Overlapping Vulnerabilities:

The Occupational Health and Safety 

of Young Immigrant Workers 

in Small Construction Firms

NIOSH and ASSE Report • May 2015
2

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Suggested Citation

NIOSH, ASSE [2015]. Overlapping vulnerabilities: the occupational safety and health 

of young workers in small construction firms. By Flynn MA, Cunningham TR, Guerin 

RJ, Keller B, Chapman LJ, Hudson D, Salgado C. Cincinnati, OH: U.S. Department of 

Health and Human Services, Centers for Disease Control and Prevention, National 

Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2015-

178.

DHHS (NIOSH) Publication No. 2015–178

May 2015

Safer • Healthier • PeopleTM

All cover images are by ©Thinkstock
3

Acknowledgements

This report was created by scientists and staff of the National Institute for Occupational Safety and Health (NIOSH) and the American Society for Safety Engineers 

(ASSE). The authors thank Paula Leite and her team at the Center for Migration Studies of the Mexican Ministry of Governance for their assistance with the data from the 

Border Survey of Mexican Migration, or EMIF Norte. They also thank Sue Dong and 

Eileen Betit, of The Center for Construction Research and Training, for their help 

in defining the size of the construction worker population with overlapping vulnerabilities and for their previous efforts at tailoring interventions for these workers. The 

authors also thank Alberto J. Caban-Martinez of the University of Miami Leonard E. 

Miller School of Medicine for his help with compiling and analyzing the data from the 

National Health Interview Survey. Seleen Collins provided editorial support, and Vanessa Williams contributed to the design and layout of this document. 

The following external peer reviewers provided comments on a draft of this report: 

Eileen Betit 

Director, Research to Practice (r2p)

CPWR-The Center for Construction Research and Training

Oscar Chacon 

Executive Director 

National Alliance of Latin American and Caribbean Communities

Charlotte Chang, DrPH

Coordinator of Research to Practice and Evaluation

University of California, Berkeley

Ann Marie Dale, PhD 

Assistant Professor of Medicine and Occupational Therapy

Washington University

Sue Dong, DrPH

Data Center Director

CPWR-The Center for Construction Research and Training

Diane Rohlman, PhD 

Associate Professor

Iowa University

Scott Schneider, MS, CIH

Director, Occupational Safety and Health 

Laborers’ Health and Safety Fund of North America

Amy Shannon, MBA

Senior Advisor

National Alliance of Latin American and Caribbean Communities
4

Contents

Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

2. Overlapping Vulnerabilities in the Construction Sector . . . . . . . . . . . . . . . . . . 8

3. Characteristics of Selected Vulnerable Populations 

in the Construction Industry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

3.1 Hispanic Immigrants 

 3.1.1 Hispanic Immigrant Workers in Construction

 3.1.2 Reasons for Disparities

 3.2 Small Business

 3.2.1 Small Business in Construction

 3.2.2 Reasons for Disparities

3.3 Young Workers

 3.3.1 Young Workers in Construction

 3.3.2 Reasons for Disparities

4. Size of the Vulnerable Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

5. Conceptualizing Overlapping Vulnerabilities and Their Interaction . . . . . . . 22

6. Interventions that Address OSH Vulnerabilities . . . . . . . . . . . . . . . . . . . . . . . . . . 26

7. How OSH Interventions May Address Multiple Vulnerabilities . . . . . . . . . . . . 30

8. References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Photo by ©Thinkstock
5

Executive Summary

The American Society of Safety Engineers (ASSE) and the National Institute for Occupational Safety and Health (NIOSH) are the initiators of an intervention effort to 

reach workers experiencing overlapping occupational safety and health (OSH) vulnerabilities in small construction businesses. This report focuses on three populations that 

research indicates are at increased risk for adverse work-related health outcomes—Hispanic immigrants (individuals born in Latin America who currently live in the United 

States), small business employees (firms with fewer than 20 employees), and young 

workers (<25 years old)—with a specific focus on implications for the construction 

industry. It explores how the combination of risk factors may result in overlapping 

vulnerabilities for workers such as young immigrants in small construction firms and 

discusses the implications for OSH professionals. 

Social dynamics such as race, class, and gender; economic trends such as the 

growth of the temporary workforce; and organizational factors such as business size 

can all contribute to the greater vulnerability of some workers to workplace illness or 

injury than others. OSH professionals will be better able to effectively assist in protecting workers if they are aware of and account for these factors when they design and 

implement safety programs and OSH interventions. 

This report first explores the demographic trends associated with each of these vulnerable groups of workers. Next, the current OSH literature is explored to determine 

the extent to which these risk factors are being examined in combination with each 

other. A conceptual model is then presented for understanding how the vulnerabilities 

interact when a worker belongs to all three groups. The report concludes by considering the efforts needed to address and reduce the pervasive and persistent occupational 

health disparities experienced by vulnerable workers:

•	 Evaluating the potential overlap and interaction of different vulnerabilities

•	 Developing interventions tailored to all relevant vulnerabilities

•	 Working with organizations known to the target community, for effective

diffusion of interventions

•	 Building relationships between OSH professionals and community organizations and focusing on the sustainability of interventions. 
6

1. Introduction

Not all workers have the same risk of being injured at work, even when they are in the 

same industry or have the same job. In addition 

to differential hazard exposure, other factors 

can make some workers more vulnerable than 

others to workplace illness or injury. These 

include social dynamics such as race, class, and 

gender; economic trends such as the growth of 

the temporary workforce; and organizational 

factors such as business size. Occupational 

safety and health (OSH) professionals will be 

better able to effectively assist in protecting 

workers if they are aware of and account for 

these factors when they design and implement 

safety programs and interventions. 

The term occupational health disparities refers 

to increased rates of work-related illness and 

injuries in particularly vulnerable populations 

[Centers for Disease Control and Prevention 

(CDC), 2011]. Vulnerable populations are 

often described using a single characteristic 

(age, race, income, employment, etc.) [Cutter et al. 2005]. A growing body of research 

explores how a particular characteristic, such 

as being an immigrant, a racial minority, or a 

temporary worker, can increase an individual’s risk for occupational injury or illness and 

suggests effective ways to improve their safety 

and health. OSH professionals have benefitted from this research in being better able 

to serve certain vulnerable groups, such as 

providing Hispanic immigrants with training 

materials in the Spanish language. However, 

as occupational health disparities research 

demonstrates, workers frequently belong to 

more than one of these vulnerable groups that 

affect their overall risk of injury or fatality 

[Krieger 2010]. Young Hispanic immigrant 

workers are never singularly Hispanic one 

day, immigrants the next day, and young persons the following day; they are all of these every day. As such, they embody the vulnerabilities associated with these characteristics, all at 
7

the same time. Practitioners and researchers 

often address these characteristics in isolation 

rather than in combination because of several 

factors, such as (1) the limitations of data sets 

used for occupational epidemiology [Souza 

et al. 2010]; (2) the important yet limited scientific approach of understanding the impact 

of each factor by studying it independently; 

and (3) the practical and immediate demands 

on practitioners (for example, overcoming 

language differences to get the job done safely 

and on time). The purpose of this report is 

to explore this combination of risk factors, 

or overlapping vulnerabilities, and to describe their implications for OSH professional 

practice. 

A worker with overlapping vulnerabilities 

is simultaneously a member of two or more 

at-risk groups such as immigrants, temporary 

workers, new workers, older workers, small 

business employees, and non-union workers. 

Each vulnerability has characteristics that add 

unique barriers to the worker’s OSH (for example, an immigrant worker’s fear of deportation for reporting unsafe conditions) [Flynn 

2010] or that intensify existing barriers to 

safety that are common for all workers (such 

as lack of training in small businesses due 

to financial constraints) [Cunningham et al. 

2014]. As these vulnerabilities are independently associated with additional risk of workplace injury or illness, the interaction between 

risk factors may create even more risk for 

groups experiencing multiple vulnerabilities 

than for those who have only one risk factor. 

However, more work is needed to clarify how 

these overlapping vulnerabilities interact and 

may intensify the risk for occupational injury 

and illness and how OSH professionals can 

effectively reduce these risks.

