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Work-related injuries and illnesses associated with child labor--United States, 1993.

During 1993, an estimated 2.1 million persons aged 16-17 years in the United States were employed. Although many children aged <16 years work, employment data are neither routinely collected nor reported for this age group, and there are no reliable estimates of the number of children in this age group who work. During summer months, when most children are not in school, employment and hours worked by children aged <18 years increase substantially. To characterize workplace-related health and safety hazards for children, CDC's National Institute for Occupational Safety and Health (NIOSH) analyzed 1993 data for workers aged <18 years from the Survey of Occupational Injuries and Illnesses (SOII), a survey administered by the Bureau of Labor Statistics (BLS), U.S. Department of Labor. This report summarizes the results of this analysis and indicates that substantial numbers of persons aged <18 years sustain work-related injuries and illnesses each year.

Absenteeism↗

Health hazards for children at work.

The International Labor Office has estimated that there are 250 million child laborers (5-14 years old) worldwide, with more than 120 million of these working full-time. The issue is complex; child labor is an economic and social reality in many developing countries. Children may provide 25% or more of a family's total income, and many traditional cultures include child labor as an integral part of the child's socialization and achievement of status in the local community. Governments may regard child labor as a key factor in keeping their economy competitively viable through the provision of cheap labor for commercial interests. And yet child labor violates children's rights and exposes them to increased health risks. Children who work full-time do not attend school and thereby lose their inherent right to an education. They may come from families ravaged by poverty, live in dilapidated housing, have unsafe water supplies, poor sanitation, and inadequate nutritious food. Working children are vulnerable to anemia, fatigue, early initiation of tobacco smoking, and other health problems. Manual labor exposes children to injury and also to poisoning from chemicals such as solvents, pesticides, metals, caustic agents used on the job, to fumes and dust, and other toxic, work-related byproducts. The International Labor Organization has sought to control the most abusive of child labor practices throughout the world. Solutions to this complex and intractable worldwide problem will also require infrastructure changes in the economic and social incentives to child labor, enlightened public health policies, and community-level advocacy and involvement.

Child↗

Fatal injuries to teenage construction workers in the US.

BACKGROUND: The construction industry is second only to agriculture in the annual number of fatal injuries in workers less than 18 years of age. We examined fatal injury reports for youth and adult workers to determine risk factors for injury and applicability of existing child labor regulations. METHODS: The US Occupational Safety & Health Administration (OSHA) investigation data for fatal work injuries from 1984 through 1998 were reviewed with respect to type of event, employer characteristics, and apparent violations of existing child labor laws under the Fair Labor Standards Act (FLSA). We also examined whether the employer met exemption criteria for federal enforcement of child labor or OSHA regulations. RESULTS: The fatality rate for teenage construction workers age 19 and younger was 12.1 per 100,000 per year, slightly less than for adult workers. Teenage workers who were fatally injured were more likely than adults to have been employed at non-union construction firms (odds ratio (OR) = 4.96, P < 0.05), firms with fewer than 11 employees (OR = 1.72, P < 0.05), and their employers were more likely to have been cited by OSHA for safety violations (OR = 1.66, P < 0.05) than for firms which were investigated because of a fatality in an adult worker. Fatalities in teenagers were more likely to occur in special construction trades such as roofing. Among fatalities in workers less than 18 years of age, approximately one-half (49%) of the 76 fatal injuries were in apparent violation of existing child labor regulations. We estimated that in 41 of the 76 cases (54%) the employer's gross annual income exceeded the $500,000 threshold for federal enforcement of child labor laws. Only 28 of 76 cases (37%) were at construction firms with 11 or more employees, which are subject to routine OSHA inspections. CONCLUSIONS: Fatal injuries in teenage construction workers differed from those in adults in that they were more likely to be at small, non-union firms of which a substantial proportion were exempt from federal enforcement of child labor laws and from routine OSHA inspections. Safety programs for young construction workers should include small, non-union construction firms and those in special construction trades such as roofing. We did not identify specific areas for new regulation but the number of fatalities reviewed was small.

