Creating a Future for Occupational Health.

Objectives: Economic, social, technical, and political drivers are fundamentally changing the nature of work and work environments, with profound implications for the field of occupational health. Nevertheless, researchers and practitioners entering the field are largely being trained to assess and control exposures using approaches developed under old models of work and risks. Methods: A speaker series and symposium were organized to broadly explore current challenges and future directions for the occupational health field. Broad themes identified throughout these discussions are characterized and discussed to highlight important future directions of occupational health. Findings: Despite the relatively diverse group of presenters and topics addressed, some important cross-cutting themes emerged. Changes in work organization and the resulting insecurity and precarious employment arrangements change the nature of risk to a large fraction of the workforce. Workforce demographics are changing, and economic disparities among working groups are growing. Globalization exacerbates the 'race to the bottom' for cheap labor, poor regulatory oversight, and limited labor rights. Largely, as a result of these phenomena, the historical distinction between work and non-work exposures has become largely artificial and less useful in understanding risks and developing effective public health intervention models. Additional changes related to climate change, governmental and regulatory limitations, and inadequate surveillance systems challenge and frustrate occupational health progress, while new biomedical and information technologies expand the opportunities for understanding and intervening to improve worker health. Conclusion: The ideas and evidences discussed during this project suggest that occupational health training, professional practice, and research evolve towards a more holistic, public health-oriented model of worker health. This will require engagement with a wide network of stakeholders. Research and training portfolios need to be broadened to better align with the current realities of work and health and to prepare practitioners for the changing array of occupational health challenges.

Urinary metabolites of 1-nitropyrene in US-Mexico border residents who frequently cross the San Ysidro Port of Entry.

Diesel exhaust presents a community exposure hazard, but methods to measure internal exposure are lacking. We report results from a community-based study using 1-nitropyrene (1-NP) and its urinary metabolites as markers of exposure to traffic-related diesel particulate matter (DPM). The study participants were Tijuana, Mexico residents who commuted on foot into San Diego, California for work or school using the International San Ysidro Port of Entry, placing them within feet of idling traffic (referred to as border commuters). The comparison group (non-border commuters) was comprised of residents of south San Diego who did not commute into Mexico. Air concentration of 1-NP in fine particulate matter (PM2.5) was measured in personal samples from participants. Spot urine samples were analyzed for 1-NP urinary metabolites 8-hydroxy-1-nitropyrene (8-OHNP) and 8-hydroxy-N-acetyl-1-aminopyrene (8-OHNAAP). Compared with non-border commuters, border commuters had two- to threefold higher mean urinary concentrations for unadjusted and creatinine-adjusted 8-OHNP and 8-OHNAAP. Urinary 8-OHNAAP and the sum of 8-OHNP and 8-OHNAAP were both associated with personal exposure to 1-NP in the prior 24 h. These results suggest that 1-NP urinary metabolites reflect recent exposure to DPM-derived 1-NP in community settings and can be useful for exposure analysis.

Whole-body Vibration Exposure Intervention among Professional Bus and Truck Drivers: A Laboratory Evaluation of Seat-suspension Designs.

Long-term exposure to seated whole-body vibration (WBV) is one of the leading risk factors for the development of low back disorders. Professional bus and truck drivers are regularly exposed to continuous WBV, since they spend the majority of their working hours driving heavy vehicles. This study measured WBV exposures among professional bus and truck drivers and evaluated the effects of seat-suspension designs using simulated field-collected data on a vibration table. WBV exposures were measured and compared across three different seat designs: an air-ride bus seat, an air-ride truck seat, and an electromagnetically active (EM-active) seat. Air-ride seats use a compressed-air bladder to attenuate vibrations, and they have been in operation throughout the transportation industry for many years. The EM-active seat is a relatively new design that incorporates a microprocessor-controlled actuator to dampen vibration. The vibration table simulated seven WBV exposure scenarios: four segments of vertical vibration and three scenarios that used field-collected driving data on different road surfaces-a city street, a freeway, and a section of rough roadway. The field scenarios used tri-axial WBV data that had been collected at the seat pan and at the driver's sternum, in accordance with ISO 2631-1 and 2631-5. This study found that WBV was significantly greater in the vertical direction (z-axis) than in the lateral directions (x-and y-axes) for each of the three road types and each of the three types of seats. Quantitative comparisons of the results showed that the floor-to-seat-pan transmissibility was significantly lower for the EM-active seat than for either the air-ride bus seat or the air-ride truck seat, across all three road types. This study also demonstrated that seat-suspension designs have a significant effect on the vibrations transmitted to vehicle operators, and the study's results may prove useful in designing future seat suspensions.

