Last data update: Apr 29, 2024. (Total: 46658 publications since 2009)
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Query Trace: Sweeney MH[original query] |
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Assessing the role of social determinants of health in health disparities: The need for data on work
Silver SR , Sweeney MH , Sanderson WT , Pana-Cryan R , Steege AL , Quay B , Carreón T , Flynn MA . Am J Ind Med 2023 BACKGROUND: Work is a key social determinant of health. Without the collection of work-related information in public health data systems, the role of social determinants in creating and reinforcing health disparities cannot be fully assessed. METHODS: The Centers for Disease Control and Prevention (CDC) maintains or supports a number of public health surveillance and health monitoring systems, including surveys, case-based disease and exposure systems, vital status records, and administrative data systems. We evaluated a convenience sample of these systems for inclusion of information in three work-related domains: employment status, industry and occupation, and working conditions. RESULTS: While 12 of 39 data systems were identified as collecting work-related data, this information was often minimal (e.g., only employment status), restricted to a subset of respondents, or only gathered periodically. Information on working conditions was particularly sparse. CONCLUSION: Historically, the limited and inconsistent collection of work-related information in public health data systems has hindered understanding of the role work plays in health disparities. Current CDC data modernization efforts present opportunities to enhance the identification and mitigation of health disparities by prioritizing inclusion of an expanded set of work-related data elements. |
Excess risk of SARS-CoV-2 infection among in-person nonhealthcare workers in six states, September 2020-June 2021
Groenewold MR , Billock R , Free H , Burrer SL , Sweeney MH , Wong J , Lavender A , Argueta G , Crawford HL , Erukunuakpor K , Karlsson ND , Armenti K , Thomas H , Gaetz K , Dang G , Harduar-Morano L , Modji K , Luckhaupt SE . Am J Ind Med 2023 66 (7) 587-600 BACKGROUND: While the occupational risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection for healthcare personnel in the United States has been relatively well characterized, less information is available on the occupational risk for workers employed in other settings. Even fewer studies have attempted to compare risks across occupations and industries. Using differential proportionate distribution as an approximation, we evaluated excess risk of SARS-CoV-2 infection by occupation and industry among non-healthcare workers in six states. METHODS: We analyzed data on occupation and industry of employment from a six-state callback survey of adult non-healthcare workers with confirmed SARS-CoV-2 infection and population-based reference data on employment patterns, adjusted for the effect of telework, from the U.S. Bureau of Labor Statistics. We estimated the differential proportionate distribution of SARS-CoV-2 infection by occupation and industry using the proportionate morbidity ratio (PMR). RESULTS: Among a sample of 1111 workers with confirmed SARS-CoV-2 infection, significantly higher-than-expected proportions of workers were employed in service occupations (PMR 1.3, 99% confidence interval [CI] 1.1-1.5) and in the transportation and utilities (PMR 1.4, 99% CI 1.1-1.8) and leisure and hospitality industries (PMR 1.5, 99% CI 1.2-1.9). CONCLUSIONS: We found evidence of significant differences in the proportionate distribution of SARS-CoV-2 infection by occupation and industry among respondents in a multistate, population-based survey, highlighting the excess risk of SARS-CoV-2 infection borne by some worker populations, particularly those whose jobs require frequent or prolonged close contact with other people. |
Work: A social determinant of health worth capturing
Armenti K , Sweeney MH , Lingwall C , Yang L . Int J Environ Res Public Health 2023 20 (2) Work is a recognized social determinant of health. This became most apparent during the COVID-19 pandemic. Workers, particularly those in certain industries and occupations, were at risk due to interaction with the public and close proximity to co-workers. The purpose of this study was to assess how states collected work and employment data on COVID-19 cases, characterizing the need for systematic collection of case-based specific work and employment data, including industry and occupation, of COVID-19 cases. A survey was distributed among state occupational health contacts and epidemiologists in all 50 states to assess current practices in state public health surveillance systems. Twenty-seven states collected some kind of work and employment information from COVID-19 cases. Most states (93%) collected industry and/or occupation information. More than half used text-only fields, a predefined reference or dropdown list, or both. Use of work and employment data included identifying high risk populations, prioritizing vaccination efforts, and assisting with reopening plans. Reported barriers to collecting industry and occupation data were lack of staffing, technology issues, and funding. Scientific understanding of work-related COVID-19 risk requires the systematic, case-based collection of specific work and employment data, including industry and occupation. While this alone does not necessarily indicate a clear workplace exposure, collection of these data elements can help to determine and further prevent workplace outbreaks, thereby ensuring the viability of the nation's critical infrastructure. |
COVID-19 Outbreaks Linked to Workplaces, 23 US Jurisdictions, August-October 2021.
