Occupational Injury Research

Protecting workers in the temporary staffing industry. Forst L, Chaudhry A, Lopez A, McCarthy M, and Hebert-Beirne J. Occupational Medicine.

In this analysis, temporary staffing companies describe a lack of cooperation and shifted responsibility with host companies. We found that temporary staffing employers describe loss of control of the working conditions once workers are placed at host/client companies. Further, they describe a contentious relationship between temporary staffing and host companies, where it is difficult to hold host companies to account. Staffing agencies also report that they often lack of knowledge of site-specific hazards, quality of onsite training, and OSHA compliance.

Workers’ compensation and the working poor: Occupational health experience among low wage workers in federally qualified health centers.  Topete L, Forst L, Zanoni J, Friedman L. Am J Ind Med.

The working poor are at highest risk of work-related injuries and have limited access to occupational health care. Community health centers can be a venue for accessing at-risk workers and to examine the experience, knowledge, and perceptions of workers’ compensation among the working poor. Fifty-one interviews of minority workers across sectors identified 23 prior work-related injured and mixed experiences with the workers’ compensation system.

Outreach to Low-Wage and Precarious Workers: Concept Mapping for Public Health Officers. Velonis A, Forst L. J Occup Environ Med.

Community based participatory research (CBPR) methodologies are increasingly being used in public health. Concept mapping, an example of CBPR, can be used by public health officials to strategize approaches to reducing health inequities among low wage workers and workers with unstable employment.

Safety Climate Among Nontraditional Workers in Construction: Arguing for a Focus on Construed External Safety Image. Stiehl E, Forst L. New Solut.

Safety climate, employees’ perceptions of work-related safety, has been promoted as a leading indicator of workplace safety in construction. While research has primarily examined internal organizational sources (e.g., manager attitudes, formal organizational policies) on these perceptions, external sources of information might be more relevant to construction workers in nontraditional jobs who work for a limited time and/or have limited interaction with other employees.

Occupational Safety and Health in the Temporary Services Industry: A Model for a Community-University Partnership. Bonney T, Forst L, Rivers S, Love M, Pratap P, Bell T, Fulkerson S. New Solut.

Workers in the temporary staffing industry face hazardous working conditions and have a high risk of occupational injury. This project brought together local workers’ centers and university investigators to build a corps of Occupational Health Promoters (OHPs) and to test a survey tool and recruitment methods to identify hazards and raise awareness among workers employed by temporary staffing companies.

Workers’ compensation filings of temporary workers compared to direct hire workers in Illinois, 2007-2012. Madigan D, Forst L, Friedman LS. Am J Ind Med.

The physical and psychological risks of temporary employment are well documented but there are still many questions regarding the consequences of injuries among these workers. This analysis examines Illinois Workers’ Compensation Commission filings from 2007 through 2012 to compare total cost of the decision, days of work missed, and percent disability of employees of temporary agencies with direct hire claims.

Spatial clustering of occupational injuries in communities. Forst L, Friedman L, Chin B, Madigan D. Am J Public Health.

Traumatic occupational injuries cluster spatially by home location of the affected workers in a predictable way. In our study, we found that among 23,200 occupational injuries, 80% of cases were located in 20% of the State’s residential ZIP codes. This puts an inequitable burden on communities and provides evidence for the possible value of community based interventions for prevention of occupational injuries especially among groups of workers that are difficult to access at the workplace.

Analysis of ethnic disparities in workers’ compensation claims using data linkage. Friedman LS, Ruestow P, Forst L. J Occup Environ Med.

The overall goal of this research project was to assess ethnic disparities in monetary compensation among construction workers injured on the job through the linkage of medical records and workers’ compensation data. The analysis indicates that white non-Hispanic construction workers are awarded higher monetary settlements despite the observation that for specific injuries the mean temporary total disability and permanent partial disability were equivalent to or lower than those in Hispanic and black construction workers.

Traumatic occupational injuries in Hispanic and foreign born workers. Forst L, Avila S, Anozie S, Rubin R.  Am J Ind Med.

Eight years of data were obtained from an urban trauma center on occupational injuries. Hispanics were more highly represented than expected; their number of injuries steadily rose over the entire period  of follow-up. Hispanics were more likely to be injured by machinery and hand tools. Workers reported hazardous working conditions, lack of workers compensation, short time in current employment, and not working in their usual job.

Barriers and Facilitators of Implementing Injury Prevention Practices by Massage Therapists. Friedman LS, Cambron JA and Madigan D. J Occup Environ Med.

