Prepandemic Feasibility of Tele-Exercise as an Alternative Delivery Mode for an Evidence-Based, Tai Ji Quan Fall-Prevention Intervention for Older Adults.

There is a critical need for fall-prevention interventions to reach medically underserved, hard-to-reach, rural older adults. The evidence-based Tai Ji Quan: Moving for Better Balance (TJQMBB) program reduces falls in older adults. This pre-COVID-19 pandemic study assessed the feasibility and impact of a 16-week tele-TJQMBB intervention in older adults. Instructors led six tele-TJQMBB classes via Zoom for 52 older adults (mean age ± SD 68.5 ± 7.7 years) at one academic and four community sites. Nearly all (97%) planned sessions were delivered. Average attendance was 61%. There were no adverse events. Fidelity was fair to good (mean 67%). Forty-one percent of sessions experienced technical disruptions. Participants improved their gait speed, balance, lower-extremity strength, and body mass index. Tele-TJQMBB was feasible with a positive impact on outcomes. This study was the first step toward establishing an additional delivery mode that could potentially expand TJQMBB's reach and maintenance.

If Smoking Were Eliminated, Which US Counties Would Still Have High Rates of Smoking-Related Cancers?

OBJECTIVE: to characterize the county variability of the impact of smoking elimination on rates of smoking-related cancers and explore whether common environmental indices predicted which metropolitan counties would experience high rates of smoking-related cancers even after smoking was eliminated. METHODS: Surveillance, Epidemiology, and End Results Program (SEER) and Environmental Protection Agency (EPA) data were obtained. County level cancer rates for 257 metropolitan SEER counties, including the observed rates and those predicted after eliminating smoking, were derived via multilevel regression modeling and age standardized to the 2016 SEER population. Associations between the EPA's Environmental Quality Index (EQI) scores and "Low Benefit" counties (counties that remain above the top 20th percentile of post-smoking elimination incidence rates) were explored via logistic regression. RESULTS: Reductions in smoking-related cancer incidence ranged from 58.4 to 3.2%. The overall EQI (OR = 1.96, 95% CI [1.34, 2.86]) and the air quality index (OR = 5.99, 95% CI [3.20, 11.22]) scores predicted higher odds of being a "Low Benefit" county. CONCLUSIONS: Substantial inequities in the post-smoking elimination cancer rates were observed; air pollution appears to be a primary explanation for this. Cancer prevention in metropolitan counties with high levels of air pollution should prioritize pollution control at least as much as tobacco control.

A comparison of owner/operator and worker perspectives on workplace safety in the West Virginia logging industry.

BACKGROUND: The logging industry is known to have one of the highest rates of fatal and nonfatal occupational injuries in the United States. Perspectives on why this study is so hazardous may differ between logging company owners/operators and workers. In this study, we explored and compared the safety perspectives of logging company owners/operators and workers in West Virginia. METHODS: Using a mixed-methods approach, we analyzed survey (n = 245) and interview (n = 14) data collected in 2015 from logging company owners/operators and workers in West Virginia. Survey data were analyzed via logistic regression; interview data were analyzed using thematic analysis. Response patterns were contrasted by occupational status (owners/operators vs. workers) in both analyses. RESULTS: Owners/operators and workers agreed on several aspects of workplace safety including the importance of personal protective equipment and the benefits of mechanization when timber harvesting. Key differences observed between owners/operators and workers included why injuries are underreported and the effects of production pressures on safety. CONCLUSION: While there was much agreement, owners/operators and workers in the West Virginia logging industry reported differences in key domains of workplace safety. These differences should be taken into account when designing and implementing safety programs in the logging industry.

Cancer rates not explained by smoking: a county-level analysis.