Accidents, Occupational↗

[Child maltreatment: social representation of the general population and the professionals working with children in the Caribbean area of Colombia].

OBJECTIVE: The main objective was to know social representations about child maltreatment (severity, etiology, and intervention strategies) of the general population and the professionals working with children in the Caribbean area of Colombia. METHOD: Sample was composed for 402 participants. From this pool of participants, 111 of them were working in child protection, 95 worked with children but not in the child protection system and 196 pertained to the general population. All participants answered to a questionnaire composed by 86 items. The questionnaire was developed to assess (1) the perceived severity of different typologies of child abuse, (2) opinions about risk factors for child maltreatment and sexual abuse, and (3) opinions about the most adequate ways of intervention with perpetrator of child abuse. RESULTS: Sexual abuse is considered as the most severe typology of child maltreatment and emotional abuse is considered as more severe than physical abuse. No differences between groups were found in perceived severity of typologies of child maltreatment. Differences in the social representation about the etiology of child maltreatment were found. Professionals working in the child protection system give more value to characteristics of parents and to the socio-economic and familiar environment in the etiology of child maltreatment than participants from the general population. Prevention and treatment programs for abusers were considered as the more relevant strategies against child maltreatment. DISCUSSION: Findings of present study suggest that social representations about child maltreatment of general population and professionals from the Caribbean area of Colombia are similar than social representation observed in other regions and countries. It is important to take into account that child labor and child poverty were considered as non-severe typologies of child maltreatment. Moreover, findings suggest that people from general population in the Caribbean area of Colombia have a relevant knowledge about agencies working for child protection.

Caribbean Region↗

Young workers.

Until recently, today's occupational safety and health experts have paid little attention to safety and health concerns of working youth. Yet with millions of children and adolescents employed each year, young workers are indeed a special population at risk deserving special attention. Occupational safety and health professionals have critical knowledge and skills to contribute to researching special issues for young workers and promoting safe and healthful work for youth. Unique opportunities for intervention hold the potential for new and rewarding partnerships with, for example, pediatricians and adolescent health specialists, child labor regulators, child injury prevention professionals, maternal and child health professionals, educators, and community leaders. Lessons learned in targeting young workers can have important implications for reaching other special populations that have not been well addressed through conventional approaches to occupational safety and health.

Accidents, Occupational↗

Green tobacco sickness in children and adolescents.

Tobacco (Nicotiana tabacum) is cultivated in more than 100 countries, and in 2004, some 5.73 million metric tons dry weight of tobacco were grown worldwide. The top five tobacco producers forecast for 2004 are China (2.01 million metric tons; 35.1%), Brazil (757 thousand metric tons; 13.2%), India (598 thousand metric tons; 10.4%), United States (358 thousand metric tons; 6.2%), and Malawi (138 thousand metric tons; 2.4%). Together, these five countries account for two-thirds of worldwide tobacco production. Tobacco farming presents several hazards to those who cultivate and harvest the plant. Although some of these hazards, such as pesticide exposure and musculoskeletal trauma, are faced by workers in other types of agricultural production, tobacco production presents some unique hazards, most notably acute nicotine poisoning, a condition also known as green tobacco sickness (GTS). GTS is an occupational poisoning that can affect workers who cultivate and harvest tobacco. It occurs when workers absorb nicotine through the skin as they come into contact with leaves of the mature tobacco plant. GTS is characterized largely by nausea, vomiting, headache, muscle weakness, and dizziness. Historically, children have played a role in agricultural production in the United States, and they continue to do so today. This includes tobacco farming. The North American Guidelines for Children's Agricultural Tasks, a set of injury prevention guidelines prepared by the National Children's Center for Rural and Agricultural Health and Safety, lists GTS as one of several hazards children face when working on tobacco farms. Children 17 years of age and younger who work on U.S. tobacco farms come from three main groups: members of farm families, migrant youth laborers (primarily Latinos), and other hired local children. All three groups are at risk for GTS. Beyond the U.S., tobacco production using child labor is an emerging topic of concern in developing nations. An international movement, advocated by the Eliminating Child Labor in Tobacco Foundation, is underway to restrict child labor in tobacco production. GTS is a unique occupational poisoning associated with tobacco farming. We suspect that many public health practitioners, clinicians, advocates, and researchers are unaware of GTS among children and adolescents. In this article, we provide an overview of GTS among young people who work in tobacco, summarize reports documenting pediatric GTS cases, explain GTS etiology, and present three case studies of pediatric GTS in Kentucky. In addition, we discuss the need for expanded surveillance and prevention of GTS, both in the United States and globally.