Massage therapists are a large workforce that compliments medical practice, but they face pervasive ergonomic hazards with over 70% reporting work-related musculoskeletal disorders. The analysis demonstrates the important role management plays in implementing safety programs and the need for policies to address musculoskeletal health in this workforce.

Attitudes and behaviors of chiropractic interns toward occupational history taking. Madigan D, Quinlan-Ruof E, Cambron JA, Forst L, Zanoni J, Conroy LM, Patil CL, Friedman LS. J Chiropr Educ.

We trained chiropractic interns on taking an occupational history. 202 clinical charts of the interns were evaluated to determine frequency and quality of documentating patient occupational histories.  A majority of interns (85% at baseline) were interested in occupational health, and 80% believed that occupational history taking was “very important.” Intern charting behaviors increased after training related to documentation of past occupation (62.9% from 32.4%) and relating the chief complaint to work (59.7% from 30.0%). Detailed occupational history taking remained low throughout the study but demonstrated a doubling in documentation after training (16.1% from 8.6%). Short training modules appear to be effective in demonstrating small changes in documentation related to occupational history taking

Medical interpretation for immigrant workers. Forst L, Masters D, Zanoni J, Avila S, Chaidez F, Miller A. New Solutions.

Foreign-born workers have high rates of occupational mortality and morbidity, despite downward trends for the U.S. workforce overall. They have limited access to health care services. Medical interpreters (MIs) facilitate care of acutely injured, low-English-proficiency (LEP) patients, including those sustaining occupational injuries. We conducted a study to assess the potential for MIs to serve as advocates of LEP patients injured at work and to deliver preventive messages.

Reliability of the AMA Guides to the Evaluation of Permanent Impairment. Forst L, Friedman L, Chukwu A.  J Occup Environ Med.

AMA’s Guides to the Evaluation of Permanent Impairment is used to rate loss of function and determine compensation and ability to work after injury or illness; however, there are few studies that evaluate reliability or construct validity. We conducted a study to evaluate the reliability of the fifth and sixth editions for back injury and to determine best methods for further study. The findings indicated that the sixth edition may not be an improvement over the fifth. A research agenda should include investigations of reliability and construct validity for different body sites and organ systems along the entire rating scale and among different categories of raters.

Madigan D, Johnson TP, Forst L, Cambron JA, Zanoni J, Patil CL, Conroy LM, Friedman LS. Needs Assessment for a Comprehensive Reemployment Program Among Residents of a Work Rehabilitation Program for Individuals With Unstable or Lack of Housing.  J Occup Environ Med.

This mixed-methods study of residents of a work rehabilitation program found that commonly reported reemployment challenges included legal barriers and unmet transportation, housing, and financial needs. More than two-thirds of residents reported no place to live after the program regardless of if they had previous precarious housing. Emerging themes included challenges regarding sufficient time for the transition to being employed, fear of relapse, and lack of long-term goals and planning.  Findings suggest that residential rehabilitation programs are an important resource. While these programs tend to focus on reemployment, their services could be enhanced by assessing individual needs and allowing for variation in reemployment preparation.

Poor Adherence to Dust, Noise and Safety regulations Predict Injury Rates in Underground Coal Mines. Friedman LS, Shannon B, Go L, Shao Y, Almberg K and Cohen RA.

Poor safety culture and broad markers of an unsafe workplace have been associated with increased injury rates in non-mining sectors, but there are no current studies evaluating the association between measures of adherence to health and safety regulations and injury rates within mining. Our study demonstrates that despite a decline in injury rates in underground coal mines over the last two decades, “sick mines” characterized by poor control of both dust and noise levels, as well as inadequate adherence to safety regulations have more injuries in its work force.

Injuries associated with long working hours among employees in the US mining industry: risk factors and adverse outcomes.  Friedman LS, Almberg K and Cohen RA.  Occup Environ Med.

The proportion of injuries occurring 9+ hours into a shift among U.S. miners has increased by almost 3-fold since 1983. Our research identified numerous factors associated with change, lack of routine, and being new at the mine that were associated with injuries occurring 9+ hours into a shift. Incidents occurring during long working hours were also more likely to result in a death or multiple workers injured. given the international shift towards hiring more contract labor and the adoption of extended workdays from 8 to 10–12 hour shifts in the mining industry.miners continue to work extended shifts with an average in excess of 47 hours per week, unlike the general US workforce where average work hours have declined to 38.5 hours per week. Adoption of comprehensive fatigue risk management plans may help ameliorate the problem.

Injuries during the first hour at work in the U.S. mining industry. Mining Industry. De S, Almberg KS, Cohen RA and Friedman LS. Am J Ind Med.

