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

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2 The NIOSH Construction Research Program T he mission of the Construction Research Program of the National Institute for Occupational Safety and Health (NIOSH) is “to eliminate occupational diseases, injuries, and fatalities among individuals working in these indus- tries through a focused program of research and prevention” (NIOSH, 2007). The Construction Research Program has evolved over time in response to congres- sional directives, to several internal initiatives, and to construction-related safety and health issues. Chapter 2 describes the evolution of the program, its strategic planning processes, the program’s structure and administration, and its resources. External factors that are beyond the control of the program but that nonetheless affect its relevance and impact in reducing fatalities, injuries, and illnesses on con- struction worksites are also described. PROGRAM EVOLUTION Although the formal Construction Research Program was not created until 1990, construction-relevant research activities at NIOSH started in the 1970s. These activities included large national surveillance and investigation activities, such as the National Occupational Hazard Survey, the National Occupational Exposure Survey, the National Traumatic Occupational Fatalities surveillance pro- gram, ­Fatality Assessment and Control Evaluations, the Sentinel Event Notifica- tion Systems for Occupational Risk, and the Adult Blood Lead Epidemiology and Surveillance program. NIOSH staff conducted research that addressed worker 32 

T h e NIOSH C o n s t r u c t i o n R e s e a r c h P r o g r a m 33 exposures to lead, asphalt fumes, and silica. Grants and contracts were awarded to support epidemiological studies investigating health risks associated with the painting trade, silicosis and its association with sandblasting, and safety profiles for specific construction activities. NIOSH researchers were also developing and disseminating criteria documents, providing research results to the Occupational Safety and Health Administration (OSHA) regarding the health and safety aspects of noise, ultraviolet radiation, elevated workstations, crystalline silica, asphalt fumes, construction work in confined spaces, excavation, and occupational expo- sure to hand-arm vibration for construction workers. In 1990, following hearings about the level of resources and programs target- ing construction safety, Congress directed NIOSH to “develop a comprehensive prevention program directed at health problems affecting construction workers by expanding existing NIOSH activities in areas of surveillance, research, and inter- vention” (NIOSH, 2007) and allocated funds for NIOSH to do so. Between 1990 and 1994, NIOSH conducted several national conferences on construction safety and health, issued cooperative agreements to encourage extramural research, and established a task group to prepare a plan and budget for construction research. By 1994, extramural research included state demonstration projects and several cooperative agreements and research grants. In the same year Congress directed NIOSH to establish a new 5-year cooperative agreement with the construction trades to develop a center for prevention-oriented strategies and programs. After NIOSH issued a request for applications (RFA) and held a competition, the agree- ment for a National Construction Center (NCC) was awarded to the Center to Protect Workers’ Rights (CPWR) and a CPWR consortium of 10 academic insti- tutions. The CPWR had been created by the Building and Construction Trades Department of the AFL-CIO in 1990 to conduct applied construction safety and health research, training, and medical screening and to provide other related services. In 1995, the NIOSH director requested an external review of the Construction Research Program. The review resulted in the establishment of a Construction Steering Committee (CSC), which included a chairperson and a representative from each NIOSH division and laboratory. The mandate of the CSC was to increase internal and external communication between researchers working on  Research conducted by entities and individuals outside of NIOSH.  CPWR was renamed “CPWR: The Center for Construction Research and Training” in 2008.   Applied Research and Technology; Surveillance, Hazard Evaluations, and Field Studies; Edu- cation and Information; Respiratory Disease Studies; Safety Research; Health Effects; Pittsburgh Research Laboratory; Spokane Research Laboratory, the Office of Extramural Projects; and ­National Personal Protective Technology. NIOSH’s laboratories are located in Pittsburgh, Pennsylvania; S ­ pokane, Washington; Cincinnati, Ohio; and Morgantown, West Virginia. 

