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Outcomes are events, occurrences, or conditions that indicate progress in achieving the purpose of the program. Outcomes reflect the results of a program activity compared with its intended purpose; outcomes may also answer the question "Will these resources result in success or contribute to the success of what we want to accomplish?"

Outcomes can be viewed from two different perspectives-ultimate and intermediate. For an occupational safety and health research program like the NIOSH Global Collaborations Program, ultimate outcomes are reductions in a particular type of worker injury or illness. Injuries and illnesses have complex causes, and any effect of program activities on rates can take years to be seen. Therefore, outcomes are often measured on an intermediate timeframe. Intermediate outcomes are necessary steps that lead to ultimate outcomes-for example, reductions in the risk of a particular type of injury or illness. For occupational safety and health research programs, achieving intermediate risk reductions is as important as achieving the ultimate outcome of decreasing injury and illness incidence rates.

Intermediate Outcomes

Preventing Hearing Loss from Chemical and Noise Exposures

Knowledge generated by this project has impacted occupational health guidance and legislation. NIOSH and extramural partners have contributed to the substantial number of outputs in this area. This partnership leads to the development of guidelines and recommended practices [PDF - 3.44 MB] to prevent occupational hearing loss from exposure to chemicals and raises awareness of the issue in a number of arenas.

In a partnership with the Nordic Expert Group (NEG) and the Karolinska Institute in Sweden, NIOSH co-authored the 2010 document Occupational exposure to chemicals and hearing impairment . The Nordic Expert Group for Criteria Documentation of Health Risks from Chemicals. Nordic Expert Group. Gothenburg. Arbete och Hälsa; 44(4): 177 pp. This document evaluates the potential for adverse human hearing effects of ototoxic chemicals found in the work environment. As combined exposures (e.g. chemical and noise) are currently not considered in the regular occupational exposure limit (OEL) setting procedures, a noise notation is discussed in the document, to be used to indicate an increased risk of hearing loss after exposure to the chemical at a level close to the OEL. The strength of evidence for ototoxicity of several chemicals was divided into three categories for agents for which: 1) human data indicate auditory effects under or near existing OELs and robust animal data support an effect on hearing from exposure (styrene, toluene, carbon disulphide, lead, mercury and carbon monoxide), 2) human data are lacking whereas animal data indicate auditory effects under or near existing OELs (p-xylene, ethylbenzene and hydrogen cyanide), 3) human data are poor or lacking and animal data indicate an auditory effect well above the existing OELs (chlorobenzene, trichloroethylene, n-hexane, n-heptane, some solvent mixtures, trimethyltin, acrylonitrile, 3,3'-iminodipropionitrile, pesticides and PCBs). This document also provides an updated description of evaluations and recommendations by national and international bodies.

In 2011, the publication ” A multicenter study on the audiometric findings of styrene-exposed workers” (Morata et al., Int J Audiol. 2011 Oct;50(10):652-60. Epub 2011 Aug 3) reported some of the results from NoiseChem, a research project funded by the European Commission 5th Framework Programme (NIOSH participated as an external partner). Data collection was under the responsibility of four research centers located in three countries (the Swedish National Institute for Working Life, the Finnish Institute for Occupational Health, the Polish Institute of Occupational Medicine and Environmental Health and, the Nofer Institute Occupational Medicine, Poland). The study concludes with evidence based recommendations for hearing loss prevention.

In 2011 NIOSH partnered with the French Institut National de Recherche et de Securité, by providing a representative to the International Advisory Committee of the Occupational Health Research Conference 2012: Health risks associated with mixed exposures, and helped with the dissemination of the event.

Finally, a new collaboration was established between NIOSH, the University of Queensland and the National Acoustic Laboratories (both in Australia) for the development of new strategies for hearing loss prevention programs in the workplace to address the risk of work-related hearing loss induced by chemicals. The study, which just received a grant from the Australian National Health and Medical Research Council (NHMRC), is scheduled to start in calendar year 2012. NIOSH helped in the development of the proposal, and will provide scientific consultation throughout the project.

The results from NIOSH collaboration son this topic have guided and will continue to contribute to occupational safety and health efforts in reducing the risks of work-related hearing loss and increase awareness of the ototoxic potential of chemicals.

More information about prevention of hearing loss can be found on the NIOSH Noise and Hearing Loss Prevention topic page .

Occupational HIV Prevention

As part of a grant, the World Health Organization (WHO) developed and tested the “Protecting Healthcare Workers: Preventing Needlestick Injuries Toolkit” in Asia and in Africa. The toolkit has been translated into Spanish and tailored to the culture for use in the joint effort between WHO, NIOSH, the Venezuelan Ministry of Health, and the Pan American Health Organization (PAHO) to test the new toolkit for wide use in Latin American countries.

More information about this WHO Project can be found in the WHO Global Occupational Health Newsletter [PDF - 313 KB] (GOHNET) Issue No. 8, Winter 2005

More information about prevention of bloodborne pathogens can be found on the NIOSH Bloodborne Pathogens topic page .

Young Workers Occupational Safety and Health Curriculum

The National Association of State Directors of Career Technical Education Consortium (NASDCTEc), has endorsed this participatory curriculum to train youth and their teachers in basic occupational safety and health principles through its Career Clusters initiative. This will facilitate offering the curriculum in U.S. schools utilizing the Career Clusters approach to workforce preparation. This project is coordinating with interested WHO Collaborating Centers.

More information about safety and health of young workers can be found on the NIOSH Young Worker Safety and Health topic page .

Assessing the Utility of Control Banding in the U.S. and Globally

NIOSH efforts to explore the utility of control banding has provided the impetus to raise awareness of this approach among safety and health practitioners. This intermediate effect can be seen in the expanded efforts to study and implement control banding strategies among the following:

Within the U.S.:

  • Professional groups
    • American Industrial Hygiene Association,
    • American Conference of Governmental Industrial Hygienists,
    • American Society of Safety Engineers, American Chemical Society
  • Industry groups
    • International Lubricant Manufacturers Association,
    • The Dow Chemical Company
  • Other governmental agencies
    • Environmental Protection Agency
    • Occupational Safety and Health Administration
  • Organized labor
    • Laborers Safety and Health Fund of North America
  • Academia
    • University of Cincinnati
    • Murray State University
    • Eastern Kentucky University


Through developing informational materials and coordinating forums, workshops, and presentation described below, NIOSH has also contributed to international efforts to promote research and evaluation of control banding. On an international level, collaborations have included:

  • Participation in various international conferences and workshops in Peru, Colombia, Mexico, Brazil, and Venezuela
  • Sponsorship, planning, and coordination of the 2nd International Control Banding Workshop (Cincinnati, Ohio, U.S., March 2004)
  • Participation in the 3rd International Control Banding Workshop (Pilanesburg, South Africa, September 2005)
  • Participation in the U.S./E.U. 4th Joint Conference of Safety and Health at Work in Orlando, Florida, U.S. (September 2005) and drafting the position paper for the subcommittee on global management of chemicals
  • Participation on a panel on control banding at the World Congress for Occupational Safety and Health in Orlando, Florida, U.S. (September 2005)
  • Participation on the WHO/ILO International Technical Group on Control Banding and development of the global plan for implementation of control banding (ongoing)
  • Provision of technical assistance using a control banding model to address silica exposures and control silicosis in Chile (2005 - present, ongoing)
  • Development of a letter of agreement among U.S. agencies (NIOSH, OSHA), the U.K. Health and Safety Executive, and the German Federal Institute for Occupational Safety and Health to collaborate on control banding research

More information about Control Banding can be found on the NIOSH Control Banding topic page .