Services

Participating core and specialty programs: Exposure Assessment, National Center for Productive Aging and Work, Occupational Health Equity, Small Business Assistance, and Surveillance.

Employers, workers, researchers, and non-governmental organizations use NIOSH information to modify work practices to reduce cardiovascular disease among services workers.

  Health Outcome Research Focus Worker population* Research Type
A Cardiovascular disease  Understanding workplace stress as a risk factor Small businesses, teachers, immigrants and other vulnerable workers Basic/etiologic

Intervention

B Cardiovascular disease Understanding shift work as a risk factor Small businesses, shift workers, immigrants and other vulnerable workers Basic/etiologic

Intervention

C Cardiovascular disease Burden characterization All services workers (esp. those in the administrative and support and waste management and remediation services subsector, and accommodation and food service subsector) Surveillance research
D Cardiovascular disease Understanding heat stress as a risk factor Landscaping, building services workers, waste management Basic/etiologic

*See definitions of worker populations

Activity Goal 1.11.1 (Basic/Etiologic Research): Conduct basic/etiologic research to better understand relationship between cardiovascular disease and risk factors among services workers.

Activity Goal 1.11.2 (Intervention Research): Conduct studies to develop and assess the effectiveness of interventions to reduce cardiovascular disease risk factors among services workers.

Activity Goal 1.11.3 (Surveillance Research): Develop new surveillance methods to improve the characterization of the burden of cardiovascular disease and its risk factors among services workers.

Burden

According to data from the National Health Interview Survey (NHIS), the only two industry groups that had significantly higher adjusted prevalence ratios for cardiovascular disease (CVD)/stroke when compared to workers in all other industry groups were both in the services sector: administrative and support and waste management and remediation services, and accommodation and food service [CDC 2014]. These industry groups also have slightly elevated proportionate mortality ratios for circulatory diseases according to the National Occupational Mortality Surveillance (NOMS) system [NIOSH 2015]. However, our current understanding of the overall burden of CVD in the services sector is limited by the small subsamples of workers in any given subsector that participate in the NHIS each year, the small number of States currently participating in NOMS, and the paucity of other data sources for assessing CVD burden among workers.

Behaviors and other factors that increase the risk of cardiovascular ill health have been characterized, however occupational factors related to CVD among workers is an emerging area of research. Workplace factors of concern related to CVD among workers in the services sector include multiple types of workplace stressors (e.g., physical exertion and physical inactivity, excessive heat or cold, noise, and long work hours) and shift work [Kivimacki 2015]. Psychosocial factors, such as job strain, are also relevant workplace stressors; a recent comprehensive review found moderately strong evidence for a relationship between coronary heart disease and job strain and low decision latitude [Theorell et al. 2016]. Among services sector workers with exposure to these work-related factors are the approximately 4.4 million workers employed in jobs classified in the building and landscape services industries [BLS 2017a]. Many of these workers are immigrants whose exposures and health outcomes are exacerbated due to stressors including many types of occupational health disparities [Landsbergis et al 2014]. In addition, in the services sector, 89% of the 3 million firms have less than 20 employees, and these small businesses typically have limited access to health and safety specialists [U.S. Census Bureau 2011].

Need

Improved surveillance methods are needed to better characterize the burden of cardiovascular disease and its risk factors among Services workers. Exposure assessment studies are needed to understand these different factors and how they are interrelated with CVD causation and progression. Further research is needed in the services sector to better understand the mechanisms by which occupational factors increase CVD risk and the proportion of CVD due to occupational factors, as well as the effectiveness of various interventions to reduce CVD among workers. Guidelines and training materials are needed for effective interventions to prevent CVD among building service workers and grounds keepers. These workplaces frequently lack access to health and safety professionals. Administrative controls and work organization improvements that may be routinely adopted at construction or manufacturing workplaces are not widely adopted for routine but intermittent tasks in building services.

Employers, healthcare providers, and non-governmental organizations use NIOSH information to reduce adverse reproductive outcomes among services workers.

NOTE: Lines in bold in the table below are priorities for extramural research.

