Research to Practice (r2p)

Stories of Impact

Recognized for outstanding research to practice efforts, these stories are examples of how NIOSH knowledge, interventions, and technologies were used to address occupational safety and health issues and contributed to reductions in workplace illness, injuries, fatalities, or hazardous exposures. In each of these projects, partners were integral to bringing NIOSH innovations into the workplace. Visit NIOSH Impact Sheets to learn more about how our research contributed to widespread changes in policy or workplace practice that led to improved worker safety and health.

The National Construction Falls Prevention Campaign and Safety Stand-down

In the United States, the construction industry employs nearly ten million workers. Construction workers are more likely to die on the job than workers in any other industry. Many construction occupations require working at heights and climbing ladders or scaffolds on a daily basis. Each year, more than 200 construction workers are killed and over 10,000 are seriously injured by falls [CPWR 2014]. Falls in construction are preventable, but remain problematic, especially among small residential construction contractors who commonly lack resources for safety personnel.

NIOSH and the NORA Construction Sector Council collaborated with The Center for Construction Research and Training (CPWR) and the Occupational Safety and Health Administration (OSHA) to develop Safety Pays, Falls Cost, the first national multilingual social marketing campaign to address the issues of falls from ladders, roofs, and scaffolds among small residential construction contractors. Safety Pays, Falls Cost encourages residential construction contractors to (1) plan ahead to get the job done safely, (2) provide the right equipment, and (3) train everyone to use the equipment safely.

Since campaign kick-off on Workers’ Memorial Day in 2012, Safety Pays, Falls Cost has increased in size, scope, and impact every year. The Safety Pays, Falls Cost campaign website, hosted by CPWR, has received over 200,000 visits. Starting in 2014, OSHA has hosted an annual National Construction Safety Stand-down, a voluntary event for employers to talk directly to employees about safety, fall hazards, and protective methods. The National Stand-down effort is estimated to have reached over 1.5 million people. During its first year, 4,882 employers and other organizations voluntarily notified OSHA of their participation. Through these organizations, 770,193 individuals participated in stand-down activities, such as conducting trainings and inspecting equipment.

The NORA Construction Sector Council, which includes federal and state agencies, employer organizations, universities, and professional organizations, led campaign activities rooted in research methods. They conducted an environmental scan, focus groups, and evaluations to shape and improve the campaign. The Sector Council also substantially contributed to supporting research, campaign educational resources, and social media outreach. Safety Pays, Falls Cost and the Stand-down serve as a platform to promote NIOSH-developed fall prevention solutions, such as the Ladder Safety application and a patented guardrail system.

Partnerships have been instrumental to the campaign’s success and its many moving parts. The campaign provides resources organized in a centralized location, making it easier for small residential contractors to access helpful safety information. The third Safety Stand-down was May 2–6, 2016.

More information about the National Construction Falls Prevention Campaign and Safety Stand-down and other construction-related topics can be found at the following websites:


CPWR [2014]. Safety pays. Falls cost. Silver Spring, MD: Center for Construction Research and Training,

Center for Workers’ Compensation Studies

Work-related injuries, illnesses, and fatalities continue to have significant financial and societal impact in the United States. Tracking these costs and the underlying hazards is essential for control of the economic and social burdens. Workers’ compensation data, such as claims and employer information, can supplement health-related data and provide a clearer understanding of the risk factors associated with work-related injuries and illnesses. Workers’ compensation systems are the largest source of occupational injury information in the United States, with millions of claims in some single-state databases. This information has tremendous potential for prevention purposes, but remains largely underutilized.

NIOSH established the Center for Workers’ Compensation Studies in 2013 with the goal of preventing and reducing work-related injuries and illnesses by using workers’ compensation data in surveillance and research activities.

Through a partnership with the Ohio Bureau of Workers’ Compensation, the Center for Workers’ Compensation Studies developed a database of 1.4 million claims from 2001 to 2010, which will be used to develop trends by industry, employer size, occupation, causation, part of body, and injury/illness diagnoses. The aim is to create usable data for insured employers to benchmark their safety and health performance against industry peers. The data will also be used to help direct the Ohio Bureau of Workers’ Compensation consultation services, develop new safety and health interventions, and focus future research.

Together, the Center for Workers’ Compensation Studies and Ohio Bureau of Workers’ Compensation evaluated the effectiveness of over 15 Ohio Bureau of Workers’ Compensation prevention programs. Since 1999, the Ohio Bureau of Workers’ Compensation has offered a Safety Intervention Grant program, where 1,800 employers have been provided matching funds to implement engineering controls. Recently, a Center for Workers’ Compensation Studies and Ohio Bureau of Workers’ Compensation study found that this program significantly reduced the total worker’s compensation claim frequency rate by 66%. This reduction in employee claims and costs contributed to an increase in funding for more employers to participate in the Safety Intervention Grant program. A total of 486 employers received funding from 2003–2009. In 2014 alone, the Safety Intervention Grant program provided $15 million to 535 employers.

