Assessment of the NIOSH Head-and-Face Anthropometric Survey of U.S. Respirator Users
John C. Bailar III, Emily Ann Meyer, and Robert Pool, Editors
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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
This study was supported by Award No. HHSH200-2005-10881 between the National Academy of Sciences and the U.S. Department of Health and Human Services. Any opinions, findings, or conclusions expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.
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Suggested citation: Institute of Medicine (IOM). 2007. Assessment of the NIOSH Head-and-Face Anthropometric Survey of U.S. respirator users. Washington, DC: The National Academies Press.
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COMMITTEE FOR THE ASSESSMENT OF THE NIOSH HEAD-AND-FACE ANTHROPOMETRIC SURVEY OF U.S. RESPIRATOR USERS
JOHN C. BAILAR III, (Chair),
University of Chicago, Illinois
LISA M. BROSSEAU,
University of Minnesota, Minneapolis
HOWARD J. COHEN,
University of New Haven, West Haven, Connecticut
ALAN L. HACK,
Los Alamos, New Mexico
SUBHASH R. LELE,
University of Alberta, Edmonton, Canada
Yale University School of Medicine, New Haven, Connecticut
JOAN T. RICHTSMEIER,
Pennsylvania State University, University Park
Rice University, Houston, Texas
ALBERT A. SCIARRETTA,
CNS Technologies, Inc., Springfield, Virginia
BRUCE M. ALTEVOGT, Study Director (since December 2006)
EMILY ANN MEYER, Study Director (until November 2006)
SARAH L. HANSON, Research Associate (since December 2006)
LORA K. TAYLOR, Senior Project Assistant
VILIJA TEEL, Senior Project Assistant
BOARD ON HEALTH SCIENCES POLICY*
FRED H. GAGE (Chair),
Salk Institute for Biological Studies, La Jolla, California
GAIL H. CASSELL,
Eli Lilly and Company, Indianapolis, Indiana
JAMES F. CHILDRESS,
University of Virginia, Charlottesville
ELLEN WRIGHT CLAYTON,
Vanderbilt University Medical School, Nashville, Tennessee
DAVID R. COX,
Perlegen Sciences, Mountain View, California
LYNN R. GOLDMAN,
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
BERNARD D. GOLDSTEIN,
University of Pittsburgh, Pennsylvania
MARTHA N. HILL,
Johns Hopkins University School of Nursing, Baltimore, Maryland
American Association for the Advancement of Science, Washington, D.C.
Vanderbilt University Medical Center, Nashville, Tennessee
JONATHAN D. MORENO,
University of Virginia, Charlottesville
E. ALBERT REECE,
University of Maryland School of Medicine, Baltimore
National Health Council, Washington, D.C.
MICHAEL J. WELCH,
Washington University School of Medicine, St. Louis, Missouri
OWEN N. WITTE,
University of California, Los Angeles
Research!America, Alexandria, Virginia
ANDREW M. POPE, Director
AMY HAAS, Board Assistant
DAVID CODREA, Financial Associate
Independent Report Reviewers
This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the NRC’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:
David Abrams, ARS Environmental Health, Inc., Minnetonka, Minnesota
Jeffrey S. Birkner, Moldex-Metric, Inc., Simi Valley, California
Fred L. Bookstein, Department of Statistics and Department of Psychology and Behavioral Sciences, Fetal Alcohol and Drug Unit, University of Washington, Seattle
Craig E. Colton, Regulatory Affairs & Training, 3M Occupational Health & Environmental Safety Division, St. Paul, Minnesota
Harry Ettinger, Los Alamos National Laboratories, New Mexico, Retired
David C. Hoaglin, Abt Associates Inc., Cambridge, Massachusetts
James Melius, New York State Laborers’ Union, Albany, New York
James Platner, Center to Protect Workers’ Rights, Silver Spring, Maryland
Aaron Richardson, Applied Biology and Aerosol Technology, Battelle Memorial Institute, Columbus, Ohio
Tim D. White, Department of Integrative Biology and Human Evolution Research Center, University of California, Berkeley
M. Donald Whorton, WorkCare, Inc., Alameda, California
Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Dr. Enriqueta C. Bond, Burroughs Wellcome Fund. Appointed by the National Research Council and the Institute of Medicine, she was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.
