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PubMed2006

Social hazards on the job: workplace abuse, sexual harassment, and racial discrimination--a study of Black, Latino, and White low-income women and men workers in the United States.

This study documents the prevalence of workplace abuse, sexual harassment at work, and lifetime experiences of racial discrimination among the United for Health cohort of 1,202 predominantly black, Latino, and white women and men low-income union workers in the Greater Boston area. Overall, 85 percent of the cohort reported exposure to at least one of these three social hazards; exposure to all three reached 20 to 30 percent among black women and women and men in racial/ethnic groups other than white, black, or Latino. Workplace abuse in the past year, reported by slightly more than half the workers, was most frequently reported by the white men (69%). Sexual harassment at work in the past year was reported by 26 percent of the women and 22 percent of the men, with values of 20 percent or more in all racial/ ethnic-gender groups other than Latinas and white men. High exposure to racial discrimination was reported by 37 percent of the workers of color, compared with 10 percent of the white workers, with black workers reporting the greatest exposure (44%). Together, these findings imply that the lived--and combined-experiences of class, race, and gender inequities and their attendant assaults on human dignity are highly germane to analyses of workers' health.

Adult↗
PubMed1991

Occupational health and safety regulation in the coal mining industry: public health at the workplace.

The strategy for preventing occupational disease and injury in the coal mining industry employs several elements. Standards are set and enforced; technical assistance, research, and development are provided; and surveillance is conducted. Compensation for black lung is a vivid reminder of the consequences of failure to prevent disease. And, workers are represented by a union that encourages active participation in all aspects of this strategy. There are significant problems in each of these elements. Regulatory reform threatens to weaken many standards, there is a decline in government research budgets, surveillance is not well monitored, and compensation for black lung is significantly more difficult to obtain now than in the past. Moreover, the conservative governments of the past decade are not friendly towards unions. Nevertheless, the fundamental structure of disease and injury prevention remains intact and, more importantly, it has a historical record of success. The Mine Safety and Health Act provided for a wide array of basic public health measures to prevent occupational disease and injury in the mining industry. These measures have been effective in reducing both risk of fatal injury and exposure to respirable coal mine dust. They are also associated with temporary declines in productivity. In recent years, however, productivity has increased, while risk of fatal injury and exposure to respirable dust have declined. At individual mines, productivity with longwall mining methods appear to be associated with increases in exposure to respirable dust. These trends are not inconsistent with similar trends following implementation of regulations by OSHA. When OSHA promulgated regulations to control exposure to vinyl chloride monomer, enforcement of the standard promoted significant efficiencies in vinyl chloride production (5). Similarly, when OSHA promulgated its standard regulating exposure to cotton dust, this effort provoked modernization in the cotton textile industry (14). It is not inevitable that occupational health and safety regulations are associated with negative economic performance. On the contrary, in some instances, public health on the job and productivity are complementary.

Accidents, Occupational↗
PubMed1997

Proportionate mortality among unionized construction operating engineers.

This report presents the results of proportionate mortality ratios (PMR) and proportionate cancer mortality ratios (PCMR) among 15,843 members of the International Union of Operating Engineers who had died between 1988-1993. Operating engineers represent one of the 15 unions in the Building and Construction Trades Department and are responsible for the operation and maintenance of heavy earthmoving equipment used in the construction of buildings, bridges, roads, and other facilities. Using U.S. proportionate cancer mortality as the referent, statistically significant elevated mortality was observed for cancers of the lung (PCMR = 1.14, 95% confidence interval (CI) = 1.09-1.19) and bone (PCMR = 2.14, CI = 1.19-3.52). Using U.S. proportionate mortality as the referent, statistically significant elevated mortality was observed for other benign and unspecified neoplasms (PMR = 1.54, CI = 1.09-2.13), emphysema (PMR = 1.37, CI = 1.20-1.55), other injuries (PMR = 1.43, CI = 1.20-1.70) (which included crushing under/in machinery, tractor rollover, run over by crane), and suicide (PMR = 1.22, CI = 1.06-1.40). The PMR for leukemia, and aleukemia (PMR = 1.19, CI = 1.02-1.37), but not the PCMR (1.07, CI = 0.92-1.24), was also significantly elevated. Some of the occupational exposures that may have contributed to these excesses include diesel exhaust, asphalt and welding fumes, silica dust, ionizing radiation, and coal tar pitch. The present study underscores the need to control airborne exposures to these substances and for injury prevention efforts aimed at operating engineers in the construction industry.