BACKGROUND: Debates over the importance of "lifestyle" versus "environment" contributions to cancer have been going on for over 40 years. While it is clear that cigarette smoking is the most significant cancer risk factor, the contributions of occupational and environmental carcinogens in air, water and food remain controversial. In practice, most cancer prevention messaging focuses on reducing cigarette smoking and changing other personal behaviors with little mention of environmental chemicals, despite widespread exposure to many known carcinogens. To inform decision-making on cancer prevention priorities, we evaluated the potential impact of smoking cessation on cancer rates. METHODS: Using cancer incidence data from 612 counties in the SEER database, and county-level smoking prevalences, we investigated the impact of smoking cessation on incidence for 12 smoking-related cancer types, 2006-2016. A multilevel mixed-effects regression model quantified the association between county-level smoking prevalence and cancer incidence, adjusting for age, gender and variability over time and among counties. We simulated complete smoking cessation and estimated the effects on county-level cancer rates. RESULTS: Regression models showed the expected strong association between smoking prevalence and cancer incidence. Simulating complete smoking cessation, the incidence of the 12 smoking-related cancer types fell by 39.8% (54.9% for airways cancers; 28.9% for non-airways cancers). And, while the actual rates of smoking-related cancers from 2006 to 2016 declined (annual percent change (APC) = - 0.8, 95% CI = - 1.0 to - 0.5%), under the scenario of smoking elimination, the trend in cancer incidence at these sites was not declining (APC = - 0.1, 95% CI = - 0.4 to + 0.1%). Not all counties were predicted to benefit equally from smoking elimination, and cancer rates would fall less than 10% in some counties. CONCLUSIONS: Smoking prevention has produced dramatic reductions in cancer in the US for 12 major types. However, we estimate that eliminating smoking completely would not affect about 60% of cancer cases of the 12 smoking-related types, leaving no improvement in the incidence trend from 2006 to 2016. We conclude that cancer prevention strategies should focus not only on lifestyle changes but also the likely contributions of the full range of risk factors, including environmental/occupational carcinogens.

Work-related deaths among youth: Understanding the contribution of US child labor violations.

BACKGROUND: Evidence shows that violations of the United States (US) child labor regulations are common. The main purpose of this study was to investigate the magnitude and nature of work-related deaths among youth involving violations of US child labor regulations. METHODS: We analyzed Census of Fatal Occupational Injury data from 2001 to 2012 using descriptive statistics and Chi-square tests. RESULTS: Between 2001 and 2012, 406 workers under age 18 were recorded in the CFOI as having suffered a fatal work-related injury. Among these cases, 233 were covered by the US child labor regulations. Forty-three percent of these cases involved at least one violation. The majority of cases that were not covered by the regulations involved decedents working on their family's farms (N = 139). CONCLUSIONS: Violations of federal child labor regulations are a significant contributor to work-related deaths among youth in the United States. Increased investment in enforcement is needed to prevent further young worker deaths involving child labor violations. Am. J. Ind. Med. 59:959-968, 2016. © 2016 Wiley Periodicals, Inc.

Occupational fatalities among young workers in the United States: 2001-2012.

BACKGROUND: While adolescent workers in the United States (US) are protected by child labor laws, they continue to suffer fatal occupational injuries. This study was designed to provide a comprehensive profile of occupational fatalities among this sub-population of US workers. METHODS: Using Census of Fatal Occupational Injuries data between 2001 and 2012, we calculated descriptive statistics and rates to examine the magnitude and nature of fatalities among workers under age 18. RESULTS: During the study period, there were 406 fatalities among young workers which translated into 24,790 years of potential life lost; 12,241 of which were in agriculture alone. Rates declined since 2001 yet Hispanics, foreign-born workers, males, and those working in agriculture continued to suffer a disproportionate fatality burden. CONCLUSIONS: Efforts to reduce young worker fatalities should focus on male Hispanics, particularly those who are foreign-born, as well as agricultural workers as these groups have the greatest fatality risks. Am. J. Ind. Med. 59:445-452, 2016. © 2016 Wiley Periodicals, Inc.

Surgical Team Stability and Risk of Sharps-Related Blood and Body Fluid Exposures During Surgical Procedures.

OBJECTIVE: To explore whether surgical teams with greater stability among their members (ie, members have worked together more in the past) experience lower rates of sharps-related percutaneous blood and body fluid exposures (BBFE) during surgical procedures. DESIGN: A 10-year retrospective cohort study. SETTING: A single large academic teaching hospital. PARTICIPANTS: Surgical teams participating in surgical procedures (n=333,073) performed during 2001-2010 and 2,113 reported percutaneous BBFE were analyzed. METHODS: A social network measure (referred to as the team stability index) was used to quantify the extent to which surgical team members worked together in the previous 6 months. Poisson regression was used to examine the effect of team stability on the risk of BBFE while controlling for procedure characteristics and accounting for procedure duration. Separate regression models were generated for percutaneous BBFE involving suture needles and those involving other surgical devices. RESULTS The team stability index was associated with the risk of percutaneous BBFE (adjusted rate ratio, 0.93 [95% CI, 0.88-0.97]). However, the association was stronger for percutaneous BBFE involving devices other than suture needles (adjusted rate ratio, 0.92 [95% CI, 0.85-0.99]) than for exposures involving suture needles (0.96 [0.88-1.04]). CONCLUSIONS: Greater team stability may reduce the risk of percutaneous BBFE during surgical procedures, particularly for exposures involving devices other than suture needles. Additional research should be conducted on the basis of primary data gathered specifically to measure qualities of relationships among surgical team personnel.

