Search

Background: The potential for work to be a risk factor for coronavirus disease 2019 (COVID-19) was recognized early in the pandemic based on the likelihood of work-related differences in exposures to COVID-19 in different occupations. Due to intense demands of the pandemic, implementation of recommendations to collect information on occupation in relation to COVID-19 has been uneven across the United States. The objective of this study was to investigate COVID-19 test positivity by occupation., Methods: We analyzed data collected from September 8 to November 30, 2020, by the Delphi Group at Carnegie Mellon University US COVID-19 Trends and Impact Survey, offered daily to a random sample of US-based Facebook users aged 18 years or older, who were invited via a banner in their news feed. Our focus was ever testing positive for COVID-19 in respondents working outside the home for pay in the past 4 weeks., Results: The major occupational groups of "Production", "Building and grounds cleaning and maintenance," "Construction and extraction," "Healthcare support," and "Food preparation and serving" had the five highest test positivity percentages (16.7%-14.4%). Highest detailed occupational categories (28.6%-19.1%) were "Massage therapist," "Food processing worker," "Bailiff, correctional officer, or jailer," "Funeral service worker," "First-line supervisor of production and operating workers," and "Nursing assistant or psychiatric aide." Differences in test positivity by occupation remained after adjustment for age, gender, and pre-existing medical conditions., Conclusion: Information on differences in test positivity by occupation can aid targeting of messaging for vaccination and testing and mitigation strategies for the current and future respiratory infection epidemics and pandemics. These results, obtained before availability of COVID-19 vaccines, can form a basis for comparison to evaluate impacts of vaccination and subsequent emergence of viral variants., (© 2022 Wiley Periodicals LLC.)

Background: While other studies have reported estimates of COVID-19 vaccine uptake by broad occupational group, little is known about vaccine uptake by detailed occupational category., Methods: Data on COVID-19 vaccination were provided by US adults ages ≥18 years old who responded to the Facebook/Delphi Group COVID-19 Trends and Impact Survey (Delphi US CTIS) in April-May 2021, reported working for pay in the past 4 weeks, and answered questions about their COVID-19 vaccine status. Percentages of occupational groups reporting having had at least one COVID-19 vaccination were weighted to resemble the US general population and calculated for 23 major occupational groups and 120 detailed occupational categories in 15 major groups., Results: COVID-19 vaccine uptake for all 828,401 working adult respondents was 73.6%. Uptake varied considerably across the 23 major occupational groups, from 45.7% for Construction and Extraction to 87.9% for Education, Training, and Library. Percentage vaccinated was also very low for Installation, Maintenance, and Repair at 52.1% and Farming, Fishing, and Forestry at 53.9%. Among the 120 detailed occupational categories, the highest percentage vaccinated was 93.9% for Postsecondary Teacher and the three lowest values were 39.1% for Any Extraction Worker in Oil, Gas, Mining, or Quarrying; 40.1% for Vehicle or Mobile Equipment Mechanic, Installer, or Repairer; and 42.0% for Any Construction Trades Worker., Conclusion: Low vaccination percentages were seen in many US occupations by the end of May 2021, early in the period of widespread availability of vaccines for adults. These findings could help inform the deployment of occupation-specific vaccinepromotion activities during future viral epidemics and pandemics., (© 2022 Wiley Periodicals LLC.)

Introduction: This paper describes the occupations in the U.S. that involve close contact with others and whether the work is outdoors or indoors (risk factors for COVID-19), including the distribution of Black and Hispanic workers over these occupations., Methods: U.S. data released from 2014 to 2019 on employment, proximity to others at work, outdoor or indoor work, and Black and Hispanic worker percentages for occupations were used. Occupations were assigned to 6 categories defined as a low, medium, or high physical closeness (proximity) at work and outdoor or indoor work. A total of 3 of the 6 categories represent a higher risk for exposure to SARS-CoV-2: medium-proximity indoor, high-proximity outdoor, and high-proximity indoor exposure., Results: A high proportion of U.S. workers may be at higher risk for exposure to SARS-CoV-2 because their occupations involve either high proximity to others indoors and outdoors (25.2%, 36.5 million workers) or medium-proximity indoors (48%, 69.6 million workers). There is a differential distribution of proximity and outdoor/indoor work by occupation, which disproportionately affects Black and Hispanic workers in some occupations., Conclusions: Implementation of COVID-19 preventive measures in work settings should be based on occupation-specific risk factors, including the extent of proximity to others and whether the work is conducted outdoors or indoors. It is important that communication messages are tailored to the languages and preferred media of the workforce., (Published by Elsevier Inc.)

