Occupational health survey of farm workers by camp health aides.

Little is known about the magnitude of occupational health problems among migrant farm workers. A community-based cross-sectional survey was conducted in two migrant farm worker communities: Homestead, Florida, and Kankakee, Illinois. Camp Health Aides (CHAs) interviewed 425 workers about job tasks, personal protective equipment (PPE), field sanitation, work exposures, and selected health conditions. Limited provision of personal protective equipment was reported among those reporting early re-entry tasks: 35% in Kankakee and 42% in Homestead were provided gloves, and 22% in Homestead and 0% in Kankakee were provided protective clothing. About two-thirds were provided toilet facilities and water for hand-washing. Workers reported high prevalences of health conditions consistent with exposure to ergonomic hazards and pesticides. The prevalence of back pain in the past 12 months was 39% in Homestead and 24% in Kankakee. Among Homestead participants, 35% experienced eye symptoms, while 31% reported skin symptoms. These symptoms were less prevalent among Kankakee participants (16% for both eye and skin symptoms). Specific areas of concern included back pain associated with heavy lifting and ladder work; eye and skin irritation associated with fertilizer application tasks and with working in fields during or after spraying of chemicals, especially early re-entry of sprayed fields; and skin irritation associated with a lack of access to hand-washing facilities. In both Kankakee and Homestead, better adherence to safety standards is needed, as well as greater efforts to implement solutions that are available to help prevent work-related musculoskeletal problems.

Cancer mortality among laundry and dry cleaning workers.

A cancer mortality study of 8,163 deaths occurring among persons formerly employed as laundering and dry cleaning workers in 28 states is described. Age-adjusted sex-race cause-specific proportionate mortality ratios (PMRs) and proportionate cancer mortality ratios (PCMRs) were computed for 1979 through 1990, using the corresponding 28-state mortality as the comparison. For those aged 15-64 years, there were excesses in black men for total cancer mortality (PMR = 130, 95% confidence interval (CI) = 105-159) and cancer of the esophagus 1 (PMR = 215, 95% CI = 111-376), and in white men for cancer of the larynx (PMR = 318, 95% CI = 117-693). For those aged 65 years and over, there were statistically nonsignificant excesses for cancer of the trachea, bronchus, and lung in black women (PMR = 128, CI = 94-170) and for cancer of other and unspecified female genital organs in white women (PMR = 225, CI = 97-443). The results of this and other studies point to the need for the effective implementation of available control measures to protect laundry and dry cleaning workers.

Mortality patterns among female nurses: a 27-state study, 1984 through 1990.

OBJECTIVES: This study examined the mortality experience of 50,000 nurses using the National Occupational Mortality Surveillance database of death certificates. METHODS: Proportionate mortality ratios adjusted by race (White, Black, or other) and 5-year age groups were calculated for selected causes of death among female nurses vs all workers and white-collar workers. RESULTS: Excess deaths among nurses less than 65 years of age were seen in both comparison groups for viral hepatitis, cancer of the nasal cavities, accidental falls, suicide, and drug-related deaths. Among nurses 65 years old or older, deaths due to chronic myeloid leukemia were in excess. Proportionate mortality ratios for breast and colon cancers, diabetes, and heart disease varied by occupational comparison group. CONCLUSIONS: These findings confirm results of previous studies and identify new associations. Redoubled efforts are called for in overcoming obstacles to reducing workplace hazards.

Gastrointestinal cancer mortality of workers in occupations with high asbestos exposures.

Asbestos, which is a well-known risk factor for lung cancer and malignant mesothelioma, has also been suggested as a gastrointestinal (GI) carcinogen. This study was conducted to assess the relationship between high asbestos exposure occupations and the occurrence of G1 cancer. Death certificate data were analyzed from 4,943,566 decedents with information on occupation and industry from 28 states from 1979 through 1990. Elevated proportionate mortality ratios (PMRs) for mesothelioma were used to identify occupations potentially having many workers exposed to asbestos. All PMRs were age-adjusted and sex- and race-specific. The PMRs for GI cancers in white males were then calculated for these occupations after excluding mesothelioma, lung cancer, and non-malignant respiratory disease from all deaths. We identified 15,524 cases of GI cancer in the 12 occupations with elevated PMRs for mesothelioma. When these occupations were combined, the PMRs for esophageal, gastric, and colorectal cancer were significantly elevated at 108 (95% confidence interval = 107-110), 110 (106-113), and 109 (107-110), respectively. Esophageal cancer was elevated in sheet metal workers and mechanical workers. Gastric cancer was elevated in supervisors in production and managers. Colorectal cancer was elevated in mechanical and electrical and electronic engineers. However, high exposure occupations like insulation, construction painter supervisors, plumbers, furnace operators, and construction electricians showed no elevations of GI cancers. In conclusion, this death certificate study supports an association between asbestos exposure and some GI cancer, however the magnitude of this effect is very small.

