Medical Monitoring and Screening in the

Workplace: Results of a Survey

September 1991

OTA-BP-BA-67

NTIS order #PB92-117738
Recommended Citation:

U.S. Congress, Office of Technology Assessment, Medical Monitoring and Screening in the

Workplace: Results of a Survey-Background Paper, OTA-BP-BA-67 (Washington, DC:

U.S. Government Printing Office, October 1991).

For sale by the U.S. Government Printing Office

Superintendent of Documents Mail Stop: SSOP. Washington, DC 20402-9328

ISBN 0-16 -035568-0
Foreword

Screening of prospective employees for

monitoring of workers’ health are generally

health status and certain behaviors and

thought to be widespread in American

workplaces, but few data exist about either practice. This OTA Background Paper presents the

results of a survey of 1,500 U.S. companies, the 50 largest utilities, and the largest unions. The

survey was designed to obtain information about the types of medical monitoring and

screening done in the United States and the extent of their use. OTA finds that virtually all

large U.S. employers use some of these tests.

OTA commissioned the survey in support of its October 1990 OTA assessment Genetic

Monitoring and Screening in the Workplace. In contrast to that report, which focused on the

issues associated specifically with genetic monitoring and screening in the workplace, this

Background Paper discusses survey results concerning the more general topic of medical

monitoring and screening as well as providing additional information about genetic

monitoring and screening. The 1990 assessment was requested by the Senate Committee on

Commerce, Science, and Transportation; House Committee on Energy and Commerce; and

the House Committee on Science, Space, and Technology. It was also endorsed by the Senate

Committee on Labor and Human Resources.

This Background Paper documents:

attitudes of corporate personnel and health officers about the appropriateness of

medical and genetic monitoring and screening;

some of the corporate criteria used to set health and other qualifications for

employment;

policies on informing employees and job applicants of test results;

provisions for company and employee access to medical records; and

the cost-effectiveness estimates for various tests.

OTA was assisted in preparing the survey instrument and Background Paper by a panel

of advisors selected for their expertise and diverse points of view on the issues covered in the

report. Advisory panelists were drawn from industry, academia, labor organizations, legal,

scientific and professional organizations, research organizations, and Federal agencies.

We gratefully acknowledge the contribution of each of these individuals. OTA, however,

remains solely responsible for the contents of this Background Paper.

/j’f AM L.

JOHN H. GIBBONS

Director

.,. Ill
Medical Monitoring and Screening in the Workplace-Advisory Panel

Judy Hayes Bernhardt

Professor and Department Chair

Community and Mental Health

Nursing

East Carolina University

Greenville, NC

Patricia A. Buffler

Professor of Epidemiology

University of Texas School of

Public Health

Houston, TX

Martin G. Cherniack

Director

Occupational Health Center

Lawrence and Memorial Hospital

New London, CT

Kurt R. Fenolio

Genetic Counselor

California Pacific Medical Center

San Francisco, CA

Theodore Friedmann

Professor of Pediatrics and

Medical Genetics

University of California,

San Diego

La Jolla, CA

Elizabeth Evans Gresch

Senior Occupational Health

Associate

The Dow Chemical Co.

Midland, MI

Bruce W. Karrh

Vice President

Safety, Health and Environmental

Affairs

E.I. du Pent de Nemours & Co.

Wilmington, DE

Elena O. Nightingale, Panel Chair

Special Advisor to the President

Carnegie Corporation of New York

Washington, DC

Marvin S. Legator

Professor and Director

Division of Environmental

Toxicology

University of Texas Medical

Branch-Galveston

Galveston, TX

Lewis L. Maltby

Director

National Task Force on Civil

Liberties in the Workplace

American Civil Liberties Union

New York, NY

Tony Mazzocchi

Secretary-Treasurer

Oil, Chemical and Atomic

Workers Union

Denver, CO

Kenneth B. Miller

Director

Occupational and Environmental

Medicine

Ithaca, NY

Benjamin W. Mintz

Professor of Law

Columbus School of Law

The Catholic University of

America

Washington, DC

Robert F. Murray, Jr.

Professor of Pediatrics, Medicine

and Genetics

Howard University College of

Medicine

Washington, DC

Thomas H. Murray

Professor and Director

Center for Biomedical Ethics

Case Western Reserve University

Cleveland, OH

Vincent M. Riccardi

Medical Director

Alfigen-The Genetics Institute

Pasadena, CA

Anthony Robbins

Professor of Public Health

Boston University School of

Public Health

Boston, MA

Stanley D. Rose

Business Unit Manager, Reagents

Perkin Elmer Cetus

Emeryville, CA

Mark A. Rothstein

Professor of Law and Director

Health Law and Policy Institute

University of Houston

Houston, TX

Sheldon W. Samuels

Executive Vice President

Workplace Health Fund

Industrial Union Department,

AFL-CIO

Washington, DC

NOTE:

iv

OTA appreciates and is grateful for the valuable assistance and thoughtful critiques provided by the advisory panel members.

The panel does not, how-ever, necessarily approve, disapprove, or endorse this report. OTA assumes full responsibility for the

report and the accuracy of its contents.
OTA Project Staff—Medical Monitoring and Screening in the Workplace:

Results of a Survey

Roger C. Herdman, Assistant Director, OTA

Health and Life Sciences Division

Michael Gough, Biological Applications Program Manager

Gretchen S. Kolsrud, Biological Applications Program Managerl

Margaret A. Anderson, Project Director

Support Staff

Cecile Parker, Office Administrator

Linda Rayford-Journiette, Administrative Secretary

Jene Lewis, Secretary

Editor

Carter R. Blakey, Bethesda, MD

Contractors

Schulman, Ronca & Bucuvalas, Inc., Washington, DC

John M. Boyle, Principal Investigator

Ken John, Research Associate

Acknowledgments to Other OTA Staff

Robyn Y. Nishimi, Senior Analyst

1 Through September 1989.
Chapter 1:

Chapter2:

Chapter3:

Chapter4:

Contents

Page

Summary and Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Preemployment Screening Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Monitoring Worker Health.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23”

Genetic Monitoring and Screening in the Workplace: Corporate

Opinion and Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Appendix A:

AppendixB:

AppendixC:

AppendixD:

AppendixE:

Index . . . . . .

Survey Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Qualitative Comments About the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Acronyms and Glossary of Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

Survey Instrument Corporate Health Officers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

Survey Instrument: Corporate Personnel Officers . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Chapter 1

Summary and Overview
CONTENTS

Page

Preemployment Screening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Monitoring Worker Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Genetic Monitoring and Screening: Practices and Policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Chapter 1

Summary and Overview

In October 1990, the Office of Technology

Assessment (OTA) released its assessment Genetic

Monitoring and Screening in the Workplace, which

considers the scientific, legal, ethical, and social

aspects of the use of such tests in a workplace

setting. It also delineates options for congressional

action with regard to issues related to genetic

monitoring and screening in the workplace. As part

of the assessment, OTA commissioned a survey on

genetic monitoring and screening in the workplace

of 1,500 U.S. companies, the 50 largest utilities, and

the 33 largest unions. The survey was conducted

from March 24 to July 15, 1989.

The 1989 OTA survey gathered information about

corporate employment practices and policies in

general, and corporate practices and policies concerning genetic monitoring and screening in particular. This was done to provide important background

information that would supplement and help to

explain the information received about genetic

monitoring and screening. This background paper

presents the survey data that was not published in the

full assessment.

OTA investigated a variety of employment practices including preemployment health examinations,

employee health qualifications and monitoring of

workers’ health. In addition, the survey obtained

information about other practices such as recordkeeping and the release of medical test results to job

applicants and workers.

The survey results were also interpreted in the

context of a 1982 OTA survey on genetic monitoring

and screening (part of the 1983 OTA assessment The

Role of Genetic Testing in the Prevention of

Occupational Disease). Trend data on the use of

genetic monitoring and screening can be obtained by

tabulating comparable questions in the 1989 and

1982 surveys. Of the 330 Fortune companies (62.4

percent) responding to the 1989 survey, 20 health

officers reported that their companies had conducted

genetic monitoring or screening, either currently or

in the past 19 years. In comparison, the 1982 survey

found 18 health officers in the Fortune 500 sample

who reported current or past use. Thus, there has

been little change between 1989 and 1982 in the

number of companies that had used genetic monitoring or screening in the workplace.

In summary, the 1989 survey found 12 Fortune

500 companies reporting current use of genetic

monitoring or screening for research or any other

reason. The ratio of current to past use of monitoring

or screening was reversed in 1982, with 6 companies

indicating current use of genetic monitoring or

screening and 12 companies indicating past but not

current use.

PREEMPLOYMENT SCREENING

The OTA survey briefly explored corporate policy concerning an illustrative range of job applicant

attributes that might affect employment eligibility.

Some job qualifications involve experience and

skills, while others may relate to cost or risk (e.g.,

loss, casualty, or liability) that the applicant represents to the company.

Fifty-two percent of corporate personnel officers

surveyed reported that their companies had a policy

concerning hiring persons with criminal records. Of

those companies having such policies, over a third

(37 percent) said their policies prohibited the hiring

of applicants with criminal records, while 8 percent

said their policies did not. Fifty-four percent in

companies with such policies said it depended on the

situation. Cigarette smoking is an example of a

personal habit that may represent potential costs to

the employer. Despite the fact that cigarette smoking

is recognized as a behavior carrying significant risks

for cancer, heart disease, and other negative health

outcomes, only 8 percent of personnel officers

reported that their companies had policies concerning hiring cigarette smokers. Nearly a third (29

percent) of those companies with policies said that

it was against corporate policy to hire smokers,

while 46 percent said that it was not. Nineteen

percent in companies with such policies said the

circumstance would dictate the hiring of smokers.

OTA also examined company policies on preexisting medical conditions. Personnel officers in more

than a third (35 percent) of the companies responding to the OTA survey reported having company

policies concerning hiring persons with preexisting

medical conditions. Sixty-nine percent of such

–3–
4 ● Medical Monitoring and Screening in the Workplace: Results of a Survey

companies said it depended on the situation, while 6

percent said it was against corporate policy to hire

those with preexisting medical conditions. Nineteen

percent said it was not against corporate policy to

hire them.

Finally, OTA found 5 percent of companies

having a policy on hiring persons with increased

genetic susceptibility to substances or conditions in

the workplace. Of those companies with a policy,

five percent said their policies prohibited the hiring

of such people, while 13 percent said their policies

did not.

These three areas did not exhaust the range of

employee characteristics that might be factored into

an employment decision. However, they provided a

simple illustration that large companies had identified a range of factors that could affect a job

applicant’s employment eligibility. All of these

factors represented preexisting conditions (criminal

record, smoking, genetic or medical conditions)

which may or may not influence the applicant’s

ability to do the job. Few companies reported a

straight-forward policy of excluding persons with

criminal records, who smoke cigarettes, or with

preexisting genetic or medical conditions from

eligibility for employment. In at least some of these

areas, a substantial proportion of large companies

had employment policies that may have excluded

such people from some jobs or under certain

conditions.

The majority of health officers responding to the

survey (69 percent) reported that there were no

specific medical criteria, other than those mandated

by regulation, that excluded job applicants from

specific jobs, sites, or positions in their companies.

However, 27 percent of the health officers reported

the existence of medical criteria that affected the

employment eligibility of job applicants. These

included back ailments or problems, pregnancy,

sensitivity to materials used in production, and

respiratory conditions.

Medical examinations are often required as a

condition of employment for job applicants in large

corporations. 1 When asked whether preemployment

health examinations are required of all, most, some,

few, or no job applicants, about half of the health

officers (49 percent) reported that preemployment

health examinations were required of all job applicants. An additional 10 percent of respondents

reported their companies required preemployment

medical examinations of most job applicants.

Health and personnel officers were queried about

what preemployment examinations they considered

acceptable. Large majorities considered tests acceptable when they are used to identify applicants who

were either physically unfit for employment (92

percent and 89 percent, respectively), currently

using drugs (86 percent and 89 percent, respectively), at increased risk to workplace hazards (85

percent and 84 percent, respectively), or emotionally

and psychologically unstable (77 percent and 73

percent, respectively).

The use of preemployment tests to identify job

applicants who represented high insurance risks was

found to be acceptable to a smaller proportion of

health and personnel officers, 49 percent and 53

percent, respectively. Similarly, about half the

health officers (51 percent) and personnel officers

(52 percent) said their companies would approve of

preemployment health exams to screen for job

applicants with genetic susceptibility to workplace

exposures.

Corporate personnel officers were asked about

some of the types of preemployment exams that job

applicants might be required to have. Fifty-one

percent of personnel officers reported that routine

physical exams were required of all applicants, as a

condition of employment. Drug testing, as part of

preemployment examinations for all applicants was

reported by 38 percent of personnel officers. The

majority (81 percent) of personnel officers responded that personality and/or psychological testing was never required of job applicants.

In companies where examination of job applicants was required, personnel officers were asked

whether it was company policy to inform applicants

of any positive test results. In most cases (81

percent), the corporate personnel officers reported

that company policy was to inform applicants of

positive test results from their preemployment

examination. However, 16 percent of the corporations conducting preemployment health examinalme OTA Suey was conduct~ prior to enactment of the Americans with Disabilities Act (ADA) (Public Law 101-336). Beginning in JdY 1992,

ADA bars preemployment medical examina tions unless they are job-related and consistent with business necessity. Bxamining the ADA’s effect on the

practices uncovered by this survey is beyond the scope of this background paper.
Chapter l-Summary and Overview ● 5

tions as part of their hiring practices reported that it

was not company policy to inform applicants of

positive test results.

Corporate health officers were asked whether

their office or the corporate personnel office decided

which specific tests would be included in

preemployment screening. Over half (53 percent)

said the corporate personnel office made the decision. By contrast, only 27 percent said the corporate

health office determines which tests were included

in preemployment screening of job applicants.

MONITORING WORKER HEALTH

Medical screening in the workplace involves

evaluating job applicants using certain medical

criteria before they are hired, or the periodic

examination of workers already employed. It can

range from a cursory questionnaire to an oral history

to a full preemployment physical, and is usually not

intended to be diagnostic. Medical monitoring, on

the other hand, involves the periodic evaluation of

employees for either the effects of a toxic substance

or its byproducts. A portion of the workforce in

many large corporations is exposed to workplace

conditions or substances that represent a health risk

to some or all employees. Two examples of such

workplace risks are chemicals and ionizing radiation. Some workplace hazards impose an equal risk

on all employees. However, other workplace exposures represent special risks to certain employees,

depending on their individual characteristics. One

mechanism a company has to detect any damage the

worker might be incurring as a result of such

exposure is to conduct some form of medical

monitoring.

The survey indicated the requirement for preemployment health examinations of job applicants was

accepted by a majority of corporate personnel

officers-regardless of whether there were known

health risks in the workplace setting. A somewhat

different picture emerged from the survey data

regarding the appropriateness of corporate monitoring of employee health when there were no known

health risks.

The majority (61 percent) of personnel officers

considered it inappropriate to require periodic medical testing of employees in workplace settings where

there were no known risks. However, the attitude

toward employee health monitoring changed radically when there were known health risks in the

workplace setting. Almost universally, corporate

personnel officers (93 percent) thought periodic

medical testing of employees in workplace settings

where there were known health risks was appropriate.

The survey explored what, if any, types of exams

companies require as part of ongoing worker health

evaluation. It was found that hearing tests were the

most commonly used type of ongoing medical

monitoring used by companies. Forty-one percent of

health officers reported that hearing tests were

required of at least some employees. Other medical

monitoring required included chest x-rays (36 percent), blood chemistry tests (35 percent), and vision

tests (32 percent). Corporate personnel officers in

companies that conducted periodic medical testing

of their employees reported, almost universally

(93 percent), that it was company policy to refer

employees to appropriate health care providers, if

positive test results were obtained. Five percent said

it was not company policy to refer to appropriate

providers.

