Services

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.

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.