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Work zones are crucial for maintaining and enhancing road infrastructure, but they also pose a significant risk to traffic safety. Between 2016 and 2020, work zone-related crashes in the United States increased by 13%, highlighting the pressing need for effective safety measures. This study examines the factors that influence work zone crashes, including traffic control devices, geometric configurations, traffic operations, and human factors. The study also investigates how these factors vary by work zone type, day of the week, and time of day. To explore these temporal and spatial impacts, the study utilized five years of fatal crash data from the Fatality Analysis Reporting System (FARS) and applied association rules mining. The findings demonstrate that rear-end crashes and collisions with other vehicles are the primary contributing factors. Although some common patterns emerged in the association rules, the study revealed temporal instability, highlighting the importance of developing work zone-specific safety countermeasures. These findings will inform the development of targeted safety interventions and ultimately reduce the risk of work zone crashes. [ABSTRACT FROM AUTHOR]

Graduates of industrial hygiene training (IH) programs must be able to meet continuously evolving health and safety needs in a wide variety of occupational settings. Therefore, academic IH graduate programs must regularly evaluate their curricula and solicit input from industry professionals to make curricular changes that will better prepare their students for professional roles in industry. The purpose of this study was to identify the training gaps that existed between industry needs and the current curriculum for a United States-accredited IH graduate training program. The research team facilitated two group interviews with the IH program advisory board, collected alumni survey data, and performed a qualitative analysis to identify skills gaps/needs for the IH Program graduates. The research team identified 3 themes from participant interviews and alumni surveys (technical, applied, and essential skills) and selected several skills within each theme that interview participants thought were necessary proficiencies for junior IH professionals. The skills identified in the qualitative interview and survey data can be incorporated into the curriculum to improve the training of IH graduate students. Additionally, by using qualitative analysis, the researchers uncovered essential skills previously unidentified in IH needs assessments, providing valuable information for all IH graduate programs. [ABSTRACT FROM AUTHOR]

Objective: Emotional exhaustion (EE)-the first stage of burnout-is related to preventable work environment exposures. We examined the understudied impact of organizational support for safety (OSS) and safety hazards (SH) on EE in a mixed licensed and unlicensed population of healthcare workers (HCWs). Methods: A work environment exposures survey was conducted in five US public healthcare facilities in 2018-2019. A total of 1059 questionnaires were collected from a predominantly female population of mixed HCWs. Results: Mean EE scores were higher among women, direct care workers, and younger subjects. In linear regression models, EE was positively associated with SH, emotional labor, psychological demands, physical demands, job strain, assault, and negative acts, while OSS was negatively associated. Safety hazard s both mediated and moderated the relationship between OSS and EE. Conclusions: When perception of SH is high, OSS has less impact on reducing EE, suggesting a need to effectively put safety policies to practice for improving EE in HCWS. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to extend safety climate research by considering perceptions across the following three hierarchical levels within a workplace: (1) senior leaders/executives, (2) field leaders/supervisors, and (3) front-line employees. Methods: We conducted a quantitative survey study at a US utility company where we collected data related to safety climate perceptions and employee-reported safety behaviors across the different levels of organizational hierarchy. Results: The findings revealed the highest safety climate scores among senior leaders/executives, followed by field leaders/supervisors, and then employees, suggesting potential discrepancies between espoused and enacted safety values in the workplace. Conclusions: These results suggest that supervisors and top managers may have different mental models of workplace safety compared with employees. Consequently, assessing perceptions at different organizational levels provides a fuller picture of safety in the workplace. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, the botanical product market saw a consumer interest increase in immune health supplements. While data are currently insufficient to support public health guidance for using foods and dietary supplements to prevent or treat COVID-19 and other immune disorders, consumer surveys indicate that immune support is the second-most cited reason for supplement use in the United States. Meanwhile, consumers showed increased attention to dietary supplement ingredient labels, especially concerning authenticity and ingredient claims. Top-selling botanical ingredients such as elderberry, turmeric, and functional mushrooms have been increasingly marketed toward consumers to promote immune health, but these popular products succumb to adulteration with inaccurate labeling due to the intentional or unintentional addition of lower grade ingredients, non-target plants, and synthetic compounds, partially due to pandemic-related supply chain issues. This review highlights the regulatory requirements and recommendations for analytical approaches, including chromatography, spectroscopy, and DNA approaches for ingredient claim verification. Demonstrating elderberry, turmeric, and functional mushrooms as examples, this review aims to provide industrial professionals and scientists an overview of current United States regulations, testing approaches, and trends for label compliance verification to ensure the safety of botanical products marketed for "immune health." [ABSTRACT FROM AUTHOR]

Background and Objectives: As the COVID-19 pandemic brought surges of hospitalized patients, it was important to focus on reducing overuse of tests and procedures to not only reduce potential harm to patients but also reduce unnecessary exposure to staff. The objective of this study was to create a Choosing Wisely in COVID-19 list to guide clinicians in practicing high-value care at our health system. Methods: A Choosing Wisely in COVID-19 list was developed in October 2020 by an interdisciplinary High Value Care Council at New York City Health + Hospitals, the largest public health system in the United States. The first phase involved gathering areas of overuse from interdisciplinary staff across the system. The second phase used a modified Delphi scoring process asking participants to rate recommendations on a 5-point Likert scale based on criteria of degree of evidence, potential to prevent patient harm, and potential to prevent staff harm. Results: The top 5 recommendations included avoiding tracheal intubation without trial of noninvasive ventilation (4.4); not placing routine central venous catheters (4.33); avoiding routine daily laboratory tests and batching laboratory draws (4.19); not ordering daily chest radiographs (4.17); and not using bronchodilators in the absence of reactive airway disease (4.13). Conclusion: We successfully developed Choosing Wisely in COVID-19 recommendations that focus on evidence and preventing patient and staff harm in a large safety net system to reduce overuse. [ABSTRACT FROM AUTHOR]

