The association between safety climate and noncombat injury events among United States Air Force workers.

INTRODUCTION: Work-related injuries are a common lagging safety indicator whereas safety climate assessments can help identify constructs serving as leading indicators. The National Institute for Occupational Safety and Health (NIOSH) partnered with the U.S. Department of the Air Force (DAF) Safety Center to examine the association between perceptions of safety climate survey constructs and the number of injury events within the DAF workforce. METHODS: The DAF administers voluntary, anonymous, occupation-specific safety climate surveys to DAF workers using the internal Air Force Combined Mishap Reduction System (AFCMRS). Survey responses from 2014 to 2018 provided by DAF workers and injury events in maintenance, support, and operations occupations were shared with NIOSH. Exploratory Factor Analysis revealed five constructs: Leadership and Communication; Organizational Safety Priority; Error Management; Resource Adequacy; and Deployment/Official Travel Impact. Squadron-level analysis included bivariate correlations and estimated Rate Ratios (RRs). RESULTS: 1,547 squadrons administered the survey, averaging 144 workers and 15.8 reportable injuries per squadron. Higher (more favorable) squadron-level construct scores were consistently correlated with fewer reported injuries (p < 0.001). Controlling for the number of workers, RRs revealed significant reductions in injury rates with each one-unit increase in responses: Leadership and Communication RR = 0.40 (95%CI: 0.32-0.48); Organizational Safety Priority RR = 0.50 (95%CI: 0.40-0.64); Error Management RR = 0.37 (95%CI: 0.30-0.47); Deployment/Official Travel Impact RR = 0.36 (95%CI: 0.29-0.45). Resource Adequacy revealed a non-significant lower injury rate RR = 0.87 (95%CI: 0.73-1.04). CONCLUSIONS: This unique study quantified safety climate and the association with injuries across a multi-year period. While safety climate measurements may be limited by frequent turnover and the self-reported, voluntary, anonymous nature of AFCMRS, the strength of this study is in the census of injuries. PRACTICAL APPLICATIONS: Future research should include longitudinal analyses to examine the impact on injuries when squadron leaders are provided feedback on safety climate survey results.

The role of funded partnerships in working towards decreasing COVID-19 vaccination disparities, United States, March 2021-December 2022.

During the COVID-19 vaccination rollout from March 2021- December 2022, the Centers for Disease Control and Prevention funded 110 primary and 1051 subrecipient partners at the national, state, local, and community-based level to improve COVID-19 vaccination access, confidence, demand, delivery, and equity in the United States. The partners implemented evidence-based strategies among racial and ethnic minority populations, rural populations, older adults, people with disabilities, people with chronic illness, people experiencing homelessness, and other groups disproportionately impacted by COVID-19. CDC also expanded existing partnerships with healthcare professional societies and other core public health partners, as well as developed innovative partnerships with organizations new to vaccination, including museums and libraries. Partners brought COVID-19 vaccine education into farm fields, local fairs, churches, community centers, barber and beauty shops, and, when possible, partnered with local healthcare providers to administer COVID-19 vaccines. Inclusive, hyper-localized outreach through partnerships with community-based organizations, faith-based organizations, vaccination providers, and local health departments was critical to increasing COVID-19 vaccine access and building a broad network of trusted messengers that promoted vaccine confidence. Data from monthly and quarterly REDCap reports and monthly partner calls showed that through these partnerships, more than 295,000 community-level spokespersons were trained as trusted messengers and more than 2.1 million COVID-19 vaccinations were administered at new or existing vaccination sites. More than 535,035 healthcare personnel were reached through outreach strategies. Quality improvement interventions were implemented in healthcare systems, long-term care settings, and community health centers resulting in changes to the clinical workflow to incorporate COVID-19 vaccine assessments, recommendations, and administration or referrals into routine office visits. Funded partners' activities improved COVID-19 vaccine access and addressed community concerns among racial and ethnic minority groups, as well as among people with barriers to vaccination due to chronic illness or disability, older age, lower income, or other factors.

Mixed messages and COVID-19 prevention: Why information isn't always enough to protect meat processing workers.