Background: Exposure to disinfectants among healthcare workers has been associated with respiratory health effects, in particular, asthma. However, most studies are cross-sectional and the role of disinfectant exposures in asthma development requires longitudinal studies. We investigated the association between occupational exposure to disinfectants and incident asthma in a large cohort of U.S. female nurses., Methods: The Nurses' Health Study II is a prospective cohort of 116 429 female nurses enrolled in 1989. Analyses included 61 539 participants who were still in a nursing job and with no history of asthma in 2009 (baseline; mean age: 55 years). During 277 744 person-years of follow-up (2009-2015), 370 nurses reported incident physician-diagnosed asthma. Occupational exposure was evaluated by questionnaire and a Job-Task-Exposure Matrix (JTEM). We examined the association between disinfectant exposure and subsequent asthma development, adjusted for age, race, ethnicity, smoking status, and body mass index., Results: Weekly use of disinfectants to clean surfaces only (23% exposed) or to clean medical instruments (19% exposed) was not associated with incident asthma (adjusted hazard ratio [95% confidence interval] for surfaces, 1.12 [0.87-1.43]; for instruments, 1.13 [0.87-1.48]). No association was observed between high-level exposure to specific disinfectants/cleaning products evaluated by the JTEM (formaldehyde, glutaraldehyde, bleach, hydrogen peroxide, alcohol quats, or enzymatic cleaners) and asthma incidence., Conclusions: In a population of late career nurses, we observed no significant association between exposure to disinfectants and asthma incidence. A potential role of disinfectant exposures in asthma development warrants further study among healthcare workers at earlier career stage to limit the healthy worker effect., (© 2019 Wiley Periodicals, Inc.)

Introduction: Existing asthma-specific job-exposure matrices (JEMs) do not necessarily reflect current working conditions in the USA and do not directly function with occupational coding systems commonly used in the USA. We initiated a project to modify an existing JEM to address these limitations, and to apply the new JEM to the entire US employed population to estimate quantitatively the extent of probable work-related asthma exposures nationwide., Methods: We started with an asthma-specific JEM that was developed for northern Europe (the N-JEM) and modified it to function with the 2010 US Standard Occupational Classification (SOC-2010) codes and to reflect working conditions in the USA during the post-2000 period. This involved cross walking from the 1988 International Standard Classification of Occupations (ISCO-88) codes used in the N-JEM to the SOC-2010 codes, transferring the N-JEM exposure assignments to the SOC-2010 codes, and modifying those assignments to reflect working conditions in the USA. The new US asthma JEM (USA-JEM) assigns exposures to 19 agents organized into five categories. The USA-JEM and N-JEM were applied to the same sample of working adults with asthma to compare how they performed, and the USA-JEM was also applied to the entire 2015 US working population to estimate the extent of occupational asthma exposures nationally., Results: The USA-JEM assigns at least one asthma-related probable exposure to 47.5% and at least one possible exposure to 14.9% of the 840 SOC-2010 detailed occupations, and 9.0% of the occupations have both probable exposure to at least one agent and possible exposure to at least one other agent. The USA-JEM has greater sensitivity for cleaning products, highly reactive disinfectants and sterilants, and irritant peak exposures than the N-JEM. When applied to the entire 2015 US working population, the USA-JEM determined that 42.6% of workers had probable exposure to at least one type of occupational asthma agent., Discussion: A new asthma-specific JEM for application in the USA was developed. Additional work is needed to compare its performance to similar JEMs and, if possible, to exposure assessments generated on a case-by-case basis., (Published by Oxford University Press on behalf of The British Occupational Hygiene Society 2019.)

Importance: Exposure to disinfectants in health care workers has been associated with respiratory health outcomes, including asthma. Despite the biological plausibility of an association between disinfectants (irritant chemicals) and risk of chronic obstructive pulmonary disease (COPD), available data are sparse., Objective: To investigate the association between exposure to disinfectants and COPD incidence in a large cohort of US female nurses., Design, Setting, and Participants: The Nurses' Health Study II is a US prospective cohort study of 116 429 female registered nurses from 14 US states who were enrolled in 1989 and followed up through questionnaires every 2 years since. The present study included women who were still in a nursing job and had no history of COPD in 2009, and used data from the 2009 through 2015 questionnaires. Clean and complete data used for this analysis were available in July 2018, and analyses were conducted from September 2018 through August 2019., Exposures: Occupational exposure to disinfectants, evaluated by questionnaire and a job-task-exposure matrix (JTEM)., Main Outcomes and Measures: Incident physician-diagnosed COPD evaluated by questionnaire., Results: Among the 73 262 women included in the analyses, mean (SD) age at baseline was 54.7 (4.6) years and 70 311 (96.0%) were white, 1235 (1.7%) black, and 1716 (2.3%) other; and 1345 (1.8%) Hispanic, and 71 917 (98.2%) non-Hispanic. Based on 368 145 person-years of follow-up, 582 nurses reported incident physician-diagnosed COPD. Weekly use of disinfectants to clean surfaces only (16 786 [22.9%] of participants exposed) and to clean medical instruments (13 899 [19.0%] exposed) was associated with COPD incidence, with adjusted hazard ratios of 1.38 (95% CI, 1.13-1.68) for cleaning surfaces only and 1.31 (95% CI, 1.07-1.61) for cleaning medical instruments after adjustment for age, smoking (pack-years), race, ethnicity, and body mass index. High-level exposure, evaluated by the JTEM, to several specific disinfectants (ie, glutaraldehyde, bleach, hydrogen peroxide, alcohol, and quaternary ammonium compounds) was significantly associated with COPD incidence, with adjusted hazard ratios ranging from 1.25 (95% CI, 1.04-1.51) to 1.36 (95% CI, 1.13-1.64). Associations were not modified by smoking or asthma status (P for interaction > .15)., Conclusions and Relevance: These longitudinal results suggest that regular use of chemical disinfectants among nurses may be a risk factor for developing COPD. If future studies confirm these results, exposure-reduction strategies that are compatible with infection control in health care settings should be developed.