34 C o n s t r u c t i o n R e s e a r c h a t NIOSH construction health and safety projects and to establish a formal review process for construction projects proposed by NIOSH researchers. In 2001, Congress directed NIOSH to expand the Construction Research Pro- gram and appropriated funds for a 3-year grant to Purdue University. This even- tually led to the formation of a Construction Safety Alliance partnership project based at Purdue. This grant included the funding of efforts for the NIOSH Student Engineering Team partnership and provided the program with necessary access to expertise, facilities, and equipment to accomplish a broad scope of work. It gave the program exposure on campus, primarily providing single-discipline graduate training in industrial hygiene, occupational health nursing, occupational medicine, and occupational safety. In 2003, an RFA was issued for the second 5-year NCC Cooperative Agreement announcement. The CPWR scored highest in the competition and was awarded the contract. In separate actions, individual projects submitted by Purdue University and Virginia Tech were also funded. STRATEGIC PLANNING AND RESEARCH GOALS As the Construction Research Program has evolved, so have its processes for strategic planning and the development of research goals. The drivers of the r ­ esearch topics and activities in the first years of the program included congres- sional mandates and directives, construction stakeholder input obtained at national conferences, and the CSC. A plan was developed that included goals related to surveillance, research, and intervention development. It also identified construc- tion workers as particularly vulnerable for fatal and nonfatal injuries, envisioned collaboration with other agencies, and recognized the importance of input from construction industry representatives, both labor and management, on research and intervention needs. In the early 1990s, NIOSH and its public and private partners used a ­consensus- building process to set priorities for a 10-year period for all occupational safety and health research, including construction. Unveiled in 1996, the first National Occu- pational Research Agenda (NORA1) identified 21 research priorities grouped into three categories: disease and injury, work environment and workforce, and ­research tools and approaches. Throughout NIOSH, a crosscutting approach to meeting the NORA research priorities was established, resulting in the use of a matrix ­approach to track, manage, and report on NORA-related research for construction and other high-risk sectors. To communicate its strategic planning priorities to its internal and extramural stakeholders, the CSC prepared annual guidance related to research needs and priorities, asking for proposals that focused on NORA priority areas relevant to construction. 

T h e NIOSH C o n s t r u c t i o n R e s e a r c h P r o g r a m 35 The development of RFAs for the second and third cooperative agreements for a National Construction Center also served as opportunities to evaluate program goals and adjust them to meet identified gaps in construction research. The 1999 RFA was structured to maintain and expand ongoing surveillance activities while generating new extramural research on construction interventions, information and technology transfer, and preventive systems research. By 2003, it was recognized that the adoption of research-based solutions by the industry had been uneven and uncertain, owing in part to gaps in the understanding of how to effectively transfer research results into practice. As a consequence, the third NCC RFA stipulated that 20 percent of direct costs were to be directed to research-to-practice (R2P) transla- tion projects and emphasized the need to measure impacts. CURRENT PROGRAM STRUCTURE AND ADMINISTRATION NIOSH has formalized its Construction Research Program using a three- c ­ omponent structure: NIOSH-wide intramural research and surveillance pro- grams, a National Construction Center cooperative agreement, and support grants and agreements for investigator-initiated extramural research projects. Figure 2.1 provides a conceptual overview of the NIOSH Construction Research Program components and the research focus of each component. NIOSH CONSTRUCTION RESEARCH PROGRAM Intramural Research National Construction Extramural Research Basic research Center Investigator-initiated grants Surveillance Industry characterization and agreements Methods research Applied research Innovative ideas Exposure assessments Industry liaison Opportunities Controls research Interventions State initiatives FIGURE 2.1  Components of the NIOSH Construction Research Program. Figure 2-1 

36 C o n s t r u c t i o n R e s e a r c h a t NIOSH Intramural research is carried out by NIOSH researchers assigned to several divisions and associated laboratories throughout NIOSH, rather than by a distinct construction research organizational entity. As such, the program operates as a matrix organization within NIOSH. Activities that focus on basic research, surveil- lance, research methods, exposure assessments, and controls research are managed through a Construction Coordinator and the CSC. The CSC monthly meetings are conducted by videoconference or conference call, and two annual face-to-face meetings are held. NIOSH conducts intramural project reviews at the division level. Each division oversees the review process using established guidelines for seeking external peer reviews, documenting the results, and certifying the review process. The NCC is operated under a competitively awarded (scientifically and pro- grammatically reviewed) 5-year cooperative agreement. The NCC is currently awarded to CPWR: The Center for Construction Research and Training. The NCC focuses on applied research, creating liaisons with the construction industry, and developing research-based interventions. It is supported through government funding from NIOSH and also from the National Institute for Environmental Health Sciences, the U.S. Department of Energy, U.S. Department of Labor, and U.S. Department of Defense. Research for NIOSH’s Construction Research Program is conducted by NCC staff dedicated to construction research and through the NCC consortium of universities, which includes 26 individual principal investigators affiliated with 19 universities, institutes, and other organizations. The NCC disseminates safety and health-related information through the Internet. The NCC’s Library of Construc- tion Occupational Safety and Health (eLCOSH) provides user-friendly information in English, Spanish, and other languages from a wide range of sources that include labor-management programs, trade magazines, universities, and government agen- cies. The NIOSH Construction Coordinator regularly meets with senior NCC personnel to coordinate research activities. In addition to the work conducted by the NCC for the Construction Research Program, extramural research is conducted for the program through investiga- tor-initiated extramural grants and cooperative agreements (all scientifically and programmatically reviewed), and through support for state health department investigators working on construction health and safety surveillance and state-level interventions. The program staff also interacts with the Center for Innovation in Construction Safety and Health at Virginia Tech. Research conducted in any one component of the program is leveraged through interactions with researchers in the other two components. Such interactions  See http://www.cdc.gov/elcosh. 