To illustrate the concept of overlapping 

vulnerabilities, this report focuses on three 

populations that research indicates are at 

increased risk for adverse work-related health 

outcomes— Hispanic immigrants (individuals living in the United States who were born 

in Latin America), small business employees (firms with fewer than 20 employees), 

and young workers (< 25 years old) —with 

a specific focus on implications for those in 

the construction industry. First, the report 

explores the demographic trends associated 

with these vulnerable groups across all industries and, specifically, as they relate to these 

groups in the construction sector. Next, it 

analyzes the current safety and health literature to determine the extent to which these 

vulnerabilities are being studied in combination with each other. Although the vulnerabilities explored here are not the only ones 

faced by the U.S. working population, they 

are of specific concern to the construction 

industry, where Hispanic immigrant workers, 

young workers, and small business employees 

have each been shown to be at increased risk 

for occupational injury and illness relative 

to other workers. This report also presents a 

conceptual model of how the vulnerabilities 

interact for individuals belonging to all three 

groups. Finally, it offers suggestions to address 

and reduce the pervasive, persistent occupational health disparities among vulnerable 

workers in construction. 

“A growing body of research 

explores how a particular 

characteristic, such as being 

an immigrant, a racial minority, 

or a temporary worker, 

can increase an individual’s 

risk for occupational injury 

or illness . . .”

Photo by ©Thinkstock
8

2. Overlapping Vulnerabilities 

in the Construction Sector

The concept of examining multiple occupational risk factors in this context is not 

new. One example explores the confluence of 

multiple social vulnerabilities in OSH outcomes by using data from the Census of Fatal 

Occupational Injuries, 2005–2009 [Steege et al. 

2014]. Findings indicate that the rate of fatal 

occupational injuries for foreign-born workers of all ages was 4.0 per 100,000, versus 3.7 

per 100,000 for all workers. “Foreign born” 

refers to nativity status and is defined as 

persons not born in the U.S. or its territories 

[Steege et al. 2014]. Furthermore, the rates for 

young foreign-born workers were even higher, 

particularly for the youngest workers (4.8 per 

100,000 for those aged 20–24 years and 6.1 for 

those aged 15–19 years). These data suggest 

that the vulnerability associated with being 

a foreign-born worker interacted with the 

vulnerabilities associated with being a young 

worker, creating an elevated risk for fatal occupational injuries. What is unclear from the 

data is which of the barriers to safety for each 

of these groups were central to this increased 

fatality rate, how they interacted to put young 

foreign-born workers at an increased risk, and 

how to best tailor interventions to reduce this 

additional risk. These are all questions that 

warrant further study. However, OSH professionals and programs can immediately begin 

to work on finding ways to effectively assist 

workers who are in overlapping vulnerable 

populations.

The next section explores the overlap of 

occupational health disparities of Hispanic 

immigrants, employees of small businesses, 

and young workers in the construction 

industry. Unfortunately, there are relatively 

few data sources that include the necessary 

detail to identify overlapping OSH vulnerabilities among young immigrant workers and 

small business employees. For this analysis, a 

“young worker” is defined as one under the 

age of 25, a “small business” is defined as one 

with 20 or fewer employees, and a “very small 

business” is defined as one with fewer than 

10 employees, on the basis of the data ranges 

used. This report suggests the importance 

of understanding how the vulnerabilities for 

occupational injury associated with being a 

Hispanic immigrant, young worker, and employee of a small business may overlap in the 

construction industry, and how these different vulnerabilities may manifest themselves, 

interact with, and build on one another in the 

lived experience of individual workers—as 

illustrated in Case Studies 1 to 3. 

Understanding the role overlapping vulnerabilities play in occupational health disparities 

requires work in at least four areas: 

• Identifying the vulnerable populations and

the associated characteristics related to 

OSH 

• Determining the size of the population

that shares more than one vulnerability 

and assessing their risk for occupational 

injury and illness relative to their counter

parts 

• Exploring how the vulnerabilities

associated with these characteristics may 

interact with one another or increase the 

risk for injury on the job 

• Designing effective interventions to reduce

the occupational health disparities associated with them. 
9

3. Characteristics of Selected 

Vulnerable Populations in the 

Construction Industry 

3.1 Hispanic Immigrants 

The Hispanic population in the United States has grown substantially in recent years. Currently, more than 50 million 

Hispanics live in this country, comprising 

roughly 16% of the total U.S. population and 

about 14% of the total U.S. workforce [U.S. 

Census Bureau 2014a]. In 2013, immigrants 

comprised half of the 22 million Hispanics employed in the United States [Kochhar 

2014]. Approximately 5% of the U.S. workforce is composed of undocumented Hispanic 

immigrants [Passel et al. 2011]. The Pew 

Hispanic Center [2008] estimated that immigrants will comprise approximately a quarter 

of the U.S. working population by 2050. It 

is also predicted that immigrants and their 

children will account for 83% of the growth 

in the working-age population of the United 

States during this same period [Congressional 

Budget Office 2005]. Unique challenges for 

employers and OSH professionals are likely to 

arise as a result of this steady influx of immigrants into the U.S. workforce. 

Hispanic immigrant workers endure a higher 

burden of occupational injury and fatality 

than do U.S.-born Hispanic, non-Hispanic, 

and non-immigrant workers [CDC 2008]. 

Immigrants often work in “3D” (dirty, dangerous, and demeaning) jobs [Connell 1993] 

and jobs considered to be high risk [Baron et 

al. 2013]. Because of their work in dangerous 

occupations (among other factors), Hispanic 

immigrant workers experience a higher occupational mortality rate (5.9 per 100,000 

full-time-equivalent workers, or FTEs) than 

all other workers (4.0 per 100,000 FTEs) 

[CDC 2008], and they were the only racial/

ethnic group with an increase in number of 

workplace fatalities in 2013 [Bureau of Labor 

Statistics (BLS) 2014e]. 

3.1.1 Hispanic Immigrant Workers in 

Construction 

One high-risk industry with a high concentration of Hispanic immigrant workers is 

construction. In 2013, Hispanic immigrants 

accounted for approximately 20% (1,798,192) 

of the construction workforce (9,106,227) in 

the United States and 75% of all Hispanics 

(2,379,323) working in this industry were immigrants [U.S. Census Bureau 2014b]. 

The rapid growth in the number of Hispanic immigrant workers in the construction industry has been accompanied by 

increased numbers of occupational injuries. 

The number of cases of nonfatal injury or 

illness among Hispanic construction workers 

nearly doubled (from 17,715 to 33,930) from 

“Hispanic immigrant workers 

endure a higher burden of 

occupational injury and fatality 

compared with U.S.-born 

Hispanic, non-Hispanic and 

non-immigrant workers.” 
10

1992 to 2006 [Dong et al. 2010]. From 2003 to 

2008, the occupation groups with the highest 

fatality rate for Hispanic construction workers were ironworkers (135 deaths per 100,000 

FTEs), roofers (28 deaths per 100,000 FTEs), 

and laborers (22 deaths per 100,000 FTEs). 

3.1.2 Reasons for Disparities 

A multitude of knowledge, cultural, and 

structural barriers contribute to the disparity in occupational injury experienced by 

Hispanic immigrants. Many immigrants are 

unfamiliar with the risks they face on the 

job, standard safety procedures in the United 

States, and the regulatory infrastructure that 

protects their right to a safe workplace [Flynn 

2014]. Therefore, workplace safety training is critical. However, immigrant workers 

frequently report not receiving any safety 

training on the job or receiving poor quality 

training [O’Connor et al. 2005]. Furthermore, 

language differences among immigrant workers, their supervisors, and coworkers are one 

of the most frequently cited barriers to safety 

[Gany et al. 2011]. In addition, cultural factors, such as how immigrants understand and 

approach work, safety, risk, and their relationship with their coworkers and employers, also 

contribute to OSH disparities among workers in this population. For example, a study 

of Hispanic immigrant workers in Chicago 

showed that workers’ behaviors reflected a 

culture that placed a high value on being 

perceived as hard workers by their employer 

[Gomberg-Muñoz 2010]. This cultural value 

increased their likelihood of taking risks, 

such as working too fast. Structural barriers—including global pressure on production and wages [Siqueira et al. 2014], racism 

[Okechukwu et al. 2014; Krieger et al. 2006], 

and industry practices, such as a growing 

reliance on temporary workers [Landsbergis 

et al. 2014]—further exacerbate occupational 

health disparities among Hispanic worker 

populations in this country.