Accidents, Occupational↗
PubMed2005

Prevalence of musculoskeletal disorders in union ironworkers.

The prevalence of musculoskeletal disorder (MSD) symptoms and doctor-diagnosed musculoskeletal disorders (DDMDs) were estimated among union construction ironworkers by a telephone-administered questionnaire. Of 1996 ironworkers eligible, 1566 were contacted and 981 were interviewed. The prevalence of self-reported MSD symptoms was high for the lower back (56%), wrist/hands/fingers (40%), knees (39%), and shoulders (36%). The most common DDMDs were tendonitis (19%), ruptured disk in the back (18%), bursitis in the shoulder (15%), and carpal tunnel syndrome (12%). Generally, the prevalence of DDMDs and MSD symptoms increased with duration of employment. In age-adjusted logistic regression analyses, those who worked 25 to 35 years were more likely to have tendonitis (odds ratio [OR] 7.1, 95% confidence interval [CI] 3.116.6), shoulder bursitis (OR 13.7, 95% CI 3.160.4), knee bursitis (OR 5.1, 95% CI 1.025.1), and ruptured intervertebral back disk (OR 6.7, 95% CI 2.617.5). The effect of prior injury was also consistently high (upper extremities, OR 4.6; lower extremities OR 5.1; lower back, OR 6.0). Among workers without prior injuries, MSD symptoms were more frequent for the lower back in structural ironwork (OR 1.7, 95% CI 1.12.6), and for the upper extremity in concrete reinforcement ironwork (OR 1.9, 95% CI 1.22.9). These findings suggest that some musculoskeletal morbidity in construction ironworkers may be work related and thus preventable.

Adult↗
PubMed1994

Lung cancer among newspaper printers exposed to ink mist: a study of trade union members in Manchester, England.

A nested case-control study of lung cancer among men exposed to ink mist in newspaper production with rotary letterpress technology is presented. It is based within a historical cohort of 9232 printing workers in Manchester (1949-63). Men who operated newspaper rotary letterpress machines had a lung cancer standardised mortality ratio (SMR) of 179 (95% confidence interval (95% CI) 144-218) when compared with rates for England and Wales for the follow up period 1950-83. When adjustment was made for the higher rates in the local area, the SMR was reduced to 122 (95% CI 98-148). The nested case control study was based on 110 lung cancer cases (1949-86) and 316 matched controls. Duration of work in a rotary letterpress machine room was positively associated with risk of lung cancer (chi 2 linear trend = 3.30, p = 0.07); mean with 30 or more years duration of exposure had a risk of 1.73 (95% CI 0.94-3.17), relative to those with less than 20 years of exposure. Adjustment for period of first exposure in a machine room reduced the strength of the positive duration effect. The magnitude of the SMRs found in the cohort study could be explained by confounding with smoking. The duration effect seen in the case-control study, however, suggests that there may be a real effect of exposure to letterpress ink mists. This is biologically plausible, as benzo[a]pyrene, a known human carcinogen, has been found in appreciable concentrations in the atmosphere of rotary letterpress machine rooms.

Adult↗
PubMedDate not supplied

Functional impairment and quality of life in retired workers of the construction trades.