The committee acknowledges with appreciation the individuals who provided information to the committee. These individuals include Heinz Ahlers, NIOSH; Roland Berry Ann, NIOSH; Jeffrey Birkner, Moldex; Les Boord, NIOSH; Bill Hoffman, NIOSH; Roy McKay, University of Cincinnati; William Newcomb, NIOSH; Alex Pappas, Edgewood Chemical Biological Center; Jim Platner, Center to Protect Workers’ Rights; Ron Shaffer, NIOSH; Julie Tremblay, Aearo; and Robert Weber, 3M. The committee is especially grateful to Bruce Bradtmiller from Anthrotech, Inc.
The National Personal Protective Technology Laboratory at NIOSH sponsored this study. We appreciate their support and especially thank Maryann D’Alessandro and Ziqing Zhuang for their efforts on behalf of this study.
We finally would like to thank the IOM staff, including Bruce Altevogt, Judy Estep, Sarah Hanson, Amy Haas, Emily Ann Meyer, Andrew Pope, and Vilija Teel.
This Committee’s task—to examine and assess the adequacy and validity of the National Institute for Occupational Safety and Health (NIOSH)-sponsored Anthrotech Survey of U.S. Respirator Users—was as challenging as it was important. Having effective respiratory protection can be, and often is, a matter of life and death. Yet the scientific bases for developing and fitting effective respiratory protection remain more art than science.
A Los Alamos National Laboratory (LANL) respirator fit-test panel, performed in the 1970s and based on a survey of Air Force personnel, has been the basis for testing and certifying respirators for the past 30 years. It is not clear, however, that the Air Force population adequately represented the range of workers even then, and more recent changes in the composition and diversity of the U.S. workforce may make it even less suitable. Developing new test panels for respirators that will fit the changing “face” of the U.S. workforce became an obvious need that NIOSH sought to address in contracting with Anthrotech to conduct a new survey of the U.S. workforce in 2001. NIOSH is to be commended for taking that initiative and also for seeking an independent review of the study’s outcome by the Institute of Medicine (IOM) (as presented in this report).
The conduct of our work was interrupted after our second meeting in order to accommodate an urgent request from the DHHS Office of the Secretary for advice on the potential reusability of disposable face masks in protecting against pandemic flu. Some of our committee members served on that committee, and then returned 6 months later to reconvene in addressing this committee’s charge.
It is always easier to critique someone else’s work than it is to develop and conduct new work. And it is with this awareness that our committee offers our evaluation and assessment. We found many weaknesses in the collection and analysis of the data that were used to develop the proposed face panels. The Anthrotech survey, rather than using novel methodology, served more as an update of a 30-year-old strategy with a larger sample population. The study would have been improved greatly by assuring that the sample was representative of workers who should be using respirators, by validating and incorporating three dimensional measures, and by measuring quantitative fit. There was also a surprising lack of detailed information about the methods that were used in its conduct. Nonetheless, the proposed NIOSH face panel represents an improvement over the existing LANL face panel, and its application is likely to improve the availability of respirators that fit a broader segment of the workforce.
The committee was not charged to comment on whether or not the survey should be redone. However, the Anthrotech research plan, survey, and data analysis had weaknesses that will limit their reliability for NIOSH purposes. As resources and time become available, NIOSH might undertake a new study with a different strategy and research plan.
The committee acknowledges and thanks the IOM staff who supported its efforts, the numerous NIOSH staff who provided detailed information and briefings, and others who provided information in open meetings, and otherwise during the conduct of this study. Appendix A lists the public meeting agendas and meeting participants. The committee most importantly thanks NIOSH for having asked these questions in the first place, for working on updating the respirator test standards, and for having a steadfast dedication to scientific research in support of the health of the public.
John C. Bailar III, M.D., Ph.D.