Shift work and breast cancer among women textile workers in Shanghai, China.

PURPOSE: Although night-shift work has been associated with elevated risk of breast cancer in numerous epidemiologic studies, evidence is not consistent. We conducted a nested case-cohort study to investigate a possible association between shift work including a night shift and risk of breast cancer within a large cohort of women textile workers in Shanghai, China. METHODS: The study included 1,709 incident breast cancer cases and 4,780 non-cases. Data on historical shift work schedules were collected by categorized jobs from the factories, where the study subjects had worked, and then were linked to the complete work histories of each subject. No jobs in the factories involved exclusively night-shift work. Therefore, night shift was evaluated as part of a rotating shift work pattern. Hazard ratios and 95 % confidence intervals were calculated using Cox proportional hazards modeling adapted for the case-cohort design for years of night-shift work and the total number of nights worked. Additionally, analyses were repeated with exposures lagged by 10 and 20 years. RESULTS: We observed no associations with either years of night-shift work or number of nights worked during the entire employment period, irrespective of lag intervals. Findings from the age-stratified analyses were very similar to those observed for the entire study population. CONCLUSIONS: The findings from this study provide no evidence to support the hypothesis that shift work increases breast cancer risk. The positive association between shift work and breast cancer observed in Western populations, but not observed in this and other studies of the Chinese population, suggests that the effect of shift work on breast cancer risk may be different in Asian and Caucasian women.

Occupational exposure to magnetic fields and breast cancer among women textile workers in Shanghai, China.

Exposure to magnetic fields (MFs) is hypothesized to increase the risk of breast cancer by reducing production of melatonin by the pineal gland. A nested case-cohort study was conducted to investigate the association between occupational exposure to MFs and the risk of breast cancer within a cohort of 267,400 female textile workers in Shanghai, China. The study included 1,687 incident breast cancer cases diagnosed from 1989 to 2000 and 4,702 noncases selected from the cohort. Subjects' complete work histories were linked to a job-exposure matrix developed specifically for the present study to estimate cumulative MF exposure. Hazard ratios and 95% confidence intervals were calculated using Cox proportional hazards modeling that was adapted for the case-cohort design. Hazard ratios were estimated in relation to cumulative exposure during a woman's entire working years. No association was observed between cumulative exposure to MFs and overall risk of breast cancer. The hazard ratio for the highest compared with the lowest quartile of cumulative exposure was 1.03 (95% confidence interval: 0.87, 1.21). Similar null findings were observed when exposures were lagged and stratified by age at breast cancer diagnosis. The findings do not support the hypothesis that MF exposure increases the risk of breast cancer.

Development of a permeation panel to test dermal protective clothing against sprayed coatings.

