Bailar III JC, Meyer EA, Pool R, eds., Washington, DC: National Academies Press, 2007 Mar; :1-108
Millions of Americans use respirators in their places of work to protect themselves from exposures to such respiratory hazards as toxic vapors and gases, harmful particulate matter, and airborne pathogens. Some respirators filter the ambient air, while others employ a separate air supply; but in either case the respirator will protect its user only if it fits properly. It must mold to the user's face in such a way that no air from the outside can leak in, even when the user is moving or speaking. It is the responsibility of the National Institute for Occupational Safety and Health (NIOSH) to certify that respirators from manufacturers meet certain minimum performance levels. NIOSH performs this task with the help of fit-test panels, each of them a group of about 25 people who have been chosen because, collectively, their facial dimensions are assumed to be representative of the respirator-wearing workforce as a whole. A respirator will be certified only if it performs effectively on the members of the panel - or at least on an appropriate subset of them. If, for example, a line of respirators in various sizes is being certified, it is not necessary that any one size fits all 25 panel members, but each of the test subjects should be able to be fitted suitably with at least one of the respirators. If such a fit-test face panel is to function effectively, the faces of its members must accurately represent the faces of the entire diverse U.S. respirator-wearing workforce. This, in turn, demands having good anthropometric data - particularly data on facial dimensions - from a representative sample of the respirator-wearing workforce. Once such data have been collected and analyzed, an appropriate fit-test panel can be designed from them. In short, certification fit testing of respirators depends upon two main factors: a well-conducted anthropometric survey of a representative sample of the respirator-wearing workforce, and a fit-test panel based on these anthropometric data that accurately represents the facial shapes and sizes of the millions of workers who use - or who should be using - respirators in their jobs. For many years NIOSH has been using the fit-test panels developed in 1972 by researchers at Los Alamos National Laboratory (LANL) based upon anthropometric data available from a U.S. Air Force study. The population sample used by the LANL researchers was a group of men and women serving in the U.S. Air Force. It is unlikely that this sample was ever representative of the broader U.S. workforce - Air Force personnel are generally young and in good health, for instance, and the U.S. Air Force has height and weight requirements as well - but in the intervening years the U.S. workforce has become much more diverse, with more women workers and more minorities. Furthermore, the growing obesity problem in the United States means that workers are, on average, much heavier than they were two or three decades ago. In addition, the ethnic composition of the U.S. workforce had changed over the 30 years. So fit-test panels based on physical characteristics of Air Force personnel from the early 1970s are unlikely to accurately represent the broad U.S. workforce today. Because of this situation, in 2001 NIOSH contracted with Anthrotech, Inc., to collect new anthropometric data that would be representative of today's respirator-wearing workforce and to use those data to design new fit-test panels. After Anthrotech finished that task, NIOSH contracted with the Institute of Medicine (IOM) to establish an ad hoc committee to review the NIOSH-sponsored Anthrotech study. This report contains the findings, conclusions, and recommendations of that IOM committee.