Participating core and specialty programs: Center for Workers’ Compensation Studies, Center for Direct Reading and Sensor Technologies, Center for Occupational Robotics Research, Occupational Health Equity, and Small Business Assistance.
Professional organizations, insurers, workers’ compensation providers, government agencies, and trade unions use NIOSH information reduce musculoskeletal disorders among construction workers.
NOTE: Goals in bold in the table below are priorities for extramural research.
|Health Outcome||Research Focus||Worker Population*||Research Type|
|A||Musculoskeletal disorders (MSDs) (esp. Back injuries, strains and sprains)||Underuse of existing interventions||Masonry, concrete, dry wall, roofing, and plumbing workers; laborers; small businesses; vulnerable workers||Translation|
|B||Musculoskeletal disorders (MSDs) (esp. Back injuries, strains and sprains)||Emerging technology (e.g., automation, robotics, drones)||Communication tower, wind energy, masonry and concrete workers; laborers||Basic/etiologic
|C||Musculoskeletal disorders (MSDs) (esp. Back injuries, strains and sprains)||Use of exoskeletons||Masonry, concrete, dry wall, roofing, and plumbing workers; laborers; small businesses; vulnerable workers||Intervention|
|D||Musculoskeletal disorders (MSDs) (esp. Back injuries, strains and sprains)||Prescription drug (incl. opioids), illicit drug, and substance use/misuse||Masonry, concrete, dry wall, roofing, and plumbing workers; laborers; small businesses; vulnerable workers||Intervention
Activity Goal 4.2.1 (Basic/Etiologic Research): Conduct basic/etiologic research to better understand the benefits and risks of emerging technologies (e.g., automation, robotics, drones) regarding musculoskeletal disorders among construction workers.
Activity Goal 4.2.2 (Intervention Research): Conduct studies to develop, enhance, and assess the effectiveness of interventions to prevent musculoskeletal disorders and use of opioids, illicit drugs, and other substances among construction workers.
Activity Goal 4.2.3 (Translation Research): Conduct translation research to understand barriers and aids to implementing effective musculoskeletal injury interventions among construction workers.
Activity Goal 4.2.4 (Surveillance Research): Conduct surveillance research to develop new approaches to collecting data on use of opioids, illicit drugs, and other substances and assessing associations with musculoskeletal injuries among construction workers.
Musculoskeletal disorders (MSDs) are common among construction workers due to the nature of the work, which is physically demanding [Schneider et al. 1998]. In 2014, “sprains and strains” represented 27.3% of all construction injuries and illnesses [BLS 2016a,b] while another 17.3% of injuries and illnesses were from “soreness, pain,” related to MSDs. Lifetime risk of “overexertion” injuries in construction is about 21%, so more than 1 in 5 construction workers might be expected to get an overexertion injury during their career [Dong, et al. 2014]. Some of the trades that have elevated rates of overexertion injuries include masonry, concrete, drywall, plumbing, and flooring among others [CPWR 2013]. Back injuries are another concern among construction workers. In 2010, the rate of back injuries among construction workers was 24.5 per 10,000 FTEs compared to 21.4 for all industries combined [CPWR 2013]. Construction trades with the highest rates of back injuries include masonry, roofing, drywall, plumbing, and glass and glazing. Many vulnerable workers have an elevated or disproportionate risk including Hispanic workers, foreign-born workers, workers in small businesses, workers, younger (teenage) workers and older (55 and over) workers [CPWR 2013]. These injuries have created a tremendous burden on workers, their families, companies and the health care system [OSHA, 2015].
The construction workforce is aging with a median age in 2015 of 42.7 years [BLS 2016c]. When older workers are injured, their injuries are more severe injuries and their compensation costs are higher [Dong et al. 2012]. MSDs not only cause days away from work, they also can shorten careers and impact retirement [Welch et al. 2010; LeMasters et al. 2006]. Many construction workers retire in their mid-50s due to MSDs. MSDs are also a main contributor to the pain epidemic [Carnide et al. 2011], which has resulted in the overuse of opioids [DHHS, 2016]. These injuries create an economic burden on workers, their families, companies and the health care system [OSHA, 2015].
MSDs are also a main contributor to the pain epidemic [Carnide et al. 2011], which has resulted in the overuse and misuse of prescription and illicit drugs including opioids, heroin, and fentanyl [DHHS 2016]. A recent analysis of workers’ compensation data from 27 states found that workers in mining and construction industries were more likely than workers in other industries to receive opioids for pain [Thumula and Liu, 2018]. Drug overdose deaths, including those associated with opioids, have significantly increased in recent years and have disproportionally impacted construction workers [Hawkins et. Al., 2019; Tiesman et.al, 2019; Harduar Morano et. Al., 2018]. In Ohio, construction workers were seven times more likely than other workers to die from an opioid overdose (2010-2016) [CPWR 2018] In one study, over half of those who died from an overdose had suffered at least one job related injury [Cheng et al. 2013].
Prevention of work-related MSDs has been a major focus of NIOSH research for many years, especially ergonomic interventions [NIOSH 2007, CPWR 2013]. Ergonomic interventions often pay for themselves by improving productivity as well as reducing injuries [Hendricks, 1996]. MSDs are a primary cause of occupational injuries and represent the largest portion of workers compensation costs. However, construction contractors may not understand the return on investment or improvements to productivity that often comes from making ergonomics changes. Surveillance and intervention research is needed to attain a better understanding of the connection between MSD injuries and opioids, illicit drugs, and substance use/misuse and the factors that influence it. There is also a need to develop and evaluate effective educational, administrative, and policy interventions to better protect construction workers from this epidemic.