3.2 Small Business

I

n 2010, firms with fewer than 500 workers 

accounted for 99.7% of all businesses in the 

United States, and businesses with fewer than 

20 workers accounted for 89.8% of the total 

“Furthermore, language 

differences among immigrant 

workers, their supervisors, 

and coworkers, are one of 

the most frequently cited 

barriers to safety.”

Photo by ©Thinkstock
11

number of firms [U.S. Census Bureau 2011]. 

Although the definition of a “small” business varies widely, particularly as it relates 

to discussions of OSH, the characteristics 

that distinguish a smaller business from a 

larger one in terms of OSH capacities include 

not only number of employees, but also the 

structure (including sole proprietorships), the 

age of the business (most new businesses are 

small), and a manager-centered culture (the 

owner/operator sets the culture of the business) [Cunningham et al. 2014]. Thus, what is 

considered a small business may vary across 

industries, and businesses with 20 or fewer 

employees tend to fit these characteristics in 

construction. Smaller firms provide the U.S. 

economy with more net new jobs than larger 

ones [Headd 2010], and a long-term downward trend in U.S. business size is expected 

[Choi and Spletzer 2012]. 

Evidence suggests that smaller businesses 

experience a disproportionate burden of occupational injuries, illnesses, and fatalities. 

Previous research has found that employees 

from smaller businesses may face increased 

exposure to physical hazards [Morse et al. 

2004], and numerous studies report a linear, 

inverse relationship between organization size 

and reports of injury, illness, and/or fatality 

[Buckley et al. 2008; Fabiano et al. 2004; Fenn 

and Ashby 2004; Jeong 1998; Mendeloff et al. 

2006; Morse et al. 2004; Page 2009; Peek-Asa 

et al. 1999], as well as an association with longer duration of work-related disability [Cheadle et al. 1994; Stover et al. 2007]. Many small 

businesses are exempt from Occupational 

Safety and Health Administration (OSHA) 

reporting regulations, which are, for the most 

part, not required for companies with 10 or 

fewer employees (with some exceptions, including in the case of a fatal incident) [OSHA 

2014]. Small businesses are also more likely 

than larger businesses to hire workers who 

are at a greater risk for occupational injury, 

including young workers, people who are 

less educated, and immigrants [Belman and 

Levine 2004]. 

The age of a business can also present OSH 

challenges. Small businesses in high-risk industries such as construction and forestry that 

failed after one to two years had an average 

injury rate about 2.5 times higher (9.7 per 100 

full-time employees) than successful companies (3.9) [Holizki et al. 2006]. Although it is 

unclear precisely why businesses with higher 

injury rates fail, it may be that an injury 

results in a loss of business continuity, which 

leads to business failure [Holizki et al. 2006]. 

3.2.1 Small Business in Construction

Approximately 90% of construction businesses employ 20 or fewer workers [BLS 2006; 

Wojcik, et al. 2003; CPWR 2013], and the 

burden of occupational injury is increased for 

small construction firms. From 1992 to 2010, 

44% (5,893) of construction workers who died 

as a result of injuries sustained while working 

were employed by companies with 10 or fewer 

employees [CPWR 2013]. Trenching and excavation appear to be particularly hazardous 

“Small businesses are also 

more likely than larger 

businesses to hire workers who 

are at a greater risk for 

occupational injury, including 

young workers, people who are 

less educated, and immigrants.”
12

activities for small businesses: approximately 

half (48%) of trenching and excavation fatalities occurred in companies with fewer than 10 

employees, and 70% of the fatalities occurred 

in companies with fewer than 50 workers 

[CDC 2004]. 

3.2.2 Reasons for Disparities 

The burden of occupational injury faced by 

small businesses is largely related to knowledge and capacity. Workers who feel that 

they are already knowledgeable about safety 

and who have concerns about the credibility of outside safety trainers may experience 

barriers to being properly trained [Hung et 

al. 2013]. Small business owners also demonstrate a lack of OSH knowledge by having 

no return-to-work policies, poor post-injury 

administration, no safety training, and a lack 

of clear management guidance [Eakin and 

MacEachen 1998; Eakin et al. 2010; Huang et 

al. 2006]. 

Fewer than 20% of small business owners 

belong to trade associations, which are a potential source for OSH resources [Gillen et al. 

2004]. Small businesses are less likely to focus 

on activities that are not directly productionrelated [Page 2009] and are less likely to 

utilize formal training methods, which are 

often perceived as costly and time-consuming 

[Kotey and Folker 2007]. A national survey 

of companies with fewer than 250 employees 

found that 87% did not have a safety committee and 87% had not used a safety consultant 

in the past five years [Dennis 2002]. Furthermore, smaller businesses are less likely to 

employ on-site safety and health personnel, 

thereby limiting access to crucial safety assistance [Pedersen and Sieber 1988], and tend to 

experience higher rates of employee turnover 

[Hope and Mackin 2007].

3.3 Young Workers 

Approximately 18.1 million workers in the United States were aged 16 to 24 in 

2013, representing 13% of the workforce 

[NIOSH 2015]. Nearly 80% of young people 

work while still in high school [BLS 2005], 

Photo by ©Thinkstock
13

and the proportion of working adolescents is 

relatively high when compared with that in 

other developed countries [National Research 

Council (NRC) 1998]. Workers younger than 

age 18—often referred to as adolescent or teen 

workers—receive special protections under 

federal and state child labor laws, which 

identify allowable and prohibited types of 

work [U.S. Department of Labor (U.S. DOL) 

2013; Castillo and Lewko 2013]. The Bureau 

of Labor Statistics projects that labor force 

participation for workers aged 16 to 24 years 

will continue to decline, for a number of reasons. These include greater academic pressure 

and more educational requirements that have 

made it more difficult for teens to pursue paid 

work [Morisi 2008], as well as a decline in real 

wages that has prompted more young people 

to pursue educational opportunities [Morisi 

2008; Fernandes-Alcantara 2012]. 

Just as the benefits of work for youth are 

well documented, so are the risks [Mortimer 

2013]. In the United States, young workers 

suffer disproportionately from workplace 

injuries. In 2013, 335 workers under 24 years 

of age died from work-related injuries [BLS 

2014d]. During the 10-year period 1998 to 

2007, an estimated 7.9 million nonfatal injuries to younger workers were treated in U.S. 

hospital emergency departments (EDs) [CDC 

2010]. The nonfatal injury rate for those 

aged 15 to 24 was 5.0 ED-treated injuries per 

100 FTEs, approximately two times higher 

than among workers aged 25 or older [CDC 

2010]. One study estimated that work-related 

injuries among youths up to age 19 accounted 

for an annual cost of $5 billion, or 3.9% of all 

workplace injury costs in the United States 

[Miller and Waehrer 1998]. 

3.3.1 Young Workers in Construction

Federal child labor laws restrict youth under age 16 from working in the construction 

sector [U.S. DOL 2013]. In 2014 only about 

4.6% of youth laborers aged 16 to 24 were 

employed in construction trades, of which 

the vast majority (approximately 83%) were 

between the ages of 20 and 24 [BLS 2014b]. 

According to 2013 data, the construction industry accounted for 8.8% of injuries and illnesses among workers aged 16 to 24, most of 

which (roughly 82%) were suffered by youth 

aged 20 to 24 years [BLS 2014c]. During the 

period 2003 to 2007, younger workers aged 

16 to 24 years in construction had the third 

highest rate of fatal injury in comparison with 

those in other industries (10.9 per 100,000 

FTEs, versus 36.5 per 100,000 FTEs in mining and 21.3 per 100,000 FTEs in agriculture) 

[CDC 2010]. 

Despite special protections for teen workers, 

young construction workers have reported 

Photo by ©Thinkstock
14

using equipment or conducting tasks prohibited by federal child labor laws [Rauscher et 

al. 2012; Runyan et al. 2006]. Young workers 

who were fatally injured were more likely than 

adults to be employed at small, nonunion 

firms, and their employers were more likely to 

have been cited by OSHA for safety violations 

[Suruda et al. 2003]. 

