Construction Research at NIOSH: Reviews of Research Programs of the National Institute for Occupational Safety and Health (2009)

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1 Introduction C onstruction is a large, dynamic, and complex industry that plays an impor- tant role in the U.S. economy and the global economy. Construction work ranges from major civil engineering and infrastructure projects (dams, highways, airports) involving a multitude of individual construction firms, to the construction and renovation of residential, commercial, and industrial structures, to routine residential repairs. In 2005, the industry accounted for $1.2 trillion of construction put in place, the equivalent of 13 percent of the U.S. gross domestic product, and employed about 11 million workers (U.S. Census Bureau, 2005). The Business Roundtable has called construction a “seminal” industry because the price of every factory, office building, hotel, or power plant that is built affects the prices that must be charged for the goods and services produced in it. These prices affect U.S. consumers and the ability of U.S. businesses to compete in a global market (BRT, 1983). Construction is also one of the most dangerous industries for workers. Among all industries, construction had the fourth highest rate of fatalities (following agriculture, mining, and transportation) and the second highest rate of nonfatal injuries and illnesses (after transportation) in 2005 (BLS, 2006a,b). Hazards in construction work include the following: working at heights, in e ­ xcavations and tunnels, on highways, and in confined spaces; exposure to high levels of noise, chemicals, and high-voltage electric lines; the use of power tools and heavy equipment; manual materials handling; and sustained awkward postures. The leading causes of death among construction workers are falls from elevations, 21 

22 C o n s t r u c t i o n R e s e a r c h a t NIOSH being struck by vehicles and equipment, electrocution, machine-related incidents, and being struck by objects (NIOSH, 2007). Significant health risks include hearing loss, silicosis, musculoskeletal disorders, skin diseases, and health effects associ- ated with exposures to lead, asphalt fumes, and welding fumes. Additional health h ­ azards and associated diseases include fume fever (metal, polymer), cadmium poisoning, carbon monoxide poisoning, acute inhalation injury (nitrogen dioxide, ozone, phosgene), manganese poisoning, asbestosis, acute solvent syndrome, ­ eripheral neuropathy, allergic contact dermatitis, chronic obstructive pulmo- p nary disease, occupational asthma, and hypersensitivity pneumonitis. The National Institute for Occupational Safety and Health (NIOSH) was estab­ lished by the Occupational Safety and Health Act of 1970 (Public Law 91-596) to “conduct (directly or by grants or contracts) research, experiments, and demonstra- tions relating to occupational safety and health, including studies of ­psychological factors involved, and relating to innovative methods, techniques, and approaches for dealing with occupational safety and health problems.” As a research agency, NIOSH does not have the authority to establish and enforce regulations on workforce safety and health. Regulatory and enforcement authority rests with other organizations, including the Occupational Safety and Health Administra- tion (OSHA), which was created by the same Public Law 91-596 that established NIOSH. ­Organizationally, NIOSH is part of the Centers for Disease Control and Prevention (CDC) in the U.S. Department of Health and Human Services, while OSHA is an agency in the U.S. Department of Labor. NIOSH has conducted construction-related research activities since the 1970s, including research on silicosis and on exposures to lead, asphalt fumes, and welding fumes. The program was formalized in 1990 when Congress allocated specific funds with which it directed NIOSH to develop a comprehensive prevention program focused on health and safety problems affecting construction workers by expanding existing NIOSH activities in the areas of surveillance, research, and intervention.  Manganese poisoning is a toxic condition resulting from chronic exposure to manganese, u ­ sually as the result of lead or arc welding.  Asbestosis is a respiratory disease caused by inhaling asbestos fibers.  Acute solvent syndrome results from acute exposure to toxic cleaners, degreasers, and solvents.  Peripheral neuropathy is nerve damage caused by trauma from external agents.  Allergic contact dermatitis is an inflammation of the skin caused by direct contact with an irritating substance.  Chronic obstructive pulmonary disease (COPD) is caused by prolonged exposure to fumes, dust, or fibers resulting in lung damage.  Occupational asthma is a lung disorder in which various substances found in the workplace lead to breathing difficulties.  Hypersensitivity pneumonitis is an inflammation of the lungs due to breathing in a foreign substance, usually certain types of dust, fungus, or molds. 