Research is also needed to effectively develop, enhance, and transfer knowledge and interventions into new or improved construction equipment and practices. This includes developing and communicating evidence-based ergonomic prevention and protective measures and graphics-based guidelines. Additional efforts are needed to transfer findings from this research into influential documents such as guidance and voluntary consensus standards. There is also a need to translate research findings into software products, applications and interactive webpages to make information easily accessible for construction stakeholders.
With changes and advances in technology, novel approaches to risk reduction are being developed. For example, robotics, automation, and exoskeletons (or human augmentation devices) can be used to improve safety and productivity, and reduce MSD risk factors that can cause back injuries, strains, and sprains. These devices are rapidly appearing in the workplace despite limited research on their effectiveness in reducing MSDs. When new technologies enter the workplace, their impact needs to be studied. Research is needed to identify and document the costs and benefits of the intervention (including any productivity gain). For exoskeletons in particular, research should aim to include a broad range of body shapes and sizes that reflect the diversity of the Construction workforce (i.e. men and women; height and weight; race and ethnicity). Research needs to consider the range of potential interventions for a particular issue including engineering and administrative controls and their relative advantages. Translation research is also needed to identify and understand the aids and barriers to adoption and to promote effective solutions to construction decision makers.InI many cases this data does not exist and needs to be collected. These new technologies have the potential to dramatically reduce the frequency and severity of MSDs in the workplace while also improving productivity. Regardless of the work system, interventions that are broadly used must be effective at reducinging risk and make a strong business case for adoption.
BLS [2016a]. TABLE R1. Number of nonfatal occupational injuries and illnesses involving days away from work by industry and selected natures of injury or illness, private industry, 2014. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, http://www.bls.gov/iif/oshwc/osh/case/ostb4367.pdfpdf iconexternal icon
BLS [2016b]. TABLE R113. Percent distribution of nonfatal occupational injuries and illnesses involving days away from work by industry and selected natures of injury or illness, private industry, 2014. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, http://www.bls.gov/iif/oshwc/osh/case/ostb4479.pdfpdf iconexternal icon
BLS [2016c] Current Population Survey, Table 18b. Employed persons by detailed industry and age. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, http://www.bls.gov/cps/cpsaat18b.htmexternal icon
Carnideexternal icon N, Hogg-Johnsonexternal icon S, Côtéexternal icon P, Furlanexternal icon A, Irvinexternal icon E, Van Eerdexternal icon D, Kingexternal icon T . Early prescription opioid use for musculoskeletal disorders and work: A critical review of the literature. Occup Environ Med 68:A75
Cheng M, Sauer, BC, Johnson E, Porucznik C. . Comparison of Opioid-Related Deaths by Work-Related Injury. Am J Ind Med 56:308-316.
CPWR . The Construction Chartbook. Fifth Ed. Silver Spring, MD: CPWR- the Center for Construction Research and Training, http://www.cpwr.com/publications/construction-chart-bookexternal icon
CPWR . Hazard Alert: Opioid Deaths in Construction. Silver Spring, MD: CPWR- the Center for Construction Research and Training.
DHHS  National Pain Strategy: A comprehensive population health-level strategy for pain. Washington, DC: U.S. Department of Health and Human Services, https://iprcc.nih.gov/docs/DraftHHSNationalPainStrategy.pdfpdf iconexternal icon
Dong X, Wang X, Fujimoto A, Dobbin R . Chronic back pain among older construction workers in the United States: a longitudinal study. Int J of Occup Environ Health 18(2):99-109
Dong X, Ringen K, Welch L, Dement J. . Risks of a lifetime in construction, part I: traumatic injuries. Am J of Ind Med 57(9):973-83. doi: 10.1002/ajim.22363. Epub 2014 Jul 24
Harduar Morano L, Steege A, Luckhaupt S . Occupational patterns in unintentional and undetermined drug-involved and opioid-involved overdose deaths — United States, 2007 – 2012. Morbidity and Mortality Weekly Report, 67(33):925-930. https://www.cdc.gov/mmwr/volumes/67/wr/mm6733a3.htm
Hawkins D, Roelofs C, Laing J, Davis L . Opioid-related overdose deaths by industry and occupation- Massachusetts, 2011-2015. Am J Ind Med [epub ahead of print]
Hendricks H . Good ergonomics is good economics, https://www.hfes.org/Web/PubPages/goodergo.pdfpdf iconexternal icon
LeMasters Gexternal icon, Bhattacharya Aexternal icon, Borton Eexternal icon, Mayfield Lexternal icon . Functional impairment and quality of life in retired workers of the construction trades. Exp Aging Res 32(2):227-42
NIOSH . Simple Solutions: Ergonomics for Construction Workers. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2007–122, http://www.cdc.gov/niosh/docs/2007-122/pdfs/2007-122.pdfpdf icon
Thumula V, Liu T . Correlates of opioid dispensing. Report No. WC-18-48. Cambridge, MA: Workers Compensation Research Institute.
Tiesman HM, Konda S, Cimineri L, Castillo DN . Drug overdose deaths at work, 2011-2016. Inj Prev, online ahead of print, http://dx.doi.org/10.1136/injuryprev-2018-043104external icon
Welch LS, Hunting KL, Haile E, Boden L . Musculoskeletal and medical conditions among construction roofers – a longitudinal study. Am J Ind Med 53(6):552-60
Note: Goal 4.2 was revised in October 2019 to add Row D and activity goal 4.2.4