Introduction: The objective of this project was to investigate U.S. meat and poultry processing workers' knowledge of COVID-19, perceived ability to protect themselves from infection, and perspectives on COVID-19 vaccines to inform COVID-19 prevention efforts within this linguistically, racially, and ethnically diverse workforce. Methods: Qualitative semi-structured in-depth interviews were conducted with Mexican, Central American, Congolese refugee, and Black or African American meat/poultry processing workers from Mississippi, Minnesota, Virginia, and Kentucky (N=40). Data were collected from December 5, 2020, to January 28, 2021. Interview audio was transcribed, and rapid qualitative data analysis was used to analyze transcripts. Results: Most participants expressed receiving mixed messages about COVID-19 protection measures: they were told how to protect themselves (n=38), but workplace policies (such as lack of paid sick leave) often undermined their efforts. Participants who were asked about COVID-19 vaccines (n=31) were aware there were one or more vaccines available to protect them from COVID-19; one-third were eager to get vaccinated. Conclusions: Community-based efforts may consider supplementing large scale unified information campaigns in order to prevent mixed messages, address worker needs to accurately gauge the threat of illness to their families and communities and empower them to prevent infection.

Assessing the Australian occupational driver behavior questionnaire in U.S. taxi drivers: Different country, different occupation and different worker population.

BACKGROUND: Promoting safe driver behaviors is an important aspect of road safety. To better understand road safety behaviors, there is a role for practical instruments that can validly measure typical road safety behaviors among occupational drivers. The Occupational Driver Behavior Questionnaire (ODBQ) was developed to assess road safety behaviors among home health nurses in Australia. METHODS: We administered a cross-sectional survey to a sample of taxi drivers in two U.S. metropolitan areas. The survey included Newnam's ODBQ-12 and a study-specific 15-item version (ODBQ-15) assessing 4 different road safety behaviors with 3 more items added and motor-vehicle crashes in the past year. Logistic regression analyses examined the association of the road safety behaviors with motor vehicle crashes. A series of confirmatory factor analysis (CFA) models assessed the construct validity of the ODBQ-12 and ODBQ-15. RESULTS: We pooled survey data from 497 Houston drivers and 500 Los Angeles drivers to assess study aims. CFA models examining the 12-item and the 15-item ODBQ versions had good model fit (Comparative Fit Index > 0.95, Tucker Lewis Index ≥ 0.95, root mean square error of approximation < 0.06, standardized root mean square residual ≤ 0.05). The ODBQ's road safety behaviors were significantly associated (p < 0.001) with crashes while working (ORs 0.51-0.75) and not working (ORs 0.57-0.84). CONCLUSIONS: The ODBQ-12 and ODBQ-15 were both significantly associated with motor vehicle crashes among taxicab drivers in two large U.S. metropolitan areas. Researchers studying occupational drivers who transport passengers may want to consider using the ODBQ-15. The 3 additional items are meaningful to this workforce and are priority areas for international road safety efforts.

Research gaps and needs for preventing worker fatigue in the transportation and utilities industries.

BACKGROUND: The transportation and utilities industries include establishments engaged in the movement of passengers and freight, or the provision of public power, water, and other services. Along with the warehousing industry, they make up the US National Occupational Research Agenda's Transportation, Warehousing and Utilities (TWU) industry sector. In 2018 the sector composed 5% of the US workforce, with approximately 8 million workers. TWU workers experienced 19% of all fatalities among U.S. workers in 2018 and 7% of total occupational injuries and illnesses. METHODS: Around-the-clock operations, heavy workloads, long and irregular shifts, complicated schedules, and time pressures characterize work across the US TWU sector. However, there are considerable differences in worker priorities and concerns between TWU industries. Major areas of concern within the sector include disparities in work schedules; required training for employee fatigue awareness and prevention; physical and mental job demands; and safety culture. RESULTS: Strategies for fatigue mitigation are critical to reduce the prevalence of injuries, safety-critical events, and crashes in TWU workers. Further research on the incidence and characterization of fatigue among TWU workers will guide the development of effective mitigation strategies. The influence of work scheduling on missed sleep opportunities and disrupted circadian rhythms should be determined. Evaluation of fatigue mitigation strategies can lead to the adoption of the most effective ones for each TWU industry. CONCLUSION: Implementation of effective strategies is critical for the health, safety, wellbeing, and productivity of workers in the TWU sector.

Findings from a systematic review of fatigue interventions: What's (not) being tested in mining and other industrial environments.