Cleaning and disinfecting tasks and product use are associated with elevated prevalence of asthma and respiratory symptoms among healthcare workers; however, the levels of exposure that pose a health risk remain unclear. The objective of this study was to estimate the peak, average, and determinants of real-time total volatile organic compound (TVOC) exposure associated with cleaning tasks and product-use. TVOC exposures were measured using monitors equipped with a photoionization detector (PID). A simple correction factor was applied to the real-time measurements, calculated as a ratio of the full-shift average TVOC concentrations from a time-integrated canister and the PID sample, for each sample pair. During sampling, auxiliary information, e.g. tasks, products used, engineering controls, was recorded on standardized data collection forms at 5-min intervals. Five-minute averaged air measurements (n = 10 276) from 129 time-series comprising 92 workers and four hospitals were used to model the determinants of exposures. The statistical model simultaneously accounted for censored data and non-stationary autocorrelation and was fit using Markov-Chain Monte Carlo within a Bayesian context. Log-transformed corrected concentrations (cTVOC) were modeled, with the fixed-effects of tasks and covariates, that were systematically gathered during sampling, and random effect of person-day. The model-predicted geometric mean (GM) cTVOC concentrations ranged from 387 parts per billion (ppb) for the task of using a product containing formaldehyde in laboratories to 2091 ppb for the task of using skin wipes containing quaternary ammonium compounds, with a GM of 925 ppb when no products were used. Peak exposures quantified as the 95th percentile of 15-min averages for these tasks ranged from 3172 to 17 360 ppb. Peak and GM task exposures varied by occupation and hospital unit. In the multiple regression model, use of sprays was associated with increasing exposures, while presence of local exhaust ventilation, large room volume, and automatic sterilizer use were associated with decreasing exposures. A detailed understanding of factors affecting TVOC exposure can inform targeted interventions to reduce exposures and can be used in epidemiologic studies as metrics of short-duration peak exposures., (Published by Oxford University Press on behalf of The British Occupational Hygiene Society 2019.)

Background: Occupational exposure to animal production is associated with chronic bronchitis symptoms; however, few studies consider associations with chronic obstructive pulmonary disease (COPD). We estimated associations between animal production activities and prevalence of self-reported COPD among farmers in the Agricultural Health Study., Methods: During a 2005-2010 interview, farmers self-reported information about: their operations (i.e., size, type, number of animals, insecticide use), respiratory symptoms, and COPD diagnoses (i.e., COPD, chronic bronchitis, emphysema). Operations were classified as small or medium/large based on regulatory definitions. Farmers were classified as having a COPD diagnosis, chronic bronchitis symptoms (cough and phlegm for ≥3 months during 2 consecutive years), or both. Polytomous logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI)., Results: Of 22,491 participating farmers (median age: 59 years), 922 (4%) reported a COPD diagnosis only, 254 (1%) reported a diagnosis and symptoms, and 962 (4%) reported symptoms only. Compared to raising no commercial animals, raising animals on a medium/large operation was positively associated with chronic bronchitis symptoms with (OR: 1.59; 95% CI: 1.16, 2.18) and without a diagnosis (OR: 1.69; 95% CI: 1.42, 2.01). Ever use of multiple organophosphates, carbaryl, lindane, and permethrin were positively associated with chronic bronchitis symptoms., Conclusion: Animal production work, including insecticide use, was positively associated with chronic bronchitis symptoms; but not consistently with COPD diagnosis alone. Our results support the need for further investigation into the role of animal production-related exposures in the etiology of COPD and better respiratory protection for agricultural workers., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Purpose of Review: Work-related asthma has been associated with poorer asthma control and frequent unscheduled healthcare visits, and can be fatal. Case reports of work-related asthma deaths are rare, but can initiate efforts to prevent additional cases. We reviewed relevant literature and data sources to evaluate whether analyzing mortality data at the population level can help identify potential sources of exposures that contribute to work-related asthma., Recent Findings: A limited number of population-based studies have addressed work-related asthma mortality. Data on asthma mortality are derived from death certificates using the International Classification of Diseases (ICD) as a standard for coding cause. However, no discrete code for work-related asthma is available. Analysis of asthma mortality relative to industries and occupations appears to identify high-risk jobs that were not identified by analyzing asthma morbidity data., Summary: Beyond recognized work-related asthma deaths, it is possible that occupational exposures have contributed to other asthma deaths that have gone unnoticed and could potentially be identified by the analysis of mortality data at the population level. Such analyses in the United States appear to assist in recognizing high-risk occupations and industries. Additional analyses would be possible if a work-related asthma ICD code were available.