The OTA survey found that the corporate personnel office of companies surveyed determined the

tests to be used in both job applicant screening and

employee health surveillance more often than the

corporate health office. Thirty-seven percent of

health officers reported that the corporate personnel

office-not the corporate health office-determined

which specific tests were conducted as part of

employee health surveillance. By contrast, only 28

percent said that the corporate health office determined which tests were part of employee health

surveillance. Fourteen percent said the location

health office determined which tests were used, and

14 percent said the location personnel office made

the determination.

The cost-effectiveness of medical tests is an

important issue for companies when deciding

whether to implement a particular test for routine

monitoring. The majority reported as cost-effective

the use of periodic blood pressure testing (75

percent) and periodic drug testing (72 percent). Few

companies (11 percent) reported periodic medical

testing for chromosomal abnormalities was costeffective for companies. The current consensus

among corporate personnel officials was that the

cost-effectiveness to the company of many forms of

employee health monitoring did not extend to

genetic monitoring for chromosomal abnormalities.
6 ● Medical Monitoring and screening in the Workplace: Results of a Survey

Medical monitoring and screening of job applicants and employees creates medical records on their

past and current health conditions. An issue of major

concern is the use of such test findings and who in

a company will have access to them. Health officers

were asked which corporate office maintains employee health records. The responsibility for employee health records appeared to be evenly divided

between the medical or occupational health office

and the personnel office. Almost half (47 percent) of

responding health officers said employee health

records in their companies were located in the

medical or occupational health office. Forty-five

percent reported the personnel office was responsible for employee health records.

Health officers were asked who had access to

medical records and under what situations access

was allowed. The health officers, identified by the

survey as frequently responsible for employee health

records, were asked about the access to those

records. For each of nine parties, the questionnaire

asked: “Does your company permit access to

employee medical records—at company discretion,

with employee permission, or both?” About 28

percent of health officers reported that access to

employee medical records by the personnel department required the employee’s permission. On the

other hand, a similar amount (29 percent) reported

that the company permitted the personnel department access to those records at company discretion.

A quarter (24 percent) reported that access was

permitted both at company discretion and with

employee permission.

Only a small proportion of companies permitted

access to employee medical records to other interested parties without the permission of the employee. The reported incidence of permitting thirdparty access to employee records, at company

discretion, was 15 percent for disability insurance

carriers, 15 percent for health insurance carriers,

13 percent for life insurance carriers, 4 percent for

other companies, and 3 percent for unions.

The employee’s access to his or her own medical

records posed another issue. The survey indicated

that in 4 in 10 (41 percent) cases, the employee’s

request was sufficient for the employee to gain

access to his or her own medical records. However,

about a third of the health officers (36 percent)

reported that access to those records by the employee

was permitted either at the company discretion or

required both company and employee permission.

GENETIC MONITORING AND

SCREENING: PRACTICES AND

POLICIES

Corporate personnel and health officers were

asked the same series of questions about the

acceptability within their companies of using genetic monitoring and screening for various purposes.

The parallel series of questions allows a comparison

of differences in acceptability of such tests in the

workplace between those responsible for employee

health and those responsible for personnel matters in

large corporations.

A majority of the personnel officers surveyed (56

percent) said that their companies considered the use

of genetic monitoring and screening for employees

or job applicants as generally acceptable to inform

employees of their increased susceptibility to

workplace hazards. This rate was similar to that of

health officers (50 percent).

The survey found some differences between

health and personnel officers in their perceptions of

the acceptability of genetic tests for some of the

other types of occupational health monitoring in

their companies. However, the more striking finding

is that companies appear to be fairly evenly split

over the acceptability of using genetic monitoring

and screening in the workplace for the benefit of

either the employee or the employer.

In order for companies to make decisions about

the feasibility of genetic monitoring and screening,

they must decide if the tests are cost-effective. The

survey found that cost-effectiveness of genetic

monitoring and screening influenced corporate decisions on implementing such programs. Only a small

proportion of corporate personnel officers felt that

any of the uses of such tests explored in the survey

were currently cost-effective. One percent of personnel officers considered the use of direct-DNA

(deoxyribonucleic acid) tests as part of preemployment screening currently cost-effective for their

companies, while the use of biochemical genetic

screening tests as part of preemployment screening

was considered as cost-effective by 3 percent of the

personnel officers surveyed. Seven percent considered the use of genetic screening to detect susceptibilities to workplace hazards as cost-effective, and 8
Chapter 1-Summary and Overview ● 7

percent felt it was cost-effective to conduct genetic

monitoring of all workers exposed to workplace

hazards. However, almost half (45 percent) felt that

such forms of genetic monitoring and screening

were not currently cost-effective.

The future of genetic monitoring and screening in

the workplace depends on corporate attitudes toward

the use of the technology. The possibility that

genetic monitoring and screening may seriously

threaten employee rights is a key concern surrounding its use. To gauge employer sensitivity to

this issue, health officers were asked whether they

agreed or disagreed that genetic monitoring and

screening pose such a threat. The survey found that

health officers were aware of the concern. Over half

(58 percent) of the health officers responding to the

survey agreed with the idea that genetic screening

represented a potential threat to the rights of

employees. Interestingly, those who reported current

genetic monitoring and screening were most likely

(79 percent) to agree that such testing represented a

potential threat to employees.

Since most health officers (62 percent) felt the

decision to conduct genetic monitoring and screening should rest with the employer, one might expect

relatively little enthusiasm about a government role

in the issue of genetic monitoring and screening.

However, a majority of health officers agreed that

government agencies should provide guidelines for

genetic monitoring (60 percent) and screening (58

percent) of job applicants and employees. In companies currently using such genetic tests, the majority

(71 percent) agreed that government agencies should

provide guidelines in these areas. The interest in

government guidelines, however, should not be

surprising given the recognition of the potential

threat to employee rights raised by the technology,

and the division of opinions over the proper uses of

such tests.

Cost-effectiveness is not the only consideration

for employers in deciding whether to use genetic

monitoring and screening. In addition, respondents

voiced concerns about the tests’ reliability and

legality, the liability associated with using them as

well as fair and appropriate uses of the technology.

The survey identified one factor that changes the

perceived cost-effectiveness of genetic monitoring

and screening in the workplace: the health insurance

risk to the employer of the employee with a genetic

disease, condition, or trait. The personnel officers

were asked about the degree to which health

insurance risk, among otherwise able-bodied job

applicants, affected employment decisions. The

majority of personnel officers (55 percent) reported

that the health insurance risk of an otherwise healthy

job applicant would not affect the likelihood of the

applicant being hired by their companies. However,

the survey found that in more than two out of five

companies (42 percent) the health insurance risk

(i.e., the risk of incurring health care costs) of the job

applicant reduced the likelihood of an otherwise

healthy, able job applicant being hired “a lot”

(3 percent) or “some” (39 percent).

The effect of concerns about health care risk on

employee testing was not simply theoretical. About

1 in 10 personnel officers (11 percent) reported that

the health insurance risk of job applicants was

assessed on a routine basis. Another quarter of the

companies (25 percent) reported that the health

insurance risk of job applicants was assessed sometimes. Hence, while a majority of companies

(63 percent) reported that they never assessed the

health insurance risk of job applicants, more than

one-third (36 percent) reported that they did assess

health insurance risk, though not necessarily on a

routine basis.

The growing concern among employers over the

rising costs of employee health insurance, and the

increased efforts to reduce those costs to the

employer could increase the scope of health insurance screening in the workplace. The costeffectiveness of employee monitoring and screening

may increase to the extent that genetic monitoring

and screening can identify employee and dependent

risks to atypical subsequent health care demands.

It is important to keep in mind, however, that the

OTA survey found that little genetic monitoring and

screening is currently being conducted by employers. The survey provides no data that it is currently

being used for health insurance screening purposes,

nor does it suggest that is the case. Moreover, only

a handfull of companies not currently conducting

genetic monitoring and screening anticipated doing

so in the next few years. Based on the survey

findings, the specter of health insurance screening

appears to be the factor most likely to alter the

current and anticipated pattern of use of genetic

monitoring or screening in the workplace.
Chapter 2

Preemployment Screening Practices
CONTENTS

Page

Corporate Policy and Employment Qualifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

criminal Records ... ... ..*. *.. ..............**+.*..*+*****"""""""*"**""`*""""'"

Cigarette Smoking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Preexisting Medical Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Genetic Susceptibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● ”. + ● ● ●

Employee Health Qualifications ... ..............................*.*****...""*"""`""

Preemployment Health Examinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Appropriate Use of Preemployment Examinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Types of Preemployment Examinations . . . ............................*********+.,

Screening for Nonadministrative Positions ... ... .*. ..*. ..*. * * * * * Q * . * * * * . * **.***..*

Release of Examination Results to Applicants . . . . . ..........*..*......****+*.****.

Who Decides on Preemployment Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tables

Table

2-1. Corporate Policy Concerning Hiring of Employees . . . . . . . . . . . . . . . . . . . . . . . . . . .

2-2. Corporate Policy Concerning Hiring of Employees . . . . . . . . . . . . . . . . . . . . . . . . . . .

2-3. Employee Health Qualifications for Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2-4. Medical Criteria for Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2-5. Jobs Excluded by Medical Criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2-6. Medical Criteria for Employment Exclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2-7. Corporate Requirements for Preemployment Health Examinations .’.. . . . . . . . . . .

2-8. Views on Preemployment Health Exams When There Are

Known Health Risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● . . . . . +.... ” +.

2-9. Views on Preemployment Health Exams When There Are

No Known Health Risks . .....***.*...........*..**..**.. . . . . . . . . . . . . . . . . . . .

2-10. Views on Preemployment Health Exams To Identify Applicants Who

Represent Risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2-11. Preemployment Screening Requirements , . ..,..**........*...*........**.+****

2-12. Tests Conducted for Preemployment Examinations . . . . . . . . . . . . . . . . . . . . . . . . . . .

2-13.

2-14.

2-15.

2-16.

2-17.

Preemployment Test Policies: Informing Applicants of Positive Results . . . . . . . .

Types of Preemployment Exam Results Normally Released . . . . . . . . . . . . . . . +...

How Information on Preemployment Exams Is Normally Released . . . . . . . . . . . .

Company Referrals to Health Care Providers If Positive Results

Are Obtained From Preemployment Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Company Office That Determines Inclusion of Tests in

Preemployment Screening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Chapter 2

Preemployment Screening Practices

As part of the Office of Technology Assessment

(OTA) survey, several questions were asked about

various preemployment screening policies of companies.

CORPORATE POLICY AND

EMPLOYMENT

QUALIFICATIONS

There are normally minimum quaifications required of job applicants for positions within a

company. At minimum, applicants must have the

ability to perform the job for which they are being

considered. Some of these job quaifications may be

based on experience, some on training, and some on

aptitude. Other employment qualifications may

relate to possible costs or risks (e.g., loss, casualty,

and liability) that the job applicant represents as an

employee to the company. The OTA survey briefly

explored corporate policy concerning an illustrative

range of job applicant attributes that might affect

employment eligibility.

Criminal Records

Fifty-two percent of corporate personnel officers

surveyed reported that their companies had a policy

concerning hiring persons with criminal records

(table 2-l). Of those companies having such policies, over a third (37 percent) said their policies

prohibited the hiring of applicants with criminal

records while 8 percent said their policies did not.

Fifty-four percent reported that individual circumstances played a role in such hiring decisions—there

‘was neither a blanket acceptance nor rejection of

applicants with criminal records (table 2-2).

Cigarette Smoking

Cigarette smoking is recognized as a behavior

carrying significant risks for cancer, heart disease,

and other negative health outcomes. Nonetheless,

only 8 percent of corporate personnel officers

reported that their companies had a policy concerning hiring cigarette smokers. Nearly a third (29

percent) of those companies with a policy said that

it was against corporate policy to hire smokers,

while 46 percent said that it was not. Nineteen

297-942 - 91 - 2 : QL3

percent said the circumstance would dictate the

hiring of smokers.

Preexisting Medical Conditions

Personnel officers in more than a third (35 percent)

of the companies responding to the OTA survey

reported that a corporate policy concerning hiring

persons with preexisting medical conditions existed.

The likelihood of a company establishing a policy

concerning preexisting medical conditions varied

little with firm size. Among companies with fewer

than 5,000 employees, 37 percent had policies about

hiring persons with preexisting conditions. An

equivalent proportion (38 percent) of companies

with 5,000 to 9,999 employees had such policies. A

slightly smaller proportion (31 percent) of companies with 10,000 or more employees had policies

concerning hiring persons with preexisting conditions.

Only 6 percent of companies that had a policy

concerning employment of persons with preexisting

conditions said hiring such applicants violated

company policy. On the other hand, only 19 percent

reported that it was not against policy to hire them.

In the majority of cases (69 percent), when such a

policy existed, the hiring of an individual with a

preexisting condition may or may not have been

against company policy-employment was presumably based on the nature of the condition.

Genetic Susceptibility

Only 5 percent of companies reported having a

corporate policy concerning hiring persons with

increased genetic susceptibility to substances or

conditions in the workplace. Of those companies

with a policy, 5 percent said their policies prohibited

the hiring of people with an increased genetic susceptibility to substances or conditions in the workplace, while 13 percent said their policies did not.

Twenty-two percent did not answer the question.

These four areas did not exhaust the range of

employee characteristics that might be factored into

an employment decision. However, they provided a

simple illustration that large companies had identified a range of factors that could affect a job

applicant’s employment eligibility. All of these

–11–
12 ● Medical Monitoring and Screening in the Workplace: Results of a Survey

Table 2-l-Corporate Policy Concerning Hiring of Employees

Q.12a. Does yourcompanyhave a policy concerning hiring: cigarette smokers; persons with criminal records; persons with preexisting

medical conditions; persons with increased genetic susceptibility to substances or conditions in the workplace?

(Base: Personnel officers)

Have policy (in percent)

Unweighed h Don’t No

Base Yes No knowa

answer

Cigarette smokers.. . . . . . . . . . . . . . . . . . . . . . . . . . (569) 8 91 0 1

Persons with criminal records . . . . . . . . . . . . . . . . . (569) 52 45 ●

3

Persons with preexisting medical conditions. . . . . (569) 35 62 * 2

Persons with increased susceptibility to substances

or conditions in workplace . . . . . . . . . . . . . . . . . . (569) 5 91 ●

4

aVolunteered response.

“Indicates less than 1 percent.

SOURCE: Office of Technology Assessment, 1991.

Table 2-2-Corporate Policy Concerning Hiring of Employees

Q.12b. Generally speaking, would you say it is against company policy to hire: cigarette smokers; persons with criminal records; persons

with preexisting medical conditions; persons with increased genetic susceptibility to substances or conditions in the workplace?

(Base: Personnel officers in companies with hiring policies covering persons asked about)

Against policy to hire (in percent)

Unweighed Don’t No

base Yes No Depends know” answer

Cigarette smokers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ( 43) 29 46 19 0 7

Persons with criminal records. . . . . . . . . . . . . . . . . . . . (269) 37 8 54 ●

2

Persons with preexisting medical conditions. . . . . . . . (21 1) 6 19 69 ●

6

Persons with increased susceptibility to substances or

conditions in workplace . . . . . . . . . . . . . . . . . . . . . . . ( 28) 5 13 60 0 22

a

volunteerd response.

‘Indicates less than 1 percent.

SOURCE: Office of Technology Assessment, 1991.

factors represented preexisting conditions (medical

or genetic condition, criminal record, smoking) that

may or may not bear on the applicant’s ability to do

the job. Few companies reported a straightforward

policy of excluding persons with criminal records,

who smoke cigarettes, or with preexisting medical or

genetic conditions from eligibility for employment.

Nonetheless, in at least some of these areas, a

substantial proportion of large companies had employment policies that may have excluded such

persons from some jobs or under certain conditions.

EMPLOYEE HEALTH

QUALIFICATIONS

Although the survey did not test the proposition,

it might be expected that most employers would

require that a job applicant or employee be physically fit or able to perform a job, in order to be

considered for the position. However, it is not easy

to specify what “physically fit’ or “able’ means in

a positive fashion. Therefore, the survey investigated whether companies had established negative

health criteria for employment.