Introduction 23 NIOSH is authorized to carry out the following: • Develop recommendations for occupational safety and health standards, • Conduct research on worker safety and health, • Conduct training and employee education, • Develop information on safe levels of exposure to toxic materials and harmful physical agents and substances, • Conduct research on new safety and health problems, • Conduct on-site investigations (health hazard evaluations) to deter- mine the toxicity of materials used in workplaces, and • Fund research by other agencies or private organizations through grants, contracts, and other arrangements (CFR, 2008). STUDY CHARGE AND EVALUATION COMMITTEE In 2004, NIOSH requested that the National Academies conduct evaluation reviews of up to 15 specific NIOSH research programs, including the Construction Research Program, to assess the relevance and impact of its research in reducing workplace injury and illness. The statement of task for the overall NIOSH effort stated the following: Each evaluation will be conducted by an ad hoc committee, using a methodology and framework developed by the Committee to Review NIOSH Research Programs (Framework Committee). Each evaluation committee will review the program’s impact, relevance, and future direc- tions. The evaluation committee will evaluate not only what the NIOSH research program is producing, but will also determine whether it is appropriate to credit NIOSH research with changes in workplace practices, hazardous exposures, and/or occupational illnesses and injuries, or whether the changes are the result of other factors unrelated to NIOSH. The program reviews should focus on evaluating the program’s impact and relevance to health and safety issues in the workplace and make recommendations for improvement. In conducting the review, the evaluation committee will address the following elements: 1. Assessment of the program’s contribution through occupational safety and health re- search to reductions in workplace hazardous exposures, illnesses, or injuries through: a. an assessment of the relevance of the program’s activities to the improvement of oc- cupational safety and health, and b. an evaluation of the impact that the program’s research has had in reducing work-related hazardous exposures, illnesses, and injuries. 

24 C o n s t r u c t i o n R e s e a r c h a t NIOSH The evaluation committee will rate the performance of the program for its relevance and impact using an integer score of 1 to 5. Impact may be assessed directly (e.g., reductions in illnesses or injuries) or, as necessary, using intermediate outcomes to estimate impact. Qualitative narrative evaluations should be included to explain the numerical ratings. 2. Assessment of the program’s effectiveness in targeting new research areas and identifying emerging issues in occupational safety and health most relevant to future improvements in workplace protection. The committee will provide a qualitative narrative assessment of the program’s efforts and suggestions about emerging issues that the program should be prepared to address. The Framework Committee developed a document (Appendix A) to guide each research program evaluation committee as it reviews materials provided by various NIOSH programs and to provide the rationale for determining final scores for each program’s impact and relevance. The Committee to Review the NIOSH Construction Research Program, which authored this report, was structured to include members with expertise in medicine, construction research, performance measurement and management, construction safety, engineering, economics, epidemiology, industrial hygiene, and control tech- nology. Committee members have worked in academia, industry, government, and labor unions (Appendix D). To conduct its evaluation, the committee met three times between July and December 2007 and corresponded through e-mail and conference calls between and after the meetings. The committee’s review was based in large part on material submitted by NIOSH in the form of an evidence package (NIOSH, 2007) contain- ing more than 500 descriptive pages of Construction Research Program goals, a ­ ctivities, products, and impacts. Staff from NIOSH and the Construction Research Program made 18 presentations to the committee during open-session meetings (Appendix B). The committee also heard from 17 stakeholder organizations during an open-session meeting, including representatives from the OSHA Directorate of Construction, labor unions, state governments, insurance companies, worker and labor management organizations, organizations of occupational safety and health experts, and other construction-relevant professional organizations. Throughout the study, additional information was received from the Construction Research Program staff in response to requests from committee members. The time period chosen by the committee for the evaluation was 1996 through 2005. To the extent possible and practical, the statistics and other information cited in this report correspond to that time period. 