Luckhaupt SE , Horter L , Groenewold MR , dePerio MA , Robbins CL , Sweeney MH , Thomas I , Valencia D , Ingram A , Heinzerling A , Nguyen A , Townsend EB , Weber RC , Reichbind D , Dishman H , Kerins JL , Lendacki FR , Austin C , Dixon L , Spillman B , Simonson S , Tonzel J , Krueger A , Duwell M , Bachaus B , Rust B , Barrett C , Morrison B , OwersBonner KA , Karlsson ND , Angelon-Gaetz K , McClure ES , Kline KE , Dangar D , Reed C , Karpowicz J , Anderson SM , Cantor S , Chaudhary I , Ellis EM , Taylor ML , Sedon A , Kocharian A , Morris C , Samson ME , Mangla AT . Public Health Rep 2022 138 (2) 333549221138294 OBJECTIVES: Early in the COVID-19 pandemic, several outbreaks were linked with facilities employing essential workers, such as long-term care facilities and meat and poultry processing facilities. However, timely national data on which workplace settings were experiencing COVID-19 outbreaks were unavailable through routine surveillance systems. We estimated the number of US workplace outbreaks of COVID-19 and identified the types of workplace settings in which they occurred during August-October 2021. METHODS: The Centers for Disease Control and Prevention collected data from health departments on workplace COVID-19 outbreaks from August through October 2021: the number of workplace outbreaks, by workplace setting, and the total number of cases among workers linked to these outbreaks. Health departments also reported the number of workplaces they assisted for outbreak response, COVID-19 testing, vaccine distribution, or consultation on mitigation strategies. RESULTS: Twenty-three health departments reported a total of 12 660 workplace COVID-19 outbreaks. Among the 12 470 workplace types that were documented, 35.9% (n = 4474) of outbreaks occurred in health care settings, 33.4% (n = 4170) in educational settings, and 30.7% (n = 3826) in other work settings, including non-food manufacturing, correctional facilities, social services, retail trade, and food and beverage stores. Eleven health departments that reported 3859 workplace outbreaks provided information about workplace assistance: 3090 (80.1%) instances of assistance involved consultation on COVID-19 mitigation strategies, 1912 (49.5%) involved outbreak response, 436 (11.3%) involved COVID-19 testing, and 185 (4.8%) involved COVID-19 vaccine distribution. CONCLUSIONS: These findings underscore the continued impact of COVID-19 among workers, the potential for work-related transmission, and the need to apply layered prevention strategies recommended by public health officials. |
Characteristics Associated With a Previous COVID-19 Diagnosis, Vaccine Uptake, and Intention to Be Vaccinated Among Essential Workers in the US Household Pulse Survey.
Steege AL , Luckhaupt SE , Guerin RJ , Okun AH , Hung MC , Syamlal G , Lu PJ , Santibanez TA , Groenewold MR , Billock R , Singleton JA , Sweeney MH . Am J Public Health 2022 112 (11) 1599-1610 Objectives. To explore previous COVID-19 diagnosis and COVID-19 vaccination status among US essential worker groups. Methods. We analyzed the US Census Household Pulse Survey (May 26-July 5, 2021), a nationally representative sample of adults aged 18 years and older. We compared currently employed essential workers working outside the home with those working at home using adjusted prevalence ratios. We calculated proportion vaccinated and intention to be vaccinated, stratifying by essential worker and demographic groups for those who worked or volunteered outside the home since January 1, 2021. Results. The proportion of workers with previous COVID-19 diagnosis was highest among first responders (24.9%) working outside the home compared with workers who did not (13.3%). Workers in agriculture, forestry, fishing, and hunting had the lowest vaccination rates (67.5%) compared with all workers (77.8%). Those without health insurance were much less likely to be vaccinated across all worker groups. Conclusions. This study underscores the importance of improving surveillance to monitor COVID-19 and other infectious diseases among workers and identify and implement tailored risk mitigation strategies, including vaccination campaigns, for workplaces. (Am J Public Health. 2022;112(11):1599-1610. https://doi.org/10.2105/AJPH.2022.307010). |
Reported exposures among in-person workers with SARS-CoV-2 infection in 6 states, September 2020-June 2021.
Free H , Luckhaupt SE , Billock RM , Groenewold MR , Burrer S , Sweeney MH , Wong J , Gibb K , Rodriguez A , Vergara X , Cummings K , Lavender A , Argueta G , Crawford HL , Erukunuapor K , Karlsson ND , Armenti K , Thomas H , Gaetz K , Dang G , Harduar-Morano L , Modji K . Clin Infect Dis 2022 75 S216-S224 BACKGROUND: Surveillance systems lack detailed occupational exposure information from workers with SARS-CoV-2 infection. The National Institute for Occupational Safety and Health partnered with six states to collect information from adults diagnosed with SARS-CoV-2 infection (either COVID-19 or asymptomatic infection) who worked in person (outside the home) in non-healthcare settings during the two weeks prior to illness onset. METHODS: The survey captured demographic, medical, occupational characteristics, and work- and non-work-related risk factors for SARS-CoV-2 infection. Reported close contact with a person known or suspected to have COVID-19 was categorized by setting as: exposure at work, exposure outside of work only, or no known exposure/didn't know if they had exposures. Frequencies and percentages of exposure types are compared by respondent characteristics and risk factors for SARS-CoV-2 infection. RESULTS: Of 1,111 qualified respondents, 19.4% reported exposure at work, 23.4% reported exposure outside of work only, and 57.2% reported no known exposure/didn't know if they had exposures. Workers in protective service occupations (48.8%) and public administration industries (35.6%) reported exposure at work most often. Over a third (33.7%) of respondents who experienced close contact with ≥10 coworkers per day and 28.8% of respondents who experienced close contact with ≥10 customers/clients per day reported exposures at work. CONCLUSIONS: Exposure to SARS-CoV-2 at work was common among respondents. Examining differences in exposures among different groups of workers can help identify populations with the greatest need for prevention interventions. The benefits of recording employment characteristics as standard demographic information will remain relevant as new and reemerging public health issues occur. |
Reported exposure trends among healthcare personnel COVID-19 cases, USA, March 2020-March 2021.
