3
Evaluation of the Relevance and Impact of the NIOSH Construction Research Program

The committee was charged with reviewing and assessing the relevance and impact of the Construction Research Program of the National Institute for Occupational Safety and Health (NIOSH) in reducing construction-related workplace illnesses and injuries. The period selected for review was 1996 through 2005, to encompass 10 years of research following the program’s first external review and the issuance of the first National Occupational Research Agenda (NORA1). As detailed in Chapter 2, the program’s strategic planning and development of research goals have evolved over the period reviewed. In 2005, the Construction Research Program established a set of four goals and corresponding sub-goals (Box 3.1), which serve as the basis for the evidence package presented by NIOSH to the committee (NIOSH, 2007). This set of goals and sub-goals represents a composite of goals and priorities that were in place during the time frame of the review and which draw from earlier “High Priority Construction Topics” and the more recent draft NIOSH Strategic Goals.

To evaluate the relevance and impact of the NIOSH Construction Research Program, the committee divided into four teams of two or three members each, with each team assigned one of the four program research goals. Each team conducted an in-depth evaluation of the materials provided by the NIOSH Construction Research Program staff along with other information made available in subsequent meetings and communications with the staff. Following the guidance in the Framework Document (Appendix A), the committee carried out its evaluation using the terminology and organization of a logic model adopted by NIOSH to



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3 Evaluation of the Relevance and Impact of the NIOSH Construction Research Program T he committee was charged with reviewing and assessing the relevance and impact of the Construction Research Program of the National Institute for Occupational Safety and Health (NIOSH) in reducing construction- related workplace illnesses and injuries. The period selected for review was 1996 through 2005, to encompass 10 years of research following the program’s first ex- ternal review and the issuance of the first National Occupational Research Agenda (NORA1). As detailed in Chapter 2, the program’s strategic planning and devel- opment of research goals have evolved over the period reviewed. In 2005, the Construction Research Program established a set of four goals and corresponding sub-goals (Box 3.1), which serve as the basis for the evidence package presented by NIOSH to the committee (NIOSH, 2007). This set of goals and sub-goals represents a composite of goals and priorities that were in place during the time frame of the review and which draw from earlier “High Priority Construction Topics” and the more recent draft NIOSH Strategic Goals. To evaluate the relevance and impact of the NIOSH Construction Research Pro- gram, the committee divided into four teams of two or three members each, with each team assigned one of the four program research goals. Each team conducted an in-depth evaluation of the materials provided by the NIOSH Construction Research Program staff along with other information made available in subse- quent meetings and communications with the staff. Following the guidance in the Framework Document (Appendix A), the committee carried out its evaluation using the terminology and organization of a logic model adopted by NIOSH to 45

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c o n s t ru c t i o n r e s e a r c h at n i o s h  BOX 3.1 Research Goals and Sub-goals of the NIOSH Construction Research Program Goal 1: Reduce the major risks associated with traumatic injuries and fatalities in construction. 1.1 Falls from elevations • 1.2 Contact with electricity • 1.3 Struck-by incidents involving vehicles/equipment • 1.4 Confined space, excavation, and trenching • 1.5 Construction vehicle rollovers • Goal 2: Reduce exposures to health hazards associated with major risks of occupational illness in construction. 2.1 Reduce noise exposures and hearing loss • 2.2 Reduce lead exposure and related health effects • 2.3 Reduce silica exposure and silicosis • 2.4 Reduce asphalt fume exposures and related health effects • 2.5 Reduce dermal exposures and related skin disorders • 2.6 Reduce welding fume exposures and related health effects • Goal 3: Reduce the major risks associated with musculoskeletal disorders in construction. • 3.1 Reduce musculoskeletal disorders • 3.2 Reduce disorders associated with excessive exposure to vibration Goal 4: Increase understanding of construction sector attributes that affect occupational safety and health outcomes. • 4.1 Use and improve surveillance resources to identify and track construction safety and health risks • 4.2 Address special populations of employers and employees within construction (e.g., immigrant workers, youth workers) • 4.3 Optimize the role of safety and health in construction training efforts • 4.4 Explore promising approaches for addressing construction hazards • 4.5 Improve diffusion of safety and health research to construction practice SOURCE: NIOSH (2007).

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e va l u at i o n o f t h e r e l e va n c e a n d i m Pa c t o f t h e P r o g r a m 47 characterize the steps in its work (Box 3.2). The evaluation process recommended in the Framework Document is illustrated in Figure 3.1. The committee examined goals, inputs, activities, and outputs to evaluate the Construction Research Program’s relevance in terms of its research priorities and the degree to which the program is engaged in appropriate transfer of activities for completed research projects and reported research results. Intermediate and end outcomes were the principal focus for the evaluation of the program’s impact. The committee also considered the number of construction-relevant projects, the num- ber of employees working on those projects, and the manner in which stakeholder input has been obtained and incorporated into program goal setting, strategic planning, and specific activities. The committee was particularly interested in the quantity and quality of program outputs (e.g., control technologies, guidelines, and education and training materials) and the degree to which those in the construction industry accepted and used Construction Research Program outputs. ASSESSMENT OF RELEVANCE In the following subsections, the committee highlights some, but certainly not all, of the activities undertaken by the Construction Research Program. The intent is to show the range of activities undertaken by both internal and external researchers. The presentation of the following material is organized by the goals and sub-goals as listed in Box 3.1. Goal 1: Reduce the Major Risks Associated with Traumatic Injuries and Fatalities in Construction Goals and Objectives Within Goal 1, NIOSH identified five sub-goal areas for reducing fatalities and risks of injuries caused by safety-related (as opposed to health-related) hazards: Sub-goal 1.1, Falls from elevations; Sub-goal 1.2, Contact with electricity; Sub-goal 1.3, Struck-by incidents involving vehicles/equipment; Sub-goal 1.4, Working in confined space, excavation, and trenching; and Sub-goal 1.5, Construction vehicle rollovers. The committee received detailed information about each sub-goal, including project listings and other pertinent data from the NIOSH Construction Research Program staff. In addition, the committee used updated program infor- mation available online and relied on the experience and expertise of its members to assess the information and its pertinence to the committee’s task. NIOSH focused on this particular goal and sub-goals for several reasons. First, when compared with other industries, construction has a disproportionately high