T h e NIOSH C o n s t r u c t i o n R e s e a r c h P r o g r a m 37 occur during regularly scheduled meetings, construction conferences, and other construction-specific networking opportunities. Program Resources Total annual funding for the Construction Research Program between fiscal year (FY) 1997 and FY 2007 has averaged about $17.8 million, ranging from a high of $20.3 million in FY 1997 to a low of $13.8 million in FY 2007 (Figure 2.2) (NIOSH, 2007). When adjusted for inflation and changes in technologies, the funding level for the program has declined in terms of real purchasing power (Figure 2.3). Funding for intramural research and extramural grants, not including the NCC, has fluctu- ated accordingly. 25 20 Budget, $ millions 15 10 5 0 FY97 FY98 FY99 FY00 FY01 FY02 FY03 FY04 FY05 FY06 FY07 Total Budget $20.4 $19.6 $17.3 $17.0 $18.0 $19.1 $15.9 $15.6 $16.8 $15.9 $13.8 Intramural $ 9.1 $ 8.3 $ 8.9 $ 9.4 $ 9.1 $10.2 $ 8.8 $ 9.0 $10.3 $ 9.0 $ 7.3 Extramural $11.3 $11.3 $ 8.4 $ 7.5 $ 9.0 $ 8.9 $ 7.2 $ 6.7 $ 6.5 $ 6.8 $ 6.5 Center $ 4.8 $ 4.9 $ 4.9 $ 5.0 $ 5.0 $ 5.2 $ 5.2 $ 5.0 $ 5.0 $ 5.0 $ 5.0 Fiscal Year FIGURE 2.2  Construction Research Program funding history, FY 1997–FY 2007. NOTE: The costs include staff salaries and overhead. SOURCE: NIOSH (2007). Figure 2-2 R01399 fully editable 

38 C o n s t r u c t i o n R e s e a r c h a t NIOSH 25 20 Budget, $ millions 15 Total Budget Adjusted (1996$) 10 5 0 00 01 02 03 04 05 06 07 FY FY FY FY FY FY FY FY Fiscal Year FIGURE 2.3  Construction Research Program funding, FY 2000–FY 2007, adjusted by the Biomedi- cal Research and Development Price Index (BRDPI). NOTE: The BRDPI adjusts for inflation and the increased costs of conducting scientific investigations due to new technologies and other factors. SOURCE: NIOSH (2007). Figure 2-3 R01399 Because the Construction Research editableis a matrix program, internal staff fully Program resources available for intramural research must be aggregated across divisions and reported as full-time equivalents (FTEs). In FY 2007, the research commitment was 56 FTEs, representing individuals from a variety of disciplines including ­behavioral sciences, epidemiology, safety engineering, safety management, statistics, general engineering, communications, industrial hygiene, and health science. CSC repre- sentatives typically allocate 10 percent of their time to program management and direction. The Construction Coordinator, who allocated 25 percent of his time to the program in 2000, currently allocates 100 percent of his time to the program. Beginning in 2006, a senior lead team representative was designated as Construc- tion Program Manager and the CSC representatives transitioned to also represent- ing NIOSH on the NORA Construction Sector Council. The NCC has 16 internal researchers and support personnel representing 30 FTEs working exclusively on research of the NIOSH Construction Research Program. Their research expertise includes economics, epidemiology, safety engi­ neer­ing, safety management, statistics, general engineering, industrial hygiene, 

