Girija Syamlal

National trends in silicosis mortality in the United States, 1981–2004†‡

BACKGROUND This article describes trends in mortality with silicosis and identifies industries and occupations with elevated silicosis mortality. METHODS A total of 6,326 deaths with silicosis for 1981-2004 were analyzed for trends and association with occupation and industry. Annual mortality rates were age-adjusted to the U.S. Year 2000 population. A linear regression model was used for analyzing mortality trends. Proportionate mortality ratios (PMRs) were based on 1,440 deaths with information on usual industry and occupation. RESULTS Overall age-adjusted mortality rates per million declined from 2.4 in 1981 to 0.7 in 2004. Industries having significantly elevated PMRs for silicosis included mining and quarrying. Occupations with elevated PMRs included those associated with metal and mineral processing. CONCLUSIONS The results suggest that considerable progress has been made towards elimination of this preventable disease. However, about 30 silicosis deaths per year have been recorded since 1995 among those of working age, warranting continued efforts to effectively limit workplace exposures.

Malignant Mesothelioma Mortality in the United States, 1999–2001

Abstract Malignant mesothelioma is strongly associated with asbestos exposure. This paper describes demographic, geographic, and occupational distributions of mesothelioma mortality in the United States, 1999–2001. The data (n = 7,524) were obtained from the National Center for Health Statistics multiple-cause-of-death records. Mortality rates (per million per year) were age adjusted to the 2000 U.S., standard population, and proportionate mortality ratios (PMRs) were calculated by occupation and industry, and adjusted for age-sex, and race. The overall age-adjusted mortality rate was 11.52, with males (22.34) showing a six fold higher rate than females (3.94). Gographic distribution of mesothelioma mortality is predominantly coastal. Occupations with significantly elevated PMRs included plumbers/pipefitters and mechanical engineers. Industries with significantly elevated PMRs included ship and boat building and repairing, and industrial and miscellaneous chemicals. These surveillance findings, can be useful in generating hypotheses and developin strategies to prevent mesothelioma.

Electronic Cigarette Use Among Working Adults — United States, 2014

Electronic cigarettes (e-cigarettes) are battery-powered devices that deliver a heated aerosol, which typically contains nicotine, flavorings, and other additives, to the user. The e-cigarette marketplace is rapidly evolving, but the long-term health effects of these products are not known. Carcinogens and toxins such as diacetyl, acetaldehyde, and other harmful chemicals have been documented in the aerosol from some e-cigarettes (1-3). On May 5, 2016, the Food and Drug Administration (FDA) finalized a rule extending its authority to all tobacco products, including e-cigarettes.* The prevalence of e-cigarette use among U.S. adults has increased in recent years, particularly among current and former conventional cigarette smokers (4); in 2014, 3.7% of all U.S. adults, including 15.9% of current cigarette smokers, and 22.0% of former cigarette smokers, used e-cigarettes every day or some days (5). The extent of current e-cigarette use among U.S. working adults has not been assessed. Therefore, CDC analyzed 2014 National Health Interview Survey (NHIS) data for adults aged ≥18 years who were working during the week before the interview, to provide national estimates of current e-cigarette use among U.S. working adults by industry and occupation. Among the estimated 146 million working adults, 3.8% (5.5 million) were current (every day or some days) e-cigarette users; the highest prevalences were among males, non-Hispanic whites, persons aged 18-24 years, persons with annual household income <

A Survey of Private Sector Respirator Use in the United States: An Overview of Findings

35,000, persons with no health insurance, cigarette smokers, other combustible tobacco users, and smokeless tobacco users. By industry and occupation, workers in the accommodation and food services industry and in the food preparation and serving-related occupations had the highest prevalence of current e-cigarette use. Higher prevalences of e-cigarette use among specific groups and the effect of e-cigarette use on patterns of conventional tobacco use underscore the importance of continued surveillance of e-cigarette use among U.S. working adults to inform public health policy, planning, and practice.

Cigarette Smoking Trends Among U.S. Working Adult by Industry and Occupation: Findings From the 2004–2012 National Health Interview Survey

Limitations of previous surveys of respirator use led the National Institute for Occupational Safety and Health (NIOSH) and the Bureau of Labor Statistics to undertake a survey of respirator use and practices among U.S. private sector employers. The survey was mailed to 40,002 private sector establishments in August 2001; the responses were used to develop national estimates. Respirator use was required in 4.5% of establishments and for 3.1% of employees. Of the establishments requiring respirator use, 95% used air-purifying respirators and 17% used air-supplied respirators. Manufacturing; mining (including oil and gas extraction); construction; and agriculture, forestry, and fishing had the highest rates of establishment respirator use. Respirators were used most frequently to protect against dust/mist, paint vapors, and solvents. Large percentages of establishments requiring respirator use had indicators of potentially inadequate respirator programs. Of establishments requiring respirator use, 91% had at least one indicator of a potentially inadequate respiratory protection program, while 54% had at least five indicators. The survey findings suggest that large numbers of employers may not follow NIOSH recommendations and Occupational Safety and Health Administration (OSHA) and Mine Safety and Health Administration (MSHA) requirements for the selection and use of respirators, potentially putting workers at risk. The findings will aid efforts to increase the appropriate use of respirators in the workplace.