Work-related deaths are a persistent occupational health issue that can be prevented. However, prevention opportunities can be hampered by a lack of adequate public health resources. The Western States Occupational Network (WestON) is a network of federal, state, and local occupational health professionals that includes a 19-state region of the United States. To encourage public health collaboration, WestON partners examined work-related fatalities within the region. Fatality counts (numerators) were obtained from the U.S. Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries restricted-access research files for all workers ages ≥15 years and fatally injured in WestON states from 2011 through 2017. Estimates of full-time equivalent hours worked (FTE) (denominators) were retrieved from the BLS Current Population Survey. Annual average fatality rates were calculated as number of fatalities per 100,000 FTE over the study period. Rates were stratified by state, select demographics, industry sector, and event/exposure types. Pearson chi-squared tests and rate ratios with 95% confidence probability limits were used to assess rate differences. All analyses were conducted using SAS v.9.4. From 2011 through 2017, the annual average overall occupational fatality rate for the WestON region was 3.5 fatalities per 100,000 FTE, comparable to the overall U.S. fatality rate. Male workers had a fatality rate almost 10 times higher than female workers in the region. Fatality rates increased with successive age groups. Alaska and New Mexico had significantly higher fatality rates for all racial/ethnic groups compared to respective regional rates. Wyoming, North Dakota, and Montana had the three highest occupational fatality rates among foreign-born workers. Agriculture/forestry/fishing, mining/oil/gas extraction, and transportation/warehousing/utilities were industry sector groups with the three highest fatality rates regionally. Transportation-related incidents were the most frequent event type associated with occupational fatalities for all 19 states. Work-related fatalities are a crosscutting occupational public health priority. This analysis can be an impetus for collaborative multistate initiatives among a dynamic and varied occupational public health network to better meet the needs of a rapidly changing workforce. [ABSTRACT FROM AUTHOR]

Background Job-exposure matrices (JEMs) are often used for exposure assessment in occupational exposure and epidemiology studies. However, general population JEMs are difficult to find and access for workers in the United States of America. Objective We aimed to use publicly available information to develop a JEM-like exposure assessment method to determine exposure to a wide range of occupational agents in a wide range of occupations for US general population studies. Methods We used information from the US Department of Labor's Occupational Information Network database (O*NET) for 19,636 job tasks and 974 civilian occupations. We used automated keyword searches to identify 1,804 job tasks that involved exposure to 50 occupational agents. We had 2 reviewers determine whether each identified job task actually involved exposure to the 50 occupational agents. We had a third reviewer, a certified industrial hygienist, assess any job task and exposure for which the first 2 reviewers disagreed. For each U.S. Census 2010 occupation code, we used this information to derive 3 exposure variables for each occupational agent: ever exposure, number of job tasks of exposure, and frequency of exposure. Results Our keyword searches identified a median of 10 (interquartile range [IQR]: 43.75) job tasks for each occupational agent, and the maximum was 308. We determined job tasks actually involved exposure to 45 occupational agents, including solvents, air pollution, pesticides, radiation, metals, etc. We derived the 3 exposure variables for these 45 occupational agents for 516 U.S. Census 2010 occupation codes. The median percentage for ever exposure to individual occupational agents was 1.16% (IQR: 1.74%), and the maximum was 11.43%. Conclusions Our JEM-like exposure assessment method based on O*NET information can be used to determine exposure to a wide range of occupational agents in a wide range of occupations for the US general population. [ABSTRACT FROM AUTHOR]

Recent data reveal an increase in the likelihood of staff injury for those working in the health care and social assistance industries (United States Bureau of Labor Statistics, 2021). Without information summarizing variables pertaining to staff injury in behavior‐analytic service settings, organizational leaders risk the safety of staff they employ. Despite the social relevance, few studies concerning the types of client‐related staff injuries have been published. The purpose of this survey was to gather data on the cause, type, bodily location of, and treatment required for staff injury by surveying organizations that serve individuals with autism spectrum disorder. Respondents ranked the leading cause of injury as client‐to‐staff interactions, type of injury as bite, location of injury as arm, and the most common treatment required as on‐site first aid. These initial data could assist in the identification of job tasks that may be associated with increased risk of injury, potential ramifications of client‐inflicted injuries on staff performance and organizational outcomes, and how to address injuries in settings within an injury‐prone industry. Implications and future research ideas are also discussed. [ABSTRACT FROM AUTHOR]

We assessed how hospitalists frame workplace safety, health, and well-being (SHW); their perception of hospital supports for SHW; and whether and how they are sharing leadership responsibility for each other's SHW. Our findings highlight the important role of local support for hospitalist SHW and reveal the systemic, hospital-wide problems that may impede their SHW. We believe that positioning hospitalists as leaders for SHW will result in systems-wide changes in practices to support the SHW of all care team members. (Am J Public Health. 2024;114(S2):S162–S166. https://doi.org/10.2105/AJPH.2024.307573) [ABSTRACT FROM AUTHOR]

Introduction: The routine use of heat-producing tools in the perioperative setting generates surgical smoke. Surgical smoke poses a known health hazard for perioperative staff working in the operating room. Objective: The objective of this best practice project was to promote evidence-based practices regarding surgical plume management in a pediatric operating room. Methods: This project was guided by the JBI Model of Evidence-Based Healthcare and used the JBI Practical Application of Clinical Evidence System and the Getting Research into Practice audit and feedback strategy to promote evidence-based practices regarding surgical smoke management in a pediatric operating room. Seven audit criteria representing best-practice recommendations were used. A baseline audit was conducted, followed by the implementation of multiple strategies developed by the key stakeholders. The project was finalized with a follow-up audit to determine any changes in compliance with best-practice recommendations. Results: Baseline audit data indicated an average of 41% compliance with best practices across all audit criteria, revealing the need for significant improvement in five of the seven criteria. Three barriers were identified and strategies were implemented, including the development and implementation of an educational module and a surgical smoke exposure risk assessment tool. Follow-up audits showed an overall improvement of 30% among five of the seven audit criteria. Conclusions: This project yielded improvements with best practices for surgical smoke management in the perioperative setting. However, additional work is required to ensure the sustainability of best practices in this setting. [ABSTRACT FROM AUTHOR]

Fieldwork is a critical tool for scientific research, particularly in applied disciplines. Yet fieldwork is often unsafe, especially for members of historically marginalized groups and people whose presence in scientific spaces threatens traditional hierarchies of power, authority, and legitimacy. Research is needed to identify interventions that prevent sexual harassment and assault from occurring in the first place. We conducted a quasi-experiment assessing the impacts of a 90-min interactive training on field-based staff in a United States state government agency. We hypothesized that the knowledge-based interventions, social modeling, and mastery experiences included in the training would increase participants' sexual harassment and assault prevention knowledge, self-efficacy, behavioural intention, and behaviour after the training compared to a control group of their peers. Treatment–control and pre-post training survey data indicate that the training increased participants' sexual harassment and assault prevention knowledge and prevention self-efficacy, and, to a lesser extent, behavioural intention. These increases persisted several months after the training for knowledge and self-efficacy. While we did not detect differences in the effect of the training for different groups, interestingly, post-hoc tests indicated that women and members of underrepresented racial groups generally scored lower compared to male and white respondents, suggesting that these groups self-assess their own capabilities differently. Finally, participants' likelihood to report incidents increased after the training but institutional reports remained low, emphasizing the importance of efforts to transform reporting systems and develop better methods to measure bystander actions. These results support the utility of a peer-led interactive intervention for improving workplace culture and safety in scientific fieldwork settings. Protocol registration: "The stage 1 protocol for this Registered Report was accepted in principle on August 24, 2022. The protocol, as accepted by the journal, can be found at: https://doi.org/10.6084/m9.figshare.21770165. [ABSTRACT FROM AUTHOR]