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c o n s t ru c t i o n r e s e a r c h at n i o s h  BOX 3.2 Logic Model Terms and Examples Planning Inputs: Stakeholder input, surveillance and intervention data, and risk assess- ments (e.g., input from Federal Advisory Committee Act panels or the National Occupational Research Agenda research partners, intramural surveillance information, Health Hazard Evaluations [HHEs]). Production Inputs: Intramural and extramural funding, staffing, management structure, and physical facilities. Activities: Efforts and work of the program, staff, grantees, and contractors (e.g., surveil- lance, health effects research, intervention research, health services research, information dissemination, training, and technical assistance). Outputs: A direct product of a NIOSH research program that is logically related to the achievement of desirable and intended outcomes (e.g., publications in peer-reviewed jour- nals, recommendations, reports, website content, workshops and presentations, data- bases, educational materials, scales and methods, new technologies, patents, and technical assistance). Intermediate Outcomes: Related to the program’s association with behaviors and changes at individual, group, and organizational levels in the workplace. An assessment of the worth of NIOSH research and its products by outside stakeholders (e.g., production of standards or regulations based in whole or in part on NIOSH research; attendance at training and educa- tion programs sponsored by other organizations; use of publications, technologies, methods, or recommendations by workers, industry, and occupational safety and health professionals in the field; and citations of NIOSH research by industry and academic scientists). End Outcomes: Improvements in safety and health in the workplace. Defined by measures of health and safety and of impact on processes and programs (e.g., changes related to health, including decreases in injuries, illnesses, or deaths and decreases in exposures due to research in a specific program or subprogram). External Factors: Actions or forces beyond NIOSH’s control (e.g., by industry, labor, regu- lators, and other entities) with important bearing on the incorporation in the workplace of NIOSH’s outputs to enhance health and safety. SOURCE: Adapted from “Framework for the Review of Research Programs of the National Institute for Occupational Safety and Health,” reproduced as Appendix A in this report.

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e va l u at i o n o f t h e r e l e va n c e a n d i m Pa c t o f t h e P r o g r a m 49 New Figure A-2.eps bitmap image FIGURE 3.1 Flowchart of the evaluation process recommended by the Framework Committee. NOTE: EC, Evaluation Committee. SOURCE: Reprinted from “Framework for the Review of Research Programs of the National Institute for Occupational Safety and Health,” reproduced as Appendix A in this report. share of work-related fatalities. Second, the rate of fatalities in construction work has not declined as quickly as that of nonfatal injuries. Third, Congress directed NIOSH to focus on reducing construction fatalities. Finally, according to the pre- sentation made and the supporting material within the evidence package (NIOSH, 2007), NIOSH theorized that by reducing fatalities, nonfatal injuries would also be reduced. Planning and Production Inputs The primary inputs to Goal 1 and its sub-goals are national and state sur- veillance data showing the causes of safety-related fatalities in the construction industry, which are (in order of frequency) falls from heights (35 percent), workers being struck by objects (12 percent), contact with electrical current (10 percent), workers struck by vehicle or equipment (6 percent), and workers caught in or crushed by collapsing materials (6 percent) (NIOSH, 2007). The Construction

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c o n s t ru c t i o n r e s e a r c h at n i o s h 50 Research Program seeks to reduce safety-related fatalities and injuries through four approaches: 1. Hazard Identification—Procedures or testing devices to determine that a hazard is present; 2. Protection Equipment—Equipment that prevents or minimizes injury if a worker encounters a hazard; 3. Avoidance/Prevention—Procedures or mechanical devices that cause the worker to avoid a hazard; and 4. Behavior/Awareness—Research aimed at preventing unsafe acts on a construction site. Table 3.1 shows the distribution of research activities (by sub-goal) for each approach as identified by the committee. For example, the program’s evidence pack- age detailed eight research activities that were associated with Sub-goal 1.1 (falls from elevations). In examining these activities, the committee determined that three of the activities involved developing protection systems, four were focused on avoidance/prevention, and one was directed toward behavior/awareness. The committee used the same method for categorizing the research activities associated with the four other sub-goals: Sub-goal 1.2, Contact with electricity; Sub-goal 1.3, Workers struck by vehicles/equipment; Sub-goal 1.4, Confined space, excavation, and trenching; and Sub-goal 1.5, Construction vehicle rollovers. TABLE 3.1 Program Distribution of Goal 1 Research Activities Focused on Reducing Safety-Related Hazards, by Sub-goals Sub-goal (Number of Research Activities) Focus of Research Activity 1.1 1.2 1.3 1.4 1.5 Hazard identification 2 1 Protection equipment 3 1 Avoidance/prevention 4 1 2 2 Behavior/awareness 1 3 1 3 3 NOTE: Goal 1 and Sub-goals 1.1 through 1.5 are listed in Box 3.1 in this chapter.