This cross-sectional study compared the quality of life and physical health of retirees from the construction industry to that of retirees from more sedentary occupations. The feasibility of cooperation from the unions and their retirees for a larger health study was also examined. The mailed health survey assessed current physical functioning, role limitations as a result of poor health, pain, and past and current problems with falls and injuries. The survey was completed by 77 construction and 174 nonconstruction retirees. Results were striking with 42.1% of the construction retirees, compared to 12.9% of the male and 14.3% of female nonconstruction retirees reporting significantly poorer health. A multiple regression analysis comparing male construction to male nonconstruction retirees showed male construction retirees were almost five times more likely to report their health as being fair or poor. Further, significantly more male construction, versus male nonconstruction retirees, reported that their physical health reduced the time they were able to spend on daily activities. Almost one in five (19.4%) construction retirees described themselves as having severe to very severe pain versus 3.1% of the male nonconstruction retirees. Construction retirees reported significantly greater problems with their vision, neck and shoulders, hands and wrists, hips, knees, and ankle/feet joints. These findings suggest that with our rapidly aging population, there will be enormous physical, emotional, and financial costs related to construction work and that prevention and intervention measures are needed for current employees in this profession.

Activities of Daily Living↗
PubMed2005

Asbestosis in an asbestos composite mill at Mumbai: a prevalence study.

BACKGROUND: Of an estimated 100,000 workers exposed to asbestos in India, less than 30 have been compensated. The reasons for such a small number are: refusal by management sponsored studies to grant medical certifications to workers suffering from occupational diseases, lack of training for doctors in diagnosis of occupational lung diseases, deliberate misdiagnosis by doctors of asbestosis as either chronic bronchitis or tuberculosis and the inherent class bias of middle class doctors against workers. The aim of the study was to identify workers suffering from Asbestosis (parenchymal and pleural non-malignant disease) among the permanent workers of the Hindustan Composites Factory and assess their disability and medically certify them, whereupon they could avail of their basic rights to obtain compensation and proper treatment. METHODS: The study was conducted by the Occupational Health and Safety Centre and the Workers' Union. Asbestosis was diagnosed if they had an occupational history of asbestos exposure for at least 15 years and showed typical radiographic findings. RESULTS: Of 232 workers in the factory, 181 participated in the survey. 22% of them had asbestosis. All the asbestos affected workers had at least 20 years of exposure. 7% had rhonchi, 34% had late basal inspiratory rates, 82% had more than 80% of Forced Expiratory Volume in the first second (FEV1)/Forced Vital capacity (FVC) ratio and 66% had FVC less than 80% of the predicted value. On radiology 7% had only pleural disease, 10% had both pleural and parenchymal disease and 82% had only parenchymal disease. The association of pleural disease with chest pain was statistically significant. CONCLUSION: We found the prevalence of asbestosis among exposed workers to be less than that anticipated for the number of years of exposure due to "Healthy Worker Effect". We suggest that all affected asbestos workers (including those who have been forced to leave) in India be medically certified and compensated. We also recommend better control of asbestos use in India. We also implore the management to provide all information about the work process and its hazards, conduct medical checkups as mandated by law and give the medical records to the workers.

Adult↗
PubMed1996

Nested case-control study of hand and wrist work-related musculoskeletal disorders in carpenters.

Unionized carpenters (n = 522) participated in a telephone interview regarding their jobs and musculoskeletal symptoms. From this group, a nested case-control study was conducted on 25 symptomatic carpenters who met a hand or wrist work-related musculoskeletal disorder (WMD) case definition and on 35 asymptomatic carpenters who were of similar age, sex, height, and weight. The purpose of the study was to determine if questionnaire symptom data could be used to estimate the prevalence of hand/wrist WMDs. To test this hypothesis, a subset of subjects underwent physical examination and electrodiagnostic testing to determine if these symptom-derived cases had findings of carpal tunnel syndrome or other hand or wrist musculoskeletal disorders. Standardized upper extremity physical examinations and unilateral ulnar and median nerve conduction studies were administered. Physical examination findings of CTS were significantly increased among WMD cases. Mean median sensory and motor distal latencies were significantly longer (P < 0.05) and median sensory amplitudes smaller in cases compared to controls. Median relative to ulnar sensory and motor latencies also were longer in cases. A median mononeuropathy at the wrist was found in 78% of the cases. These findings suggest that symptom-derived WMD data are useful in estimating estimating the prevalence of CTS among carpenters.

Adult↗
PubMedDate not supplied

1993 survey of salaries & responsibilities for hospital biomedical/clinical engineering & technology personnel.