OBJECTIVES: Design, construct, and characterize an apparatus to evaluate dermal protective clothing for resistance to polymerizing materials. Specifically, we evaluated the permeation of the most common glove material used in automotive collision repair (0.10-0.13 mm or 4-5 mil latex) with representative isocyanate-containing clear coats. Our ultimate goal is to make informed recommendations on dermal protective materials to prevent isocyanate exposures and reduce the likelihood of occupational illness in automotive collision repair and other industries. METHODS: A novel permeation panel was developed to assess dermal protective clothing. With this apparatus, up to eight test materials may be evaluated under typical-spray application conditions. Solid collection media comprised of 1-(2-pyridyl)-piperazine (2-PP)-coated fiberglass filters or colorimetric SWYPE™ pads were placed behind test materials to capture permeants. The 2-PP-coated filters were subsequently analyzed using a modified OSHA42/PV2034 method. Color change in the SWYPEs provided an immediate field estimate of breakthrough time. In addition, Teflon filters were mounted proximal to the permeation cells to measure the mass of clear coat applied to the panel and to evaluate loading homogeneity. This study evaluated the permeation of isocyanates through 0.10-0.13 mm latex glove material at a fixed time (30 min post-spraying) and over a time course (6-91 min post-spraying). RESULTS: Monomers 1,6-hexamethylene diisocyanate (HDI) and isophorone diisocyanate (IPDI) permeated through (0.10-0.13 mm) latex glove material under typical glove use conditions (30 min). The latex glove material exhibited immediate breakthrough, with a permeation rate of 2.9 ng min(-1) cm(-2). The oligomeric forms of HDI and IPDI did not permeate the latex glove material. The spray application at 71 ± 5 °F was fairly homogeneous (33.7 ± 8 mg weight of dry clear coat per 5 cm(2)). CONCLUSIONS: The permeation panel is a viable method to assess dermal protective clothing performance against polymerizing materials. Thin (0.10-0.13 mm) latex gloves were determined to be ineffective barriers to the isocyanates commonly found in clear coats. Because this type of glove is used frequently in auto body shops, the potential for isocyanate exposure is of concern. Permeation tests with other dermal protective clothing materials and other clear coat formulations are needed to make recommendations about alternative materials.

Wood dust exposure and risk of lung cancer.

OBJECTIVES: Despite the compelling association between wood dust and sinonasal cancer, there has been little systematic and rigorous study of the relationship between wood dust and lung cancer. We investigated whether a history of wood dust exposure through occupational and hobby-related activities was associated with increased lung cancer risk. METHODS: We conducted a population-based case-control study, with 440 cases and 845 age-matched controls. Using detailed work and personal histories, quantitative estimates of cumulative exposure to wood dust (thought to be primarily from softwood) were calculated for each participant. Using unconditional logistic regression adjusted for age and smoking status, risk of lung cancer was examined in relation to employment in wood-related occupations, working with wood as a hobby, as well as cumulative wood dust exposure that took into account both occupational and hobby-related sources. RESULTS: While we observed an increased risk of lung cancer associated with working in a sawmill (OR=1.5; 95% CI: 1.1, 2.1), we found no evidence of increased risks with other occupations, working with wood as a hobby or with estimated cumulative exposure to wood dust. Contrary to our hypothesis, we observed modest decreased risks with exposure to wood dust, although no dose-response relationship was apparent. CONCLUSIONS: This study provided somewhat reassuring evidence that softwood dust does not increase the risk of lung cancer, but future studies should evaluate exposure to hardwood dusts. Suggestive evidence for an inverse association may be attributable to the presence of endotoxin in the wood dust, but the lack of a dose-response relationship suggests a non-causal relationship.

Physical activity, physical exertion, and miscarriage risk in women textile workers in Shanghai, China.

BACKGROUND: Strenuous occupational physical activity and physical demands may be risk factors for adverse reproductive outcomes. METHODS: A retrospective study in the Shanghai, China textile industry study collected women's self-reported reproductive history. Occupational physical activity assessment linked complete work history data to an industry-specific job-exposure matrix. Odds ratios (OR) and 95% confidence intervals (CI) were estimated by multivariate logistic regression for the first pregnancy outcome and utilized generalized estimating equations to consider all pregnancies per woman. RESULTS: Compared with women employed in sedentary jobs, a reduced risk of miscarriage was found for women working in jobs with either light (OR 0.18, 95% CI: 0.07, 0.50) or medium (OR 0.24, 95% CI: 0.08, 0.66) physical activity during the first pregnancy and over all pregnancies (light OR 0.32, 95% CI: 0.17, 0.61; medium OR 0.43, 95% CI: 0.23, 0.80). Frequent crouching was associated with elevated risk (OR 1.82, 95% CI: 1.14, 2.93; all pregnancies per woman). CONCLUSIONS: Light/medium occupational physical activity may have reduced miscarriage risk, while specific occupational characteristics such as crouching may have increased risk in this cohort.