The majority of health officers responding to the

survey (69 percent) reported that there were no

specific medical criteria, other than those mandated

by regulation (e.g., chest x-rays for certain jobs), that

excluded job applicants from specific jobs, sites, or

positions in their companies. However, 27 percent of

the health officers reported the existence of medical

criteria that affected the employment eligibility of

job applicants (table 2-3). The existence of medical

criteria for employment was reported most frequently in the industry areas of electric utilities

(65 percent), other chemicals (43 percent), and

pharmaceuticals (40 percent).

Space was provided for health officers to write in

which specific medical criteria excluded employment in which jobs. A variety of medical criteria

was cited that excluded job applicants or employees

from at least some jobs. In companies that reported

medical criteria for at least some jobs, the conditions
Chapter 2-Preemployment Screening Practices . 13

Table 2-3-Employee Health Qualifications for

Employment

Q.6. Are there any specific medical criteria, other than those

mandated by regulation, that would exclude individuals from

eligibility for certain positions, jobs, or sites in your company

(e.g., hypersensitivity to dust or platinum, pregnancy)?

(Base: Health officers)

Have policy (in percent)

Unweighed No

base Yes No answer

Total . . . . . . . . . . . . . . . (494) 27 69 4

Type of business

Electrical utility . . . . . ( 39) 65 32 2

Pharmaceutical . . . . (21) 40 58 1

Other chemical . . . . . (42) 43 56 2

Petroieum . . . . . . . . (5) 38 62 O

Electronic . . . . . . . . . (19) 39 0

Other

manufacturing . . . (154) 29 65 7

Nonmanufacturing . . (214) 2 5 72 3

SOURCE: Office of Technology Assessment, 1991.

most often cited as excluding employment were

back ailments or problems (29 percent) and visual

acuity or sight impairment (14 percent) (table 2-4).

Other frequently cited conditions that excluded

applicants from some jobs included pregnancy (8

percent), diabetes (7 percent), hearing impairment or

deafness (6 percent), and sensitivity to materials

used in production (6 percent). Respiratory conditions, in general (6 percent), and asthma, in particular (2 percent), were also cited.

Other medical conditions that excluded employment in certain jobs were also reported by some

health officers. These exclusionary conditions included: epilepsy (5 percent), heart conditions (5 percent), sensitivity to chemicals (4 percent), acquired

immune deficiency syndrome (AIDS)/human

immunodeficiency virus (HIV) infection (4 percent),

color blindness (3 percent), and renal diseases (1

percent). Drug use was also cited (4 percent) as a

medical criterion that excluded employment in some

jobs. The survey did not determine the consequences

to an employee if one of these conditions developed

after being hired.

A small number (9 percent) of the health officers

reporting medical requirements for employment

indicated that the criteria excluded the employee

from all, most, or even a wide variety of jobs (table

2-5). The jobs most often excluded for persons that

do not meet certain medical criteria were positions

requiring heavy lifting or physical labor (20 percent). Other jobs excluded by medical criteria

Table 2-4-Medical Criteria for Employment

Q.6a. Which medical criteria would exclude employment (in

which jobs)?

(Base: Health officers in companies that exclude individuals from

certain positions)

Unweighed base

Medical criteria

Back aliments/problems . . . . . . . . . . . . . . . . . . . . . .

Visual impairment/problems with vision . . . . . . . . .

Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hearing impairment/deafness . . . . . . . . . . . . . . . . .

Respiratory problems/conditions. . . . . . . . . . . . . . .

Sensitivity to production materials. . . . . . . . . . . . . .

Epilepsy/epileptic seizures . . . . . . . . . . . . . . . . . . .

Heart/cardiac conditions/diseases.. . . . . . . . . . . . .

AIDS/HIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Allergies/sensitivity to chemicals . . . . . . . . . . . . . . .

Drug use/abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Medical conditions (unspecified) . . . . . . . . . . . . . . .

Allergic reactions/sensitivity. . . . . . . . . . . . . . . . . . .

Color blindness . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sensitivity to dust . . . . . . . . . . . . . . . . . . . . . . . . . . .

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Medical conditions aggravated by work

environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Renal/kidney conditions/diseases . . . . . . . . . . . . . .

Alli other mentions . . . . . . . . . . . . . . . . . . . . . . . . . . .

No answer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(178)

29%

14

8

7

6

6

6

5

5

4

4

4

4

3

3

3

2

1

1

32

15

SOURCE: Office of Technology Assessment, 1991.

Table 2-5-Jobs Excluded by Medical Criteria

Q.6b. In which jobs would employment be excluded by certain

medical criteria?

(Base: Health officers in companies that exclude individuals from

certain positions)

Unweighed base

Jobs excluded

Jobs/positions requiring lifting/heavy lifting/

physical labor . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Exposure to miscellaneous workplace elements . . .

Jobs involving driving/vehicle/mobiIe operations. . .

Exposure to chemicals/chemical toxins . . . . . . . . . .

Exposure to radiation/radioactive materials . . . . . . .

Jobs involving heavy machinery/equipment

operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Jobs/positions requiring good vision/visual acuity. .

Jobs requiring respiratory protection . . . . . . . . . . . . .

Jobs involving heights/climbing/high elevation . . . . .

Exposure to Iead/heavy metals . . . . . . . . . . . . . . . . .

Exposure to materials harmful during pregnancy . . .

Most/various/all positions . . . . . . . . . . . . . . . . . . . . . .

All other mentions . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No answer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(178)

20%

7

5

5

4

4

3

3

2

2

1

9

25

2

SOURCE: Office of Technology Assessment, 1991.

included those involving driving (5 percent), exposure to chemicals (5 percent), exposure to radiation

(4 percent), heavy machinery (4 percent), and those

requiring good vision (3 percent) and respiratory

protection (3 percent).
14 ● Medical Monitoring and Screening in the Workplace: Results of a Survey

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Chapter 2-Preemployment Screening Practices . 15

It is interesting to examine a couple of examples

in depth (table 2-6). Health officers were given three

blank spaces to write in medical criteria that

excluded employment in certain jobs. Of the 41

cases where back problems were cited as a reason for

excluding people from jobs, 30 of them were for jobs

requiring lifting, 2 were for jobs involving heavy

machinery, 3 were for jobs involving heights, 1 was

for exclusion for most, various, or all positions, and

8 were for other reasons. (This table presents data

from all three mentions that health officers made.)

Drug abuse was cited as a cause for job exclusion in

14 cases-2 involving driving, 1 exposure to chemicals, 10 for most, various, or all positions, and 2 for

other reasons.

Preemployment Health Examinations

Medical examinations are often required of applicants for jobs in large corporations.l When asked

whether preemployment health examinations are

required of all, most, some, few, or no job applicants,

about half of the health officers (49 percent) reported

that preemployment health examinations were required of all job applicants. Moreover, the survey

found 59 percent of respondents reported their

companies required preemployment medical examinations of all or most job applicants (table 2-7).

The notion of required preemployment examinations was widely accepted as appropriate. Virtually

all (94 percent) corporate personnel officers surveyed considered it appropriate to require preemployment health examinations of job applicants in

workplace settings where there were known risks

(table 2-8). However, the survey indicated that the

existence of known risk was not primarily responsible for the acceptability of preemployment examinations. Even when there were no known health risks,

two-thirds (67 percent) of corporate personnel directors considered preemployment health examinations

of job applicants appropriate (table 2-9).

Appropriate Use of Preemployment

Examinations

The OTA survey asked corporate health and

personnel officers what their company policies were

toward some of the possible purposes and uses of

preemployment medical exams. Identical questions

Table 2-7-Corporate Requirements for

Preemployment Health Examinations

Q.1. In your company, are preemployment health examinations

required of all, most, some, few, or no job applicants?

(Base: Health officers)

Unweighed base (494)

All job applicants . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49%

Most job applicants . . . . . . . . . . . . . . . . . . . . . . . . . 10

Some job applicants. . . . . . . . . . . . . . . . . . . . . . . . . 7

Few job applicants . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

No answer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

SOURCE: Office of Technology Assessment, 1991.

Table 2-8-Views on Preemployment Health Exams

When There Are Known Health Risks

Q.2. Do you think it is generally appropriate or generally inapproptiate for a company to require preemployment health

examinations of job applicants in workplace settings where

there are known health risks?

(Base: Personnel officers)

Unweighed base (569)

Appropriate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94%

Inappropriate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

No answer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

SOURCE: Office of Technology Assessment, 1991.

Table 2-9-Views on Preemployment Health Exams

When There Are No Known Health Risks

Q.1. Do you think it is generally appropriate or generally inappropriate for a company to require preemployment health

examinations of job applicants in workplace settings where

there are no known health risks?

(Base: Personnel officers)

Unweighed base (569)

Appropriate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67%

Inappropriate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Don’t knowa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ●

No answer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

aVolunteered response.

‘Indicates less than 1 percent.

SOURCE: Office of Technology Assessment, 1991.

were put to both corporate health officers and

personnel officers to see whether their different roles

might produce different norms concerning company

policies on the uses of medical information collected

from job applicants.

l~e OTA ~ey wss conducted prior to enactment of the Americans with Disabilities Act (ADA) (Public I.aw 101-336). Be-g in JulY 19% < ADA bars preernployment medical examina tions unless they are joMelated and consistent with business necessity. Ex amining the ADA’s effect on the

practices uncovered by this SUIVey is beyond the scope of this background paper.
16 ● Medical Monitoring and Screening in the Workplace: Results of a Survey

Table 2-10-Views on Preemployment Health Exams To Identify Applicants Who Represent Risks

Q.2. Would your company consider it acceptable or unacceptable to conduct a preemployrnent health examination in order to identify job

applicants?

(Base: Health officers/personnel officers)

Percent

Unweighed Un- Don’t No

base Acceptable acceptable Dependsa

know answer

Who are physically unfit for employment:

Health officers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Personnel officers . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Who are emotionally or psychologically unstable:

Health officers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Personnel officers . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Who are currently using drugs:

Health officers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Personnel officers . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Who are at increased risk to workplace hazards:

Health officers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Personnel officers . . . . . . . . . . . . . . . . . . . . . . . . . . . .

With genetic susceptibility to workplace exposures:

Health officers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Personnel officers . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Who represent high insurance risks:

Health officers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Personnel officers . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5

0

(400)

(542)

92

89

3

10

0

0

0

0

●

o

1

1

9

3

(400)

(542)

77

73

14

23

7

9

0

0

●

1

7

2

(400)

(542)

86

89

(400)

(542)

85

84

8

13

0

0

●

o

7

3

(400)

(542)

51

52

34

40

1

0

1

1

13

6

0

0

(400)

(542)

49

53

40

41

1

●

10

6

wolunt~red response.

‘Indicates less than 1 percent.

SOURCE: Offics of Technology Assessment, 1991.

Physical Fitness Workplace Risks

The majority of personnel and health officers also

reported that the use of preemployment examinations would be considered acceptable in their

companies to identify job applicants who were at

increased risk to workplace hazards. Six out of

seven personnel officers (84 percent) reported that

their companies would consider it acceptable to

screen job applicants for increased risk to workplace

hazards. About the same proportion of corporate

health officers (85 percent) concurred.

There was almost universal agreement among

corporate health and personnel officers that their

companies would consider it acceptable to conduct

preemployment medical examinations to identify

job applicants who were physically unfit for employment. Nine out of ten (89 percent) corporate

personnel officers said that their companies would

consider it acceptable to conduct a preemployment

health examination for that purpose. About the same

proportion (92 percent) of corporate health officers

agreed that this use of preemployment examinations

would be acceptable (table 2-10). Emotional and Psychological Stability

The majority of corporate officials responding to

the survey also reported that their companies would

consider the use of preemployment health exams to

identify persons who were emotionally or psychologically unstable as appropriate. Nearly 3 out of 4

personnel officers (73 percent) said that the use of

preemployment exams for this purpose would be

considered acceptable to their companies. A similar

proportion of health officers (77 percent) agreed that

this use of preemployment health examinations

would be acceptable.

Drug Use

The acceptability of using preemployment health

examinations to identify job applicants who were

currently using drugs was also almost universal.

Nine out of ten personnel officers (89 percent) said

that their companies would consider it acceptable to

conduct preemployment examinations for that purpose. A similar proportion of health officers (86

percent) agreed with them.
Chapter 2-Preemployment Screening Practices ● 17

Table 2-11—Preemployment Screening Requirements

Q. IO. As part of your preemployment hiring practices, do you currently require each of the following as a condition of employment for all

applicants, only applicants for certain plants or job classifications or histories, or for no applicants?

(Base: Personnel officers)

Percent

Selected Selected

Unweighed Al l plants/ renditions/ No

base applicants jobs histories Botha None answer

Routine physical examination. . . . . . . . . (569) 51 14 3 1 31 1

Other medical criteria, e.g., lower back

x-ray, allergy testing . . . . . . . . . . . . . . . (569) 10 18 11 2 56 2

Personality/psychological testing . . . . . . (569) 2 9 5

* 81 3

Drug testing . . . . . . . . . . . . . . . . . . . . . . . (569) 38 10 1

* 48 3

“Both “plankJjobs” and “conditionsJhistories” volunteered.

“Indicates less than 1 percent.

SOURCE: offi~ of Technology Assessment, 1991.

Insurance Risks

In addition to issues of physical and behavioral

suitability for employment, the health and personnel

officers were asked about the acceptability of using

preemployment health examinations to identify job

applicants who represented high insurance risks.

About half (53 percent) of the corporate personnel

officers surveyed reported that screening for high

insurance risk would be an acceptable reason for

preemployment examinations in their companies. A

similar proportion of health officers (49 percent)

agreed with them.

Genetic Susceptibility

The survey also found that a majority of the

corporate health and personnel officers concurred

that their companies would consider it acceptable to

screen job applicants for genetic susceptibility to

workplace exposures. Fifty-two percent of personnel

officers and 51 percent of health officers reported

that their companies would approve of a preemployment health examination to identify job applicants

with genetic susceptibility to workplace exposures.

Types of Preemployment Examinations

The survey interviewed the corporate personnel

officers about some of the types of preemployment

examinations that might be required of job applicants.

Physical Examinations

The majority of personnel officers (51 percent)

reported that routine physical examinations were

required as a condition of employment for applicants, regardless of plant or job classifications, or

medical conditions or histories. A smaller number

(14 percent) reported that routine physical examinations were required as a condition of employment for

at least certain plants or job classifications. However, 31 percent of corporate personnel officers

reported that their preemployment hiring practices

required no routine physical examinations for applicants (table 2-1 1).

Drug Testing

Drug testing, as part of preemployment examinations, was also reported by many personnel officers.

Nearly 4 out of 10 (38 percent) companies reported

that drug testing was required as a condition of

employment for all job applicants. In addition,

another 10 percent required drug testing as part of

the preemployment hiring practices for at least

certain plants or job classifications. Only 1 percent

reported that drug testing was restricted to job

applicants with certain medical conditions or histories. Forty-eight percent reported that their preemployment hiring practices required no drug testing

for applicants.

Other Medical Criteria

A number of companies (10 percent) required

other medical criteria, such as lower back x-rays or

allergy testing, for all jobs. However, some companies required other medical criteria as part of their

hiring practices for certain plants or job classifications (18 percent), applicants with certain medical

conditions or histories (11 percent), or both (2 percent). Fifty-six percent reported that their preemployment hiring practices required no other medical

criteria as part of their preemployment hiring

practices.
18 Medical Monitoring and Screening in the Workplace: Results of a Survey

Table 2-1 2—Tests Conducted for Preemployment

Examinations

Q.3. Which of the following are normally part of the preemployment examination in your company for nonadministrative

Positions? a

(Base: Health officers in companies that require preemployment

examinations of job applicants)

Unweighted base (400)

Personal medical history. . . . . . . . . . . . . . . . . . . . . . 93%

Family medical history. . . . . . . . . . . . . . . . . . . . . . . 65

Simple physical examinations . . . . . . . . . . . . . . . . . 89

Standard blood chemistry tests. . . . . . . . . . . . . . . . 55

EKG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Chest x-ray . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Pulmonary function test. . . . . . . . . . . . . . . . . . . . . . 22

Eye and hearing exam . . . . . . . . . . . . . . . . . . . . . . . 67

Urinalysis for drug abuse . . . . . . . . . . . . . . . . . . . . . 54

Lower back x-ray . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Don’t knowb 

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ●

No answer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

aRespondents could give more than one answer.