The Journal of Clinical Engineering has conducted its eighth annual survey of the salaries paid to biomedical/clinical engineering and technology personnel in U.S. hospitals. This paper reports the salary and work responsibility data obtained from 1,497 professionals in relationship to: Certification; Region of the U.S.; Teaching versus Nonteaching Facilities; Years of Experience; Education; Union Membership; and Gender. Data are included on Wage Increases and Job Responsibilities. Data are as of 12/31/92 and are compared to 12/31/91. Last year, new job categories were introduced for the overall department or group Director or Manager and the BMET Specialist. The average BMET I has 3.1 years of experience and earns $24,418 +/- $4,615 (Std. Dev.). The average BMET II has 6.8 years of experience and earns $29,853 +/- $5,782. The average BMET III has 13.3 years of experience and earns $37,205 +/- $6,269. The average BMET Specialist has 13.9 years of experience and earns $42,808 +/- $9,420. The average BMET Supervisor has 13.4 years of experience and earns $39,206 +/- $7,709. The average Clinical Engineer has 9.1 years of experience and earns $40,121 +/- $8,242. CE Supervisors have an average 12.1 years of experience and an average salary of $47,353 +/- $15,501. The overall group or department Director or Manager has 15.7 years of experience and earns $51,237 +/- $16,381 on average. Wages are the highest on the East and West Coasts. Again this year, the lowest wages were in the Southeast. BMET wages advanced up to 4.6%, year to year. The highest quartile of Director/Managers now earns between $56,000 and $212,000 per year. Certified individuals variously earn up to $7,995 more than noncertified.

Age Factors↗
PubMed2005

Coming up for air: experts, employers, and workers in campaigns to compensate silicosis sufferers in Britain, 1918-1939.

Government regulation of dangerous trades and the compensation of those injured by their work remains a matter of considerable debate among medical historians. Trade unions have frequently been criticized for pursuing financial awards for their members rather than demanding improvements in health and safety at the workplace. This article examines the neglected subject of silicosis injuries in Britain from the time when the first legislation was passed for compensation of those suffering from the harmful affects of silica dust in 1918 to the outbreak of war in 1939, when a major new study was under way which would transform the scientific understanding and the legal compensation of those who were diagnosed as being ill with pneumoconiosis. It is argued that in framing legislation from compensation, politicians and their civil servants sought to retain the legal framework created in 1897-1906 and developed a model of industrial insurance which depended to a large extent on a co-operative relationship with leading employers. Medical scientists identified silica as a uniquely hazardous agent in workers' lung disease, which emphasizing the specialist knowledge required for its diagnosis. One remarkable feature of the selective compensation schemes devised after 1918 was the reliance on geological rather than pathological evidence to prove compensation rights as well as strict employment limits on those eligible to claim. only the campaigning of labour organizations and persistent evidence of lung disease among anthracite coal miners led to a significant relaxation of compensation rules in 1934 and the fresh scientific investigation which transformed the medical understanding of respiratory illness among industrial workers.

Coal Mining↗
PubMed1982

Housestaff activism: the emergence of patient-care demands.

There have been two trends within the physician housestaff movement: increased acceptance of collective bargaining and unions, and a shift from narrower economic to broader political demands, including some involving patient care. Case studies of politically active housestaff associations in New York, Chicago, and Los Angeles are used to examine the emergence of "patient-care" demands and their compatibility with collective bargaining frameworks. As house-staff have become principal providers of care to indigent populations in public hospitals, and economic cutbacks have endangered service as well as the positions of physicians, patient-care demands arise and become infused with demands for participation and control in decision-making. Common factors in the politicization of housestaff have been the contribution of activists of the sixties as leaders, and the impact of fiscal crisis and economic retrenchment in the seventies. However, the emergence and resolution of these issues has differed depending upon legal, political, historical, and organizational variations. In general, patient-care issues are supported by housestaff when they dovetail with housestaff interests. However, physician interests can diverge from those of patients, as in the case of manpower redistribution. On the whole, wages and benefits have done better than educational or patient-care demands. Educational demands have met with counterattack, and patient care, limited by the traditional scope of collective bargaining, has had to evolve indirectly, and has been hurt by long-term economic trends. Finally, national housestaff organization is limited by the wide-ranging politics and ideas of diverse regional organizations which represent different types of training institutions and career orientations.

