaign to eliminate flammable products and reduce use of products high in volatile organic compounds (VOCs) in hardwood floor finishing in Massachusetts. Leading participants were Vietnamese-American organizations and businesses. Following the public health campaign, a multi-lingual survey of self-reported experiences with fires, product use, exposure to outreach activities, and changes made, was conducted with floor finishers. One hundred nine floor finishers responded. Over 40% reported fires at their companies' jobs, mostly caused by lacquer sealers. Over one third had heard radio or TV shows about health and safety in floor finishing, and over half reported making changes as a result of outreach. Exposure to various outreach activities was associated with reducing use of flammable products, increasing use of low-VOC products, and greater knowledge about product flammability. However, most respondents still reported using flammable products. Outreach led by community partners reached large proportions of floor finishers, was associated with use of safer products, and adds to recent work on CBPR with immigrant workers. Continued use of flammable products supports the belief that an enforceable ban was ultimately necessary to eradicate them.

Getting to Know You: Occupational Health Researchers Investigate Employee Assistance Professionals' Approaches to Workplace Stress

Workplace stress is strongly associated with health problems, including cardiovascular disease. The occupational health field is developing partnerships with a variety of health professions to prevent and address job stress at the organizational level. A review of literature for and about employee assistance professionals was conducted to explore their perspectives on these issues. Results show high awareness regarding the health effects of job stress and a wide range of approaches to address this problem. EAPs appear to be a potential strong partner in efforts to prevent workplace stress, but face obstacles to intervening at the level of the work environment.

Barriers to Workplace Stress Interventions in Employee Assistance Practice: EAP Perspectives

Occupational health literature links stressful working conditions with cardiovascular and other chronic diseases, injuries, and psychological distress. We conducted individual interviews with employee assistance professionals (EAPs) to understand opportunities and barriers for EAPs to address job stress through organization level interventions. EAPs described their primary role as assisting individual employees versus designing company wide interventions. The most salient barriers to organization level interventions cited were lack of access to company management and (for contracted EAPs) perceptions of contract vulnerability. Education about workplace stress interventions may be most effectively directed at EAPs who are already integrated with company level work groups.

Reducing hazardous cleaning product use: a collaborative effort

Workplace hazards affecting vulnerable populations of low-wage and immigrant workers present a special challenge to the practice of occupational health. Unions, Coalition for Occupational Safety and Health (COSH) groups, and other organizations have developed worker-led approaches to promoting safety. Public health practitioners can provide support for these efforts. This article describes a successful multiyear project led by immigrant cleaning workers with their union, the Service Employees International Union (SEIU) Local 615, and with support from the Massachusetts COSH (MassCOSH) to address exposure to hazardous chemicals. After the union had identified key issues and built a strategy, the union and MassCOSH invited staff from the Massachusetts Department of Public Health's Occupational Health Surveillance Program (OHSP) to provide technical information about health effects and preventive measures. Results included eliminating the most hazardous chemicals, reducing the number of products used, banning mixing products, and improving safety training. OHSP's history of public health practice regarding cleaning products enabled staff to respond promptly. MassCOSH's staff expertise and commitment to immigrant workers allowed it to play a vital role.

The Boston-area HASWIC Research Circle: an innovative participatory method for coloring in the picture of a special work environment

Recent qualitative studies have investigated some of the hazards affecting women in non-traditional trades such as construction. However, one-time interactions among researcher participants, and between researchers and participants, in standard settings such as focus groups and interviews, cannot provide the time, space, and relationships to fully explore tradeswomen's in-depth knowledge of their work environment. This study applied a Scandinavian method called the Research Circle to convene a group of experienced women construction workers repeatedly over a period of two years so they could collaborate with researchers in explaining workplace issues. The results both validated and expanded upon previous findings about health and safety for women in construction, including gender discrimination, lack of access to sanitary facilities, retaliation for reporting hazards and injuries, and inadequate training and equipment. Especially important, findings illustrate some of the complex hierarchical social structures involved in both female and male construction workers responding to hazardous conditions.