This exploratory study looked at the experiences of social work, occupational therapy, and nursing students who participated in an interprofessional simulation that was offered virtually due to the impact of COVID-19. The simulation was a one-day event that introduced advanced care planning to the students through an IPE team approach and incorporated various learning and teaching modalities. Using conventional content analysis of the post-program survey data from 255 students (35 occupational therapy; 87 social work; and 133 nursing), three primary themes were identified for the value of learning virtual interprofessional collaboration during a pandemic: (1) catalyst for telehealth education; (2) patient, family & professional safety; and (3) connection and continuity of care. In addition, students identified four primary themes that were learned and perceptions of what could lie ahead beyond the simulation: (1) patient & family convenience and inclusion; (2) expand interprofessional team involvement; (3) alleviate disparities/increase access; and (4) the "new normal" of virtual IP Collaboration. [ABSTRACT FROM AUTHOR]

Among the first 20 high-priority chemical substances selected by USEPA to undergo risk evaluation as part of the Toxic Substances Control Act, as amended by the Frank R. Lautenberg Chemical Safety for the 21st Century Act of 2016 is 1,3-butadiene (1,3-BD). Because much of the literature related to occupational exposure to 1,3-BD is associated with the use of the substance in synthetic rubber production and few data have been published for exposures to 1,3-BD manufacturing workers, existing industrial hygiene data collected at facilities where the substance is manufactured or processed as a reactant were compiled and analyzed. The dataset was comprised of personal air samples collected between 2010 and 2019 at facilities located throughout the United States and was compiled into a single database using a uniform data collection template. Data designated by the companies as full-shift were stratified by job group and one of three operational conditions of the workplace: routine, turnaround, and non-routine. Data designated by the companies as short-term and task-level were stratified by task description, sample duration, and operational condition. The final aggregated database contained a total of 5,676 full-shift personal samples. Mean concentrations of 1,3-BD for the job groups ranged from 0.012 ppm to 0.16 ppm. High-end estimates of 1,3-BD air concentrations for the job groups under routine operations ranged from 0.014 ppm to 0.23 ppm. The aggregated database also included 1,063 short-term and task-level personal samples. For short-term samples (< =15 min), mean concentrations ranged from 0.49 ppm to 3.9 ppm, with the highest concentrations observed for the cleaning and maintaining equipment tasks. For task samples with durations greater than 15 min, mean concentrations ranged from 0.49 to 3.6 ppm, with the highest concentrations observed for the unloading and loading task. In addition to the personal air sampling records, information on the use of PPE during various tasks was compiled and analyzed. This data set provides robust quantitative air concentration data and exposure control information for which occupational exposures to 1,3-BD in the Manufacturing and Processing as a Reactant condition of use can be assessed. [ABSTRACT FROM AUTHOR]

Our study examined the occupational health and safety (OHS) issues that impact environmental public health workforces across various health departments in the U.S. The objective was to generate an OHS risk profile for the workforce to inform future preventative strategies. Data for our study were collected via a cross-sectional online survey (N = 158) supplemented by a virtual focus group (N = 7) discussion to confirm and explore some of the themes and data items that emerged from the survey. Descriptive statistics were used to provide information about the variables in the data sets and to identify relationships between them. Nonparametric tests were used to determine statistical significance between two or more variables that were not normally distributed. Focus group data were analyzed thematically. Our study indicates that the environmental health (EH) workforce in the U.S. is exposed to a range of significant workplace hazards. Some of the OHS concerns identified in our study are similar to those observed in Australia and New Zealand. Biological and chemical exposures appear to be important hazards; however, further study is required to determine the nature and mechanism of these hazards within the EH workforce. Furthermore, our study suggests that the COVID-19 pandemic had a significant impact on the health and safety of EH professionals. [ABSTRACT FROM AUTHOR]

COVID-19 profoundly shaped how service providers in the antiviolence sector interact with clients, coworkers, and community stakeholders. In addition to stressors inherent in antiviolence work, service providers negotiated new, challenging social distancing and remote communication strategies. In this paper, we analyze interviews with 23 antiviolence workers in the US Great Plains region, focusing on participants' descriptions of workplace boundaries and intimacy. We demonstrate how COVID-19 both expanded and contracted public/private boundaries and formal/informal connections in antiviolence workers' daily experiences. Pandemic conditions revealed the pressing need for frontline workers to exercise discretion over levels of intimate engagement with coworkers and clients. [ABSTRACT FROM AUTHOR]

The article argues that child farm injuries are never accidents and that the professional discipline of agricultural safety and health and the agricultural media failed to keep pace with injury prevention or occupational safety groups that have transitioned their terminology term from accident to incident. It traces the historical roots of the problem of accidents and highlights initiatives undertaken by the U.S. National Farm Medicine Center to replace the term accident with an alternate term.