California↗
PubMedDate not supplied

1992 survey of salaries & responsibilities for hospital biomedical/clinical engineering & technology personnel.

The Journal of Clinical Engineering has conducted its seventh annual survey of the salaries paid to biomedical/clinical engineering and technology personnel in U.S. hospitals. This paper reports the salary and work responsibility data obtained from 1,482 professionals in relationship to: Certification; Region of the U.S.; Teaching versus Nonteaching Facilities; Years of Experience; Education; Union Membership; and Gender. Data are included on Wage Increases and Job Responsibilities. Data are as of 12/31/91 and are compared to 12/31/90. This year, new job categories were introduced for the overall department or group Director or Manager and the BMET Specialist. The average BMET I has 2.4 years of experience and earns $23,647 +/- $4,442 (Std. Dev.). The average BMET II has 6.6 years of experience and earns $30,128 +/- $5,696. The average BMET III has 12.9 years of experience and earns $35,855 +/- $5,942. The average BMET Specialist has 13.5 years of experience and earns $40,910 +/- $8,938. The average BMET Supervisor has 13.3 years of experience and earns $37,905 +/- $6,786. The average Clinical Engineer has 7.4 years of experience and earns $40,413 +/- $7,899. CE Supervisors have an average 12.2 years of experience and an average salary of $46,927 +/- $9,935. The overall group or department Director or Manager has 15 years of experience and earns $49,096 +/- $17,333 on average. Wages are the highest on the West Coast. This year, the lowest wages were in the Southeast. Because of survey changes in supervisor survey categories, year-to-year changes for supervisor wages cannot be evaluated. BMET wages, however, advanced 6% to 9%, year to year. The highest quartile of Director/Managers now earns between $53,000 and $245,000 per year. Certified individuals generally earn up to $3,257 more than noncertified, except for BMET Specialists where the certified respondents earned less than the noncertified.

Biomedical Engineering↗
PubMed1994

Extended mortality follow-up among men and women in a U.S. furniture workers union.

The addition of 5 years of follow-up and over 411,000 person-years of observation to a cohort of 34,081 men and women employed in U.S. furniture and other related industries allowed the investigation of mortality patterns among women and minority races in addition to white men. A significant excess of pleural mesotheliomas occurred among white men (standardized mortality ratio [SMR] = 3.7, 95% confidence interval [CI] = 1.2-8.7) but could not be linked to a particular type of furniture manufacturing. SMRs for myeloid leukemia and chronic nephritis were elevated among white men employed in the wood furniture industry but were not statistically significant. Males in the black/other race categories in wood furniture plants showed nonsignificant mortality excesses for infectious diseases and cancers of the prostate and colon and rectum. Among white women employed in wood furniture plants, mortality was elevated for cancers of the pancreas and lung during the most recent follow-up period. In metal furniture plants, mortality was raised among men in both race groups for kidney cancer (black/other SMR = 8.0, 95% CI = 1.6-23.2; white SMR = 2.1, 95% CI = 0.4-6.2) and diabetes mellitus (black/other SMR = 2.2, 95% CI = 0.6-5.6; white SMR = 1.8, 95% CI = 0.7-3.9). Stomach cancer mortality was significantly elevated (SMR = 3.3, 95% CI = 1.3-6.8) among white men in metal furniture plants and was of the same magnitude over both the previous and the most recent follow-up periods. Among those working with textiles, SMRs were significantly elevated for leukemia (SMR = 6.1, 95% CI = 1.2-7.8) and cancers of the colon and rectum (SMR = 3.2, 95% CI = 1.3-4.5) for white women. Lung cancer mortality was increased for white men and women in textile operations, but SMRs were not statistically significant. SMRs for a number of other causes of death that were elevated at the end of the earlier follow-up period were not increased during the new follow-up period.

Air Pollutants, Occupational↗
PubMed2002

Continuing exposure to hexavalent chromium, a known lung carcinogen: an analysis of OSHA compliance inspections, 1990-2000.