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e va l u at i o n o f t h e r e l e va n c e a n d i m Pa c t o f t h e P r o g r a m 5 Activities and Outputs Sub-goal .: Falls from Elevations Falls from roofs, structural steel, scaffolds, ladders, and aerial lifts to lower elevations are the largest single cause of fatal injuries among construction workers. Falls account for one-third of construction fatalities, and construction fatalities from falls account for one-half of fall fatalities (394 of 770) across all industries (NIOSH, 2007). Falls are also a major cause of serious, nonfatal injuries. Researchers in the Construction Research Program conducted a number of surveillance and investigation studies about fall injuries and fatalities, often learning where to focus prevention efforts in the process. They also conducted intervention research, training, and dissemination efforts. Over the period 1992 to 2005, program researchers authored a total of 29 peer-reviewed journal articles on this topic, provided 99 presentations, and developed 32 NIOSH and National Construction Center (NCC) publications, as well as 163 miscellaneous documents such as Fatality Assessment and Control Evaluation (FACE) reports, patents, and book chapters. Products related to program outputs have included adjustable guardrail assemblies, improved footware designs for work on roofs, and modified fall-protection harnesses. NIOSH’s research in the area of fatalities and injuries caused by falls from elevations has also included virtual reality technology. The Construction Research Program published validation studies for the surround-screen virtual reality (SSVR) system, the first SSVR system in the world designed for occupational fall-prevention research. The system is currently used to evaluate human performance at eleva- tion, identify risk factors leading to fall incidents, and assess new fall-prevention strategies. Other work in this area has included publications addressing the effect of visual cues on balance control and research that addresses prototypes for sensory- enhancing technology to improve workers’ balance (NIOSH, 2007). Sub-goal .2: Contact with Electricity Contact with electricity accounts for 10 percent of all construction-related fatalities. Construction accounted for almost half (47 percent) of all deaths associated with contact with electricity across all industries between 1992 and 2002 (Cawley and Homce, 2006). Deaths and injuries due to contact with electricity occur not just among electricians, but also among roofers, painters, laborers, operating engineers, and carpenters, all of whom may work near overhead power lines (OHPLs), wiring, transformers, light fixtures, machines, and power tools.

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c o n s t ru c t i o n r e s e a r c h at n i o s h 5 In the area of contact with electricity and electrocutions, NCC researchers conducted a survey of work practices among 5,000 International Brotherhood of Electrical Workers electricians. Failure to lock out or tag out electrical equip- ment before beginning to work is a major cause of construction electrocutions. Researchers in the Construction Research Program have also been evaluating the performance of OHPL proximity-warning alarm devices on mobile cranes. The test protocol for the evaluation was developed in conjunction with a number of partners including the International Union of Operating Engineers (IUOE), the Center to Protect Workers’ Rights (CPWR), Occupational Safety and Health Administration (OSHA), Zachry Construction Corporation, Allied Safety Systems, Inc. (manufacturer of Sigalarm), Allied 99 Safety Engineering, Inc. (OHPL alarm manufacturer), and the Association of Equipment Manu- facturers. Full-scale electrical tests were executed using a mobile crane outfitted with the OHPL alarm devices from two manufacturers. The tests quantified the distance from a power line at which each alarm device sounded a warning in various crane-and-power line configurations (NIOSH, 2007). Construction Research Program staff were also awarded a patent for an OHPL-contact alarm system. Sub-goal .3: Struck-by Incidents Involving Vehicles/Equipment Struck-by incidents can involve workers struck by vehicles, mobile equipment, or falling and flying objects. Almost half of the 802 construction workers killed by vehicles or equipment between 1995 and 2002 worked on highway and street construction projects (BLS, 2007). Falling objects can include wrenches or other equipment and tools, whereas flying objects include nail guns and other power tools. More than 22,000 workers per year are treated in hospital emergency rooms for nail gun injuries (CDC, 2007). In the area of workers struck by vehicles/equipment, program researchers have conducted 53 highway and street construction Fatality Assessment and Control Evaluation investigations. In 2000, they began evaluating interventions involv- ing a variety of proximity-warning systems that provide construction equipment operators the ability to monitor blind spots. They have also evaluated administra- tive approaches for controlling construction vehicle and worker movements within work zones (referred to as internal traffic control plans, or ITCPs). The program has disseminated a significant amount of research information to owners’ and workers’ organizations and associations, including the Washington State Department of Transportation, American Road and Transportation Builders Association, IUOE, National Asphalt Pavement Association, and OSHA. The disseminated informa- tion has included information from research for the development of standards and relevant materials incorporated into course curricula for construction engineering

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e va l u at i o n o f t h e r e l e va n c e a n d i m Pa c t o f t h e P r o g r a m 53 and management. NCC research has included surveillance efforts to contribute to the understanding of factors related to safety during nighttime construction in work zones. Results from these surveillance activities are used to identify new risk factors, identify injury-prevention strategies, and guide and prioritize future research efforts. Sub-goal .4: Confined Space, Excavation, and Trenching Between 1992 and 2001, approximately 540 construction workers died in trenching or excavation cave-ins (MMWR, 2004). Between 1997 and 2001, an additional 89 workers died in confined spaces, such as storage tanks, pits, boilers, ventilation and exhaust ducts, sewers, tunnels, pipelines, and underground utility vaults (Meyer, 2003). NIOSH has a long-standing interest in safety risks associated with construction work in trenches, excavations, and confined spaces. NIOSH issued a recommended standard for working in confined spaces in 1979, issued safety guidance in 1987, and provided technical input to OSHA for the revision of its excavation standard in 1989. The program also provided input in 1995 to OSHA’s general industry standard for confined spaces. Program researchers have used surveillance data from a variety of sources to identify activities, trades, and risk factors regarding fatal and nonfatal injuries in trenches and confined spaces. They provided support for ongoing efforts to develop pocket guides to chemical hazards commonly used in confined spaces. They have prepared 30 publications, and products, and provided training for 6,700 workers in 31 states. The Construction Research Program has undertaken a number of safety interventions for excavation and trenching, including teleoperation of mechanical devices to dig trenches and install pipe, the trench box safety project, and safety in trench operations. Program researchers also assisted in the design of a compact disc (CD)-based training module to raise awareness of trenching hazards. Later they modified the CD on the basis of feedback from decision makers, trainers and consultants, and workers in the construction industry. Sub-goal .5: Construction Vehicle Rollovers Heavy equipment—cranes, excavators, tractors, loaders, bulldozers, pavers— are commonly used on construction projects. Vehicle overturns or rollovers are among the most common causes of construction fatalities associated with vehicles and equipment. For vehicle rollovers, NIOSH conducted a number of investigations and used existing surveillance resources and programs to identify risk factors associated with

