NIOSH Extramural Research and Training

FY 2020 Highlights: Research Grants

At a glance

NIOSH funds four types of investigator-initiated research grants. This page spotlights the accomplishments of six grants in FY 2020.

Warehouse worker in safety vest holding his lower back

Introduction

The NIOSH extramural research program supports relevant, high-quality scientific investigations that help reduce work-related injuries, illnesses, and fatalities. These awards include funding for large projects (R01) as well as small projects (R03) and exploratory research grants (R21). The extramural research portfolio also includes mentored research scientist development (K01) awards. These offer postdoctoral training for the next generation of occupational safety and health scientists.

You can also find this and more in NIOSH Extramural Research and Training Program: Annual Report of Fiscal Year 2020.

Preventing slips, trips, and falls

Project Title: Impact of Worn Shoes on Slipping (R01 Grant). Principal Investigator: Kurt Beschorner

Slip and fall accidents are a leading and quickly growing cause of U.S work-related injuries. Twenty-seven percent of nonfatal work injuries resulting in lost workdays in 2018 were linked to slips, trips, and falls.

An important part of preventing slips and falls is the shoes' tread, which provides friction with the floor. However, not all treads are the same. Some treads have patterns that create strong traction with the floor surface. Other tread designs have difficulty gripping the floor during walking. This is especially true around water and other liquids, due to reduced coefficient of friction.

Heavily worn shoes increase the risk of slipping. Worn shoes lose traction when they come into contact with fluids and can no longer release these liquids. The fluid becomes trapped in the shoe and pressurized. This decreases the shoe's coefficient of friction and increases the risk of slipping.

Before this study, limited knowledge existed about the rate at which shoe tread becomes worn. How shoe wear causes a reduced coefficient of friction was also not fully understood. To address this issue, investigators at the University of Pittsburgh conducted a study. They looked at key causes of worn shoe tread and the tread thresholds or points where shoes become unsafe. Researchers determined how friction or traction are linked to the size of the worn regions—a finding not previously reported in studies.

Using this information, they created the battery test that indicates the threshold when the friction of shoes has deteriorated. It can be used for inspecting shoes. They also developed virtual computer models that predict the wear patterns over time. Models also predict the deterioration in friction of shoe treads as a shoe became worn. Scientists calculated the impact of worn regions on friction.

They validated one of these computer models by comparing its results with real-life workers wearing different shoes on the job. They also tested workers' shoes on flooring covered in liquid. The studies' findings highlight the usefulness of this type of computer model in designing slip-resistant shoes. Ultimately this can decrease work-related slips and falls.

Information about this project has been widely shared with varied footwear companies and Grainger industrial supply company. A committee within the ASTM International standards organization focused on pedestrian/walkway safety and footwear also received the findings. Researchers highlighted their findings via 12 journal articles, 22 conference presentations, and a keynote conference speech. The NORA Traumatic Injury Cross-Sector Council also partnered with researchers to create posters. They depict restaurant and healthcare workers on using the battery test for shoe inspections to determine slipping risk.

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Effects of work-hour restrictions on medical resident

Project Title: Impact of Lifting Work Hour Restrictions on First-year Resident Safety, Health, and Well-Being (R01 Grant). Principal Investigator: Laura Barger

Some of the leading occupational hazards that resident physicians face are associated with extended work shifts, according to research. On example is include motor vehicle crashes, which can occur as these workers commute to and from work. Another example is percutaneous injuries, such as injuries from a needlestick or other sharp objects.

The Accreditation Council for Graduate Medical Education (ACGME) changed its policy on work hour restrictions for resident physicians in 2011. It went from a maximum of 24–28 hours to 16 hours.

Researchers at Brigham and Women's Hospital found a link between this work-hour limit and improvements in physician safety and health. These scientists examined the effect of ACGME's work-hour regulations on the safety of first-year resident physicians. They focused on varied outcomes, including motor vehicle crashes, near crashes, and percutaneous injuries.

They collected and analyzed safety outcome data from 15,276 first-year resident physicians. Data included reported work hours, extended shifts, and hours of sleep. Participants in the study included physicians in a residency program from 2002 through 2007. It also another group who were resident physicians from 2014 through 2017 after the ACGME restriction.

Researchers found that, following the ACGME regulation, resident physicians had a considerably lower risk of motor vehicle crashes and percutaneous injuries. They also had lower risk of attentional failures, or injuries caused by lack of attention. The average hours of nightly sleep also increased. In contrast, extended shifts and prolonged or long weekly work hours were linked to negative safety outcomes.

These findings are important because ACGME lifted the 16-hour work limit in 2017. First-year resident physicians can now work 24–28 consecutive hours. The American Journal of Medicine featured this study in FY 2020. It was highlighted in several news outlets in the healthcare field including Becker's Hospital Review and Medical Xpress.

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Factors linked to low back pain among workers

Project Title: Exposure Response Relationships for Low Back Pain From Pooled Data (R01 Grant). Principal Investigator: Jay Kapellusch

Low back pain (LBP) is a leading cause of global disability and a frequent cause of limited activity and lost workdays. Research shows that risk factors for LBP may vary across studies due to lack of a standard case definition for LBP. Many studies also have limited or imprecise measures of exposures for LBP in the workplace, especially related to health outcomes. Because of these challenges, there is not a clear link between biomechanical risk factors related to physical movement and LPB.

