4
Future Research and Program Improvement

The committee was asked to address the Construction Research Program’s effectiveness in targeting new research areas and identifying emerging issues most relevant to future improvements in the health and safety of workers in construction workplaces. The committee was also asked to make recommendations to improve the program. Because there is some overlap among these tasks, the committee chose to discuss all of these issues together in one chapter.

The first section of Chapter 4 provides a brief overview of the Construction Research Program’s new and emerging research areas as presented in the evidence package (NIOSH, 2007) provided to the committee by the program staff of the National Institute for Occupational Safety and Health (NIOSH). The next section, in accord with the Framework Document (Appendix A), presents the committee’s analysis of and recommendations regarding emerging issues and new research areas. The analysis and recommendations are based on discussions with stakeholders and on individual committee members’ knowledge of the construction industry and their backgrounds and expertise. The committee also considered the resources available to the program. Thus, although it recognized that nanoparticles and nanotechnology are emerging as areas of research, the committee believed other areas to be of higher priority. Chapter 4 concludes with the committee’s recommendations for overall program improvement.



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4 Future Research and Program Improvement T he committee was asked to address the Construction Research Program’s effectiveness in targeting new research areas and identifying emerging issues most relevant to future improvements in the health and safety of workers in construction workplaces. The committee was also asked to make recommenda- tions to improve the program. Because there is some overlap among these tasks, the committee chose to discuss all of these issues together in one chapter. The first section of Chapter 4 provides a brief overview of the Construction Research Program’s new and emerging research areas as presented in the evidence package (NIOSH, 2007) provided to the committee by the program staff of the National Institute for Occupational Safety and Health (NIOSH). The next section, in accord with the Framework Document (Appendix A), presents the committee’s analysis of and recommendations regarding emerging issues and new research areas. The analysis and recommendations are based on discussions with stakehold- ers and on individual committee members’ knowledge of the construction industry and their backgrounds and expertise. The committee also considered the resources available to the program. Thus, although it recognized that nanoparticles and nano- technology are emerging as areas of research, the committee believed other areas to be of higher priority. Chapter 4 concludes with the committee’s recommendations for overall program improvement. 82

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future research and Program imProvement 83 OVERVIEW OF NEW AND EMERGING RESEARCH AREAS The Construction Research Program’s research agenda has evolved over time on the basis of identified health and safety needs in the construction industry: • Phase : 990-995—The research agenda focuses on needs assessment and developing surveillance capacity. • Phase 2: 996-2004—The first National Occupational Research Agenda (NORA1) focuses on risk-specific intervention research, including a special focus on musculoskeletal disorders and ergonomics. • Phase 3: 2005 and beyond—NORA2 focuses on translation and diffu- sion of research (research-to-practice). During each of the three phases, multiple methods were used to identify new and emerging issues. The next phase of priority setting will be focused on the second itera- tion of the National Occupational Research Agenda. NORA2 differs from NORA1 in being sector-based; one of the sectors is construction.1 The intent is to expedite the translation of research into practice in the workplace. The NORA Construction Sector Council will play a key role in bringing together researchers and practitioners to identify and prioritize the challenges and related research needs facing the con- struction industry now and in the future. The Construction Sector Council will also need to coordinate with other sector councils to explore and prioritize some crosscutting topics, for example, that of workers struck by vehicles or equipment on road projects, which affects both the construction and transportation sectors. In the evidence package provided to the committee (NIOSH, 2007), the NIOSH program staff noted that many of the predominant characteristics of the construc- tion industry that currently have an impact on health and safety on the job site (e.g., short-term contracting, the predominance of small employers with high turnover among their employees, temporary employment, multiple-employer worksites, a multicultural workforce, and episodic exposure to risks) will not change signifi- cantly. The staff also identified a number of anticipated changes that may have safety and health implications for the future. These changes, which may warrant targeted research activities, include the likelihood that financing costs, project man- agement costs, and costs of supplies, technology, equipment, and energy will rise. Such cost increases may lead construction company owners in some segments of the industry to pursue cost savings by hiring more unskilled, lower-paid workers; engaging in subcontracting rather than direct hiring of prime contractors; and/or 1The sectors are Agriculture, Forestry and Fishing, Construction, Healthcare and Social Assis- tance, Manufacturing, Mining, Services, Transportation, Warehousing and Utilities, and Wholesale and Retail Trade.