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c o n s t ru c t i o n r e s e a r c h at n i o s h 5 construction vehicle overturns and to develop prevention measures to address them. This work yielded, among many things, guidance titled “NIOSH Alert—Preventing worker injuries and deaths from mobile crane tip-over, boom collapse, and uncon- trolled hoisted loads” (as indicated in NIOSH, 2007). The dissemination of this alert was combined with that of numerous publications and presentations. Goal 2: Reduce Exposures to Health Hazards Associated with Major Risks of Occupational Illness in Construction Goals and Objectives Goal 2 pertains to eliminating or at least mitigating health hazards on construc- tion sites. Its six specific sub-goals target the following: Sub-goal 2.1, Reduce noise exposures and hearing loss; Sub-goal 2.2, Reduce lead exposure and related health effects; Sub-goal 3.3, Reduce silica exposure and silicosis; Sub-goal 2.4, Reduce asphalt fume exposures and related health effects; Sub-goal 2.5, Reduce dermal exposures and skin disorders; and Sub-goal 2.6, Reduce welding fume exposures and related health effects. The Centers for Disease Control and Prevention (CDC) has defined two types of exposure: acute exposure is exposure to a specific chemical for 14 days or less; chronic exposure is exposure to a chemical for 365 days or more (CDC, 2008). For construction research, the program has further defined these terms to note that chronic exposures happen not just over time but also across multiple worksites, causing a cumulative effect with potentially negative physical reactions revealing themselves after a particular project is completed. In this situation, it is not always one particular chemical or substance that is the cause, but rather it is the cumula- tive effect of the exposure over time. In the case of acute exposures, any resulting negative effects occur more quickly and are more easily connected to a particular chemical or substance. Planning and Production Inputs Unlike the available statistics for safety-related hazards, meaningful national statistics are not available to identify the leading causes of workplace-related diseases or deaths and to help target health-related research and interventions. It is in fact well established that work-related illnesses are very difficult to rec- ognize and often remain unreported or underreported on OSHA logs and thus are not captured by the Bureau of Labor Statistics (BLS) annual survey. This underreporting problem masks the true occurrence of occupational illness in construction.

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e va l u at i o n o f t h e r e l e va n c e a n d i m Pa c t o f t h e P r o g r a m 55 Researchers in the Construction Research Program have relied on a variety of sources, including national and state-level illness statistics, knowledge and extrapolation of construction exposures, studies based on information on death certificates, and international surveillance to identify and characterize many of the health hazards present on construction sites. Once such hazards are identified, program researchers have engaged in detailed planning efforts with construc- tion industry stakeholders to prioritize the needs as well as to help the program develop, implement, and evaluate interventions to eliminate or at least mitigate health outcomes from exposures that are health hazards. Stakeholder input has been gathered by program researchers using multiple methods, including spon- soring and/or attending construction safety and health national conferences and initiating and developing partnerships with contractors, contractor organizations, labor unions, and equipment manufacturers. For example, lead exposure and its adverse health consequences together with noise exposure and hearing loss were identified as important issues by stakeholders at national conferences sponsored by the Construction Research Program. Program surveillance data supported the identification of these issues as a priority for research. Activities and Outputs Sub-goal 2.: Reduce Noise Exposures and Hearing Loss NIOSH has a distinct research program for hearing loss across all industries that has its own set of goals and sub-goals, funding, and staffing. The Institute of Medicine’s review of the Hearing Loss Research Program noted that “research efforts [addressing engineering controls to reduce noise exposure] have been concentrated in the mining sector, with some attention to the construction sector” (IOM, 2006, p. 6). One of the Hearing Loss Research Program goals is to develop engineering controls to reduce noise exposure. Two of the sub-goals are to reduce noise generated by roof bolting machines using wet and mist drill- ing and to reduce noise exposures to construction workers using a Web-based database for powered hand tools. Although the Hearing Loss Research Program has developed the database, it has not translated the research into engineering noise controls (IOM, 2006, p. 10). The evaluation committee for the Hearing Loss Research Program also stated that “noise control engineering should be the primary approach to prevention of hearing loss” (IOM, 2006, p. 17). Within the construction industry, all workers are at risk for exposure to harm- ful levels of noise from heavy equipment and power tools. Noise exposures in con- struction tend to be highly episodic, with relatively short duration but extremely high peak characteristics (referred to as impulse noise), for example, exposure to jackhammers. Workers can be exposed to such noise while acting as operators of