Introduction 25 TRENDS IN CONSTRUCTION WORKPLACE SAFETY AND HEALTH Fatality rates and nonfatal injury and illness rates provide a benchmark for mea- suring the success of an industry’s occupational safety and health strategies. ­Between 1992 and 2005, 16,000 construction workers died from work-related ­ injuries. In 2005 alone, 1,243 construction workers died from job-related traumatic injuries. This number accounted for 22 percent of job-related deaths across all industries, a figure that is disproportionately high given that construction workers account for 8 percent of the workforce. The death rate for construction workers was almost three times that of full-time workers for all industries: 11.1 deaths per 100,000 con- struction workers compared with 4.2 deaths per 100,000 workers in all industries. Among all sectors, construction had the fourth highest rate of fatalities in 2005 (after agriculture, mining, and transportation) (CPWR, 2007, Section 32). Nonetheless, when compared with statistics from the past, these numbers indi- cate significant improvements in construction workplace safety. Between 1992 and 2005, the overall rate of construction-related fatalities declined from 14.3 to 11.1 per 100,000 workers, which translates to 350 fewer deaths per year for a workforce of 11 million people. Nonfatal injuries and illnesses are also an important indicator of workplace safety and health. In 2005, construction workers accounted for 414,900 injuries and illnesses, a rate of 239.5 per 10,000 workers, the second highest of all indus- tries. Of the 414,900 cases, 157,100 were serious enough to result in lost workdays (CPWR, 2007). As with fatalities, the rate of nonfatal injuries and illnesses also declined significantly, although the exact numbers are not clear owing to changes in reporting requirements. The statistics for nonfatal injuries and illnesses are misleading in one sense, however: Of the total cases reported, only 2.5 percent were illness-related (CPWR, 2007). Thus, for construction, this statistic is in actuality indicative of nonfatal i ­ njuries. Also, the data fail to include the large portion of the construction work- force that is self-employed or employed by firms with fewer than 10 workers.  In 2002, the Occupational Safety and Health Administration implemented a number of changes in the definitions of injury and illness cases recorded by employers. The new definitions in turn resulted in changes in occupational injury and illness statistics provided by the Bureau of Labor Sta- tistics. There is some disagreement as to the overall effect of these changes. For example, one author writes that “while these data follow the trend of declining cases and rates seen throughout the past decade, because of the change in definition they cannot be compared with data from prior years” (Wiatrowski, 2004). In contrast, others note that although the changes in coding systems have signifi- cantly affected the compatibility of injury and illness data for construction subsectors over time, the impact on the construction industry as a whole is relatively small (CPWR, 2007, Section 32). 

26 C o n s t r u c t i o n R e s e a r c h a t NIOSH Data on construction-related illnesses are, in fact, difficult to come by. Na- tional statistics are not available to guide all occupational disease research. National estimates do indicate that occupational illness is an important problem and that the total burden from the number of deaths due to occupational illness is likely to exceed that for occupational injury by a factor ranging from 4 to 11 (Steenland et al., 2003). A number of studies with data from death certificates are also available; the studies indicate that occupational diseases remain significantly undercounted, and thus it can be deduced that deaths associated with occupational disease are underestimated. For example, construction was the most frequently listed industry on asbestosis and silicosis death certificates from 1990 to 1999 (24.6 percent and 13.4 percent, respectively) (CDC, 2008). Lacking specific data related to illnesses, researchers must rely on the picture provided by a variety of sources such as n ­ ational data, state-level illness statistics, knowledge and extrapolation of construc- tion exposures, and international surveillance findings. To set the context for evaluating the Construction Research Program, it is also important to describe some characteristics of the construction industry and its workforce that directly influence the relevance of research and the potential impact of research-based activities and products. CHARACTERISTICS OF THE Construction INDUSTRY National Statistics for the Industry National statistics for the construction industry are limited in their usefulness because they do not include the almost 2.5 million self-employed “one person” businesses without other paid employees, or approximately 1.5 million public employees performing construction (U.S. Census Bureau, 2005). The data available from the Bureau of Labor Statistics divide construction into three subsectors using the North American Industry Classification System (NAICS) (Table 1.1). The Construction of Buildings subsector comprises establishments involved in constructing residential, industrial, commercial, and institutional buildings. The Heavy and Civil Engineering Construction subsector includes establishments i ­ nvolved in infrastructure projects—for example, water, sewer, oil, and gas pipe- lines; roads and bridges; and power lines. The Specialty Trade Contractors sub­ sector engages in activities such as plumbing, electrical work, masonry, carpentry, and roofing that are generally needed in the construction of all building types. Thus, while two of the subsectors refer to types of construction projects, the third refers to types of workers who work on all types of projects. This categorization obscures differences in injury and illness rates among different types of projects. 