BACKGROUND: Hexavalent chromium is widely recognized to be a lung carcinogen. However, the U.S. Occupational Safety and Health Administration (OSHA) has failed to reduce the permissible exposure limit (PEL), despite having acknowledged in 1994 that the current limit is too high. In 1993, Public Citizen and the Paper, Allied-Industrial, Chemical and Energy Workers International Union (PACE) petitioned to lower the PEL from the current 100 microg/m(3) to 0.5 microg/m(3) as an 8-hr time-weighted average (TWA). METHODS: To assess industry compliance with the current PEL, and to determine the feasibility of achieving the proposed lower limit of 0.5 microg/m(3), we conducted a secondary data analysis of OSHA's Integrated Management Information System (IMIS) database. This database contains 813 measurements of hexavalent chromium exposure from inspections performed during the years 1990-2000. RESULTS: There was a statistically significant decline in the annual number of measurements over the study period from 127 in 1990 to 67 in 2000 (F = 0.0009; linear regression). The median TWA measurement was 10 microg/m(3) (range: 0.01-13,960 microg/m(3)) and the median ceiling measurement was 40.5 microg/m(3) (range: 0.25-25,000 microg/m(3)). Neither median TWA nor median ceiling exposures (if hexavalent chromium was detected) declined significantly during the study period (F = 0.065 and 0.57, respectively). Overall, 13.7% of TWA measurements were at or below the Public Citizen/PACE proposed standard; 65.0% were between the Public Citizen/PACE proposal and the current OSHA PEL; and 21.3% exceeded the OSHA PEL. Compared to OSHA measurements, state measurements were less likely to detect hexavalent chromium (40.2% vs. 52.1%; P = 0.0007; chi-square) and less likely to issue any citation (9.3% vs. 19.1%; P = 0.0003), including citations for overexposure if the exposure exceeded the PEL (54.8% vs. 78.8%; P = 0.012). CONCLUSIONS: U.S. workers continue to be exposed to dangerously high hexavalent chromium levels, but low exposure levels were found in some industries. Further investigations should examine whether state plans provide weaker enforcement than federal OSHA.

Carcinogens, Environmental↗
PubMed1996

Mortality of Carpenters' Union members employed in the U.S. construction or wood products industries, 1987-1990.

This study evaluated the mortality of 27,362 members of the U.S. Carpenters' Union who died in 1987-1990. Age-adjusted proportionate mortality ratios (PMRs) and proportionate cancer mortality ratios (PCMRs) were computed using the U.S. age-, gender-, and race-specific proportional mortality for the years of the study. For white male carpenters who were last employed while in construction industry locals, raised mortality was observed for lung cancer (PCMR = 107, CI = 103, 111), bone cancer (PMR = 181, CI = 107, 286), asbestosis (PMR = 283, CI = 158, 457), emphysema (PMR = 115, CI = 102, 130), transportation injuries (PMR = 121, CI = 109, 135), and falls (PMR = 122, CI = 104, 142). For white male carpenters who were last employed while in industrial wood products locals, significantly raised mortality occurred for stomach cancer (PMR = 187, CI = 136, 250), male breast cancer (PCMR = 469, CI = 128, 720), and transportation injuries (PMR = 136, CI = 110, 173). Excess breast cancer was associated with last employment inn wood machining trades. Nasal cancer mortality was not elevated. A total of 121 mesotheliomas were observed. Contributing cause of death analyses revealed raised mortality for these and additional causes; 4,594 (18%) death certificates mentioned occupational and other lung disease as a contributing factor, resulting in significantly elevated mortality. These data show that construction carpenters have moderately elevated mortality for the diseases caused by asbestos (lung cancer and malignant mesothelioma) and from traumatic injuries. The finding of elevated mortality for stomach, bone, and breast cancer was unexpected and requires further evaluation of possible occupational factors. This study confirms that construction carpentry is an extremely hazardous trade. The data suggest that additional preventive action guarding against asbestos exposure and occupational injury is urgently needed in this occupation.

Accidental Falls↗
PubMed2000

Proportionate mortality among unionized roofers and waterproofers.

