The Health Hazard Evaluation Program at NIOSH

Reviews of Research Programs of the National Institute for Occupational Safety and Health

Committee to Review the NIOSH Health Hazard Evaluation Program

Division on Earth and Life Studies

NATIONAL RESEARCH COUNCIL AND INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

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The Health Hazard Evaluation Program at NIOSH Reviews of Research Programs of the National Institute for Occupational Safety and Health Committee to Review the NIOSH Health Hazard Evaluation Program Division on Earth and Life Studies

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THE NATIONAL ACADEMIES PRESS • 500 Fifth Street, N.W. • Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was requested by the National Institute for Occupational Safety and Health of the Centers for Disease Control and Prevention and supported by Award No. 211-2006-19152 (Task Order 001). Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. The content of this publication does not necessarily reflect the views or poli- cies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. International Standard Book Number-13: 978-0-309-12647-2 International Standard Book Number-10: 0-309-12647-9 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet http://www.nap.edu. Copyright 2009 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. Suggested Citation: National Research Council. 2008. The Health Hazard Evaluation Program at NIOSH. Committee to Review the NIOSH Health Hazard Evaluation Program. Rpt. No. 7, Reviews of Research Programs of the National Institute for Occupational Safety and Health. Washington, DC: The National Academies Press.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal govern- ment on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to as- sociate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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COMMITTEE TO REvIEW THE NIOSH HEALTH HAzARD EvALuATION PROgRAM ROGENE F. HENDERSON, Chair, Lovelace Respiratory Research Institute, Albuquerque, NM JOEL BENDER, General Motors Corporation, Detroit, MI EULA BINGHAM, University of Cincinnati, OH JAMES E. CONE, New York City Department of Health and Mental Hygiene JOHN R. FROINES, Center for Occupational and Environmental Health, University of California, Los Angeles (from 07/19/2007 to 04/28/2008) MONICA GAUGHAN, University of Georgia, Athens CLARION JOHNSON, Exxon Mobil Corporation, Fairfax, VA FRANKLIN E. MIRER, Hunter College of the City University of New York, New York BARBARA SILVERSTEIN, Washington State Department of Labor and Industries, Tumwater ROSEMARY K. SOKAS, University of Illinois, Chicago MICHAEL J. WRIGHT, United Steelworkers, Pittsburgh, PA National Research Council Staff SAMMANTHA L. MAGSINO, Study Director SUSAN R. McCUTCHEN, Senior Program Associate TONYA E. FONG YEE, Senior Project Assistant 

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Preface “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” —Constitution of the World Health Organization T he National Institute for Occupational Safety and Health (NIOSH) Health Hazard Evaluation (HHE) Program was derived from a legislative promise to workers and employers that NIOSH would provide timely information regarding whether concentrations of substances normally found in the workplace have potentially toxic effects. NIOSH has the authority, in response to written re- quest, to enter a workplace and measure potentially hazardous exposures, conduct medical evaluation of employees, and obtain available information from employ- ers. Though these are essentially the same authorities provided for Occupational Safety and Health Administration (OSHA) inspections, invoked by the same parties who can trigger such inspections, health hazard evaluations are supposed to be something different. OSHA inspections are intended to ensure compliance with existing safety regulations, whereas HHEs are conducted to identify health hazards in a workplace. HHEs emphasize health effects identification through medical in- vestigation and exposure assessment techniques combined with an epidemiological perspective, and can be at the cutting edge in identifying emerging occupational health hazards through scientific documentation of observations of those at the workplace. At the request of NIOSH, the Committee to Review the NIOSH Health Hazard Evaluation Program was formed to evaluate the relevance, impact, and future direc- tions of the program. The HHE Program is not a traditional research program but responds to a wide variety of requests for assistance to identify a broad spectrum of hazards. The committee’s composition reflects this diversity with expertise in ii

