# Presentation: 476107

## For ACCSH Meeting 3/15/01  

**IN THE CONSTRUCTION INDUSTRY**
**For ACCSH Meeting 3/15/01****  **

**Carol Merry Stephenson, Ph.D.**
**      ****Mark Stephenson, Ph.D.**

**National Institute for Occupational Safety & Health**
**Centers for Disease Control & Prevention**

## OVERVIEW

**   ****Review of the problem**
**  ****Highlights from recent and ongoing research **
**    **
**  ****What’s new in technology and at NIOSH?**

## HOW BIG IS THE PROBLEM?

**HOW BIG IS THE PROBLEM?**

**Hearing loss from noise is the **
**most common occupational **
**illness (NIDCD), and the **
**2nd-most self-reported **
**occupational illness for American**
** ****workers.**

**NIHL accounts for about 1 in 5 **
**losses severe enough for a person **
**to report trouble hearing (AAA).**

## Construction noise: 

**Construction noise: **
**many sources, hours, variable levels; dynamic**

**Neitzel**

## Which Construction Workers are at Risk? 

**Highest Risk:**
_**Projects:**_** road construction, carpentry, concrete**
_**Trades:**_** carpenters, laborers, operators, ironworkers, sheet metal workers**
_**Stage:**_** excavation, erection, finish**
**Studies small; need comprehensive assessments**

**Neitzel**

## Task/Tool

- Noise Levels forCommon Tools

## Impulsive Peaks by Trade   

**carpenters**

**laborers**

**ironworkers**

**electricians**

**operators**

**Neitzel**

## Hearing Loss Among Male Carpenters

**Hearing Loss Among Male Carpenters**
**as a Function of Age**

## Slide 9

## The Average 25 Year Old Carpenter

**The Average 25 Year Old Carpenter**
**Has 50 Year Old Ears!**

##   Noise monitoring

**  ****Controlling excessive noise**
**  ****Individually fitted protection**
**  ****Education/Training**
**  ****Baseline & annual audiometry**
**  ****Procedures for preventing**
**   ****additional hearing loss**
**  ****Record Keeping**

**OSHA Standard for Construction:  29 CFR 1926.52 **
**PEL of 90 dBA**

**What Constitutes A Hearing Conservation Program?**

## How can hearing conservation programs be developed for construction that follow prevention guidelines and regulations without ignoring the concerns of labor

**How can hearing conservation programs be developed for construction that follow prevention guidelines and regulations **_**without ignoring**_** the concerns of labor**
**and management?**

**THE CHALLENGE:**

## NIOSH HIERARCHY OF CONTROLS

**Remove the hazard**
**Remove the worker**
**Protect the worker**

- Photo Courtesy of Rick Neitzel

## PREVALENCE OF PROGRAM ASPECTS

**PREVALENCE OF PROGRAM ASPECTS**
**BY COMPANY SIZE**

## Percent of Companies in Michigan That Provided Monitoring Hearing Tests - 1999

**Percent of Companies in Michigan That Provided Monitoring Hearing Tests - 1999**

## Percentage of Time Hearing Protectors are Worn “Most of the Time” When Working in Loud Noise

## Don’t make the mistake of

**thinking your job is over if you simply provide hearing protection and periodic hearing tests.**

**Without **_**training**_** workers how to recognize noise hazards, utilize noise controls, and use hearing protectors, you may be wasting your money.**

## Factors Affecting Behavioral Change:

**    **
** ****Individual Level**
- Knowledge/beliefs
- Attitudes/values
- Readiness for change
- Decision-making style
- Skills/ Self-efficacy

**Organizational Level**
- Worksite norms- safety culture
- Union/ management priorities (TIME!)
- Modeling by trainers & foremen
- OSH curricula during  apprenticeship
- Environmental support

**Notes:**
In addition to looking at individual factors from a socio-behavioral perspective, we also made a commitment to examine and emphasize the importance of work organizational factors.  
1.  The UBC made prevention of noise-induced hearing loss a national priority by publicizing the issue in newsletters and at their meetings.

2.  The UBC trainers participated in training workshops targeting hearing loss prevention and made the commitment to model good hearing health.  Many of the trainers are retired craftsmen who suffer tinnitis and/or NIHL, several prominent spokesmen came forward offering credible testimonials.

3.  A hearing loss prevention module is under development for use in the centers.  The module includes written and video educational materials, as well as instructor led sessions teaching apprentices skills necessary to identify noise hazards, take corrective noise control action when possible, and correctly use a variety of HPDs when appropriate.  

4.  Centers will also structure their environment to support hearing health behavior-for example, convenient access to HPDs.