Introduction 27 TABLE 1.1  Construction Industry Subsectors as Defined by the North American Industry Classification System NAICS Employment Nonfatal Rates, 2004b Code Construction Subsector 2005a Injury Illness 236 Construction of Buildings 1,782,200 5.5 13.4 237 Heavy and Civil Engineering Construction 974,800 5.8 16.2 238 Specialty Trade Contractors 4,714,000 6.6 13.4 23 Construction Sector 7,416,000 6.2 13.8 aExcludes self-employed and publicly employed workers. bInjury rates per 100 employees per year; illness rates per 10,000 employees per year. SOURCE: CPWR (2007). Construction workers across the entire industry are typically younger than the national labor force, although the average age in the industry has been increas- ing. The majority of construction workers are ages 25 to 54 (75.4 percent), are male (90.3 percent), and are white (90.8 percent) (NIOSH, 2007). However, these numbers mask significant differences within segments of the industry, such as the proportions of unionized and non-union workers, the percentages of workers in skilled trades, and those in unskilled or manual labor jobs. Hispanics are the fastest-growing ethnic group and the largest minority group in the United States, accounting for 14 percent of the U.S. population. This growing population works in some of the most dangerous industries in the nation, with construction having a larger share of Hispanic workers than any U.S. industry except agriculture. The number of Hispanic workers in construction tripled in the past decade to 2.6 million in 2005 (or 23 percent of all construction ­workers). Almost 75 percent of Hispanic construction workers were born outside the United States and about two-thirds (or 1.7 million) were not U.S. citizens in 2005 (CPWR, 2007). The construction industry is overwhelmingly one of small establishments. Of the 710,000 construction firms with payrolls in the United States in 2002, almost 80 percent had fewer than 10 employees, accounting for 24 percent of the con- struction workforce. In contrast, only 585 construction firms (less than 1 percent) had 500 or more employees (8 percent of construction workers). Ninety-eight percent of all firms had fewer than 100 workers (79 percent of the construction workforce), while 2 percent of all firms had 100 or more workers (21 percent) (CPWR, 2007). This type of statistical categorization is important in determining the rates and causes of fatalities, injuries, and illnesses, as well as demographic changes across and 