BACKGROUND: The United Union of Roofers, Waterproofers, and Allied Workers (UURWAW) is one of the 15 building and construction trades departments in the AFL-CIO. The U.S. roofing industry, including both roofing and waterproofing applications, both unionized and nonunionized, comprises about 25,000 firms, employing approximately 300,000 people, about 200,000 of whom are involved in the application of roofs. The specific toxins to which roofers may be exposed at the job site include, among others, bitumens (asphalt and/or coal tar pitch) as well as asbestos and fiberglass from roof removal operations. Excess deaths from occupational injuries are also of concern. METHODS: This study evaluated causes of mortality among 11,144 members of the UURWAW. Age-adjusted proportionate mortality ratios (PMRs) were computed with 95% confidence intervals (CI) using U.S. age-, gender-, and race-specific proportional mortality rates for the years of the study, 1950-1996. RESULTS: Statistically significant increased PMRs were found for all injuries (PMR = 142, CI = 134-150), especially falls (PMR = 464, CI = 419-513) and other injuries (PMR = 121, CI = 107-137), cancers of the lung (PMR = 139, CI = 131-148), bladder (PMR = 138, CI = 111-170), esophagus (PMR = 134, CI = 107-166), larynx (PMR = 145, CI = 106-193), and cancers of other and unspecified sites (PMR = 130, CI = 112-149), pneumoconioses and other nonmalignant respiratory diseases (PMR = 115, CI = 103-128), and homicides (PMR = 153, CI = 135-172). The occupational exposures which may have contributed to the excess risks of malignant and nonmalignant respiratory diseases include, among others, asphalt fumes, coal tar pitch volatiles and asbestos; however, cigarette smoking must also be considered a contributing factor. CONCLUSIONS: The present study underscores the need to control airborne exposures to hazardous substances and especially to examine fall prevention efforts within the roofing industry. Am. J. Ind. Med. 37:478-492, 2000. Published 2000 Wiley-Liss, Inc.

Accidental Falls↗
PubMed2002

Smoking cessation in a blue-collar population: results from an evidence-based pilot program.

BACKGROUND: Taft Hartley Funds provide group health care coverage for 10 million union workers as well as their dependents in industries such as construction and transportation. The adult smoking rate in these populations is estimated at approximately 40%, therefore, these funds include 9 million adult smokers. The absence of evidence demonstrating the effectiveness of smoking cessation programs has kept Taft Hartley Funds from investing in smoking cessation benefits. METHODS: A prototype for Taft Hartley Funds consistent with the Federal Clinical Guidelines for Smoking Cessation was designed and implemented in a pilot demonstration in the Carpenters Health and Security Trust of Western Washington. Participants chose a 1-call or more intensive 5-call smoking cessation counseling plan provided by the Group Health Cooperative's Free and Clear program. Medications were limited to the nicotine patch, nicotine gum, and Bupropion. Assessment of outcomes was performed by Free and Clear through a telephone survey 12 months following the enrollment date. RESULTS: Nine hundred thirty-five smokers participated in the program. This pilot evaluation covers 325 participants with at least 12 months since enrollment; 75% were male, the average age was 41.4 and 63% had smoked at least one pack per day for more than 20 years. Sixty-one percent selected 5-Call Counseling; 39% 1-Call. Seventy-five percent also used smoking cessation medications: gum, 4%; patch, 32%; Bupropion 21.5%; patch plus Bupropion, 15.7%. The point-prevalence-quit rates were: overall, 27.5%; 1-Call, 25.5%; and 5-Call, 28.9%. The cost of the program was $1025.28 per smoker who quit, or $11.78 per full-time equivalent employee covered by the Fund per year. The compounded savings in reduced lifetime tobacco-related medical costs for the participants who quit are estimated to be 15 times the cost of the program, yielding an annual return on investment of 27.6%. CONCLUSIONS: These results strongly suggest that smoking cessation programs can be effective even in such hard-to-reach populations as itinerant building trades workers, provided that the program is designed to their needs and environment. Based on these findings, health plans need to consider whether they are at risk of violating their fiduciary duties if they fail to offer smoking cessation benefits.

Administration, Cutaneous↗