Wolunteereci response.

“Indicates less than 1 percent.

SOURCE: Office of Technology Assessment, 1991.

By contrast, personality and/or psychological

testing is rare as part of preemployment examinations. Four out of five personnel directors (81 percent) said that it was never required. Whereas,

9 percent reported that personality or psychological

testing was required for certain plants or job

classifications and 5 percent said it was required for

applicants with certain medical conditions or histories. In light of the fact that the majority of corporate

officials reported that their companies would consider using preemployment health exams to identify

persons who were emotionally or psychologically

unstable as appropriate, it is interesting to note that

this type of testing is rare.

Screening for Nonadministrative Positions

Corporate health officers, who reported that

preemployment examinations were required of at

least some employees, were asked what kinds of

tests were normally part of the preemployment

examinations in their companies for nonadministrative positions. A personal medical history was the

most commonly reported requirement (93 percent)

of the preemployment examination (table 2-12).

Many also required simple physical examinations

(89 percent) as part of preemployment examination

for nonadministrative positions. Eye and hearing

exams (67 percent) and family medical histories

(65 percent) were frequently reported as normal

parts of preemployment examinations.

Table 2-13-Preemployment Test Policies: informing

Applicants of Positive Results

Q. Il. Is it company policy to inform applicants of positive test

results?

(Base: Personnel officers in companies that require any type of

examination of job applicants)

Unweighed base (473)

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81%

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Not sure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

No answer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

SOURCE: Office of Technology Assessment, 1991.

In 4 out of 10 (38 percent) companies surveyed,

the corporate personnel officer indicated that drug

testing was required for all positions. The health

officers confirmed this widespread adoption among

large corporations of routine drug testing at the

preemployment stage. Among health officers in

corporations with any preemployment examinations, 54 percent reported that urinalysis for drug use

was a normal part of the preemployment examination for nonadministrative positions. This represents

44 percent of the total health officer sample.

More than half (55 percent) of companies requiring any form of preemployment exams reported

requiring standard blood chemistry tests. A minority

also reported requiring chest x-rays (43 percent) or

pulmonary function tests (22 percent). A lower back

x-ray was required as part of the normal preemployment examination of job applicants by 20 percent of

the companies requiring preemployment exams.

One-sixth (16 percent) said that electrocardiograms

(EKGs) were a normal part of the preemployment

exam.

Release of Examination Results to Applicants

The personnel officers in companies conducting

any type of examination of job applicants as part of

their preemployment hiring practices were asked

whether or not it was company policy to inform

applicants of positive (abnormal findings) test results. In most cases (81 percent), the corporate

personnel officer reported that the company policy

was to inform applicants of positive test results from

their preemployment examination. However, among

the corporations conducting preemployment health

examinations as part of their hiring practices,

16 percent reported that it was not company policy

to inform applicants of positive test results (table

2-13).
Chapter 2-Preemployment Screening Practices 19

Table 2-14-Types of Preemployment Exam Results

Normally Released

Q.4. Which of the following types of preemployment examinations would normally be released to job applicants?a

(Base: Health officers in companies with any form of preempioyment examination)

Table 2-15-How Information on Preemployment

Exams Is Normally Released

Q.5. How would that information normaiiy be released to job

applicants?

(Base: Health officers in companies that normally release results

of preemployment examinations)

Unweighted base (400) Unweighted base (335)

Normal results (negative findings). . . . . . . . . . . . . . 22%

Positive findings already indicated in

medical history . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Positive findings not reflected in medical history.. 21

Positive findings which disqualify them

from employment . . . . . . . . . . . . . . . . . . . . . . . . . 22

Positive findings which affect position/site

eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

All of the above . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

Net: Normal results only..... . . . . . . . . . . . . . . . . . 3

Net: Positive results only. . . . . . . . . . . . . . . . . . . . . 63

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . 12

aRespo~en@ could give more than one answer.

SOURCE: Office of Technology Assessment, 1991.

Corporate health officers were asked a slightly

different question. Those in companies that conducted any form of preemployment examination

were asked what kinds of results from a preemployment examination would normally be released to a

job applicant. Fifty percent reported that both

normal results (negative findings) and any type of

positive findings would usually be released to a job

applicant (table 2-14). In addition, another 22 percent reported that positive findings which disqualified the applicant from employment were

released; 21 percent reported that positive findings

not reflected in the medical history were released;

15 percent reported that positive findings which

affected eligibility for positions or sites were released; and 15 percent reported that positive findings

already indicated in the medical history were released. However, mirroring the response of the

personnel officers, 12 percent of the health officers

in companies conducting preemployment health

examinations reported that no results from the

preemployment exams were normally released to

job applicants.

In companies that release information from the

preemployment health examinations to job applicants, the information was normally released to the

job applicant as part of a consultation with the

medical staff. This was done through a medical

consultation only (47 percent), or with both a letter

and medical consultation (23 percent). Few compaLetter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6%

Consultation with medical staff... . . . . . . . . . . . . . . 47

Both . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Consultation and other . . . . . . . . . . . . . . . . . . . . . . . 2

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

SOURCE: Office of Technology Assessment, 1991.

Table 2-16-Company Referrals to Health Care

Providers If Positive Results Are Obtained From

Preemployment Tests

Q.11a. Is it company policy to refer applicants to appropriate

health care providers if positive test results are obtained?

(Base: Personnel officers in companies that require any type of

examination of job applicants)

Unweighed base (473)

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59%

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Don’t knowa 

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ●

No answer ... , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

avolunteer~ response.

“Indicates less than 1 percent.

SOURCE: Office of Technology Assessment, 1991.

nies reported releasing the information to job

applicants through letters alone (6 percent) (table

2-15).

According to corporate personnel officers in

companies that did release examination results to job

applicants, most companies took steps to refer

applicants with positive results to health care

providers. Six out of ten (59 percent) personnel

officers in companies that released test results said

that it was company policy to refer applicants to

appropriate health care providers if positive test

results were obtained. On the other hand, 36 percent

reported that it was not company policy to refer

applicants with positive results to health care

providers (table 2-16).

Who Decides on Preemployment Tests

Over half (53 percent) of the corporate health

officers surveyed said that the corporate personnel

office determined which specific tests were apart of

the preemployment screening (table 2-17). By contrast, only 27 percent said that the corporate health
20 ● Medical Monitoring and Screening in the Workplace: Results of a Survey

office determines which tests were part of the

preemployment screening of job applicants. In only

a minority of cases did either the health office

(11 percent) or the personnel office (16 percent) at

the location or establishment level determine which

specific tests were performed. These figures added

up to more than 100 percent because some respondents indicated more than one office was involved in

determining which specific tests would be part of the

preemployment screening.

The survey findings indicated that in most companies (72 percent) decisions about specific tests to be

used in preemployment screening were made at the

corporate level. Moreover, in the majority of

companies (63 percent), decisions were made about

preemployment tests by the personnel office, rather

than by the health office.

Table 2-17-Company Office That Determines

Inclusion of Tests in Preemployment Screening

Q.30a. Which office determines whether or not a specific test will

be conducted as part of preemp/oyment screening?a

(Base: Health officers)

Unweighed base (494)

Corporate personnel . . . . . . . . . . . . . . . . . . . . . . . . . 53%

Corporate health . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Location personnel . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Location health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Don’t knowb 

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ●

No answer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Net: Corporate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72

Net: Personnel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

Net: Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

aRespondents could give more than one answer.

bvoluntwr~ response.

‘Indicates less than 1 percent.

SOURCE: Office of Technology Assessment, 1991.
Chapter 3

Monitoring Worker Health
CONTENTS

Page

Workplace Risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Chemicals and Ionizing Radiation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Individual Susceptibility to Risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Medical Surveillance of Employees . . . . . . * . . . . . . . . . * * . . . . * . . * . + . . . * . * . . . * . ..*.*?..* 24

Appropriateness of Monitoring Worker Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Periodic Medical Testing ... ... . ...................*..**...*.*.*....*+***..*****. 25

Types of Employee Health Evaluations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Employee Medical Records . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Access to Employee Medical Records . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Statistical Recordkeeping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Release of Test Results to Employees and Others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Who Decides on Surveillance Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Cost-Effectiveness of Surveillance Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Chapter 3 Reference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Tables

Table Page

3-1. Employee Exposure to Workplace Hazards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

3-2. Rotation of Employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

3-3. Awareness of Known Workplace Conditions to Which Individual

Susceptibility May Differ .*. e . . . . . * . . . . . . . . * * * * . . . . * . . * . . . . * . . . . . * * .*.*.*.., 25

3-4. Appropriateness of Monitoring When There Is No Known Health Risk . . . . . . . . 25

3-5. Appropriateness of Monitoring When There Is Known Health Risk . . . . . . . . . . . . 25

3-6. Periodic Medical Testing of Persons in Risk Categories . . . . . . . . . . . . . . . . . . . . . . . 26

3-7. Medical Surveillance of Employees With Jobs That May Expose Them to

Environmental Health Risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

3-8. Types of Employee Health Evaluations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

3-9. Company Office Responsible for Employee Health Records . . . . . . . . . . . . . . . . . . . 28

3-10. Company Access to Employee Records . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

3-11. Statistical Recordkeeping of Job Termination Reasons . . . . . . . . . . . . . . . . . . . . . . . . 29

3-12. Statistical Recordkeeping of Job Termination Reasons . . . . . . . . . . . . . . . . . . . . . . . . 29

3-13. Informing Employees of Periodic Medical Testing Results .,. . . . . . . . . . . . . . . . . . 29

3-14. Referring Employees to Health Care Providers if Periodic Medical Testing

Results Are Positive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

3-15. Releasing Periodic Medical Test Results Outside the Company . . . . . . . . . . . . . . . . 30

3-16. Circumstances of Releasing Periodic Medical Test Results

Outside the Company . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

3-17+ Company Office Determining Which Tests Are Conducted as Part of Employee

Health Surveillance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

3-18. Views on General Cost-Effectiveness of Periodic Medical Testing . . . . . . . . . . . . . 31
Chapter 3

Monitoring Worker Health

In most large corporations, some portion of the

workforce is exposed to workplace conditions or

substances that represent a health risk to some or all

employees. The Occupational Safety and Health Act

(Public Law 91-596) requires that each employer

. . . shall assume safe and healthful working

conditions for working men and women. ” It is well

known, however, that some people are more susceptible to adverse effects from some exposures than

others. For instance, serum alpha- 1-antitrypsin deficiency can enhance the risk of emphysema when

people are exposed to certain occupational risk

factors. One possible method to protect people with

such genetic constitutions and, perhaps, allow

higher exposure levels in the workplace, is to

identify those at special risk.

WORKPLACE RISK

The survey posed a series of questions to personnel and health officers concerning workplace risks

and the monitoring of employees. Two workplace

risks important to corporations are chemicals and

ionizing radiation. Under certain conditions, exposures to chemicals and ionizing radiation may cause

chromosomal damage. Also, certain individuals are

more susceptible than others to exposures from these

materials (l). As noted in the previous chapter,

health officers reported that job applicants and

employees with certain medical conditions were

excluded from jobs involving exposure to chemicals

and radiation.

Chemicals and Ionizing Radiation

The survey found that chemicals and ionizing

radiation were fairly common among large corporations. More than half of the corporate health

officers (52 percent) reported that at least some of

their employees were exposed to chemicals or

ionizing radiation in the workplace setting (table

3-l).

The likelihood of employee exposure to chemicals or ionizing radiation clearly varied by industry

sector. Almost all health officers from companies

classified as pharmaceutical (96 percent), petroleum

(93 percent), and other chemicals (93 percent)

reported that at least some of their employees were

Table 3-l-Employee Exposure to Workplace Hazards

Q.7. Are any employees in your company exposed to chemicals

or ionizing radiation in the workplace setting?

(Base: Health officers)

Percent

Unweighed No

base Yes No answer

Total . . . . . . . . . . . . . . . (494) 52 46 2

Type of business

Electrical utility . . . . . ( 39) 84 16 0

Pharmaceutical . . . . ( 21) 96 4 0

Other chemical . . . . . ( 42) 5

Petroleum . . . . . . . . ( 5) 93 7 0

Electronic . . . . . . . . . ( 19)

Other

manufacturing . . . (154) 54 41 4

Nonmanufacturing . . (214) 49 50 1

SOURCE: Office of Technology Assessment, 1991.

exposed to chemicals or ionizing radiation in the

workplace. Similarly, the majority of health officers

(84 percent) from companies classified as electric

utilities reported these forms of workplace exposure.

Half of companies (51 percent) classified as electronic or semiconductor manufacturers reported

employee exposure to chemicals or ionizing radiation. However, even among those companies classified as other manufacturing, a majority (54 percent)

reported employees exposed to chemical and ionizing radiation. And, almost half (49 percent) of those

companies categorized as nonmanufacturing reported some employee exposure to these types of

workplace conditions.

Health officers in companies with workplace

exposures involving chemicals and ionizing radiation were asked if exposed employees were routinely rotated to avoid prolonged exposure. Fortyone percent reported that employees exposed to

chemicals or ionizing radiation were routinely

rotated to avoid prolonged exposure. The majority of

companies in which there were workplace exposures

to chemicals and ionizing radiation (54 percent)

reported that exposed employees were not routinely

rotated (table 3-2). This was particularly true for

companies in the electronics industry (96 percent),

the chemical industry (69 percent), and electric

utilities (69 percent), where these types of exposures

might have been fairly widespread.)

–23–
24 ● Medical Monitoring and Screening in the Workplace: Results of a Survey

Table 3-2—Rotation of Employees

Q.7a. Are those employees who are exposed to chemicals or ionizing radiation routinely rotated to avoid prolonged exposure?

(Base: Health officers in companies that report employees are exposed to chemicals or ionizing radiation)

Percent

Unweighed Don’t No

Base Yes No knowa

answer

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (325) 41 54 2 3

Type of business

Electrical utility.. . . . . . . . . . . . . . . . . . . . . . . . . . . ( 36) 30 69 0 1

Pharmaceutical . . . . . . . . . . . . . . . . . . . . . . . . . . . ( 20) 26 58 0 16

Other chemical . . . . . . . . . . . . . . . . . . . . . . . . . . . ( 40) 31 69 1 0

Petroleum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ( 4) 52 48 0 0

Electronic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ( 12) 4 96 0 0

Other manufacturing . . . . . . . . . . . . . . . . . . . . . . (104) 32 57 4 7

Nonmanufacturing.. . . . . . . . . . . . . . . . . . . . . . . . (109) 47 50 2 1

Number of employees

Less than 5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . (149) 47 49 2 3

5,000 to 9,999 . . . . . . . . . . . . . . . . . . . . . . . . . . . ( 53) 33 66 0 2

10,000 or more . . . . . . . . . . . . . . . . . . . . . . . . . . . (121) 21 67 8 4

avoluntgered response.

SOURCE: Office of Technology Assessment, 1991.

It should be noted, however, that several health

officers commented that they defined exposure as

including the potential for exposure. In other words,

employees in certain positions might have run a risk

of exposure to chemicals and ionizing radiation

without actually being exposed. In these instances,

rotation was unnecessary because the exposure was

only potential exposure.

Individual Susceptibility to Risk

Some workplace hazards impose an equal risk on

all employees. Other workplace exposures, however, represent special risks to certain employees,

depending on the individual characteristics of the

employee.

The majority of health officers (65 percent) said

that none of their employees was exposed to

workplace conditions which imposed differential

risks on workers depending on individual susceptibilities. On the other hand, nearly a third (31

percent) reported that employees in their companies

were exposed to conditions with differential risks for

health, depending on the employee’s susceptibility

(table 3-3). Among pharmaceutical firms alone, 71

percent of health officers reported occupational

exposure of employees to conditions with differential individual susceptibility.