Noise-induced hearing loss (NIHL) continues to be a pervasive problem for the nation's workforce, particularly the nation's mining personnel. As one of the leading health and safety organizations in the world, the National Institute for Occupational Health and Safety (NIOSH) in Pittsburgh maintains a Hearing Loss Prevention Program (HLPP) to conduct research to reduce NIHL loss among the nation's miners. This document provides a brief overview of this HLPP, describing some of the research techniques involved in the development of engineering noise controls, methods for the development of administrative noise controls, and some of the products available to the public to protect the nation's workers hearing. [ABSTRACT FROM AUTHOR]

Asian and Asian Americans (A/AA) are a group overlooked in general health outcomes but especially occupational safety and health outcomes. In the United States, the beauty service microbusiness industry (e.g., nail salons) predominantly employs immigrant Asian women who regularly encounter a plethora of occupational hazards (e.g., harmful chemical exposures -toluene, formaldehyde, bloodborne pathogens, fungi. However, due to the precariousness of beauty service jobs, cultural and linguistic barriers, and social determinants of health, A/AA beauty service workers face complex occupational safety and health challenges that require interdisciplinary collaboration and cultural competency to address. This commentary will discuss a multi-level approach including specific outreach partners that will offer the required diverse skillsets necessary for improving the occupational safety and health for this worker population in this microbusiness industry. Implications and suggestions for interventions and policy changes are also recommended utilizing the National Institute on Minority Health and Health Disparities' Research Framework. [ABSTRACT FROM AUTHOR]

This study suggests that lack of adequate PPE can lead to HCP burnout, which may result in employees quitting. A pandemic preparedness plan for future pandemics or outbreaks that does not include adequate and appropriate PPE may increase health care personnel burnout and intention to leave post. Objective: The aim of the study is to explore associations among personal protective equipment (PPE) availability, workplace environment, and burnout among US healthcare personnel during the COVID-19 pandemic. Methods: The study used an online healthcare provider (HCP) survey (December 2020–February 2021) regarding PPE confidence, availability, burnout, and workplace environment. Results: Lack of appropriate PPE was reported by 27% of 799 US HCP surveyed. Burnout, reported by 77% of HCP, was more likely among females, those with fewer years of professional experience, and those with a higher desire to quit, and less likely for those who perceived PPE was adequate or their employer took all steps to minimize workplace risks. Conclusions: This study suggests that lack of adequate PPE can lead to HCP burnout, which may result in employees quitting. A pandemic preparedness plan that includes adequate PPE is essential for HCP well-being, patient health, and employer fiscal health. [ABSTRACT FROM AUTHOR]

We developed an opioid hazard awareness module for inclusion in required miner safety refresher training. The module was disseminated throughout the United States and post-training surveys showed improved knowledge and positive response to the training. Clinicians can improve care of high-risk worker patients by recommending employer support for such training. Objective: In response to elevated risk factors, an opioid hazard awareness training for the sand, stone, and gravel mining sector was developed and embedded in annual safety training. Methods: After positive results from a prior study among Massachusetts workers, a revised training was disseminated across the United States. Two hundred post-training surveys were obtained and compared with results from the Massachusetts cohort. Results: Participants' knowledge about opioid-based medications, confidence in talking to a doctor about opioids and/or to a coworker about their own use of opioids, and ability to refer struggling coworkers to resources improved. Massachusetts respondents had slightly more favorable responses. Both cohorts had strong positive views of the training. Conclusions: These results highlight the feasibility and effectiveness of opioid hazard prevention training for a high-risk worker population. [ABSTRACT FROM AUTHOR]

The impact of water consumption bolus volume and frequency on hydration biomarkers during work in the heat is unknown. In a randomized, crossover fashion, eight males consumed either 500 mL of water every 40 min or 237 mL of water every 20 min during 2 hr of continuous walking at 6.4 kph, 1.0% grade in a 34 °C/30% relative humidity environment, followed by 2 hr of rest. Hydration biomarkers and variables were assessed pre-work, post-work, and after the 2 hr recovery. There were no differences in body mass between trials at any time point (all p > 0.05). Percent change in plasma volume during work was not different when 237 mL of water was repeatedly consumed (−1.6 ± 8.2%) compared to 500 mL of water (−1.3 ± 3.0%, p = 0.92). Plasma osmolality was maintained over time (p = 0.55) with no difference between treatments (p = 0.21). When consuming 500 mL of water repeatedly, urine osmolality was lower at recovery (205 ± 108 mOsmo/L) compared to pre-work (589 ± 95 mOsmo/L, p < 0.01), different from repeatedly consuming 237 mL of water which maintained urine osmolality from pre-work (548 ± 144 mOsmo/L) through recovery (364 ± 261 mOsmo/L, p = 0.14). Free water clearance at recovery was greater with repeated consumption of 500 mL of water (1.2 ± 1.0 mL/min) compared to 237 mL of water (0.4 ± 0.8 mL/min, p = 0.02). Urine volume was not different between treatments post-work (p = 0.62), but greater after 2 hr of recovery when repeatedly consuming 500 mL of water compared to 237 mL (p = 0.01), leading to greater hydration efficiency upon recovery with repeated consumption of 237 mL of water (68 ± 12%) compared to 500 mL (63 ± 14%, p = 0.01). Thirst and total gastrointestinal symptom scores were not different between treatments at any time point (all p > 0.05). Body temperatures and heart rate were not different between treatments at any time point (all p > 0.05). Drinking larger, less frequent water boluses or drinking smaller, more frequent water boluses are both reasonable strategies to promote adequate hydration and limit changes in body mass in males completing heavy-intensity work in the heat. [ABSTRACT FROM AUTHOR]

We report on five SARS‐CoV‐2 congregate setting outbreaks at U.S. Operation Allies Welcome Safe Havens/military facilities. Outbreak data were collected, and attack rates were calculated for various populations. Even in vaccinated populations, there was rapid spread, illustrating the importance of institutional prevention and mitigation policies in congregate settings. [ABSTRACT FROM AUTHOR]

Background: Nurses experienced intense ethical and moral challenges during the COVID-19 pandemic. Our 2020 qualitative parent study of frontline nurses' experiences during the COVID-19 pandemic identified ethics as a cross-cutting theme with six subthemes: moral dilemmas, moral uncertainty, moral distress, moral injury, moral outrage, and moral courage. We re-analyzed ethics-related findings in light of refined definitions of ethics concepts. Research aim: To analyze frontline U.S. nurses' experiences of ethics during the COVID-19 pandemic. Research design: Qualitative analysis using a directed content methodology. Participants and research context: The study included 43 nurses from three major metropolitan academic medical centers and one community hospital in the northeastern, mid-Atlantic, midwestern, and western United States. Ethical considerations: Participant privacy and data confidentiality were addressed. Findings: Moral dilemmas arose from many situations, most frequently related to balancing safety and patient care. Moral uncertainty commonly arose from lacking health information or evidence about options. Moral distress occurred when nurses knew the right thing to do, but were prevented from doing so, including with end-of-life issues. Moral injury (accompanied by suffering, shame, or guilt) occurred after doing, seeing, or experiencing wrongdoing, often involving authority figures. Nurses expressed moral outrage at events and people within and outside healthcare. Despite difficult ethical situations, some nurses exemplified moral courage, sometimes by resisting policies they perceived as preventing compassionate care, guided by thinking about what was best for patients. Discussion: This content analysis of ethics-related subthemes revealed conceptual characteristics and clarified distinctions with corresponding exemplars. Conceptual clarity may inform responses and interventions to address ethical quandaries in nursing practice. Conclusions: Ethics education in nursing must address the moral dilemmas of pandemics, disasters, and other crises. Nurses need time and resources to heal from trying to provide the best care when no ideal option was available. [ABSTRACT FROM AUTHOR]