Possibilities and challenges in occupational injury surveillance of day laborers.

BACKGROUND: Day laborers in the US, comprised largely of undocumented immigrants from Mexico and Central America, suffer high rates of occupational injury according to recent estimates. Adequate surveillance methods for this highly transient, largely unregulated group do not currently exist. This study explores chart abstraction of hospital-based trauma registry records as a potential injury surveillance method for contingent workers and day laborers. We sought to determine the degree of completeness of work information in the medical records, and to identify day laborers and contingent workers to the extent possible. METHODS: Work-related injury cases from a hospital-based trauma registry (2001-2006) were divided by ethnicity (Hispanic vs. non-Hispanic origin) and presence of social security number (SSN: yes, no), resulting in four groups of cases. Medical records were abstracted for 40 cases from each group; each case was assigned values for the variables "day labor status" (yes, no, probably not, probable, unknown) and "employment type" (contingent, formal, unknown). RESULTS: Work information was missing for 60% of Hispanic cases lacking SSN, as compared with 33-47% of the other three groups. One "probable" day laborer was identified from the same group. Non-Hispanics with SSN were less frequently identified as contingent workers (5% as compared with 15-19%). CONCLUSIONS: This method revealed severe limitations, including incomplete and inconsistent information in the trauma registry and medical records. Approaches to improve existing resources for use in surveillance systems are identified. The potential of an active surveillance approach at day labor hiring centers is also briefly discussed.

Objective color scale for the SWYPE surface sampling technique using computerized image analysis tools.

Colorimetric SWYPE pads are useful tools for identifying unpolymerized aliphatic isocyanates on a variety of surfaces. This technique has been used in autobody shops to determine the presence of hexamethylene diisocyanate and other aliphatic isocyanates that are important constituents of many automotive coatings. SWYPEs have the advantage of being relatively inexpensive, rapid, and portable. The color change elicited by aliphatic isocyanates (from yellow to red) provides a visual indication of the extent of surface contamination. To quantify isocyanate contamination based on the colorimetric response, an objective color scale was developed for isocyanate loading. Sampled pads were digitized on a calibrated, portable flatbed scanner, and red-green-blue (RGB) histograms of SWYPE images were created. A calibration curve was created from a series of reference images derived from SWYPEs loaded with an isocyanate-containing product. The SWYPE RGB analysis allowed for quantification over a range of isocyanate loadings: from approximately 0.01 to 24.0 microg/cm(2), with reproducibility of >90%, accuracy >90%, and a surface extraction efficiency of >90%. RGB analysis exhibited a lower detection limit than visual scoring (approximately 3 microg versus approximately 10 microg). The colorimetric response was cross validated with a high-performance liquid chromatography quantitative assay. When combined with RGB analysis, SWYPE colorimetric wipes represent a rapid and inexpensive method to assess objectively surface contamination with aliphatic isocyanates.

Exposure to fall hazards and safety climate in the aircraft maintenance industry.

