Participating core and specialty program: Safe●Skilled●Ready Workforce, Personal Protective Technology
Researchers, insurance companies, government agencies, labor groups, and employers utilize NIOSH information in decision-making about designing, structuring, and managing work to reduce illnesses and injuries among construction workers in non-standard work arrangements.
NOTE: Goals in bold in the table below are priorities for extramural research.
|Health Outcome||Research Focus||Worker Population*||Research Type|
|A||Respiratory diseases, Musculoskeletal disorders (MSDs), Fatal and non-fatal injuries from falls, Opioid and other substance use disorders, Hearing loss||Better characterize risk factors for workers in non-standard work arrangements||Vulnerable workers, small businesses||Surveillance research|
|B||Respiratory diseases, MSDs, Fatal and non-fatal injuries from falls, Opioid and other substance use disorders, Hearing loss, Heat-related illnesses||Increase use of existing safety and health programs and interventions among workers in non-standard work arrangements||Vulnerable workers , small businesses||Translation|
|C||Respiratory diseases, MSDs, Fatal and non-fatal injuries from falls, Opioid and other substance use disorders, Hearing loss, Heat-related illnesses||Develop new cost-effective safety and health programs and interventions for workers in non-standard work arrangements||Vulnerable workers, small businesses||Intervention|
Activity Goal 7.1.1 (Intervention Research): Conduct intervention studies to develop and assess the cost-effectiveness of new safety and health programs and interventions to reduce illness and injury among construction workers in non-standard work arrangements
Activity Goal 7.1.2 (Translation Research): Conduct translation research to understand barriers and aids to implementing effective safety and health programs and interventions among construction workers in non-standard work arrangements.
Activity Goal 7.1.3 (Surveillance Research): Conduct surveillance research to better characterize risk factors for construction workers in non-standard work arrangements.
During the last recession, the construction sector saw a 23% decrease in the number of construction workers [CPWR 2013]. Many workers displaced during the recession are not returning to construction, and an influx of new workers is entering the sector. In 2013, about 1.3 million temporary workers were employed in construction, accounting for nearly 14% of the construction workforce [CPWR 2015]. A growing number of these new entrants have non-standard work arrangements and are new immigrants, or contingent workers. This means that they may belong to one or more vulnerable groups of workers at disproportionate risk for occupational injury or illness. The construction sector has one of the highest shares of workers in non-standard arrangements [Katz and Kruger 2016].
Workers employed through temporary agencies in 2005 were more likely to be African-American and Hispanic [BLS 2005]. Temporary workers, accounted for roughly 13.3% of the construction workforce from 2011−2013, were more likely to be younger than in the overall construction work force during that period [CPWR 2015]. Employment in the construction industry involves relatively short-term contracts. According to CPWR, approximately 30% of construction workers were employed in nonstandard work arrangements; 22% were independent contractors and 8% were in alternative arrangements, including temporary workers, day laborers, on-call workers, and workers provided by contract firms. [CPWR 2015; CPWR 2019]. About 35% of temporary workers were under age 35 years, compared to less than 30% of permanent construction workers in 2011−2013 [CPWR 2015]. Many temporary workers hold multiple jobs, and in 2012 approximately 16% of temporary construction workers were considered poor [CPWR 2015]. Temporary workers are more likely to experience more occupational hazards than permanent workers, including hazards associated with outdoor work, exposure to vapors/gas/dust/fumes, and skin contact with chemical substances [CPWR 2015]. Misclassification as independent contractors can leave temporary workers without access to needed safety and health precautions as well as workers’ compensation.
Respiratory disease, musculoskeletal disorders, fatal and non-fatal injuries from falls, hearing loss, and drug overdose deaths are particularly high among construction workers and are priorities for construction sector leadership [CPWR 2013, Tiesman et al 2019]. Construction workers have been commonly prescribed opioids to treat pain associated with MSDs and injuries, [Thumala and Liu 2018] , contributing to the opioid crisis. In Ohio, construction workers were seven times more likely than other workers to die from an opioid overdose (2010-2016) [CPWR 2018c] In one study, over half of those who died from an overdose had suffered at least one job related injury [Cheng et al. 2013].
Heat stress is also a problem for the construction sector, with 650 known cases of nonfatal heat-related illnesses and injuries occurring within the sector in 2017 [Acharya et al. 2018, BLS 2018]. Many of these hazardous exposures are more common for temporary construction workers compared to their full-time counterparts [CPWR 2015].