28 C o n s t r u c t i o n R e s e a r c h a t NIOSH within the industry. This information, in turn, is important in determining which areas of research should be of high priority. However, statistical characterizations lose much of the richness and variation that characterize construction work in the field. They also fail to convey the relative ease or difficulty of influencing worker health and safety in different sectors and, in turn, the ability of research-based a ­ ctivities to have an impact on fatalities, injuries, illnesses, or special populations. To provide context for its evaluation of both the relevance and the impact of the NIOSH Construction Research Program, the committee considered it important not only to include statistical breakdowns that affect relevance but also to describe briefly construction project processes and stakeholders and the segmentation of the industry from the perspective of industry practitioners. This segmentation has implications for the potential impact of the Construction Research Program on construction workplace health and safety. Projects and Stakeholders The construction industry delivers buildings of all types, manufacturing and industrial facilities, civil infrastructure, and public works. Each construction ­project is initiated by an “owner,” which may be a government entity, a corporation, or an individual. In addition to the owner, a construction project may involve architects, engineers, general contractors, subcontractors, members of trade unions, skilled trades persons, manual laborers, suppliers, financing institutions, legal represen- tatives, insurance companies, and others. All of these stakeholders operate in an environment in which there is continual demand to deliver projects in less time and at lower cost. However, not all individuals involved in construction projects identify them- selves as working in the construction industry. For example, owners, architects, and engineers serve the industry but may not say that they “work in construction.” Similarly, many manufacturers of products used in the construction industry are classified as just that—manufacturers. The boundary is more subtle for companies that fabricate products for use in construction. The involvement of such an array of stakeholders poses two challenges: (1) determining who is responsible and account- able for workplace safety and health and (2) determining who is in the best position to use and implement research-based information, technologies, and products. Segmentation of the Industry In contrast to the NAICS categorization of three sectors—Construction of Buildings, Heavy and Civil Engineering Construction, and Specialty Trade C ­ ontractors—many industry practitioners consider construction to have at least 

Introduction 29 four distinct sectors—residential, commercial, industrial, and heavy construc- tion.10 Specialty trade contractors and manual laborers are involved in each of these sectors. The sectors delineated by industry practitioners differ from each other in terms of the characteristics of project owners and their sophistication and/or involve­ment in the construction process, the complexity of projects, the source and magnitude of financial capital, required labor skills, the use of specialty equipment and ­ materials, design and engineering processes and knowledge, and other fac- tors. When viewed in this way, radical differences are apparent among the sectors regarding worker training, and owner and contractor surveillance of workplace safety and health. These differences often determine the level of availability of health and safety interventions. For example, workers in unions generally receive training through apprenticeship programs, often including some training related to health and safety. Established labor-management committees in unions provide a distinct structure for transferring training and engineering controls to workers in the field. Such structures do not typically exist for non-union workers in small firms or manual laborers. Similarly, owners that contract for multiple projects (e.g., large corporations with multiple facilities) and large contractors have greater a ­ ccess to and more resources for participating in owner and contractor associations and organizations that identify best practices than do owners who build only one project or firms with fewer than 10 employees. The residential sector builds single-family houses, townhouses, and low-rise (up to five-story) multifamily apartments and condominiums and accounts for about 35 percent of the total construction value put in place annually. In 2005, construction was started on approximately 1.72 million new single-family homes (CPWR, 2007). However, the total number of establishments and total number of workers involved in residential construction is not known owing to current methods for gathering statistical data (CPWR, 2007). What is clear is that with the exception of a few “national” contractors that may build up to 20,000 units per year (e.g., Pulte Homes), most residential contractors employ fewer than 10 workers. Residential construction workers and subcontractors tend to move among several projects at any one time and may work as subcontractors to several different general contractors. Some specialty trade workers may have formal training, but many workers, including manual laborers, have only on-the-job experience. In an environment of thousands of small firms and transient workers, gathering data through surveillance and other research techniques or disseminating health- and safety-related information and products is difficult. Compliance with regulations 10 Somepractitioners would suggest that transportation-related projects be treated as a fifth seg- ment of construction based on the characteristics of these types of projects (Hinze, 2001). 