Factors influencing ergonomic intervention in construction: trunkman case study

This case study examines factors affecting the use of equipment designed to prevent lower back strain in laborers who pour concrete on major highway construction sites. Qualitative methods of organizational analysis were used to characterize factors identified from interviews and participant observation. The major obstacles to the use of the control on site were 1. Managers placing a low priority on ergonomics. 2. Safety officers' limited power in organizational hierarchies. 3. Rationalizing, rather than challenging, resistance to change. 4. Lack of a forum to share knowledge about interventions. Several organizational factors impeded the adoption of a technically effective, low-cost safety control on the site studied. The implementation of the control ultimately resulted from actions taken by the investigators, suggesting that safety programs present at the site are not always adequate to realize feasible interventions.

Protecting workers and residents from wood floor-finishing hazards

The recent deaths of three hardwood floor finishers in the Boston area have highlighted the urgency of addressing hazards in this industry. Among other dangers to health and safety, fire is a constant threat in a work setting that combines highly flammable solvents, large quantities of airborne wood dust, electrical equipment, heat, and friction inside old homes. Immigrant workers, who perform a large proportion of this work, are at special risk. An Environmental Justice partnership of community-based organizations, community health centers, and environmental health researchers funded by the National Institute of Environmental Health Sciences (the "Dorchester Occupational Health Initiative") had been studying the occupational health of hardwood floor finishing when these workers died. This preparation enabled community, health, labor, business, and political leaders to mobilize a response and release recommendations within weeks of the second fatal fire. Their report, adapted below, contains important information for health and labor activists in all areas where wood flooring is common. Most notably, the use of less flammable (higher flash point) products can help reduce the risk of more fatal fires. For further information, please contact the Massachusetts Coalition for Occupational Safety and Health, masscosh.org.

The occupational health of Southeast Asians in Lowell: a descriptive study

To assess the occupational health of a group of vulnerable workers, Southeast Asians, in Lowell, Massachusetts, researchers surveyed 160 residents of Cambodian or Lao ethnicity regarding working conditions, health problems, and use of medical services. Over 40% reported work in electronics and computer assembly. A fourth of those currently employed held temporary jobs. Workplace hazards included soldering fumes; inadequate ventilation; prolonged sitting or standing; awkward postures; unguarded machinery; shift work; long hours; and pressure to produce quickly. Common work-related health problems included sprains and strains, headache, dizziness, and flu-like symptoms. Less than a third of the respondents knew about workers' compensation. Household surveys can provide otherwise unavailable occupational health data for defined populations.

Occupational health of Southeast Asian immigrants in a US city: a comparison of data sources

OBJECTIVES

This study sought to characterize occupational injury and illness cases identified through 3 different sources of data on a population of immigrant workers.

METHODS

Participants were Cambodian and Lao workers living in Lowell, Mass. A household survey allowed comparisons between characteristics of work-related cases documented in workers' compensation wage replacement records and hospital records and characteristics of self-reported cases.

RESULTS

The household survey captured types of cases missing from existing data, particularly illnesses self-reported to be associated with chemical exposures. Injuries and illnesses affecting the study population appeared to be significantly underrepresented in workers' compensation wage replacement data.

CONCLUSIONS

Community-based methods can supplement available occupational health data sources.

Occupational injury and illness surveillance: conceptual filters explain underreporting

Occupational health surveillance data are key to effective intervention. However, the US Bureau of Labor Statistics survey significantly underestimates the incidence of work-related injuries and illnesses. Researchers supplement these statistics with data from other systems not designed for surveillance. The authors apply the filter model of Webb et al. to underreporting by the Bureau of Labor Statistics, workers' compensation wage-replacement documents, physician reporting systems, and medical records of treatment charged to workers' compensation. Mechanisms are described for the loss of cases at successive steps of documentation. Empirical findings indicate that workers repeatedly risk adverse consequences for attempting to complete these steps, while systems for ensuring their completion are weak or absent.