BACKGROUND: Fatigue negatively impacts mineworker health and safety. In this paper, we identify fatigue interventions tested on industrial shiftworkers and explore their effects and the factors that may influence application in an industrial setting such as a mine site. METHODS: This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. A structured, systematic search of the literature was conducted to identify relevant studies published between 1980 and 2020. Researchers independently conducted article screening and study quality appraisals against pre-established criteria, and then extracted data and conducted a narrative synthesis of the included studies. RESULTS: Seven intervention studies, out of 1651 articles initially screened, were retained for narrative synthesis. Four studies tested the alerting effects of bright-light treatment, one evaluated the effectiveness of blue-light blocking glasses at improving daytime sleep quality and nighttime vigilance, and two examined whether sleep hygiene and alertness management trainings improved sleep quality or alertness. There was substantial evidence for the use of bright-light treatments to improve night shiftworker alertness, but insufficient evidence to draw conclusions about the effectiveness of blue-light blocking glasses and sleep hygiene and alertness management trainings due to the small number of studies included. Shiftworkers were mostly male and employed in industrial subsectors such as production and manufacturing, oil and gas, and transportation. No mining-specific intervention studies were identified. CONCLUSIONS: Future research is needed to identify effective fatigue risk management interventions for the mining industry as well as best practices for implementing these interventions with mineworkers.

Impact of a crime prevention ordinance for small retail establishments.

BACKGROUND: Ordinances requiring the implementation of robbery prevention measures have been enacted at the city level in many jurisdictions. We evaluated the impact of an ordinance requiring crime prevention measures on subsequent crime rates. METHODS: Crime reports for robbery and aggravated assault from January 2006 through December 2015 were linked to randomly-selected convenience stores and small retail grocers in Houston (n = 293). Store characteristics and compliance with a list of safety measures were collected by surveyors in 2011. Generalized linear mixed models were used to compare rates of crime before and after the implementation of the ordinance. RESULTS: Robberies decreased significantly after the ordinance went into effect (rate ratio = 0.38; 95% confidence interval 0.29-0.51). No individual safety measure was associated with decreased robbery rates. No similar decrease was observed for aggravated assault. CONCLUSIONS: City ordinances mandating crime prevention measures can be effective. We could not parse out the effectiveness of individual elements, suggesting a comprehensive approach may be more effective.

Individual, business-related, and work environment factors associated with driving tired among taxi drivers in two metropolitan U.S. cities.

INTRODUCTION: Violence-related events and roadway incidents are the leading causes of injury among taxi drivers. Fatigue is under-recognized and prevalent in this workforce and is associated with both injury outcomes. We describe the association of individual, business-related, and work environment factors with driving tired among taxi drivers in two very different cities. METHOD: We developed a comprehensive survey for licensed taxi drivers. We trained surveyors to administer the 30-min survey using systematic sampling among taxi drivers waiting for fares in two large U.S. cities: the Southwest (City 1) and the West (City 2). A driving tired scale of the Occupational Driver Behavior Questionnaire was the outcome. Multivariate logistic models described driving tired behavior in city-specific models using adjusted Odds Ratios (ORadj). RESULTS: City 1 and City 2 had 496 and 500 participants, respectively. Each driving tired behavior was significantly more prevalent in City 2 than City 1 (p < .05). There were more variables and a greater diversity of variables in the models describing drowsy driving in City 1 than City 2. In City 1, variables describing negative safety climate (ORadj = 1.15), socio-demographic groups (identifying as Asian, educational attainment), passenger-related violence (ORadj = 1.79), and company tenure (ORadj =1.15) were associated with driving tired. In City 2, high perceived safety training usefulness (ORadj = 0.48) was associated with driving tired. A risk factor for driving tired that was common to both cities was job demands (ORadj = 1.21 in City 1; 1.43 in City 2). CONCLUSIONS: These findings represent two diverse taxi populations driving in two geographically distinct regions that differ in safety regulation. It is important that safety measures that include fatigue awareness training are reaching all drivers. Fatigue management training should be integrated into driver safety programs regardless of location. Practical applications: Fatigue management strategies that recognize individual factors, business-related characteristics, and work environment are an important component of road safety and are particularly relevant for occupational drivers.

Fatal work-related falls in the United States, 2003-2014.