Surgical Procedure Characteristics and Risk of Sharps-Related Blood and Body Fluid Exposure.

OBJECTIVE To use a unique multicomponent administrative data set assembled at a large academic teaching hospital to examine the risk of percutaneous blood and body fluid (BBF) exposures occurring in operating rooms. DESIGN A 10-year retrospective cohort design. SETTING A single large academic teaching hospital. PARTICIPANTS All surgical procedures (n=333,073) performed in 2001-2010 as well as 2,113 reported BBF exposures were analyzed. METHODS Crude exposure rates were calculated; Poisson regression was used to analyze risk factors and account for procedure duration. BBF exposures involving suture needles were examined separately from those involving other device types to examine possible differences in risk factors. RESULTS The overall rate of reported BBF exposures was 6.3 per 1,000 surgical procedures (2.9 per 1,000 surgical hours). BBF exposure rates increased with estimated patient blood loss (17.7 exposures per 1,000 procedures with 501-1,000 cc blood loss and 26.4 exposures per 1,000 procedures with >1,000 cc blood loss), number of personnel working in the surgical field during the procedure (34.4 exposures per 1,000 procedures having ≥15 personnel ever in the field), and procedure duration (14.3 exposures per 1,000 procedures lasting 4 to <6 hours, 27.1 exposures per 1,000 procedures lasting ≥6 hours). Regression results showed associations were generally stronger for suture needle-related exposures. CONCLUSIONS Results largely support other studies found in the literature. However, additional research should investigate differences in risk factors for BBF exposures associated with suture needles and those associated with all other device types. Infect. Control Hosp. Epidemiol. 2015;37(1):80-87.

Factors affecting high school teacher adoption, sustainability, and fidelity to the "Youth@Work: Talking Safety" curriculum.

BACKGROUND: Our objective was to identify individual- and organizational-level factors that affect high school teacher adoption, sustainability, and fidelity to the occupational safety and health curriculum, "Youth@Work: Talking Safety." METHODS: We analyzed survey data collected from 104 high school teachers across the US who were trained in the curriculum since 2004. Linear and Cox regression were used to examine bivariate associations between individual and organizational-level factors and the outcomes of interest. RESULTS: Except for perceived complexity, all individual-level factors (acceptance, enthusiasm, teaching methods fit, and self-efficacy) were associated with one or more outcomes of interest (P-values ranged from <0.001 to 0.031). Priority for non-academic courses (P = 0.035) and supportive organizational climate (P = 0.037) were the organizational-level factors associated with sustainability and number of lessons delivered, respectively. CONCLUSIONS: Consistent with the literature, individual-level factors influenced teacher adoption and, to a lesser extent, sustainability, and fidelity to the Youth@Work: Talking Safety curriculum and should be considered in attempts to promote the curriculum's use in high schools.

Setting culture apart: distinguishing culture from behavior and social structure in safety and injury research.

The concept of culture is now widely used by those who conduct research on safety and work-related injury outcomes. We argue that as the term has been applied by an increasingly diverse set of disciplines, its scope has broadened beyond how it was defined and intended for use by sociologists and anthropologists. As a result, this more inclusive concept has lost some of its precision and analytic power. We suggest that the utility of this "new" understanding of culture could be improved if researchers more clearly delineated the ideological - the socially constructed abstract systems of meaning, norms, beliefs and values (which we refer to as culture) - from concrete behaviors, social relations and other properties of workplaces (e.g., organizational structures) and of society itself. This may help researchers investigate how culture and social structures can affect safety and injury outcomes with increased analytic rigor. In addition, maintaining an analytical distinction between culture and other social factors can help intervention efforts better understand the target of the intervention and therefore may improve chances of both scientific and instrumental success.