Objectives: To investigate the association between occupational exposure to disinfectants/antiseptics used for hand hygiene and asthma control in nurses., Methods: In 2014, we invited female nurses with asthma drawn from the Nurses' Health Study II to complete two supplemental questionnaires on their occupation and asthma (cross-sectional study, response rate: 80%). Among 4055 nurses (mean age: 59 years) with physician-diagnosed asthma and asthma medication use in the past year, we examined asthma control, as defined by the Asthma Control Test (ACT). Nurses were asked about the daily frequency of hand hygiene tasks: 'wash/scrub hands with disinfectants/hand sanitizers' (hand hygiene) and 'wash/scrub arms with disinfecting products' (surrogate of surgical hand/arm antisepsis). Analyses were adjusted for age, race, ethnicity, smoking status and body mass index., Results: Nurses with partly controlled asthma (ACT: 20-24, 50%) and poorly controlled asthma (ACT ≤19, 18%) were compared with nurses with controlled asthma (ACT=25, 32%). In separate models, both hand and arm hygiene were associated with poorly controlled asthma. After mutual adjustment, only arm hygiene was associated with poorly controlled asthma: OR (95% CI) for <1 time/day, 1.38 (1.06 to 1.80); ≥1 time/day, 1.96 (1.52 to 2.51), versus never. We observed a consistent dose-response relationship between frequency of arm hygiene tasks (never to >10 times/day) and poor asthma control. Associations persisted after further adjustment for surfaces/instruments disinfection tasks., Conclusions: Frequency of hand/arm hygiene tasks in nurses was associated with poor asthma control. The results suggest an adverse effect of products used for surgical hand/arm antisepsis. This potential new occupational risk factor for asthma warrants further study., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Objective: The objective of the study is to examine associations between use of specific pesticides and lifetime allergic rhinitis and current asthma in US primary farm operators., Methods: The 2011 Farm and Ranch Safety Survey data from 11,210 primary farm operators were analyzed. Pesticide use on the farm was determined using an affirmative response to the question of whether the operator ever mixed, loaded, or applied pesticides on their farm in the 12 months prior to the interview. Operators who answered "yes" were further asked about the specific trade name and formulation identifiers of the product they used and personal protective equipment (PPE) used. Data were weighted to produce national estimates. Adjusted prevalence odds ratios (PORs) were calculated using logistic regression. The referent group included operators who did not use any pesticides in the 12 months prior to the interview., Results: Of an estimated 2.1 million farm operators, 40.0% used pesticides, 30.8% had lifetime allergic rhinitis, and 5.1% had current asthma. Insecticide and herbicide use were significantly associated with lifetime allergic rhinitis and current asthma. The use of 2,4-dichlorophenoxyacetic acid (POR = 1.5; 95% CI 1.2-1.9) and carbaryl (POR = 2.3; 1.4-3.7) was significantly associated with lifetime allergic rhinitis. Of operators using pesticides, 64.9% used PPE the last time they mixed, loaded, or applied pesticides., Conclusions: Pesticide use was associated with lifetime allergic rhinitis and current asthma among farm operators. Further studies are needed to clarify the dose-response relationship between pesticide use and adverse respiratory health effects.

Purpose: Allergic rhinitis is associated with decreased quality of life, and reduced workplace performance and productivity. This study investigated the prevalence of lifetime allergic rhinitis and factors associated with allergic rhinitis among US primary farm operators., Methods: The 2011 Farm and Ranch Safety Survey data collected from 11,210 active farm operators were analyzed. Survey respondents were determined to have lifetime allergic rhinitis based on a "yes" response to the question: "Have you ever been told by a doctor, nurse, or other health professional that you had hay fever, seasonal allergies, or allergic rhinitis?" Data were weighted to produce nationally representative estimates., Results: An estimated 30.8% of the 2.1 million active farm operators had lifetime allergic rhinitis in 2011. The allergic rhinitis prevalence varied by demographic and farm characteristics. Farm operators with allergic rhinitis were 1.38 (95% CI 1.22-1.56) times more likely to be exposed to pesticides compared with operators with no allergic rhinitis. The association with pesticide exposure for allergic rhinitis and current asthma, and allergic rhinitis alone was statistically significant and greater than that for current asthma alone., Conclusion: Certain groups of farm operators may be at increased risk of allergic rhinitis. Studies should further investigate the association of allergic rhinitis with specific pesticide exposure.