3.3.2 Reasons for Disparities 

Although the literature on work-related injuries among adolescents is limited in comparison with that on injuries among adult workers, a substantial base of evidence has been 

built over the past two decades that identifies 

both individual factors and work-related 

factors that increase the risk for job-related 

injuries among youth. Individual factors 

including minority status [CDC 2010; Mardis 

and Pratt 2003], low socioeconomic status 

[Rauscher and Meyers 2008], and adolescent 

risk taking and sensation seeking—the desire 

to pursue novel and intense experiences 

[Spear 2000; Steinberg 2005; Steinberg et al. 

2011]—may increase young people’s likelihood of experiencing a job-related injury 

[Sudhinaraset and Blum 2010]. Work-related 

risk factors include fast pace of work [Breslin 

et al. 2007], inadequate supervision [Runyan et al. 2006; Runyan and Zakocs 2000; 

Zakocs et al. 1998], equipment use [Knight 

et al. 1995; Mardis and Pratt 2003], working 

late, and working with cash and customers 

[NIOSH 2003; Richardson and Windau 2003; 

Zierold and Anderson 2006]. Lack of job 

knowledge and skills, lack of job training, and 

lack of job control also contribute to heightened risk among younger workers, who might 

be less likely to recognize hazards, less likely 

to speak up regarding safety issues [Tucker 

and Turner 2013], and less aware of their legal 

rights as workers [NIOSH 2003]. 

Case Studies

Because it is associated with numerous occupational safety risks, such as falls, 

equipment malfunctions and/or incidents, 

and working outdoors in extreme temperatures, construction is one of the most dangerous industries in the United States [Dong et 

al. 2011]. In 2013, there were 796 fatal on-thejob injuries to workers in the construction 

industry—more than in any other industry 

sector and accounting for 18% of all workrelated deaths in the United States that year 

[BLS 2014a]. This industry may be particularly hazardous to vulnerable workers. To demonstrate how the combination of overlapping 

vulnerabilites of being a Hispanic worker, a 

young worker, and a small business employee 

in the construction sector can contribute to 

devasting results, three case studies involving 

fatal workplace injuries in the construction 

industry are presented here.
15

Case Study 1

Two brothers, aged 15 and 16, were hired to work on a construction crew doing trench 

work. They were Hispanic immigrants who had been in the United States for a little over 

a year and spoke little English. When they applied for the job, they provided false documentation listing both of their ages as 22. The company employed 11 workers at the 

job site. Once the brothers were hired, they immediately started working and received 

no orientation or safety training. The crew leader gave instructions in English, which a 

bilingual employee would translate into Spanish. On their second day of work, as the 

two were working in the trench (Photo 1), it collapsed on top of them, critically injuring both. Although coworkers uncovered the teens and emergency services arrived 

quickly, the brothers could not be revived. It is unknown why the youths were in the 

trench, as the crew leader had not instructed anyone to be in the trench at that time. 

The brothers’ true ages were not revealed until two days later, when the boys’ parents 

gave their birth certificates to the funeral director [NIOSH 2004b]. 

Photo 1 (Case Study 1). Location at which the two victims 

were buried by the trench collapse. Photo courtesy of county coroner.

LOCATION OF VICTIMS
16

Case Study 2 

A 16-year-old Mexican immigrant went to work with his father and uncles at the construction site for a condominium development (see Photograph 2). He was hired by a 

concrete and framing subcontractor who led a crew of 18 workers. While he was working with his uncle on an elevated work platform (see Photograph 3), the boy fell and hit 

his head on concrete 10 feet below. His father ran to him from another area of the work 

site and found him disoriented and unable to walk without support. The project coordinator told the crew leader to take the boy to a nearby hospital, but instead the crew 

leader took him and his father to a drugstore to buy aspirin and drove them home. By 

the time the boy’s uncles arrived home that evening, the boy was vomiting and unable 

to walk. His family took him to the crew leader’s home, and the crew leader drove them 

to the emergency room. Fearing legal repercussions, the family told emergency room 

staff that the teenager had hit his head falling off a bicycle. Given the extent of his injuries, the hospital staff doubted that a bike fall was the cause. Within an hour of arriving 

at the hospital, he died. It took the police a few days to learn that the boy died as a result of a workplace injury. The project coordinator did not find out that his worker had 

died until four days later, when news reporters arrived at the work site [NIOSH 2004a].

Photo 2 (Case Study 2). This condominium project was the site at which the 

worker’s fatal fall occurred. Photo by SCOSHA.
17

Case Study 3

An 18-year-old recent Mexican immigrant heard about a construction job from a 

friend. Although his English was limited and he needed his friend to translate for him, 

he was hired. The youth did not receive the comprehensive safety training that new 

employees usually received because the foreman assumed that one of the three project managers provided him with the training. However, each project manager thought 

the other had trained the new employee. On his second day on the job, the youth was 

assigned to operate a roller to compact side-by-side plots where the foundation for 

townhouses would be laid. He was told to observe a coworker on the roller and mimic 

his movements. While working on an incline where he could not be seen by his friend 

or supervisors, he was thrown from the operator’s cab and subsequently crushed by 

the machine. He was not wearing a seatbelt, and the area where he was working had 

a slope of 45 degrees, far exceeding the maximum safe incline of 17 degrees recommended by the manufacturer. The rescue squad pronounced him dead at the scene 

[NIOSH 2008]. 

Photo 3 (Case Study 2). In this close-up view of the condominium 

stairwell and balcony area, the black rectangle illustrates the elevated 

platform, the letter A shows the young worker’s approximate location 

before falling, and the letter B shows the approximate location 

of his fall onto concrete, about 10 feet below. Photo by County 

Coroner’s Office, South Carolina
18

4. Size of the Vulnerable Population

The next task in exploring these overlapping vulnerabilities is getting a better idea 

of the size of the population that shares these 

characteristics (that is, how many Hispanic 

immigrants are young workers and how many 

are employed in small construction firms). 

According to U.S. Census data, in 2013, the total number of construction workers employed 

in businesses with fewer than 10 employees 

was almost 2 million (1,873,475) [U.S. Census Bureau 2014b]. Of the nearly 1.5 million 

(1,482,495) Hispanic immigrants working in 

construction, about 40% (551,928) worked 

in firms with fewer than 10 employees. The 

proportion is similar for young workers. In 

2013, there were over three-quarters of a million (758,613) construction workers aged 24 

or younger, of whom nearly a third (221,531) 

worked in construction firms with fewer than 

10 employees. 

Young Hispanic immigrants are more likely 

to work for a very small business than are 

other racial and ethnic groups that make up 

much of the construction workforce. In 2013, 

approximately 121,560 foreign-born Hispanics 

Table 1. Age distribution of construction workers, by ethnicity, 2009–2013

Age group

2009 2011 2013

Hispanic

White

nonHispanic

Hispanic

White

nonHispanic

Hispanic

White

nonHispanicForeignborn NativeForeignborn NativeForeignborn Native

16–24 10.4% 13.9% 10.5% 8.7% 14.5% 10.0% 8.2% 20.0% 11.5%

25–34 37.6% 40.7% 23.6% 35.3% 35.8% 23.9% 33.9% 28.5% 25.8%

35–44 31.9% 20.1% 22.7% 32.2% 23.0% 22.3% 30.5% 27.7% 22.2%

45–54 15.6% 18.8% 26.6% 18.2% 16.0% 25.4% 19.6% 15.7% 21.8%

55–64 3.1% 5.5% 13.9% 4.4% 8.0% 15.1% 7.4% 7.4% 15.1%

65+ 1.4% 0.9% 2.7% 1.2% 2.7% 3.3% 0.3% 0.7% 3.7%

Total 100% 100% 100% 100% 100% 100% 100% 100% 100%

Weighted 

number 1,309,700 414,400 4,183,300 1,307,600 472,900 4,088,600 1,482,500 476,400 4,307,700

Source: 2010–2014 March Supplement to the Current Population Survey, U.S. Census Bureau. Calculations by CPWR Data Center.

Note: Wage and salary workers only. Only odd years are presented to concisely demonstrate 

5-year trends.

Table 1. Age distribution of U.S. construction workers, by ethnicity, 2009-2013.

Source: 2010–2014 March Supplement to the Current Population Survey, U.S. Census Bureau. Calculations 

by CPWR Data Center.