The fumes created from welding activities present a unique occupational hazard. Due to the complex processes which govern fume formation, the characterization of welding fumes is difficult. Emission factors (EFs) are one method to characterize fume formation from different processes and scenarios. This paper reviews the development of EFs and similar metrics both historic research which contributed to the US EPAs AP-42 summary of welding emission factors released in 1995, and more recent research initiatives. Through a critical analysis of what research has been done in this area and the strength of the emission factors developed, this paper proposes a set of recommendations for future research. Research on emission factors for gas metal arc welding (GMAW) is the most complete amongst the different types of electric arc welding. Despite it being generally known that flux core arc welding (FCAW) creates significant fume emissions compared to some of the other processes few studies have looked at FCAW since the AP-42. Shielded metal arc welding is also under-researched particularly in terms of metal-specific emission factors. The influence of different welding activity parameters such as welding location, speed or current is well defined for GMAW but requires more attention for other welding processes. Further effort towards compiling and comparing available emission factor data of quality, evaluating the available data statistically and organizing this data in a practically useful way is required. The availability of reliable emission factors will allow the development or improvement of exposure modelling tools that would be very useful for exposure assessment when monitoring is not practical.s [ABSTRACT FROM AUTHOR]

The presumed high exposure to volatile organic compounds among construction workers has not been substantiated with biomonitoring evidence. This study found that construction occupation was associated with increased blood concentrations of toluene, ethylbenzene, o-xylene, and m-/p- xylene. The findings inform interventions for exposure reduction using engineering controls and personal protective equipment. Objective: This study aimed to examine blood benzene, toluene, ethylbenzene, o-xylene, and m-/p-xylene (BTEX) concentrations and their trends contrasting construction workers with workers in other occupations from 1999 to 2014 in the United States. Methods: Using data from the National Health and Nutrition Examination Survey, quantile regressions were performed to investigate associations between occupation and blood BTEX concentrations. Results: We found that high-risk and construction occupations were associated with increased blood concentrations of toluene, o-xylene, and m-/p-xylene at the 50–90th percentiles (P50–90), and ethylbenzene at P70–90. Moreover, although blood concentrations of ethylbenzene, o-xylene, and m-/p-xylene trended down among all US workers, no decreasing trend was observed for benzene and toluene among construction workers. Conclusions: Future studies are warranted to address questions about specific tasks to better assess VOC exposure from various trades. [ABSTRACT FROM AUTHOR]

The findings from this study highlight significant disparities in the risk for occupational environmental heat injuries, including risk related to industry and occupation. These findings may be useful for identifying and developing interventions for high-risk populations. Objective: This study describes the characteristics of workers experiencing occupational heat-related injuries/illnesses in the United States and explores the associations between states' average annual temperatures and heat-related injury/illness rates. Methods: The number and rate of occupational environmental heat injuries/illnesses were calculated according to age group, gender, race/ethnicity, occupation group, and state from 2011 to 2019. Results: Injury/illness rates were higher among Black and Hispanic workers. Workers in farming, fishing, and forestry; installation, maintenance, and repair; and construction/extraction occupations had the highest rates. There was a positive correlation between states' average annual temperatures and heat-related injury/illness rates. Discussion: There are demographic and occupational disparities in occupational environmental heat-related injuries/illnesses in the United States and a correlation between these injuries/illnesses and state average annual temperatures. There is a need for policies and other interventions to protect workers from occupational environmental heat injuries/illnesses. [ABSTRACT FROM AUTHOR]

Children represent some of the most vulnerable and most valuable members of society. When acutely ill or injured, pediatric emergency departments (EDs) provide first line, specialized care for children and adolescents. Unique and unpredictable, the pediatric ED environment requires a wide range of health care professionals to care for children and their families and often includes hospital-employed security professionals and local law enforcement personnel to ensure safe and protective spaces paramount for optimal patient care. However, an active policing presence within environments designed to promote healing can paradoxically contribute to harm, particularly for Black and Brown patients. As health care systems pledge to dismantle structural racism and achieve health equity, efforts must include anti-racist reforms of threat management systems within clinical environments. We propose assessment and evaluation of current security and police encounters within pediatric EDs. We call for institution of policies that mitigate biases, address medical mistrust, distinguish clinical from criminal aggression, and minimize punitive contact with police. We outline a multitiered, patient-centered approach to disruptive and violent acts that prioritizes prevention, early intervention, and de-escalation strategies with a goal of reducing the perceived need for policing presence in pediatric EDs. [ABSTRACT FROM AUTHOR]

When organizational attributes like management commitment and communication are favorable, they are known to positively influence safety behaviors, morale, and well-being. Fire departments should focus on improving overall safety culture as a way to address the mental health burden of fire and rescue service work. Objective: This study aimed to examine the COVID-19 pandemic's impact on fire service safety culture, behavior and morale, levers of well-being, and well-being outcomes. Methods: Two samples (Stress and Violence against fire-based EMS Responders [SAVER], consisting of 3 metropolitan departments, and Fire service Organizational Culture of Safety [FOCUS], a geographically stratified random sample of 17 departments) were assessed monthly from May to October 2020. Fire department–specific and pooled scores were calculated. Linear regression was used to model trends. Results: We observed concerningly low and decreasing scores on management commitment to safety, leadership communication, supervisor sensegiving, and decision-making. We observed increasing and concerning scores for burnout, intent to leave the profession, and percentage at high risk for anxiety and depression. Conclusions: Our findings suggest that organizational attributes remained generally stable but low during the pandemic and impacted well-being outcomes, job satisfaction, and engagement. Improving safety culture can address the mental health burden of this work. [ABSTRACT FROM AUTHOR]

