Data show that between the years 1998 and 2006 an estimate of more than 14,000 occupational injuries associated with the horse-racing industry were treated in U.S. hospital emergency rooms. Further, between 1992 and 2006, 79 deaths occurred to those working in this industry. These numbers are almost certainly underestimates of the true numbers. The data demonstrate that jockeys are not the only workers exposed to hazards in this industry. Trainers, grooms, exercise riders, and various others encounter many of the same hazards as jockeys, and it is important that these occupations have the same health and safety protections, for example, wearing safety vests and helmets when in close proximity with horses. The true risk for injuries in this industry cannot be properly evaluated without sustained data collection over an extended period of time, including collecting data on the number of workers in this industry and the injuries and fatalities that occur. It is not within the scope of current national surveillance systems to collect data to the detail necessary to accurately capture these injuries. Furthermore, without appropriate denominator data, injury rates cannot be calculated. The calculation of injury rates would allow for meaningful comparisons to workers in other industries. In order to accurately collect these data, a standardized injury report form could be created to collect critical information about injury incidents. This information could then be recorded and maintained in a centralized database. The development of such a system would allow for meaningful analyses to determine the etiology of injury in the United States for this industry. Northern California has implemented a system where track-side Board of Stewards provide independent reports on the purported cause, final reported status, and outcomes of injuries to jockeys. Other states could use the Northern California system as a model for their own horse racing injury surveillance. The variation of regulations between states creates an additional complication for worker safety and health. Safety and health concerns could be more easily managed if regulations were more synchronized among states. This would help improve health and safety requirements and PPE use regulations. To be competitive in this sport, jockeys must be vigilant in maintaining a low body weight. To keep a minimum weight, jockeys often resort to weight-reducing techniques, commonly known in the industry as 'wasting' and 'flipping.' These techniques pose a hazard to a jockey's long-term health. These activities may also lead to more immediate hazards if a jockey is dehydrated or otherwise not fit to ride. Representatives in other sports where weight can be an issue, like wrestling, have examined alternatives to weight requirements for keeping athletes healthy, such as minimum body fat requirements [NFHS 2006]. These alternatives should be evaluated for relevance in the horse-racing industry. Also, providing some form of health and nutritional education to jockeys would be prudent. Many opportunities exist for research regarding worker safety and health in the horse-racing industry and injury prevention. The possibility for lead exposure should be quantitatively assessed. If it is found that the exposure limits exceed current standards, this hazard could be remedied either by using an alternative to lead weights, such as weighted pads, or by encapsulating all lead weights. An evaluation of the effect of silica or synthetic fibers on the respiratory health of workers also is needed. The potential benefits of synthetic surfaces for the well-being of the horse should be weighed against possible respiratory ailments that jockeys and horses may suffer. As with all emerging safety and health issues, NIOSH will do its best to continue monitoring the health and safety of these workers. An effort on the part of horse-racing industry representatives (race tracks, racing commissions, and horse owners) can be taken to lessen the many hazards faced by workers in the horse-racing industry. However, the responsibility to improve the safety and health of employees in this industry lies among all participants. Below are some measures for consideration. Industry Representatives (Race Tracks, Racing Commissions, and Horse Owners): 1. Make safety and health issues a part of the everyday, decision-making processes (e.g., whether races are held, conditions for canceling a race, assessments of a jockey's fitness to ride); 2. Work with jockeys and other professional associations to ensure adequate insurance and support for injured workers, while encouraging primary injury prevention practices; 3. Assess the health implications of the current weight requirements and options for adjusting weights consistently in consultation with health experts; 4. Develop and maintain a track-, state-, or corporate-level monitoring system to collect data on workers and their injuries and illnesses, which could serve as a model for developing a national-level surveillance system; 5. Develop standards for quality on-track and off-track medical care for all facilities that include the use of staff certified in Advanced Cardiac Life Support and adequate medical equipment; 6. Explore workplace and jockeys' room conditions with the intent of developing criteria for design, safety, hygiene, ventilation, and habitation; 7. Integrate the safety of both humans and animals into the design of equipment and facilities (e.g., padded starting gates and safety rails); 8. Support independent scientific inquiry into the dynamic health status of workers in the horse-racing industry; and, 9. Develop and provide appropriate education, consultation, referral, and treatment for jockeys regarding eating and weight control issues. Jockeys: 1. Become educated about proper nutrition and consider healthy alternatives for weight management; 2. Wear PPE and ensure that it is properly fitted and in good condition; and, 3. Work with industry representatives and professional associations to ensure appropriate support and follow up for injured workers, while encouraging primary injury prevention practices. Professional Associations: 1. Promote the safety and health of jockeys and other race track staff by working with industry representatives; 2. Work with industry representatives and jockeys to ensure appropriate support and follow up for injured workers; 3. Work with industry representatives to ensure adequate on-track and off-track medical care is available at all facilities; 4. Work with industry representatives to develop criteria for safe, clean jockeys' rooms; and, 5. Support industry representatives and jockeys in the development of appropriate education, consultation, referral, and treatment for eating and weight control issues. Other Race Track Workers: 1. Become educated and trained in safety issues relevant to work responsibilities; 2. Consider wearing PPE (e.g., helmets and vests) when in the vicinity of a horse; and, 3. Work with industry representatives and professional associations to ensure appropriate support and follow up for injured workers, while encouraging primary injury prevention practices.