Cynthia F. Robinson

Obesity and other risk factors: The National Survey of U.S. Long-Haul Truck Driver Health and Injury

BACKGROUND Drivers of heavy and tractor-trailer trucks accounted for 56% of all production and nonsupervisory employees in the truck transportation industry in 2011. There are limited data for illness and injury in long-haul truck drivers, which prompted a targeted national survey. METHODS Interviewers collected data during 2010 from 1,670 long-haul truck drivers at 32 truck stops across the 48 contiguous United States that were used to compute prevalence estimates for self-reported health conditions and risk factors. RESULTS Obesity (69% vs. 31%, P < 0.01) and current smoking (51% vs. 19%, P < 0.01) were twice as prevalent in long-haul truck drivers as in the 2010 U.S. adult working population. Sixty-one percent reported having two or more of the risk factors: hypertension, obesity, smoking, high cholesterol, no physical activity, 6 or fewer hours of sleep per 24-hr period. CONCLUSION Survey findings suggest a need for targeted interventions and continued surveillance for long-haul truck drivers.

Mortality patterns among electrical workers employed in the U.S. Construction Industry, 1982–1987†

BACKGROUND Studies of electrical workers in the utility and manufacturing industries have reported excess site-specific cancer. No previous studies of electrical workers in the construction industry have been conducted. METHODS Our study evaluated the mortality patterns of 31,068 U.S. members of the International Brotherhood of Electrical Workers who primarily worked in the construction industry and died 1982-1987. RESULTS Comparison to the U.S. population by using the NIOSH life table showed significantly elevated proportionate mortality for many causes. Excess mortality for leukemia (proportionate mortality ratio (PMR)=115) and brain tumors (PMR=136) is similar to reports of electrical workers with occupational exposure to electric and magnetic fields in the electric utility or manufacturing industry. Excess deaths due to melanoma skin cancer (PMR=123) are consistent with findings of other PCB-exposed workers. A significantly elevated PMR was observed for the diseases caused by asbestos: lung cancer (PMR=117), asbestosis (PMR=247), and malignant mesothelioma (PMR=356) and from fatal injuries, particularly electrocutions (PMR=1180). The findings of statistically significant excess deaths for prostate cancer (PMR=107), musculoskeletal disease (PMR=130), suicide (PMR=113), and disorders of the blood-forming organs (PMR=141) were unexpected. CONCLUSIONS Results suggest that more detailed investigations of occupational risk factors and evaluation of preventive practices are needed to prevent excess mortality in this hazardous occupation. Am. J. Ind. Med. 36:630-637, 1999. Published 1999 Wiley-Liss, Inc.

Cancer mortality among women employed in fast-growing U.S. occupations.

Our study examined cancer mortality before the age of 65 for women employed in the fastest growing and/or traditionally female occupations. Analysis of mortality data from 28 U.S. states for 1984-1995 revealed elevated proportionate cancer mortality ratios (PCMRs). The highest PCMRs observed were thyroid cancer among health aides, lymphatic and multiple myeloma among computer programmers, and brain cancer among actresses and directresses. Some of the excess mortality occurred for occupations that have been previously cited. These included elevated breast and ovarian cancer among teachers, Hodgkins disease among hairdressers and cosmetologists, and thyroid cancer among health aides and therapists. A few of the associations were new, i.e., had not been previously observed. These included cancer of the connective tissue and lymphatic system among computer programmers, ovarian cancer and leukemia among secretaries, and lymphatic cancer and multiple myeloma among child care workers. These findings should be further investigated with epidemiologic and environmental studies.

Cancer mortality in health and science technicians

BACKGROUND Nearly one million U.S. women are employed as health or science technicians with various chemical and biological exposures, but few studies have looked at their health outcomes. METHODS Using 1984-1995 mortality data with coded occupation information, we calculated race- and age-adjusted proportionate cancer mortality ratios (PCMRs) and 95% confidence intervals for two age groups for black and white women with occupations of clinical laboratory (CLT), radiologic, and science technician. RESULTS For CLTs, the PCMRs for breast cancer were borderline significantly elevated. The PCMRs for leukemia were significantly elevated, particularly for myeloid leukemia. Radiologic technicians had no significantly elevated PCMRs. Science technicians had significantly elevated PCMRs for non-Hodgkins lymphoma and multiple myeloma in the younger age group. DISCUSSION The elevated risks for lymphatic and hematopoietic neoplasms in CLTs and science technicians may be associated with occupational exposures.