## INFLUENCING HEARING  HEALTH

**BEHAVIOR AMONG WORKERS**

**Studies utilizing a health communication/ promotion**
**approach indicate that education and training **
**must address two concepts:**

**Remove Barriers**

**Develop Self-Efficacy**

**Research by NIOSH, Drs. Lusk, Kerr, Lankford & others!**

## I believe exposure to loud noise can hurt my hearing.

- Strongly
- Agree

- Agree

- Strongly
- Disagree

- Disagree

- Neither

**I believe exposure to loud noise can hurt my hearing.**

- UBC

**Notes:**
Susceptibility:   Carpenters know noise causes hearing loss

## I think my hearing is being hurt by exposure 

- Strongly
- Agree

- Agree

- Strongly
- Disagree

- Disagree

- Neither

**I think my hearing **_**is being hurt**_** by exposure **
**to loud noise at work.**

**Notes:**

So.. What stage were most of these carpenters in?  In fact, many are actively concerned about NIHL-- it is on their radar screen!  They are at least in the contemplation stage, if not further along. 

Other questions and focus groups revealed that many carpenters know friends and family members suffering the physical and social effects of NIHL.  

## What are some of the barriers cited by construction workers and their supervisors?

**What are some of the barriers cited by construction workers and their supervisors?**

** **_**THE FOUR C’s**_
**Comfort**
** ****Convenience**
** ****Cost (personal & $) **
** ****Communications / hear**
**   ****important sounds**

**THERE ARE OVER 200 DIFFERENT HEARING PROTECTORS. EVERYONE CAN FIND A PROTECTOR THAT MEETS THEIR NEEDS.**
**  **
_***THE BEST HEARING PROTECTOR IS THE ONE THAT’S WORN!***_

## RESULTS OF FOCUS GROUPS

**Workers may be less **
**concerned about getting**
**a hearing loss then about **
**developing tinnitus.**
**“****I expected to lose my **
**hearing.  But, I thought**
**it would be quiet.”**

## Percent of People With Tinnitus

**Percent of People With Tinnitus**

- American Tinnitus Association

## Does this research-based communication stuff result in education & training programs that really work?  You bet !

**Does this research-based communication stuff result in education & training programs that really work?  **_**You bet **_**!**

## I think it will be hard to hear warning signals (like 

- Strongly
- Agree

- Agree

- Strongly
- Disagree

- Disagree

- Neither

**I think it will be hard to hear warning signals (like **
**back-up beeps) if I am wearing hearing protectors.**

## Wearing hearing protectors is annoying.

- Strongly
- Agree

- Agree

- Strongly
- Disagree

- Disagree

- Neither

**Wearing hearing protectors is annoying.**

## What Training Approaches & Messages Make Sense to Construction Workers/ Managers? 

**Get their attention**
**Raise their consciousness **
**Provide Information that enables people to do the right thing**

## Engage All Stakeholders

-   **“****Engage persons having an investment in what will be learned ...and what will be done with the knowledge”**

**Notes:**
Can we show video clip of a focus group discussions with BOTH supervisors and apprentices, even without audio, it would be a powerful thing to show while I’m taking...

So when you come in, even though the company may be footing the bill, we are recommending you say “ we need a joint labor-management team” to work on HLP.  

Getting the message out-- coal miners focus groups told us to send message home to spouse in pay envelopes.  In the coal miner culture of West VA and  eastern KY, we learned that wives were an important stakeholder in the miners’ safety and health program-- a stakeholder is not just who is directly served, but also who is affected.

## Agree on expected effects of the training:

**Agree on expected effects of the training:**

**  ****Increase use of controls**

**Notes:**
Picture of factory and picture of construction side by side

For carpenters:  how can we get started with a training program. Lets get this on the radar screen.  For example, at largest residential construction site at a midwestern state-- every worker had hardhats, the week we were there, we did not see one person wearing HP.  How can we educate labor and management to to take this issue seriously.

For IHF:  we have been documenting NIHL for years, how can we prevent new NIHL.

## Use Credible Data- Site Specific If Possible

**Perceived by stakeholders as *****believable***
**Useful, feasible, accurate, & representative of crafts at site**

**Blah, blah, blah...**
**Blah, blah, blah...**

**Notes:**
Use Einstein going blah...

When stakeholders are involved in collecting the data, they are more likely to accept the conclusions and act on the recommendations.

All types of data have limitations...overall credibility can be improved by using multiple measures or multiple procedures to assess each element of your HLPP.  

Ex:  HP usage... direct observation + self report + supervisor report + co-worker reports + HP purchase records.

