5
Review of Research on High-Priority Populations at Risk

“Priority populations at risk”, “populations at risk”, and “special populations” are descriptors used by National Institute for Occupational Safety and Health (NIOSH) in referring to selected groups of people with various degrees of involvement in agriculture, forestry, and fishing (AFF) activities. The definition includes those “underserved by traditional occupational health approaches” and at high risk of illness or injury. In the agricultural sector, the AFF Program presented information on research among selected populations while for the forestry and fishing sectors all workers were viewed as special populations.

STRATEGIC GOALS AND OBJECTIVES

Goal 2: Priority Populations at Risk—Reduce injuries, illnesses, and fatalities in subgroups of the working population determined to be at high risk or underserved by traditional occupational health approaches.

Population studies outside the traditional occupational health approach make reference to the study of illness and injury, focusing less on the workplace and more on the social context within which illnesses and injuries occur. Although social context has been integrated into the study of illness and injury in many of the projects conducted by NIOSH in the last decade, research focuses on traditional views of worker populations that exclude family members, the elderly, and often-times women in the activities of the AFF Program.



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5 Review of Research on High-Priority Populations at Risk “Priority populations at risk”, “populations at risk”, and “special populations” are descriptors used by National Institute for Occupational Safety and Health (NIOSH) in referring to selected groups of people with various degrees of involve- ment in agriculture, forestry, and fishing (AFF) activities. The definition includes those “underserved by traditional occupational health approaches” and at high risk of illness or injury. In the agricultural sector, the AFF Program presented infor- mation on research among selected populations while for the forestry and fishing sectors all workers were viewed as special populations. STRATEGIC GOALS AND OBJECTIVES Goal 2: Priority Populations at Risk—Reduce injuries, illnesses, and fatalities in subgroups of the working population determined to be at high risk or under- served by traditional occupational health approaches. Population studies outside the traditional occupational health approach make reference to the study of illness and injury, focusing less on the workplace and more on the social context within which illnesses and injuries occur. Although social context has been integrated into the study of illness and injury in many of the projects conducted by NIOSH in the last decade, research focuses on traditional views of worker populations that exclude family members, the elderly, and often- times women in the activities of the AFF Program. 9

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a g r i c u lt u r e , f o r e s t r y , fishing research niosh and at 80 The program listed goals for populations identified as meriting special attention: • Child labor: Protection of children living and working on farms, under- standing the exposure. Reduce injuries, illnesses, and fatalities among children working on farms. • Minority populations: Reduce injuries, illnesses, and fatalities among mi- grant and minority farm workers. • Logging: Reduce injuries, illnesses, and fatalities among logging workers. • Fishing: Reduce injuries, illnesses, and fatalities among commercial fishermen. The NIOSH research priority-setting process in relation to AFF populations at risk was based on perceived needs, consultation with experts, and charges given to the agency. As defined by NIOSH, populations at risk include children, minority groups, logging workers, and fishery workers. Child labor is a complicated issue because children living in a farm environment are involved in various farming activities often viewed as chores rather than work by parents. Minorities are classified by race and ethnicity, and studies included Hispanic and Latino, Navajo, and black farmers and farm workers. Many of the studies of Hispanics and Latinos have centered on hired orchard workers. Loggers and fishermen have received less attention in the AFF Program than agriculture, consequently high-risk populations in those sectors have not been well described. Other age, gender, racial, and ethnic minority groups were not included as populations at risk in the agricultural sector. Intramural ac- tivities related to populations at risk in all sectors have focused on surveillance to fill in data gaps peculiar to AFF, such as gaps in data from the Department of Labor, Bureau of Labor Statistics (DOL/BLS). The extramural activities have been region- ally appropriate and include a wide range of agricultural settings and populations that integrate the social context in which illnesses and injuries occur. In forestry and fishing, there was some extramural funding provided on a regional basis. The high-priority research topics defined in the National Occupational Re- search Agenda (NORA) have been modified recently to adopt an approach based on industry sectors and to establish sector-specific research goals and objectives. This emphasis promotes research-to-practice through sector-based partnerships. “Special populations at risk” were aligned with work environment and workforce categories and share priority status to a lesser degree with emerging technologies, indoor environment, mixed exposures, and work organization. It is not apparent how the priorities based on industry sectors might be used to differentiate issues associated with, for example, child labor in the context of a small family fishing operation or a small family farm operation. Although the setting is different, some