National Survey of US Long-Haul Truck Driver Health and Injury: health behaviors.

Objective:To compare selected health behaviors and body mass index (modifiable risk factors) of US long-haul truck drivers to the US working population by sex. Methods:The National Survey of US Long-Haul Truck Driver Health and Injury interviewed a nationally representative sample of long-haul truck drivers (n = 1265) at truck stops. Age-adjusted results were compared with national health surveys. Results:Compared with US workers, drivers had significantly higher body mass index, current cigarette use, and pack-years of smoking; lower prevalence of annual influenza vaccination; and generally lower alcohol consumption. Physical activity level was low for most drivers, and 25% had never had their cholesterol levels tested. Conclusions:Working conditions common to long-haul trucking may create significant barriers to certain healthy behaviors; thus, transportation and health professionals should address the unique work environment when developing interventions for long-haul drivers.

NIOSH national survey of long-haul truck drivers: Injury and safety.

Approximately 1,701,500 people were employed as heavy and tractor-trailer truck drivers in the United States in 2012. The majority of them were long-haul truck drivers (LHTDs). There are limited data on occupational injury and safety in LHTDs, which prompted a targeted national survey. The National Institute of Occupational Safety and Health conducted a nationally representative survey of 1265 LHTDs at 32 truck stops across the contiguous United States in 2010. Data were collected on truck crashes, near misses, moving violations, work-related injuries, work environment, safety climate, driver training, job satisfaction, and driving behaviors. Results suggested that an estimated 2.6% of LHTDs reported a truck crash in 2010, 35% reported at least one crash while working as an LHTD, 24% reported at least one near miss in the previous 7 days, 17% reported at least one moving violation ticket and 4.7% reported a non-crash injury involving days away from work in the previous 12 months. The majority (68%) of non-crash injuries among company drivers were not reported to employers. An estimate of 73% of LHTDs (16% often and 58% sometimes) perceived their delivery schedules unrealistically tight; 24% often continued driving despite fatigue, bad weather, or heavy traffic because they needed to deliver or pick up a load at a given time; 4.5% often drove 10miles per hours or more over the speed limit; 6.0% never wore a seatbelt; 36% were often frustrated by other drivers on the road; 35% often had to wait for access to a loading dock; 37% reported being noncompliant with hours-of-service rules (10% often and 27% sometimes); 38% of LHTDs perceived their entry-level training inadequate; and 15% did not feel that safety of workers was a high priority with their management. This survey brings to light a number of important safety issues for further research and interventions, e.g., high prevalence of truck crashes, injury underreporting, unrealistically tight delivery schedules, noncompliance with hours-of-service rules, and inadequate entry-level training.

Occupational Lung Cancer in US Women, 1984-1998

BACKGROUND Lung cancer is the leading cause of cancer death in US women, accounting for 72,130 deaths in 2006. In addition to smoking cessation, further reduction of the burden of lung cancer mortality can be made by preventing exposure to occupational lung carcinogens. Data for occupational exposures and health outcomes of US working women are limited. METHODS Population-based mortality data for 4,570,711 women who died between 1984 and 1998 in 27 US States were used to evaluate lung cancer proportionate mortality over time by the usual occupation and industry reported on death certificates. Lung cancer proportionate mortality ratios were adjusted for smoking, using data from the National Health Interview Survey (NHIS) and the American Cancer Societys Cancer Prevention Study II. RESULTS Analyses revealed that 194,382 white, 18,225 Black and 1,515 Hispanic women died 1984-1998 with lung cancer reported as the underlying cause of death. Following adjustment for smoking, significant excess proportionate lung cancer mortality was observed among US women working in the US manufacturing; transportation; retail trade; agriculture, forestry, and fishing; and nursing/personal care industries. Women employed in precision production, technical, managerial, professional specialty, and administrative occupations experienced some of the highest significantly excess proportionate lung cancer mortality during 1984-1998. CONCLUSIONS The results of our study point to significantly elevated risks for lung cancer after adjustment for smoking among women in several occupations and industries. Because 6-17% of lung cancer in US males is attributable to known exposures to occupational carcinogens, and since synergistic interactions between cigarette smoke and other occupational lung carcinogens have been noted, it is important to continue research into the effects of occupational exposures on working men and women.