PROBLEM: Falls represent a significant occupational hazard, particularly in industries with dynamic work environments. This paper describes rates of noncompliance with fall hazard prevention requirements, perceived safety climate and worker knowledge and beliefs, and the association between fall exposure and safety climate measures in commercial aircraft maintenance activities. METHODS: Walkthrough observations were conducted on aircraft mechanics at two participating facilities (Sites A and B) to ascertain the degree of noncompliance. Mechanics at each site completed questionnaires concerning fall hazard knowledge, personal safety beliefs, and safety climate. Questionnaire results were summarized into safety climate and belief scores by workgroup and site. Noncompliance rates observed during walkthroughs were compared to the climate-belief scores, and were expected to be inversely associated. RESULTS: Important differences were seen in fall safety performance between the sites. The study provided a characterization of aircraft maintenance fall hazards, and also demonstrated the effectiveness of an objective hazard assessment methodology. Noncompliance varied by height, equipment used, location of work on the aircraft, shift, and by safety system. DISCUSSION: Although the expected relationship between safety climate and noncompliance was seen for site-average climate scores, workgroups with higher safety climate scores had greater observed noncompliance within Site A. Overall, use of engineered safety systems had a significant impact on working safely, while safety beliefs and climate also contributed, though inconsistently. IMPACT ON INDUSTRY: The results of this study indicate that safety systems are very important in reducing noncompliance with fall protection requirements in aircraft maintenance facilities. Site-level fall safety compliance was found to be related to safety climate, although an unexpected relationship between compliance and safety climate was seen at the workgroup level within site. Finally, observed fall safety compliance was found to differ from self-reported compliance.

Occupational risk factors for endometrial cancer among textile workers in Shanghai, China.

OBJECTIVE: A case-cohort study was conducted to investigate associations between occupational exposures and endometrial cancer nested within a large cohort of textile workers in Shanghai, China. METHODS: The study included 176 incident endometrial cancer cases diagnosed from 1989 to 1998 and a randomly-selected age-stratified reference subcohort (n = 3,061). Study subjects' complete work histories were linked to a job-exposure matrix developed specifically for the textile industry to assess occupational exposures. Hazard ratios (HR) and 95% confidence intervals were calculated using Cox proportional hazards modeling adapted for the case-cohort design, adjusting for age at menarche and a composite variable of gravidity and parity. RESULTS: An increased risk of endometrial cancer was detected among women who had worked for > or =10 years in silk production (HR = 3.8, 95% CI 1.2-11.8) and had exposure to silk dust (HR = 1.7, 95% CI 0.9-3.4). Albeit with few exposed women (two cases and eight subcohort women), there was a 7.4-fold increased risk associated with > or =10 years of silica dust exposure (95% CI 1.4-39.7). CONCLUSIONS: The findings suggest that some textile industry exposures might play a role in endometrial carcinoma and should be further replicated in other occupational settings.

Physical exposure differences between children and adults when using standard and small computer input devices.

By the age of five years, 75% of the children in the USA are using computers and at this age they are only one-half to two-thirds the size of and about one-fifth as strong as their adult counterparts. Fourteen children between five and eight years of age and their same-gender biological parents (giving a total of 28 subjects) were evaluated using both a standard and a smaller, child-proportional input device during standardised mouse and keyboard tasks. Typing and computer mouse performance were measured with tracking software, wrist posture was measured with an electrogoniometer and electromyography was used to measure finger flexor and extensor muscle activity in the right arm. With the small mouse, both children and adults performed the mouse task significantly faster and made significantly fewer errors. When using the standard-sized mouse and keyboard, children worked with significantly greater ulnar deviation and significantly less extension than their adult counterparts. When children used the smaller mouse, finger flexor muscle activity, finger extensor muscle activity and ulnar deviation significantly decreased, with little change in wrist extension compared to the standard mouse. No significant differences were observed between the standard and small keyboards for children or their parents. Compared to their adult counterparts, children had to apply twice the relative force, as a percentage of their maximum capacity, to activate the buttons and keys on the input devices. These measured differences may have application in the design of computer input devices for children.

Occupational health and safety experience of day laborers in Seattle, WA.