We analyzed data from U.S. MSHA Part 50 reports, 1983-2015, to evaluate risk factors associated with injuries during the first hour of a shift. Risk factors associated with these injuries included being female, being older, working on Sunday and Monday, having an irregular shift start, working night shifts, employed in surface mining operations and mine operators with less than 200 employees, and mechanisms of injury related to falls, movement of equipment and personnel, and struck by/caught between boxes and containers. Injurious incidents occurring during the first hour of work were associated with mass injury events involving five or more workers. Although the injury rates were substantially lower during the first hour of work compared to all other work hours, this study identified risk factors and mechanisms of injury that are highly preventable during the first hour of work.

More information about mining related research go to our UIC MinER Center.

Financial Conflicts of Interest and Study Results in Environmental and Occupational Health Research. Friedman LS and Friedman M.   Journal of Occupational and Environmental Medicine.

Our findings show a clear relationship between negative results in studies evaluating adverse health outcomes in humans and financial COI arising from relationships with organizations involved in the processing, use or disposal of industrial and commercial products.  Employment was a key factor.  Based on statistical models, only 13.5% of the studies without financial COI reported negative results (“safe”).  In contrast, 28.3% of the studies published by authors with a financial COI reported negative findings when none of the authors were employed by that organization.  However, when any of the authors were employed by an organization involved in the processing, use or disposal of the hazard, 58.8% of these studies reported that the hazards they were evaluating were “safe” or “posed no health risks”. If the lead author worked for the military, the proportion of the studies that reported negative findings rose to 83.3%.

Association Between Financial Conflicts of Interest and ILO Classifications for Black Lung Disease. Friedman LS, De S, Almberg K and Cohen RA. Ann Am Thorac Soc.

B-readers hired by coal operators contesting claims or miners filing workers’ compensation claims seemingly showed bias in their diagnosis while those hired most of the time or exclusively by the USDOL, which administers the FBLP, did not. However, there were far more B-readers’ medical opinions filed on behalf of the employer. Of 64 physicians who determined an absence of black lung disease for 95% (10,505) of their classifications, around 93% of those diagnosis were made by B-readers who were hired most of the time by the employer.

Huang Z and Friedman LS.  Occupational injury surveillance pyramid description and association of medical care utilization with low income among work-related injuries.  Am J Ind Med. Am J Ind Med.

An analysis of 2004-2016 National Health Interview Survey data demonstrated that 53.1% of occupational injury were exclusively treated outside of a hospital setting and never captured by hospital/emergency department data systems, which comprises 40% (3.0 million) of total missed days of work and 44% ($452 million) of total cost of lost productivity among full-time workers. These “minor work-related injuries” exclusively treated outside hospital tend to be ignored when defining national injury prevention priorities, but this analysis indicates that such an approach fails to capture a large portion of injuries significant enough to result in missed days of work and cost of lost productivity

Huang Z and Friedman LS.  Work-related burn injuries hospitalized in U.S. burn centers: 2002-2011.  J Occup Environ Med.

An analysis of the National Burn Repository found 22,969 work-related burn injuries using a algorithm to extract occupational incidents from various text fields. In contrast, the single work-related field intended to capture occupational injuries only captured 4,696 cases (20.5% of total cases). The highest numbers of burns were observed in construction/extraction, food preparation, and durable goods production occupations. Occupations with a mean total body surface area (TBSA) burned greater than 10% include transportation and material-moving, architecture and engineering, and arts/design/entertainment/sports/media occupations. When using multiple fields for case ascertainment, the NBR dataset is a valuable data source for occupational burn injury investigations.

Friedman LS and Forst L. The Impact of OSHA Recordkeeping Regulation Changes on Occupational Injury And Illness Trends In The U.S.: A Time-Series Analysis.  Occ Environ Med. 

The Bureau of Labor Statistics Survey of Occupational Injuries and Illnesses is one of the key surveillance tools used to monitor occupational health in the U.S.  Our analysis shows that major recordkeeping changes were associated with significant declines in recorded occupational injuries and illnesses.  The substantial declines in the number of injuries and illnesses correspond directly with changes in OSHA recordkeeping rules. Changes in employment, productivity, OSHA enforcement activity and sampling error do not explain the large decline. Based on the baseline slope (join-point regression analysis, 1992-4), the authors expected a decline of 407 964 injuries and illnesses during the period of follow-up if no intervention occurred; they actually observed a decline of 2.4 million injuries and illnesses of which 2 million or 83% of the decline can be attributed to the change in the OSHA recordkeeping rules.