Objectives: To identify and summarise volatile organic compound (VOC) exposure profiles of healthcare occupations., Methods: Personal (n=143) and mobile area (n=207) evacuated canisters were collected and analysed by a gas chromatograph/mass spectrometer to assess exposures to 14 VOCs among 14 healthcare occupations in five hospitals. Participants were volunteers identified by their supervisors. Summary statistics were calculated by occupation. Principal component analysis (PCA) was used to reduce the 14 analyte inputs to five orthogonal factors and identify occupations that were associated with these factors. Linear regressions were used to assess the association between personal and mobile area samples., Results: Exposure profiles differed among occupations; ethanol had the highest geometric mean (GM) among nursing assistants (∼4900 and ∼1900 µg/m(3), personal and area), and 2-propanol had the highest GM among medical equipment preparers (∼4600 and ∼2000 µg/m(3), personal and area). The highest total personal VOC exposures were among nursing assistants (∼9200 µg/m(3)), licensed practical nurses (∼8700 µg/m(3)) and medical equipment preparers (∼7900 µg/m(3)). The influence of the PCA factors developed from personal exposure estimates varied by occupation, which enabled a comparative assessment of occupations. For example, factor 1, indicative of solvent use, was positively correlated with clinical laboratory and floor stripping/waxing occupations and tasks. Overall, a significant correlation was observed (r=0.88) between matched personal and mobile area samples, but varied considerably by analyte (r=0.23-0.64)., Conclusions: Healthcare workers are exposed to a variety of chemicals that vary with the activities and products used during activities. These VOC profiles are useful for estimating exposures for occupational hazard ranking for industrial hygienists as well as epidemiological studies., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Purpose: Exacerbation is a critical event in asthma management. We investigated whether exacerbation of symptoms is associated with farming exposures among agricultural pesticide applicators with asthma., Methods: Participants were pesticide applicators with active asthma (wheezing and breathing problems in past 12 months) who completed enrollment questionnaires for the Agricultural Health Study (AHS). Exacerbation of asthma was defined as having visited a hospital emergency room or doctor for an episode of wheezing or whistling in the past 12 months. Exposures of interest were using 36 specific pesticides in the past 12 months and conducting various agricultural activities. Adjusted odds ratios (ORs) were estimated by logistic regression while controlling for potential confounders., Results: The 926 AHS adult pesticide applicators with active asthma included 202 (22%) with exacerbation. Inverse associations with exacerbation were observed for two herbicides [glyphosate, odds ratio (OR) = 0.5, 95% confidence interval (CI) 0.3, 0.8, and paraquat, OR = 0.3, 95% CI 0.1, 0.9] and several agricultural activities (repairing engines, grinding metal, driving diesel tractors, and performing veterinary procedures). Only asthma cases with allergies (i.e., doctor-diagnosed hay fever or eczema, 46%) had positive exacerbation-pesticide associations, with OR = 2.1 (95% CI 1.1, 4.1) for the herbicide pendimethalin and OR = 10.2 (95% CI 1.9, 55) for the insecticide aldicarb., Conclusions: The inverse associations with two pesticides and specific farm activities are consistent with the possibility that asthma cases prone to exacerbation may avoid exposures that trigger symptoms. Although limited by small sample size and a cross-sectional design, our study suggests that use of specific pesticides may contribute to exacerbation of asthma among individuals with allergies.

Children with asthma can experience chronic morbidity that may interfere with education and career progression. The authors investigated retrospectively whether a history of childhood asthma is associated with educational level and longest-held occupation, by gender. Cross-sectional analysis included a nationally representative sample of 10,452 adults aged ≥20 years who participated in the US National Health and Nutrition Examination Survey (2001-2004). Logistic regression was used to assess associations between a childhood-asthma history and educational level, employment, and longest-held occupation. An estimated 6.9% of men and 5.8% of women had a childhood-asthma history. Persons with a childhood-asthma history tended to have a higher educational level than those with no asthma history. Among those who ever worked, and after adjustment for age and race/ethnicity, men with a childhood-asthma history were more likely to work in health-diagnosing occupations, other professional occupations, and as cooks; women with a childhood-asthma history were more likely to work in management-related, entertainment-related, and health service occupations. Compared with those with no asthma history, persons with a childhood-asthma history tended to achieve a higher educational level and, if they worked, were more likely to work in particular occupations.

