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Background: Exposures associated with coal mining have long been linked to occupational disease. More recently, investigators have suggested that this industry may affect community health., Methods: We explored associations between age-adjusted, county-level respiratory disease hospitalization rates (RHRs) in West Virginia and total, surface, and underground coal production, taking into account relevant sociodemographic and behavioral covariates. RHRs were calculated for 2005 to 2009, and analyses were performed to assess the effect of coal production after adjusting for sociodemographic factors., Results: After controlling for percent below poverty, percent urban, and smoking, neither total nor underground tonnage was associated with RHR. Surface coal production, however, was significantly related with RHR (P < 0.05)., Conclusions: Surface coal production makes a small but significant contribution to RHR in West Virginia after accounting for other important sociodemographic and behavioral determinants of health.

Objective: To identify significant predictors of initial and repeated adherence with bladder cancer screening in a high-risk occupationally exposed cohort., Methods: We analyzed longitudinal (13 years) health survey data and a cross-sectional behavioral health survey from the Drake Health Registry Study. Construct validity of the behavioral health survey scales was evaluated using factor analysis. Initial compliance and repeated adherence were examined in separate logistic regression models., Results: "Barriers to screening" and "social influence" were associated with initial participation. Lower or no alcohol consumption, comorbidities, worry that screening would find bladder cancer, and ease of arranging schedules were associated with continued adherence., Conclusions: Factors affecting adherence with bladder cancer screening change for initial participation and for continued adherence. To enhance overall adherence, specific strategies should be implemented when initiating a screening program and revised accordingly over time.

Noise induced hearing loss (NIHL) is among the 10 leading occupational diseases, afflicting between 7.4 and 10.2 million people who work in noise above 85 dBA. Although mandatory hearing conservation programs (HCPs) have been in effect since 1972, this problem persists, as hearing protectors are not consistently used by workers, or may not attenuate to manufacturer's estimates in real world conditions. In this study, information from noise and hearing protection use measurements taken at an automobile assembly plant were used to construct average lifetime noise exposure and hearing protection compliance estimates for use in modeling to predict both total hearing loss and onset of two accepted definitions of hearing loss. There were 301 males and females in this cohort; their mean age was 42.6 (7.2) years, and mean tenure was 14.3 (3.5) years. Average length of follow-up was 14.0 years. There were 16 members of this cohort who had hearing loss at the speech frequencies (defined as an average hearing level > or = 25 dB at 500, 1000, and 2000 Hz). In cross-sectional multivariate analyses, years of employment, male gender, and proportion of time wearing hearing protection were the factors most associated with hearing loss at the average of 2000, 3000, and 4000 Hz (p < 0.0001) controlling for age, transfer status (as a surrogate for previous noise exposure), race, and lifetime average noise exposure. The most consistent predictor of hearing loss in both univariate and multivariate analyses was percentage of time having used hearing protection during the workers' tenure.

The National Institute of Occupational Safety and Health rates noise-induced hearing loss as one of the top 10 work-related problems, involving at least 11 million workers. This retrospective study examines the differences between pure-tone hearing loss and race/ethnicity in 216 white and 70 non-white male metal fabricating workers. Significant variables upon univariate analysis found to be associated with race/ethnicity were mean years of employment and proportion of time worked without hearing protection. Among whites, the permanent threshold average for 1, 2, 3 and 5 kHz was 25.99 dB, compared with 17.71 dB in non-whites (P < 0.01). Backwards stepwise regression indicated that race/ethnicity, after being adjusted for years of employment, was the major-effect variable. The results of this study suggest that occupational noise exposure alone does not alone account for the racial hearing differences.

The Drake Chemical Workers' Health Registry combined notification of workers about bladder cancer risk with access to a free program for screening and diagnosis. Evaluation of the project has given rise to several findings and new research questions. Findings in this article illustrate the following evaluation issues: 1) studying the combination of strategies that are most effective and cost effective to notify workers of their disease risks, 2) determining the realistic yield from strategies to gain participation in health screening and other protective services for notified workers, 3) identifying the notification strategies that were most effective for different kinds of participants, 4) using process evaluation to identify key activities for ensuring continued participation of cohort members in screening, and 5) examining the extent to which participants are willing to quit smoking to protect their health.