Researchers at the University of Wisconsin Milwaukee aimed to understand the occurrence, risk factors, and health effects of LBP among workers. In this study, scientists combined and analyzed data from multiple past studies. They looked at differences in the prevalence or frequency of LBP and risk factors for this health issue. Researchers also examined connections between

  • Biomechanical or physical stressors for various work tasks,
  • Personal factors like demographics,
  • Psychosocial factors,
  • LBP prevalence, and
  • LBP incidence or rate of new cases.

This project focused on LBP cases, in general, and those that resulted in workers seeking medical treatment and having lost workdays. Scientists analyzed data for 1,650 workers from 82 facilities, mostly in the manufacturing and warehousing industries. They measured biomechanical stressors related to workers' limits on lifting objects, including maximum weight, reach, and twisting.

Researchers used the Revised NIOSH Lifting Equation (RNLE). This is a common tool to assess risk of lifting and lowering tasks at work. For a comprehensive analysis, researchers compared the RNLE data to other identified physical exposure variables at work.

According to researchers, prevalence and incidence of LBP were linked to biomechanical stressors measured via the RNLE and physical exposure variables. Health outcomes like seeking medical care and having lost work time were also linked to LBP. Scientists also linked factors like advanced age, history of LBP, and psychosocial factors to either LBP, health outcomes, or both. However, these factors did not impact the relationship found between biomechanical stressors, LBP, and health effects.

Researchers say these findings demonstrate biomechanical exposures are independent risk factors for LBP and health outcomes. This study is significant because it could potentially influence organizational and governmental policies on workplace physical exposures.

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Interventions for Vietnamese nail salon workers

Project Title: A Feasibility Study to Develop a Multilevel Occupational Health Intervention Program for Nail Salon Employees and Owners (R21 Grant). Principal Investigator: Tran Huynh

In the United States, more than half of nail salon workers identify as Vietnamese. According to research, they face various hazards. These include exposure to dangerous chemicals from nail products, ergonomic hazards, and clients potentially spreading infectious diseases. The challenges facing Vietnamese nail salon workers are linked to barriers with several causes. These include social marginalization, a lack of health and safety training, gaps in policy, and economic pressures.

The long-term exposure of chemicals from nail products puts nail salon workers at risk of health problems that include:

  • Reproductive and cognitive developmental issues;
  • Cancer;
  • Allergies;
  • Irritation to the respiratory, dermatological, and central nervous systems; and
  • Musculoskeletal pain impacting the bones, muscles, tendons, ligaments, and soft tissues.

Research is lacking on evidenced-based interventions for Vietnamese nail salon workers. There also are not enough studies on facilitators and barriers to their workplace settings adopting occupational health best practices.

Building on a past NIOSH-funded project, Drexel University researchers are using theory-based information to create a toolkit for salon owners. They will test the effectiveness of this intervention in Philadelphia area Vietnamese nail salons.

The toolkit will include trainings and self-assessment checklists. These allow salon owners to measure their work settings for chemical safety, infection control, and ergonomics. The toolkit will also include educational materials for salon owners, managers, and nail technicians. These will cover effective occupational safety and health practices and workers' rights.

So far, scientists have developed and pilot tested four online training modules with a small sample of salon owners and workers. The courses focus on infection control, chemical safety, ergonomics, and labor rights. Lessons learned from this effort will be used to improve training for the next cohort in the study. The principal investigator on this study also wrote an opinion article in The Philadelphia Inquirer. It discusses workplace safety and health issues facing immigrant nail salon workers.

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Reducing the impact of client death on home care aides

Project Title: Exploring the Role of Client Death Support in Home Care Workers' Grief, Stress, and Job Satisfaction (K01 Grant). Principal Investigator: Emma Tsui

Prior research shows that home care aides experience grief, burnout, and job insecurity following the death of a client. These workers typically help older clients with daily living activities and healthcare needs. The death of a client can be a harsh reality and work-associated stressor. Studies found home care aides experience emotional strain and short-term job loss until they are reassigned to a new case. Relatively little is known about home care agencies' perspectives on this topic and how they address it and support their aides.

Scientists at The City University of New York Graduate School of Public Health and Health Policy studied this issue. They interviewed leaders from eight New York City home care agencies on facilitators and barriers to how they handle client death. According to the study, the agencies mainly had a range of informal practices in reaction to a client dying. Very few preventive efforts were in place to help home care aides deal with the issue.

In particular, after clients die, the organizations did not provide paid leave. Workers lacked appropriate emotional support such as counseling or responsive case reassignment. Organizations also provided limited to no training on end-of-life care and the emotional experiences surrounding client death. Rather, agencies relied on their coordinators to informally handle home care aides' needs. However past studies have shown they often emphasize staffing priorities over the needs of aides.

While most leaders in this study recognized that home care aides need more support, they mentioned one major barrier. Lack of funding and available resources related to employment and healthcare policy prevented more support. Nevertheless, researchers note that policy changes can increase well-being and retention among this critical workforce. Examples include increased wages, paid time off, and emotional support services for aides.

Details: Interventions to Reduce the Impact of Client Death on Home Care Aides: Employers' Perspectives

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Content Source:
National Institute for Occupational Safety and Health