This research identified occupational and work-life demands due to the COVID-19 pandemic in fire-based first responders. These data empower clinicians to consider upstream primary prevention approaches to mitigate these demands and prevent secondary and tertiary outcomes that may occur if demands are not properly managed. Objective: The US fire service experienced increased demands due to COVID-19. This qualitative study explored the pandemic's impact on work-life balance and safety. Methods: Five interviews and 10 focus groups were conducted with 15 fire departments in the COVID-19 RAPID Mental Health Assessment. Coding and multilevel content analysis were conducted in NVivo. Results: Four department support themes were identified: emotional/social (33.1%), policy (28.4%), instrumental (22.9%), and informational (15.5%). Four work-life balance themes were identified: life (51.2%), children (18.1%), physiological (16.5%), and work (14.2%). We observed more departmental resources to help mitigate job demands within the work environment compared with those for work-life demands. Conclusions: Job resources are needed to mitigate demands and improve safety culture and mental well-being of the fire service under normal conditions, and for the next pandemic, natural disaster, or long-term emergency. [ABSTRACT FROM AUTHOR]

The mining industry plays a critical role in the U.S. economy, with active mines in every state producing materials such as those used to construct houses and roads, make medicines, and manufacture cars and electronics. Throughout its history, mining has been a male-dominated industry. Recent estimates indicate that between 10% and 17% of miners are women. Previous occupational safety and health (OSH) research has focused primarily on the male experience. In more recent years, the mining industry has engaged in efforts to increase workforce diversity through the recruitment and retention of women miners. To meet the needs of a diverse workforce, it is critically important to identify OSH concerns that are unique to populations that have been understudied and to develop work-related policies and practices that improve their work experiences and health outcomes. The purpose of this article is to describe the specific OSH challenges women as miners face and to discuss how the National Institute for Occupational Safety and Health's (NIOSH) Mining Program is situated to address these challenges through its Mining Program Strategic Plan. [ABSTRACT FROM AUTHOR]

Most meatpacking workers are Black, Latinx, and immigrant workers earning low wages and at high risk for occupational injury. Most meat and poultry plants have on-site workplace clinics (OWCs) where workers are required to obtain care for work-related injuries or illnesses before seeking outside clinical assessment or intervention. Although OWCs can help plant managers identify and mitigate hazards, government and other investigations reveal that OWCs in meatpacking plants not only fail to advocate for safer work conditions, but also nurture conditions that exacerbate injury and illness. This article explores ethical challenges for health care professionals in OWCs, including companies' pressure to keep so-called "recordable" injuries low. This article also suggests changes to support OWCs' roles in safety and injury prevention. [ABSTRACT FROM AUTHOR]

Our study demonstrated attenuated cardiovascular reactivity is predictive of future fatigue in truck drivers, who are a safety critical workforce. Attenuated responses to stress may have negative consequences for health and for driving safety, and cardiovascular stress reactivity could identify drivers who may be at heightened risk for developing fatigue. Objectives: This study aimed to investigate the impact of a 6-month health intervention on truck drivers' cardiovascular reactivity to stress and whether cardiovascular reactivity was predictive of depression, anxiety, or fatigue symptoms at 6-month follow-up. Methods: Two hundred thirty-eight truck drivers completed a 6-month cluster randomized controlled trial to increase physical activity and completed a stress protocol (Stroop and mirror-tracing tasks) with measurements of heart rate, systolic blood pressure, and diastolic blood pressure taken, alongside fatigue, anxiety, and depressive symptoms assessment. Measures were taken at 0 and 6 months. Results: Analyses showed a negative relationship between 0-month diastolic blood pressure reactivity and 6-month persistent fatigue. Trends toward negative relationships between systolic blood pressure reactivity and future anxiety and fatigue symptoms at 6 months were evident. Conclusions: Our findings may have serious implications, as fatigue can be a major cause of road traffic collisions in truck drivers. [ABSTRACT FROM AUTHOR]

An early mobility program in a small community hospital resulted in high levels of staff engagement and decreased rates for falls and heel and sacral pressure injuries. [ABSTRACT FROM AUTHOR]

The future of agricultural work in the United States (U.S.) must account for at least two important trends: 1) the persistence of the industry being riddled with high rates of injury and illness and 2) the growing proportion of hired farmworkers compared to family farmworkers working in these dangerous environments. These workers confront structural disadvantages that impede social justice and prosperity. Social structures like policies, economic systems, institutions, and social hierarchies create health disparities, often along the lines of social categories. The result is an already dangerous industry with vulnerable workers facing unjust risks, especially those that are undocumented. Agricultural health and safety professionals and other stakeholders should engage structural competency curricula in order to increase awareness of impact of structures and be better positioned to improve farmworker health and wellbeing. Similar work has been successful in the training healthcare professionals, e.g. the Structural Competency Working Group (SCWG). New strategies are needed to improve farmworker wellbeing and retain an adequate agricultural workforce. A greater understanding of the social and structural concerns that farmworkers face is an important step towards occupational and social justice. It is also clear that it will require collaboration and community-based efforts creating a larger team of people using similar concepts related to the structural influences on whether health and wellbeing are distributed equitably. This work is being moved forward in healthcare, social work, worker organizations, and community-based initiatives. Agricultural health and safety professionals have a vital contribution to make if they join the ranks. [ABSTRACT FROM AUTHOR]

Trends: Agritourism is increasingly popular, generating the need for additional employees. Given the labor shortages in the U.S., this motivates producers on agritourism operators to develop strategies to address the labor shortages, some of which could impact worker safety. Research and current initiatives: Contributing factors to labor shortages in agriculture include the aging workforce, declining rural populations, the stressful nature of agricultural work, long hours and less labor intensive options. Foreign labor has been impacted by immigration policy changes, H2A program inefficiencies and the recent pandemic. Staffing agritourism operations is further complicated by the need for seasonal employees and staff with varying skill sets, such as hospitality, food service, and retail; industries with critical labor shortages. Some strategies agritourism operators employ to address staff shortages (e.g. employees work longer hours, hiring younger staff) may impact safety. Collaborations between producers and safety professionals could help develop strategies to address labor shortages while ensuring worker safety. Gaps in knowledge, regulation and practice: More information is needed on employees on agritourism operations including the number of employees, hours worked, tasks performed, safety training provided, impact of customers in worksites, injuries incurred, current strategies employed to address the labor shortages, and motivators for staff to participate in safety training. Recommendations for the future: Research is needed to address the gaps in knowledge previously mentioned, and the information gathered used to develop recommendations, safety strategies and resources to help agritourism operators employ effective recruitment and retention strategies that also help establish a safe working environment. [ABSTRACT FROM AUTHOR]

An editorial is presented on characterizing occupational health in the cannabis cultivation industry. Topics include need to identify the health and safety needs of cannabis workers and lay plans for unified and coordinated research and advocacy efforts; and Marijuana Reform pardoning Federal offenses of simple marijuana possession and initiating review of federal scheduling.