BACKGROUND: Falls are the second leading cause of work-related fatalities among US workers. We describe fatal work-related falls from 2003 to 2014, including demographic, work, and injury event characteristics, and changes in rates over time. METHODS: We identified fatal falls from the Bureau of Labor Statistics (BLS), Census of Fatal Occupational Injuries and estimated rates using the BLS Current Population Survey. RESULTS: From 2003 to 2014, there were 8880 fatal work-related falls, at an annual rate of 5.5 per million FTE. Rates increased with age. Occupations with the highest rates included construction/extraction (42.2 per million FTE) and installation/maintenance/repair (12.5 per million FTE). Falls to a lower level represented the majority (n = 7521, 85%) compared to falls on the same level (n = 1128, 13%). CONCLUSIONS: Falls are a persistent source of work-related fatalities. Fall prevention should continue to focus on regulation adherence, Prevention through Design, improving fall protection, training, fostering partnerships, and increasing communication.

Work-Related Violent Deaths in the US Taxi and Limousine Industry 2003 to 2013: Disparities Within a High-Risk Working Population.

OBJECTIVE: We describe the magnitude and distribution of violent work-related deaths among taxi and limousine drivers, a high-risk population. METHODS: We analyzed rates using the Bureau of Labor Statistics Census of Fatal Occupational Injuries (CFOI) for all violent work-related deaths in the taxi and limousine industry from 2003 to 2013. We described demographics, work characteristics, and other injury details, examining temporal trends for nativity and race/ethnicity. RESULTS: Men (adjusted rate ratio [RRadj] 6.1 [95% confidence interval [CI] 2.6-14.1]), blacks (RRadj 2.3 [95% CI 1.6-3.4]), Hispanics (RRadj 2.1 [95% CI 1.3-3.4]), and drivers in the South (RRadj 2.7 [95% CI 1.9-3.9]) had significantly higher fatality rates than comparison groups. Over time, the rates remained substantially higher compared with all workers. CONCLUSIONS: The taxi and limousine industry continues to face a disproportionately dangerous working environment. Recommended safety measures implemented uniformly by cities, companies, and drivers could mitigate disparities.

6th National Occupational Injury Research Symposium: Advancing Occupational Injury Research Through Integration and Partnership.

INTRODUCTION: The National Occupational Injury Research Symposium (NOIRS) is the only regularly held forum exclusively dedicated to occupational injury research and prevention. METHOD: The 2015 conference theme, advancing occupational injury research through integration and partnership, shaped the conference and is reflected in articles selected for this special issue. RESULTS' CONCLUSION: The 6th NOIRS, held May 19-21, 2015, brought together more than 250 researchers, occupational safety practitioners and students to share and discuss occupational injury research. Articles in this special issue highlight some of the research presented at the conference, reflect multiple scientific disciplines and approaches, cover a breadth of occupational injury causes and worker populations, and provide examples of research advanced by partnerships. PRACTICAL APPLICATIONS: The next NOIRS, tentatively scheduled for 2018, will build upon the theme of integration and partnership as well as feedback from conference attendees.

A post-conference evaluation of the 2015 National Occupational Injury Research Symposium.

INTRODUCTION: The National Occupational Injury Research Symposium (NOIRS) is the only national forum focused on occupational injury research findings, data and methods, and prevention strategies; it has been convened every 3-5years since 1997. Held in May 2015, the 6th symposium's theme was "Advancing Occupational Injury Research through Integration and Partnership." Organizers requested that attendees complete a post-meeting evaluation to assess meeting impact, and gather information useful in planning subsequent meetings and activities. METHOD: The questionnaire was publicized via a quick response code and link to the survey on symposium book cover, and mentioned at each scientific session. The online survey was designed to be completed in ≤15min; no identifying information was collected. Survey link remained open for seven days post-symposium. RESULTS: About 50% of registered attendees responded. Almost half were attending their first NOIRS. Most were researchers (69%); 45% were affiliated with government and 38% with university or research institute. Five of six reported that the symposium mostly or completely met expectations. Reasons for attending included gaining exposure to new areas of research (87%), sharing their research (80%), and to develop new ideas for conducting research (79%). The majority (90%) reported that the symposium provided adequate networking opportunities. The conference venue was reported as good or better by 69%, moreso among repeat attendees (77%) compared to first-timers (61%). DISCUSSION: The evaluation demonstrated that NOIRS was valuable to attendees, and provided a forum for sharing research results, developing new research ideas, and networking. Respondents provided input on different aspects of NOIRS and suggestions useful in planning next NOIRS, tentatively scheduled for 2018. NOIRS 2015 objectives for integration across disciplines and partnership with industry and safety professionals were partially met. In planning NOIRS 2018, more attention should be paid to attracting and engaging a broader spectrum of attendees.