Rationale: Occupational exposures can contribute to the exacerbation as well as the onset of asthma. However, work-exacerbated asthma (WEA) has received less attention than occupational asthma (OA) that is caused by work., Objectives: The purpose of this Statement is to summarize current knowledge about the descriptive epidemiology, clinical characteristics, and management and treatment of WEA; propose a case definition for WEA; and discuss needs for prevention and research., Methods: Information about WEA was identified primarily by systematic searches of the medical literature. Statements about prevention and research needs were reached by consensus., Measurements and Main Results: WEA is defined as the worsening of asthma due to conditions at work. WEA is common, with a median prevalence of 21.5% among adults with asthma. Different types of agents or conditions at work may exacerbate asthma. WEA cases with persistent work-related symptoms can have clinical characteristics (level of severity, medication needs) and adverse socioeconomic outcomes (unemployment, reduction in income) similar to those of OA cases. Compared with adults with asthma unrelated to work, WEA cases report more days with symptoms, seek more medical care, and have a lower quality of life. WEA should be considered in any patient with asthma that is getting worse or who has work-related symptoms. Management of WEA should focus on reducing work exposures and optimizing standard medical management, with a change in jobs only if these measures are not successful., Conclusions: WEA is a common and underrecognized adverse outcome resulting from conditions at work. Additional research is needed to improve the understanding of the risk factors for, and mechanisms and outcomes of, WEA, and to inform and evaluate preventive interventions.

Objective: Little is known about the risk of sensitization and chronic beryllium disease (CBD) among workers performing limited processing of copper-beryllium alloys downstream of the primary beryllium industry. In this study, we performed a cross-sectional survey of employees at three copper-beryllium alloy distribution centers., Methods: One hundred workers were invited to be tested for beryllium sensitization using the beryllium blood lymphocyte proliferation test (BeLPT); a sensitized worker was further evaluated for CBD. Available beryllium mass concentration air sampling data were obtained for characterization of airborne exposure., Results: One participant, who had exposure to other forms of beryllium, was found to be sensitized and to have CBD, resulting in a prevalence of sensitization/CBD of 1% for all tested., Conclusions: The overall prevalence of beryllium sensitization and CBD for workers in these three copper-beryllium alloy distribution centers is lower than for workers in primary beryllium production facilities.

Estimates of the number of workers in the United States occupationally exposed to beryllium were published in the 1970s and 1980s and ranged from 21,200 to 800,000. We obtained information from several sources to identify specific industries with beryllium exposure and to estimate the number of current workers potentially exposed to beryllium. We spoke with representatives from the primary beryllium industry and government agencies about the number of exposed workers in their facilities. To identify industries in the private sector but outside the primary industry, we used data from the Integrated Management Information System (IMIS), which is managed by the Occupational Safety and Health Administration, and the Health Hazard Evaluation program of the National Institute for Occupational Safety and Health. We used IMIS data from OSHA inspections with a previously developed algorithm to estimate the number of potentially exposed workers in nonprimary industries. Workers potentially exposed to beryllium included 1500 current employees in the primary beryllium industry and 26,500 individuals currently working for the Department of Energy or the Department of Defense. We identified 108 four-digit Standard Industrial Classification (SIC) categories in which at least one measurement of airborne beryllium was > or = 0.1 microg/m3. Based on the subset of 94 SIC categories with beryllium > or = 0.1 microg/m3, we estimated 26,400 to 106,000 workers may be exposed in the private sector (outside the primary industry). In total, there are as many as 134,000 current workers in government and private industry potentially exposed to beryllium in the United States. We recommend that the results of this study be used to target at-risk audiences for hazard communications intended to prevent beryllium sensitization and chronic beryllium disease.

Background and Aims: Work related asthma (WRA) is one of the most frequently reported occupational lung diseases in a number of industrialised countries. A better understanding of work aggravated asthma (WAA), as well as work related new onset asthma (NOA), is needed to aid in prevention efforts., Methods: WAA and NOA in the United States were compared using cases reported to the National Institute for Occupational Safety and Health (NIOSH) from four state Sentinel Event Notification Systems for Occupational Risks (SENSOR) surveillance programmes for 1993-95., Results: A total of 210 WAA cases and 891 NOA cases were reported. WAA cases reported mineral and inorganic dusts as the most common exposure agent, as opposed to NOA cases, in which diisocyanates were reported most frequently. A similar percentage of WAA and NOA cases still experienced breathing problems at the time of the interview or had visited a hospital or emergency room for work related breathing problems. NOA cases were twice as likely to have applied for workers' compensation compared with WAA cases. However, among those who had applied for worker compensation, approximately three-fourths of both WAA and NOA cases had received awards. The services and manufacturing industrial categories together accounted for the majority of both WAA (62%) and NOA (75%) cases. The risk of WAA, measured by average annual rate, was clearly the highest in the public administration (14.2 cases/10(5)) industrial category, while the risk of NOA was increased in both the manufacturing (3.2 cases/10(5)) and public administration (2.9 cases/10(5)) categories., Conclusions: WAA cases reported many of the same adverse consequences as NOA cases. Certain industries were identified as potential targets for prevention efforts based on either the number of cases or the risk of WAA and NOA.