The number of agricultural fatalities and injuries related to agricultural quad bike use has risen substantially in the last two decades. Safe engineering design features such as crush protection and roll bars have proven potential to lessen the burden of injury but have traditionally not been included in many quad bike safety training programs. The aim of this study was to survey more than 700 young adults working in U.S. and Canadian agriculture to examine self-reported quad bike safety behaviors and awareness of quad bike safety design engineering features. We found that U.S. males continue to be at higher risk for quad bike-rollover incidents when compared to other groups. Even when accounting for other factors such as age and country, we found that participants who reported youth occupational quad bike use (≤14 years old) were up to 200% more likely to allow extra riders and up to 489% more likely to not wear a helmet when compared to participants who reported beginning occupational quad bike use in adulthood. These findings support the Agricultural Youth Work Guideline (AYWG) for occupational quad bike use at age 16. Less than 20% of young adults working in agriculture were aware of safe design features such as wide frames, stability ratings, crush protection devices, and accessories made by the original equipment manufacturer. There is tremendous need to educate the future agricultural workforce about the importance of choosing quad bikes with safer design features. [ABSTRACT FROM AUTHOR]

Agricultural employers have faced extreme challenges in recruiting and retaining an adequate workforce. Various societal changes have made hiring local workers into agricultural jobs difficult. Therefore, there is a growing reliance on foreign workers and visa programs to meet labor demands. One such program, the TN visa, can be an effective and useful tool for recruiting professional labor for livestock operations, and many agricultural employers have already seen its value. It is likely that the use of the TN program will continue to grow in the future. However, there is opportunity for misuse and abuse of the TN program because there are few administrative rules and limited oversight. We offer recommendations to improve the TN program and the well-being of TN professionals including additional oversight of the program, transparency in recruiting and contracting workers, educating TN workers about U.S. labor rights, ensuring fair pay, and allowing a path to work authorization for TN workers' spouses and children who accompany them in the U.S. Clearly, sustainable solutions to the farm labor shortage are needed. As a field, we need to better understand workforce recruitment and retention concerns as well as mechanisms being used to address such concerns and their impact on workers' health, safety, and well-being. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic spurred some regulators in the USA to require occupational health and safety programs to prevent COVID-19 transmission in workplaces. The objective of this study was to describe such state and federal regulations enacted between January 2020 and January 2022. Regulations, including emergency temporary standards (ETS) and permanent standards, were identified through a search of Nexis Uni and Bloomberg Law and review of US OSHA websites and the Federal Register. Full texts were reviewed for regulatory scope, hazard and exposure definitions, determination of exposure or risk levels, and control strategies. Four state (California, Michigan, Virginia, and Oregon) and two federal regulations were identified. All regulations described respiratory aerosols as the primary source of SARS-CoV-2 and recognized person-to-person transmission by droplet, airborne, and contact routes. Only the US OSHA ETS for healthcare explicitly stated that inhalation of respiratory particles was the most likely method of COVID-19 transmission. The Virginia, Michigan, and Oregon regulations described different categories of risk defined by exposure frequency and duration or specific workplace activities. California described exposure as places and times when employees come into contact or congregate with other people. The US OSHA ETS for healthcare described exposure as involving close contact with suspected or confirmed COVID-19 patients. While all of the state regulations required strategies from across the hierarchy, only the Virginia regulations specifically incorporated the hierarchy of controls. Only the California and Virginia regulations explicitly linked control strategies to the transmission route, while Virginia demarcated control strategies by risk level. Oregon linked risk level to occupancy levels and physical distancing requirements and referred to the use of a layered approach for transmission control. The US OSHA ETS for healthcare defined droplet and airborne precautions but made no mention of the hierarchy of controls or risk levels. Respirators were discussed in most of the regulations. The first Michigan regulation explicitly required respirators appropriate to exposure risk. The California regulations noted that respirators protect the wearer while face coverings protect people around the wearer. These regulations offer insights for a permanent US OSHA infectious disease regulation, such as the need to consider a range of transmission modes including near- and far-range aerosol inhalation, endemic and novel pathogens, workplaces beyond healthcare settings, factors that contribute to exposure and risk, the hierarchy of controls, the role of vaccination, and the importance of written exposure assessment and infection prevention plans. [ABSTRACT FROM AUTHOR]

Latino day laborers (LDL) are a vulnerable population of workers facing considerable risk for occupational injury. Under the guidance of our Community Advisory Board, we developed and tested the feasibility, acceptability and preliminary effects of Vales+Tú (You Are Worth More), a workplace injury risk-reduction program implemented by promotores on street-corners where LDL seek employment. The program was informed by theoretical perspectives emphasizing individual and group agency and self-determination. A pilot three-arm cluster-randomized community trial was conducted among 75 LDL. The intervention arms consisted of an individualized Brief Motivational Interview, a Group Problem Solving activity and a standard of care control (OSHA safety cards). We met our study goal of 25 LDL per intervention arm, and contacted 88% of participants post intervention. Participants evaluated the interventions favorably. At post-test, the Brief Motivational Interview group reported significant reductions in exposure to workplace hazards and increases in risk-reduction practices. The Group Problem Solving participants showed significant reductions in exposure to hazards (t -test −4.16, p < 0.001). Both intervention groups increased their reliance on corner peers, a measure of social support. Standard of care participants increased in self-efficacy to work safely. Overall, the only significant different between the three study conditions was in self-efficacy. These findings provide evidence of the feasibility and acceptability of Vales+Tú and show preliminary program efficacy. A large-scale replication trial will permit a more formal modeling of the study findings. Clinical Trial Registration (ClinicalTrials.gov): NCT04378348. [ABSTRACT FROM AUTHOR]