Compliance to two city convenience store ordinance requirements.

BACKGROUND: Robbery-related homicides and assaults are the leading cause of death in retail businesses. Robbery reduction approaches focus on compliance to Crime Prevention Through Environmental Design (CPTED) guidelines. PURPOSE: We evaluated the level of compliance to CPTED guidelines specified by convenience store safety ordinances effective in 2010 in Dallas and Houston, Texas, USA. METHODS: Convenience stores were defined as businesses less than 10 000 square feet that sell grocery items. Store managers were interviewed for store ordinance requirements from August to November 2011, in a random sample of 594 (289 in Dallas, 305 in Houston) convenience stores that were open before and after the effective dates of their city's ordinance. Data were collected in 2011 and analysed in 2012-2014. RESULTS: Overall, 9% of stores were in full compliance, although 79% reported being registered with the police departments as compliant. Compliance was consistently significantly higher in Dallas than in Houston for many requirements and by store type. Compliance was lower among single owner-operator stores compared with corporate/franchise stores. Compliance to individual requirements was lowest for signage and visibility. CONCLUSIONS: Full compliance to the required safety measures is consistent with industry 'best practices' and evidence-based workplace violence prevention research findings. In Houston and Dallas compliance was higher for some CPTED requirements but not the less costly approaches that are also the more straightforward to adopt.

Suicide in U.S. Workplaces, 2003-2010: a comparison with non-workplace suicides.

INTRODUCTION: Suicide rates have risen considerably in recent years. National workplace suicide trends have not been well documented. The aim of this study is to describe suicides occurring in U.S. workplaces and compare them to suicides occurring outside of the workplace between 2003 and 2010. METHODS: Suicide data originated from the Census of Fatal Occupational Injury database and the Web-Based Injury Statistics Query and Reporting System. Suicide rates were calculated using denominators from the 2013 Current Population Survey and 2000 U.S. population census. Suicide rates were compared among demographic groups with rate ratios and 95% CIs. Suicide rates were calculated and compared among occupations. Linear regression, adjusting for serial correlation, was used to analyze temporal trends. Analyses were conducted in 2013-2014. RESULTS: Between 2003 and 2010, a total of 1,719 people died by suicide in the workplace. Workplace suicide rates generally decreased until 2007 and then sharply increased (p=0.035). This is in contrast with non-workplace suicides, which increased over the study period (p=0.025). Workplace suicide rates were highest for men (2.7 per 1,000,000); workers aged 65-74 years (2.4 per 1,000,000); those in protective service occupations (5.3 per 1,000,000); and those in farming, fishing, and forestry (5.1 per 1,000,000). CONCLUSIONS: The upward trend of suicides in the workplace underscores the need for additional research to understand occupation-specific risk factors and develop evidence-based programs that can be implemented in the workplace.

Occupational ladder fall injuries - United States, 2011.

Falls remain a leading cause of unintentional injury mortality nationwide [corrected].Among workers, approximately 20% of fall injuries involve ladders. Among construction workers, an estimated 81% of fall injuries treated in U.S. emergency departments (EDs) involve a ladder. To fully characterize fatal and nonfatal injuries associated with ladder falls among workers in the United States, CDC's National Institute for Occupational Safety and Health (NIOSH) analyzed data across multiple surveillance systems: 1) the Census of Fatal Occupational Injuries (CFOI), 2) the Survey of Occupational Injuries and Illnesses (SOII), and 3) the National Electronic Injury Surveillance System-occupational supplement (NEISS-Work). In 2011, work-related ladder fall injuries (LFIs) resulted in 113 fatalities (0.09 per 100,000 full-time equivalent [FTE] workers), an estimated 15,460 nonfatal injuries reported by employers that involved ≥1 days away from work (DAFW), and an estimated 34,000 nonfatal injuries treated in EDs. Rates for nonfatal, work-related, ED-treated LFIs were higher (2.6 per 10,000 FTE) than those for such injuries reported by employers (1.2 per 10,000 FTE). LFIs represent a substantial public health burden of preventable injuries for workers. Because falls are the leading cause of work-related injuries and deaths in construction, NIOSH, the Occupational Safety and Health Administration, and the Center for Construction Research and Training are promoting a national campaign to prevent workplace falls. NIOSH is also developing innovative technologies to complement safe ladder use.