Billock RM , Groenewold MR , Sweeney MH , de Perio MA , Gaughan DM , Luckhaupt SE . Am J Infect Control 2022 50 (5) 548-554 BACKGROUND: Health care personnel (HCP) have experienced significant SARS-CoV-2 risk, but exposure settings among HCP COVID-19 cases are poorly characterized. METHODS: We assessed exposure settings among HCP COVID-19 cases in the United States from March 2020 to March 2021 with reported exposures (n = 83,775) using national COVID-19 surveillance data. Exposure setting and reported community incidence temporal trends were described using breakpoint estimation. Among cases identified before initiation of COVID-19 vaccination programs (n = 65,650), we used separate multivariable regression models to estimate adjusted prevalence ratios (aPR) for associations of community incidence with health care and household and/or community exposures. RESULTS: Health care exposures were the most reported (52.0%), followed by household (30.8%) and community exposures (25.6%). Health care exposures and community COVID-19 incidence showed similar temporal trends. In adjusted analyses, HCP cases were more likely to report health care exposures (aPR = 1.31; 95% CI:1.26-1.36) and less likely to report household and/or community exposures (aPR = 0.73; 95% CI:0.70-0.76) under the highest vs lowest community incidence levels. DISCUSSION: These findings highlight HCP exposure setting temporal trends and workplace exposure hazards under high community incidence. Findings also underscore the need for robust collection of work-related data in infectious disease surveillance. CONCLUSIONS: Many reported HCP cases experienced occupational COVID-19 exposures, particularly during periods of higher community COVID-19 incidence. |
Truck driver reported unrealistically tight delivery schedules linked to their opinions of maximum speed limits and hours-of-service rules and their compliance with these safety laws and regulations
Chen GX , Sieber WK , Collins JW , Hitchcock EM , Lincoln JE , Pratt SG , Sweeney MH . Saf Sci 2021 133 Objectives: The study objectives were to examine U.S. long-haul truck drivers (LHTDs)' opinions on their safety needs and to assess the associations of driver reported unrealistically tight delivery schedules with: (1) their opinions on their compensation, maximum speed limits, and Hours-of-Service (HOS) regulations, and (2) their behaviors of noncompliance with these safety laws and regulations. Method(s): National Institute for Occupational Safety and Health analyzed data from its 2010 national survey of LHTD health and injury. A total of 1,265 drivers completed the survey. Logistic regression was used to examine the associations between driver reported unrealistically tight delivery schedule and their opinion on safety and unsafe driving behaviors. Result(s): Drivers who reported often receiving an unrealistically tight delivery schedule (an estimated 15.5% of LHTDs) were significantly more likely than drivers who reported never receiving an unrealistically tight delivery schedule to report that: (1) increasing the current maximum speed limit on interstate highways by 10 miles per hour (mph) would improve safety (odds ratio (OR) = 2.1); (2) strictly enforcing HOS rules would not improve safety (OR = 1.8); (3) they often drove 10 mph or more over the speed limit (OR = 7.5); (4) HOS regulations were often violated (OR = 10.9); (5) they often continued to drive despite fatigue, bad weather, or heavy traffic because their must delivery or pick up a load at a given time (OR = 7.5); and (6) their work was never adequately rewarded (OR = 4.5). When presented with 11 potential safety strategies, the largest percentage of LHTDs (95.4%) selected that building more truck stops/parking areas would improve truck driver safety. Conclusion(s): Driver reported unrealistically tight delivery schedules are associated with drivers' beliefs in safety laws/regulations and risk-taking behaviors. LHTDs see building more truck stops/rest areas as the most wanted safety need among the 11 potential safety strategies that were asked about in the survey. |
Case investigations of infectious diseases occurring in workplaces, United States, 2006-2015
Su CP , de Perio MA , Cummings KJ , McCague AB , Luckhaupt SE , Sweeney MH . Emerg Infect Dis 2019 25 (3) 397-405 Workers in specific settings and activities are at increased risk for certain infectious diseases. When an infectious disease case occurs in a worker, investigators need to understand the mechanisms of disease propagation in the workplace. Few publications have explored these factors in the United States; a literature search yielded 66 investigations of infectious disease occurring in US workplaces during 2006-2015. Reported cases appear to be concentrated in specific industries and occupations, especially the healthcare industry, laboratory workers, animal workers, and public service workers. A hierarchy-of-controls approach can help determine how to implement effective preventive measures in workplaces. Consideration of occupational risk factors and control of occupational exposures will help prevent disease transmission in the workplace and protect workers' health. |
Prevalence, recognition of work-relatedness, and effect on work of low back pain among U.S. workers
Luckhaupt SE , Dahlhamer JM , Gonzales GT , Lu ML , Groenewold M , Sweeney MH , Ward BW . Ann Intern Med 2019 171 (4) 301-304 This is the prepublication, author-produced version of a manuscript accepted for publication in Annals of Internal Medicine. This version does not include post-acceptance editing and formatting. The American College of Physicians, the publisher of Annals of Internal Medicine, is not responsible for the content or presentation of the author-produced accepted version of the manuscript or any version that a third party derives from it. Readers who wish to access the definitive published version of this manuscript and any ancillary material related to this manuscript (e.g., correspondence, corrections, editorials, linked articles) should go to Annals.org or to the print issue in which the article appears. Those who cite this manuscript should cite the published version, as it is the official version of record. |
Tdap vaccination among healthcare personnel - 21 states, 2013