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review research h i g h - P r i o r i t y P o P u l at i o n s risk of on at 8 of the concerns about children working in family-run operations—such as youth operating machinery and children playing at or visiting the workplace—are similar. To establish an approach based on industry sectors and to develop sector-specific research goals and objectives may be disadvantageous in relation to an approach that requires the integration of social context and the interconnectedness of all AFF activities and populations at risk. Given that there was no clear definition of populations at risk in its review of NIOSH’s AFF activities, the committee used the NIOSH AFF classifications of populations at risk. LOGIC SUBMODEL Information received from the NIOSH AFF Program (NIOSH, 2006a) related to inputs, activities, outputs, intermediate outcomes, and end outcomes in research on priority populations at risk is summarized in the priority populations at risk research logic submodel (Figure 5-1). INPUTS Child Labor In 1996, NIOSH was charged with reducing injuries and illnesses in child workers. As a result, it assigned 75 percent of available funds ($5 million dollars) to extramural research and 25 percent to intramural activities, which consisted primarily of surveillance. ACTIVITIES Child Labor The major issues in relation to child labor identified by NIOSH and stakehold- ers were traumatic and cumulative injuries related to farming activities. Those activities included living on, working on, and visiting a farm. Efforts were focused on childhood injury prevention, surveillance of fatal injuries, and childhood agri- cultural musculoskeletal disorders (MSDs). In consultation with experts, NIOSH did a thorough qualitative review of the hazardous orders (HOs) for youth working in agriculture and made recommendations for changing 8 of the 11 HOs. Surveys were conducted over a number of years that were focused on identi- fied problems or populations, such as the migrant and seasonal farm workers, selected farm operations, and racial minority farm operators. One follow-up study was conducted when injuries occurred on a farm using a national representative

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Inputs Activities Outputs Intermediate Outcomes End Outcomes 8 Planning inputs: 1. Child labor 1. Child labor 1. General and work-related 1. Child labor 1. Child labor Publications included in CAIS decrease in number of injured Childhood injury and Surveillance 2. Minority populations Meetings and conferences youths prevention Hazardous orders (HOs) 3. Logging Testimony to ESA Use of data/information for Research 4. Fishing Department of Labor use of 2. Decline of fatalities and other programs, such as Farm Partnerships and extramural HOs occupational injury and illness Safety 4 Just Kids and the activities Safe areas for children associated with logging National Safe Kids Campaign Production Inputs: Citation of 10 of the HOs 2. Minority populations 1. Budget 2. Minority populations 3. Impressive reduction of fatalities Use of 4 HOs for regulatory Varied degrees of research and 2. Staff Hired farmworker survey in commercial fishing action outreach activities 3. Facilities Partnerships for dissemination Hispanic/Latino and African- 4. Management structure of survey results 2. Migrant American farmers 5. Extramural entities Peer-review publications Positive testimonials from Panels on hired farm workers 6. Partners Outreach publications pesticide training Collaborations and partnerships with other agencies including 3. Logging 3. Logging CES Peer-review publications Workshops Farm operators Conferences and public Participation in inter-agency Information sharing testimonies prevention programs Training of Mexican MDs 3. Logging 4. Fishing through FACE Helicopter-related deaths Peer-review publications Expansion of FACE to different National logging standards Fishing vessel safety states conferences and workshops ROPS and FOPS Training on accident Decline in the fatality rate FACE investigation Lobster fisheries Mechanical harvesting Deck safety 4. Fishing Full-time equivalents 4. Fishing Preseason dockside inspection Alaska Field Station Marine safety training Surveillance Technical assistance for fishery Fatality reduction management Partnerships Unclear definitions of populations at risk used by different agencies Lack of child labor laws Poor surveillance and reliance on outside sources of data Poor understanding of the scope and cost of AFF studies Indecisions regarding long-term support of different projects Regulatory environment External Factors FIGURE 5-1 Priority populations at risk research logic submodel. CAIS = Child Agricultural Injury Survey, CES = Cooperative Extension Service, ESA = Employment Standards Administration, FACE = Fatality Assessment and Control Evaluation, FOPS = falling object protective structure, ROPS = rollover protective structure.