Industrial hygiene characterization of automotive wood model shops

A suspicion of an excess cancer risk in automotive model shops prompted the Industrywide Studies Branch, NIOSH, to conduct a proportionate mortality study and an industrial hygiene characterization of operations in these shops. The mortality study showed a statistically significant excess proportion of deaths due to colon cancer and leukemia (for woodshops only). The materials used in the model shops include various natural woods, laminated woods, plastics, resins, varnishes, putties and paints. Personal breathing zone samples were collected for total and respirable dust, amines, various hydrocarbons (including styrene, and toluene), formaldehyde, and nitrosamines. Particle size distribution studies were conducted on the wood dust and bulk airborne samples of dusts were subjected to various mutagenicity test systems. Work practices, ventilation and general housekeeping were checked. Total wood dust samples ranged from 0.03 to 25 mg/m3 with an average around 1.0 mg/m3. The percent respirable dust ranged from 19 to 38% as measured with Andersen impactors. Solvent exposure samples ranged from non-detectable to about 10% of the OSHA Permissible Exposure Levels. Relevant recommendations for improvement of contaminant control were made.

A Cohort Mortality Study of Chemical Laboratory Workers at Department of Energy Nuclear Plants

OBJECTIVE This study evaluates the mortality experience of 6,157 chemical laboratory workers employed at United States Department of Energy facilities. METHODS All cause, all cancer and cause-specific standardized mortality ratios were calculated. Cox regression analyses were conducted to further evaluate the relation between chemical exposure and mortality risk due to selected cancers. RESULTS The mortality due to all causes combined and all cancers combined were below expectation for the cohort. There were no statistically significant elevations reported among males for any specific cancer or non-cancer outcome. There no statistically significant elevations among females for any specific non-cancer and most specific cancers; however, multiple myeloma deaths were significantly elevated (SMR = 3.56; 95% CI = 1.43-7.33; number of observed deaths, n = 7). Statistically significant elevations were seen among workers employed 20+ years for leukemia using both 2- and 5-year lag periods. Also, a statistically significant positive trend of elevated lung cancer mortality with increasing employment duration was seen using both 5- and 10-year lags. A similar trend was seen for smoking related cancers among men. CONCLUSION While lymphatic and hematopoietic cancer mortality was below expectation, a significant elevation of multiple myeloma deaths among females and an elevation of leukemia among workers employed 20+ years (possibly due to radiation and benzene exposure) were observed. A NIOSH case-control study is underway to examine more closely the relation between multiple myeloma and a variety of chemical exposures among workers employed at the Oak Ridge K-25 facility.

Mortality Patterns of US Female Construction Workers by Race, 1979-1990

In 1990, the US construction industry employed 7.6 million workers, of whom 8% were women. Only one epidemiologic study for women employed in the construction industry was previously published. We analyzed usual occupation and industry codes on death certificates from 28 states between 1979 and 1990 to evaluate mortality patterns among both black and white female construction industry workers. Proportionate mortality for cancer and several other chronic diseases was significantly elevated among 2,273 white female and 197 black female construction workers. White women younger than age 65 at death had significantly elevated proportionate mortality ratios (PMRs) for all cancer, lung cancer, and traumatic fatalities. Black women younger than age 65 at death had a significantly elevated PMR for traumatic fatalities. Elevated mortality for specific cancer sites and other diseases was observed for white and black women employed in construction trades. These results suggest that more detailed investigations that include women and other minorities should be undertaken.