The initial focus of the Center for Workers’ Compensation Studies—which is to build internal and external capacity by working with Ohio Bureau of Workers’ Compensation—lays the foundation for future, scalable partnerships with other states. As well, the center is developing resources and tools to foster collaborations between public and private partners and maximize the use of worker’s compensation data.

For more information about NIOSH’s Centers for Workers’ Compensation Program visits:

Partnering with Industry to Build Safe EMS Work Environments

Fast-pace, intense, and mobile characterize the work environment of emergency medical services (EMS) workers. In 2011, an estimated 27,800 injuries and illnesses among EMS workers were treated in U.S. hospital emergency departments [NIOSH 2014]. During emergency transport of patients, EMS workers are at risk of vehicle crash-related injuries and fatalities. Prior NIOSH research, as well as National Highway Traffic Safety Administration and NIOSH crash investigations, identified seating, occupant restraints, the patient cot, and loose medical equipment as key risk factors contributing to EMS worker fatality rates that exceed the general worker population by a factor of three.

Recognizing that ambulances fall outside most federal crash safety regulations, during the period from 2011 through 2015, NIOSH and the National Truck Equipment Association co-chaired ten ambulance-component-specific committees to develop a family of crash test methods. These test methods, now published by the Society of Automotive Engineers (SAE), improved the crashworthiness of ambulance patient compartment components such as worker seating, the patient cot, equipment mounts, and the ambulance body structure.

During test methodology development, manufacturers partnered with NIOSH to redesign and test new products to meet the proposed requirements. Many partners initially chose to test existing hardware, often with less-than-optimal results. By the completion of this effort, all industry partners had produced and tested new crashworthy products that met the performance requirements delineated by SAE. In addition, each industry partner moved forward, manufactured these new crashworthy products, and made them commercially available prior to the adoption of the new test methods by a single state.

NIOSH then successfully acted as the primary liaison to ensure the SAE published test methods were incorporated into each of three bump-to-bump national standards or specifications. On July 1, 2015, the General Services Administration (GSA) adopted the new crashworthy test methods into their Star-of-Life Ambulance Specification (KKK-A-1822F). Thirty states previously adopted the GSA Specification in their regulatory language; these states are also required to install new components, tested to the new NIOSH-generated SAE test methods, in all new ambulances ordered after July 1, 2015. Products not tested are no longer available in these states. Remaining states are considering adoption of the GSA Specification, NFPA’s 1917 Ground Ambulance Standard, and the CAAS Ground Vehicle Standard (CAAS GVS 2016), all of which include these new test methods.

Partnerships developed early and maintained throughout the project accelerated the introduction of new products into the market, thus improving worker safety. The team is now working with the National Association for State EMS Officials to increase adoption of these test methods by all 50 states and five U.S. territories through a joint educational campaign.

More information about emergency medical service-related topics can be found at the following websites:


NIOSH [2014]. Emergency medical services workers. Morgantown, WV: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,

Partnership to Increase Health Equity among Spanish-speaking Immigrant Workers (Consulates)

About 18 million Latino immigrants live in the United States [Batalova and Terrazas 2010]. They have a workplace fatality rate of 5.9 per 100,000, which is almost 50% higher than the rate for all workers [Cierpich 2008]. Workplace safety training is critical, but immigrant workers frequently report not receiving any job safety training or receiving poor quality training. Language barriers, cultural differences, and social structures are also challenges. Stakeholders and partners such as the U.S.-Mexico Border Health Commission and the Mexican consulates sought assistance from NIOSH to address these issues.

NIOSH worked with Ventanillas de Salud, the Mexican Foreign Ministry’s health promotion program for its U.S. diaspora, serving more than one million people, and with experts from academia, organized labor, and trade associations. This collaboration led to a key partnership with the Mexican consulates and the development of highly-tailored educational materials. NIOSH is now represented on the National Advisory Board for the Ventanillas de Salud program. Pamphlets, videos, and posters were created to raise awareness among Spanish-speaking immigrant workers about occupational safety and health (OSH) issues and to provide tools and motivation for those workers to seek additional information and assistance.

The first month of a campaign targeting organizations that work with Spanish-speaking immigrant workers resulted in more than 1,000 brochure and poster downloads and more than 1,000 video views. Time spent on both the English and Spanish landing pages was above average for NIOSH pages, and a few thousand visitors delved deeper into the additional materials.

