FY 2019 Extramural Research Program Highlights: Cooperative Agreements

NIOSH values state programs and gives financial and technical support to state health and labor agencies, universities, and other eligible groups to develop and expand their occupational health surveillance programs. The NIOSH extramural surveillance portfolio includes 26 state recipients composed of 49 projects focusing on work-related injuries and death, exposures and hazards, and worker populations of interest. These programs use and distribute surveillance data to find the incidences of job-related injuries, illnesses, exposures, and fatalities. They help to discover trends, research opportunities, emerging issues, and high-risk worker populations. The programs also create and send out targeted educational and prevention materials, adapting materials to best protect workers. They often engage in outreach and involve partners in public health and safety to advance “data into action.”

State surveillance program outputs are the products of both nonresearch and research activities and include publications. We collected publications by NIOSH-funded extramural researchers from principal investigator reports to NIOSH, the NIH Reporter database, the NIOSHTIC-2 database, and the PubMed database. From October 1, 2018, through September 30, 2019, the state surveillance program published 29 articles in peer-reviewed journals. Find a searchable database of NIOSH publications, which includes grantee final reports and publications, by using the NIOSHTIC-2 publications search.

Raising Awareness and Changing Laws: New Report on Firefighter Health and Safety

Firefighters work in environments and under conditions that are potentially risky to their safety and health. Firefighters participate in a wide variety of tasks that include search and rescue, emergency response and medical services, disaster assistance, fire prevention, and hazardous material response. In FY 2019, the Montana Occupational Health & Safety Surveillance Program released a new report providing a detailed look at state firefighters’ injuries, illnesses, and fatalities. The publication highlighted various data sources including the Montana Workers’ Compensation claims data, the Bureau of Labor Statistics Survey of Occupational Injuries and Illnesses data, death records, and information from the Montana Cancer Tumor Registry. According to the report, during 2007–2017, firefighters filed the most workers’ compensation claims related to emergency or medical services, and the most common injury they filed claims for was back strains from lifting. In addition, during 2011– 2015, firefighters diagnosed with cancer most often had the illness in their prostrate, lung, and bronchus.

The Montana surveillance program shared these and other findings with a wide range of groups, including the Montana Fire Chiefs’ Association, Montana State Council of Professional Firefighters, and the Montana State Firemen’s Association. The surveillance program also distributed the report to the Montana Municipal Interlocal Authority, which provides workers’ compensation for paid and volunteer fire departments throughout the state. The surveillance program also widely disseminated the report findings and firefighter safety prevention tips to stakeholders via a quarterly newsletter written with the Forestry Division of the Montana Department of Natural Resources and Conservation that oversees the state’s wildland firefighter program.

The Montana State Legislature also received the report during the 2019 legislative session, which helped inform lawmakers’ decision to pass Senate Bill 160. The measure allows presumptive coverage of certain illnesses for firefighters. In April 2019, the state’s governor signed the bill into law, known as the Firefighter Protection Act.

Details:

• Firefighters in Montana: Health & Safety Issues
• 2019 Montana Legislature: Senate Bill 160
• Montana Worker Health

A 3-Year Look at Commercial Motor Vehicle Crashes in New Hampshire

The New Hampshire Occupational Health Surveillance Program partnered with the state’s Department of Safety, State Police Operations, to measure risks associated with commercial motor vehicles. They analyzed information from the New Hampshire State Police on commercial vehicle crashes from 2015 through 2017. Using the Integrated Database Management System, a variety of data were collected, including information on the type of accident, location, age of driver, road condition, weather, day of week, time of day, physical condition of those in the vehicle (injury status), and apparent cause of the accident. The data specifically focused on commercial motor vehicles, or vehicles used to transport goods or passengers for business that weighed more than 10,000 pounds.

According to the surveillance findings, most accidents happened during the week, in daylight hours, and in good weather conditions when the roads were dry. Crashes most often involved drivers, ages 46 through 55 years, and involved a collision with another moving vehicle. The cause of commercial motor vehicle accidents varied by driving conditions, including whether the roads were dry versus being wet and icy. Driver inattention or distraction marked the top cause of crashes during good driving conditions when the roads were dry. In comparison, when driving conditions were poor, including roads being wet, icy, or covered with snow, traveling at unsafe speeds led the top cause of accidents.

The New Hampshire Occupational Health Surveillance Program presented these and other findings at the 2019 New Hampshire Traffic Safety Conference, the 2019 Annual Public Health Association Conference, and the 2019 annual meeting for the Council of State and Territorial Epidemiologists.