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review research h i g h - P r i o r i t y P o P u l at i o n s risk of on at 83 sample of emergency department records. Important data were collected in the surveys. However, comparison of results across the surveys has been hampered by differences in data collection procedures, in definitions of target populations, and in denominators. MSD studies were more comprehensive and included plans for dissemination of information and for community involvement. A majority of the activities conducted in the extramural programs and partner- ships were investigator-initiated research project grants (R01 grants) and included support for conferences and interactions with extramural partners. The R01 com- ponent was strong and involved different centers, such as the National Children’s Center for Rural and Agricultural Health and Safety (NCCRAHS), a center that conducts research on children’s agricultural injury prevention. Research in the center has produced measurable results in the form of qualitative and quantitative outcomes. The materials produced from the childhood agricultural initiative have been referenced and used in outreach activities. Conferences were useful for sharing experiences and ideas among the different centers and extramural participants. Minority Populations Under the assumption that different minority farmworker groups face different hazards, the AFF Program has studied American Indians, Hispanic and Latino hired laborers and orchard workers, and minority farm operators, including Hispanics and African Americans. Cultural factors and conceptions of health and disease in minority group workers have been proposed as affecting the underreporting of various conditions. Further, different agricultural activities have been associated with different hazards. For example, the variety of jobs that orchard workers per- form at different times of the year, the long working hours involved in these jobs, and the strenuous working conditions (such as carrying heavy containers up and down ladders) are some of the possible causes cited for high rates of illness and injury. In addition, changes in agricultural practices among certain populations may also lead to changes in the hazards in a specific population. An example of this is the move among Navajo from subsistence farming to cattle ranching. These types of changes require monitoring and quick response to reduce the risks among the worker populations involved. In 1995, NIOSH convened a panel of experts on hired farm workers. Three years later, the panel issued its report and made recommendations for surveillance. Several high-priority subjects were identified, including MSDs, pesticide-related conditions, traumatic injuries, respiratory conditions, dermatitis, infectious dis- eases, cancer, eye conditions, and mental health. In 1998, an Occupational Health Supplement was developed to be included in the National Agricultural Workers Survey (NAWS) in collaboration with government organizations including DOL,

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a g r i c u lt u r e , f o r e s t r y , fishing research niosh and at 84 the U.S. Environmental Protection Agency, the U.S. Food and Drug Administration, the National Cancer Institute, the Health Resources and Services Administration (HRSA), and the Occupational Safety and Health Administration (OSHA); and with researchers from community organizations, universities, industry, advocacy groups and extension. The questionnaire was translated into Spanish, pilot tested, and revised. The survey results indicated that hired farm workers and migrant workers were younger than other workers. The results also indicated low English literacy, which has implications for health because of the inability to understand job-related instructions in English. The current survey focuses on mental health and psychological factors, but the continuation of this survey is uncertain because of funding issues. As part of the AFF Program, the U.S. Department of Agriculture (USDA) con- ducted a Minority Farm Operators Occupational Health Survey in 2000. Several other organizations took part at different stages during the project, including academic institutions and research organizations. The response rate was low, and additional sampling was required; at that point, the method was changed, and data were collected using face-to-face interviews. The prevalence of various health and related conditions, including hearing loss, access to medical care, and mental health symptoms were estimated. This work highlights the importance of adapting methods to meet the needs of special populations in order to obtain health- and injury-related data for occupational health. Several extramural studies have been conducted in conjunction with the Co- operative Extension Service (CES) assigned to the Navajo Nation to assess Navajo occupational safety and health needs. Projects included cattle handling and safety equipment, development of a training video, a loan program to purchase safety equipment, and development of an education program related to flash flooding. These projects were conducted with cultural sensitivity of the target population using stakeholder involvement and provided an important example of how to use CES, extramural researchers, and AFF Program staff to conduct needs assessment to develop educational and hazard reduction interventions. Participatory research has been used in several other extramural studies funded by the AFF Program in several states involving Hispanic and Latino workers. Use of a participatory approach has resulted in improved success with interventions in relation to pesticide exposures and ergonomics. Logging Logging is historically one of the most hazardous industries in the United States. Logging fatality and injury rates have slowly declined since the mid-1950s; injury rates are twice the rate of all U.S. workers. In 1994, NIOSH published re-