Note: Wage and salary workers only. Only odd years are presented to concisely demonstrate 5-year trends.
19

employed in construction were 16 to 24 years 

of age (8.2% see Table 1), and from 2009 to 

2013, just under half of all young Hispanic 

immigrants in construction worked for a 

very small business (59,320 for 2013, based 

on the percentages provided in Tables 1 and 

2). There were approximately three times 

as many foreign-born Hispanic workers as 

native-born Hispanic construction workers, 

and a greater proportion of younger foreignborn workers were employed in the smallest 

construction establishments than were their 

native-born Hispanic and white, non-Hispanic counterparts. 

Additionally, according to estimates based 

on the National Health Interview Survey 

[CDC 2013] (see Table 3), approximately 

two-thirds of Hispanic construction workers 

in the United States in 2013 were not citizens, 

a factor that has been identified as a possible 

contributor to occupational health disparities 

among immigrants [Schenker 2010; Flynn 

2010]. These survey data, shown in Table 

3, also indicate nearly one quarter (23.5%) 

of all U.S. Hispanic construction workers 

have been on the job for less than a year, and 

nearly three quarters (70.4%) have been on 

the job for less than 5 years. One potential 

occupational health barrier identified by this 

survey is the high proportion (81.9%) of Hispanic construction workers who report they 

receive no paid sick leave. This proportion is 

higher than among the overall construction 

sample (75.7% with no paid sick leave) and 

much higher than among the overall working population in the survey (43.4%), which 

is noteworthy because previous research 

suggests paid sick leave may help businesses 

reduce the incidence of nonfatal occupational injuries [Asfaw et al. 2012]. The data 

presented in Table 3 also support the conclusions from the Current Population Survey 

data that the majority of Hispanic construction workers in the United States are foreign 

born, and a significant proportion work for a 

small business establishment with fewer than 

10 employees.

The census data provide an overall sense of 

the numbers of individuals who fall into each 

of the overlapping vulnerable populations of 

young Hispanic immigrants working in small 

businesses, and the National Health InterTable 2. Percentage of young construction workers employed in establishments

 with fewer than 10 employees, by ethnicity, 2009–2013

Year

Age 16 – 24

Hispanic

Foreign-born Native White, non-Hispanic

2009 44.9% 34.1% 32.1%

2010 51.5% 42.7% 38.4%

2011 31.4% 29.6% 31.2%

2012 41.3% 33.0% 42.0%

2013 48.8% 34.0% 26.7%

Average 43.6% 34.7% 34.1%

Source: 2010-2014 March Supplement to the Current Population Survey, U.S. Census Bureau. Calculations by CPWR Data Center.

Note: Wage and salary workers only. Those without establishment information were excluded.

Table 2. Percentage of young construction workers employed 

in establishments with fewer than 10 employees, by ethnicity, 2009–2013.

Source: 2010–2014 March Supplement to the Current Population Survey, U.S. Census Bureau. Calculations by CPWR Data Center.

Note: Wage and salary workers only. Those without establishment information were excluded.
20

Table 3. Social and employment characteristics of U.S. Hispanic 

Table 3. Sociological and employment characteristics of U.S. Hispanic construction workers construction workers participating in the 2013 National Health Interview Survey (n = 330).

participating in the 2013 National Health Interview Survey (n=330)

Employment characteristics

Hispanic construction workers

Population estimate n %

TOTAL 2,148,307 330 100.0

 Age/years

 18–19 28,208 3 1.3%

 20–24 179,209 22 8.3%

 25–34 721,110 112 33.6%

 35–44 665,675 105 31.0%

 45–54 344,409 54 16.0%

 55–64 175,745 27 8.2%

 65+ 33,951 7 1.6%

 Citizenship status

 Yes, US Citizen 747,988 109 34.9%

Not a US Citizen 1,393,693 220 65.1%

 Born in the U.S.

 Yes, Born in U.S. 383,573 56 17.9%

 Foreign-Born 1,764,734 274 82.1%

 Number of employees at work 

 1–9 1,092,776 175 53.9%

 10–24 380,474 56 18.8%

 25–49 178,701 27 8.8%

 50–99 185,038 27 9.1%

 100+ 192,140 29 9.5%

 Number of years on the job

 Less than 1 year 439,116 68 23.5%

 1–5 876,271 133 46.9%

 6–10 223,055 36 12.0%

 11–15 186,655 28 10.0%

 15 years or more 141,345 21 7.6%

 Paid sick leave at current job

 Yes 378,878 54 18.1%

 No 1,719,891 268 81.9%
21

view Survey data provide some additional 

details about these groups. The Mexican Ministry of Governance conducts a regular census 

of immigrants returning to Mexico (Border 

Survey of Mexican Migration, or EMIF Norte, 

Consejo Nacional de Poblacion [CONAPO 

2010]), and it recently included questions 

about OSH. This data source provides some 

evidence that the occupational health experiences of Hispanic immigrants who have 

worked for small businesses in the United 

States place them at elevated risk for injury 

and illness. 

Among immigrants returning to Mexico from 

January to March 2010 (n = 5,458), approximately 75% of respondents worked for a business with 50 or fewer employees (see Figure 

1). This percentage is nearly the inverse of the 

proportion (28%) of U.S. workers that were employed in an establishment with fewer than 50 

employees in 2007 [U.S. Census Bureau 2011]. 

This finding alone is cause for greater attention 

to the issue of overlapping vulnerabilities.

Persons who worked for smaller establishments were less likely to get training (28% of 

respondents in workplaces with 50 or fewer 

employees received training, compared with 

39% in workplaces with more than 50 employees). Additionally, those who worked for 

smaller establishments were less likely to sign 

a contract with their employer and were less 

likely to have benefits.

The median age among immigrants returning to Mexico who worked while they were in 

the United States was 38 years. This is lower 

than the median age of 42 years in the U.S. 

workforce [BLS 2013]. Although this finding 

does not necessarily mean there is a greater 

proportion of young workers among immigrants working in the United States than 

among native-born workers, these data mirror 

a similar pattern in data for Hispanic-origin 

workers in the United States versus the overall 

U.S. workforce [BLS 2013]. 

On the basis of these data, one can conclude 

it is likely that Hispanic immigrants working 

in the U.S. face greater OSH challenges than 

native-born workers, not only because of the 

unique barriers they encounter as immigrants 

but also because of the lack of OSH resources 

available in smaller businesses, where the majority of Hispanic immigrants are employed. 

However, these data are rather limited in that 

they include only a very small number of the 

~19 million Hispanic immigrants living in the 

United States and only immigrants returning 

to Mexico. 

Figure 1. Percent of workforce employed by smaller or larger businesses. 

Note: Comparison data for all U.S. workers are from 2007 U.S. Census, and 

categories are <50 and ≥50, whereas EMIF Norte categories are ≤50 and >50.

*Total number of paid employees in U.S. Census data = 117,310,118.
22

5. Conceptualizing Overlapping 

Vulnerabilities and Their Interaction

The third step in looking at overlapping vulnerabilities is understanding how they 

interact with one another, and the degree to 

which they present unique barriers to reducing these disparities. As described in the 

preceding sections, a growing body of literature addresses occupational health disparities 

in the construction industry and explores 

how particular groups of workers are at an 

increased risk for occupational injury or illness. These articles often address the unique 

risks, barriers to safety, and possible interventions for groups such as young workers, 

immigrants, and small business employees 

and owners. A scan of the literature published 

since 1995 was conducted. This scan was not 

an exhaustive review, but provided a general 

idea of the degree to which the overlap of the 

identified vulnerabilities is addressed in the 

literature. 

Of the 48 papers reviewed, only 17 addressed 

at least two of the three vulnerabilities central 

to this report (see Table 4). Only two articles 

were found that addressed all three characteristics (young workers, Hispanic immigrants, 

and small business employees) [Dong et 

al. 2013; Dong et al. 2014]. In general, the 

researchers found that each of the three vulnerabilities placed workers at higher risk for 

negative occupational health outcomes. However, the majority of the articles addressed 

each of the vulnerabilities independently and 

did not examine how the risk may change for 

an individual who belongs to more than one 

of these groups. 

Two articles addressed the overlap or interrelatedness of two of the vulnerabilities. 