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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  placing an increased demand on construction labor productivity, including pres- sure on construction schedules. The evidence package states that this desire of construction company owners for increased productivity may lead to their exerting pressure on design and engineering firms to develop new (and untested) construc- tion methods and to putting pressure on production labor to work for lower wages or to produce more per unit cost. In reviewing the evidence package, the committee determined that the Con- struction Research Program’s process for setting priorities for conducting future research on health hazards is not clear or evident. For example, there is little emphasis and limited focus on dermal exposure in construction, yet it remains a significant route of exposure to hazardous chemicals in this industry. A transpar- ent process governing the resource and time commitments to be used in selecting high-priority health-related projects would assist the program and its stakeholders in their decision-making processes. Priority Topics for Future Research In 2002, the Construction Sector Council, which provides direction for the Construction Research Program’s activities, identified a number of priority topics in which research would be most likely to improve the program’s impact. These topics were grouped into three categories: 1. Health and injury outcome topics that target the following: • Leading types of fatal and nonfatal traumatic injuries in construction; • Low-back injuries and other cumulative work-related musculo- skeletal disorders among construction workers; and • Occupational illness topics that focus on respiratory disease and hearing loss. Respiratory disease includes airways disease, asthma, chronic obstructive lung disease, and silicosis. 2. Chemical and physical exposure topics that target the following: • Vibration, • Asphalt fumes, and • Lead and dust particles. 3. Approaches and sector topics that target the following groups and issues within construction: • Small and self-employed contractors; • Special subpopulations at risk within construction, such as Hispanic workers, day laborers, young workers, and aging workers; • The role of project design as a primary prevention tool for address- ing construction hazards;

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future research and Program imProvement 85 • Addressing work organization in construction and improving the understanding of how it affects health and safety; • Working with building owners and clients to promote and evaluate construction best practices; and • Leveraging promising approaches from related high-risk sectors such as agriculture and mining into construction. Some of these topics were further developed into NIOSH Construction Research Program strategic goals in 2005. NIOSH shared these strategic goals as input to the NORA Construction Sector Council in 2006, and most but not all of these 2002 and 2005 topics were subsequently incorporated in some form into the NORA2 Preliminary Draft National Construction Agenda Strategic Goals (Box 4.1). The draft National Construction Agenda is the first national effort to create an agenda for health and safety in the construction industry. Goals 1.0 through 7.0 are clas- sified as “outcome goals” that will result in actual reductions in injuries, exposures, illnesses, and disorders among construction workers. Goals 8.0 through 14.0 are classified as “contributing-factor goals.” These goals are defined as factors that rep- resent important influences impacting the likelihood that prevention and control measures and actions are taken on a construction site. For each of the 14 strategic goals, the NORA2 agenda includes intermediate goals that reflect an intermediate step and outcome necessary to move toward a strategic goal. In some cases, contributing-factor goals overlap with outcome goals. For example, an intermediate goal for preventing falls to lower levels at a construc- tion site (Goal 1.0) is to partner with architects, engineers, and construction orga- nizations to expand the use of prevention-through-design practices (Goal 13.0). Some of the topics in the categories above represent areas in which the program is already engaged. These areas offer important opportunities to move research to practice (R2P). Other topics include some new areas for research. In the following section, the committee’s recommendations for future research areas are, to the extent possible, presented within the context of the NORA2 goals. The committee is particularly interested in emphasizing to the Construction Research Program staff that it place an increased amount of research time, effort, and resources on the contributing-factors goals—specifically, Strategic Goals 8.0 through 14.0. For all of the goals, the committee also recommends that the program keep the worker and contractor in mind as the ultimate destination for its R2P efforts. Following are two critical research questions that should remain in the forefront of these efforts: (1) How can the program get vital information to the worker “in the trench” or “on the steel”? and (2) How does the program persuade contractors and workers to effectively use the interventions that are developed through research?

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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 4.1 NORA2 Preliminary Draft National Construction Agenda Strategic Goals STRATEGIC GOAL 1.0—Reduce construction worker fatalities and serious injuries caused by falls to a lower level. STRATEGIC GOAL 2.0—Reduce fatal and nonfatal injuries from contact with electricity among construction workers. STRATEGIC GOAL 3.0—Reduce fatal and serious injuries associated with struck-by incidents associated with objects, vehicles, and collapsing materials and structures. STRATEGIC GOAL 4.0—Reduce hearing loss among construction workers by increased use of noise reduction solutions, practices, and hearing conservation programs by the construction community. STRATEGIC GOAL 5.0—Reduce silica exposures and future silicosis risks among construc- tion workers by increasing the availability and use of silica dust controls and practices for tasks associated with important exposures. STRATEGIC GOAL 6.0—Reduce welding fume exposures and future related health risks among construction workers by increasing the availability and use of welding fume controls and practices for welding tasks. STRATEGIC GOAL 7.0—Reduce the incidence and severity of work-related musculoskeletal disorders among construction workers in the U.S. STRATEGIC GOAL 8.0—Increase understanding of factors that comprise both positive and negative construction safety and health cultures; and, expand the availability and use of ef- fective interventions to maintain safe work practices 100% of the time in the construction industry. ANALYSIS OF AND RECOMMENDATIONS REGARDING EMERGING ISSUES AND NEW RESEARCH AREAS Reduce Fatalities and Nonfatal Injuries (NORA2 Goals 1.0, 2.0, and 3.0) The NORA2 draft agenda focuses on workers’ falls to lower levels at construc- tion sites, their contact with electricity, and their being struck by objects, vehicles, and collapsing materials and structures. The Construction Research Program has already conducted relevant and valuable research in reducing fatalities and nonfatal