OSH is now one of the five priority topics for health promotion activities conducted in Mexican consulates across the United States. All 50 consulates are distributing the NIOSH-developed materials. The Mexican Ministry of Government, U.S. Embassy in Mexico, OSHA, and several community-based organizations have also expressed interest in distributing the materials.

The increased institutional support for OSH in Mexican consulates, given their significant profile in immigrant communities, will likely lead to a heightened awareness of OSH-related issues among immigrants and the organizations that serve them, including governments from other Latin American countries. This project has generated interest in OSH and immigration among other Mexican Ministries, particularly around improving surveillance. Finally, the partnership and materials-development process provide a model for how to reach this population in an appropriate and effective way and establishes an institutional conduit for OSHA and immigrant organizations to collaborate better.

More information about this campaign and immigrant work-related topics can be found at the following website:


Batalova J, Terrazas A. [2010]. Frequently requested statistics on immigrants and immigration in the U.S. Migration Information Source,  

Cierpich H, Styles L, Harrison R, et al. [2008]. Work-related injury deaths among Hispanics-United States, 1992-2006. Journal of the American Medical Association, 300(21), 2479–2480.

New and Updated NIOSH YOUTH@WORK – Talking Safety Curriculum

In 2013, there were approximately 18.1 million workers less than 24 years of age, and these workers represented 13% of the workforce. For the 10-year period of 1998 to 2007, an annual average of 795,000 nonfatal injuries caused young workers to be treated in U.S. hospital injury departments. In 2012, 375 workers younger than 24 years old died from work-related injuries, including 29 deaths of youths younger than 18 years old. Jobs typically held by young workers have many hazards and contribute to their high occupational injury rates. Inexperience and lack of safety training may also increase injury risks for young workers.

With input from our partners, NIOSH developed the NIOSH Youth@Work—Talking Safety curriculum for use in middle schools and high schools and other relevant settings. The new Talking Safety, which supersedes the existing young worker curriculum, has been rewritten to include new case studies and learning activities; redesigned with partner input to meet current educational standards; updated with current state and Federal child labor regulations, minimum wage laws, and other OSH information and resources; and customized for each state.

The new curriculum articulates a framework, the NIOSH 8 Core Competencies, for foundational, workplace safety and health skills that young people need before entering the workforce. These include skills to recognize the short-and long-term effects of job injuries and illnesses; recognize job hazards and the best methods for controlling them; understand worker rights and responsibilities; and know how to communicate about problems on the job.

Talking Safety has been used by schools, health departments, and OSH organizations across the country. In particular, NIOSH partnered with the Miami-Dade County Public Schools—the fourth-largest U.S. school district, with more than 355,000 students—to use Talking Safety in all 8th grade science courses. The Miami-Dade County Public Schools also integrated workplace safety and health as an “essential element” into the District Pacing Guide, which instructs teachers on the mandatory content to be covered in a particular subject area (e.g., 8th grade science). Talking Safety will reach approximately 18,000 youth in the Miami-Dade County Public Schools each year.

The knowledge and abilities taught through Talking Safety complement the job-specific skills learned at work or through apprenticeships and other job training programs. The curriculum equips working youth with the critical life skills they need to stay safe and healthy at work, now and throughout their lives.

For more information about NIOSH’s Youth@Work—Talking Safety curriculum visit:

Silica Dust Control for Asphalt Pavement Milling Machines

At least 1.7 million U.S. workers in various industries and occupations, including construction, are exposed to respirable crystalline silica. Occupational silica exposure can cause silicosis, a debilitating and potentially fatal lung disease, and is also associated with lung cancer, chronic obstructive pulmonary disease (COPD), and renal disease. Approximately 367,000 U.S. workers are employed in highway, street, and bridge construction. Many of these workers use cold-milling machines or worker in close proximity to these machines. Cold-milling machines generate dust that often contains respirable crystalline silica that can be transported by air currents to worker breathing zones near the milling machines.

NIOSH collaborated with industry, management, labor, and government stakeholders through the Silica/Asphalt Milling Machine Partnership to address silica exposure. NIOSH and its partners played a key role in the implementation of this study by spending more than a decade of their time and resources to have NIOSH test and evaluate numerous iterations of silica dust controls on their milling machines at dozens of highway construction sites around the country.

The collaborative effort resulted in Best Practice Engineering Control Guidelines to Control Worker Exposure to Respirable Crystalline Silica during Asphalt Pavement Milling. Additionally, the partnership research resulted in the development and implementation of a ventilation control that attaches to the milling machine to reduce silica dust before it can reach the worker.