A medical surveillance program and epidemiologic study of 408 former workers of the Drake Chemical Company (now a Superfund waste site) was established in 1986. The Drake Health Registry Study was initiated because these workers had probable past exposures to beta-naphthylamine (BNA), a potent bladder carcinogen. The registry is widely viewed as a model for notification of workers at high risk of disease due to past occupational exposures. By the 40th month, 90% of the 366 living workers had been notified of the existence of the registry; 262 had been enrolled in the annual or semi-annual screening for bladder cancer. Among these, 27 persons have had abnormal screening results indicating moderate to high risk of bladder cancer and have been made eligible for further diagnostic tests. While no invasive bladder tumors were found among 18 persons completing the extended diagnostic evaluation, two diagnoses of moderate to severe dysplasia have been made. The registry has also identified three living and three deceased cases of bladder cancer in the cohort; a mortality analysis showed a 20- to 30-fold excess of bladder cancer. An incidence projection, based on the six identified cases, reveals that between six and ten new bladder cancer cases are likely to occur among the Drake cohort over the next 20 year period.

In 1986, the Drake Health Registry Study initiated bladder cancer screening for 366 persons at high risk because of occupational exposure to beta-naphthylamine. The Drake Health Registry Study screening protocol consists of urinalysis, Papanicolaou cytology, and quantitative fluorescence image analysis. A positive screening test qualifies participants for a full diagnostic evaluation. The screening protocol has been modified during the first 3 years of the program's existence to address unexpected patterns of test results and to incorporate advances in screening technology. The current protocol, which has a two-tiered screening schedule, has been utilized successfully for 15 months. Of the 26 positive results to date most have been based on abnormal Papanicolaou cytology and/or quantitative fluorescence image analysis. Bladder abnormalities were cited among most of the 18 study members who underwent diagnostic evaluation, including chronic cystitis, inflammation, hyperplasia, and dysplasia. We conclude that the screening program is detecting very early changes in a relatively young cohort and that these persons must be monitored over a number of years to ensure adequate medical surveillance.

The present study assessed the relationships among occupational noise exposure, noise-induced hearing loss, and high blood pressure. The study population consisted of 245 retired metal assembly workers from Pittsburgh aged 56 to 68 with chronic noise exposure of 30 or more years at greater than or equal to 89 dBA. Results of the audiometric testing indicated 52% of the younger workers (ages 56 to 63) have severe noise-induced hearing loss (greater than or equal to 65 dBA loss at 3, 4, or 6 kHz) and 67% of older workers (ages 64 to 68). Body mass index and alcohol intake were significantly related to systolic and diastolic blood pressure. Among older men, there was a marginally significant increased prevalence of high blood pressure (greater than or equal to 90 mm diastolic or taking blood pressure medicine) among those with severe noise-induced hearing loss (P = .05). Moreover, another measure of hearing loss at high frequencies, speech discrimination score in noise (measured in the better ear), referred to as the W-22 MAX score, was also found to be related to the prevalence of high blood pressure in the older (64 to 68) age group (P less than .05). Multiple regression analysis revealed W-22 MAX and severe noise-induced hearing loss were independent predictors of hypertension in the older, but not in the younger group of retired workers.

Recent studies of health effects from chronic exposure to noise in the workplace have not consistently addressed nonoccupational variables. A cross-sectional study was conducted with 197 randomly selected male hourly workers from a noisy plant (greater than or equal to 89 dBA) in Pittsburgh to fully assess noise exposure and hearing loss, incorporating information on duration of exposure, noise level, occupational and medical histories, audiometric evaluation, and external noise sources. Population audiometric profiles are characteristic of noise-induced hearing loss; mean hearing thresholds for press room men were significantly higher at 2, 3, and 6 kHz (p less than or equal to .05). Only 40% of the men consistently wore hearing protection. Recent use of ototoxic drugs, noisy hobbies/second jobs, military service, family history of hearing loss, and ear-related problems were not found to have a significant effect on hearing levels at high frequencies, suggesting that observed hearing losses were of an occupational origin.

Whole body vibration is an environmental stressor to which a substantial portion of the American workforce has been exposed. Numerous experimental studies have examined the acute effects of exposure to WBV but only in the last decade have the chronic effects been addressed. However, to date, no comprehensive review has been conducted of this common occupational exposure. This paper critically reviews the existing literature and summarizes the known health effects. Experimental study results are generally inconsistent and dependent on the characteristics of the vibration exposure. NIOSH's epidemiological studies have shown that several disorders are more prevalent in some occupations; however, causal relationships have not been established. Health professionals should be aware of potential ill effects that may result from exposure to WBV in combination with other environmental stressors.