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future research and Program imProvement 87 STRATEGIC GOAL 9.0—Improve the effectiveness of safety and health management pro- grams in construction and increase their use in the industry. STRATEGIC GOAL 10.0—Improve understanding of how construction industry organization factors relate to injury and illness outcomes; and increase the sharing and use of industry- wide practices, policies, and partnerships that improve safety and health performance. STRATEGIC GOAL 11.0—Increase the recognition and awareness of construction hazards and the means for controlling them through broad dissemination of quality training for construction workers, including non-English speaking workers. STRATEGIC GOAL 12.0—Increase understanding of how vulnerable worker groups experi- ence disproportionate risks in construction work and expand the availability and use of effective interventions to reduce injuries and illnesses among these groups. STRATEGIC GOAL 13.0—Increase the use of “prevention through design (PtD)” approaches to prevent or reduce safety and health hazards in construction. STRATEGIC GOAL 14.0—Improve surveillance at the Federal, State, and private level to support the identification of hazards and associated illnesses and injuries; the evaluation of intervention and organizational program effectiveness; and the identification of emerging health and safety priorities in construction. SOURCE: Reprinted from NORA Construction Sector Council (2008). injuries from workers’ falls and contact with electricity. In some areas where the knowledge base has been well developed, such as in the avoidance of the use of aluminum ladders when doing electrical work, or in improving safety performance through routine inspections, future activities should focus on R2P. The commit- tee supports a shift in research to less developed areas such as incidents in which workers are struck by vehicles, equipment, or objects. The committee cautions, however, that although research on fatalities from these sources is expected to result in safety improvements with respect to nonfatal traumatic injuries as well, such a fatality-driven approach may not adequately

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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  address other important areas for nonfatal injuries. One such area has been falls occurring at the same level. Such slip, trip, and fall injuries have been a major source of morbidity and disability in general industry and are likely to represent a major problem in construction as well. Since these injuries infrequently result in fatalities, they have not been captured in the current priority-setting system. Capturing and tracking the downstream effects of such nonfatal injuries would provide a clear picture of the types of upstream research that could serve to reduce such injuries. Research in this area should address methodologies for identifying and including other causes of traumatic injury, along with how to improve dissemination of the research results, particularly to vulnerable populations. The committee believes that “frequency of injuries” should be considered as a criterion for setting priorities with regard to research topics addressing traumatic injury. Other factors for consideration could be the ease of implementation of evidence-based interventions or the cost of implementation. Much of the Construction Research Program’s work has involved technological or engineering solutions to safety issues—for example, fall-protection equipment or warning systems regarding proximity to overhead power lines. What appears to be needed is a greater focus on the use of these technologies in the field. An example is equipment that has been developed for fall protection. During the stakeholder panels conducted by the committee, some stakeholders indicated that wearing this equipment is more dangerous than not wearing it. This problem indicates to some degree that the program is failing to effectively disseminate to safety trainers and stakeholders the information pertaining to the proper use of fall-protection gear. The existing mind-set within the industry that fall-protection gear is not valuable, or even worse that it is perceived to be dangerous, underscores a disconnect between the practice of using this gear and the true benefits and protection that can be derived from using it. The committee suggests that future research should focus more on barriers to implementation of fall-protection equipment or other technologies. A potentially fruitful area of research collaboration that could perhaps hasten the adop- tion of innovative solutions would be with construction equipment manufacturers. In the committee’s discussions with stakeholders on injury and fatality risk reduction, stakeholders expressed interest in using excavation as an issue to learn more about implementation issues. The Occupational Safety and Health Admin- istration (OSHA) trenching standard approach is viewed as effective, and the remaining obstacles to prevention of injuries from collapsing materials appear to be related to raising awareness and getting contractors and workers to use existing standards. This issue represents a potential new R2P research area, with stakeholder interest in the continuation of efforts to explore other approaches of OSHA’s Ad- visory Committee for Construction Safety and Health trenching work group and by members of the NORA Construction Sector Council.