## Share and Apply Lessons Learned

- Training does not automatically translate into action--it takes effort.
- All stakeholders need feedback.
- Need a “Champion” to actively follow-up

**Notes:**
Rodney dangerfield slide?

We studied HP use at a power plant. The workers knew they had STS, but only 33% chose to wear HP before the intervention.  After the intervention, focussing on their primary complaint “comfort” still only 63% chose to wear HP-- a third of these workers decided they didn’t care!

## Any questions?

**Any questions?**

- Raise Awareness

## It’s Really Pretty Simple.....

**Wear this now...**

**Or wear this later!**

- Get their attention

## Slide 35

## Effect of not wearing your hearing protector

**Effect of not wearing your hearing protector**
**on the amount of effective noise reduction**

## TRAINING HELPS YOU AND YOUR WORKERS

**TRAINING HELPS YOU AND YOUR WORKERS**
**MAKE SMART CHOICES ABOUT HPDs.**

## Perhaps Best of ALL--

**Education & training will enable you to take advantage**
**of exciting new  and emerging technologies.**

**  ****HPD rating methods**
**  “****Flat” attenuation HPDs**
**  ****Communication devices**
**  ****Fit-testing**
**  ****TTS monitors**
**  ****Personal noise monitors**
**  ****Records/Information management **

## Estimated Hearing Protection in an A-Weighted

**Estimated Hearing Protection in an A-Weighted**
**Noise Environment as a Function of Rating Method**

## New Flat Attenuation 

**&**
**Communication Devices**

## New Methods for Estimating Actual Performance

**   ****FIT-TEST METHOD**
**Fit-test system feasible for field use**
**Using fit-test enabled workers to learn to correctly fit a new plug**
**Knowledge gained and consciousness raised**

## TTS Monitoring

- New Devices
- Training exercises to teach self-monitoring
-       (RADIO exercise)

## PERSONAL NOISE MONITORING

**PERSONAL NOISE MONITORING**

## HearSaf 2000 Information Management System

**HearSaf 2000 ****Information Management System**
- 				    http://www.safe-at-work.com

## New NIOSH Noise Efforts Relevant to Construction

**New NIOSH Noise Efforts Relevant to Construction**

- Developed with input from NORA Hearing Loss Team
- Involves cross-division collaborations with staff from Pittsburgh, Cincinnati, and Spokane.

## Possible External Partners:We Are Seeking Others!

**LABOR**
**UMWA**
**USWA**
**UAW**
**UBC&J**
**Equipment Manufacturers**
**JOY **
**Fletcher**
**Others ...**
**Operators & Trade Associations**
**BCOA, NMA, NSA**
**CONSOL, Newmont, others**

**Assess workplace factors and existing knowledge**
**Conduct and evaluate intervention efforts**
**Disseminate information and evaluate efforts**

**    ****Convene workshops, meetings, and symposia to obtain input, facilitate collaboration, and disseminate findings.**

**NO NOISE!**

## PROGRAM SUMMARY

- Individual projects capitalize on the strengths of existing facilities and expertise throughout the Institute
- Strong linkages to existing projects and external partners from labor, industry, academia, etc.
- Data collection activities will support multiple projects
- Projects are designed to take advantage of unique opportunities and to address historic barriers
- Outcomes from projects satisfy both short and long term needs in hearing loss prevention

## The New NORA Projects  

- 1) National Surveillance of Noise Exposure and Hearing Loss/ John Franks
- 2) Definition and Assessment of Engineering Noise Controls/ David Podobinski
- 3) Web-based outreach to small constuction and mining/ Carol Merry Stephenson
- 4) Accommodation of Noise-Exposed, Hearing-Impaired Workers/ Thais Morata
- 5) Noise Sampling strategies and Exposure-Response Models/ Mary Prince

## Web-Based Outreach to Small Construction & MiningNoise Control and Hearing Loss Prevention

******Assess the quality and availability of current information.**
******Determine new information needs.**
******Create an appropriate web-site to meet identified needs & coordinate on-going output from all aspects of NIOSH noise program.**
******Evaluate the web-site & products**

- www.nidcd.nih.gov

- www.hearingconservation.org

## NIOSH Toll-Free Number:  (800) 35-NIOSH

**NIOSH Toll-Free Number:  (800) 35-NIOSH**
**http://www.cdc.gov/niosh/homepage.html**

**Mark R. Stephenson, Ph.D.           Carol M. Stephenson, Ph.D.**
**(513) 533-8144                                 (513) 533-8581**
** ****mos9@cdc.gov                                cem3@cdc.gov****	**

## Just a Few Wise-Ears Web Links

- www.nidcd.nih.gov
- www.cdc.gov/niosh
- www.aearo.com
- www.3m.com
- www.howardleight.com
- www.hearnet.com
- www.hearingconservation.org