MEDICAL SURVEILLANCE OF

EMPLOYEES

Two possible motivations for medical surveillance of employees can be inferred from the survey.

First, half of all companies surveyed reported

employees were exposed to chemicals and ionizing

radiation, which were associated with negative

health outcomes under certain circumstances. Second, nearly one-third of the companies interviewed

reported workplace exposures of some employees to

conditions in which health outcomes were related to

individual susceptibility. Both of these factors could

prompt an employer to monitor employee health

because of possible adverse health effects related to

exposure.

Appropriateness of Monitoring Worker Health

The survey indicated the requirement for preemployment health examinations of job applicants was

accepted by a majority of corporate personnel

officers-regardless of whether there were known

health risks in the workplace setting. A somewhat

different picture emerged from the survey data

regarding the appropriateness of corporate monitoring of employee health when there were no known

health risks.

Corporate personnel officers were asked whether

they believed it is generally appropriate or generally

inappropriate for a company to require periodic

medical testing of employees in workplace settings

where there are no known health risks. The majority

(61 percent) considered it inappropriate to require

medical testing of employees in workplace settings

where there were no known risks (table 3-4).

However, the attitude toward employee health
Chapter 3-Monitoring Worker Health .25

Table 3-3-Awareness of Known Workplace Conditions to Which Individual Susceptibility May Differ

Q.8. Are any employees in your company exposed to any known workplace condition where there is a greater risk of negative health

outcome, depending upon individual susceptibilities?

(Base: Health officers)

Percent

Unweighed Don’t No

Base Yes No knowaanswer

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (494) 31 65 ●3

Type of business

Electrical utility . . . . . . . . . . . . . . . . . . . . . . . . . . . . ( 39) 37 62 1 0

Pharmaceutical . . . . . . . . . . . . . . . . . . . . . . . . . . . ( 21) 71 14 0 15

Other chemical . . . . . . . . . . . . . . . . . . . . . . . . . . . ( 42) 49 49 2 0

Petroleum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ( 5) 44 56 0 0

Electronic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ( 19) 91 0 3

Other manufacturing . . . . . . . . . . . . . . . . . . . . . . (154) 35 63 0 2

Nonmanufacturing . . . . . . . . . . . . . . . . . . . . . . . . . (214) 29 67 ●

4

aVolunteered response.

“Indicates lees than 1 peroent.

SOURCE: Office of Technology Assessment, 1991.

monitoring changed radically when there were

known health risks in the workplace setting. The

survey found that, almost universally, corporate

personnel officers (93 percent) thought that it was

appropriate to require periodic medical testing of

employees in workplace settings where there were

known health risk (table 3-5).

Periodic Medical Testing

A majority of personnel officers (58 percent) said

that their corporate policies did not require periodic

medical testing of employees in risk categories.

However, 4 out of 10 personnel officers (41 percent)

reported that periodic medical testing of persons at

risk was required under corporate policy (table 3-6).

(It should be noted that the Office of Technology

Assessment did not define persons at risk, it was left

up to the company to define this term.)

Among the companies surveyed, there was no

consistent relationship between periodic medical

testing of employees and company size. Among

firms with less than 5,000 employees, 40 percent

reported periodic medical testing. This rate fell to 35

percent in firms with 5,000 to 9,999 employees.

However, it was highest (50 percent) in firms with

10,000 or more employees.

The rates of reported employee health monitoring

were highest in the petroleum companies (97 percent). A policy of periodic medical testing of

employees at risk was also reported by a majority of

pharmaceutical companies (72 percent), other chemical companies (68 percent), electronic manufacturers (64 percent), and electric utilities (58 percent).

Table 3-4-Appropriateness of Monitoring When

There Is No Known Health Risk

Q.4. Do you think that it is generally appropriate or generally

inappropriate for a company to require periodic medical

testing of employees in workplace settings where there are

no known health risks?

(Base: Personnel officers)

Unweighed base (569)

Appropriate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39%

Inappropriate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

Not sure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ●

No answer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ●

● indicates less than 1 percent.

SOURCE: Office of Technology Assessment, 1991.

Table 3-5-Appropriateness of Monitoring When

There Is Known Health Risk

Q.5. Do you think that it is generally appropriate or generally

inappropriate for a company to require periodic medical

testing of employees in workplace settings where there are

known health risks?

(Base: Personnel officers)

Unweighted base (569)

Appropriate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93/%

Inappropriate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Not sure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . *

No answer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

‘Indicates less than 1 percent.

SOURCE: Office of Technology Assessment, 1991.

By contrast, the rate of periodic employee monitoring fell to 47 percent in other manufacturing

companies and 36 percent in all other nonmanufacturing companies.

The relationship between occupational exposure

to workplace risks and the likelihood of periodic
26 ● Medical Monitoring and Screening in the Workplace: Results of a Survey

Table 3-6-Periodic Medical Testing of Persons in

Risk Categories

Q.19. Is it your company’s policy to conduct periodic medical

testing of persons in any risk categories?

(Base: Personnel officers)

Percent

Unweighed No

base Yes No answer

Total . . . . . . . . . . . . . . . . . . . (569) 41 58 1

Number of employees

Less than 5,000 . . . . . . . . (308) 40 59 j

5,000 to 9,999 . . . . . . . . . (99) 35 64

10,000 or more . . . . . . . . . (154) 50 48 3

Type of business

Electrical utility. . . . . . . . . ( 43) 58 38 3

Pharmaceutical . . . . . . . . ( 20) 72 28 0

Other chemical . . . . . . . . . ( 37) 68 26 6

Petroleum. . . . . . . . . . . . . ( 10) 97 0

Electronic . . . . . . . . . . . . . ( 21) 64 36 0

Other manufacturing . . . . (176)

Nonmanufacturing . . . . . . (262) 36 63 ●

“Indicates less than 1 percent.

SOURCE: Office of Technology Assessment, 1991.

employee health monitoring was put into perspective by the corporate health officers. As noted earlier

in this chapter, approximately half of the health

officers reported that employees in their companies

were exposed to chemicals or ionizing radiation in

the workplace setting.

A majority of health officers in companies in

which employees were exposed to chemicals or

ionizing radiation (53 percent) reported that medical

surveillance was conducted of employees whose

jobs might have exposed them to health risks (table

3-7). The use of medical surveillance was less

frequent among affected companies with fewer than

5,000 employees (46 percent) than among those with

5,000 to 9,000 employees (75 percent) or 10,000 or

more employees (66 percent).

The survey yielded information concerning not

only the extent of health monitoring among employees at potential risk, but the limits of that monitoring

as well. Over half of large companies (58 percent)

did not perform any routine employee health monitoring, even among employee groups at risk to

occupational health problems. Moreover, even in

companies where employees were exposed to chemicals and ionizing radiation, nearly half (46 percent)

did not perform any form of medical surveillance of

workers at risk other than that required by the

Occupational Safety and Health Administration

(OSHA).

Table 3-7-Medical Surveillance of Employees

With Jobs That May Expose Them to Environmental

Health Risks

Q.7b. Does your company conduct any form of medical surveilIance of employees whose jobs may expose them to

environmental health risks, other than testing required by

OSHA?

(Base: Health officers in companies with employees exposed to

chemicals or ionizing radiation in the workplace)

Percent

Unweighed No

base Yes No answer

Total . . . . . . . . . . . . . . . . . . . (325) 53 46 1

Number of employees

Less than 5,000 . . . . . . . . (149) 46 52 2

5,000 to 9,999 . . . . . . . . . ( 53) 75 25 0

10,000 or more . . . . . . . . . (171) 33

SOURCE: Office of Technology Assessment, 1991.

Types of Employee Health Evaluations

The survey explored what, if any, types of exams

companies require as part of ongoing worker health

evaluation and as a condition of continued employment of all employees, only those in certain plants or

jobs, or only employees with certain medical conditions or histories. It also obtained information about

the companies that require no testing of any workers.

The survey found that hearing tests were the most

commonly used type of ongoing health testing of the

seven categories investigated in the study. Four out

of ten (41 percent) health officers reported that

hearing tests were required of at least some employees (table 3-8). Eleven percent reported that hearing

tests were required of all applicants.

Blood chemistry tests, chest x-rays, and vision

tests were also part of ongoing worker health

evaluations in many of the large companies. Approximately one-third of responding companies

reported that they tested at least some employees.

Tests required included chest x-rays (36 percent),

blood chemistry tests (35 percent), and vision tests

(32 percent). Thirty percent of responding health

officers reported that pulmonary function tests were

required of at least some employees. However, only

3 percent of responding health officers reported that

pulmonary function tests were required for all

employees. Only 6 percent of companies required

tests for hypersensitivity for any workers as part of

routine health evaluations.

In the bulk of these cases, the requirement for the

medical testing was neither company wide nor re-
Chapter Monitoring Worker Health ● 27

Table 3-8-Types of Employee Health Evaluations

Q.9a. As part of on going work evaluation, does the company require, as a condition of continued employment, all employees, only those

in certain plants or jobs, only employees with certain medical conditions or histories, or no employees to have:

(Base: Health officers)

Percent

Selected Selected

Unweighed All plants/ conditions/ Don’t No

base employees jobs histories Botha None knowbanswer

Routine physical

examination . . . . . . . . . . (494) 14 18 4 2 48 * 14

Test for hypersensitivity . . (494) ● 2 3 1 69 * 25

Hearing tests . . . . . . . . . . . (494) 11 26 2 2 44 ●

15

Pulmonary function tests . (494) 3 21 4 2 50 0 20

Vision tests . . . . . . . . . . . . . (494) 11 17 2 2 49 0 19

Chest x-rays . . . . . . . . . . . (494) 6 15 13 2 47 0 17

Blood chemistry tests . . . . (494) 10 16 8 1 48 0 17

aBoth “@ant#jobs” and “conditions/histories” Volunteered.

Wolunteerd response.

“Indicates less than 1 percent.

SOURCE: Office of Technology Assessment, 1991.

stricted to workers with certain medical conditions.

Rather, these types of ongoing health evaluations

were required for employees in certain plants or jobs.

Aside from specific tests, the survey investigated

the use of routine physical examinations as part of

ongoing worker evaluations. Little more than a third

(38 percent) of the companies surveyed reported that

routine physical exams were required of any workers. One in seven companies (14 percent) required

routine physical examinations as part of ongoing

worker evaluations of all employees.

Employee Medical Records

Any medical monitoring and screening of employees and job applicants creates medical records

on their past and current health conditions including

specific test results. A major concern associated

specifically with genetic monitoring and screening,

as with all medical testing, is the use of test findings.

The use of such information depends, in part, on who

will have access to those records. The survey

examined the standard practice of industry in

maintainingg employee health records and permitting

access to those records.

All medical testing in the workplace, regardless of

the nature of the tests being performed, raises

questions of medical records and their maintenance.

The survey found that companies conduct a wide

variety of job applicant screening tests and ongoing

medical evaluation tests of employees. Once such

tests are conducted, the question of where the results

are kept is raised. Hence, health officers were asked

which corporate office maintains employee health

records.

The responsibility for employee health records is

evenly divided between the medical or occupational

health office and the personnel office. About half

(47 percent) of the health officers responding to the

survey reported that the medical or occupational

health office was responsible for employee health

records in their companies. In the other half (45 percent), the health officer reported that the personnel

office was responsible for employee health records.

In only a handful of cases (4 percent) was the

responsibility for employee health records lodged in

some other corporate office (table 3-9).

Access to Employee Medical Records

The health officers, identified by the survey as

frequently responsible for employee health records,

were asked about the access to those records. For

each of nine parties, the questionaire asked: “Does

your company permit access to employee medical

records—at company discretion, with employee

permission, or both?’

About 3 in 10 (28 percent) health officers reported

that access to employee medical records by the

personnel department required the employee’s permission. On the other hand, 3 in 10 (29 percent)

reported that the company permitted the personnel

department access to those records at company

discretion (table 3-10). A quarter (24 percent)

reported that access was permitted both at company

discretion and with employee permission.

.-)n7 nA.n -. - -. -
28 ● Medical Monitoring and Screening in the Workplace: Results of a Survey

Table 3-9-Company Office Responsible for Employee Health Records

Q.39. Which office in your company is responsible for employee health records?

(Base: Health officers)

Percent

Medical/

Unweighed occupational No

Base health Personnel Other answer

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (494) 47 45 4 6

Type of business

Electrical utility.. . . . . . . . . . . . . . . . . . . . . . . . . . . ( 39) 40 44 9 9

Pharmaceutical . . . . . . . . . . . . . . . . . . . . . . . . . . . ( 21) 85 16 0 0

Other chemical . . . . . . . . . . . . . . . . . . . . . . . . . . . ( 42) 54 38 0 9

Petroleum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ( 5) 56 44 0 0

 Electronic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ( 19) 27 68 0 4

Other manufacturing . . . . . . . . . . . . . . . . . . . . . . (154) 53 44 3 4

Nonmanufacturing. . . . . . . . . . . . . . . . . . . . . . . . . (214) 44 45 5 7

SOURCE: Office of Technology Assessment, 1991.

Table 3-10-Company Access to Employee Records

Q.40. Does your company permit access to employee medical records-at company discretion, with employee permission, or both to:

(Base: Health officers)

Percent

Unweighed At company Employee Don’t No

base discretion permission Both knowsaanswer

Personnel department . . . . . . . . . . . . . . . . . . . . . . . . . . (494) 29 28 24 ●

19

Health insurance carriers . . . . . . . . . . . . . . . . . . . . . . . (494) 15 38 20 ●27

Life insurance carriers . . . . . . . . . . . . . . . . . . . . . . . . . . (494) 13 39 19 ●29

Disability insurance carriers. . . . . . . . . . . . . . . . . . . . . (494) 15 35 24 ●27

Unions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (494) 3 26 12 ●58

Other companies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (494) 4 31 11 ●55

Employee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (494) 14 41 22 ●

23

Employee’s spouse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (494) 3 37 13 * 47

Other family . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (494) 2 33 13 ●

52

avolunteered response.

‘Indicates less than 1 percent.

SOURCE: Office of Technology Assessment, 1991.

Only a small proportion of companies permitted

access to employee medical records to other interested parties without the permission of the employee. The reported incidence of permitting thirdparty access to employee records, at company

discretion, was 15 percent for disability insurance

carriers, 15 percent for health insurance carriers,

13 percent for life insurance carriers, 4 percent for

other companies, and 3 percent for unions.

The employee’s access to his or her own medical

records posed another issue. The survey indicated

that in 4 in 10 (41 percent) cases, the employee’s

request was sufficient for the employee to gain

access to his or her own medical records. However,

about a third of the health officers (36 percent)

reported that access to those records by the employee

was permitted either at the company discretion or

required both company and employee permission.

Statistical Recordkeeping

Corporate personnel officers were asked whether

or not their companies maintained statistical data on

the reasons for job terminations. Six out of ten

companies (62 percent) reported having statistical

data on job terminations. There was no clear

relationship between company size and the likelihood of maintaining statistical data on job terminations.

Less than 1 percent of the companies surveyed

reported that biochemical or cytogenetic tests were

listed in statistical data as rejection categories for

employee job terminations (table 3-11). Among

those that kept statistical data on employee termina-
Chapter Monitoring Worker Health ● 29

Table 3-n-Statistical Recordkeeping of Job

Termination Reasons

Q.20a. Are biochemical or cytogenetic tests used as rejection

categories in these data?

(Base: Personnel officers)

Unweighed base (354)

Yes ●

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97%

No answer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

“Indicates less than 1 percent.

SOURCE: office of Technology Assessment, 1991.

Table 3-13-informing Employees of Periodic Medical

Testing Results

Q.19a. Is it company policy to inform employees of positive

test results?

(Base: Personnel officers in companies that conduct periodic

medical testing of persons in any risk categories)

Unweighed base (277)

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97%

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

No answer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

SOURCE: Office of Technology Assessment, 1991.

Table 3-12-Statistical Recordkeeping of Job Termination Reasons

Q.20b. Are other medical criteria used as rejection categories in these data?