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future research and Program imProvement 89 Reduce Hearing Loss (NORA2 Goal 4.0) It is well established that exposure to noise causes hearing loss and that pre- vention programs are effective in protecting the hearing of construction workers. Reducing construction workers’ exposure to causes of hearing loss and reducing the numbers and rate of hearing-loss cases ought to be a principal health and safety objective of the construction industry. The primary objective of the Construction Research Program should be to develop engineering controls and to find ways to broadly implement effective hearing-loss prevention measures. The activities proposed by the Construction Research Program in the evidence package appear to be well suited to meeting this objective. The Construction Research Program’s development of models for “portable” hearing-conservation programs in construction will help address issues created by the temporary and mobile nature of the workforce. Assessing the effectiveness of implemented hearing-conservation programs will also be an important activity for identifying factors that could lead to more widespread adoption of hearing- conservation practices by contractors. Expanding the powered-hand-tool database and working with stakeholders to develop engineering control measures for hand tools will be a valuable activity. Additional Construction Research Program activities would be properly devoted to training and guidelines that address noise controls, impulse noise, and noise caused by machinery and equipment. Continuing the program’s current work to measure impulse noise and develop effective intervention measures to protect workers from the adverse effects of impulse noise will constitute an important contribution to this area. Regarding another major source of noise emissions, heavy equipment, the committee suggests that the program examine what research would be effective in characterizing exposures from this source and work with stakeholders (equipment manufacturers, trade associations, trade unions, and others) to develop noise engi- neering solutions focusing on sources of emissions from the equipment. Quieter heavy equipment could play an important role in reducing noise exposures experi- enced by construction workers. Reduce Silica Exposures and Future Risks of Silicosis (NORA2 Goal 5.0) The Construction Research Program has done exceptional work in identifying emerging issues and targeting new research on silica. Planned silica research activi- ties include several areas that deserve increasing attention, including improvements in silicosis surveillance, development and delivery of worker training programs, expanding control technology work to focus on additional construction activities

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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 90 that generate airborne silica, and gathering and assessing toxicology information on substitutes for abrasive blasting. The tearing up of old asphalt highway paving and the laying down of new asphalt can generate dust containing asphalt and silica. The program has identi- fied a future research initiative to reduce exposures to silica and asphalt during this asphalt milling operation. Such operations involve many of the same partners that participated in the now completed road-paving project. Reduce Welding Fume Exposures and Risks (NORA2 Goal 6.0) The Construction Research Program has identified an extensive and well- thought-out set of emerging issues involving welding fumes that will be the target of new research initiatives. Regarding health-effects research, the program has identified a significant emerging problem concerning exposure to manganese from welding operations and the possible link to neurological effects such as Parkinson’s disease. Considerable concern exists regarding this possible linkage, which is cur- rently the subject of litigation by welders across the United States. The findings from this work will assist greatly in providing firm data on which to determine whether or not risks exist. Additionally, the National Toxicology Program will be carrying out animal studies of chronic welding exposures, using the NIOSH generation and delivery system, to look at carcinogenic and neurological effects of welding fumes. Such studies, with the assistance of the program, will be important advances in the understanding of the toxicity of welding fumes. The results of this work could help identify risk reduction needs and the potential for decreasing adverse health outcomes among welders. The program has also outlined a plan to expand its work on developing and implementing engineering controls that are designed to reduce exposures to welding fumes. Additional exposure characterizations will be undertaken, and evaluations of the impact of local exhaust ventilation will likewise be performed. Although these additional data are valuable, they only become useful in reducing risks to welders if engineering controls are implemented in the field. The program has also identified a number of steps that it intends to initiate to ensure that the research findings from the planned activities are disseminated. The diffusion plan includes a variety of approaches that offer the potential to expand implementation, including the development of case studies, job specifications, and collaborative programs with contractors, unions, and equipment manufacturers. If these efforts are realized, exposures and risks to welders will be decreased, con- stituting a major accomplishment.