Examining occupational health and safety disparities using national data: a cause for continuing concern.

BACKGROUND: Occupational status, a core component of socioeconomic status, plays a critical role in the well-being of U.S. workers. Identifying work-related disparities can help target prevention efforts. METHODS: Bureau of Labor Statistics workplace data were used to characterize high-risk occupations and examine relationships between demographic and work-related variables and fatality. RESULTS: Employment in high-injury/illness occupations was independently associated with being male, Black, ≤high school degree, foreign-birth, and low-wages. Adjusted fatal occupational injury rate ratios for 2005-2009 were elevated for males, older workers, and several industries and occupations. Agriculture/forestry/fishing and mining industries and transportation and materials moving occupations had the highest rate ratios. Homicide rate ratios were elevated for Black, American Indian/Alaska Native/Asian/Pacific Islanders, and foreign-born workers. CONCLUSIONS: These findings highlight the importance of understanding patterns of disparities of workplace injuries, illnesses and fatalities. Results can improve intervention efforts by developing programs that better meet the needs of the increasingly diverse U.S. workforce.

Cities with camera-equipped taxicabs experience reduced taxicab driver homicide rates: United States, 1996-2010.

BACKGROUND: Driving a taxicab remains one of the most dangerous occupations in the United States, with leading homicide rates. Although safety equipment designed to reduce robberies exists, it is not clear what effect it has on reducing taxicab driver homicides. FINDINGS: Taxicab driver homicide crime reports for 1996 through 2010 were collected from 20 of the largest cities (>200,000) in the United States: 7 cities with cameras installed in cabs, 6 cities with partitions installed, and 7 cities with neither cameras nor partitions. Poisson regression modeling using generalized estimating equations provided city taxicab driver homicide rates while accounting for serial correlation and clustering of data within cities. Two separate models were constructed to compare (1) cities with cameras installed in taxicabs versus cities with neither cameras nor partitions and (2) cities with partitions installed in taxicabs versus cities with neither cameras nor partitions. Cities with cameras installed in cabs experienced a significant reduction in homicides after cameras were installed (adjRR = 0.11, CL 0.06-0.24) and compared to cities with neither cameras nor partitions (adjRR = 0.32, CL 0.15-0.67). Cities with partitions installed in taxicabs experienced a reduction in homicides (adjRR = 0.78, CL 0.41-1.47) compared to cities with neither cameras nor partitions, but it was not statistically significant. CONCLUSIONS: The findings suggest cameras installed in taxicabs are highly effective in reducing homicides among taxicab drivers. Although not statistically significant, the findings suggest partitions installed in taxicabs may be effective.

Nonfatal work-related injuries and illnesses - United States, 2010.

In 2012, the U.S. civilian labor force comprised an estimated 155 million workers. Although employment can contribute positively to a worker's physical and psychological health, each year, many U.S. workers experience a work-related injury or illness. In 2011, approximately 3 million workers in private industry and 821,000 workers in state and local government experienced a nonfatal occupational injury or illness. Nonfatal workplace injuries and illnesses are estimated to cost the U.S. economy approximately $200 billion annually. Identifying disparities in work-related injury and illness rates can help public health authorities focus prevention efforts. Because work-related health disparities also are associated with social disadvantage, a comprehensive program to improve health equity can include improving workplace safety and health.

Fatal work-related injuries - United States, 2005-2009.

In 2012, the U.S. civilian labor force comprised an estimated 155 million workers. Although employment can contribute positively to a worker's physical and psychological health, each year, many U.S. workers are fatally injured at work. In 2011, a total of 4,700 U.S. workers died from occupational injuries. Workplace deaths are estimated to cost the U.S. economy approximately $6 billion annually. Identifying disparities in work-related fatality rates can help public health authorities focus prevention efforts. Because work-related health disparities also are associated with social disadvantage, a comprehensive program to improve health equity should include improving workplace safety and health.