Details:

• Characteristics of Commercial Motor Vehicle Crashes Reported in the New Hampshire State Police Commercial Crash Dataset for Years 2015 Through 2017
• New Hampshire Occupational Health Surveillance Program

Drug Overdose the Leading Cause of Death at Work in Massachusetts (2016–2017)

The Massachusetts Department of Public Health (MDPH) reported unintentional drug overdose as the leading single cause of fatal injury at work. These unintentional overdoses resulted in 54 deaths in Massachusetts from 2016 through 2017. Although these deaths occurred across most industry sectors, the leading sectors were Accommodation and Food Service, Construction, and Real Estate and Leasing. In a Fatality Assessment and Control Evaluation (FACE) report, MDPH provides an overview of these fatal occupational injuries in Massachusetts, including details from both the FACE and the Census of Fatal Occupational Injuries projects. The report also examines other workplace deaths like falls, electrocutions, exposure to toxic chemicals, workplace opioid and other drug overdoses, homicides, suicides, and motor vehicle-related fatalities that occur while traveling on the job.

Details:

• Fatal Injuries at Work, Massachusetts Fatality Update, 2016–2017
• NIOSH Science Blog: Drug Overdose in the Workplace and the Role of Opioids
• Mass.Gov: Occupational Health Surveillance Program (OHSP)
• Opioids in the Workplace: NIOSH Extramural Research

Evaluating Workplace Adoption of Health and Safety Strategies in Nebraska

Workplace health and wellness programs focus on population health strategies that target chronic diseases—the leading cause of death and disability in the United States. However, while there are many approaches to improving worker safety and health through workplace initiatives, limited understanding exists about employers’ adoption of them. Having a worksite health and wellness program integrated into an organization’s structure, built on a solid organizational foundation, can lead to success. One way to achieve this is through a basic organizational governance infrastructure, as identified in the Centers for Disease Control and Prevention Workplace Health Model.

Focused on this topic, the Nebraska Occupational Health Surveillance Program conducted a study in partnership with the Nebraska Department of Health and Human Services’ chronic disease programs, the University of Nebraska-Lincoln, and the University of Oklahoma. They investigated the implementation of workplace health governance and planning strategies and safety policies among worksites in Nebraska. Researchers analyzed data from the Nebraska Worksite Wellness Survey for three different years (2010, 2013, and 2016), containing information from 4,784 worksite representatives.

Looking at data over time and by occupational sector, the study found adoption of workplace health governance and planning strategies increased over the years and largely varied across sectors. The highest level of implementation occurred in educational services. The lowest numbers were in other services, construction, and transportation and warehousing. In contrast, worksites more commonly reported implementing safety policies than workplace health governance and planning strategies, but numbers varied by industry. According to researchers, the most common barrier to any type of adoption was time constraints, and stress marked the top worker health issue, negatively impacting business. The International Journal of Environmental Research and Public Health published the study’s findings in July 2019, as part of a special issue on using TWH to advance worker health and safety.

Details:

• Assessing Workplace Health and Safety Strategies, Trends, and Barriers Through a Statewide Worksite Survey
• Nebraska: Dept. of Health and Human Services: Occupational Health Surveillance in Nebraska

Investigation on Stone Fabrication Workers and Silicosis Featured in National News

Stone fabrication workers, especially those working with engineered stone, are at risk for silicosis, according to an investigation involving four state surveillance programs in California, Colorado, Texas, and Washington. Prior to this study, a number of outbreaks of silicosis cases were reported internationally among stone countertop fabrication workers, but only one in the United States.

Silicosis—an incurable, disabling, and sometimes fatal lung disease—is caused by exposure to respirable crystalline silica. Silicosis can develop when silica particles trigger inflammation and fibrosis in the lungs. A type of crystalline silica, known as quartz, is commonly found in stone, and workers who cut, polish, or grindstone materials can be exposed to its dust.

The study, published in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report (MMWR), described 18 cases of silicosis among workers in the stone fabrication industry in California, Colorado, Texas, and Washington. These cases included the first two deaths in the country and were identified through separate investigations in each state. The cases were confirmed by computed tomography scan of the chest, or lung biopsy findings. In addition to silicosis, the surveillance programs found several patients had autoimmune disease and latent tuberculosis infection. This project involved the California Department of Public Health, the Colorado Department of Public Health and Environment, the Texas Department of State Health Services, and Washington State Occupational Respiratory Disease Surveillance Program.

Since being published in September 2019, the MMWR article has been featured in 64 national and trade news outlets, including National Public Radio and Safety+Health magazine, and has already been cited in at least eight peer-reviewed journal articles.