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review research h i g h - P r i o r i t y P o P u l at i o n s risk of on at 85 search indicating the differences in logging-related fatality rates across the country; the highest fatality rate was associated with manual harvesting of saw timber, for which there was no logging safety standard. Several logging-related activities have been conducted by NIOSH, includ- ing support of OSHA’s adoption of a national standard for the logging industry, coordination of a statewide injury and helicopter-fatality intervention in Alaska, targeting logging fatalities in Fatality Assessment and Control Evaluation (FACE) investigations, and evaluation of mechanical logging methods. In 1989, OSHA proposed a new standard in logging, which was largely based on standards developed in the 1976 NIOSH document titled “Criteria for a Recom- mended Standard: Logging from Felling a First Haul.” From 1989 to 1990, NIOSH continued to offer comments to OSHA, provided data from the National Traumatic Occupational Fatality (NTOF) Surveillance System of the AFF Program, and made several important recommendations related to safety equipment, snakebite protec- tion, work organization and communications, and safe felling techniques. These efforts culminated in the adoption of standards by OSHA in 1994, which included many of the recommendations made by the AFF Program. Helicopter logging emerged in the late 1980s as a form of transportation mainly because of restrictions on road-building in Alaska’s national forests. Investigations conducted by NIOSH staff showed that improper operation and maintenance were the main problems associated with the crashes. In 1993, a prevention matrix was developed by the Alaska Interagency Working Group for the Prevention of Occu- pational Injuries, which included representatives from the Federal Aviation Ad- ministration, the National Transportation Safety Board, the U.S. Coast Guard, the USDA Forest Service, OSHA, the Alaska Department of Labor, the Alaska Depart- ment of Social Services, and the AFF Program to identify risk factors for helicopter crashes. The result was a reduction in helicopter crashes: only one helicopter crash has occurred since 1993. Clearly the active involvement of other organizations in cooperation with NIOSH provides an example of successful partnering resulting in direct benefits for loggers in Alaska. The programs in logging have focused on acute traumatic injuries and have not addressed other hazard and illnesses that might be related to logging. There has been a lack of work on the cultural and social issues that influence work-related illnesses and injuries among loggers. Fishing In 1990, the AFF Program goal was to reduce the number and rate of commer- cial fishing fatalities by 50 percent by 2005. In 1991-1992, data sharing agreements with the U.S. Coast Guard (USCG) and Alaska state troopers were established and

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a g r i c u lt u r e , f o r e s t r y , fishing research niosh and at 86 a comprehensive surveillance system for occupational fatalities, the Alaska Occu- pational Injury Surveillance System (AOISS), were established. High-risk groups and types of gear were identified as deserving of attention for interventions. An interagency effort was created that included the participation of many organizations. Many intervention programs have been implemented since then, and assistance has been offered on prevention of vessel-related fatalities, nonfatal work-related inju- ries, and fatalities due to loss of vessels. The program provides a model for build- ing collaborative working relationships with other agencies to provide surveillance data from which to design intervention programs. However, the work focused on traumatic injuries and neglected other health hazards associated with fishing. OUTPUTS Child Labor Numerous peer-reviewed publications were part of the Childhood Agricul- tural Injury Survey (CAIS), as were presentations in scientific conferences and professional meetings and NIOSH internal documents that were published and disseminated through a variety of media outlets. The overall citation index of the peer-reviewed papers is high. Although a vast number of publications are avail- able through the NIOSH Web site, documents are not cataloged, and searches are cumbersome and time consuming. In 2004, the AFF Program provided testimony on child labor regulations to the Employment Standards Administration (ESA). The DOL used NIOSH recommen- dations regarding the HOs covering youths of all ages and farms of all types. The AFF Program HO report was presented to the International Labour Organization (ILO). No evidence was provided on the impact of the presentations. NCCRAHS documents were used to design safe areas for children on farms. Although the idea for safe play areas was well received, the impact of the program is unknown because there is no information available on how many safe areas for children have been built on the farms as a result of the study. Three prominent outcomes are highlighted in the NIOSH evidence package (NIOSH, 2006a). One is a paper showing that motor vehicles and intentional causes of death are major issues for youths living on farms (Goldencamp et al., 2004). Another is a conference report that influenced the AFF Program in 2002, in reference to childhood agricultural injury prevention and modifications that were made in NORA priorities (Lee et al., 2002). The third is a 1996 report on children in agriculture (National Committee for Childhood Agricultural Injury Prevention, 1996). It is not clear why those items were highlighted, inasmuch as no policy change or intervention program develop- ment is cited or connected to them. No comparative study is offered to show that motor vehicle issues, for example, are different for youths not living on farms.