O'Halloran AC , Lu PJ , Meyer SA , Williams WW , Schumacher PK , Sussell AL , Birdsey JE , Boal WL , Sweeney MH , Luckhaupt SE , Black CL , Santibanez TA . Am J Prev Med 2017 54 (1) 119-123 INTRODUCTION: Outbreaks of pertussis can occur in healthcare settings. Vaccinating healthcare personnel may be helpful in protecting healthcare personnel from pertussis and potentially limiting spread to others in healthcare settings. METHODS: Data from 21 states using the 2013 Behavioral Risk Factor Surveillance System industry/occupation module were analyzed in 2016. Tetanus, diphtheria, and acellular pertussis (Tdap) vaccination status was self-reported by healthcare personnel along with their occupation, healthcare setting/industry, demographics, and access to care factors. To compare groups, t-tests were used. The median state response rate was 44.0%. RESULTS: Among all healthcare personnel, 47.2% were vaccinated for Tdap. Physicians had higher Tdap coverage (66.8%) compared with all other healthcare personnel except nurse practitioners and registered nurses (59.5%), whose coverage did not statistically differ from that of physicians. Tdap vaccination coverage was higher among workers in hospitals (53.3%) than in long-term care facilities (33.3%) and other clinical settings, such as dentist, chiropractor, and optometrist offices (39.3%). Healthcare personnel who were younger, who had higher education, higher annual household income, a personal healthcare provider, and health insurance had higher Tdap vaccination coverage compared with reference groups. Tdap vaccination coverage among healthcare personnel in 21 states ranged from 30.6% in Mississippi to 65.9% in Washington. CONCLUSIONS: Improvement in Tdap vaccination among healthcare personnel is needed to potentially reduce opportunities for spread of pertussis in healthcare settings. On-site workplace vaccination, offering vaccines free of charge, and promoting vaccination may increase vaccination among healthcare personnel. |
Influenza vaccination among workers - 21 U.S. states, 2013
O'Halloran AC , Lu PJ , Williams WW , Schumacher P , Sussell A , Birdsey J , Boal WL , Sweeney MH , Luckhaupt SE , Black CL , Santibanez TA . Am J Infect Control 2017 45 (4) 410-416 BACKGROUND: Influenza illnesses can result in missed days at work and societal costs, but influenza vaccination can reduce the risk of disease. Knowledge of vaccination coverage by industry and occupation can help guide prevention efforts and be useful during influenza pandemic planning. METHODS: Data from 21 states using the 2013 Behavioral Risk Factor Surveillance System industry-occupation module were analyzed. Influenza vaccination coverage was reported by select industry and occupation groups, including health care personnel (HCP) and other occupational groups who may have first priority to receive influenza vaccination during a pandemic (tier 1). The t tests were used to make comparisons between groups. RESULTS: Influenza vaccination coverage varied by industry and occupation, with high coverage among persons in health care industries and occupations. Approximately half of persons classified as tier 1 received influenza vaccination, and vaccination coverage among tier 1 and HCP groups varied widely by state. CONCLUSIONS: This report points to the particular industries and occupations where improvement in influenza vaccination coverage is needed. Prior to a pandemic event, more specificity on occupational codes to define exact industries and occupations in each tier group would be beneficial in implementing pandemic influenza vaccination programs and monitoring the success of these programs. |
Exposure control practices for administering nitrous oxide: a survey of dentists, dental hygienists and dental assistants
Boiano JM , Steege AL , Sweeney MH . J Occup Environ Hyg 2016 14 (6) 0 Engineering, administrative, and work practice controls have been recommended for many years to minimize exposure to nitrous oxide during dental procedures. To better understand the extent to which these exposure controls are used, the NIOSH Health and Safety Practices Survey of Healthcare Workers was conducted among members of professional practice organizations representing dentists, dental hygienists and dental assistants. The anonymous, modular, web-based survey was completed by 284 dental professionals in private practice who administered nitrous oxide to adult and/or pediatric patients in the seven days prior to the survey. Use of primary engineering controls [i.e., nasal scavenging mask and/or local exhaust ventilation (LEV) near the patient's mouth] was nearly universal, reported by 93% and 96% of respondents who administered to adult (A) and pediatric (P) patients, respectively. However, adherence to other recommended precautionary practices were lacking to varying degrees, and were essentially no different among those administering nitrous oxide to adult or pediatric patients. Examples of work practices which increase exposure risk, expressed as percent of respondents, included: not checking nitrous oxide equipment for leaks (41% A; 48% P); starting nitrous oxide gas flow before delivery mask or airway mask was applied to patient (13% A; 12% P); and not turning off nitrous oxide gas flow before turning off oxygen flow to the patient (8% A; 7% P). Absence of standard procedures to minimize worker exposure to nitrous oxide (13% of all respondents) and not being trained on safe handling and administration of nitrous oxide (3%) were examples of breaches of administrative controls which may also increase exposure risk. Successful management of nitrous oxide emissions should include properly fitted nasal scavenging masks, supplemental LEV (when nitrous oxide levels cannot be adequately controlled using nasal masks alone), adequate general ventilation, regular inspection of nitrous oxide delivery and scavenging equipment for leaks, availability of standard procedures to minimize exposure, periodic training, ambient air and exposure monitoring, and medical surveillance. |
Secondhand smoke in the operating room? Precautionary practices lacking for surgical smoke
Steege AL , Boiano JM , Sweeney MH . Am J Ind Med 2016 59 (11) 1020-1031 BACKGROUND: Consensus organizations, government bodies, and healthcare organization guidelines recommend that surgical smoke be evacuated at the source by local exhaust ventilation (LEV) (i.e., smoke evacuators or wall suctions with inline filters). METHODS: Data are from NIOSH's Health and Safety Practices Survey of Healthcare Workers module on precautionary practices for surgical smoke. RESULTS: Four thousand five hundred thirty-three survey respondents reported exposure to surgical smoke: 4,500 during electrosurgery; 1,392 during laser surgery procedures. Respondents were mainly nurses (56%) and anesthesiologists (21%). Only 14% of those exposed during electrosurgery reported LEV was always used during these procedures, while 47% reported use during laser surgery. Those reporting LEV was always used were also more likely to report training and employer standard procedures addressing the hazards of surgical smoke. Few respondents reported use of respiratory protection. CONCLUSIONS: Study findings can be used to raise awareness of the marginal use of exposure controls and impediments for their use. Am. J. Ind. Med. Published 2016. This article is a U.S. Government work and is in the public domain in the USA. |