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future research and Program imProvement 9 Reduce the Incidence and Severity of Work-Related Musculoskeletal Disorders (NORA2 Goal 7.0) NIOSH has clearly been the leader in musculoskeletal disorders (MSD) research in the United States. The goals, activities, and outputs pertaining to this research area have addressed issues that are highly relevant for improving the musculoskeletal health of construction workers. The program has effectively acquired a diverse spec- trum of inputs. It has attempted to focus its activities in this area of construction research on the major tools used and the exposures that occur in construction work. Nonetheless, obtaining surveillance data on construction-related MSDs, including exposure assessment data, has been and continues to be a challenge owing to industry segmentation and a mobile workforce. Additional research is needed on the economics of preventing ergonomic injury. The construction program should develop a stronger evidence base in terms of describing both the need for and the impact and return on investment from the adoption of ergonomic interventions. Results of such interventions will yield progress over time, given consistent application. Research-to-practice efforts should focus on applying such interventions through community health programs designed to instill ergonomic awareness in workers. Industrywide programs are needed to bring cross-sector support for such changes. Measurement issues pertaining to vibration are also a key emerging research area. Future research should address and identify a pathway for a healthier environ- ment that minimizes the effects of vibration on workers. Increase Understanding of Construction Safety and Health Cultures and Improve the Effectiveness of Management Programs (NORA2 Goals 8.0 and 9.0) The NORA2 agenda includes a preliminary description of the construction safety and health culture as the attitudes, values, priorities, and behaviors of man- agement and its employees and understanding the impact of this culture on the development, implementation, performance, oversight, and enforcement of safety and health. To date, the program has conducted little research to examine systematically the impact of culture and safety and health management systems on reducing injuries and illnesses and improving conditions in the construction industry. There is evidence, however, that a matter of critical importance in preventing injuries and fatalities on construction projects is how well participating parties (owners, con- tractors, contractor associations, insurance carriers, and, as appropriate, unions) work together to establish a project safety culture that involves and seeks input

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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 9 and buy-in from the crafts. For example, work performed by the Construction Industry Institute, an organization of owners and contractors devoted to conduct- ing research in the construction industry, has demonstrated the positive impact of safety culture and management commitment on substantially reducing injuries and fatalities. The committee believes that the program should devote significant resources to improving the understanding of the elements of construction culture and safety and health management systems that are effective in reducing the risk of injury and illness and in improving conditions on construction projects. Work of this nature, coupled with advancements in engineering controls and other technological inter- ventions, offers great potential for helping contractors manage safe projects and for protecting workers. This research should also focus on identifying the barriers to implementing effective safety culture and management systems. Research might incorporate behavioral psychology approaches and their application to culture change. The influx of Hispanic workers into the construction industry in the United States adds another level of complexity to this area of research. Within the industry, many misconceptions exist about the higher cost of doing work more safely. An economic analysis of safety could focus on how products and processes within the marketplace can be rearranged to improve worker safety as well as contributing to an understanding of the downstream impacts of an enhanced safety culture. Research could also be undertaken to consider the role of the owner of a construction project in promoting a culture of safety and promoting good health practices to reduce the risks of injury and illness. Increase Understanding of Construction Industry Organizational Factors (NORA2 Goal 10.0) Goal 10.0 relates to the organizational complexity at construction worksites, which may involve multiple contractors and subcontractors, evolving produc- tion techniques, all operating independently but in close proximity. The intent of this goal is to promote research and stakeholder activities that will increase the knowledge of how construction industry organization and industry structure can influence safety and health performance. Within this goal area, the committee recommends that the program increase its research focus on small contractors and on residential construction. Small businesses, which account for the majority of construction firms and workers, are typically more difficult to reach than are larger firms, yet safety and health risks among small businesses are often greater. Although a substantial part of the burden of morbidity and mortality occurs in residential construction, relatively little research specific to residential construction has been conducted. Residential

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future research and Program imProvement 93 construction poses a number of unique challenges to health and safety, including geographically dispersed worksites, a highly mobile workforce, and a relatively short build cycle that involves rapid changes in conditions on worksites. The small size of many residential contractors and in some areas of the country the transient and nonorganized labor force have been barriers to educational and research efforts. The interventions and safety guidelines may need to take a less traditional approach than those for the commercial, industrial, and heavy and civil engineer- ing sectors. Within the construction industry, many misconceptions exist about the higher cost of doing work more safely. An economic analysis of safety could focus on how products and processes within the marketplace can be rearranged to improve work safety as well as to improve understanding of the downstream impacts of an enhanced safety culture. Improve Training and Its Dissemination (NORA2 Goal 11.0) One area of opportunity for greater impact as determined by the committee’s exchange with the stakeholder community is that of training to bring about an increased culture of safety within the construction industry. More attention is needed on how best to change workers’ and contractors’ safety behavior by chang- ing their attitudes about safety and their understanding of related issues. Some work has been done in this area, notably in hearing conservation. A 1998 study reported that construction workers believed that they had developed occupational- noise-induced hearing loss (Lusk et al., 1998). The study showed a need for signifi- cant improvement in the consistent use of hearing protection among construction workers and a need to design hearing-conservation programs for the construction industry. For many safety issues, such as trenching or ladder safety, the barrier to preven- tion is not the absence of knowledge, but the need for more widespread applica- tion of well-known safe work practices. To reach the many and decentralized target audiences with educational materials, the program should study the use of novel settings for dissemination, such as backhoe rental firms for trench safety education. Increase Understanding of Risks to Vulnerable Worker Groups (NORA2 Goal 12.0) In evaluating the Construction Research Program’s research related to vulner- able populations (young workers, women, and immigrant workers) in the con- struction industry, the committee determined that for the most part the outputs