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e va l u at i o n o f t h e r e l e va n c e a n d i m Pa c t o f t h e P r o g r a m 7 focus in order to maintain its excellence and continue its work in high-priority areas. These are discussed in Chapter 4. ASSESSMENT OF IMPACT To determine the impact that the NIOSH Construction Research Program has had on reducing safety and health hazards in construction projects, the committee focused on the intermediate and end outcomes of the program as outlined in the Framework Document. These outcomes are defined as follows: • Intermediate outcomes: Related to the program’s association with behav- iors and changes at individual, group, and organizational levels in the workplace. An assessment of the worth of NIOSH research and its products by outside stake- holders (e.g., production of standards or regulations based in whole or in part on NIOSH research; attendance at training and education programs sponsored by other organizations; use of publications, technologies, methods, or recommenda- tions by workers, industry, and occupational safety and health professionals in the field; and citations of NIOSH research by industry and academic scientists). • End outcomes: Improvements in safety and health in the workplace. Defined by measures of health and safety and of impact on processes and programs (e.g., changes related to health, including decreases in injuries, illnesses, or deaths and decreases in exposures due to research in a specific program or subprogram). The committee recognized first that the program cannot directly impose change in the workplace or change in workplace behaviors that is necessary to reduce fatalities, serious injuries, and work-related illnesses. What the program can be expected to do is to contribute evidence-based knowledge about hazards and the prevention of adverse outcomes. The program can also be expected to promote plausible, evidence-based, risk-reducing actions by others, including OSHA and other regulatory agencies, equipment manufacturers, construction project owners, contractors, and workers. For this reason, the committee primarily relied on inter- mediate outcomes in its evaluation of impact. The committee also considered external factors that bear on the incorporation of program outputs in workplace practices, particularly the segmentation of the industry. Goal 1: Reduce the Major Risks Associated with Traumatic Injuries and Fatalities in Construction The reduction of fatalities and serious injuries within the construction industry is a significant end outcome for any safety-related program. During the period

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c o n s t ru c t i o n r e s e a r c h at n i o s h 7 reviewed, 1996 through 2005, the rate of fatalities in the construction industry declined by 3.2 deaths per 100,000 workers. Given a workforce of 8 million, this translates to about 250 fewer work-related deaths per year. The rate of injuries also declined significantly, perhaps by as much as 45 percent, although changes in statistical data-gathering methods make it difficult to compare data over the entire review period. The question before the committee was the extent to which the Construction Research Program and its activities contributed to these positive outcomes. The answer was not clearcut. A number of factors have been cited for these declines, including a greater emphasis on safety by owners and contractors in the industrial and infrastructure sectors of the industry and by some unions. Additional factors include increasing health care costs, which create a greater awareness of the costs of unsafe practices, and business school curriculums that stress the significance of management commitment in the implementation of safety programs. All of these represent management and behavior/awareness practices. The Construction Research Program has primarily focused on technologies for safety, in areas including fall protection and interventions, contact with electricity, proximity-warning systems, trenching and excavation standards, and training activities. The program has also generated a range of intermediate outcomes that have likely helped to reduce traumatic injuries. Intermediate outcomes have included hundreds of publications and presentations, training, and training aids. Research generated by the program has been incorporated in standards and course curricula used by some states and industry associations and in OSHA standards for working in confined spaces. Although it is not possible to determine exactly how much the program has contributed to the decline in fatality and injury rates on construction sites, the committee concluded that the program did have some impact on both end outcomes and well-accepted intermediate outcomes. Goal 2: Reduce Exposures to Health Hazards Associated with Major Risks of Occupational Illness in Construction Data that could be used to measure end outcomes, such as decreases in the number of cases of silicosis, hearing loss, or lead poisoning, are not available. For that reason, the committee’s evaluation of the program’s impact for the Goal 2 area focused almost exclusively on intermediate outcomes. In the area of hearing loss, program research has been important in the development of an evidence-based, revised hearing-conservation standard for construction that could be issued by OSHA in the future, as well as a new American National Standards Institute (ANSI) standard for preventing hearing loss in construction. Other training materials and

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e va l u at i o n o f t h e r e l e va n c e a n d i m Pa c t o f t h e P r o g r a m 73 methods developed by the program are being adopted by the Carpenter’s Union for its 500,000 members and by construction contractors in Washington State. In regard to lead exposures, New York and New Jersey have used the Construc- tion Research Program work on surveillance of blood lead levels to enhance their focused efforts to address construction worker exposures in their states, including the development of outreach and educational materials for use in high-risk con- struction activities. Surveillance data have also been used to evaluate the effective- ness of intervention measures. In addition, ABLES data have been used by OSHA in performing the review of its construction lead standard. Data and guidance developed by the Construction Research Program have also been used by the Steel Structure Painting Council’s painting contractor certification program that assesses a contractor’s ability to protect worker health and safety on projects involving lead coatings on steel. The field-portable techniques for sampling and analysis developed by the program were used by the EPA in developing its regulations on renovation and remodeling for residential abatement projects. The program’s lead “take-home” work was used by Congress in developing legislation requiring HUD to conduct a lead-paint-abatement demonstration pro- gram. At HUD’s request, the program evaluated the worker protection measures in its demonstration projects. The report to Congress on take-home issues has also been cited as reference material by the National Association of the Remodel- ing Industry. Other exposure characterization data gathered by the Construction Research Program have been used by federal government agencies, including HUD and OSHA, in the development of their requirements and guidance for worker protection. Several states, including California and Massachusetts, used the expo- sure characterization data to develop their programs to reduce lead exposures for construction workers. The model specifications for worker protection measures on steel structures, developed by the program, have been used by the Federal Highway Administration and a number of states (New York, New Jersey, Michigan, Maryland, Missouri) to assist them in developing job specifications for such work in their states. The Construction Research Program has also generated a range of intermediate outcomes regarding silica and silicosis. The program’s risk-assessment characteriza- tions and hazard-review document for silica have been used by several organiza- tions, including the California Office of Environmental Health Hazard Assessment and the United Kingdom’s Health and Safety Executive, in setting standards. The work conducted on engineering control development for a variety of tasks generating airborne silica (e.g., working with masonry products or using jack- hammers) has been adopted by some organizations, including trade organizations, labor unions, and contractor associations.

