FY 2020 Extramural Research Program Highlights: Investigator-Initiated Research

The mission of NIOSH is to develop new knowledge in the field of occupational safety and health and then transfer it to practice. The extramural research program advances this mission through its research. This work helps in identifying workers at risk, developing methods for measuring hazard exposures, and detecting adverse health effects. The program also helps in determining the frequency of job-related hazards, increasing understanding of the causes of work-related diseases and injuries, and reducing or eliminating hazard exposures. Grantees share research results through diverse communication channels, including scientific meetings, conferences, and workshops.

Investigator-initiated research outputs are the products of 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, 2019, through September 30, 2020, R01 grant-funded researchers published 90 articles in peer-reviewed journals. The numbers of peer-reviewed publications for the other investigator-initiated research mechanisms are 3 (R03), 1 (U13), 8 (R21), and 12 (K01). Find a searchable database of NIOSH publications, which includes grantee final reports and publications, by using the NIOSHTIC-2 publications search.

Preventing Slips, Trips, and Falls by Predicting Wear on Shoes

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. According to the NIOSH Traumatic Occupational Injuries webpage, 27% 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, especially 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, decreasing the shoe’s coefficient of friction and increasing the risk of slipping.

Before this study, limited knowledge existed about the rate at which shoe tread becomes worn and how shoe wear causes a reduced coefficient of friction. To address this issue, investigators at the University of Pittsburgh looked at key causes of worn shoe tread and the tread thresholds or points where shoes become unsafe. Looking at the size of the shoes’ treads and the worn regions, 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 and can be used for inspecting shoes. They also developed virtual computer models that predict the wear patterns over time and 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, as well as 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 to decrease work-related slips and falls.

Information about this project has been widely shared with varied footwear companies, Grainger industrial supply company, and a committee within the ASTM International standards organization focused on pedestrian/walkway safety and footwear. Researchers also highlighted their findings via 12 journal articles, 22 conference presentations, and a keynote speech at the Slips, Trips & Falls Conference Madrid 2020. The NORA Traumatic Injury Cross-Sector Council also partnered with researchers to create posters for restaurant and healthcare workers on using the battery test for shoe inspections to determine slipping risk.

Details:

• Impact of Worn Shoes on Slipping
• How to Inspect Your Shoes: A Guide for When to Replace Slip-resistant Shoes Using a AA battery
• Influence of Averaging Time-interval on Shoe-floor-contaminant Available Coefficient of Friction Measurements
• Changes in Under-shoe Traction and Fluid Drainage for Progressively Worn Shoe Tread
• Predicting Slips Based on the STM 603 Whole-footwear Tribometer Under Different Coefficient of Friction Testing Conditions
• Outside NIOSH: Computer Model Predicts Wear on Shoes
• NORA Traumatic Injury Prevention Cross- Sector Council, Posters: Slip Resistant Shoe Tread Wear

Study Examines Effects of Work-hour Restrictions on Physician Safety and Health

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. These include motor vehicle crashes, which can occur as these workers commute to and from work, and 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 from 24–28 hours to 16 hours. In this study, 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, focusing 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, which included reported work hours, extended shifts, and hours of sleep. Participants in the study included physicians in a residency program from 2002 through 2007, and 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, percutaneous injuries, and attentional failures, or injuries caused by lack of attention. The average hours of nightly sleep also increased for this group of workers. 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, and first-year resident physicians can now work 24–28 consecutive hours. The American Journal of Medicine featured this study in FY 2020, and it was highlighted in several news outlets in the healthcare field including Becker’s Hospital Review and Medical Xpress. Researchers at Brigham and Women’s Hospital plan to continue examining changes in resident physicians’ health outcomes, following the latest ACGME policy change.

Details:

• The Association Between Resident Physician Work-hour Regulations and Physician Safety and Health
• Impact of Lifting Work Hour Restrictions on First-year Resident Safety, Health, and Well-Being

Factors Linked to Low Back Pain for Manufacturing and Warehousing 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 many studies due to lack of a standard case definition for LBP. Past studies use different definitions, resulting in varying risk factors. Many studies also have limited or imprecise measures of exposures for LBP in the workplace, especially related to health outcomes. Because of these challenges and other limited research methods, 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, looking at differences in their prevalence or frequency of LBP and risk factors for this health issue. They 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), a common tool to assess risk of lifting and lowering tasks at work. The RNLE focuses on an object’s weight, the hand location, travel distance, angle of body twisting, lifting frequency, and length and type of grasp; measurements on these factors are combined for a single metric. For a comprehensive analysis, researchers compared the RNLE data to other identified physical exposure variables at work, including load moment and trunk posture.

Participants in this study had an average age of 35 years, and 75% were male and 68% non-Hispanic White. According to researchers, prevalence and incidence of LBP, along with health outcomes like seeking medical care and having lost work time, were linked to biomechanical stressors measured via the RNLE and other physical exposure variables. Scientists also linked factors like advanced age, history of LBP, and psychosocial factors to either prevalence and/or incidence of 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, previously featured in Journal of Occupational and Environmental Medicine and Human Factors and other publications, is significant because it could potentially influence organizational and governmental policies on workplace physical exposures.

Details:

• Exposure-Response Relationships for Low Back Pain From Pooled Data
• Prevalence of Low Back Pain, Seeking Medical Care, and Lost Time Due to Low Back Pain Among Manual Material Handling Workers in the United States
• Psychosocial Factors and Low Back Pain Outcomes in a Pooled Analysis of Low Back Pain Studies
• Evaluating Different Measures of Low Back Pain Among U.S. Manual Materials Handling Workers: Comparisons of Demographic, Psychosocial, and Job Physical Exposure

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, and 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 caused by 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, as well as studies on facilitators and barriers to their workplace settings adopting occupational health best practices. Building on a past NIOSH-funded K01 project, Drexel University researchers are using theory-based information to create a toolkit for salon owners and will test the effectiveness of this intervention in Philadelphia area Vietnamese nail salons. The toolkit will include trainings and self-assessment checklists, which 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 on 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 seven 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 metro Philadelphia newspaper, The Philadelphia Inquirer, on workplace safety and health issues facing immigrant nail salon workers.

Details:

• An Immigrant Daughter’s Call to Help Philadelphia’s Nail Salons | Opinion
• A Feasibility Study to Develop a Multilevel Occupational Health Intervention Program for Nail Salon Employees and Owners

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. Because 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. When this occurs, studies found home care aides experience emotional strain and short-term job loss until they are reassigned to a new case. However, there is limited research focused on 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, interviewing leaders from a sample of 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 and very few preventive efforts to help home care aides deal with the issue. In particular, after clients die, the organizations did not provide paid leave and lacked appropriate emotional support such as counseling or responsive case reassignment. They 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 to this happening is the lack of funding and available resources related to employment and healthcare policy. Nevertheless, researchers note that policy changes leading to increased wages, paid time off, and emotional support services for aides can increase well-being and retention among this critical workforce. Their findings have been reported in the Journal of Applied Gerontology.

Details:

• Interventions to Reduce the Impact of Client Death on Home Care Aides: Employers’ Perspectives