Women: work and health.

OBJECTIVES: This report describes the sociodemographics, household characteristics, and health of women according to workforce status and job conditions. The report also presents data on men for comparison. METHODS: This report combines data from numerous data systems, including: The National Health Interview Survey, National Health and Nutrition Examination Survey, National Maternal and Infant Health Survey, National Hospital Ambulatory Medical Care Survey, National Traumatic Occupational Fatalities Surveillance System, and the National Occupational Mortality Surveillance System, which are conducted by the U.S. Department of Health and Human Services; the Census of Fatal Occupational Injuries and Annual Survey of Occupational injuries and illnesses conducted by the U.S. Department of Labor; and the Current Population Survey conducted by the U.S. Department of Commerce. The report also presents selected tables from publications of the Women's Bureau and the Bureau of Labor Statistics, U.S. Department of Labor. RESULTS: The report presents summary data on physical conditions and exposures, health conditions attributed to work, other health conditions that impact on work, health promotion in the workplace, and health-related benefits provided by employers. Most estimates are shown according to sex, age, race, ethnicity, educational attainment, and major occupational group.

Occupation and cervical cancer: an opportunity for prevention.

Cervical cancer remains an important health problem for women. Few published studies have examined cervical cancer with respect to a woman's occupation. This study examines the association of cervical cancer mortality and occupation in a large national database. The purpose of the study is to recommend which occupations may most require health promotion activities. Mortality data from the National Occupational Mortality Surveillance System were used to calculate the proportion of deaths from cervical cancer according to occupation. This study is based on standardized death certificate data for almost 2 million deaths among women in 27 states, covering the period 1985-1990. Our results are consistent with those in previous studies, with service and apparel manufacturing workers showing elevated risk. Data presented show a difference in cervical cancer mortality by occupational group. Identification of these occupations suggests which women could be targeted for preventive services. Women in occupations with low socioeconomic status are less likely to have access to health promotion programs. Resources should be directed to these women.

Assessment of mortality in the construction industry in the United States, 1984-1986.

Construction, one of the larger industries in the United States, employs 7.6 million workers, many in skilled trades occupations. Previously published data about potential worksite exposures and mortality of construction site workers are limited. We analyzed occupation and industry codes on death certificates from 19 U.S. states to evaluate mortality risks among men and women usually employed in construction occupations. Proportionate mortality ratios (PMRs) for cancer and several other chronic diseases were significantly elevated among 61,682 white male construction workers who died between 1984 and 1986. Men younger than age 65, who were probably still employed immediately prior to death, had significantly elevated PMRs for cancer, asbestos-related diseases, mental disorders, alcohol-related disease, digestive diseases, falls, poisonings, traumatic fatalities that are usually work-related, and homicides. Elevated PMRs for many of the same causes were observed to a lesser degree for black men and white women whose usual industry was construction. In addition, women experienced excess cancer of the connective tissue and suicide mortality. Various skilled construction trades had elevated PMRs for specific sites, such as bone cancer and melanoma in brickmasons, stomach cancer in roofers and brickmasons, kidney and bone cancer in concrete/terrazzo finishers, nasal cancer in plumbers, pulmonary tuberculosis in laborers, scrotal cancer and aplastic anemia in electricians, acute myeloid leukemia in boilermakers, rectal cancer and multiple sclerosis in electrical power installers, and lung cancer in structural metal workers. Using a standard population of blue collar workers did not result in fewer elevated PMRs for construction workers. Despite lifestyle differences and other limitations of the study, the large numbers of excess deaths observed in this study indicate the need for preventive action for construction workers.

Mortality patterns among construction workers in the United States.

Thirteen authors from the National Institute for Occupational Safety and Health contribute to this summary of recent and ongoing national occupational mortality surveillance studies of construction workers, including studies conducted under NIOSH's Fatality Assessment and Control Evaluation project, Sentinel Health Events project, National Occupational Mortality Surveillance System, and other projects.

A comparison of analyses of occupational bladder cancer: death certificate vs. population-based case-control interview data.

The authors examined the utility of death certificate data for occupational health surveillance by comparing the ability of the data to identify high-risk occupations for bladder cancer with that of a population-based case-control study. Death certificate data for white males from 23 states for 1979-1987 were analyzed using proportionate mortality ratios. The case-control study used cancer registry cases for 1977-1978. Results were compared for 21 a priori suspect occupations. A broad definition of agreement resulted in agreement for 62% of the occupations; the death certificate study identified eight of 15 occupations identified by the case-control study and neither study identified five of the categories. While death certificate data have many limitations, our results indicate that death certificate data can provide clues to some potential occupational health problems. With the advantages of inexpensive data, large sample size, and industrial coverage, more refined analyses of the data should prove useful for occupational mortality surveillance and hypothesis generation.

An application of the Sentinel Health Event (Occupational) concept to death certificates.