Adolescent↗

The ecological model and the study of child abuse in Nigeria.

Physical abuse and exploitative child labor are two common forms of child abuse in Nigeria. Exploitative child labor exists in both the formal and informal sectors where children work as hairdressers, beggars' assistants, hawkers, and as factory and agricultural workers under conditions characterized by long hours, hazardous environment, and meager remuneration. Research on the incidence of physical abuse in Nigeria is less systematic, and few empirical studies are available. Physical abuse is primarily the result of corporal punishment which has become excessive. Poverty and the existence of a dependent capitalist economy are often proffered as the primary causes of child abuse. While both explanations have some validity, their unidimensional nature limits their explanatory capacity. These explanations also lead to the belief that very little can be done to improve the quality of children's lives until the social order is restructured. The ecological model proposes that child abuse can best be understood if it is analyzed multidimensionally with emphasis on the individual, family, social environment, and cultural milieau, as well as the dynamic interaction between these levels. This model appears appropriate for the study of child abuse in Nigeria, and its application is advocated as a vehicle for improving the quality of child abuse research.

Child↗

[Influence of labor induced by prostaglandins on the metabolism and blood coagulation system of the mother and child during labor].

22 pregnancies at term were terminated by dilatation of the uterine cervix, low amniotomy, and by intravenous administration of PGF2alpha or PGE2. The average infusion time was 4 hours 10 minutes, and the average total dose of PGF2alpha amounted to 2,0 mg and of PGE2 0,2 mg. Parameters of acid-base changes, carbohydrate and energic state changes, gas metabolism, and changes in coagulation and fibrinolysis in mother and in fetus were analyzed during labor and after birth. Labor activity and fetal cardiac action were monitored cardiotocographically. Checked against 50, and for the coagulation 12 uncomplicated spontaneous deliveries, we have found no disadvantageous changes in the parameters investigated.

Acid-Base Equilibrium↗

Public health and working children in twentieth-century America: an historical overview.

Throughout this century, concern for the health of America's youth has been a driving force in the long fight to regulate child labor. The prevalence of children in dangerous trades like mining and mill work at the start of the century was a major factor behind the creation of a national child labor reform movement. Not until the Fair Labor Standards Act of 1938, however, were reformers able to secure universal age, hour and health standards for working youngsters. In the decades following World War 2, child labor dramatically declined in the United States. But new waves of immigration in the 1980s, along with increased participation of high school students in the service sector, have contributed to a resurgence in juvenile employment and focused renewed attention on the health risks faced by minors in the workplace.

Adolescent↗

The SIMPOC Philippine Survey of Children 2001: a data source for analyzing occupational injuries to children.

Child labor is a global issue that exists in both industrialized and developing countries. With the unanimous adoption of International Labour Organization (ILO) Convention No. 182 in 1999 calling for the immediate elimination of the worst forms of child labor, ratifying member countries have committed themselves to identifying hazardous work for children in the context of their respective legislative frameworks. Part of tackling the problem of child labor is knowing what types of occupational activities children are engaged in, what types of work environments they are under, and what risks of injuries and illnesses they are exposed to while working. Using the Philippines as a country example, this study introduces a promising data source on children's work and presents a methodology for examining hazardous work to children through the examination of injury rates. Data for this study rely primarily on a nationally representative dataset from the Survey of Children 2001 carried out by the Philippine National Statistics Office, covering the months of October 2001 to September 2002.

Accidents, Occupational↗

Work-related deaths in children.