NIOSH national survey of long-haul truck drivers: injury and safety
Chen GX , Sieber WK , Lincoln JE , Birdsey J , Hitchcock EM , Nakata A , Robinson CF , Collins JW , Sweeney MH . Accid Anal Prev 2015 85 66-72 Approximately 1,701,500 people were employed as heavy and tractor-trailer truck drivers in the United States in 2012. The majority of them were long-haul truck drivers (LHTDs). There are limited data on occupational injury and safety in LHTDs, which prompted a targeted national survey. The National Institute of Occupational Safety and Health conducted a nationally representative survey of 1265 LHTDs at 32 truck stops across the contiguous United States in 2010. Data were collected on truck crashes, near misses, moving violations, work-related injuries, work environment, safety climate, driver training, job satisfaction, and driving behaviors. Results suggested that an estimated 2.6% of LHTDs reported a truck crash in 2010, 35% reported at least one crash while working as an LHTD, 24% reported at least one near miss in the previous 7 days, 17% reported at least one moving violation ticket and 4.7% reported a non-crash injury involving days away from work in the previous 12 months. The majority (68%) of non-crash injuries among company drivers were not reported to employers. An estimate of 73% of LHTDs (16% often and 58% sometimes) perceived their delivery schedules unrealistically tight; 24% often continued driving despite fatigue, bad weather, or heavy traffic because they needed to deliver or pick up a load at a given time; 4.5% often drove 10miles per hours or more over the speed limit; 6.0% never wore a seatbelt; 36% were often frustrated by other drivers on the road; 35% often had to wait for access to a loading dock; 37% reported being noncompliant with hours-of-service rules (10% often and 27% sometimes); 38% of LHTDs perceived their entry-level training inadequate; and 15% did not feel that safety of workers was a high priority with their management. This survey brings to light a number of important safety issues for further research and interventions, e.g., high prevalence of truck crashes, injury underreporting, unrealistically tight delivery schedules, noncompliance with hours-of-service rules, and inadequate entry-level training. |
Precautionary practices of respiratory therapists and other health-care practitioners who administer aerosolized medications
Tsai RJ , Boiano JM , Steege AL , Sweeney MH . Respir Care 2015 60 (10) 1409-17 BACKGROUND: Respiratory therapists (RTs) and other health-care workers are potentially exposed to a variety of aerosolized medications. The National Institute for Occupational Safety and Health (NIOSH) Health and Safety Practices Survey of Healthcare Workers describes current exposure control practices and barriers to using personal protective equipment during administration of selected aerosolized medications. METHODS: An anonymous, multi-module, web-based survey was conducted among members of health-care professional practice organizations representing RTs, nurses, and other health-care practitioners. A module on aerosolized medications included submodules for antibiotics (amikacin, colistin, and tobramycin), pentamidine, and ribavirin. RESULTS: The submodules on antibiotics, pentamidine, and ribavirin were completed by 321, 227, and 50 respondents, respectively, most of whom were RTs. The relatively low number of ribavirin respondents precluded meaningful interpretation of these data and may reflect the rare use of this drug. Consequently, analysis focused on pentamidine, classified by NIOSH as a hazardous drug, and the antibiotics amikacin, colistin, and tobramycin, which currently lack authoritative safe handling guidelines. Respondents who administered pentamidine were more likely to adhere to good work practices compared with those who administered the antibiotics. Examples included training received on safe handling procedures (75% vs 52%), availability of employer standard procedures (82% vs 55%), use of aerosol delivery devices equipped with an expiratory filter (96% vs 53%) or negative-pressure rooms (61% vs 20%), and always using respiratory protection (51% vs 13%). CONCLUSIONS: Despite the availability of safe handling guidelines for pentamidine, implementation was not universal, placing workers, co-workers, and even family members at risk of exposure. Although the antibiotics included in this study lack authoritative safe handling guidelines, prudence dictates that appropriate exposure controls be used to minimize exposure to the antibiotics and other aerosolized medications. Employers and employees share responsibility for ensuring that precautionary measures are taken to keep exposures to all aerosolized medications as low as practicable. |
Adherence to precautionary guidelines for compounding antineoplastic drugs: a survey of nurses and pharmacy practitioners
Boiano JM , Steege AL , Sweeney MH . J Occup Environ Hyg 2015 12 (9) 588-602 Precautionary guidelines detailing standards of practice and equipment to eliminate or minimize exposure to antineoplastic drugs during handling activities have been available for nearly three decades. To evaluate practices for compounding antineoplastic drugs, the NIOSH Health and Safety Practices Survey of Healthcare Workers was conducted among members of professional practice organizations representing primarily oncology nurses, pharmacists, and pharmacy technicians. This national survey is the first in over 20 years to examine self-reported use of engineering, administrative and work practice controls and PPE by pharmacy practitioners for minimizing exposure to antineoplastic drugs. The survey was completed by 241 nurses and 183 pharmacy practitioners who compounded antineoplastic drugs in the seven days prior to the survey. They reported: not always wearing two pairs of chemotherapy gloves (85%, 47%, respectively) or even a single