(Base: Personnel officers)

Percent

Unweighed No Don’t

base Yes No answer knowa

Total . . . . . . . . . . . . . . . . . . . . . . . (354) 20 75 3 1

Number of employees

Less that 5,000 . . . . . . . . . . . . . (354) 19 77 3 1

5,000 to 9,999 . . . . . . . . . . . . . (354) 34 61 5 0

10,000 or more . . . . . . . . . . . . . (354) 18 77 4 1

avolunteered response.

SOURCE: Office of Technology Assessment, 1991.

tions, relatively few reported the use of medical

criteria as reasons for such actions. One-fifth

(20 percent) of companies maintaining statistical

data on job terminations reported that medical

criteria appeared as termination categories (table

3-12). This was more common among companies

with 5,000 to 9,999 employees (34, percent) than

among either those with fewer than 5,000 employees

(19 percent) or more than 10,000 employees (18

percent).

Release of Test Results to Employees

and Others

The personnel officers in companies that conducted any type of periodic medical testing of

employees in any risk categories were asked whether

it was company policy to inform employees of

positive test results. In almost every case (97

percent), the corporate personnel officers reported

that it was company policy to inform employees of

positive test results. Only 1 percent of corporations

that periodically tested their employees had no

policy of informing employees of positive test

results (table 3-13). Two percent of personnel

officers did not answer this question.

Corporate personnel officers in companies that

conducted periodic medical testing of their employees reported, almost universally, that it was company policy to refer employees to appropriate health

care providers, if positive test results were obtained.

Ninety-three percent of personnel officers in companies that conducted periodic testing of employees at

risk said that it was policy to refer employees with

positive test results to medical providers. Five

percent of companies conducting such tests reported

that it was not policy to refer employees to health

care providers if positive test results were obtained

(table 3-14).

The personnel officers in firms conducting health

monitoring were also asked if company policy

allowed the release of positive test results to anyone

outside of the company, other than the employee. In

a majority of cases (74 percent), corporate policy did

not permit such release. However, nearly a quarter

(24 percent) of personnel officers said company

policy allowed the release of positive test results, at

least under certain circumstances (table 3-15).

Those companies allowing the outside release of

positive test results were asked under which circumstances this could happen. Most commonly, such
30 ● Medical Monitoring and Screening in the Workplace: Results of a Survey

Table 3-14—Referring Employees to Health Care

Providers if Periodic Medical Testing Results

Are Positive

Q.19b. Is it company policy to refer employees to health care

providers if positive test results are obtained?

(Base: Personnel officers in companies that conduct periodic

medical testing of persons in any risk categories)

Unweighted base (277)

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93%

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

No answer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

SOURCE: Office of Technology Assessment, 1991.

Table 3-15-Releasing Periodic Medical Test Results

Outside the Company

Q.19c. Is it company policy to release positive test results to

anyone outside the company, other than the employee?

(Base: Personnel officers in companies that conduct periodic

medical testing of persons in any risk categories)

Unweighed base (277)

Yes . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . 24%

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74

No answer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

SOURCE: Office of Technology Assessment, 1991.

Table 3-16-Circumstances of Releasing Periodic

Medical Test Results Outside the Company

Q.19d. Under what circumstances?

(Base: Personnel officers in companies that release results of

periodic medical tests to anyone outside the company)

Unweighed base (62)

Done with employee’s consent/written

authorization/release . . . . . . . . . . . . . . . . . . . . . . 33%

Through employee’s personal/family physician . . . 23

If required by Federal/State law . . . . . . . . . . . . . . . 20

At employee’s request . . . . . . . . . . . . . . . . . . . . . . . 9

Other circumstances . . . . . . . . . . . . . . . . . . . . . . . . . 15

SOURCE: Office of Technology Assessment, 1991.

release of positive results occurred with the employee’s consent or written authorization for release

(33 percent) (table 3-16). Nearly a quarter (23 percent) said that the positive test results could have

been released through the employee’s personal or

family physician. One in five (20 percent) said it was

policy to release the results if required by Federal or

State law. One in ten (9 percent) said results could

be released at the employee’s request, with no

specification of formal written consent or release.

Fifteen percent reported other circumstances under

which such information could be released outside of

the company.

Table 3-17-Company Office Determining Which

Tests Are Conducted as Part of Employee

Health Surveillance

Q.30b. Which office determines whether or not a specific test will

be conducted as part of employee health surveillance?a

(Base: Health officers)

Unweighted base (494)

Corporate personnel . . . . . . . . . . . . . . . . . . . . . . . . . 37%

Corporate health . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Location personnel . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Location health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Don’t knowb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ●

No answer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Net: Corporate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

Net: Personnel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

Net: Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

aReSpo~en~ could give more than one answer.

Wolunteersd response.

“Indioates less than 1 percent.

SOURCE: Office of Technology Assessment, 1991.

Who Decides on Surveillance Tests

Thirty-seven percent of health officers reported

that the corporate personnel office-not the corporate health office-determined which specific tests

were conducted as part of employee health surveillance (table 3-17). By contrast, only 28 percent said

that the corporate health office determined which

tests were part of employee health surveillance. In

only a minority of cases were specific medical

surveillance tests determined at the location or

establishment level. And, at this level, the health

office (14 percent) and the personnel office (14 percent) were equally likely to determine which tests

were conducted.

The survey found that in most companies decisions on specific tests for employee health surveillance were made at the corporate level (60 percent),

rather than at the establishment level. The survey

also suggested that decisions on specific surveillance tests were more often the responsibility of the

personnel office than the health office. However, it

should be recognized that smaller companies might

have no health office.

Cost-Effectiveness of Surveillance Tests

The survey found that health officers reported that

the determination of which specific tests were

performed as part of employee health surveillance

rests, most often, with the personnel office. The

survey also explored how corporate personnel officers viewed some of these tests—in terms of
Chapter Monitoring Worker Health ● 31

Table 3-18-Views on General Cost-Effectiveness of Periodic Medical Testing

Q.6. Do you think it is generally cost-effective or not cost-effective for a company to conduct periodic medical testing of employees for:

(Base: Personnel officers)

Percent

Unweighed cost- Not cost- Don’t No

Base effective effective knowa

answer

High blood pressure . . . . . . . . . . . . . . . . . . . . . . . . . (528) 75 21 1 4

Respiratory function. . . . . . . . . . . . . . . . . . . . . . . . . (528) 54 39 1 6

Malignancies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (528) 42 49 1 8

Hearing function . . . . . . . . . . . . . . . . . . . . . . . . . . . . (528) 58 36 1 5

Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (528) 50 42 2 6

Chromosomal abnormalities . . . . . . . . . . . . . . . . . . (528) 11 76 3 9

Drug abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (528) 72 22 1 5

aVOluntxred response.

SOURCE: Office of Technology Assessment, 1991,

cost-effectiveness. For each of seven types of tests,

corporate personnel officers were asked whether

they considered periodic medical testing of employees to be generally cost-effective.

Among the seven tests examined in the survey,

personnel officers reported periodic medical testing

for high blood pressure as the most cost-effective.

Three out of four corporate personnel officers

(75 percent) considered it cost-effective for a company to conduct periodic medical testing of employees for high blood pressure. Only 21 percent felt

periodic blood pressure testing was not costeffective (table 3-18).

Drug testing was also seen as a cost-effective form

of periodic testing by the majority of personnel

officers. Nearly three out of four (72 percent)

reported that it was generally cost-effective for a

company to conduct periodic medical testing of

employees for drug abuse. Only 22 percent felt that

periodic tests for drug abuse were not cost-effective.

A majority of personnel officers considered hearing

tests (58 percent), respiratory function (54 percent),

and periodic vision testing (50 percent) of employees was cost-effective.

In contrast, a smaller proportion (11 percent) of

the personnel officers surveyed said periodic medical testing of employees for chromosomal abnormalities was cost-effective for companies. There was

almost no variation in this opinion by company size.

Moreover, although there was some variation in the

opinion about the cost-effectiveness of periodic

monitoring of chromosomal abnormalities by industry type--it WaS highest among other chemical

companies (14 percent) and lowest among electric

utilities (5 percent), pharmaceutical companies

(5 percent), and electronic manufacturers (O percent)-these differences were relatively small. The

current consensus among corporate personnel officials was that the cost-effectiveness to the company

of many forms of employee health monitoring did

not extend to genetic monitoring for chromosomal

abnormalities.

CHAPTER 3 REFERENCE

1. U.S. Congress, Office of Technology Assessment,

Genetic Monitoring and Screening in the Workplace,

OTA-BA-455 (Washington, DC: U.S. Government

Printing Office, October 1990).
Chapter 4

Genetic Monitoring and Screening

in the Workplace:

Corporate Opinion and Practice
CONTENTS

Page

Attitudes About Genetic Monitoring and Screening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Company Policy and Genetic Monitoring and Screening . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Acceptable Uses of Genetic Monitoring and Screening ., * * . . . . ., * . * . . . . * . ******..* 35

Employer Attitudes Toward Genetic Monitoring and Screening in the Workplace . . . . 36

Cost-Effectiveness of Genetic Monitoring and Screening . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

The Impact of Genetic Monitoring and Screening on the Workplace . . . . . . . . . . . . . . . . . . 39

Screening TO Identify Persons With Health Risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Basis for Genetic Monitoring and Screening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . +...... 39

How Results Are Disseminated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Workplace Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Treatment of Identified Risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Why Companies Have Decided Against Genetic Monitoring and Screening . . . . . . . . . 41

Personnel Officer Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Health Insurance and Genetic Monitoring and Screening . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Chapter 4 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Tables

Table Page

4-1, Acceptable Uses of Genetic Monitoring and Screening: Personnel Officers . . . . . 36

4-2. Acceptable Uses of Genetic Monitoring and Screening: Health Officers . . . . . . . . 36

4-3. Attitudes Toward Genetic Monitoring and Screening . . . . . . . . . . . . . . . . . . . . . . . . . . 37

4-4. Cost-Effectiveness of Genetic Monitoring and Screening . . . . . . . . . . . . . . . . . . . . . . 38

4-5. Screening Conducted To Identify Persons With Increased Health Risks . . . . . . . . 39

4-6. Types of Screening Conducted To Identify Persons With Increased

Health Risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

4-7. Genetic Monitoring or Screening for Specific Purposes . . . . . . . . . . . . . . . . . . . . . . . . 40

4-8. Handling of Abnormal Genetic Test Results for Employees . . . . . . . . . . . . . . . . . . . 40

4-9. Changes in Workplace Practice or Exposure Level Due to

Results of Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

4-10. Exclusion or Choice: Treatment of Employees at Risk . . . . . . . . . . . . . . . . . . . . . . . 42

4-11. Reasons Companies Have Chosen Not To Use Genetic Monitoring

or Screening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

4-12. Recommendations for Genetic Screening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

4-13. Criteria for Genetic Screening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

4-14. Recommendations for Genetic Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

4-15. Criteria for Genetic Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

4-16. Hiring of Job Applicants Considered To Be Health Insurance Risks . . . . . . . . . . . 44

4-17. Assessing Health Insurance Risks of Job Applicants . . . . . . . . . . . . . . . . . . . . . . . . . . 45

4-18. Assessing Health Insurance Risks of Dependents of Job Applicants . . . . . . . . . . . . 45
Genetic Monitoring

Chapter 4

and Screening in the Workplace:

Corporate Opinion and Practice

ATTITUDES ABOUT GENETIC

MONITORING AND SCREENING

To gauge the extent of current and possible future

use of genetic monitoring and screening in the

workplace, the survey explored corporate attitudes

toward such techniques. Health and personnel officers were asked their views concerning corporate

genetic monitoring and screening policies, the costeffectiveness of such testing, and uses and handling

of test results.

Genetic testing includes a number of technologies

to detect genetic traits, changes in chromosomes, or

changes in DNA. As used in the workplace, it

encompasses two activities: monitoring and screening. Thus, genetic testing of employee populations

involves both examining persons for evidence of

induced change in their genetic material (monitoring) and methods to identify individuals with

particular inherited traits or disorders (screening).

Company Policy and Genetic Monitoring

and Screening

Corporate health officers were asked whether

their companies had a formal policy related to

genetic tests, either in the screening of job applicants

or the monitoring of employee health. Only 1

percent of health officers reported a formal company

policy on genetic screening tests. Similarly, only 1

percent reported a company policy on genetic

monitoring tests. Hence, even among the largest

industrial companies, only a handful of companies

had developed a formal policy on genetic monitoring and screening.

Rather than signifying a lack of corporate opinion

about the use of such tests, such a response could

indicate that attitudes toward genetic monitoring and

screening had not been expressed as policy. In order

to explore corporate opinion concerning genetic

monitoring and screening, the survey asked health

and personnel officers about their companies’ attitudes toward the use of genetic tests.

Acceptable Uses of Genetic Monitoring

and Screening

Corporate personnel and health officers were

asked the same series of questions about the

acceptability within their companies of using genetic monitoring and screening for various purposes.

The parallel series of questions allows a comparison

of differences in perceived acceptability of genetic

monitoring and screening in the workplace between

those responsible for employee health and those

responsible for personnel matters in large corporations.

A majority of the personnel and health officers

surveyed (56 percent and 50 percent) said that their

companies considered the use of genetic monitoring

and screening tests for employees or job applicants

as generally acceptable to inform employees of their

increased susceptibility to workplace hazards (table

4-1 and 4-2). The aim of the question was to get at

their understanding of current company policy.

Three of the other five possible uses of genetic

monitoring or screening in the workplace were

considered as generally unacceptable by pluralities

of the personnel officers responding to the question.

Close to half (48 percent) felt that their companies

would consider it generally unacceptable to conduct

genetic monitoring or screening of employees to

“exclude employees with increased susceptibility

from risk situations.” This compares with 51

percent for the health officers. The survey did not

ask what happened to employees who were excluded. Over half of the personnel and health officers

also felt it would be generally unacceptable to their

companies to use genetic tests to “establish links

between genetic predisposition and workplace hazards’ (52 percent and 55 percent) or to “monitor

chromosomal changes associated with workplace

exposure” (53 percent and 55 percent).

The personnel officers and health officers differed

somewhat in their perceptions of the acceptability of

using genetic tests to “establish evidence of preemployment health status for liability purposes. ”

Although 50 percent of health officers considered

–35–
36 ● Medical Monitoring and Screening in the Workplace: Results of a Survey

Table 4-l—Acceptable Uses of Genetic Monitoring and Screening: Personnel Officers

Q.8. Would your company consider the use of genetic tests for employees or job applicants as generally acceptable or unacceptable to:

(Base: Personnel officers)

Percent

Unweighed Generally Generally Don’t No

base acceptable unacceptable knowa

answer

Make a clinical diagnosis of a sick employee.. . . . (569) 47 46 1 5

Establish links between genetic predisposition

and workplace hazards . . . . . . . . . . . . . . . . . . . . . (569) 40 52 2 6

Inform employees of their increased susceptibility

to workplace hazards. . . . . . . . . . . . . . . . . . . . . . (569) 56 37 1 7

Exclude employees with increased susceptibility

from risk situations . . . . . . . . . . . . . . . . . . . . . . . . (569) 45 48 1 7

Monitor chrornosomal changes associated with

workplace exposures . . . . . . . . . . . . . . . . . . . . . . (569) 39 53 1 7

Establish evidence of preemployment health status

for liability purposes . . . . . . . . . . . . . . . . . . . . . . . (569) 47 45 1 7

avoiunteered response.

SOURCE: Office of Technology Assessment, 1991.

Table 4-2—Acceptable Uses of Genetic Monitoring and Screening: Health Officers

Q.1O. Would your company consider the use of genetic screening or monitoring of employees or job applicants as generally acceptable

or unacceptable to:

(Base: Health officers)

Percent

Unweighed Generally Generally Don’t No

base acceptable unacceptable knowa

answer

Make a clinical diagnosis of a sick employee. . . . . (494) 43 48 1 7

Establish links between genetic predisposition

and workplace hazards . . . . . . . . . . . . . . . . . . . . . (494) 36 55 ●

9

Inform employees of their increased susceptibility

to workplace hazards. . . . . . . . . . . . . . . . . . . . . . (494) 50 42 ●

8

Exclude employees with increased susceptibility

from risk situations . . . . . . . . . . . . . . . . . . . . . . . . (494) 39 51 ●

10

Monitor chrornosomal changes associated with

workplace exposures . . . . . . . . . . . . . . . . . . . . . . (494) 34 55 * 10.