Background: HMO databases offer an opportunity for community based epidemiologic studies of asthma incidence, etiology and treatment. The incidence of asthma in HMO populations and the utility of HMO data, including use of computerized algorithms and manual review of medical charts for determining etiologic factors has not been fully explored., Methods: We identified adult-onset asthma, using computerized record searches in a New England HMO. Monthly, our software applied exclusion and inclusion criteria to identify an "at-risk" population and "potential cases". Electronic and paper medical records from the past year were then reviewed for each potential case. Persons with other respiratory diseases or insignificant treatment for asthma were excluded. Confirmed adult-onset asthma (AOA) cases were defined as those potential cases with either new-onset asthma or reactivated mild intermittent asthma that had been quiescent for at least one year. We validated the methods by reviewing charts of selected subjects rejected by the algorithm., Results: The algorithm was 93 to 99.3% sensitive and 99.6% specific. Sixty-three percent (n = 469) of potential cases were confirmed as AOA. Two thirds of confirmed cases were women with an average age of 34.8 (SD 11.8), and 45% had no evidence of previous asthma diagnosis. The annualized monthly rate of AOA ranged from 4.1 to 11.4 per 1000 at-risk members. Physicians most commonly attribute asthma to infection (59%) and allergy (14%). New-onset cases were more likely attributed to infection, while reactivated cases were more associated with allergies. Medical charts included a discussion of work exposures in relation to asthma in only 32 (7%) cases. Twenty-three of these (72%) indicated there was an association between asthma and workplace exposures for an overall rate of work-related asthma of 4.9%., Conclusion: Computerized HMO records can be successfully used to identify AOA. Manual review of these records is important to confirm case status and is useful in evaluation of provider consideration of etiologies. We demonstrated that clinicians attribute most AOA to infection and tend to ignore the contribution of environmental and occupational exposures.

Background: The US employer-based surveillance system for documenting occupational injuries and illnesses undercounts chronic diseases. We suggest a method to estimate the number of individuals who are newly-recognized with silicosis each year in the United States., Methods: Data from US death certificates, the Michigan state-based surveillance system, and capture-recapture analysis were used to calculate national estimates of silicosis., Results: From 1987 to 1996, 2,787 deaths occurred in the United States where silicosis was mentioned on the death certificates. During the same period, in Michigan 77% of death certificates with a mention of silicosis were confirmed as silicosis-related deaths and the ratio of the number of living to deceased confirmed silicosis cases was 6.44. The proportion of confirmed silicosis deaths, the ratio of the living to deceased silicosis cases and capture-recapture analysis from the Michigan surveillance system, were used to estimate that there were 3,600-7,300 cases per year of silicosis in the United States from 1987 to 1996., Conclusions: Our estimate of the annual number of newly-recognized silicosis cases is significantly larger than the estimate from the employer-based reporting system used for counting occupational disease in the United States. This employer-based surveillance system is inadequate for determining the frequency of occupational disease. Our analysis which combines a readily-available and relatively inexpensive national administrative database (i.e., death certificates) with a more costly state-based active surveillance system is a cost-effective model that could be used to provide better estimates of a number of different occupational diseases. Accurate estimates of occupational illnesses are essential to both determine temporal trends and evaluate efforts to prevent silicosis., (Copyright 2003 Wiley-Liss, Inc.)

The objective was to elaborate the descriptive epidemiology of work-related cases of reactive airways dysfunction syndrome (RADS). Cases of work-related asthma (WRA) were identified in four states in the United States during 1993-1995 as part of the Sentinel Event Notification Systems for Occupational Risks (SENSOR). Information gathered by follow-back interview was used to describe 123 work-related RADS cases and to compare them to 301 other WRA cases whose onset of disease was associated with a known asthma inducer. RADS represented 14% of all new-onset WRA cases identified by the state SENSOR surveillance systems. RADS cases had significant adverse medical and occupational outcomes identified by follow-back interview. In particular, 89% still had breathing problems, 78% had ever sought emergency care and 39% had ever been hospitalized for work-related breathing problems, 54% had applied for worker compensation benefits, and 41% had left the company where they experienced onset of asthma. These values equaled or exceeded the comparable figures for those WRA cases whose onset was attributed to a known inducer. Work-related RADS represents a minority of all WRA cases, but the adverse impact of this condition appears to equal that of other WRA cases.

Adults with asthma who had been enrolled in an HMO for at least a year were requested to complete a questionnaire about their health status. Approximately 25% of the 1,461 participants responded positively to "Does your current work environment make your asthma worse?" and were classified as having workplace exacerbation of asthma. Those with workplace exacerbation were more likely to have never attended college, be current or former smokers, have a history of other respiratory diseases, have missed work or usual activities at least one day in the past for weeks, and report their asthma was moderate, severe, or very severe. Percentages with workplace exacerbation of asthma were highest for mining and construction (36%), wholesale and retail trade (33%), and public administration (33%), and lowest for educational services (22%), finance, insurance, and real estate (22%), and non-medical and non-educational services (18%). Future studies are needed for objective validation of self-reported workplace exacerbation, and to follow subjects prospectively to clarify the temporal sequence of workplace exacerbation and asthma severity, and how other respiratory conditions and smoking might contribute to work-related worsening of asthma.