Suruda et al. [2003] showed how fatal injuries 

for teenage construction workers tended to 

concentrate in small businesses, more so than 

for adults. O’Connor et al. [2005] explored 

the adequacy of safety and health training 

for young Hispanic immigrant construction 

workers, because being both young workers 

and immigrants put them at risk. They found 

that a quarter of the Hispanic teens working 

in construction received no safety training 

and approximately a quarter received less 

than one hour of training. Given the lack of 

research that focuses on overlapping vulnerabilities across all industries, generally, and 

in the construction sector, specifically, more 

work needs to be done to document how 

these different vulnerabilities may overlap and 

interact.

 1The literature scan in this report was conducted with Google Scholar in December 2014 (key words: Latino 

construction workers, small business construction workers, subcontractor construction safety, contracted and 

subcontracted employee construction safety, young construction workers) to search for evidence relevant to overlapping vulnerabilities among young workers, Hispanic workers, and small business employees in the construction industry. Results from the first 15 search pages were examined, and relevant publications were included in 

the scan. Additionally, articles from published literature reviews were examined [Scruggs and Arroyo 2014; van 

der Molen et al. 2012; Chapman 2013], as well as relevant articles known to the authors. The scan identified and 

evaluated forty-eight (48) studies: twenty-one (21) about Hispanic workers or Hispanic construction workers, 

eleven (11) studies of people working for small business, and sixteen (16) studies of younger workers. 
23

2

This scan of the literature focused on Hispanic immigrant status, small business, and young workers. However, 

there are a number of factors that could be explored. For example, temporary work status is another factor that 

warrants further research, on its own and in interaction with other vulnerabilities, such as immigrant or youth 

status. Not only are temporary workers often exposed to hazardous working conditions, but they also tend to have 

less job experience and safety training, a combination that can increase their risk of occupational injury [Benavides et al. 2006; Walter et al. 2002]. Temporary employment is very common in the construction industry, which 

has been found to have the highest prevalence rate for nonstandard work, at 44% [Alterman et al. 2013]. About 

12% of construction companies use day laborers, 22% of companies have no full-time employees, and 8% hire 

workers through temporary agencies [CPWR 2013]. Using data from workers’ compensation claims in Washington State, Smith and colleagues [2010] found that temporary workers had higher injury rates than did permanent 

employees for all injury types in the construction industry. Temporary workers who experience occupational 

injuries may not report their injuries due to a lack of knowledge about occupational health rights or a fear of 

jeopardizing future employment opportunities [Nicholson et al. 2008]. Further research is needed to explore this 

disparity and better inform intervention efforts.

Table 4. Published studies on Hispanic, young, and small business 

construction workers that address multiple vulnerabilities, 1995–2015.

C = collected during the study but not used for reporting or analysis. 

R = reported and/or used in analysis, to some degree.

*Also addresses temporary vs. permanent employment status. 

Table 4. Papers on Hispanic, younger, and small business construction

workers that address multiple vulnerabilities, 1995–2015

Study (Number of subjects) Study type Size of firm

Age of 

employee

Native vs 

foreign born

Forst et al. 2013 (446) Intervention - C C

Sokas et al. 2009 (92) Intervention - C R

Flynn and Sampson 2012 (40) Risk Factor C R -

Arcury et al. 2014 (87) Risk Factor - R R

Nissen 2008 (283) Risk Factor - R R

O’Connor et al. 2005 (50) Risk Factor - R R

Grzywacz et al. 2012 (108) Risk Factor - R R

Holte et al. 2014 (673) Risk Factor R R -

Pedersen et al. 2012 (183,738) Risk Factor R R -

Darragh et al. 2004 (97 firms) Intervention R R -

Suruda et al. 2003 (326) Risk Factor R R -

Polivka 1996 (3,422,000)* Risk Factor - R -

Buchanan et al. 2005 (21)* Risk Factor - R R

Contreras and Buchanan 2012 (42)* Intervention - R R

Steege et al. 2014 (26,996) Risk Factor - R R

Papers that address more than two vulnerabilities

Dong et al. 2014 (2,986) Risk Factor R R R

Dong et al. 2013 (8,123) Risk Factor R R R

C = collected during the study but not used for reporting or analysis; 

R = reported and/or used in analysis, to some degree.

*Also addresses temporary vs. permanent employment status.2

2

This scan of the literature focused on Hispanic immigrant status, small business, and young workers. However, there are a 

number of factors that could be explored. For example, temporary work status is another factor that warrants further 

research, on its own and in interaction with other vulnerabilities, such as immigrant or youth status. Not only are temporary 

workers often exposed to hazardous working conditions, but they also they tend to have less job experience and safety 

training, a combination that than can increase their the risk of occupational injury (Benavides et al., 2006; Walter et al., 

2002). Temporary employment is very common in the construction industry, which has been found to have the highest 

prevalence rate for non-standard work, at 44% [.1% (Alterman et al., 2013].). About 12% of construction companies use day 

laborers, 22% of companies have no full-time employees, and 8% hire workers through temporary agencies [(CPWR, 2013].). 

Using data from workers’ compensation claims in Washington State, Smith and colleagues [(2010]) found that temporary 

workers had higher injury rates than didcompared with permanent employees for all injury types in the construction industry. 

Temporary workers who experience occupational injuries may not report their injuries because ofdue to a lack of knowledge 

about occupational health rights or a fear of jeopardizing future employment opportunities [(Nicholson et al., 2008].). 

Further research is needed to explore this disparity and better inform intervention efforts.
24

A critical next step for improving OSH 

outcomes among vulnerable populations 

is to build on the work that addresses multiple vulnerabilities when developing safety 

programs and interventions. Each of these 

vulnerable populations brings unique barriers that are not shared across groups. Figure 

2 illustrates a way to visualize areas of overlap 

for specific vulnerable groups. Consider that 

Hispanic immigrants may have language 

barriers, young workers may not feel comfortable voicing safety concerns, and small 

business employees may not have access to 

up-to-date safety training. Although each of 

these barriers is associated with a particular 

vulnerable group, many workers experience 

more than one of these barriers because they 

belong to multiple vulnerable groups. For 

example, young Hispanic immigrant workers (area 2 in Figure 2) may be at even greater 

risk of occupational injury or illness because 

they experience both language difficulties and 

hesitation to voice safety concerns on account 

of power differentials they associate with age 

differences and fear of reprisals (such as being 

fired or having their documentation status 

questioned).

In another example, a Hispanic immigrant 

working in a larger organization may feel 

unsafe performing a particular task such as 

working from a ladder. As an immigrant, the 

worker may be unable to speak to the supervisor because of a language barrier. However, 

because he or she works in a larger organization, there may be a safety professional on the 

job, supervisory support for stopping work to 

address a safety concern, bilingual employees 

who can coach the worker through the task, 

training available to safely perform the work, 

and/or safety equipment available to help 

perform the task more safely. Any or all of 

these forms of assistance may help the worker 

overcome or neutralize the language barrier. 

A Hispanic immigrant in a smaller business 

may also be reluctant to speak to the supervisor, but the language barrier may be more 

insurmountable without the supports that are 

available at the larger organization (area 1 in 

Figure 2).

Other limitations arise in addressing only 

one of multiple vulnerabilities for a given 

population of workers, rather than assessing how multiple vulnerabilities overlap and 

interact (area 4 in Figure 2). For example, 

numerous organizations have developed 

Spanish-language OSH training materials. 

Indeed, some of these materials have been 

specifically tailored not only to the language 

needs of Hispanic immigrants, but also to 

the cultural context in which these workers 

operate [Scruggs and Arroyo 2014]. However, 

these training materials have not necessarHispanic

Immigrants

Small Business 

Employees

Young

Workers

1

4

3

2

Figure 2. Overlap of OSH vulnerabilities.
25

ily been developed to address the concerns 

of young workers or with consideration for 

their use by small employers. Thus, many in 

the intended audience (areas 1, 2, and 4 in 

Figure 2) may not benefit from the interven-

tion effort because barriers related to only one 

aspect of their OSH vulnerabilities (that is, 

being an immigrant) were being considered 

during intervention development. Such train-

ing intervention efforts might be enhanced 

by considering the unique barriers younger 

workers encounter and what is feasible for 

smaller contractors to implement, or delivery 

mechanisms that take into account how they 

might see value in supporting OSH training 

for the Hispanic immigrant workforce from 

which they draw employees.