T h e NIOSH C o n s t r u c t i o n R e s e a r c h P r o g r a m 39 science, medicine and toxicology. The CPWR has a consortium of academic and other institutions that have been awarded, through peer review, monies to work on a variety of construction-related projects. Goals, Objectives, and Future Plans The Construction Research Program focuses its activities on the achievement of four major goals: • Goal 1: Reduce the major risks associated with traumatic injuries and fatalities in construction. • Goal 2: Reduce exposures to health hazards associated with major risks of occupational illness in construction. • Goal 3: Reduce the major risks associated with musculoskeletal dis­ orders in construction. • Goal 4: Increase understanding of construction sector attributes that affect occupational safety and health outcomes. Two to six sub-goals are associated with each of the four major goals. The goals are a composite of goals and priorities that draw from NORA1, and internally generated strategic goals and high-priority topics. The Construction Research Program proposes to continue with the current three-component organizational structure. There will be an open recompetition for the NCC in 2008-2009, and as in the past, scientific peer review will determine its award. The program expects that many of the current targeted areas requiring health and safety research will remain the same, but anticipates that some refocus­ing of program research efforts and emphases will be required by the influx of Hispanic w ­ orkers into the construction industry, continuing changes in work organization, and the introduction of new technologies and materials such as nanoscale materials. A draft of the second National Occupational Research Agenda (NORA2) was released for public comment in December 2007. The program intends to use the NORA2 Construction Sector Council goals for construction, combined with the findings and recommendations from this National Research Council review, to guide its next NCC Cooperative Agreement and to further strengthen the future program and its research directions. External Factors In accord with the Framework Document (Appendix A), the committee identi- fied external factors that may have affected the Construction Research Program’s 

40 C o n s t r u c t i o n R e s e a r c h a t NIOSH relevance and impact during the 10-year period under review. The Framework Document addresses external factors as follows: External factors may be considered as forces beyond the control of NIOSH that may affect the evolution of a program. External factors influence NIOSH’s progress through all phases of the logic model and flowchart, from inputs to end outcomes. . . . Identification of external factors by an EC [Evaluation Committee] is essential because it provides the context for evaluation of the NIOSH program. External factors may be best assessed on the basis of the expert judgment of EC members who have knowledge of the field of research. Information regarding external factors should also be sought from NIOSH, OSHA, and MSHA [Mine Safety and Health Administration] staff and from other stakeholders. Several significant external factors affect both the relevance and the impact of the Construction Research Program, as described below. Lack of Regulatory Authority A fundamental external factor affecting the relevance and impact of the Con- struction Research Program is the fact that the program and NIOSH are research entities lacking regulatory authority. As such, the program can produce knowledge about construction workplace safety and health hazards and provide the applica- tion of this knowledge through a range of activities. Although the Construction Research Program can make recommendations to regulatory agencies, project owners, and contractors, how those recommendations are used, if at all, is beyond the control of the program. Because NIOSH does not have standard-setting or enforcement authority, it relies on Congress and federal agencies such as OSHA, as well as on standards organi­zations, unions, and project owners and contractors both to implement and to enforce the outcomes and recommendations yielded by its research. For example, research conducted by the program and other organizations has identified effective interventions to protect construction workers from exposure to hazards such as crystalline silica and excessive noise. However, unless OSHA or another organiza- tion promulgates and enforces standards based on the available research, it is very difficult to link the impact of the program’s research directly to reduced fatalities, injuries, and illnesses. Methods other than standards for transferring research into practice are avail- able, but they present similar issues of enforcement authority. For example, owners and clients who purchase construction services insert requirements in bid specifica- tions to protect workers against unregulated as well as regulated hazards. Unfor- tunately, in the absence of such bid specifications and in the intensely competitive environment of construction contract bidding, those contractors who choose to 

T h e NIOSH C o n s t r u c t i o n R e s e a r c h P r o g r a m 41 devote resources to improving the health and safety of their workers by addressing unregulated hazards may be placed at a competitive disadvantage when bidding against contractors who do not choose to do so. Until the health and safety research from the program can be implemented through regulations promulgated by ­others or through changes in owners’ and contractors’ practices and behaviors, it will be very difficult to assess the degree to which the program’s efforts have directly impacted worker health and safety on construction sites. Resources Total funding for NIOSH over the period FY 1996 through FY 2005 increased in absolute numbers, with a decrease in FY 2006. This increase is more modest once the absolute numbers are adjusted for inflation and for the increased costs of conducting scientific investigations due to new technologies and other factors using the Biomedical Research and Development Price Index (Table 2.1). Over the same period, funding for the Construction Research Program has declined as a percentage of the overall NIOSH budget (Figure 2.4). The committee believes that the level of resources available to the Construc- tion Research Program has significantly limited the capacity of the program for conducting research activities across the broad range of safety and health hazards that are present on construction worksites. The lack of resources also limits the capacity of the program to conduct surveillance and training activities for the residential sector of construction with its preponderance of small firms located in TABLE 2.1  Overall NIOSH Budget, FY 1996–FY 2006 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 Budget 161 173 184 204 226 260 276 273 277 286 255a ($ millions) Adjusted 161 N.A. N.A. N.A. 199 221 227 217 212 211 182 (BRDPI)b (millions of 1996 $) NOTE: N.A., not available. aIn 2006, Congress redirected $35 million from the NIOSH budget appropriation to the Centers for Disease Control and Prevention for business support services. bNational Institutes of Health Biomedical Research and Development Price Index (BRDPI). SOURCE: NIOSH (2007). 

