There is mounting evidence that racial and ethnic minorities, including immigrant groups, are disproportionately exposed to health and safety hazards in the workplace. The existing occupational health surveillance systems for non-fatal injuries and illnesses, however, provide little information about the occupational health experience of minority and immigrant workers, many of whom may not access workers' compensation systems or specialty medical care, important sources of occupational health surveillance data. Community Health Centers (CHC), which provide medical care and other services to low income residents, potentially serve as an important point of access to these worker populations. In this study, the Occupational Health Surveillance Program of the Massachusetts Department of Public Health (OHSP-MDPH) examined the feasibility of collecting data on the occupational health experience of low income minority and immigrant workers through CHCs. The specific aims of this surveillance research study were: to administer a waiting room survey about occupational health experience to a sample of working adults seeking care at CHCs in urban Massachusetts and analyze survey findings; to evaluate this method for ongoing or periodic occupational health surveillance of low income working populations; and to evaluate whether CHCs currently collect data about patients' employment that can be used for ongoing occupational health surveillance at the community level. A brief questionnaire to be administered in waiting rooms while patients awaited appointments was developed with input from occupational health and survey research experts as well as community stakeholders. The questionnaire contained 46 questions regarding occupation, industry, working hours, health and safety training received on the job, exposure to potential hazards, knowledge of key occupational health resources, recent experience of an occupational injury or illness, and demographics. The English-language survey instrument was translated into five additional languages. Five CHCs in urban neighborhoods of eastern Massachusetts responded to a MDPH Request for Responses to participate in the study. At each CHC, surveys were administered orally by trained interviewers in (at least) the two most commonly spoken languages. Across the five CHCs, 1,428 surveys were administered: 749 in English, 394 in Spanish, 180 in Vietnamese, 53 in Cape Verdean Creole (53), 33 in Portuguese and 19 in Cambodian Khmer. CHC patients participated in the survey at a rate of 64.7%. Half of those who did not participate were refusals; the remaining patients were ineligible for the survey because they had not worked in the previous 12 months. The sample of CHC patients surveyed was 64% female and 34% male with a mean age of 34.8; 66% were born outside the mainland United States. The occupational distribution of the survey respondents closely resembled the employment profile of immigrant workers in Massachusetts, with 31.5% of respondents working in service occupations. The distribution of occupation varied by race and country of origin. Approximately 20% of those surveyed reported experiencing a health condition (injury, illness or other condition) in the last year that they believed to be due to work. Less than half reported receiving workplace safety training; 39% reported that they were unfamiliar with workers' compensation and 62.7% reported that they were unfamiliar with OSHA. Awareness of these occupational health resources varied markedly by race and country of origin with Hispanic and Asian workers being least aware. These findings point to the need to promote occupational health surveillance and prevention activities at the community level and to increase the provision of occupational health services to the divergent group of workers served by CHCs. Administration of the survey in collaboration with CHCs and review of their existing data systems also provided information about CHCs as potential ongoing partners in documenting and addressing occupational health concerns of lower income workers. Providers, public health staff and administrators had few resources to provide occupational health care to their patients and were largely unaware of reporting requirements to the state's occupational health surveillance systems. CHCs collected little data on their patients' work; the data collected were rarely used to inform diagnosis, treatment or management of health problems. Nevertheless, CHC providers remained interested in providing better occupational health services to their patients. Repeated administration of an occupational health survey would undoubtedly yield valuable information, however, addressing CHC providers' lack of occupational health resources and developing systems for ongoing documentation of work-related health conditions among patient populations may be a more effective strategy to bring about more lasting change at CHCs.
Occupational Health Surveillance Program, Massachusetts Department of Public Health, 250 Washington St., Boston MA 02108