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Preface iii respiratory toxicology, public health, occupational health, industrial hygiene, risk communication, occupational medicine, occupational epidemiology, indoor envi- ronmental quality, and environmental health. The committee also has expertise in public health program evaluation (see Appendix E). It was guided, but not bound, by the evaluation criteria established by the National Academies Committee to Review NIOSH Research Programs. In this evaluation, the committee provides recommendations to improve what it believes is already a worthwhile program and provides a vision for the HHE Program of the future. The committee thanks NIOSH staff for their kind assistance and willingness to share their knowledge. Raymond Sinclair, Teresa Schnorr, and Allison Tepper were indispensible in their efforts to answer innumerable questions from the committee. NIOSH briefers at the committee’s September 2007 meeting were very helpful and included Bruce Bernard, Kay Kreiss, Teresa Schnorr, Teresa Seitz, Allison Tepper, Lewis Wade, and Ken Wallingford. Other NIOSH staff attended the meeting and contributed to the discussions, including Marlene Ackman, Fred Blosser, Christine Branche, Chad Dowell, Kelly Durst, Lynn Jenkins, Greg Lotz, Michelle Martin, Ken Martinez, John Piacentino, Doug Trout, Doug Weissman, and Ainsley Weston. Eric Landree and Valerie Williams from the RAND Corporation also spoke with the committee. The committee received thoughtful input from a large number of stakehold- ers to inform its deliberations. Members particularly appreciated the willingness of several stakeholders to speak directly with the committee during its meetings. Shelley Davis (Farmworker Justice, Washington, D.C.), Janie Gittleman (Cen- ter to Protect Workers’ Rights, Silver Spring, Maryland), José Olíva (Interfaith Worker Justice, Chicago, Illinois), Frank Renshaw (Rohm and Haas Company, Corydon, Pennsylvania), Marthe Kent (OSHA Region 1, Boston, Massachusetts), Andrea Kidd-Taylor (Community Health and Policy, Morgan State University, Baltimore, Maryland), Kenneth Rosenman (Occupational and Environmental Health, Michigan State University, Lansing), and Joshua Sharfstein (Baltimore City Health Department, Maryland) participated in panel discussions during the committee’s second meeting. At the committee’s third meeting, Linda Ayala dis- cussed (via telecom) her experiences related to an HHE conducted for the Alameda County (California) Public Authority for In-Home Services; Peggy Hoffman, Glenn Jones, and Barbara Smisko discussed (via telecom) experiences regarding HHEs conducted at Kaiser Permanente in California; Tom Tripp and Bryant Hardy spoke with the committee (via telecom) about their HHE experiences at U.S. Magnesium in Utah; and Barbara Materna and Roger Speakman described an evaluation at a flavor and fragrance manufacturing company in California. These discussions were vital to the evaluation process and provided the committee with multiple view- points. The committee is also grateful to the nearly 60 respondents to its online

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Preface ix request for information (see Appendix C). Many thoughtful comments about the HHE Program were received and provided necessary fuel for discussion. Those comments and recommendations are summarized in Appendix D. The committee was sorry to lose the services of John Froines (Center for Oc- cupational and Environmental Health, University of California, Los Angeles) as a member midway though the evaluation process, but it is indebted to him for his thoughtful comments on early drafts of the manuscript provided as an unpaid consultant. This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures ap- proved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We thank the following individuals for their participation in the review of this report: Susan E. Cozzens, Technology Policy and Assessment Center, Georgia Institute of Technology James W. Curran, Rollins School of Public Health, Emory University Edward A. Emmett, School of Medicine, University of Pennsylvania William H. Farland, Vice President for Research, Colorado State University Lora E. Fleming, Miller School of Medicine and Rosenstiel School of Marine and Atmospheric Sciences, Miami Christopher C. green, School of Medicine, Wayne State University Dan Hair, Workers Compensation Fund of Utah Leslie Israel, Center for Occupational and Environmental Health, University of California, Irvine Philip J. Landrigan, Department of Community & Preventive Medicine and Children’s Environmental Health Center, Mount Sinai School of Medicine Scott Schneider, Laborers’ Health and Safety Fund of North America, Washington, D.C. Mark J. utell, School of Medicine and Dentistry, University of Rochester Eric Welch, Public Administration, University of Illinois at Chicago Although the reviewers listed above have provided many constructive com- ments and suggestions, they were not asked to endorse the conclusions or recom- mendations nor did they see the final draft of the report before its release. The review of this report was overseen by John C. Bailar, the University of Chicago