In conclusion, an additive or compound effect 

of multiple vulnerability factors may influence 

OSH outcomes for vulnerable individuals. 

Although the specific mechanisms and quan-

titative effects of these interactions are beyond 

the scope of this report and require additional 

research, OSH practitioners can significantly 

improve their OSH outreach efforts by con-

sidering the multiple vulnerable groups their 

target audiences may include.

“. . . OSH practitioners can 

significantly improve their 

OSH outreach efforts by 

considering the multiple 

vulnerable groups their target 

audiences may include.”

Photo by ©Thinkstock
26

6. Interventions That 

Address OSH Vulnerabilities

Numerous efforts have shown promise in addressing the unique needs of vulnerable workers. Interventions, such as those 

described below, could be expanded to address multiple vulnerabilities. These examples 

certainly do not cover the entire range of 

positive efforts by various organizations to 

address vulnerable worker groups, but they 

do provide several elements of interventions 

that OSH professionals may consider for more 

effectively assisting vulnerable worker and 

employer groups with OSH. 

For example, on the larger strategic level, 

NIOSH has developed a binational partnership with the Mexican government to identify 

and address occupational health inequities 

among immigrant workers [Flynn et al. 2013]. 

This collaboration focuses on three key areas: 

research and surveillance, outreach, and 

building institutional capacity. With assistance from NIOSH, the Mexican government 

institutionalized OSH as a priority topic for 

health promotion through the Ventanillas de 

Salud, the country’s public health outreach 

program in the United States. NIOSH is 

currently assisting with efforts to link health 

promotion, legal services, and research activities to improve the OSH of Mexicans living 

in the United States [O’Connor et al. 2014]. 

This partnership couples NIOSH technical 

expertise with existing Mexican government 

systems. Although this has been a very successful partnership, it is important to note 

that Hispanic immigrants come from many 

countries and the appropriate institutions for 

reaching workers may vary from one national 

group to the next. 

In another example, New Labor, a membership-based worker center in New Jersey, 

implemented a program to teach immigrant 

day laborers to serve as peer safety leaders. 

The program trained the laborers to recognize 

safety and health hazards, to communicate 

effectively with coworkers and supervisors, 

and to facilitate tailored OSHA 10-hour training. By 2014, more than 500 workers in New 

Jersey and New York received OSHA 10-hour 

cards through this program [Scruggs and Arroyo 2014].

NIOSH developed a model for OSH intervention diffusion to small businesses based 

Photo by ©Thinkstock
27

on existing research on using intermediary 

organizations as delivery channels. Examples 

of intermediaries include suppliers of goods 

and services to small businesses, such as trade 

associations, insurers, chambers of commerce, 

building supply stores, and unions. These 

organizations provide infrastructure that 

facilitates intervention delivery between initiating public health/safety agencies and the 

small businesses as a means of overcoming 

the resource scarcity issue [Hasle and Limborg 2006; Hasle et al. 2012; Olsen et al. 2012]. 

Intermediaries can also provide an infrastructure for evaluating intervention efforts. This 

model can be referred to as an initiator–intermediary–small business diffusion model 

[Cunningham and Sinclair 2015; Sinclair et al. 

2013]. This model has been applied successfully with several intermediary organizations 

in multiple targeted areas, including trenching 

in construction [Cunningham and Sinclair 

2015]. Results of these applications of the 

model indicated that intermediary organizations were highly attuned to providing smaller 

businesses with what they want, including 

OSH services. This recommendation has been 

echoed specifically to address the potential 

role of intermediaries in reaching contractors 

who employ Hispanic workers [Scruggs and 

Arroyo 2014].

In another example of a promising strategy 

to address occupational health disparities 

among Hispanic immigrants working in small 

construction businesses, researchers in San 

Francisco and Philadelphia assessed perceptions of barriers to fall prevention among 

both workers and contractors. Key lessons 

learned centered around contractors as being 

the most important target audiences, the need 

for clear, strong incentives for contractors 

to provide rather than ignore fall protection 

measures, and that fall protection training 

for Latino immigrant workers should include 

content on immigrant and worker rights, and 

addressing barriers. On the basis of their findings, they identified contractor associations, 

unions, worker centers, and other partners 

they could leverage to influence contractors to 

promote safer fall-prevention practices. These 

intermediary organizations offered OSHA 10-

hour training to workers and employers, and 

each of the target audiences was incentivized 

to participate: workers could pursue employment opportunities, small businesses were 

able to find OSHA-10-hour-certified workers, 

and trade associations were able to offer a 

benefit to their members [Scruggs and Arroyo 

2014]. 

In an effort targeting both employers with 

fewer than 50 employees and Spanish-speaking employers, the Labor and Occupational 

Health Program [LOHP 2015] at the University of California, Berkeley, has developed a 

model training program that teaches small 

business owners and managers to develop 

and implement their own injury and illness 

prevention programs (IIPPs). The model 

“Key lessons learned 

centered around contractors 

as being the most important 

target audiences . . .”
28

program includes a half-day interactive training session and a guide for writing an IIPP. 

The sessions are conducted by trainers from 

LOHP and Cal/OSHA Consultation Service. 

Although evaluation data have not yet been 

published, this effort is a clear example of assisting employers to deliver effective IIPPs to 

workers who are vulnerable not only because 

they are in small businesses, but also possibly 

because they are immigrants. The LOHP also 

found California’s State Compensation Insurance Fund to be a valuable intermediary and 

partner in bringing people to the training.

In interventions focused on young workers in 

construction, much of the effort is on educational settings. A recent report on integrating 

OSH training into career technical education in construction noted that teaching the 

OSHA-10 (usually providing students with 

OSHA-10 cards) is almost universal at the 

community college level and is growing at the 

high school level [Bush and Andrews 2013]. 

The same report also notes that when educators rely on the OSHA-10 as the primary 

classroom content, their students may not 

be learning all of the basic foundational and 

leadership OSH skills they will need. To address such concerns, NIOSH and its partners 

have developed Youth@ Work—Talking Safety

[NIOSH 2014], a free curriculum that teaches 

foundational workplace safety and health 

skills and knowledge, known as the NIOSH 8 

Core Competencies. The curriculum covers 

basic infor¬mation relevant to any occupation 

at any stage of work life. The Core Competencies include the ability to: 

• Recognize that work has both benefits

and risks, and that all workers can be 

injured, become sick, or even be killed on 

the job 

• Recognize that work-related injuries and

illnesses are predictable and can be 

prevented

• Identify hazards at work and predict how

workers can be injured or made sick 

• Recognize how to prevent injury and

illness 

• Identify emergencies at work and decide

on the best ways to address them 

• Recognize employer and worker rights and

responsibilities 

• Find resources that help keep workers safe

and healthy on the job 

• Demonstrate how to communicate

Photo by ©Thinkstock
29

effectively with others on the job when 

feeling unsafe.

Integrating foundational workplace safety and 

health skills as missing life skills into curricula may be one way to ensure that every 

individual, before entering the workforce, 

has the basic workplace knowledge and skills 

necessary to engage in safe and healthy work. 

Currently, demonstration projects are under 

way in five states (California, Florida, New 

York, Oklahoma, and Oregon) to find ways to 

integrate the competencies delivered through 

Talking Safety in school- and communitybased programs, youth development organizations, professional organizations, and 

temporary employment agencies. 

Finally, it is also worth noting that there has 

been considerable effort toward teaching 

both employers and employees in the construction industry how to develop a stronger 

safety culture and safety climate within their 

organizations and on job sites. Safety culture

reflects the organization’s core values and 

assumptions about safety (espoused, a fixed 

state, qualitative), while safety climate refers to 

the shared perceptions about safety among a 

homogeneous group on site at a given point in 

time (enacted, variable, quantitative) [Hecker 

and Goldenhar 2013]. One example of guidance in developing a stronger safety culture in 

construction is a set of worksheets designed 

by CPWR to help managers, safety professionals, and hourly craft workers learn about 

some of the important leading indicators of 

safety climate as well as ideas for strengthening them [CPWR 2014]. If safety culture 

among smaller construction firms can be 

improved, it will help to create an atmosphere 

where vulnerable workers may be encouraged 

to speak up and employers are able to communicate more effectively about OSH issues 

with vulnerable workers. 