pair (8%, 10%); not always using closed system drug-transfer devices (75%, 53%); not always wearing recommended gown (38%, 20%); I.V. lines sometimes/always primed with antineoplastic drug (19%, 30%); and not always using either a biological safety cabinet or isolator (9%, 15%). They also reported lack of: hazard awareness training (9%, 13%); safe handling procedures (20%, 11%); and medical surveillance programs (61%, 45%). Both employers and healthcare workers share responsibility for adhering to precautionary guidelines and other best practices. Employers can ensure that: workers are trained regularly; facility safe-handling procedures reflecting national guidelines are in place and support for their implementation is understood; engineering controls and PPE are available and workers know how to use them; and medical surveillance, exposure monitoring and other administrative controls are in place. Workers can seek out training, understand and follow facility procedures, be role models for junior staff, ask questions and report any safety concerns. |
National Survey of US Long-Haul Truck Driver Health and Injury: health behaviors
Birdsey J , Sieber WK , Chen GX , Hitchcock EM , Lincoln JE , Nakata A , Robinson CF , Sweeney MH . J Occup Environ Med 2015 57 (2) 210-216 OBJECTIVE: To compare selected health behaviors and body mass index (modifiable risk factors) of US long-haul truck drivers to the US working population by sex. METHODS: The National Survey of US Long-Haul Truck Driver Health and Injury interviewed a nationally representative sample of long-haul truck drivers (n = 1265) at truck stops. Age-adjusted results were compared with national health surveys. RESULTS: Compared with US workers, drivers had significantly higher body mass index, current cigarette use, and pack-years of smoking; lower prevalence of annual influenza vaccination; and generally lower alcohol consumption. Physical activity level was low for most drivers, and 25% had never had their cholesterol levels tested. CONCLUSIONS: Working conditions common to long-haul trucking may create significant barriers to certain healthy behaviors; thus, transportation and health professionals should address the unique work environment when developing interventions for long-haul drivers. |
Overview of the National Occupational Mortality Surveillance (NOMS) system: leukemia and acute myocardial infarction risk by industry and occupation in 30 US states 1985-1999, 2003-2004, and 2007
Robinson CF , Walker JT , Sweeney MH , Shen R , Calvert GM , Schumacher PK , Ju J , Nowlin S . Am J Ind Med 2015 58 (2) 123-37 BACKGROUND: Cancer and chronic disease are leading causes of death in the US with an estimated cost of $46 billion. METHODS: We analyzed 11 million cause-specific deaths of US workers age 18-64 years in 30 states during 1985-1999, 2003-2004, and 2007 by occupation, industry, race, gender, and Hispanic origin. RESULTS: The highest significantly elevated proportionate leukemia mortality was observed in engineers, protective service, and advertising sales manager occupations and in banks/savings & loans/credit agencies, public safety, and public administration industries. The highest significantly elevated smoking-adjusted acute myocardial infarction mortality was noted in industrial and refractory machinery mechanics, farmers, mining machine operators, and agricultural worker occupations; and wholesale farm supplies, agricultural chemical, synthetic rubber, and agricultural crop industries. CONCLUSIONS: Significantly elevated risks for acute myocardial infarction and leukemia were observed across several occupations and industries that confirm existing reports and add new information. Interested investigators can access the NOMS website at http://www.cdc.gov/niosh/topics/NOMS/. |
Adherence to safe handling guidelines by healthcare workers who administer antineoplastic drugs
Boiano JM , Steege AL , Sweeney MH . J Occup Environ Hyg 2014 11 (11) 728-40 The toxicity of antineoplastic drugs is well-documented. Many are known or suspected human carcinogens where no safe exposure level exists. Authoritative guidelines developed by professional practice organizations and federal agencies for the safe handling of these hazardous drugs have been available for nearly three decades. As a means of evaluating the extent of use of primary prevention practices such as engineering, administrative and work practice controls, personal protective equipment (PPE) and barriers to using PPE, NIOSH conducted a web survey of healthcare workers in 2011. The study population primarily included members of professional practice organizations representing healthcare occupations which routinely use or come in contact with selected chemical agents. All respondents who indicated that they administered antineoplastic drugs in the past week were eligible to complete a hazard module addressing self-reported health and safety practices on this topic. Most (98%) of the 2,069 respondents of this module were nurses. Working primarily in hospitals, outpatient care centers and physician offices, respondents reported that they collectively administered over 90 specific antineoplastic drugs in the past week, with carboplatin, cyclophosphamide and paclitaxel the most common. Examples of activities which increase exposure risk, expressed as percent of respondents, included: failure to wear nonabsorbent gown with closed front and tight cuffs (42%); intravenous (I.V.) tubing primed with antineoplastic agent by respondent (6%) or by pharmacy (12%); potentially contaminated clothing taken home (12%); spill or leak of antineoplastic agent during administration (12%); failure to wear chemotherapy gloves (12%); and lack of hazard awareness training (4%). The most common reason for not wearing gloves or gowns was "skin exposure was minimal"; 4% of respondents, however, reported skin contact during handling and administration. Despite the longstanding availability of safe handling guidance, recommended practices are not always followed, underscoring the importance of training and education for employers and workers. |
Prevalence of workers with shifts in hearing by industry: a comparison of OSHA and NIOSH hearing shift criteria