With the advent of new sensing technologies and robust field-deployable analyzers, monitoring approaches can now generate valuable hazard information directly in the workplace. This is the case for monitoring respirable dust and respirable crystalline silica concentration levels. Estimating the quartz amount of a respirable dust sample by nondestructive analysis can be carried out using portable Fourier transform infrared spectroscopy (FTIR) units. Real-time respirable dust monitors, combined with small video cameras, allow advanced assessments using the Helmet-CAM methodology. These two field-based monitoring approaches, developed by the National Institute for Occupational Safety and Health (NIOSH), have been trialed in a sandstone quarry. Twenty-six Helmet-CAM sessions were conducted, and forty-one dust samples were collected around the quarry and analyzed on-site during two events. The generated data generated were used to characterize concentration levels for the monitored areas and workers, to identify good practices, and to illustrate activities that could be improved with additional engineered control technologies. Laboratory analysis of the collected samples complemented the field finding and provided an assessment of the performance of the field-based techniques. Only a fraction of the real-time respirable dust monitoring sessions data could be corrected with laboratory analysis. The average correction factor ratio was 5.0. Nevertheless, Helmet-CAM results provided valuable information for each session. The field-based quartz monitoring approach overestimated the concentration by a factor of 1.8, but it successfully assessed the quartz concentration trends in the quarry. The data collected could be used for the determination of a quarry calibration factor for future events. The quartz content in the dust was found to vary from 14% to 100%, and this indicates the need for multiple techniques in the characterization of respirable dust and quartz concentration and exposure. Overall, this study reports the importance of the adoption of field-based monitoring techniques when combined with a proper understanding and knowledge of the capabilities and limitations of each technique. [ABSTRACT FROM AUTHOR]

The article features the ASET Position Statement of the 24/7 Staffing for Neurodiagnostic Long-Term EEG Monitoring Services in 2022. Topics discussed include patients safety supports the need for 24/7 staffing, employee safety considerations support a 24/7 staffing model, and service delivery environments that require 24/7 technologist support. Also noted are American Epilepsy Society (AES) and National Association of Epilepsy Centers (NAEC) guidelines for AE centers on Levels 3 and 4 care.

Objectives This study: (i) assessed the relationship between noise exposure and injury risk, comprehensively adjusting for individual factors, psychosocial stressors, and organizational influences; (ii) determined the relative importance of noise on injuries; (iii) estimated the lowest observed adverse effect level (LOAEL) of noise on injury risk to determine the threshold of noise considered hazardous to injuries; and (iv) quantified the fraction of injuries that could be attributed to hazardous noise exposure. Methods In this cross-sectional study at 10 US surface mine sites, traditional mixed effects, Poisson regression, and boosted regression tree (BRT) models were run on the number of reported work-related injuries in the last year. The LOAEL of noise on injuries was identified by estimating the percent increase in work-related injuries at different thresholds of noise exposure using a counterfactual estimator through the BRT model. A population attributable fraction (PAF) was quantified with this counterfactual estimator to predict reductions in injuries at the LOAEL. Results Among 18 predictors of work-related injuries, mine site, perceived job safety, age, and sleepiness were the most important predictors. Occupational noise exposure was the seventh most important predictor. The LOAEL of noise for work-related injuries was a full-shift exposure of 88 dBA. Exposure ≥88 dBA was attributed to 20.3% (95% CI: 11.2%, 29.3%) of reported work-related injuries in the last year among the participants. Conclusions This study further supports hypotheses of a dose–response relationship between occupational noise exposure and work-related injuries, and suggests that exposures ≥88 dBA may increase injury risk in mining. [ABSTRACT FROM AUTHOR]

This article explores key nursing liability issues associated with the pandemic, including immunity, documentation, crisis standards of care, delegation and assignment, scope of practice, floating, travel nursing, telehealth, and misinformation and social media. [ABSTRACT FROM AUTHOR]

Social workers are at risk of experiencing burnout, which is associated with numerous negative outcomes for professionals, agencies, and their clients. The purpose of this study is to examine the relationship between professional burnout and workplace conditions, with a particular focus on incidents of client violence. Data were from the 2015–2016 Social Work Safety Survey (SWSS) (N = 141). A multiple linear regression model was created to examine the effect of various workplace conditions on feelings of burnout, including experiencing incidents of client violence, workplace setting, average hours worked, length of time at current job, working primarily with clients who had experienced trauma, satisfaction with supervision, and having participated in a safety training. Feelings of burnout significantly increased as number of incidents of client violence and/or threats of client violence increased (B = 0.14). Additionally, the greater the average hours worked per week (B =.02) and working in private clinical practice (B = 0.63) significantly increased burnout scores. Length of time at current job was inversely predictive of feelings of burnout (B = −0.03). The findings from this study have significant implications for social work education and practice which may omit or overlook the effects of client violence and threats of violence in burnout prevention. [ABSTRACT FROM AUTHOR]

Social work has been a part of the essential workforce historically and throughout the COVID‐19 pandemic, yet lack recognition. This work explores the experiences and invisibility of social workers within the pandemic response. Data are drawn from a large cross‐sectional survey of US‐based social worker from June to August of 2020. A summative content analysis of responses to the question 'What do you wish people knew about social work during the COVID‐19 pandemic' was undertaken. Participants (n = 515) were majority white (72.1%) and female (90.8%). Seven coding categories were subsequently collapsed into three domains: (1) meeting basic needs, (2) well‐being (emotional distress and dual role) and (3) professional invisibility (workplace equals, physical safety, professional invisibility and organisational invisibility). Meeting social needs requires broad‐based policies that strengthen the health and social safety net. Social workers have and will continue to play a critical role in the response, and recovery from COVID‐19. Organisational and governmental policies must expand to increase the visibility and responsiveness to the needs of social care providers. [ABSTRACT FROM AUTHOR]

This study was conducted to evaluate the prevalence and risk factors for work-related respiratory conditions (asthma, farmer's lung, sinusitis, rhinitis, and environmental allergies, diagnosed by a physician) among farm and ranch operators in the central US. A survey was conducted by the Central States Center for Agricultural Safety and Health (CS-CASH) in 2018, focusing on work-related injuries, illnesses, exposures, and preventive measures in a seven-state region (Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and South Dakota). Farms and ranches (n = 16,818) with an email address and annual sales exceeding $5,000 were randomly selected for the survey. Agricultural production and weather data were merged with survey responses. The relationship between exposures and respiratory conditions was analyzed using generalized estimating equations. We received responses from 3,268 agricultural operations (19% response rate) containing information on 4,064 individual operators. The life-time prevalence of (any) respiratory conditions among farm/ranch operators was 18%. Risk factors for respiratory conditions included exposures to grain/hay/feed dust (OR 2.41), animal confinement dust (OR 1.57), field/road dust (OR 2.11), manure/silage gasses (OR 1.66), anhydrous ammonia (OR 1.51), fuels/solvents/paints (OR 1.92), older age group >70 vs. <43 (OR 1.40), female gender (OR 1.82), and being primary vs. third operator (OR 1.61). Farmers and ranchers have a high prevalence of respiratory conditions associated with dust and gas exposures at work. More effective protective measures are needed using the hierarchy of controls, including improved use of respiratory protection. [ABSTRACT FROM AUTHOR]