An analysis of OSHA fatality investigations for 1984-1987 found 104 work-related deaths in children. The largest category (30%) involved industrial vehicles and equipment, followed by electrocution (17%) and falls (11%). Forty-three deaths (41%) occurred while engaged in types of work prohibited for children by the Fair Labor Standards Act (FLSA). Three deaths involved work with conveyors, an activity currently permitted for child workers under FLSA. OSHA issued citations for safety violations in 70% of deaths. Since OSHA investigates only some work-related deaths, the actual number of child labor fatalities during the four year period was probably higher. Using information from OSHA and from death certificate data, we estimate that there are at least 100 work-related deaths in the United States in children under 18 each year. Hazardous child labor continues to occur even in industries regulated by OSHA and FLSA.

Accidents, Occupational↗

Occupational injury deaths of 16 and 17 year olds in the US: trends and comparisons with older workers.

OBJECTIVE: To examine patterns of occupational injury deaths of 16 and 17 year olds in the United States for the three year period 1990-2, examine trends since the 1980s, and compare fatality rates with those of older workers. METHODS: Occupational injury deaths were analyzed using the death certificate based National Traumatic Occupational Fatalities (NTOF) surveillance system. Fatality rates were calculated using estimates of full time equivalent (FTE) workers based on data from the Current Population Survey, a monthly household survey. RESULTS: There were 111 deaths of 16 and 17 year olds for the years 1990-2. The average yearly rate was 3.5 deaths/100,000 FTE. The leading causes of death were motor vehicle related, homicide, and machinery related. All causes occupational injury fatality rates for 16 and 17 year olds were lower than for adults for 1990-2. Rates for the leading causes of death (motor vehicle related, homicide, and machinery related) were comparable or slightly higher than the rates for young and middle aged adult workers. Although rates decreased dramatically from 1980 to 1983, the decreasing trend attenuated in later years. CONCLUSIONS: Comparisons of youth fatality rates to those of adult workers should address differences in patterns of employment, most importantly hours of work. Comparisons to narrow age groupings of adults is preferable to a single category of all workers 18 years and older. Increasing compliance with federal child labor regulations could help reduce work related deaths of youth. Other measures are needed, however, as there are many work hazards, including those associated with homicides, that are not addressed by United States federal child labor law regulations.

Accidents, Occupational↗

Environmental and occupational medicine and injury prevention: education and impact, classroom and community.

The core value guiding the work of physicians and health workers, including those in Environmental and Occupational Epidemiology and Medicine and Injury Prevention, is to protect the health of the public, especially its most vulnerable individuals. In these fields, we emphasize teaching the use of epidemiology, the core discipline of public health, as a tool for early detection and prevention of disease and injury, as well as an instrument for hypothesis testing. The classic core topics are toxic and physical exposures and their effects, and strategies for their prevention; emerging issues are child labor, mass violence, and democide. In environmental health, students need to be prepared for the reality that the most important and severe problems are often the most difficult to investigate, solve, and evaluate. The following are some recommendations for producing graduates who are effective in protecting communities from environmental hazards and risks: (1) Teach the precautionary principle and its application; (2) Evaluate programs for teaching environmental and occupational health, medicine and epidemiology in schools of public health by their impact on the WHO health indicators and their impact on measures of ecosystem sustainability; (3) Develop problem-oriented projects and give academic credit for projects with definable public health impact and redefine the role of the health officer as the chief resident for Schools of Public Health and Community Medicine; (4) Teach the abuses of child labor and working conditions of women in the workplace and how to prevent the hazards and risks from the more common types of child work; (5) Upgrade teaching of injury prevention and prevention of deaths from external causes; (6) Teach students to recognize the insensitivity of epidemiology as a tool for early detection of true risk; (7) Teach the importance of context in the use of tests of statistical significance; (8) Teach the epidemiologic importance of short latency periods from high exposures as sentinel events for later group risk for cancer and stating the case for action; (9) Protect students and colleagues who are whistleblowers in environmental health from harassment and punishment; (10) Develop curricula and workshops that promote the use of epidemiologic tools for preventing genocide, democide, and their precursors. Schools of Public Health and Community Medicine are at the interface between the resources of academic power and the major problems of community health. Implementing the above recommendations will strengthen academic investigation and impact.

Curriculum↗