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c o n s t ru c t i o n r e s e a r c h at n i o s h 7 Information on control measures generated by the program has also played a role in the promulgation or development of standards designed to reduce silica exposures in construction. California OSHA has used data from the program to regulate silica exposures, and New Jersey used data to pass legislation prohibit- ing the dry grinding and sawing of masonry products. Likewise, OSHA has used the engineering control information generated by the program for preparing its cost and technological feasibility analysis as part of its work on a proposed silica standard for construction. All of these government regulatory efforts are likely to reduce exposures and protect workers from the hazards of silica. The analytical work conducted by the Construction Research Program has resulted in the lowering of the limits at which airborne concentrations of silica can be accurately and reliably measured. This major advancement will help set the stage for lowering the OSHA permissible exposure limit to a level that can now be reli- ably measured. The lowering of the exposure limit should in turn reduce the risk of workers for developing silicosis and lung cancer from inhaling respirable silica. Construction workers operating heavy equipment in cabs are exposed to airborne silica and are at risk of developing silicosis. In response to work with the Construction Research Program, a cab filtration system has been commercially developed, as has a patented leak test for use with cabs. As a result, workers in cabs with the filtration equipment are likely to have reduced exposures to airborne silica. Overall the silica exposure control program has generated a substantial number of intermediate out- comes that could result in fewer new cases of silicosis among construction workers. A rare example of the achievement of an end outcome for health is the pro- gram research with commercial asphalt pavers and the development of engineering controls. The program has demonstrated that engineering controls reduce asphalt fume exposure by 50 to 80 percent (Mickelson et al., 1999, 2006). Because the controls have been broadly implemented and have been well accepted within the highway-paving industry, asphalt fume exposures among 300,000 highway-class road-paving workers have been significantly reduced. In addition, evaluations of control on new pavers at 12 sites across the United States have indicated that workers’ personal exposures to total particulate matter and benzene-soluble matter (two primary contaminants of concern) were both consistently reduced to levels below U.S. government-recommended values (Mickelson et al., 2006). This project represented a good example of how the NIOSH research process has benefited the health and safety of both unionized and non-unionized construction workers. This effort on behalf of the pavement workers also generated more attention to asphalt exposure control for roofing industry workers. In contrast to these activities, the program’s work in the area of dermal expo- sures has been limited, due in part to the narrow focus on skin disorders associated with the use of Portland cement.

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e va l u at i o n o f t h e r e l e va n c e a n d i m Pa c t o f t h e P r o g r a m 75 Regarding welding fume exposures, the Construction Research Program has produced several important intermediate outcomes. Program evaluations of the health-effects literature have been used by the American Welding Society in its assessments, and OSHA used, at least in part, the cancer risk assessments from the program for reducing the exposure limit for hexavalent chromium. The new OSHA hexavalent chromium standard and a reduced exposure limit will potentially impact all welders across the United States, including those in the construction industry. A more limited intermediate outcome has occurred in relation to the program’s work on exposure characterization and intervention research. Local exhaust- ventilation systems have been put in place on a major power plant turn-around project, and several pipe fitter apprenticeship programs have upgraded their local exhaust-ventilation systems at their training centers. Goal 3: Reduce the Major Risks Associated with Musculoskeletal Disorders in Construction Research performed or funded by the Construction Research Program has been of critical importance to other researchers focusing on musculoskeletal disorders. Half of published research on MSDs in construction has been performed or funded by the program. It is safe to say that over the past decade there are virtually no significant studies of MSDs in construction that have not cited NIOSH-supported work. An important output from this research is the building of additional research and training capacity at the universities that have received NIOSH funding. Pro- gram funding not only produces research aimed at measuring and reducing MSDs and risk factors for MSDs, but also provides the means to educate future practi- tioners and researchers. A review of intermediate outcomes and their impact shows a number of nota- ble accomplishments. Most striking is that from 1990 to 2003, the NCC researchers were responsible for 50 percent of all journal publications about ergonomic hazards and controls in the U.S. construction industry. A review of the current construc- tion literature since 2003 reveals that a similarly high proportion of peer-reviewed journal articles assessing MSDs in construction has been done by researchers in the Construction Research Program, through program extramural grants, or in collaboration with other NIOSH researchers. Key program publications on construction ergonomics and the design of hand tools have been widely distributed, with 130,000 hard copies distributed and almost 200 downloads per month from the NIOSH Web site. In surveillance activi- ties, there have been more than 25 journal articles and 9 conference presentations on exposure assessment, 63 journal articles and 30 presentations on MSDs, and

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c o n s t ru c t i o n r e s e a r c h at n i o s h 7 30 journal articles or presentations, 28 newsletter articles, and 3 NIOSH publica- tions on intervention evaluation (NIOSH, 2007). The large number of practice- oriented materials disseminated indicates significant interest in program-generated research by people in the health and safety community. A number of research tools created by the program have been used by others in the health and safety research community. A questionnaire for surveillance of MSDs among construction workers has been translated into several languages and used by other researchers. The portable data logger for exposure assessment and also the Posture, Activity, Tools, and Handling (PATH) observational exposure- assessment method for construction are being used by other research teams outside NIOSH. In an example of crosscutting research and technology transfer, the data logger and PATH method have both been adapted for use in other industries. A number of training programs have been based on Construction Research Program materials. Using program funding, the United Brotherhood of Carpenters developed an ergonomics training program that has trained more than 60 instruc- tors and hundreds of carpenters in ergonomics related to construction work. The Smart Mark module is used nationally, with more than 4,000 instructors training more than 50,000 construction workers annually. This health and safety program includes an ergonomics module directed at MSDs; other portions of the Smart Mark program are directed at avoiding common musculoskeletal acute injuries such as sprains and strains. Other interventions have included the identification of overhead drilling as a hazard. These interventions have been approached both through participatory ergonomics, which resulted in changing practices during the “Big Dig” construction project in Boston. The program has also funded a project to develop an improved overhead drilling method using a drill jig. This method was developed by the University of California and has been demonstrated at the Construction Safety Council meeting as well as at other venues. Plans to commer- cialize this innovation are under way. Interventions have also included evaluations of the effectiveness of participa- tory ergonomics programs on the incidence, severity, and cost of MSDs on a large construction project. The program has been active in the design of hand tools. Sheet metal workers were previously identified as a group with a very high prevalence of carpal tunnel syndrome. Using several exposure-assessment methods, program researchers compared the musculoskeletal load on the wrists and forearm using conventional metal snips. They worked with a major manufacturer of hand tools to develop a new metal snip that is less stressful to the hand and wrist. These snips are now commercialized and selling well in a variety of retail outlets carrying hand tools. A participatory ergonomics program on the incidence, severity, and cost of MSDs on a large construction project demonstrated a 25 to 35 percent cost reduction at sites