Non-standard work arrangements are understudied but increasingly prevalent, and their determinants and health and safety consequences are poorly understood. NIOSH has been assessing quality of work life for a long time and is well-positioned to examine the determinants and effects of work arrangements. Surveillance research is needed to better characterize and track the complex risk factors and overlapping vulnerabilities for construction workers in non-standard work arrangements, as well as the burden suffered by the workers and their families, employers, and society. Translation research is needed to identify and disseminate barriers and aids to implementation of proven effective safety and health programs and interventions to reduce illness and injury for workers in non-standard work arrangements.
Intervention research is needed to evaluate the determinants and consequences of existing and new work arrangements. The focus of such research could include studying the relationship between product and service quality and safety, the business case for safety, procurement practices, owner and management commitment to safety, selection of contractors and subcontractors, the use of temporary employees and independent contractors, and novel work arrangements in construction and their impact on leading and lagging indicators of safety and health. Newly identified risk factors will provide opportunities for innovative intervention research. Findings from this research needs to be incorporated into mandatory and consensus standards, guidance and other influential documents. There is also a need to translate research findings into software products, applications and interactive webpages to maximize its impact on construction stakeholders.
Researchers, insurance companies, employers, owners and labor unions effectively integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being (i.e. Total Worker Health [TWH] approach) in the Construction sector.
NOTE: Goals in bold in the table below are priorities for extramural research.
|Health Outcome||Research Focus||Worker Population*||Research Type|
|A||Fatal and non-fatal injuries; illnesses||Work and non-work factors that contribute to worker safety, health, and well-being (i.e. Total Worker Health [TWH] approach) (e.g., substance misuse, tobacco use, shift work, fatigue, musculoskeletal health, heat stress)||All construction workers, especially vulnerable workers||Intervention|
|B||Fatal and non-fatal injuries; illnesses||Improve data around risks to worker safety, health, and well-being||All construction workers, especially vulnerable workers||Surveillance research|
|C||Fatal and non-fatal injuries; illnesses||Barriers and facilitators to implementing TWH research findings||All construction workers, especially vulnerable workers||Translation|
|D||Fatal and non-fatal injuries; illnesses||Evaluate effectiveness and adoption of TWH polices, practices and programs||All construction workers, especially vulnerable workers||Intervention Translation|
Activity Goal 7.11.1 (Intervention Research): Conduct studies to develop and assess the effectiveness of interventions that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being in Construction.
Activity Goal 7.11.2 (Translation Research): Conduct translation research to understand barriers and aids to implementing policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts in Construction.
Activity Goal 7.11.3 (Surveillance Research): Conduct surveillance research to better track risks to worker safety, health and well-being in Construction.
Construction comprises residential and commercial building and heavy and civil engineering (e.g., water and sewer lines, highways, and bridges), and includes specialty trades such as roofing, plumbing, electrical, and drywall. Over 10 million workers are employed in construction in the U.S., and these workers face risks of fatal and non-fatal injuries resulting from falls from elevated surfaces, struck-by incidents, and musculoskeletal disorders, as well as illnesses from noise, silica, and other exposures. Many different adverse health outcomes are particularly high among construction workers and are a continuing and difficult problem [CPWR 2018a].
Construction work is demanding and labor-intensive, involving significant manual material handling and awkward postures. Many of the building trades require skilled workers who are sometimes in short supply [CPWR 2018]. U.S. construction workers are at high risk of traumatic injuries and other adverse health consequences because of inherently dangerous tasks and dynamic conditions that are present on many of construction sites. A growing number of construction workers have non-standard work arrangements (approximately 30% of the industry) and are new immigrants, or contingent workers. Many of them belong to one or more vulnerable groups of workers (small businesses, Hispanic immigrants, young or older workers) at disproportionate risk for occupational injury or illness [Katz and Kruger 2016].
Systemic changes to our economy and socio-demographic workforce factors are rendering some past approaches to protecting workers ineffective. Increasingly, employers in the construction industry face tighter profit margins, demanding timelines and global completion. Workers and employers must navigate new types of work arrangements, the aging of the workforce, high levels of work-related stress, and the growing challenges of both work and home life. Many construction firms continue to confront the legacy hazards of the traditional workplace, such as traumatic injury, chemical exposures, and shift work. Approximately 90% of construction firms are small businesses with fewer than 20 employees. These small businesses often lack adequate time and resources to properly address safety and health. According to CPWR, (from 2003-2016) the rate of fatal injuries for small employers (<20 employees) was significantly higher than for large employers (> 20 employees). Additionally for the same period, the fatality rates have risen for small businesses at the same time they have fallen for large businesses [CPWR 2018b]. Scientific evidence now supports what many safety and health professionals, as well as workers themselves, have long suspected—that risk factors in the workplace can contribute to common health problems previously considered unrelated to work.