Masterson EA , Sweeney MH , Deddens JA , Themann CL , Wall DK . J Occup Environ Med 2014 56 (4) 446-55 OBJECTIVE: The purpose of this study was to compare the prevalence of workers with National Institute for Occupational Safety and Health significant threshold shifts (NSTS), Occupational Safety and Health Administration standard threshold shifts (OSTS), and with OSTS with age correction (OSTS-A), by industry using North American Industry Classification System codes. METHODS: From 2001 to 2010, worker audiograms were examined. Prevalence and adjusted prevalence ratios for NSTS were estimated by industry. NSTS, OSTS, and OSTS-A prevalences were compared by industry. RESULTS: Twenty percent of workers had an NSTS, 14% had an OSTS, and 6% had an OSTS-A. For most industries, the OSTS and OSTS-A criteria identified 28% to 36% and 66% to 74% fewer workers than the NSTS criteria, respectively. CONCLUSIONS: Use of NSTS criteria allowing for earlier detection of shifts in hearing is recommended for improved prevention of occupational hearing loss. |
NIOSH Health and Safety Practices Survey of Healthcare Workers: training and awareness of employer safety procedures
Steege AL , Boiano JM , Sweeney MH . Am J Ind Med 2014 57 (6) 640-52 BACKGROUND: The Health and Safety Practices Survey of Healthcare Workers describes current practices used to minimize chemical exposures and barriers to using recommended personal protective equipment for the following: antineoplastic drugs, anesthetic gases, high level disinfectants, surgical smoke, aerosolized medications (pentamidine, ribavirin, and antibiotics), and chemical sterilants. METHODS: Twenty-one healthcare professional practice organizations collaborated with NIOSH to develop and implement the web-based survey. RESULTS: Twelve thousand twenty-eight respondents included professional, technical, and support occupations which routinely come in contact with the targeted hazardous chemicals. Chemical-specific safe handling training was lowest for aerosolized antibiotics (52%, n = 316), and surgical smoke (57%, n = 4,747). Reported employer procedures for minimizing exposure was lowest for surgical smoke (32%, n = 4,746) and anesthetic gases (56%, n = 3,604). CONCLUSIONS: Training and having procedures in place to minimize exposure to these chemicals is one indication of employer and worker safety awareness. Safe handling practices for use of these chemicals will be reported in subsequent papers. |
Obesity and other risk factors: the National Survey of U.S. Long-Haul Truck Driver Health and Injury
Sieber WK , Robinson CF , Birdsey J , Chen GX , Hitchcock EM , Lincoln JE , Nakata A , Sweeney MH . Am J Ind Med 2014 57 (6) 615-26 BACKGROUND: Drivers of heavy and tractor-trailer trucks accounted for 56% of all production and nonsupervisory employees in the truck transportation industry in 2011. There are limited data for illness and injury in long-haul truck drivers, which prompted a targeted national survey. METHODS: Interviewers collected data during 2010 from 1,670 long-haul truck drivers at 32 truck stops across the 48 contiguous United States that were used to compute prevalence estimates for self-reported health conditions and risk factors. RESULTS: Obesity (69% vs. 31%, P < 0.01) and current smoking (51% vs. 19%, P < 0.01) were twice as prevalent in long-haul truck drivers as in the 2010 U.S. adult working population. Sixty-one percent reported having two or more of the risk factors: hypertension, obesity, smoking, high cholesterol, no physical activity, 6 or fewer hours of sleep per 24-hr period. CONCLUSION: Survey findings suggest a need for targeted interventions and continued surveillance for long-haul truck drivers. |
Prevalence of work-related dermatitis in the working population: authors' response to letter from Rosenman and Fussman
Luckhaupt SE , Sussell AL , Sweeney MH , Sestito JP , Calvert GM . Am J Ind Med 2014 57 (1) 127-8 As in the recent commentary by Halperin [2013], the letter from Rosenman and Fussman [] acknowledges that the inclusion of questions about the work-relatedness of common health conditions, including dermatitis, in the 2010 National Health Interview Survey Occupational Health Supplement (NHIS-OHS) [Luckhaupt et al., 2013] advanced knowledge on the magnitude of occupational injury and illness in the United States. Collecting data about work-related injuries and illnesses directly from workers through population-based surveys such as the NHIS bypasses some of the barriers to employer reporting of work-related conditions as found in the Survey of Occupational Illnesses and Injuries conducted by the US Department of Labor [Azaroff et al., 2002]. But, as Rosenman and Fussman point out, the estimates produced from the questions included in the 2010 NHIS-OHS, which are based on respondents having been told by a healthcare professional (HCP) that their condition was work-related, still likely underestimate the true magnitude of work-related health conditions. Barriers also exist that prevent many work-related conditions from being recognized by healthcare providers. One way of capturing data on likely work-related cases of dermatitis and other conditions is to directly ask workers for their opinions as to the work-relatedness of their condition. Although some survey questions that address worker perceptions of the work-relatedness of their conditions have been used by three states in the Behavioral Risk Factor Surveillance System (BRFSS), the specific questions varied by year and none of them were validated. | Rosenman and Fussman cited two studies that were based on BRFSS data from these three states. These two studies illustrate different ways to ask workers about their perceptions of the work-relatedness of health conditions [Stanbury et al., 2008; Lutzker et al., 2010]. |
Public health surveillance data: legal, policy, ethical, regulatory, and practical issues
Bernstein AB , Sweeney MH . MMWR Suppl 2012 61 (3) 30-4 In the United States, data systems are created by the ongoing, systematic collection of health, demographic, and other information through federally funded national surveys, vital statistics, public and private administrative and claims data, regulatory data, and medical records data. Certain data systems are designed to support public health surveillance and have used well-defined protocols and standard analytic methods for assessing specific health outcomes, exposures, or other endpoints. However, other data systems have been designed for a different purpose but can be used by public health programs for surveillance. Several public health surveillance programs rely substantially on others' data systems. An example of data used for surveillance purposes but collected for another reason is vital statistics data. CDC's National Center for Health Statistics (NCHS) purchases, aggregates, and disseminates vital statistics (birth and death rates) that are collected at the state level. These data are used to understand disease burden, monitor trends, and guide public health action. Administrative data also can be used for surveillance purposes (e.g., Medicare and Social Security Disability data that have been linked to survey data to monitor changes in health and health-care use over time). |