Biomarkers of exposure to organophosphorous insecticides among farmers' families in rural El Salvador: factors associated with exposure

Most studies of the health effects of pesticides have concentrated on occupational exposure. Little is known about community environmental exposure to agricultural pesticides. The purpose of this study was to investigate nonoccupational pesticide exposure among farmers' families in rural El Salvador, a country known for intensive use of extremely toxic compounds. The study population included all residents 8 years and older living in five agricultural communities in El Salvador. Current exposure to organophosphate insecticides (OPs) was established through analysis of urine samples for alkyl phosphate metabolites of OPs. Nearly half of 358 analyzed samples had detectable levels of OP metabolities. Of subjects not performing agricultural fieldwork, 30% nonetheless excreted detectable levels of metabolities. Similar rates held for children and adults. The best independent predictors for an individual's excretion of OP metabolites were (a) performing fieldwork during the past 2 weeks, (b) the head household farmer's application of OPs during the past 2 years, and (c) the household mother reporting use of OPs in the home or yard. The latter factors were significantly associated with metabolite excretion regardless of whether the individual had done fieldwork. The results of this study support the hypothesis that a large proportion of rural Salvadorans, including children, is exposed to pesticides through environmental as well as occupational routes.

Acute health effects associated with nonoccupational pesticide exposure in rural El Salvador

Little is known about the health effects of nonoccupational pesticide exposure in agricultural communities of poor countries. Therefore, this study investigated acute symptoms associated with nonoccupational exposure to organophosphate insecticides (OPs) in rural El Salvador, a region known for intensive pesticide use. In the five communities studied, 2-week prevalences of several acute symptoms were associated with living with a farmer who had recently applied methyl parathion. These included cramps in limbs (odds ratio 2.1, 95% confidence interval 1.2-3.7), chest pressure (OR 2.3, 95% CI 1.3-4.0), change in defecation (OR 2.3, 95% CI 1.3-4.1), feeling dazed (OR 2.4, 95% CI 1.3-4.4), and eyes tearing (OR 2.5, 95% CI 1. 4-4.5). Associations were found regardless of whether the individuals reporting the symptoms had themselves performed field labor. These results suggest that living in areas where pesticides are used on crops may represent an environmental health concern, especially for children.

Childhood malnutrition and postwar reconstruction in rural El Salvador: a community-based survey

CONTEXT

The 1992 peace settlement that ended the civil war in El Salvador included land redistribution and other provisions designed to improve the socioeconomic status of ex-combatants and vulnerable civilians.

OBJECTIVE

To describe associations between postwar social and economic assistance programs, especially land reform, and current child health status as reflected by nutrition in a population of resettled rural refugees.

DESIGN

A population-based cross-sectional survey of child nutritional status and principal elements of the reconstruction process.

SETTING

A single rural municipality in northern El Salvador.

PARTICIPANTS

A representative sample of 761 children younger than 5 years, living in 27 villages.

MAIN OUTCOME MEASURE

Prevalence of stunting (low height for age) in children younger than 5 years.

RESULTS

Prevalence of stunting was 32.4%. Stunting was significantly more prevalent among children whose families cultivated less land (odds ratio [OR] for stunting per additional hectare of redistributed land cultivated, 0.64; 95% confidence interval [CI], 0.44-0.93). Less than half of newly transferred land was being cultivated by its owners. Most of the children (84.7%) lived in families cultivating 2 hectares or less of redistributed land. Stunting was also more prevalent among children whose households lacked piped water (adjusted OR, 2.72; 95% CI, 1.87-3.96) vs those who had had piped water since before the cease-fire.

CONCLUSIONS

Malnutrition, particularly stunting, persisted at high levels and was strongly associated with delay in full cultivation of redistributed land and in provision of water.

The accumulation of oligosaccharides in tissues and body fluids of cats with alpha-mannosidosis

Oligosaccharides were extracted from tissues and body fluids of five kittens with alpha-mannosidosis, three being from the same litter. The kittens were all of different ages at death and were compared to normal and heterozygote cats. The oligosaccharides were analyzed by high-pressure liquid chromatography after perbenzoylation and were identified by comparison with compounds of known structure. This provided a detailed picture of the distribution of oligosaccharides in each tissue, and a method for quantitation of the total oligosaccharides. With the exception of the youngest animal (death at day 2), the oligosaccharide elution profiles were broadly similar for all tissues and fluids, and were typical of feline alpha-mannosidosis. In contrast, concentrations of total oligosaccharides diverged widely from one source to another, from a high of 17.3 mumol/g to a low of 0.04 mumol/g. The results are interpreted in the context of glycoprotein catabolism.