BACKGROUND: Day Labor is a growing part of the informal economy in the US, and in Seattle, and may entail a high risk of injury and illness at work. METHODS: We surveyed 180-day laborers, at two worker centers and an unregulated "Street" location concerning their job-specific exposures and injury experience. RESULTS: Exposures to both health and safety hazards were common at all three sites. After controlling for type of work, immigrant workers were 1.5-2 times more likely than non-immigrant day laborers to report exposure to hazardous conditions. Among the 180 participants 34 reported injuries were classified as "recordable." We estimated an injury rate of 31 recordable injuries per 100 full time employees. The three hiring locations had differing job experiences and exposures. Those hired through worker centers had a lower risk of exposures, while the Street workers were more likely to refuse hazardous work. CONCLUSIONS: Day laborers are exposed to numerous hazards at work, resulting in high injury rates. Multiple approaches including community based organizations which may provide some employment stability and social support for protection at work are needed to reduce occupational injury and illness risk among these vulnerable populations.

Occupational exposures and ovarian cancer in textile workers.

BACKGROUND: Occupational risk factors for ovarian cancer have been investigated only to a limited extent. We conducted a case-cohort study to examine associations between occupational exposures and ovarian cancer in the textile industry. METHODS: We compared 261 incident ovarian cancer cases diagnosed between 1989 and 1998 with an age-stratified reference subcohort (n = 3199) from a cohort of 267,400 textile workers in Shanghai, China. Occupational exposures were assessed by job-exposure matrices designed for the textile industry, and estimates of quantitative cotton dust and endotoxin. We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) with Cox proportional hazards modeling adapted for the case-cohort design. RESULTS: A decreased risk of ovarian cancer was associated with ever having worked in cotton manufacturing production (HR = 0.7; 95% CI = 0.4-1.0). An increased risk was associated with ever having worked in textile finishing (2.1; 0.9-5.0). We found an increasing risk of ovarian cancer associated with cumulative exposure to silica dust (for <10 years exposure, HR = 6.8 [CI = 0.6-76]; for > or =10 years, 5.6 [1.3-23.6]), although these results are based on only 8 exposed subcohort women (0.3%) and 4 cases (1.3%). We also detected inverse risk gradients for cumulative exposures to endotoxin when exposures were lagged by 20 years (in highest quartile, HR = 0.6 [CI = 0.4-1.1]). CONCLUSION: Silica dust may increase the risk of ovarian cancer, and cotton dust and endotoxin may reduce risk.

Occupational exposures and breast cancer among women textile workers in Shanghai.

BACKGROUND: Breast cancer incidence rates have been increasing in China over the past 2 decades. Most studies have focused on reproductive, dietary, and genetic risk factors. Little is known about the contribution of occupational exposures. METHODS: We conducted a case-cohort study within a cohort of female textile workers who had participated in a randomized trial of breast self-examination in Shanghai, China. We compared 1709 incident breast cancer cases with an age-stratified reference subcohort (n = 3155 noncases). Cox proportional hazards modeling, adapted for the case-cohort design, was used to estimate hazard ratios for breast cancer in relation to duration of employment in various job processes and duration of exposure to several agents. We also evaluated the associations of cotton dust and endotoxin with breast cancer. RESULTS: Cumulative exposures to cotton dust and endotoxin demonstrated strong inverse gradients with breast cancer risk when exposures were lagged by 20 years (trend P-values <0.001). We did not observe consistent associations with exposures to electromagnetic fields, solvents, or other chemicals. CONCLUSION: Endotoxin or other components of cotton dust exposures may have reduced risks for breast cancer in this cohort, perhaps acting at early stages of carcinogenesis. Replication of these findings in other occupational settings with similar exposures will be needed to confirm or refute any hypothesis regarding protection against breast cancer.

Lung cancer risk among female textile workers exposed to endotoxin.