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review research h i g h - P r i o r i t y P o P u l at i o n s risk of on at 8 Furthermore, we cannot determine whether the results of the report on children in agriculture were used as the basis of intervention programs. The CAIS database on youth farm injuries contains data from surveys con- ducted in 1998, 2001, and 2004. Only basic information with regard to traumatic injuries is available. Children are particularly vulnerable to risks and hazards when performing complex agricultural tasks, considering their age, sociological and de- velopmental status, and body size. These types of sociological and psychological factors, among others, are rarely considered and would be important to understand. Thus a more integrated and interdisciplinary approach is needed when dealing with children in agriculture. Migrants The National Agricultural Workers Survey Occupational Health supplement is currently under review. The document summarizes results of the survey, will be shared with researchers and the ten Centers for Agricultural Disease and Injury Research, Education, and Prevention, and will be available on NIOSH and DOL Web sites. The National Center for Farmworker Health will assist in the dissemina- tion of survey results by sharing data with migrant worker health clinics, HRSA, the DOL, Migrant Health Promotion, the National Institutes of Health, and other organizations. The document may be essential for disseminating the results of the survey, but the survey was conducted in 1999, and the information will be dated when it is published. No specific date for the completion of the document and dissemination of the results was provided. Educational materials for migrants and minority groups have been included in the National Agriculture Safety Database (NASD) for the agriculture community and for adaptation by agricultural safety specialists. The NASD contains many cataloged educational materials and resources in English and Spanish from differ- ent sources. Particularly highlighted is the inclusion in the database of a bilingual NIOSH document: Simple Solutions: Ergonomics for Farm Workers. The accessibility of this document for workers was not addressed, as many agricultural workers do not read English or Spanish. Use of the standard approaches to dissemination of information for agricultural workers is evident throughout the AFF Program and neglects social and cultural differences in terms of preferred modes of communica- tion, as well as literacy and language barriers. Logging Outputs related to logging include peer-reviewed publications, conferences, testimony, government publications, and NIOSH Web sites. Three workshops with proceedings were held between 1993 and 1997 to address helicopter logging

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a g r i c u lt u r e , f o r e s t r y , fishing research niosh and at 88 crashes. NIOSH testimony that influenced OSHA’s logging standards is cited. Three government publications on prevention of logging injury and death prevention were produced in 1976, 1994, and 1998. NIOSH seems to have reached a plateau in relation to logging research and programs in 2002. The issues or challenges for the logging industry seem to be specific to that sector, and the industry has been responsive to proposed improve- ments. However, there are significant changes in logging procedures and practices that need to be addressed in the future. Fishing A number of articles have been published in a variety of media and range from scientific publications to industry trade articles. Five conferences centering on fishing vessel safety have been sponsored by the AFF Program. Seven selected outputs are highlighted by NIOSH with various levels of development, comple- tion, and impact: Fishing Industry Safety and Health Workshop In 1992, a conference was held to raise awareness and promote injury and disease prevention programs, and resulted in workshop proceedings. There were 77 attendees from Alaska and the West Coast. NIOSH Current Intelligence Bulletin A decline in the fatality rate in commercial fishermen has been noted since 1998, when the Commercial Fishing Industry Vessel Safety Act was passed. The implication is that NIOSH work in this matter has contributed to the decline in fatalities. However, the number of vessel sinkings has not decreased. The AFF Program made 11 recommendations regarding improvements in vessel stability, training, avoidance of harsh weather, falls overboard, and other issues associated with deck safety. The document has been used as a resource by six states and by federal, academic, and private organizations. Eight of the 11 recommendations were adopted by USCG. FISH Workshop The Second National Fishing Industry Safety and Health Workshop (FISH II) was sponsored and organized by the AFF Program in 1997; the proceedings became available in 2000. Attendance at the workshop is not given, but attendees