Occupational health literacy and work-related injury among U.S. adolescents.

Building on the concept of 'health literacy' used in the U.S., we developed an analogous measure specific to safety in the workplace labeled 'occupational health literacy' (OHL) and investigated whether OHL is a protective factor against work-related injury (WRI) among adolescents. Using cross-sectional survey data from 2262 14 to 18-year olds in five high schools across the US, we found that OHL (level of occupational safety and health (OSH) information and training received combined with knowledge and awareness of OSH information and concepts) is positively associated with WRI prevalence. This association appears to be largely driven by the OHL subscale on respondents' receipt of safety training, which likely represents job hazardousness and may be overwhelming any protective effect of OHL on work injury. This exploratory study has shown that more precise measurement of OHL and confounding variables (job hazardousness) will be crucial in further studies exploring a OHL-WRI relationship.

Safety, incentives, and the reporting of work-related injuries among union carpenters: "you're pretty much screwed if you get hurt at work".

BACKGROUND: In the high-risk construction industry little is known about the prevalence or effects of programs offering rewards for workers and/or their supervisors for improved safety records or those that punish workers in some way for injury. METHODS: We conducted an anonymous survey of 1,020 carpenter apprentices in three union training programs to document prevalence of their exposure to such efforts. We explored associations between perceptions of the reporting of work-related injury and elements of these programs. RESULTS: Fifty-eight percent (58%; n = 592) reported some safety incentive or negative consequence of work-related injuries on their current jobsite. Reporting of work-related injuries was 50% less prevalent when workers were disciplined for injury experiences. Otherwise, we saw minimal evidence of association between injury reporting practices and safety incentive programs. However, considerable evidence of fear of reprisal for reporting injuries was revealed. Less than half (46.4%) reported that work-related injuries were reported in their current workplace all or most of the time; over 30% said they were almost never or rarely reported. CONCLUSIONS: There are multiple layers of disincentives to the reporting of work-related injuries that hamper understanding of risk and pose threats to workplace safety and productivity. These pressures do not arise in a vacuum and are likely influenced by a host of contextual factors. Efforts that help us understand variation across jobsites and time could be enlightening; such inquiries may require mixed methodologies and should be framed with consideration for the upper tiers of the public health hierarchy of hazard control.

Musculoskeletal injuries among hospital patient care staff before and after implementation of patient lift and transfer equipment.

OBJECTIVE: Using an observational research design and robust surveillance data, we evaluated rates of musculoskeletal (MS) injuries, days away from work, and restricted work days among patient care staff at a medical center and community hospital in the United States over 13 years, during which time a "minimal manual lift" policy and mechanical lift equipment were implemented. METHODS: Workers' compensation claims data were linked to human resources data to define outcomes of interest and person-time at risk to calculate rates. Poisson and negative binomial regression with lagging were used to compare outcome rates in different windows of time surrounding the intervention. Patterns of MS injuries associated with patient-handling were contrasted to patterns of other MS injuries that would not be affected by the use of mechanical lift equipment. RESULTS: At the medical center, no change in the patient-handling MS injury rate followed the intervention. A 44% decrease was observed at the community hospital. At both hospitals, the rate of days away declined immediately - before it was reasonable for the intervention to have been adopted. CONCLUSIONS: Institutional-level changes at the time of the intervention likely influenced observed results with findings only partially consistent with an intervention effect. Observational studies can be useful in assessing effectiveness of safety interventions in complex work environments. Such studies should consider the process of intervention implementation, the time needed for intervention adoption, and the dynamic nature of work environments.

Young worker safety in construction: do family ties and workgroup size affect hazard exposures and safety practices?

OBJECTIVE: Little is known about how social aspects of the work environment influence exposures or safety practices affecting young construction workers. Our objective was to investigate whether working on a construction site with a small number of workers (≤10 vs. 11-50) or having a family-firm connection (working in a family-owned firm or one in which a family member also works) impacts hazard exposures and safety practices. PARTICIPANTS: Participants included 187 North Carolina construction workers 14 to 17 years old who were surveyed about their jobs. METHODS: We conducted stratified analyses using cross-tabulations and chi-square statistics to measure associations between workgroup size (i.e., the total number of workers on a jobsite) and family-firm connections (yes/no) and hazard exposures (e.g., saws) and safety practices (e.g., supervision). RESULTS: Having a family-firm connection was associated with fewer hazard exposures and greater safety practices. Youth who worked on jobsites with a larger workgroup (11-50 workers) reported more hazards but also more safety practices. CONCLUSIONS: Family-firm connections, in particular, may have a protective effect for youth in construction. Even though the statistical significance of our findings on workgroup size was limited in places, the pattern of differences found suggest that further research in this area is warranted.