Total Worker Health promotes the integration of occupational safety and health (OSH) protection with workplace policies, programs, and practices to prevent injury and illness and advance overall health and well-being through research, interventions, partnerships, and capacity-building to meet the needs of the 21st century workforce. Evidence suggests that integrating occupational safety and health protection program activities with health promotion program activities may be more effective for safeguarding worker safety, health, and well-being than either of these programmatic activities on their own [Sorensen et al. 2013, NIOSH 2012, DeJoy and Southern 1993, Sauter 2013]. Despite these developments, there is need for continued research to better understand the benefits of integrated approaches to prevention and to promote more comprehensive intervention, especially among certain occupations and industries including construction.
There is a need within the construction industry to better understand the risks to construction worker safety, health, and well-being. This is particularly true for small construction businesses. These risks need to be examined holistically to examine both occupational and non-occupational factors and the interaction between them. Intervention research is needed to improve our understanding of the value of TWH programs, policies, and practices for the construction worker and their ability to improve workplace safety and health outcomes. There is also a need to better understand the barriers and potential aids within the construction industry and organized labor that can adversely impact adoption of TWH approaches that may be beneficial.
Acharya P, Boggess B, Zhang K . Assessing heat stress and health among construction workers in a changing climate: A review. Int J Environ Res Public Health 15(2), 247. doi:10.3390/ijerph15020247
BLS . Injuries, Illnesses, and Fatalities, 2017. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, https://www.bls.gov/iif/#dataexternal icon
BLS . News: contingent and alternative employment arrangements. Washington D.C.: Department of Labor, Bureau of Labor Statistics, pp. 1-20.
Cheng M, Sauer, BC, Johnson E, Porucznik C. . Comparison of Opioid-Related Deaths by Work-Related Injury. American Journal of Industrial Medicine 56:308-316. 2013.
CPWR . Quarterly data report: Nonstandard work arrangements in the construction industry. First Quarter. Silver Spring, MD: CPWR- the Center for Construction Research and Training. https://www.cpwr.com/sites/default/files/publications/Quarter1-QDR-2019_0.pdfpdf iconexternal icon
CPWR [2018a]. The Construction Chart Book—The US construction industry and its workers. Silver Spring, MD: CPWR – The Center for Construction Research Training, https://www.cpwr.com/publications/research-findings-articles/construction-chart-bookexternal icon
CPWR [2018b]. Quarterly Data Report—Fatal Injuries among Small Construction Establishments. Silver Spring, MD: CPWR – The Center for Construction Research Training, https://www.cpwr.com/sites/default/files/publications/Quarter3-QDR-2018_0.pdfpdf iconexternal icon
CPWR [2018c]. Hazard Alert: Opioid Deaths in Construction. Silver Spring, MD: CPWR- the Center for Construction Research and Training.
CPWR . The construction chartbook. Fifth Ed. Silver Sping, MD: CPWR- the Center for Construction Research and Training. http://www.cpwr.com/publications/construction-chart-bookexternal icon
CPWR . Quarterly data report: temporary workers in the construction industry. Second Quarter. Silver Spring, MD: CPWR- the Center for Construction Research and Training. http://www.cpwr.com/sites/default/files/publications/Second%20Quarter%202015.pdfpdf iconexternal icon
DeJoy D, Southern D . An integrative perspective on work-site health promotion. J Occup Med. 35: 1221–1230.
Katz LF, Krueger AB . The rise and nature of alternative work arrangements in the United States, 1995-2015. Washington D.C.: National Bureau of Economic Research No. w22667, https://krueger.princeton.edu/sites/default/files/akrueger/files/katz_krueger_cws_-_march_29_20165.pdfpdf iconexternal icon.
NIOSH . Research Compendium; The NIOSH Total Worker Health™ Program: Seminal Research Papers 2012. 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. 2012-146, https://www.cdc.gov/niosh/docs/2012-146/default.html.
Sauter SL . Integrative approaches to safeguarding the health and safety of workers. Ind Health 51: 559–561.
Sorensen G, McLellan D, Dennerlein JT, Pronk NP, Allen JD, Boden LI, Okechukwu CA, Hashimoto D, Stoddard A, Wagner GR  Integration of health protection and health promotion: Rationale, indicators, and metrics. J Occup Environ Med 55(12 Suppl.): S12–S18.
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
Note: In October 2019, goal 7.1 was revised to include opioid and other substance use disorders and goal 7.11 was added.