Background: Data from a stratified sample of hospital emergency rooms in the USA were used to describe nonfatal work-related inhalation injuries and illnesses during July 1995 to July 1996., Methods: Information was abstracted from emergency room records by the Consumer Product Safety Commission (CPSC) as part of the National Electronic Injury Surveillance System (NEISS) for all work-related injuries and illnesses regardless of product involvement., Results: There were an estimated 44,423 occupational inhalation cases nationwide, with an annual rate of 3.6 cases/10(4) workers/year. The rate for men (4.4 cases/10(4)) was greater than that observed for women (2.6 cases/10(4)), and the rates tended to decline with increasing age. An estimated 4.6% of the cases were hospitalized for further treatment. The highest rate by industry was 16.4 cases/10(4) for public administration (which included fire and police departments). Among non-firefighters, there were an estimated 6,470 cases nationwide in which respiratory symptoms or conditions were noted, which yielded an annual rate of 0.5 cases/10(4) (95% CI 0.3, 0.7). Chlorine compounds were a common agent for the cases with adverse respiratory outcomes., Conclusions: The NEISS data provide an efficient method to learn about the national frequency of work-related inhalation injuries and illnesses. The National Institute for Occupational Safety and Health (NIOSH) is exploring two ways to use these data: first, to routinely review the reports to conduct surveillance for work-related inhalation cases; and second, to consider working with CPSC to conduct follow-back interviews of selected cases in order to learn more about the circumstances of the exposure, prior training of the case, and outcome of the exposure. Am. J. Ind. Med. 38:140-148, 2000. Published 2000 Wiley-Liss, Inc.

The objective of the study was to estimate the incidences of physician-diagnosed cases of work-related asthma (WRA) in Michigan and the entire United States. The statewide surveillance system for WRA in Michigan receives reports primarily from three sources: physicians, hospital discharge data, and worker's compensation claims. Knowledge of the overlap in reports from these sources was used in conjunction with capture-recapture methods to estimate the total number of diagnosed cases of WRA, and incidence rates were calculated using the estimated number of civilian employees in Michigan as the population at risk. For the entire United States, the product of a national incidence rate for asthma among adults and estimates of the proportion that is work-related was used. A total of 933 cases of WRA were reported to the Michigan surveillance program during 1988-1995, of which 904 were reported by at least one of the three main sources and equaled an average incidence of 27 cases/10(6)/year. This estimate was less than the range of estimates 58 to 204 cases/10(6)/year in Michigan arrived at using the capture-recapture methods. The national estimates of WRA ranged from 63 to 441 cases/10(6)/year. The authors' indirect estimates are closer to estimates from Canada, Sweden, and Finland than most existing direct estimates in the United States, but probably still underestimates the magnitude of WRA incidence because of the limitations of physician recognition of the work-relatedness of asthma among adults.

The goal of this study was to determine whether respiratory symptoms were associated with the lower concentrations of respirable coal mine dust that were required by the U.S. Coal Mine Health and Safety Act (CMHSA) of 1969. The subjects were 1,866 male miners who had participated in the National Study of Coal Workers' Pneumoconiosis (NSCWP) and been tested at least twice, initially in either Round 1 (R1) (1969-71) or Round 2 (R2) (1972-75) and then finally in Round 4 (R4) (1985-88). Self-reported information elicited with a standardized questionnaire was used to determine the presence at the final round (i.e., R4) of chronic bronchitis, shortness of breath, and wheeze. Cumulative coal mine dust exposure was characterized for both the pre- and post-CMHSA periods. Controlling for age and other potential confounders, increased risks for the symptoms were associated with higher levels of both measurements of exposure. Moreover, the adverse effects of the lower, post-CMHSA exposure were evident for shortness of breath and wheeze especially among subjects who had little pre-CMHSA coal mining experience. These findings provide additional evidence of the limitations of the current 2.0 mg/m3 coal mine dust standard to prevent respiratory disease.

A high risk of death from liver HSA has been documented from past exposures to VC. Similar to other carcinogens, the risk of VC-induced liver HSA appears to increase as the second or third power of time from onset of exposure. It is possible to project future mortality using this power relationship, estimates of VC exposure, and observed mortality to 1980. These projections suggest that 200-600 deaths may occur in the United States and 550-2,800 in Western Europe from liver HSA. These projections also suggest that a 1 ppm standard in the VC industry will go far to protecting workers from future malignant disease.