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review research h i g h - P r i o r i t y P o P u l at i o n s risk of on at 89 were divided into working groups and developed recommendations on prevention of vessel-related fatalities, man-overboard fatalities, diving fatalities, and nonfatal work-related injuries. Three interventions were implemented on the basis of the recommendations; the success of the recommendations cannot be determined from the information provided. Line Entanglement in the Lobster Fishery Lobster fishermen experience a fatality rate 2.5 times the national average for all industries (NIOSH, 2005b). Recommendations were developed with regard to work practices and engineering controls to reduce the risk of entrapment injuries, an industry-related publication was produced and distributed, and two peer-re- viewed articles and one NIOSH document were issued. No data were provided on the long-term effect of the project on reduction of injuries among lobstermen. Deck Safety Products The Deck Safety Project started in 2000 with a clear plan that included the development of a program for crab fishermen. Focus groups and tours of vessels to identify safety problems were conducted, and the resulting information was published in a handbook in 2002. The second focus of the project was the Southeast Alaska fishermen. The emergency-stop system (e-stop) was developed for use in the event that a fisherman is entangled around a winch and was tested in 2005 and 2006. Work on the distribution and impact of the e-stop continues, but it seems that it is being installed in many vessels. No data on how many e-stops have been installed were provided, so the impact is yet to be determined. IFISH I, II, and III Three International Fishing Industry Safety and Health (IFISH) conferences have been held in conjunction with academic, industry, and international part- ners. The AFF Program has been a sponsor and major collaborator for these three conferences. Full-time Equivalent Estimates Given the nature of the industry, counting fishermen to obtain injury or ill- ness rates is problematic. The AFF Program has developed a procedure to estimate the number of “full-time equivalent fishermen” for Alaska fisheries to compare fatalities and injuries to other Alaskan workers. No data are provided on how good the estimation is or has been, and no comparative study is shown or referenced

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a g r i c u lt u r e , f o r e s t r y , fishing research niosh and at 90 to evaluate it. If this approach can be used in other studies of fisheries in other regions of the country it will provide an important advance in comparative risk and in focusing interventions. INTERMEDIATE OUTCOMES Child Labor Surveillance activities have been influential in defining what types of outreach and research programs on childhood injury and prevention were needed. The data generated have been used by NCCRAHS and other programs, such as Farm Safety 4 Just Kids and the National Safe Kids Campaign. The data have been cited in proposed congressional legislation, and the Children’s Act for Responsible Em- ployment (CARE) Act (HR 3482). The AFF Program has been actively involved with child labor HOs and the dissemination of information about the HOs. A number of stakeholder groups including government agencies, the Young Worker Health and Safety Network, the Farmworker Justice Fund, and the ILO have used data and recommendations on the HOs to support recommendations to reduce the risk of injury to young workers in agriculture. Migrants Five testimonials given after a 2006 pesticide training workshop are offered as examples of the intended use of extramural AFF Program efforts. All the testimo- nials are complimentary, but they do not constitute program evaluation results, and they constitute merely a collection of comments made by participants in a training workshop. These intermediate outcomes address a small percentage of the overall activities involving migrant workers that have been conducted by the AFF Program. Logging Results of investigations of helicopter logging fatalities offered sound informa- tion that was used by an interagency group in Alaska and other agencies, including the Future Farmers of America, the USDA Forest Service, and the Alaska Depart- ment of Labor. Three workshops were held in 1995, 1996, and 1997 by the Alaska Interagency Working Group for the Prevention of Occupational Injuries and the AFF Program. A Helicopter Logging Safety Committee was formed in 1997 with support from the Helicopter Association International (HAI) and has established