30 C o n s t r u c t i o n R e s e a r c h a t NIOSH or the use of best practices (e.g., proper trenching operations) is problematic: Con- struction contractors may not have the knowledge, training, or incentives to apply best practices, while regulatory enforcement agencies such as OSHA do not have the resources to inspect small projects, but must instead focus on large projects employing greater numbers of workers. The commercial sector builds projects such as schools, churches, high-rise multi­family buildings, offices, and retail buildings, among others. This sector a ­ ccounts for about 25 percent of the total construction value put in place per year. Construction firms and contractors working in this sector may have a mix of large and small projects and a larger, more stable group of full-time workers and sub­ contractors. Some of this sector’s workers may belong to labor unions and may have specialized training through apprenticeships. Gathering and disseminating health and safety information in this type of environment is less problematic than doing so in the residential sector: In the commercial sector, project and business man- agers tend to have more professional training and are more aware of the impacts and costs of injuries and illnesses. In this sector, compliance with health and safety regulations is more likely to occur as a result of management-initiated practices or the occasional OSHA inspection. The industrial sector delivers projects such as manufacturing plants and oil refineries and accounts for about 25 percent of total construction value put in place annually. The owners of industrial projects, usually large corporations, typi- cally build them to produce the products that they market. Because such projects are specialized, cost hundreds of millions of dollars, and are integral to the busi- ness “bottom line,” owners are more likely to be closely involved in such projects. Contractor firms working in this sector tend to be large, sophisticated firms, and their workers are likely to be trained and certified, by trade associations, labor unions, or sometimes the contractor. For some types of projects, both owners and contractors are members of professional organizations, such as the Construction Industry Institute, that share best practices. Workers tend to stay on one site, work- ing on one project at a time rather than moving among several sites simultane- ously. In this ­environment, it is much easier to identify those with a direct interest in worker safety and health and then to gather and disseminate research-based information. The heavy-construction sector delivers large infrastructure projects, includ- ing dams; water, sewer, and gas lines; tunnels, highways, and bridges; and air- ports. Govern­mental entities serve as the owner of many but not all such projects. Construction firms working in this sector range from relatively small specialized contractors to large, national firms. Much of the work involves the use of heavy equipment and may require fewer workers per project than are needed in other sectors. As with industrial-type projects, the awareness and involvement in health 

Introduction 31 and safety issues by owners and contractors in the heavy-construction sector is relatively high. References BLS (Bureau of Labor Statistics). 2006a. Fatality Data. Available at http://www.bls.gov/iif/oshcfoi1. htm. Accessed June 15, 2008. BLS. 2006b. Injury and Illness Data. Available at http://www.bls.gov/iif/oshsum.htm. Accessed June 15, 2008. BRT (Business Roundtable). 1983. More Construction for the Money: Summary Report of the Construction Industry Cost Effectiveness Project. Available at http://www.ce.berkeley.edu/ ~tommelein/BRTMORECONSTRUCTIONFORTHEMONEY.pdf. Accessed June 20, 2008. CDC (Centers for Disease Control and Prevention). 2008. World Report Data. Available at http:// www2a.cdc.gov/drds/WorldReportData/pdf/Table03-06.pdf. Accessed June 15, 2008. CFR (Code of Federal Regulations). 2008. Title 29, Part 671, Sections 20, 21 and 22. CPWR (Center to Protect Workers’ Rights). 2007. The Construction Chart Book: The U.S. Construc- tion Industry and Its Workers. 4th ed. Washington, D.C.: Center for Construction Research and Training. Hinze, J.W. 2001. Construction Contracts. New York: McGraw-Hill Companies. NIOSH (National Institute for Occupational Safety and Health). 2007. NIOSH Construction Research Program Evidence Package. Washington, D.C., July. Steenland, K., C. Burnett, N. Lalich, E. Ward, and J. Hurrell. 2003. Dying for work: The magnitude of U.S. mortality from selected causes of death associated with occupation. American Journal of Industrial Medicine 43:461-482. U.S. Census Bureau. 2005. Nonemployer Statistics and Construction Spending. Available at http:// www.census.gov/epcd/nonemployer/2005/us/US000_23.htm and http://www.census.gov/const/ C30/ototsa2005.pdf. Accessed July 15, 2008. Wiatrowski, W.J. 2004. Occupational injury and illness: New recordkeeping requirements. Monthly Labor Review Online. December, pp. 10-24. Available at http://www.bls.gov/opub/mlr/2004/12/ art2abs.htm. Accessed July 15, 2008.