Establish evidence of preemployment health status

for liability purposes . . . . . . . . . . . . . . . . . . . . . . . (494) 41 50 ● 9

avtmnteered response.

“Indicates less than 1 percent.

SOURCE: Offioe of Technology Assessment, 1991.

this an unacceptable use for genetic tests, 47 percent

of personnel officers considered it acceptable.

The use of genetic monitoring and screening tests

“to make a clinical diagnosis of a sick employee”

was considered as generally acceptable to 47 percent

of personnel officers, compared with the 48 percent

of health officers who felt such a use was generally

unacceptable. The survey found some differences

between health and personnel officers in their

perceptions of the acceptability of genetic tests for

occupational health monitoring in their companies.

However, the more striking finding is that companies appear to be fairly evenly split over the

acceptability of using genetic monitoring and

screening in the workplace for the benefit of either

the employee or the employer. Regardless of the

health and personnel officers interpretations of

company policy, the Office of Technology Assessment (OTA) survey found no significant change

from 1982 to 1989 in the number of companies using

monitoring and screening (1,2).

Employer Attitudes Toward Genetic

Monitoring and Screening in the Workplace

The future of genetic monitoring and screening in

the workplace depends on corporate attitudes toward

the use of the technology. The possibility that

genetic monitoring and screening technology may
Chapter 4-Genetic Monitoring and Screening in the Workplace: Corporate Opinion and Practice ● 37

Table 4-3-Attitudes Toward Genetic Monitoring and Screening

Q.41. How do you feel about the following general statements concerning genetic screening and monitoring in the workplace? For each

statement, please indicate whether you agree strongly, agree somewhat, disagree somewhat, or disagree strongly.

(Base: Health officers)

Percent

Unweighed Agree Agree Disagree Disagree Don’t No

Base strongly somewhat somewhat strongly knowa

answer

It’s fair for employers to use genetic

screening to identify individuals whose

increased risk of occupational disease

poses the potential for greater costs

to the employer. . . . . . . . . . . . . . . . . . .

The employer should have the option of

deciding how to use the information

obtained through genetic screening

and monitoring. . . . . . . . . . . . . . . . . . .

The decision to perform genetic

screening of job applicants and

employees should be the

employers. . . . . . . . . . . . . . . . . . . . . .

The decision to perform genetic

monitoring of employees should be the

employers. . . . . . . . . . . . . . . . . . . . . .

Government agencies should provide

guidelines for genetic screening of job

applicants and employees. . . . . . . . . .

Government agencies should provide

guidelines for genetic monitoring of

employees. . . . . . . . . . . . . . . . . . . . . .

Genetic screening in the workplace

represents a potential threat to the

rights of employees. . . . . . . . . . . . . . .

(494) 17 39 15 18

(494) 15 32 19 24

10

(494) 29 33 12 14 ●12

(494) 29 33 12 16 ●

10

(494) 34 27 11 18 * 10

(494) 33 27 11 18 ●

10

(494) 20 38 16 15 ●11

avolunteer~ response.

“Indicates less than 1 percent.

SOURCE: Office of Technology Assessment, 1991.

seriously threaten employee rights is a key concern

surrounding its use. To gauge employer sensitivity

to this issue, health officers were asked whether they

agreed or disagreed that genetic monitoring and

screening pose such a threat. The survey found that

health officers were aware of the concern. Nearly

6 out of 10 (58 percent) of the health officers

responding to the survey agreed with the idea that

genetic screening represented a potential threat to

the rights of employees (table 4-3). However, health

officers were more likely to agree somewhat (38 percent) than strongly (20 percent) with the notion.

Interestingly, those who reported that their companies currently employed genetic monitoring and

screening were most likely (79 percent) to agree that

such testing represented a potential threat to employees.

Although such testing was perceived as a potential threat to employee rights, 6 out of 10 health

officers (62 percent) agreed that “the decision to

perform genetic screening of job applicants and

employees should be the employer’ s.” The same

proportion (62 percent) also agreed that “the decision to conduct genetic monitoring of employees

should be the employers.’ Most health officers felt

that the employer had the right to make the decision

whether or not to conduct such tests.

The basic issue in many minds, however, is not

what information would be collected by genetic

monitoring and screening in the workplace, but how

it would be used. Earlier questions about workplace

uses of genetic monitoring and screening indicated

that health officers reacted more favorably to uses

designed to inform employees of risk and to

establish relationships between exposure and health

outcomes. Hence, a somewhat more controversial

use of genetic monitoring and screening was explored here.

Health officers also were asked whether they

agreed that it is unfair for employers to use genetic

screening to identify individuals whose increased
38 ● Medical Monitoring and Screening in the Workplace: Results of a Survey

Table 4-4-Cost-Effectiveness of Genetic Monitoring and Screening

Q.7. Do you think it is currently cost-effective or not cost-effective for a company like yours to:

(Base: Personnel officers)

Percent

Unweighed cost- Not cost- Not an Not No

base effective effective issuea

sure answer

Conduct biochemical genetic tests as part of

preemployment screening . . . . . . . . . . . . . . . . . . . . . (569) 3 52 1 43 2

Conduct direct-DNA tests as part of preemployment

screening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (569) 1 53 1 44 2

Conduct genetic monitoring of all workers exposed to

workplace hazards. . . . . . . . . . . . . . . . . . . . . . . . . . . (569) 8 45 1 44 2

Conduct genetic screening of workers to detect genetic

susceptibilities to workplace hazards . . . . . . . . . . . . (569) 7 45 1 45 2

aVolunteered response.

SOURCE: Office of technology Assessment, 1991.

risk of occupational disease poses the potential for

greater costs to the employer. A majority of the

health officers (56 percent) agreed while only a third

of the health officers (33 percent) disagreed. However, among those companies currently conducting

genetic monitoring and screening, the majority of

health officers (57 percent) disagreed with such use

of genetic tests. Only 43 percent of the health

officers from such companies agreed that it was fair

for employers to use genetic screening to reduce

their risk of costs associated with occupational

disease.

Health officers were more evenly divided on the

issue of who should decide how the information

obtained from genetic monitoring and screening

would be used. Almost half (47 percent) agreed that

the employer should have the option of deciding

how to use such information. Nearly an equal

proportion (43 percent), however, disagreed. Current genetic testers reported a stronger opposition to

this position with over half of the health officers

(56 percent) from companies reporting current testing disagreeing that the employer should have the

option of deciding how to use such information.

Since most health officers felt the decision to

conduct genetic monitoring and screening rested

with the employer, one might expect relatively little

enthusiasm about a government role in the issue of

genetic monitoring and screening. However, 6 in 10

health officers (61 percent) agreed with the notion

that “government agencies should provide guidelines for genetic screening of job applicants and

employees.’ Virtually the same proportion of health

officers (60 percent) agreed that ‘government agencies should provide guidelines for genetic monitoring of employees. ” In companies currently using

such genetic tests, the majority (71 percent) agreed

that government agencies should provide guidelines

in these areas.

The interest in government guidelines, however,

should not be surprising given the recognition of the

potential threat to employee rights raised by the

technology, and the division of opinions over the

proper uses of such tests. Government guidelines

would fill the absence of any professional or

corporate consensus on the applications, uses, and

limits of genetic monitoring and screening in the

workplace.

Cost-Effectiveness of Genetic Monitoring

and Screening

The current economic feasibility of genetic monitoring and screening in the workplace was examined

by asking personnel officers how cost-effective they

considered the technology. Few corporate personnel

officers believe that any of the uses of such tests is

currently cost-effective. One percent of personnel

officers considered the use of direct-DNA tests as

part of preemployment screening currently costeffective for their companies, and 3 percent considered the use of biochemical genetic screening tests

as part of preemployment screening as COSteffective. In contrast, 52 and 53 percent of the

personnel officers surveyed found that both types of

testing were not cost-effective (table 4-4).

A larger percentage of personnel officers (7

percent) considered using genetic screening to

detect genetic susceptibilities to workplace hazards

as cost-effective. A similar proportion (8 percent) of

corporate personnel officers felt it was currently
Chapter 4-Genetic Monitoring and Screening in the Workplace: Corporate Opinion and Practice ● 39

Table 4-5-Screening Conducted To Identify Persons

With Increased Health Risks

Q.8a.. Do you conduct any form of screening to identify employees or job applicants at increased risk for these jobs?

(Base: Health officers in companies where employees are

exposed to workplace conditions with greater risk of negative

health outcome)

Unweighted base (180)

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71%

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

No answer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

SOURCE: office of Technology Assessment, 1991.

cost-effective to conduct genetic monitoring of all

workers exposed to workplace hazards. However,

nearly six times as many personnel officers (45

percent) felt that such forms of genetic monitoring

and screening were not currently cost-effective.

THE IMPACT OF GENETIC

MONITORING AND SCREENING

ON THE WORKPLACE

Screening To Identify Persons With

Health Risks

Most company health officers did not believe that

their employees were exposed to workplace conditions where individual susceptibilities affect the

likelihood of negative health outcomes. The majority (65 percent) said that employees in their companies were not exposed to such conditions.

Only 31 percent reported that employees were

exposed to workplace conditions in which individual susceptibilities affect the risk of negative health

outcomes. In those companies employees are usually screened for the susceptibility. In 7 out of 10 of

those companies (71 percent) some form of screening was used to identify employees or job applicants

at increased risk for those jobs (table 4-5).

Medical histories represented the primary mechanism for screening employees or job applicants for

individual susceptibility to workplace risk. Nearly

9 out of 10 (88 percent) of those companies reporting screening for individual susceptibility used

medical histories to identify the individuals at risk

(table 4-6).

Other forms of nongenetic screening were also

important. Three-fifths of the companies (61 percent) conducting any form of screening for individTable 4-6-Types of Screening Conducted To Identify

Persons With Increased Health Risks

Q.8b. Which, if any, of the following types of screening are

conducted to identify increased individual susceptibility to

workplace risk?a

(Base: Health officers in companies where screening is conducted to identify employees or job applicants at increased risk of

negative health outcome)

Unweighed base (139)

Medical history . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88%

Nongenetic screening (e.g., lower back x-ray,

allergy testing) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

Genetic screening . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

No answer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

aRes~~ents could give more than one answer.

SOURCE: Office of Technology Assessment, 1991.

ual susceptibilities to workplace exposures reported

using some form of nongenetic screening (e.g.,

allergy testing, lower back x-rays) other than medical histories.

Only 1 percent of health officers in companies

where screening is conducted to identify employees

or applicants at increased risk of negative health

outcomes reported that their companies conducted

genetic screening to identify increased susceptibility

to workplace risk. These cases included one electric

utility and one manufacturing and two nonmanufacturing companies. It is interesting to note that two of

these four companies did not report genetic monitoring and screening on the other specific questions

concerning genetic monitoring and screening (i.e.,

they were not included in the earlier estimates of the

rates of genetic monitoring and screening) (l).

Overall, the survey found that genetic monitoring

and screening played a limited role in identifying

workplace risk. Although most companies that

recognized differential employee risk used some

form of screening to identify increased individual

susceptibility, almost none used genetic monitoring

and screening. This could indicate that, at present,

medical histories and nongenetic tests are viewed as

adequate to corporate needs.

Basis for Genetic Monitoring and Screening

The survey data lead to the conclusion that

relatively few of the companies that responded

conduct genetic tests of employees or job applicants

to identify individual susceptibility to workplace

conditions. The question remains, however, about

what triggers genetic monitoring and screening in

297-942 - 91 - 4 : QL3
40 ● Medical Monitoring and Screening in the Workplace: Results of a Survey

Table 4-7-Genetic Monitoring or Screening for

Specific Purposes

Q.22. Has genetic screening or monitoring ever been done in

your company based on:

(Base: Health officers in companies that have ever done genetic

screening or monitoring)

Unweighed base (59)

Family history . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16%

Gender . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Ethnic or racial background . . . . . . . . . . . . . . . . . . . 19

Cofactors (e.g., smoking). . . . . . . . . . . . . . . . . . . . . o

Job exposures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 .

SOURCE: Office of Technology Assessment, 1991.

the workplace. Earlier OTA survey findings suggested that a substantial portion of the reported

genetic monitoring and screening in the workplace

was idiosyncratic-related to individual employee

requests, research projects, and the like (1,2).

However, to the extent that systematic testing was

being conducted, the basis of that individual testing

becomes important.

A total of 59 health officers (12 percent) out of the

494 participating in the survey reported some form

of pastor present genetic monitoring or screening of

employees by their companies. These health officers

were asked about the factors considered in initiating

genetic monitoring or screening in their companies.

Nineteen percent of health officers in those companies reported that such testing was based on ethnic

or racial background, as in the case of sickle cell

trait. Five of the eight doing such testing had 10,000

or more employees. Workplaces in all eight companies involved employee exposure to chemicals or

ionizing radiation (table 4-7).

Sixteen percent of health officers from such

companies reported that their firms had done genetic

monitoring or screening based on family history.

Once again, all were from companies in which

employees were exposed to chemicals or ionizing

radiation and 4 of the 6 companies had 10,000 or

more employees.

Thirteen percent of health officers in companies

that have ever conducted genetic monitoring or

screening reported job exposures as the basis of such

testing. In all of these cases employees were exposed

to chemicals or ionizing radiation. Most of the cases

(10 out of 12) involved companies with 10,000 or

more employees.

Table 4-8-Handling of Abnormal Genetic Test

Results for Employees

Q.24. Is counseling offered to all employees with abnormal

(positive) genetic test results by the company or are they

referred to their own physicians?

(Base: Health officers in companies that have ever done genetic

screening or monitoring)

Excluding

missing

Unweighed base (59) values

Company counseling . . . . . . . . . . . . . 6% 9%

Referred to own physicians . . . . . . . . 44 70

Both . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 21

No answer . . . . . . . . . . . . . . . . . . . . . . 37

SOURCE: Office of Technology Assessment, 1991.

Only 9 percent of health officers reported that

genetic monitoring or screening had ever been done

on the basis of gender. These cases involved, once

again, companies in which employees were exposed

to chemicals or ionizing radiation. (Glucose-6-

phosphate dehydrogenase deficiency is an example

of a genetic disorder that affects only males.)

Genetic monitoring or screening based on cofactors,

such as smoking, was reported by none of the health

officers surveyed.

How Results Are Disseminated

The corporate health officers in companies that

had conducted genetic monitoring and screening of

employees, regardless of the basis of the testing,

were asked about the conditions under which test

results were disseminated to the affected employees.

In those companies that informed employees of

genetic monitoring and screening results, the survey

found that the employee with abnormal test results

was typically referred to his or her own physician.

Over one-third (37 percent) of the health officers

from companies which had ever conducted any form

of genetic monitoring or screening did not respond

to this question. Among health officers responding

to the question, 70 percent reported that employees

with abnormal findings were referred to their own

physicians exclusively (table 4-8). Another 21

percent of the health officers reported that counseling was offered by the company, as well as the

employee being referred to his or her own physician.

The remaining 9 percent reported that the employee

was given counseling by the company, with no

mention of referral to a personal physician.
Chapter 4-Genetic Monitoring and Screening in the Workplace: Corporate Opinion and Practice . 41

Table 4-9-Changes in Workplace Practice or Exposure Level Due to Results of Monitoring

Q.28. Has your company ever instituted or changed a workplace practice or exposure level due to the results of:

(Base: Health officers)

Percent

Unweighed Don’t No

Base Yes No knowaanswer

Genetic monitoring in your own establishment(s) . (494) 1 92 ●

8

Other nongenetic medical monitoring in your own

establishment(s) . . . . . . . . . . . . . . . . . . . . . . . . . . (494) 30 63 1 7

Genetic monitoring in another company’s

establishment(s) . . . . . . . . . . . . . . . . . . . . . . . . . . (494) 1 91 ●

7

Other nongenetic medical monitoring in another

company’ s establishment(s) . . . . . . . . . . . . . . . . . (494) 11 81 1 7

Information published by Federal agencies,

including NIOSH and OSHA . . . . . . . . . . . . . . . . (494) 55 40 1 5

Wduntggrgd response.