This article describes a computer-based application of the Sentinel Health Event (Occupational) [SHE(O)] concept, developed in conjunction with five states, to monitor deaths which are occupationally related. The states have coded their state death certificate files for industry and occupation, using the decedent's usual occupation and industry as reported on the death certificate. From these files, the SHE(O) computer program selects deaths which are likely to be work-related, based on a previously published SHE(O) list of 50 disease rubrics and associated industries and occupations. The computer program matches the SHE(O) list with the recorded industry, occupation, and underlying cause of death. The program has been tested using 1984 death certificate data from Maine, upstate New York (excluding New York City), North Carolina, Pennsylvania, and Rhode Island. Approximately 1 to 2 per cent of all deaths were selected by the program, with lung cancer and coal workers' pneumoconiosis being the most frequent cause of death. The SHE(O) program may be useful for identifying deaths which are potentially occupationally related, but its utility and its application to death certificates needs further evaluation before recommending widespread use. Limitations are discussed, as well as plans for improving the application of the SHE(O) concept to death certificates.

Death certificate-based occupational mortality surveillance in the United States.

Surveillance of cause-specific mortality patterns by occupation and industry through the use of death certificate records is a simple and relatively inexpensive approach to the generation of leads as to potential occupational disease problems. Researchers from the National Institute for Occupational Safety and Health (NIOSH) have been working with the National Center for Health Statistics, other federal agencies, and state health departments on a number of programs to foster the development of standardized, routine coding of occupation and industry entries on death certificates by state health departments. Thirty-one states and the District of Columbia are now doing such coding. These data are being analyzed currently by investigators at NIOSH and at individual state health departments for the purpose of hypothesis generation on occupation-disease relationships. The proportionate mortality ratio method is the predominant method being used, as appropriate denominator data are not generally available. This type of surveillance is particularly useful for the study of occupation and industry groups for which it is difficult to assemble cohorts, such as groups that are predominantly non-union and in small workplaces. Limitations of this surveillance include its inappropriateness for monitoring those occupational diseases which are not often fatal, and the limited scope and accuracy of death certificate information.

Maternal occupation and industry and the pregnancy outcome of U.S. married women, 1980.

Data from the 1980 National Natality and National Fetal Mortality Surveys were used to characterize the occupations of women during the year before delivery; to search for disproportionate numbers of adverse pregnancy outcomes in specific occupational groups; and to compare demographic, reproductive, and lifestyle characteristics of employed mothers to those of mothers not employed in the year before delivery. National estimates were derived from the sample through a complex poststratified ratio adjustment procedure. For all pregnancy outcome groups, the greatest proportion of mothers were employed in three industry categories: professional and related services, wholesale and retail trade, and manufacturing; and in four occupation categories: clerical and kindred workers; professional, technical, and kindred workers; service workers; and operatives. Compared with employed mothers of live-born infants, a greater proportion of employed mothers of low birth weight infants worked full-time but stopped working before the third trimester. Compared with unemployed mothers, a larger proportion of employed mothers were between 20-29 years old, college educated, had a total family income of $21,000 or more per year, received early prenatal care, had no previous pregnancy, and drank alcohol during pregnancy. Estimates from this study may be used to (a) provide a better perspective of the magnitude of reproductive health problems, (b) target certain industrial populations for further research, and (c) assist in identifying causes of reproductive failure.

Uses of computer-generated maps in occupational hazard and mortality surveillance.

The purpose of the present paper was to describe five ways in which computer-generated maps for 3,073 United States political subdivisions (counties) are being used as a part of the National Institute for Occupational Safety and Health surveillance system. Four maps show the approximate spatial location of potential workplace hazards in terms of (i) worksites, (ii) estimates of the proportion of workers at risk for US counties, and (iv) counties within a selected state. A fifth map shows age-standardized county-level mortality for a cause of death associated with an occupational risk. These five types of maps represent first efforts to present and disseminate information in an effective format and to generate occupational health surveillance leads that may warrant further research.

Job demands and worker health in machine-paced poultry inspection.

A questionnaire survey was used to assess job stress, strain, and health complaints associated with machine-paced poultry inspection. Four groups of employees, with differing amounts of time on the inspection line, were compared: full-time inspectors, part-time inspectors, rotating relief inspectors, and a supervisory group. Results showed full-time inspectors to have generally the highest job stress and poorest work environment scores. Social support from supervisors was lowest for the full-time inspectors, while rotating relief inspectors had the least support from others at work. Measures of psychological and behavioral strain were highest for the full-time inspectors, usually followed by the rotating relief inspectors. Health complaints showing a difference by group involved the respiratory, skin, musculoskeletal, gastrointestinal, and visual systems. Full-time inspectors and the highest frequency rates for 17 symptoms, while rotating relief inspectors were highest for nine. Relative to workers in previously studied occupations, full-time inspectors were high on stresses and strains and low on social. Recommendations for improvements were made based on a model relating stresses to health effects.