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e va l u at i o n o f t h e r e l e va n c e a n d i m Pa c t o f t h e P r o g r a m 77 using the participatory ergonomics program compared with costs at other sites not using the program (NIOSH, 2007). Intel Corporation has now adopted this program for use on all its international and U.S.-based construction projects. Other translation and dissemination activities have included the Oregon Construction Ergonomics Initiative (CEI), a collaborative group of industry professionals including contractors and labor representatives and supported by Oregon OSHA. In addition to disseminating information, the CEI has worked with Oregon OSHA to provide consultation to a wide range of construction companies. The program publication A Guide to Selecting Non-Powered Hand Tools has had more than 100 citations or links by organizations in the United States, Canada, Brazil, Japan, and Europe (NIOSH, 2007). This publication is an example of the impact of program education dissemination on a variety of audiences, including health and safety professional associations, government agencies, educational insti- tutions, trade unions, trade associations, and health and safety resource guides. Major new technology and method developments from the program’s vibra- tion research include instrumentation of handles and biodynamic response mea- surement methods that are used by researchers all over the world: for example, development of new tool- and glove-testing methods, development of a new method to characterize the grip force applied on cylindrical handles, and a novel three-dimensional hands-on vibration test system that has become a commercial product in a joint effort with two private companies. Other outcomes have included major contributions to International Organization for Standardization and ANSI guidelines on vibration. A major factor limiting the impact of the program’s research on health and safety is the absence of regulatory requirements to prevent work-related MSDs, except for the relatively weak standard that exists in the state of California. OSHA promulgated ergonomics regulations late in 2000 based in large part on research performed under program leadership. This standard was struck down in 2001. The Washington State ergonomics regulation, which had a large construction compo- nent, was struck down in a referendum in 2004. The absence of a specific standard for the prevention of work-related MSDs has made it more difficult for research findings to be translated into changes in equipment or behavior. Goal 4: Increase Understanding of Construction Sector Attributes That Affect Occupational Safety and Health Outcomes Assessing the impact of Goal 4 activities presented a different challenge from that of assessing the impact of Goals 1 through 3, given the nature of the research goals of Goal 4.

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c o n s t ru c t i o n r e s e a r c h at n i o s h 7 An effective resource for surveillance data is The Construction Chart Book: The U.S. Construction Industry and Its Workers (CPWR, 2007). This source provides a compilation of data that illustrates how the industry is performing, growing, and changing. Its fourth edition was published in December 2007. Among its many illustrations and data charts, the book also addresses the surging Hispanic popula- tion in the construction industry. Although the Construction Research Program has made efforts to produce outputs in the form of publications targeting small businesses, and although many of these publications have been produced in Spanish, the challenge remains about how best to get this information to the target audiences. The program has taken important first steps in addressing the safety and health of the Hispanic segment of the U.S. construction workforce despite the complexity and challenging nature of the problem. These steps include collaboration with NIOSH’s Traumatic Injuries Program, the NIOSH Occupational Health Disparities Coordinated Emphasis Area, community and day-labor organizations, and colleagues within state and federal government. Key focus areas for program researchers have included the identifica- tion of major socioeconomic and work organization factors contributing to health and safety disparities, along with the impact of language differences. With respect to the program’s R2P efforts, a number of barriers still exist. First, extramural projects funded by the program were directed to use 20 percent of direct costs for R2P efforts. However, given the size, diversity, and segmentation of the construction industry, the aforementioned funding level has been insufficient to implement more active R2P dissemination strategies and to evaluate their effective- ness. Outputs generated by external grantees and/or partners should be included by the program’s researchers in the program’s R2P efforts as well. Internally, program researchers have been encouraged to translate research findings to lay publications for target audiences and stakeholders. Indeed, an R2P plan is now required for all internally funded projects. However, this activity falls outside the mainstream job duties for the NIOSH bench scientists, chemists, engi- neers, epidemiologists, and industrial hygienists. In addition, many do not have the expertise for preparing or producing such documents other than those for peer-reviewed journals. OVERALL EVALUATION OF IMPACT In addition to its other assessment tasks, the charge to the committee requires an overall assessment of the impact of the Construction Research Program. The scoring criteria are summarized in Box 3.5. The committee evaluated the impact of the program using the same process that it used for relevance. The scoring criteria for impact are linked to a program’s