  Health Outcome Research Focus Worker population* Research Type
A Adverse reproductive outcomes Chemical exposures Immigrants and other vulnerable workers, young women, personal services workers, small businesses Basic/etiologic

Surveillance Research

B Adverse reproductive outcomes Chemical exposures Nail and hair salon workers, small businesses Intervention

*See definitions of worker populations

Translation

Activity Goal 1.12.1 (Basic/Etiologic Research): Conduct basic/etiologic research to better understand relationship between chemical exposures and adverse reproductive outcomes among personal care services sector workers.

Activity Goal 1.12.2 (Intervention Research): Conduct studies to develop and assess the effectiveness of interventions to reduce chemical exposures associated with adverse reproductive outcomes among nail salon workers.

Activity Goal 1.12.3 (Translation Research): Conduct translation research to understand barriers and aids to implementing effective interventions to reduce chemical exposures associated with adverse reproductive outcomes among nail salon workers.

Activity Goal 1.12.4 (Surveillance Research): Develop new surveillance methods to measure the burden of chemical exposures and adverse reproductive outcomes among services workers.

Burden

In the services sector, 89% of the 3 million firms have less than 20 employees, and these small businesses typically have limited access to health and safety specialists [U.S. Census Bureau 2011]. The personal care services component of the sector employs approximately 1.45 million workers [BLS 2017b]. Many of these workers are employed in hair and nail salons and are exposed to a wide variety of chemicals that potentially cause a number of health effects including reproductive toxicity [Pak et al 2013]. The hair and nail salon industry largely employs women of reproductive age and also employs a high proportion of minorities and immigrants [BLS 2017c; Maslin Nir 2015a,b].

Need

Etiologic studies are needed concerning reproductive hazards from exposure to many of the chemicals used in nail salons (e.g., phthalates, ethyl methacrylate, toluene, and formaldehyde) and among other workers in the personal care services industries (e.g., epidemiologic studies of low level solvent exposures and reproductive outcomes for the personal care industry). Businesses in the services sector (particularly the small businesses) need evidence-based data to support interventions to reduce chemical exposures among their workers. Studies on identifying effective outreach methods through trusted partners are needed for all workers in the services sector, particularly among workers in small businesses and among the immigrant populations.

BLS [2017a]. Occupational employment statistics 37-0000 building and grounds cleaning and maintenance occupations (major group). Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, https://www.bls.gov/oes/current/oes370000.htmExternal

BLS [2017b]. Industry at a Glance. Personal and laundry services: NAICS 812. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, https://www.bls.gov/iag/tgs/iag812.htmExternal

BLS [2017c]. 18. Employed persons by detailed industry, sex, race, and Hispanic or Latino ethnicity. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, https://www.bls.gov/cps/cpsaat18.htm

CDC [2014]. Prevalence of coronary heart disease or stroke among workers aged <55 years — United States, 2008–2012. MMWR 63(30):645-649.

Kivimaki M, Kawachi I [2015]. Work stress as a risk factor for cardiovascular disease. Curr Cardiol Rep 17:74.

Landsbergis PA, Grzywacz JG, LaMontagne AD [2014]. Work organization, job insecurity, and occupational health disparities. Am J Ind Med 57:495-515.

Maslin Nir S [2015a] The price of nice nails. New York Times, May 7, https://www.nytimes.com/2015/05/10/nyregion/at-nail-salons-in-nyc-manicurists-are-underpaid-and-unprotected.html?comments

Maslin Nir S [2015a] Perfect nails, poisoned workers. New York Times, May 8, https://www.nytimes.com/2015/05/11/nyregion/nail-salon-workers-in-nyc-face-hazardous-chemicals.html

NIOSH [2015]. National Occupational Mortality Surveillance (NOMS) — proportionate mortality for cardiovascular, neurodegenerative, & renal diseases by industry for services sector. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, https://www.cdc.gov/niosh/topics/noms/noms2charts/services/noncancer-index.html.

Theorell T, Jood K, Jarvholm LS, Vingard E, Perk J, Ostergren PO, Hall C [2016]. A systematic review of studies in the contributions of the work environment to ischaemic heart disease development. Eur J Public Health 26:470-477.

U.S. Census Bureau [2011]. Statistics for all U.S. firms with paid employees by geographic area, industry, gender, and employment size of firm: 2007 Washington, DC: U.S. Department of Commerce, U.S. Census Bureau, https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=SBO_2007_00CSA09&prodType=tableExternal

Page last reviewed: April 24, 2018