Prevalence of dermatitis in the working population, United States, 2010 National Health Interview Survey
Luckhaupt SE , Dahlhamer JM , Ward BW , Sussell AL , Sweeney MH , Sestito JP , Calvert GM . Am J Ind Med 2012 56 (6) 625-34 BACKGROUND: Prevalence patterns of dermatitis among workers offer clues about risk factors and targets for prevention, but population-based estimates of the burden of dermatitis among US workers are lacking. METHODS: Data from an occupational health supplement to the 2010 National Health Interview Survey (NHIS-OHS) were used to estimate the prevalence of dermatitis overall and by demographic characteristics and industry and occupation (I&O) of current/recent employment. RESULTS: Data were available for 27,157 adults, including 17,524 current/recent workers. The overall prevalence rate of dermatitis among current/recent workers was 9.8% (range among I&O groups: 5.5-15.4%), representing approximately 15.2 million workers with dermatitis. The highest prevalence rates were among I&O groups related to health care. Overall, 5.6% of dermatitis cases among workers (9.2% among healthcare workers) were attributed to work by health professionals. CONCLUSIONS: Dermatitis affected over 15 million US workers in 2010, and its prevalence varied by demographic characteristics and industry and occupation of employment. The prevalence rate of work-related dermatitis based on the NHIS-OHS was approximately 100-fold higher than incidence rates based on the Bureau of Labor Statistics' Survey of Occupational Illness and Injury. (Am. J. Ind. Med. Published 2012. This article is a U.S. Government work and is in the public domain in the USA.) |
Prevalence and work-relatedness of carpal tunnel syndrome in the working population, United States, 2010 National Health Interview Survey
Luckhaupt SE , Dahlhamer JM , Ward BW , Sweeney MH , Sestito JP , Calvert GM . Am J Ind Med 2012 56 (6) 615-24 BACKGROUND: Patterns of prevalence and work-relatedness of carpal tunnel syndrome (CTS) among workers offer clues about risk factors and targets for prevention. METHODS: Data from an occupational health supplement to the 2010 National Health Interview Survey were used to estimate the prevalence of self-reported clinician-diagnosed CTS overall and by demographic characteristics. The proportion of these cases self-reported to have been attributed to work by clinicians was also examined overall and by demographic characteristics. In addition, the distribution of industry and occupation (I&O) categories to which work-related cases of CTS were attributed was compared to the distribution of I&O categories of employment among current/recent workers. RESULTS: Data were available for 27,157 adults, including 17,524 current/recent workers. The overall lifetime prevalence of clinician-diagnosed CTS among current/recent workers was 6.7%. The 12-month prevalence was 3.1%, representing approximately 4.8 million workers with current CTS; 67.1% of these cases were attributed to work by clinicians, with overrepresentation of certain I&O categories. CONCLUSIONS: CTS affected almost 5 million U.S. workers in 2010, with prevalence varying by demographic characteristics and I&O. (Am. J. Ind. Med. (c) 2012 Wiley Periodicals, Inc.) |
Influenza-associated hospitalizations by industry, 2009-10 influenza season, United States
Luckhaupt SE , Sweeney MH , Funk R , Calvert GM , Nowell M , D'Mello T , Reingold A , Meek J , Yousey-Hindes K , Arnold KE , Ryan P , Lynfield R , Morin C , Baumbach J , Zansky S , Bennett NM , Thomas A , Schaffner W , Jones T . Emerg Infect Dis 2012 18 (4) 556-562 In response to pandemic (H1N1) 2009, data were collected on work status and industry of employment of 3,365 adults hospitalized with laboratory-confirmed influenza during the 2009-10 influenza season in the United States. The proportion of workers hospitalized for influenza was lower than their proportion in the general population, reflecting underlying protective characteristics of workers compared with nonworkers. The most commonly represented sectors were transportation and warehousing; administrative and support and waste management and remediation services; health care; and accommodation and food service. |
Documenting occupational history: the value to patients, payers, and researchers
Luckhaupt SE , Calvert GM , Sweeney MH . J AHIMA 2011 82 (7) 34-7 Recording patient work history is vital to identifying work-related injuries and illnesses. As electronic health records become widespread, this is an important time to ensure occupational health data elements are included in EHR standards. |
Workplace assaults on nursing assistants in US nursing homes: a multilevel analysis
Tak S , Sweeney MH , Alterman T , Baron S , Calvert GM . Am J Public Health 2010 100 (10) 1938-45 OBJECTIVES: We examined risk factors for injuries to nursing assistants from assaults by nursing home residents at both the individual and the organizational level. METHODS: We analyzed data from the 2004 National Nursing Assistant Survey that were linked to facility information from the 2004 National Nursing Home Survey by use of multilevel modeling that accounted for the complex survey design effect. RESULTS: Thirty-four percent of nursing assistants surveyed reported experiencing physical injuries from residents' aggression in the previous year. Mandatory overtime (odds ratio [OR]=1.65; 95% confidence interval [CI]=1.22, 2.24) and not having enough time to assist residents with their activities of daily living (OR=1.49; 95% CI=1.25, 1.78) were strongly associated with experiencing injuries from assaults. Nursing assistants employed in nursing homes with Alzheimer care units were more likely to experience such injuries, including being bitten by residents. CONCLUSIONS: Reducing mandatory overtime and having a less demanding workload may reduce the risk of workplace violence. In particular, prevention activities should be targeted at those nursing homes that care for cognitively impaired patients. (Am J Public Health. Published online ahead of print August 19, 2010: e1-e8. doi:10.2105/AJPH.2009.185421). |
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