Annual workplace injury, illness, and fatality rates for all workers, reported to the Bureau of Labor (BLS), are at an all-time low and have been dropping for the past several years. In 2003, the most recent year for which data is available, there were 5,559 reported job injury-related fatalities, 60,000 occupational disease-related fatalities, and 4.3 million injuries that required more than first aid (http://www.bls.gov/news.release/pdf/cfoi.pdf). Some say this proves that health and safety conditions are improving for US workers. However, a recent study estimates that the BLS reports miss as much as 69% of all injuries.1 Workplace health and safety professionals are skeptical too. They know that there are many disincentives for employers and employees to report injuries and illnesses,2 although fatalities are generally accurate because it is hard to hide a death.
Furthermore, it is clear that there are certain groups that are more at risk than others. Two of these more vulnerable populations are immigrant and adolescent workers. More specifically, increasing attention is being focused on Hispanics because they are the largest immigrant group in the United States and are a population that continues to grow. The US Census Bureau predicts that by the year 2050 Hispanics will represent 1 of every 4 persons in the United States, up from about 1 in 8 in 2000.3 The rate of on-the-job deaths for Hispanics has been higher than for Whites and Blacks since 2000, and this group also is at a higher risk for nonfatal injuries and illnesses. The United States has the highest proportion of working teens of any developed country, with about 80% having worked by the time they graduate from high school. Working teens experience 2 times the rate of injuries as working adults, with estimates that annually about 60,000 teens are admitted to emergency rooms because of such injuries and approximately 200,000 experience a job-related injury.4 In 2002 there were 41 adolescents who died from injuries sustained on the job.
The reasons why these 2 populations are particularly vulnerable are many and, in some cases, similar. Both tend to be part of the "marginal" workforce, working in low-paid, unskilled, often hazardous jobs-where they assume that danger is part of the job. Or, in the case of teens, because they are young and healthy they think they are "invulnerable" to injury. Because of their marginality, both groups are often anxious to please the supervisor/employer and consequently do not ask for personal protective equipment (gloves, safety glasses, hearing protection, respirators, etc), training, or safer working conditions. Immigrants typically work as construction laborers, agricultural workers, or in the service sector. Teens often work in retail-where they are at risk for robbery-related violence-or the service sector. It is becoming increasingly evident that neither group receives adequate information and training about how to work safely. With Hispanic immigrants, either the information is not provided in their first language or some have limited literacy skills, or both. With teens, many employers, rather than provide legally required training, assume coworkers will share safety tips with teens.
These 6 articles discuss some of the conditions under which the workers toil and examine some interventions undertaken with these vulnerable groups. The last one-on nurses' response to the SARS outbreak in Hong Kong in 2003-raises a new issue whose relevance may increase if the outbreak recurs or other epidemics occur.
The first 2 articles talk about working teens. Zierold et al conducted a comparison of working and nonworking teens and found little difference in school performance. In fact, the grade-point average was slightly higher for those who did work. Interestingly, although the incidences of work-related injuries, "near misses," and being asked to do dangerous work were low overall, they were disproportionately experienced by non-White males. The reasons for this may be related to the kind of work non-White males do and their reluctance to speak up when asked to do unsafe work, but more research is needed to identify causes before designing effective injury prevention programs for this subgroup. Linker et al implemented an educational program for working teens in the state of Washington and found an increase in knowledge about health and safety and the ability to apply the knowledge gained to problem scenarios. The impact of this intervention on injury and illness rates was not assessed. It is difficult to do this because of how injury and illness statistics are reported in the United States. Here age of worker is not reported, whereas in the Canadian province of British Columbia-which has had a similar program in their public schools-the statistical reporting system has shown a 44% decrease in injury rates for 15- to 24-year-old workers since its inception in 1995.5
The next pair of articles focuses on immigrant workers. To find out what immigrant Spanish-speaking orchard workers think about health and safety in their industry, Salazar and colleagues' ethnographic survey revealed awareness of their job risks, but that they had limited ability to avoid injuries and illnesses. This is the first phase of a project that will lead to a more detailed survey in order to develop targeted interventions for preventing injuries and illnesses in this population. Brunette took the next step and involved Hispanic immigrant construction workers in the development of educational and training materials on construction safety. She includes an examination of how to develop linguistically and culturally appropriate safety training materials, not least of which is choosing an effective translation method since there are many materials in English that can be adapted.
Thompson et al make the argument that since low-income minorities and underserved populations are at the greatest risk for compromised health, Worksite Wellness Programs (WWPs) are currently not but must be designed in a culturally sensitive way for these populations. They broaden the traditional mandate of WPPs-which generally focus on nutrition, tobacco use, alcohol and other drugs, mental health, exercise-to include occupational health and safety promotion.
In the last article, Chan et al address a new issue that healthcare professionals are facing when responding to an infectious disease outbreak. In caring for those infected with the outbreak of severe acute respiratory syndrome (SARS) in Hong Kong in early 2003, they found that hospital-based nurses at moderate risk for this infection reported more stress and less coping ability than those at high risk. Their findings have policy implications for hospital support systems and related policies for such workers in the advent of other outbreaks such as the avian influenza virus-which is currently an issue in Vietnam and some think could mutate into a pandemic-or a bioterrorist agent.
These articles highlight some of the issues and interventions that have been implemented for these vulnerable populations. Other vulnerable populations not addressed herein include (1) women workers, who are disproportionately exposed to ergonomic hazards and often face the problem of having to use personal protective equipment that has been designed for a larger male body; and (2) older and disabled workers, whose bodies present physical limitations for some kinds of work. The National Institute for Occupational Safety and Health's (NIOSH's) Special Populations at Risk initiative is involved in a number of projects aimed at promoting new methods and approaches for addressing the needs of these populations, which are frequently underrepresented in traditional occupational health and safety research.
Speaking of tradition, practicing health professionals-physicians, physician assistants, nurse practitioners, nurses and allied professions-typically receive no or little training in this field. Nevertheless, they can learn how to incorporate occupational histories when conducting a medical history, identify professionals trained in this area for referrals, partner with others conducting occupational screenings/surveillance, provide to patients educational materials on workers' occupational health rights and how to identify hazards/work safely, and provide patient education on occupational health promotion.
Marianne P. Brown, MPH
Past Director and Associate, UCLA, Labor Occupational Safety and Health Program, Los Angeles, CA, Issue Editor
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