Photo by ©Thinkstock
30

7. How OSH Interventions May 

Address Multiple Vulnerabilities

I

n light of the examples of interventions 

provided, several important points should 

be considered for addressing multiple vulnerabilities. Developing effective interventions 

requires an understanding of both the unique 

barriers and assets these groups have. For 

OSH professionals to be able to more effectively assist workers with multiple vulnerabilities, more work needs to be done in three 

domains: researching overlapping vulnerabilities, developing and refining interventions, 

and building sustainable efforts. 

1. Research is needed to understand how 

different vulnerabilities may overlap and 

interact with one another in the lived experience of workers. These research needs could 

be met with the following actions:

• Examining existing data sets to identify 

groups of workers belonging to more than 

one vulnerable population and developing 

methods for collecting data on multiple risk 

factors 

• Adding data fields to existing data-collection efforts related to other key vulnerable 

populations (for example, when surveying 

worker populations, gather data on business 

size, age, years in country, place of birth, work 

arrangement, etc.)

• Expanding efforts that focus on one 

vulnerability to consider the potential overlap 

with other vulnerabilities (such as immigration, age, size of employer, and work arrangement) as more than just alternate explanations 

of effects or confounding factors to control 

for. 

2. Interventions for a particular group 

should consider factors such as place of birth, 

business size, age, and work arrangement to 

ensure that materials are tailored to address 

barriers for all relevant vulnerabilities that 

workers face. Consider intervention elements 

such as these:

• Culturally tailoring safety certifications and training programs and delivering 

these trainings through resource-appropriate 

channels. Vulnerable workers would likely 

benefit from gaining not only basic OSH 

skills, such as the ability to identify hazards 

and understand how they can be controlled, 

but also leadership skills such as being able to 

problem-solve and speak up in the workplace.

• Creating interest in safety certifications and training programs as a competitive advantage for workers from vulnerable 

populations while also creating demand for 

these credentials among employers. Safety 

certifications may help to empower vulnerable 

workers if there is a demand for them among 

desirable employers. Whereas many larger 

employers may require particular certifications as a condition of employment, smaller 

employers may need to be convinced of the 

value that a prospective employee’s certification or training can add to their business. 

The business value of employee certification 

is likely best communicated to employers by 

the intermediaries within their communities, such as trade associations, insurers, and 

chambers of commerce. 

• Increasing awareness among employers

of the increased risks of occupational injury 

and illness among the vulnerable populations they employ. Many employers are likely 

already aware of specific challenges such as 

language barriers or lack of access to training, 

but they may benefit from additional infor-
31

mation about the risks associated with each 

vulnerability factor that may affect their workforce, as well as training on how to effectively 

communicate safety information. 

• Assisting small employers with basic 

workplace safety and health activities. Small 

employers need assistance to implement activities such as hazard recognition and control 

and writing safety plans in a manner that is 

both culturally and resource-appropriate for 

their workplaces.

3. Diffusion of tailored interventions will 

be most effective by working with the institutions and organizations that already 

serve these communities. OSH professionals 

often do not have longstanding institutional 

relationships with key organizations in these 

communities, nor the institutional capacity 

and cultural competence to work effectively 

with these groups. Likewise, the intervention 

models that OSH organizations have developed with their partners may not be appropriate for use with these organizations. Effective 

and sustainable intervention efforts should 

include these factors:

• Understanding how professionals 

and institutions working within each of the 

relevant communities of vulnerable workers 

can work together to address areas of overlapping vulnerabilities. By partnering, professionals and organizations that were working 

with separate target groups can expand their 

networks and create new client or membership opportunities. 

• Using established intervention models, 

such as the initiator–intermediary–small business diffusion model described in this report, 

to reach vulnerable populations. Such models 

place responsibility on both initiators and 

intermediaries to develop and market interventions that will be valued. 

• Developing longstanding, institutional 

relationships with key organizations who 

work within communities of vulnerable workers and employers. OSH professionals and organizations will need to network and interact 

to identify and build relationships within each 

of these communities. Utilizing webpages and 

“For OSH professionals 

to be able to more effectively 

assist workers with multiple 

vulnerabilities, more work 

needs to be done in three 

domains: researching 

overlapping vulnerabilities, 

intervention development and 

refinement, and building 

sustainable efforts.” 

Photo by ©Thinkstock
32

social media campaigns can support intervention efforts, but a concerted effort to build relationships among OSH professionals and key 

community organizations will likely provide a 

greater and more sustainable impact.

• Working to integrate OSH into current activities and efforts that new partner 

organizations are already doing. These new 

partner organizations need not necessarily be 

work-focused (such as faith-based organizations or hometown associations for a particular nationality), but they should be a trusted 

source of information and active within the 

community. Adding OSH elements to their 

ongoing activities that may not have been specifically OSH-focused increases the chances 

that interventions will be tailored to the 

needs of the community and the institutional 

capacity of the partner organization. Adding an OSH component to ongoing activities 

also limits the burden of the intervention on 

the partner and allows OSH professionals to 

benefit from their existing infrastructure. This 

often limits the scope of the intervention and 

requires some flexibility. However, it is often 

a more sustainable model and can facilitate 

the development of long-term institutional 

relationships. 

• Conducting data-driven evaluations

of intervention efforts to demonstrate their 

effectiveness. Previous interventions have 

included such evaluations to varying degrees. 

OSH professionals and community organizations will be better able to assess and improve 

the impact of their efforts among vulnerable 

populations if effective measures are in place 

to evaluate their efforts. The initiating public 

health/safety organizations can also assist 

with evaluation.

The American Society of Safety Engineers 

(ASSE) and NIOSH are the initiators of 

an effort to reach workers who experience 

overlapping OSH vulnerabilities in small 

construction businesses with an intervention to improve OSH. This is a diverse and 

particularly vulnerable target audience that is 

not likely to be reached by a single communication effort directly from either ASSE or 

NIOSH. On the basis of the considerations offered in this report for effectively intervening 

to improve OSH among workers with multiple, overlapping vulnerabilities, the specific 

content and delivery of such an intervention 

will depend on the engagement and input of 

key intermediaries. Thus, intermediaries and 

OSH professionals who are in direct contact 

with employers of workers experiencing overlapping vulnerabilities should join this effort. 

They will likely find value in offering OSH 

assistance to vulnerable workers and employers, not only in terms of protecting workers, 

promoting socially responsible practices, and 

enhancing public perceptions and relations, 

but also in the opportunities for new business 

relationships, such as in training new audiences, creating an expanded referral network, 

bringing on new clients, and adding value to 

existing memberships or client relationships. ■

Photo by ©Thinkstock
33

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The American Society of Safety Engineers (ASSE) and the 

National Institute for Occupational Safety and Health (NIOSH) 

are the initiators of an effort to reach workers who experience 

overlapping OSH vulnerabilities in small construction 

businesses with an intervention to improve OSH.

EXAMPLES OF POTENTIAL BARRIERS TO IMPROVING OSH OUTCOMES

Overlapping Vulnerabilities:

The occupational health and safety of young 

immigrant workers in small construction firms

The risk to these workers cannot be impacted by 

a single communication effort from ASSE and 

NIOSH. Interventions will depend on the 

engagement and input of OSH professionals 

who are in direct contact with employers of 

workers experiencing overlapping 

vulnerabilities. 

Read more at www.asse.org/workersatrisk

S E

A S

®

HISPANIC IMMIGRANTS

Language barriers

Fear of reprisals

Limited knowledge of 

OSH laws

SMALL BUSINESSES

Fewer resources such 

as safety training 

and equipment

Limited time for OSH 

activities

YOUNG WORKERS

Discomfort voicing 

concerns

Age power 

differential

Overlapping vulnerabilities may intensify the risk for 

occupational injury and illness. 

JOIN THE 

CONVERSATION
The American Society of Safety Engineers (ASSE) and NIOSH 

are the initiators of an effort to reach workers who experience 

overlapping OSH vulnerabilities in small construction businesses 

with an intervention to improve OSH.

DHHS (NIOSH) Publication No. 2015–178