BACKGROUND: Reduced risk of lung cancer among workers in the cotton textile industry has been observed since the 1970s. Bacterial endotoxin, a contaminant of raw cotton fiber and cotton dust, has been proposed as a protective agent that may act through the innate and acquired immune systems. We examine the association between endotoxin exposure and lung cancer risk in a cohort of female textile workers. METHODS: We conducted a case-cohort study nested within a cohort of 267,400 female textile workers in Shanghai, China. We compared the cumulative exposure histories of 628 case patients diagnosed with incident lung cancer from January 1, 1989, through December 31, 1998, with those of a lung cancer-free reference subcohort of 3184 workers who were frequency matched by 5-year age-groups to all cancer patients in the cohort. Cumulative endotoxin exposure for all participants was based on historic measurements and on additional measurements for this study. Relative risks and 95% confidence intervals (CIs) were estimated by hazard ratios (HRs) from Cox proportional hazards models. We conducted exposure-response trend analyses by use of cumulative exposures with lag times of 0, 5, 10, 15, or 20 years to account for disease latency. All analyses controlled for age and smoking status. All statistical tests were two-sided. RESULTS: Cumulative exposure to endotoxin was strongly, statistically significantly, and inversely associated with lung cancer risk. The inverse trend was greatest with a 20-year lag time, for which highest endotoxin exposure was associated with a statistically significantly 40% less risk of lung cancer (HR = 0.60, 95% CI = 0.43 to 0.83; P(trend) across quintiles = .002) than non-exposure. From a reported population rate of lung cancer among women in Shanghai of 19.1 per 100,000 for the year 2000 and the estimated reduction in risk of lung cancer observed for 20 years of endotoxin exposure in this population of workers, the incidence of lung cancer in this cohort was reduced by approximately 7.6 per 100,000 (range = 3.2-10.9 per 100,000). CONCLUSIONS: Long-term and high-level exposure to endotoxin, compared with no exposure, appears to be associated with a reduced risk of lung cancer in this cohort.

Comparing the results of five lifting analysis tools.

The objective of this study was to compare the results of the NIOSH, ACGIH TLV, Snook, 3DSSPP and WA L&I lifting assessment instruments when applied to a uniform task (lifting and lowering milk cases with capacities of 15 and 23l). To enable comparisons between the various lifting assessment instruments, the outputs of each method were converted to an exposure index similar to the NIOSH Lifting Index. All instruments showed higher exposures associated with lifting the 23l cases versus the 15l cases. The NIOSH, ACGIH TLV and Snook methods were similar in their results with respect to the pattern of exposure over various height levels and the differences in exposures associated with lifting 15 and 23l cases. However, the WA L&I and 3DSSPP predicted substantially lower exposures. The reasons for instrument differences are presented so that practitioners can better select the methods they need and interpret the results appropriately.

Development of a job exposure matrix (JEM) for the textile industry in Shanghai, China.

We developed a job exposure matrix (JEM) for the Shanghai textile industry constructed along three axes: industry sector, textile process, and hazardous agent. We assessed 35 different categories of dust, chemical, and physical agents for 149 textile processes within nine industry sectors: cotton, cotton/synthetic, cotton/other (nonsynthetic), wool, silk, synthetic, mineral, other mixed (e.g., wool and synthetic), and nonproduction. The JEM was constructed from two components: a priori assessment of the textile process by a team of U.S. industrial hygienists, and the prevalence of exposures reported by Chinese industrial hygienists in specific textile processes within the factory. The JEM was applied to an ongoing case-cohort study of cancer in women textile workers. The JEM assessed only dichotomous exposure (ever/never), and could be coupled with cumulative exposure by years of employment. The most common exposures in cotton mills were cotton dust and solvent exposures. Dyeing processes had the highest frequency of exposures, including solvents, acids, bases and caustics, bleaching agents, dyes, dye chemicals and intermediates, and formaldehyde. Only two processes were identified with formaldehyde exposure, beck dyeing and resin finishing. The most prevalent exposures among the subcohort, occurring in more than 60% of the women, were electromagnetic fields, lubricants, and cotton dust. More than one-third of subcohort subjects were also exposed to synthetic fiber dust, and slightly less than one-third of women were exposed to endotoxin. This JEM could be applicable for epidemiologic research in other textile industries.