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review research h i g h - P r i o r i t y P o P u l at i o n s risk of on at 9 its own helicopter logging guidelines. NIOSH reports that owing to its involve- ment in HAI activities, the insurance industry has also become involved and has substantially discounted helicopter insurance costs for operators. Reports from the AFF Program and FACE have been adapted and distributed by Forest Research Association (FRA) and its members. The AFF Program and FACE participated in an evaluation of logging and wood-processing plants in Mexico and in the training of 35 Mexican occupational medicine residents. In 14 years, 65 logging-related fatalities have been investigated through FACE programs; the highest numbers were in Alaska, Kentucky, and West Virginia. The distribution of NIOSH findings from different studies is done by FRA. On the basis of results related to the reduction of injury rates with use of mechanized logging systems, the West Virginia Workers Compensation Board is holding meetings on incentives for logging companies and may establish lower rates for mechanized logging companies. These activities demonstrate significant involvement of stakeholders in use of data generated through the AFF Program. Fishing Preseason Dockside Inspection Program As a result of working group activities in the 1997 FISH Workshop, USCG designed and implemented a preseason dockside inspection program for vessel safety in the Bering Sea crab fisheries. The industry supports the initiative, and in an evaluation conducted by USCG with assistance from the AFF Program, there was only one fatality between 1999-2005, whereas seven had occurred in the preceding 5 years. This collaborative effort provides evidence of a successful program which involves stakeholders from industry, USCG, and the AFF Program. Marine Safety Training The AFF Program funded the Alaska Marine Safety Education Association (AMSEA) to develop the training project for certified drill conductors who observe required monthly emergency drills. The AFF Program conducted an evaluation for AMSEA of the effectiveness of the training program for prevention of commer- cial fishing fatalities. In an evaluation of the training program, there was a small non-significant increase in the likelihood that victims had not received training, but victims were significantly less likely to have worn an immersion suit and more likely to have not used a life raft. AFF Program data have provided AMSEA with information that can be used to focus training efforts and to justify increasing the number of trained workers.

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a g r i c u lt u r e , f o r e s t r y , fishing research niosh and at 9 Technical Assistance for Fishery Management NIOSH has been involved in assisting various groups or programs since 1992. In 1995, individual fishing quotas (IFQs) were implemented. NIOSH analyzed USCG data and showed that search-and-rescue missions declined by 63 per- cent after the implementations of the IFQs. There was also a decline in deaths among halibut fishermen from eight in 1992-1994 to zero since implementation of the IFQs. Another quota-based system was implemented for the Bering Sea crab fisheries. NIOSH data were used, and its work was mentioned in the materials developed and distributed when the quota system was debated. Therefore AFF Program activities have been used to increase safety through administrative control approaches to fishing. END OUTCOMES Child Labor Data provided by NIOSH show a decrease in the number of youth injuries in general and in work-related youth injuries. For example, a 51 percent reduction in work-related youth injuries is reported as a direct effect of NIOSH programs. It is not easy to establish a direct association with the AFF programs that produced these results. Logging NIOSH reports that AFF Program activities and outputs have contributed to the declines in fatalities and occupational injury and illness associated with log- ging since the proposed OSHA logging standard of 1989. For example, from 1989 to 2003, the number of cases of logging-related occupational injury or illness per 100 full-time workers decreased by 13.1. The American Pulpwood Association dis- tributed the summaries and recommendations from the AFF FACE investigations targeting the leading causes of deaths in logging nationally. The rates of injuries and leading causes of deaths in logging, such as being struck by falling objects, decreased by 38 percent and machinery-related deaths by 48 percent between 1984-1989 to 1996-2001. AFF Program activities likely had an impact on these reductions. Fishing Fatalities in commercial fishing have been reduced dramatically; there has been a 74 percent decline since 1990 in Alaska and a 51 percent annual decline in the

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review research h i g h - P r i o r i t y P o P u l at i o n s risk of on at 93 fatality rate in Alaska. The NIOSH AFF Program involvement in various programs and projects has likely contributed, in part, to those declines. Its contribution includes offering assessments, analyzing injury data, identifying high-risk groups, estimating denominators and rates, offering support for interventions, and assess- ing the success of the interventions. EXTERNAL FACTORS Changes in national leadership, including changes in DOL and ESA, have affected the NIOSH AFF Program. Federal agencies are required to evaluate the economic impact of proposals, and this may be difficult to estimate when the pro- posals are for exploratory or qualitative studies. Child Labor The absence of adequate child labor laws, as applied to youth on family farms, may increase the risk of injury and exposure to hazards to young workers. Migrants A series of events are cited as external factors that affected the completion of surveys or programs. Among them are the hiring of contractors to conduct surveys, collaborations with other federal organizations, and DOL’s indecision regarding support of the NAWS. Continued support of this program is warranted.