Prevalence of Chronic Obstructive Pulmonary Disease in the U.S. Working Population: An Analysis of Data from the 1997–2004 National Health Interview Survey

OBJECTIVE To examine trends in age-adjusted cigarette smoking prevalence among working adults by industry and occupation during 2004-2012, and to project those prevalences and compare them to the 2020 Healthy People objective (TU-1) to reduce cigarette smoking prevalence to ≤12%. METHODS We analyzed the 2004-2012 National Health Interview Survey (NHIS) data. Respondents were aged ≥18 years working in the week prior to the interview. Temporal changes in cigarette smoking prevalence were assessed using logistic regression. We used the regression model to extrapolate to the period 2013-2020. RESULTS Overall, an estimated 19.0% of working adults smoked cigarettes: 22.4% in 2004 to 18.1% in 2012. The largest declines were among workers in the education services (6.5%) industry and in the life, physical, and social science (9.7%) occupations. The smallest declines were among workers in the real estate and rental and leasing (0.9%) industry and the legal (0.4%) occupations. The 2020 projected smoking prevalences in 15 of 21 industry groups and 13 of the 23 occupation groups were greater than the 2020 Healthy People goal. CONCLUSIONS During 2004-2012, smoking prevalence declined in the majority of industry and occupation groups. The decline rate varied by industry and occupation groups. Projections suggest that certain groups may not reach the 2020 Healthy People goal. Consequently, smoking cessation, prevention, and intervention efforts may need to be revised and strengthened, particularly in specific occupational groups.

Prevalence of lifetime asthma and current asthma attacks in U.S. working adults: an analysis of the 1997-2004 National Health Interview Survey data.

To estimate the prevalence and the population attributable fraction of chronic obstructive pulmonary disease (COPD) in the U.S. adult workers, we analyzed data obtained from the National Health Interview Surveys for the period 1997–2004. The overall COPD prevalence was 4.0% (95% confidence interval [CI] 3.9–4.1%). The prevalence was higher in females (5.4%, 95% CI 5.3–5.6%) than in males (2.8%, 95% CI 2.7–2.9%); in Whites (4.2%, 95% CI 4.1–4.3%) than in Blacks (3.4%, 95% CI 3.1–3.7%) and other races (2.4%, 95% CI 2.1–2.8%). Compared with insurance, real estate and other finance industry, the top three industries associated with significantly higher prevalence odds ratios (PORs) (adjusted for age, sex, race, and smoking) were other educational services (POR = 1.5, 95% CI 1.0–2.3); transportation equipment (POR = 1.4, 95% CI 1.1–1.8); and social services, religious and membership organizations (POR = 1.4, 95% CI 1.1–1.7). Compared with managers and administrators, except public administration occupation, the top three occupations with significantly higher PORs were health service (1.8, 95% CI 1.5–2.1), other protective service (POR = 1.6, 95% CI 1.2–2.2), and material moving equipment operators (POR = 1.6, 95% CI 1.1–2.3). The overall population attributable fraction for association of COPD with employment was 12.2% for industry and 17.4% for occupation. Further studies are needed to determine specific risk factors associated with COPD in industries and occupations with elevated prevalence and POR.

Chronic Obstructive Pulmonary Disease Prevalence Among Nonsmokers by Occupation in the United States

Objective: To estimate national prevalences of lifetime asthma and asthma attacks among workers by age, sex, race, occupation and industry, and estimate population attributable fraction to employment for asthma attacks in the United States. Methods: The 1997–2004 National Health Interview Survey data for currently working adults aged ≥18 years were analyzed. Results: Lifetime asthma prevalence was 9.2%; the social services religious and membership organizations industry and the health service occupation had the highest asthma prevalence. Asthma attack prevalence among workers with asthma was 35.4%; the primary metal industry and the health assessment and treating occupation had the highest attack prevalence. Approximately, 5.9% of cases reporting an asthma attack were attributed to employment when considering industries and 3.8% when considering occupations. Conclusions: Future studies and intervention strategies should address the higher prevalence of asthma in certain industries and occupations.

Respirator Use and Practices in Agricultural Crop Production Establishments

Objective:To examine the prevalence of chronic obstructive pulmonary disease (COPD) among nonsmokers by occupation in the United States. Methods:The 1997 to 2004 National Health Interview Survey data for working adults aged 25 years or more were used to estimate the COPD prevalence and to examine change in COPD prevalence between 1997 to 2000 and 2001 to 2004 by occupational groups. Results:During 1997 to 2004, COPD prevalence was 2.8%. The COPD prevalence was highest in financial records processing (4.6%) occupations. There was a slight increase in COPD prevalence during the two survey periods from 2.8% during 1997 to 2000 compared with 2.9% during 2001 to 2004. Conclusions:No significant changes in the COPD prevalence between the two periods were found. Nevertheless, the elevated COPD prevalence in certain occupational groups suggests that other risk factors play a role in developing COPD.

Respirator Use Among US Farm Operators: Evidence from the 2006 Farm and Ranch Safety Survey

ABSTRACT The risk of developing respiratory diseases can be reduced by either wearing respiratory protection under the guidance of an effective respiratory protection program or using controls. In 2001, the Survey of Respirator Use and Practices gathered information on the types of respirators used, respirator use practices, and the respirator program characteristics from 40,002 randomly selected US establishments. This report presents findings of the Survey of Respirator Use and Practices for the Agricultural Production—Crops industry and compares them with National Institute for Occupational Safety and Health (NIOSH) recommendations. Approximately one third of all Agricultural Production—Crops establishments required respirator use. Of the Agricultural Production—Crops establishments that required respirator use, (1) a written program to determine what type of respirator to use was not adopted by management in 73% of the establishments; (2) 21% did not know whether air sampling was conducted for substances for which employees were required to use respirators; (3) 29.5% did not provide respirator training for employees; (4) employees were not assessed for medical fitness to wear a respirator or it was not known whether the employees were assessed, in 49.4%; and (5) the program administrator had received no respirator training in 29.5%. Of the Agricultural Production—Crops establishments that required respirator use, 69.5% had at least 3 indicators of a potentially inadequate respiratory protection program. The high rates of indicators of potential inadequacies suggest widespread problems with respiratory protection programs in the Agricultural Production—Crops industry, indicating a potential for improvement.