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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 9 of the program have addressed high-priority areas. However, intervention-related, measurable outcomes have been very limited, which may be an indication that program investigators, internal and external, have been unable to access adequate study populations, especially among the Hispanic workforce. In addition, there have not been reported evaluations of the literacy level, user friendliness, clarity, or design of the materials produced specifically for Hispanic workers. The committee believes that the program should conduct and validate health and safety research on Hispanic workers that incorporates social, cultural, and external factors into the research design and implementation processes. Research on, dissemination to, and transfer activities for Hispanic workers will not be effective if informational materials are created by simply translating existing materials from English to Spanish. A clear plan for transfer activities and dissemination of research findings is necessary. In some cases it may be more effective to train Hispanic workers to teach safety-related training for this industry subpopulation than to use professional trainers who may not be attuned to social and cultural factors. Role of Design (NORA2 Goal 13.0) Improving the role of design in promoting health and safety is an important goal. Such research should focus on improving health and safety during all phases of a project, starting with the architect or engineer, continuing with the general contractor who maps out processes, and reaching the contractor who builds the project. Project design, construction processes, building materials, behaviors and work activities, tools, and fasteners could all be improved to promote greater health and safety. Three examples of such design interventions would be (1) designing residences so that fall-protection tie-off points are available during the construction process, (2) building gables and other roof structures on the ground and hoisting them into place rather than building them at height, and (3) using smaller and/or lighter blocks and sheets of building materials. The Construction Research Program could also look at process issues, such as ways to reduce rework (and the potential for injuries and illnesses) through more focused work planning. Opportunities also exist for design improvement in work flow and methods to reduce worker exposures to hazardous materials, such as silica or welding fumes, by minimizing the number of times that a task is performed. Similarly, research could look at reorganizing tasks that require, for example, work- ing overhead or in awkward positions, to reduce their frequency and duration. An economic analysis of safety could focus on how products and processes within the marketplace can be rearranged to improve work safety and could also advance the understanding of the downstream impacts of an enhanced safety cul- ture. The chemical industry’s Responsible Care program is an example of this.

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future research and Program imProvement 95 Improve Surveillance (NORA2 Goal 14.0) The intent of Goal 14.0 is to improve surveillance in order to identify exist- ing and emerging hazards and research needs and to evaluate intervention and organizational program effectiveness. One aspect of this goal is the development of “leading indicators” as opposed to “lagging indicators.” An example of a leading indicator is information on the exposure or the existence of programs and practices that correlate with safety and health performance. The NIOSH evidence package lists the various data series collected with the Safety Database and the Construction Industry and Construction Workforce Databases. These series seem to include most available data, although the series on Construction Market Trends from F.W. Dodge is a limited extraction of the avail- able data. The raw data from the U.S. Department of Labor’s Bureau of Apprentice- ship Training (BAT) also appear to be missing. These training data would be useful to collect, as well as supplemental apprenticeship data from states such as California that do not feed their data into the BAT. Other data that might be useful include state-based data on the number of licensed craftspersons, for example, electricians or plumbers, once the data have been collected for several years. Government sur- veys on single-person firms and firms providing health insurance are also available. In both instances, either these data include construction as an industry category or it is possible to disaggregate the data into construction as an industry category. In short, more data on training, health insurance, licensing, and other factors might be collected. Such data are important because training and experience are key factors in determining health and safety outcomes. Licensing and apprenticeship training are measures of training, and benefits, particularly health insurance, play a role in retaining workers in construction, which should influence health and safety outcomes. The larger problem is that data designed to describe and help formulate better understanding of the workings of construction as they relate to health and safety outcomes require an analytical framing—that is, identification of the relevant data regarding construction that influence health and safety outcomes. For instance, it may be that the size of contractor firms influences safety outcomes or changes in safety outcomes. This question could be traced using available data from the Bureau of Labor Statistics (BLS) on the total injury rate by size of firms over time. More generally, one of the main products of the collaboration between the Construction Research Program and the National Construction Center (NCC) in surveillance research is the Construction Chart Book (CPWR, 2007). This unique and helpful reference could be made stronger and more effective in assisting in surveillance efforts if it were more strongly rooted in an analytical framework based