42 C o n s t r u c t i o n R e s e a r c h a t NIOSH 350 300 250 NIOSH Budget Budget, $ millions 200 150 Construction Research 100 Budget 50 0 97 98 99 00 01 02 03 04 05 06 Fiscal Year FIGURE 2.4  Comparison of NIOSH total budget and Construction Research Program budget in unadjusted dollars, FY 1996–FY 2006. SOURCE: NIOSH (2007). Figure 2-4 R01399 every community in the country. The program needs to focus its R2P efforts on fully editable those sectors in which more formal mechanisms exist for reaching large contractors (heavy construction, industrial, commercial) and significant numbers of workers (labor unions). A related issue is that until very recently, NIOSH senior management had not made the commitment to assign at least one full-time senior-level staff person to coordinate the array of projects and activities carried out within the Construc- tion Research Program and one lead team member to serve as the Construction Program Manager. Over the review period, the Construction Research Program has primarily been under the direction of a steering committee of representatives from other program areas. There has been no single, senior-level person to advo- cate solely for the Construction Research Program and resources. The committee believes that the lack of full-time senior-level management has limited what could reasonably be accomplished by the program. 

T h e NIOSH C o n s t r u c t i o n R e s e a r c h P r o g r a m 43 Industry Segmentation As described in Chapter 1, the construction industry is highly segmented with respect to the number and wide variety of stakeholders involved, by the type of con- struction project, the physical environment in which it is built, how it is designed, the project’s funding source (public versus private), and additional factors. This industry segmentation has significant implications for evaluating the impact of the Construction Research Program. First, it can be difficult to choose which research areas will have the greatest impact on the health and safety of the greatest number of workers, since safety and health performance across the different construction sectors varies significantly. This is primarily due to differences in the makeup of the workforce, exposures that workers may face on different types of projects, and the owner organizations. The segmentation also makes it difficult for individual researchers to translate research findings and promising health and safety interven- tions effectively and efficiently into practice across the industry as a whole. Owners, especially those who are responsible for multiple projects or are in the public sector and are large contractors, can play an important role in construction health and safety by implementing safety practices and promoting a positive safety culture on their jobs and also by using contract language crafted to promote such an environment. In the union segment of construction, required union appren- ticeship programs and established labor-management committees provide distinct structural vehicles for transferring worker training and engineering controls that generally do not exist in the non-union sector. Similarly, contractor associations and organizations offer an effective means for reaching non-union as well as union contractors. However, a large majority of construction firms are small operators with non-union, transient workforces. They may lack the resources to seek out the best practices or participate in training programs. Proactively disseminating research-based information to thousands of firms is challenging. Even when the information reaches such firms, there are few mechanisms for measuring the degree to which it has had any positive impact on health and safety. The segmentation of the construction industry has also contributed to a related but distinct issue—that of engaging outside researchers interested in construc- tion health and safety research in the program’s extramural grants program. First, the complexity of the construction industry makes it difficult for researchers to access and then study specific and stable populations of construction workers or employers. Also, the inadequacy of surveillance data makes it somewhat difficult to ensure that research priorities reflect the most important issues. The Construction R ­ esearch Program staff conveyed to the committee in its meetings, with some degree of frustration, that they have been unable to induce many extramural researchers to apply for grant monies to study how worker behavior and employer/management 

44 C o n s t r u c t i o n R e s e a r c h a t NIOSH leadership skills can work together to promote a positive safety culture, a topic that is increasingly recognized as a key to best practices implementation. REFERENCES CPWR (Center to Protect Workers’ Rights). 2002. Noise-induced hearing loss in construction. In: The Construction Chart Book, 3rd ed. Washington, D.C.: CPWR, Ch. 43. CPWR. 2007. The Construction Chart Book: The U.S. Construction Industry and Its Workers. 4th ed. Washington, D.C.: Center for Construction Research and Training. NIOSH (National Institute for Occupational Safety and Health). 2007. NIOSH Construction Research Program Evidence Package. Washington, D.C., July.