Currently, all U.S. and foreign manufacturers of heavy construction equipment that currently sell pavement-milling machines to the U.S. market have the NIOSH-evaluated retrofit kits available. Two manufacturers with the majority of the U.S. market began putting silica dust controls on new milling machines in 2015. It is anticipated that new silica dust controls will be on at least 50% of milling machines in the United States by 2020, and nearly 100% of U.S. machines by 2025.

The impact of the developed engineering controls and guidance stretches beyond the United States. The French Institute National de Recherche et de Sécurité (INRS) expressed interest in a French translation of the guidance document and similar implementation of engineering controls in Europe. Also, a 20,000 character summary of the milling document that the INRS translated to French will be published in a French HST review journal in a few months.

For more information about silica and other construction-related topics visit:

Epidemiology and Engineering Safety for the Fishing Industry

Commercial fishing is generally identified as the most dangerous occupation worldwide, with a rough estimate of 24,000 work-related deaths per year according to the Food and Agriculture Organization. In the United States, the commercial fishing work-related fatality rate is 23 times the rate for all workers. Eighty-six percent of fatalities are caused by drowning after a vessel disaster or a fall overboard. Although the risk of drowning is high, most deckhands do not wear personal flotation devices (PFDs) while working on deck. Currently, regulatory agencies do not mandate that workers wear PFDs.

A past NIOSH study found that workers had low PFD use if they believed PFDs interfered with work, were an entanglement hazard, or felt uncomfortable. NIOSH recommended that manufacturers collaborate with workers in the design and promotion of more comfortable PFDs. Throughout the PFD study, NIOSH actively engaged PFD manufacturers to improve understanding of the PFD market. This broad network proved to be a valuable pathway for sharing research findings with manufacturer representatives.

In response to the dissemination efforts, a new PFD manufacturer, Kent Safety Products, approached NIOSH about a potential partnership. NIOSH provided study design details and raw data, including direct comments regarding fishermen’s PFD preferences, and discussed next steps toward the development of an innovative PFD. In accordance with NIOSH recommendations, the manufacturer engaged fishermen in the development process, collecting additional preference data from fishermen on other PFD models. As a result, Kent Safety Products designed and manufactured an innovative “tactical deck vest.” After a series of field tests and adjustments, the final product was released to the commercial market in late November 2014 and subsequently won the 2014 Fisheries Supply Innovation Award (Safety Category).

According to the manufacturer, the product launch was very successful. Sales figures demonstrated a high rate of initial acceptance of the PFD in the workplace. In the first year, over 2,000 units were sold. About 80% of those sales were to fishermen in the Pacific Northwest. More would have been sold, but the manufacturers ran out of smaller sizes almost immediately.

Kent Safety Products continued to build upon the innovative PFD design. They revealed a new PFD prototype featuring a new high visibility design and lighter weight form at the 2015 Pacific Marine Expo. Kent Safety Products offers the original model along with the new model, thus providing options to meet the varied preferences of commercial fishermen. Ultimately, if fishermen perceive that a PFD model alleviates comfort and safety concerns, more may choose to wear PFDs and fewer lives will be lost.

More information about PFDs and commercial fishing-related topics can be found at the following websites:

Development, Evaluation, and Commercialization of the NIOSH Multi-functional Guardrail System

Falls are the leading cause of construction fatalities, accounting for one-third of workplace-related deaths in the industry. Each year, more than 200 construction workers are killed and more than 10,000 are seriously injured by falls. Guardrail systems have been shown to protect laborers who have to work near unguarded steep-sloped roof edges and holes, skylights, interior floor edges, and stairways that have not yet had handrails installed.

An analysis of fatalities and severe injuries caused by workers falling through roof and floor holes and existing skylights, in conjunction with a study to evaluate guardrails, prompted NIOSH to develop a multi-functional guardrail system. The patented fall-prevention system (U.S. Patent No. 7,509,702) meets all OSHA safety requirements for guardrails, and has more adjustability than any other system on the market.

Next NIOSH worked with two residential West Virginia contractors to evaluate the guardrail system externally on the roof and internally on the stairs for edge protection and address any user acceptance issues. Training in the use of the fall-prevention system was provided by the West Virginia University Safety and Health Extension Office in partnership with the NIOSH research team.

In 2014, Reese Wholesale licensed the guardrail system from NIOSH and has the system commercial available under the name, The Protector Guardrail System.

Much of the success and impact of the NIOSH-Reese Wholesale multi-functional guardrail system is credited to the strong collaboration between NIOSH and its partners. The guardrail is an adaptable, easy-to-install fall-prevention system designed to improve safety conditions for residential and commercial construction workers.

For more information about the NIOSH-Reese Wholesale guardrail system and other construction-related topics visit:

Page last reviewed: March 28, 2018