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e va l u at i o n o f t h e r e l e va n c e a n d i m Pa c t o f t h e P r o g r a m 79 BOX 3.5 Framework Document Scoring Criteria for Impact 5 = Research program has made major contribution(s) to worker health and safety on the basis of end outcomes or well-accepted intermediate outcomes. 4 = Research program has made some contributions to end outcomes or well-accepted intermediate outcomes. 3 = Research program activities are ongoing and outputs are produced that are likely to result in improvements in worker health and safety (with explanation of why not rated higher). Well accepted outcomes have not been recorded. 2 = Research program activities are ongoing and outputs are produced that may result in new knowledge or technology, but only limited application is expected. Well accepted outcomes have not been recorded. 1 = Research activities and outputs do not result in or are NOT likely to have any application. SOURCE: Reprinted from Box 3 of “Framework for the Review of Research Programs of the National Institute for Occupational Safety and Health,” reproduced as Appendix A in this report. contributions to worker health and safety based on end outcomes or well-accepted intermediate outcomes. In terms of end outcomes, the committee concluded that the Construction Research Program, through its development of some technolo- gies such as fall-protection equipment and proximity-warning systems, has made some contributions to the overall declines in fatalities and injuries, although the full extent of that impact is not known. Additionally, the program has had a posi- tive impact on the health of workers exposed to asphalt fumes generated during road-paving operations. The program has also been responsible for a large range of intermediate outcomes. Its research on musculoskeletal disorders is cited in about half of all publications on this topic (NIOSH, 2007). The program has provided evidence for the development of OSHA standards on ergonomics, hearing conservation,

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c o n s t ru c t i o n r e s e a r c h at n i o s h 0 respiratory crystalline silica, trenching practices, and lead in construction. Some of these standards have been issued, others have not. However, whether the stan- dards are issued and enforced is beyond the control of the program. Its training and training dissemination activities have been extensive, and it is likely that they have contributed to the prevention and reduction of health and safety hazards on some construction worksites. The committee also determined that the segmentation of the industry and the less-than-adequate level of resources have had a bearing on the program’s impact. Thus, although program-generated publications, technologies, and training are relevant for all segments of the construction industry, their diffusion has varied by construction sector. It is particularly difficult to reach the residential sector because so many residential contractors are self-employed or employ fewer than 10 workers. The level of funding available limits the ability of the program to conduct surveillance research and to provide more direct training to owners and workers in this sector. Using the scoring criteria for rating the program’s impact, the committee determined that the Construction Research Program has made some contribu- tions to construction health and safety as measured by either end outcomes or well-accepted intermediate outcomes. However, committee members had divergent views about whether these contributions could be classified as major contributions across the entire program. On that basis, the committee assigned the program an impact score of 4. As it did with respect to the program’s relevance, the committee made recommendations intended to improve the program’s impact in the future. These are presented in Chapter 4. REFERENCES BLS (Bureau of Labor Statistics). 2007. Occupational Injuries, Illnesses, and Fatalities. Available at http://www.bls.gov/iif/#tables. Accessed August 15, 2008. Cawley, J.C., and G.T. Homce. 2006. Occupational electrical injuries in the United States, 1992-2002. Pp. 325-338 in Proceedings of the IEEE Petroleum and Chemical Industry Committee Annual Conference, September 11-13, 2006, Philadelphia, Pa. CDC (Centers for Disease Control and Prevention). 2007. Nail gun injuries treated in emer- gency departments—United States 2001-2005. In Morbidity and Mortality Weekly Report 56(14):329-332. CDC. 2008. Toxicological Profile Information Sheet. Available at http://www.atsdr.cdc.gov/toxprofiles/ tp100-c9.pdf. Accessed August 15, 2008. CPWR. 1999. Employers Guide to Skin Protection for Work with Wet Cement in Construction. Avail- able at http://www.cdc.gov/elcosh/docs/d0400/d000457/d000457.html. CPWR. 2007. The Construction Chart Book: The U.S. Construction Industry and Its Workers. 4th ed. Silver Spring, Md.: Center for Construction Research and Training.

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e va l u at i o n o f t h e r e l e va n c e a n d i m Pa c t o f t h e P r o g r a m 8 Dement, J., K. Ringen, L. Welch, E. Bingham, and P. Quinn. 2005. Surveillance of hearing loss among construction and trades workers at Department of Energy nuclear sites. American Journal of Industrial Medicine 48:348-358. Espinosa, A.J., J.J. Sanchez Hernandez, F.P. Bravo, M. Gonzalez-Baron, A.P. Zamora, and A.E. Espinosa. 1999. Cutaneous malignant melanoma and sun exposure in Spain. Melanoma Research 9(2):199-205. IOM (Institute of Medicine). 2006. Hearing Loss Research at NIOSH. Washington, D.C.: The National Academies Press. Meyer, S. 2003. Fatal occupational injuries involving confined spaces. Occupational Safety and Health 72(11):58-64. Mickelson, R.L., K.R. Mead, S.A. Shulman, and T.E. Brumagin. 1999. Evaluating engineering con- trols during asphalt paving using a portable tracer gas method. American Journal of Industrial Medicine Supplement 1:77-79. Mickelson, R.L., S.A. Shulman., A.J. Kriech, L.V. Osborn, and A.P. Redman. 2006. Status of worker exposure to asphalt paving fumes with the use of engineering controls. Environmental Science and Technology 40(18):5661-5667. MMWR (Morbidity and Mortality Weekly Report). 2004. Occupational fatalities during trenching and excavation work—United States, 1992-2001. MMWR 53(15):311-314. NIOSH (National Institute for Occupational Safety and Health). 2007. NIOSH Construction Research Program Evidence Package. Washington, D.C., July. NRC (National Research Council). 2001. Musculoskeletal Disorders and the Workplace: Low Back and Upper Extremities. Washington, D.C.: National Academy Press. Society of Toxicologic Pathology. 2006. Welding fume exposure and associated inflammatory and hyperplastic changes in the lungs of tumor susceptible mice. Toxicolology Patholology 34:364.