Details:

• Severe Silicosis in Engineered Stone Fabrication Workers—California, Colorado, Texas, and Washington, 2017–2019

Preventing Occupational Health Risks Associated With Class B Biosolids

The Illinois Occupational Surveillance Program released a report on hazards associated with the production and use of Class B Biosolids. Biosolids are the remains or leftovers of organic waste and residues from the treatment of municipal, commercial, and industrial wastewater—or sewage including toilet waste. In a typical wastewater treatment plant, biosolids are separated from wastewater and are sold for agricultural purposes and energy production. They often have large amounts of pathogens, or disease-causing organisms, but biosolids can be treated to reduce these levels. The U.S. Environmental Protection Agency (EPA) categorizes biosolids into two classes: (1) Class A, which undergo a treatment process to decrease pathogens to undetectable levels—these are publicly sold without restrictions—and (2) Class B, which are not treated to the same extent as Class A, so are allowed to have an acceptable amount of pathogens. Class B Biosolids are restricted both to the public and on where they can be applied.

A review of the literature revealed limited information about occupational hazards related to biosolids. As a result, the Illinois Surveillance Program investigated the occupational sources and hazards linked to Class B Biosolids, identifying the workers who at risk for exposure and the health hazards they face. The report also identified controls that employers can implement to reduce exposure.

According to researchers, biosolids are most commonly used for agricultural production, forest reclamation, and landscaping. Class B Biosolids are most frequently applied on land in the United States, either to condition soil or fertilize crops. Among the workers with the greatest exposure risk are water treatment employees, who have daily contact with biosolids, applicators, or those who apply and spread biosolids, and agricultural workers. Individuals working with biosolids are at risk of physical hazards such as slips, trips, and falls; motor vehicle crashes while transporting the substance; respiratory issues; dermal or skin irritation; and infection caused by the bacteria, viruses, protozoa, and helminth worms in biosolids.

Scientists identified multiple engineering, administrative, and personal protective strategies to control or limit exposure to biosolid-related hazards. These critical controls include, but are not limited to, maintaining worker hygiene to reduce dermal and respiratory exposure, using personal protective equipment, modifying equipment and practices to prevent unnecessary aerosolization of biosolids, and substituting Class B Biosolids with Class A Biosolids.

These findings are important because EPA biosolids laws and regulations (40 CFR Part 503) prohibit the public from being exposed to Class B Biosolids for at least a year after its application, and workers are not exempt. They have the greatest risks before, during, and after Class B Biosolids are applied, when concentrations of pathogens are the highest.

Details:

• Occupational Health Risks From Class B Biosolids
• Illinois Occupational Health Surveillance Program 2

Injury, Hospitalization, and Fatality Rates Among Young New Jersey Workers

Around 200,000 working adolescents have job-related injuries or illnesses each year in the United States partly due to inexperience in the workplace, lack of job-specific training, and/or lack of physical or emotional maturity or both. New Jersey law requires all youth injuries related to a school-sponsored work activity be reported to the New Jersey Safe Schools Program (NJ SS)—an online reporting system managed by the state’s Department of Education. This is the only state law in the United States focused on surveillance data for young workers participating in school-sponsored work or secondary school career-technical-vocational education.

The State of New Jersey Department of Health Occupational Health Surveillance Unit aimed to understand injuries and hospitalizations among adolescent workers, including injury types, causes, and disparities. The surveillance program analyzed and compared data from both the NJ SS and the state health department’s hospitalization and fatality records. The latter numbers provided additional information on injuries related to secondary school career-technical-vocational education as well as injuries unrelated to this area. The project focused on injuries during 2007–2016 for workers 14 through 21 years of age.

Data were reported demographically, as estimated annual crude rates, which are calculations per 100,000 employed individuals. Researchers reviewed 651 job-related injury cases from New Jersey hospital discharge data and 772 cases from the NJ SS. According to reported findings, crude hospitalization rates per year gradually decreased over time, and there was an annual decrease in injuries reported in the NJ SS database. However, young adults, 19 through 21 years old, along with individuals who were white and male, had the highest hospitalization and fatality rates. Workers younger than 17 years old had the most injury reports in the NJ SS database. According to scientists, this information could possibly indicate a tendency for young males to have riskier jobs than females. In addition, understanding disparities in injuries could inform public health prevention efforts. The journal Injury Epidemiology highlighted these findings.

Details:

• Reported Injury, Hospitalization, and Injury Fatality Rates Among New Jersey Adolescent Workers
• NJ Health: Occupational Health Surveillance