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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 9 on the key factors influencing health and safety outcomes. This would entail fram- ing safety within an economic, sociological, and organizational behavior analysis that would inform both what data were to be collected and how those data are presented. The Construction Research Program staff and the NCC have identified two key weaknesses in national injury and illness statistics—namely, that illnesses in construction are not well canvassed by the BLS survey and that injuries are increasingly underreported. High turnover among firms and labor may account for the first weakness, while strategies for the avoidance of premiums for worker compensation abetted by the increased employment of undocumented workers in construction may account for the second weakness. Although neither the program nor the NCC is well positioned to remedy the need for raw data relative to these factors, more work could be done to estimate the degree of underreporting, par- ticularly in the case of injuries, by relating reported injuries to changing worker compensation costs. The program staff and the NCC are limited in their surveillance-based efforts to using data collected by others and in case studies. Accompanying these cost- based limitations are serious limitations in these second-party data. However, some of these limitations can be addressed. For instance, while there are no population- based surveys linking safety training with injury and illness outcomes, the increas- ing practice within some industries to prequalify contractors on the basis of their safety history or capabilities has the potential for providing these data on a limited- sample basis. Also, although there is no direct linkage between injury and illness data and workforce data, the fact that both types of data are gathered on a state- by-state basis provides the possibility for some linking of the two types. Given budgetary constraints and the constraints imposed by others on how data are collected, continued creativity in developing second-best approaches to making data cohere into a larger, better-linked picture of safety and construction should be encouraged. Other suggestions for improvement include wrapping the gathering and pre- sentation of surveillance data more thoroughly in a social science understanding of the causes of injuries and illnesses in construction in order to complement the engineering and epidemiological understanding of these events. The program’s work in demonstrating that elevated blood lead levels among construction workers can be reduced through a focused surveillance program also identifies an emerging research area. A substantial amount of work by the program, coupled with its influence on surveillance and worker protection regulations, offers an opportunity not only for the assessment of that influence but also an opportu- nity to improve worker safety and health. The focus of future work on improving color lead-detection wipes in the field will also provide an important and useful

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future research and Program imProvement 97 advancement in methods to ensure that potential lead exposures are identified. The program should also examine any differences in practices that may exist with work involving lead in commercial renovation and remodeling, and in steel structures other than bridges, and suggest any additional measures that may be necessary to protect construction workers. Additional Areas for Future Research In reviewing the Construction Sector Council goals, the NORA2 draft goals, and the NIOSH evidence package presented to the committee, the committee noted that a major gap across all areas is the paucity of well-performed intervention studies. The Construction Research Program has done excellent work in demon- strating the importance of risk factors and in suggesting interventions. The next step is to test these interventions through studies that measure the effectiveness of these interventions in construction work settings. Evaluating intervention effective- ness would help to validate the importance of risk factors and give more impetus to the dissemination of results by demonstrating the benefits of interventions. Evaluating the cost-effectiveness of specific safety and health measures would be particularly effective in speeding the dissemination of research to practice by dem- onstrating benefits to owners, contractors, and workers. That said, the committee recognizes that intervention studies are expensive and can be difficult to perform on construction worksites. No additional future research appears to be contemplated by the program with respect to reducing exposures to asphalt in roofing operations, despite some success in identifying work practices that can reduce worker exposure to asphalt fumes. The committee recommends that the Construction Research Program examine the potential for building on its previous work to develop and implement engineering control approaches for roofing operations. One other area not included in the program’s future research activities is that of skin disease. In response to a modest research effort on this topic and its rather limited focus on Portland cement, the program has identified only a limited num- ber of emerging issues targeted for continuing research in this area. These include developing a guide to working safely with epoxy resins (patterned after the work with Portland cement) and addressing the issue of potential ultraviolet exposures from welding operations. Both of these topics seem relevant for additional research. Overall, the committee is concerned that research on skin disorders is receiv- ing insufficient attention. Exposures to chemicals that pose a hazard to the skin appear to be common across the construction industry. Skin disease appears to be an appropriate topic for inclusion in continuing research focusing on improving surveillance of hazards and outcomes.