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Preface x (emeritus), and Linda Hawes Clever, California Pacific Medical Center. Appointed by the National Research Council, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution. Finally, the committee wishes to thank National Academies staff Sammantha Magsino, program officer; Susan McCutchen, senior program associate; and Tonya Fong Yee, senior project assistant, for the many long hours spent guiding this report through the committee process. The report could not have come to completion without their persistent efforts. Rogene F. Henderson Chair

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Contents SuMMARY 1 1 INTRODuCTION 13 Charge to the Committee, 13 The Evaluation Process, 16 Report Organization, 18 2 DESCRIPTION OF THE HEALTH HAzARD EvALuATION PROgRAM 20 Introduction, 20 Historical Overview, 21 Inputs, 25 Activities, 34 Ouputs, 41 3 RELEvANCE OF THE HEALTH HAzARD EvALuATION PROgRAM 42 Evaluation of Relevance, 42 Relevance of Inputs (Planning and Resources), 43 Relevance of Activities, 62 Relevance of Outputs, 70 Emerging Issues, 75 xi

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contents xii Emergency Response, 78 Relevance Score, 80 4 IMPACTS OF THE HEALTH HAzARD EvALuATION PROgRAM: REDuCTIONS IN HARM AND TRANSFER OF KNOWLEDgE 82 Definition of Impact, 82 1. Health Hazard Evaluation Program Impact on Reducing Worker Risk and Preventing Occupational Illness in Investigated Worksites, 85 2. Transfer of Program-Generated Information to Relevant Employers and Employees Beyond Investigated Workplaces, 92 3. Impact of the Health Hazard Evaluation Program on NIOSH Research and Policy Development Programs, 97 4. Transfer of Program-Generated Hazard and Prevention Information to the Occupational Health Community, 107 Impact Score, 119 5 vISION AND RECOMMENDATIONS 121 Vision for the Health Hazard Evaluation Program, 121 Recommendations, 122 REFERENCES 128 APPENDIXES A Framework for the Review of Research Programs of the National Institute for Occupational Safety and Health 141 B Materials Provided by the NIOSH Health Hazard Evaluation Program 186 C Committee Information Gathering 188 D Stakeholder Input: Key Recommendations and Emerging Health Hazards 196 E Biographical Sketches 203

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Tables, Figures, and Boxes TABLES 2-1 Budget for the HHE Program by Branch and Class: Fiscal Years 2000-2007, 28 2-2 Frequency of HHE Field Investigations by Sector and Hazard: Fiscal Years 1998-2007, 35 3-1 HHE Program Strategic and Intermediate Goals, Performance Measures, and Committee Comments, 44 3-2 Frequency of HHE Field Investigations by Source of Request and Hazard Class: Fiscal Years 1998-2007, 53 3-3 Frequency of HHE Field Investigations by Source of Request and Sector: Fiscal Years 1998-2007, 55 4-1 Distribution of HHE Investigations by Strategic Goal and Hazard Type, 84 4-2 Examples of HHEs Resulting in Wide Impacts (1978-2006), 86 4-3 HHE Program Interaction with the NIOSH Authoritative Recommendations Program, 103 FIguRES 2-1 Logic model of the HHE Program, 22 xiii