Objective measures of adoption of patient lift and transfer devices to reduce nursing staff injuries in the hospital setting.

BACKGROUND: Interventions to reduce patient-handling injuries in the hospital setting are often evaluated based on their effect on outcomes such as injury rates. Measuring intervention adoption could address how and why observed trends in the outcome occurred. METHODS: Unit-level data related to adoption of patient lift equipment were systematically collected at several points in time over 5 years on nursing units at two hospitals, including hours of lift equipment use, equipment accessibility, and supply purchases and availability. RESULTS: Various measures of adoption highlighted the adoption process' gradual nature and variability by hospital and between units. No single measure adequately assessed adoption. Certain measures appear well-correlated. CONCLUSION: Future evaluation of primary preventive efforts designed to prevent patient-handling injuries would be strengthened by objective data on intermediate measures that reflect intervention implementation and adoption.

Implementation and adoption of mechanical patient lift equipment in the hospital setting: The importance of organizational and cultural factors.

BACKGROUND: Work focused on understanding implementation and adoption of interventions designed to prevent patient-handling injuries in the hospital setting is lacking in the injury literature and may be more insightful than more traditional evaluation measures. METHODS: Data from focus groups with health care workers were used to describe barriers and promoters of the adoption of patient lift equipment and a shift to a "minimal-manual lift environment" at two affiliated hospitals. RESULTS: Several factors influencing the adoption of the lift equipment and patient-handling policy were noted: time, knowledge/ability, staffing, patient characteristics, and organizational and cultural aspects of work. The adoption process was complex, and considerable variability by hospital and across units was observed. CONCLUSIONS: The use of qualitative data can enhance the understanding of factors that influence implementation and adoption of interventions designed to prevent patient-handling injuries among health care workers.

A lift assist team in an acute care hospital-prevention of injury or transfer of risk during patient-handling tasks?

A Lift Assist Team (LAT) was created on three units at a medical center where nursing staff were at high risk for patient-handling injuries. LAT members were drawn from the hospital's pool of patient transporters. Using qualitative and quantitative data, this case study summarizes the development, implementation, and experiences of the LAT. Nursing staff valued the LAT, reporting increased staff safety and improved patient care. LAT members reported greater job satisfaction and a newfound sense of assimilation into the nursing group compared to when their role was patient transport only. However, over time, their job responsibilities expanded beyond those officially designated for LAT members. Active, ongoing surveillance of the LAT's exposures and outcomes is warranted to understand whether patient-handling injury risk is shifting from nursing personnel to LAT members.

Non-fatal construction industry fall-related injuries treated in US emergency departments, 1998-2005.

BACKGROUND: There is a growing recognition that common occupational injury surveillance systems in the US fail to reflect true injury risk; this failure limits efforts to accurately monitor efforts to prevent work-related injuries on a national level. METHODS: Data from the National Electronic Injury Surveillance System occupational supplement (NEISS-Work) were used to describe fall-related injuries treated in US emergency departments among workers in the construction industry (1998-2005). These data do not require workers' compensation as the payer in order to be classified as work-related. RESULTS: Based on NEISS-Work estimates, a total of 555,700 (95% confidence interval (CI): 390,700-720,800) non-fatal work-related injuries among workers in the construction industry were the result of a fall, resulting in an annual rate of 70 (95% CI: 49-91) per 10,000 full-time equivalents. Younger workers had higher rates of falls, whereas older workers were more likely to suffer serious injuries. The majority of the injuries (70%) were precipitated by falls to a lower level from roofs, ladders, and scaffolding. CONCLUSIONS: The patterns of fall-related injuries identified in these data are consistent with other reports. In contrast to the declining rates of falls requiring days away from work reported through the Bureau of Labor Statistics Survey of Occupational Injuries and Illnesses, construction industry fall-related injury rates estimated through NEISS-Work remained unchanged from 1998 to 2005 providing another perspective on this serious cause of morbidity in the construction industry.