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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 9 OVERARCHING RECOMMENDATIONS FOR PROGRAM IMPROVEMENT The overarching recommendations listed below apply to the Construction Research Program as a whole. Transferring Research to Practice Recommendation 1: Research-to-practice (R2P) efforts should involve indi- viduals with the training or with the experience and skills to create strategic diffusion and social marketing plans for National Institute for Occupational Safety and Health research and to evaluate such plans’ effectiveness. Recommendation 2: Consideration should be given to having the majority of research-to-practice efforts of the Construction Research Program con- ducted through the National Construction Center. A number of barriers currently exist within the program structure that limit the R2P efforts and likely their effectiveness. First, although the most recent cooperative agreement for the National Construction Center includes language stipulating that 20 percent of direct costs be used to increase the knowledge base for the effective diffusion of R2P for construction, in most cases this is not enough to implement more active dissemination strategies and evaluate their effectiveness. Outputs gen- erated by external grantees and partners need to be included 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 a requirement for all internally funded projects. The individual expertise called for by the committee in Recommendation 1 above does not necessarily need to reside in NIOSH staff. It could also be expertise within other government agencies such as the Centers for Disease Control and Prevention or OSHA or within the private sector, called on by the program to accomplish its diffusion goals more effectively. Given that NIOSH is a federal agency, the document review process can be lengthy, and limitations are sometimes placed on what can and cannot be said, given that recommendations may be interpreted as policy. The National Construc- tion Center is not constrained by these barriers, however, and thus consideration should be given to having the majority of R2P efforts conducted through the NCC; see Recommendation 2 above. This would allow the program staff to partner with NCC researchers and stakeholders and to focus on conducting the diffusion-related research necessary to determine the optimum ways to reach target audiences.

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future research and Program imProvement 99 Resources Recommendation 3: High-level attention should be given to determining how to provide program resources that are commensurate with a more robust pursuit of the Construction Research Program’s goals. Recommendation 4: The Construction Program Coordinator and the Construction Program Manager should both be devoted full-time to the Construction Research Program. Recommendation 5: The National Construction Center should continue to be used as an important component in the Construction Research Program. During its review, the committee concluded that in spite of budget constraints, the Construction Research Program has made an impact on one of the most dangerous and largest of U.S. industries. The total budget for the program from FY 1997 through FY 2007 has, in fact, stayed even or slightly declined in real dollars. It has also been declining as a portion of the total NIOSH budget during all of the period reviewed, 1996-2005. The committee finds the funding level inadequate and recommends that high-level attention be given to determining how to pro- vide program resources that are commensurate with a more robust pursuit of the program’s goals (see Recommendation 3, above). A related matter, addressed in Recommendation 4 above, 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 program. The committee supports NIOSH’s action in making this a full-time position and recommends that NIOSH continue this practice into the future. Until 2005, program activities were directed through the Construction Steer- ing Committee, which is composed of representatives from NIOSH divisions and laboratories. In 2005, NIOSH appointed a senior lead team representative as the Construction Program Manager. The committee supports this action and recom- mends that this position also be devoted full-time to the Construction Research Program. The committee encourages NIOSH to ensure that this position has some level of budgetary authority and management responsibility so that the Construc- tion Program Manager can provide strategic and programmatic leadership and also assist in holding the program accountable for achieving its future research goals. As indicated in Recommendation 5 above, the committee also recommends that the National Construction Center continue to be used as an important com- ponent in NIOSH’s Construction Research Program.

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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 100 Increased Communication with Rule-Making Authorities Recommendation 6: The Construction Research Program should establish a closer connection with the Occupational Safety and Health Administration and other regulatory or consensus standards organizations to help ensure that the program’s research is applied effectively in rule-making efforts. The committee recommends that the program increase its current level of com- munication with OSHA and other regulatory or consensus standards organizations about the evidence generated from its research activities. In addition to discussing research findings, program staff should communicate more fully on the economics of occupational disorders and illnesses and their impact on workers and contractors in the industry. Such information will provide valuable supporting documentation for recommendations made by the program with respect to regulatory action. Any role that the Construction Research Program can play in developing or strength- ening standards that address risk exposure will likely increase its impact on risk reduction for occupational disorders and illnesses. REFERENCES 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. Lusk, S.J., M.J. Kauffman, and A. Sirkka. 1998. Use of hearing protection and perceptions of noise exposure and hearing loss among construction workers. American Industrial Hygiene Associa- tion Journal 59(7):466-470. NIOSH (National Institute for Occupational Safety and Health). 2007. NIOSH Construction Research Program Evidence Package. Washington, D.C., July. NORA (National Occupational Research Agenda) Construction Sector Council. 2008. National Occupational Research Agenda (NORA) Draft Preliminary Comment Version. Available at http://www.cdc.gov/niosh/nora/comment/public/constdraftdec2007/pdfs/constdraftdec2007.pdf. Accessed August 15, 2008.