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tables, figures, and boxes xi 2-2 Total HHE Program FTEs, 29 2-3 HHE requests by decade by SIC sector, 33 2-4 Flow diagram representing the HHE Program triage process for prioritizing HHE requests and allocating resources for response, 36 3-1 Distribution of HHE requests by response category, 51 4-1 Routes of HHE Program impact beyond investigated workplaces, 93 BOXES S-1 Committee Recommendations, 9 S-2 Committee Scoring Criteria, 12 1-1 Vulnerable or Underserved Populations, 16 1-2 Scoring Criteria, 17 2-1 Definitions of Common Terms, 21 2-2 Triage Response Categories, 37 2-3 HHE Program Triage Criteria, 38 3-1 Surveillance and the HHE Program, 58 3-2 Bronchiolitis Obliterans (Popcorn Lung) and Diacetyl, 60 3-3 Interstitial Pneumonitis (Flock Worker’s Lung) and Flock, 63 3-4 Work-Related Musculoskeletal Disorders, 64 3-5 Biological and Chemical Hazards in the Meat and Poultry Industries, 65 4-1 HHE Program Response to Anthrax Contaminations, 117

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Abbreviations and Acronyms ACGIH American Conference of Governmental Industrial Hygienists AR Authoritative Recommendations Program (of NIOSH) ATSDR Agency for Toxic Substances and Disease Registry BLS Bureau of Labor Statistics BSC Board of Scientific Counselors (of NIOSH) CDC Centers for Disease Control and Prevention COSTEP Commissioned Officer Student Training and Extern Program CPWR CPWR—The Center for Construction Research and Training (formerly the Center to Protect Workers’ Rights) DBCP 1,2-dibromo-3-chloropropane DEOC Director’s Emergency Operations Center (of the CDC) DRDS Division of Respiratory Disease Studies (of NIOSH) DSHEFS Division of Surveillance, Hazard Evaluations, and Field Studies (of NIOSH) x

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a b b r e v i at i o n s a n d a c r o n y m s xi EIS Epidemic Intelligence Service EPA Environmental Protection Agency Epi-X A secure electronic communication network maintained by CDC ERC Education and Research Centers for Occupational Safety and Health FACE Fatality Assessment Control and Evaluation FEMA Federal Emergency Management Agency Framework Committee National Academies Committee for the Review of NIOSH Research Programs Framework Document Framework for the Review of the Research Programs of the National Institute for Occupational Safety and Health (8/10/07 version) FSB Field Studies Branch (of NIOSH) FTE Full-time equivalent GAO Government Accountability Office HAZWOPER Hazardous Waste Operations and Emergency Response Standard HETAB Hazard Evaluations and Technical Assistance Branch (of NIOSH) HHE Health hazard evaluation HHS Department of Health and Human Services HP Hypersensitivity pneumonitis ICE Immigration and Customs Enforcement (of the U.S. Department of Homeland Security) IEQ Indoor environmental quality IMIS Integrated Management Information System (of OSHA) IOM Institute of Medicine LOHP Labor Occupational Health Program (of the University of California, Berkeley) MMWR Morbidity and Mortality Weekly Report MSHA Mine Safety and Health Administration MWF Metalworking fluid

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a b b r e v i at i o n s a n d a c r o n y m s xii NAICS North American Industry Classification System NIEHS National Institute of Environmental Health Sciences NIOSH National Institute for Occupational Safety and Health NOPD New Orleans Police Department NORA National Occupational Research Agenda (of NIOSH) NRC National Research Council NTP National Toxicology Program (of HHS) OD Office of the Director (of NIOSH) OHB Occupational Health Branch (of California) OHSP Occupational Health Surveillance Program (of the Massachusetts Department of Public Health) OMB Office of Management and Budget OSH Occupational safety and health OSHA Occupational Safety and Health Administration OSH Act Occupational Safety and Health Act of 1970 PEL Permissible exposure limit RDRP Respiratory Disease Research Program (of NIOSH) REL Recommended exposure limit RTI Research Triangle Institute SENSOR Sentinel Event Notification System for Occupational Risk (of NIOSH) SIC Standard Industrial Classification TLV Threshold limit value TOPOFF Top Officials (a terrorism preparedness exercise) USDA U.S. Department of Agriculture USPS U.S. Postal Service WMSD Work-related musculoskeletal disorder 9/11 Terrorist attacks of September 11, 2001

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