“Indicates less than 1 percent.

SOURCE: Office of Technology Assessment, 1991.

Workplace Changes

Only 1 percent of health officers said that their

own genetic monitoring programs resulted in a

change in workplace practice or exposure level

(table 4-9). One percent also reported making such

changes in their own firms on the basis of genetic

monitoring results in another company.

The most common source of changes in workplace practice, however, was the Federal Government. A majority (55 percent) of the health

officers reported that their companies had instituted

or changed workplace practices or exposure levels

due to information published by Federal agencies,

including the National Institute for Occupational

Safety and Health (NIOSH) and the Occupational

Safety and Health Administration (OSHA).

Treatment of Identified Risk

Since personnel officers may be in a position to

use information obtained from genetic tests for

personnel action, the survey asked their opinions

about whether employees with identified susceptibilities should be excluded from positions of known

risk.

The majority of personnel officers surveyed (58

percent) felt that the individual with genetic susceptibilities should be excluded from positions of

known risk (table 4-10). On the other hand, a third

of personnel officers (35 percent) believed that the

employee should be allowed to take the job, if he or

she waived corporate liability. In both large and

small companies, only a minority of personnel

officers adopted the employee choice model of

handling genetic susceptibility. It should be noted

that this forced choice question may not have

exhausted the range of options open to employers

and employees when genetic susceptibility was

identified. A number of respondents objected to the

starkness of the choice of answers in the question.

Nonetheless, the question did help to reveal a sense

of the present balance between employee rights and

employer responsibility in this area.

Why Companies Have Decided Against

Genetic Monitoring and Screening

In both 1989 and 1982, a number of companies

that had conducted genetic monitoring or screening

in the past reported that they no longer do so. The

reasons companies decided to stop genetic monitoring or screening are extremely relevant in considering the future of genetic monitoring or screening in

the workplace. Equally important, Knot more so, are

the reasons that influence companies never to begin

genetic monitoring or screening of employees.

Indeed, these reasons are particularly important in

examining whether events between 1982 and 1989

caused those considering the use of genetic monitoring and screening in 1982 to abandon those plans.

In order to examine this issue, all health officers

were asked whether their companies had considered

and decided against the use of genetic monitoring or

screening in the past 10 years based on their own or

other companies’ experiences with monitoring or

screening.
42 ● Medical Monitoring and Screening in the Workplace: Results of a Survey

Table 4-10-Exclusion or Choice: Treatment of Employees at Risk

Q.9. If an employer becomes aware that an employee has a genetic susceptibility to serious illness if he or she is exposed to substances

in the workplace, do you think the employer should exclude that employee from those jobs for which he/she is at increased risk or

do you think the employer should allow the employee to take those jobs, if he/she waives corporate liability?

(Base: Personnel officers)

Percent

Unweighed Allow It Not Don’t No

base Exclude to take depends legal a

knowbanswer

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Type of business

Electrical utility . . . . . . . . . . . . . . . . . . .

Pharmaceutical . . . . . . .. . . . . . . . . . . .

Other chemical. . . . . . . . . . . . . . . . . . .

Petroleum . . . . . . . . . . . . . . . . . . . . . .

Electronic . . . . . . . . . . . . . . . . . . . . . . .

Other manufacturing. . . . . . . . . . . . . .

Nonmanufacturing . . . . . . . . . . . . . . . .

Number of employees

Less than 5,000 . . . . . . . . . . . . . . . . . .

5,000 to 9,999 . . . . . . . . . . . . . . . . . . .

10.000 or more . . . . . . . . . . . . . . . . . . .

(569)

( 43)

( 20)

( 37)

( 10)

( 21)

{176)

(262)

(308)

( 99)

(154)

58

52

50

37

63

80

63

57

58

55

62

35

32

47

50

30

9

26

38

36

38

31

●

o

0

0

0

0

0

●

o

1

0

1

1

0

0

3

0

0

1

1

0

1

1

0

0

7

0

6

1

●

●

1

2

5

15

3

6

5

5

10

3

6

6

4

avolunteered response including “not legal” and “=nnOt be done.”

bvolunteered response.

‘Indicatee less than 1 percent.

SOURCE: Office of Technology Assessment, 1991.

Two percent of those surveyed in 1989 reported

that their companies had decided to discontinue or

not to initiate new genetic monitoring in the past

10 years based on their own experience (table 4-11).

This included one health officer who reported that

genetic monitoring or screening was being currently

conducted, two who reported that genetic testing

was discontinued, and six health officers at companies that had never conducted genetic monitoring or

screening. Three percent reported that their companies had chosen not to use genetic monitoring

because of the results of genetic monitoring in

another establishment.

Two percent of health officers reported that their

companies had chosen not to use genetic screening

based on their fins’ own experiences. This included

two health officers at companies that currently

conducted genetic monitoring or screening, two at

companies that had discontinued genetic testing and

six at companies that had never conducted genetic

monitoring or screening. Two percent of health

officers reported that their firms had chosen not to

use genetic screening because of the results of

genetic screening at another company.

The results to this question suggested that experiences with genetic monitoring and screening provided only a partial explanation for why some

companies chose to discontinue genetic testing.

First, many of those “former testers” did not cite

experiences in their own establishments or others as

the reason they stopped testing. Second, a number of

“current testers” indicated that they chose not to

test in the past based on experiences with genetic

testing, but they were apparently currently using

some tests from the survey’s genetic testing inventory. This suggests that the choice ‘not to test’ may

reflect decisions about individual tests or individual

cases, not about biochemical genetic screening and

cytogenetic monitoring in the generic sense.

More importantly, the majority of health officers

in companies that never conducted genetic monitoring or screening did not cite past experiences in their

own or other companies as the reason for not using

genetic monitoring or screening. There seems little

evidence that events or concerns about genetic

monitoring or screening between 1982 and 1989 had

led more than a handful of companies away from

using such tests.

Personnel Officer Recommendations

Nearly 9 out of 10 personnel officers (88 percent)

said that, if asked, they would recommend against

the use of genetic screening as part of preemployment screening (table 4-12). Two percent of the

personnel officers reported they “didn’t know.”

Thirty-five personnel officers (6 percent) reported
Chapter 4--Genetic Monitoring and Screening in the Workplace: Corporate Opinion and Practice . 43

Table 4-n-Reasons Companies Have Chosen Not To Use Genetic Monitoring or Screening

Q.29. In the past 10 years has your company chosen not to use genetic screening or monitoring due to the results of:

(Base: Health officers)

Percent

Unweighed Don’t No

Base Yes No knowa

answer

Genetic monitoring in your own estabiishment(s) . (494) 2 86 ●

12

Genetic monitoring in another company’s

establishment . . . . . . . . . . . . . . . . . . . . . . . . . . (494) 3 85 *12

Genetic screening in your own establishment(s) . . (494) 2 84 2 13

Genetic screening in another company’s

establishment . . . . . . . . . . . . . . . . . . . . . . . . . . (484) 2 84 1 13

aVolunteered response.

“Indicates less than 1 percent.

SOURCE: Office of Technology Assessment, 1991.

Table 4-1 2—Recommendations for Genetic Screening

Q.22. If you were asked, would your recommmend to your company

that genetic screening be done as part of preemployment

screening?

(Base: Personnel officers)

Unweighed base (569)

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69%

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88

Don’t knowa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

No answer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

avolunt~red response.

SOURCE: Office of Technology Assessment, 1991,

that, if asked, they would recommend genetic

screening be done as part of preemployment screening.

Those who would recommend genetic screening

were asked to specify the criteria that the screening

should be based on. The two leading criteria for

recommending the use of preemployment genetic

screening were predisposition to work-related illnesses (23 percent) and the cost-effectiveness of the

screening (23 percent). Workplace exposure to

hazardous material (19 percent) was another criterion presented. Others suggested that the screening

must be based on government guidelines and consistent with laws (10 percent) (table 4-13).

The personnel officers had similar attitudes toward genetic monitoring. Nine out of ten corporate

personnel officers (89 percent) said that they would

recommend against periodic genetic monitoring of

employees (table 4-14). Two percent “didn’t

know.” Six percent-43 personnel officers in the

sample-said they would recommend that such

monitoring of employees be conducted.

Q.22.

Table 4-13-Criteria for Genetic Screening

if you were asked, would you recommend to your company

that genetic screening be done as part of preemployment

screening? if yes, based on what criteria?a

(Base: Personnel officers who would recommend genetic

screening)

Unweighted base (35)

in high risk areas (unspecified) . . . . . . . . . . . . . . . . 4%

Workplace//on-the-job exposure/hazardous

materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Predisposition to work-related illness/hazardous to

those with certain traits. . . . . . . . . . . . . . . . . . . . 23

if participation was voluntary/optional. . . . . . . . . . . .

Based on government guidelines/consistent with

laws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

if cost-effective/depends on cost-effectiveness . . . 23

All other mentions . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

aRespondents rxwkf give more than one answer.

‘Indicates less than 1 percent.

SOURCE: Office of Technology Assessment, 1991.

The two leading criteria for recommending periodic genetic monitoring were workplace exposure to

hazardous material (29 percent) and the costeffectiveness of the tests (21 percent). Other criteria

included predisposition to work-related illnesses

(10 percent), government guidelines (9 percent), or

voluntary participation (2 percent) (table 4-15).

Health Insurance and Genetic Monitoring

and Screening

The survey found that cost-effectiveness of genetic monitoring and screening influenced corporate

decisions on implementing such programs. While

most personnel officers in companies using genetic

monitoring and screening cited cost-benefit analysis

as an important factor in the decision to conduct such
44 ● Medical Monitoring and Screening in the Workplace: Results of a Survey

Table 4-14-Recommendations for Genetic

Monitoring

Q.23. If you were asked, would you recommend to your company

that periodic genetic monitoring of employees be done?

(Base: Personnel officers)

Unweighed base (569)

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6%

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

Don’t knowa

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

No answer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Volunteered response.

SOURCE: Office of Technology Assessment, 1991.

Table 4-15-Criteria for Genetic Monitoring

Q.23. If you were asked, would you recommend to your company

that periodic genetic monitoring of employees be done? If

yes, based on what criteria?a

(Base: Personnel officers who would recommend genetic

monitoring)

Unweighed base (43)

In high risk areas (unspecified) . . . . . . . . . . . . . . . . 49%

Workplace/on-the-job exposure/hazardous

materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Predisposition to work-related illness/hazardous to

those with certain traits. . . . . . . . . . . . . . . . . . . . 10

If participation was voluntary/optional.. . . . . . . . . . 2

Based on government guide lines /consistent with

laws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

If rest-effective/depends on cost-effectiveness . . . 21

All other mentions . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

aReSpo~en~ could give more than one answer.

SOURCE: Office of Technology Assessment, 1991.

tests, only a small proportion considered the tests to

be cost-effective.

Cost-effectiveness was not the only reason put

forward against adoption of genetic monitoring and

screening by employers. In addition, respondents

voiced concerns about the tests’ reliability and

legality, the liability associated with them as well as

fair and appropriate uses of the technology. Nonetheless, when one considers the survey findings of

very widespread adoption of drug testing in the

workplace, it seems fair to conclude that the

cost-effectiveness of employee medical monitoring

and screening may be more important than consensus on reliability, legality, and employee rights, in

adoption of workplace tests (see ch. 2).

The survey identified one factor that could change

the perceived cost-effectiveness of genetic monitoring and screening in the workplace: the health

insurance risk to the employer of the employee with

a genetic disease, condition, or trait. The survey

Table 4-1 6-Hiring of Job Applicants Considered To

Be Health Insurance Risks

Q.27. lf a job applicant is currently healthy and able to perform the

job, but is considered to be a health insurance risk would

that consideration reduce the likelihood of his/her being

hired by your company-a lot, some, or not at all?

(Base: Personnel officers)

Unweighed base (569)

A lot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3%

some . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Not at ail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

No answer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

SOURCE: office of Technology Assessment, 1991.

provided some evidence that employers are interested in the health care risks of healthy, asymptomatic individuals, in job decisions. Moreover, a

number of employers were currently screening job

applicants to identify the health care risk of the

applicant and his or her dependents.

It is worth mentioning that of the 565 personnel

officers that responded to the survey, 24 percent

purchased their current health insurance plan(s)

from a private carrier, 42 percent were self-insured,

and 33 percent cited both types of plans (see app. A).

The personnel officers were asked about the

degree to which health insurance risk, among

otherwise able-bodied job applicants, affected employment decisions. The majority of personnel

officers (55 percent) reported that the health insurance risk of an otherwise healthy job applicant

would not affect the likelihood of the applicant being

hired by their companies. However, the survey

found that in 42 percent of companies, the health

insurance risk of the job applicant reduced the

likelihood of an otherwise healthy, able job applicant being hired “a lot” (3 percent) or “some” (39

percent) (table 4-16).

The effect of concerns about health insurance risk

on decisions about employee testing is not simply

theoretical. About 1 in 10 personnel officers (11

percent) reported that the companies assessed health

insurance risk of job applicants on a routine basis.

Another quarter of the companies (25 percent)

reported that the health insurance risk of job

applicants was assessed sometimes. Hence, while 6

out of 10 companies (63 percent) reported that they

never assessed the health insurance risk of job

applicants, more than one-third (36 percent) reported

that they did assess health insurance risk, though not

necessarily on a routine basis (table 4-17).
Chapter 4-Genetic Monitoring and Screening in the Workplace: Corporate Opinion and Practice . 45

Table 4-17—Assessing Health Insurance Risks of

Job Applicants

Q.28. Does your company assess the health insurance risk of job

applicants on a routine basis, sometimes or never?

(Base: Personnel officers)

Unweighed base (569)

On a routine basis . . . . . . . . . . . . . . . . . . . . . . . . . . . 11?40

Sometimes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Never . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

No answer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

SOURCE: Office of Technology Assessment, 1991.

Perhaps even more striking is the extent to which

health insurance risk was already being assessed in

some large companies. Among those conducting any

assessments of the health insurance risk of applicants, 1 in 10 (9 percent) companies also considered

the health of dependents in the assessment (table

4-18). The responses to the preceding questions

varied little between self-insured companies, companies with a private insurance carrier, and companies with both types of plans.

The growing concern among employers over the

rising costs of employee health insurance, and the

increased efforts to reduce those costs to the

employer, are likely to increase the scope of health

insurance screening in the workplace. To the extent

that genetic monitoring and screening can identify

employee and dependent risk to atypical subsequent

health care demands, cost-effectiveness as a means

of employee monitoring and screening may be

increased.

The survey suggests that the cost and reliability of

such tests are more of a factor than any issue of

fairness. Even at this point in time, half of the

personnel officers interviewed (53 percent) considered the use of a preemployment health exam in

order to identify job applicants who represent high

insurance risks as acceptable. If genetic tests could

be used to predict risk to subsequent health condiTable 4-18-Assessing Health Insurance Risks of

Dependents of Job Applicants

Q.28a. Does the health insurance assessment of job applicants

also consider the health of dependents?

(Base: Personnel officers in companies that assess the health

insurance risk of job applicants)

Unweighed base (198)

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9%

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88

No answer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

SOURCE: Office of Technology Assessment, 1991.

tions more reliably than medical histories and

nongenetic tests, given the present climate of

corporate opinion and practice related to employee

screening, one would expect the new technology to

be increasingly adopted as it passes a costeffectiveness review.

It is important to keep in mind, however, that very

little genetic monitoring and screening is currently

being conducted by employers. The survey does not

suggest that it is currently being used for health

insurance screening purposes. Moreover, only a

handful of companies that were not currently conducting genetic monitoring and screening anticipated doing so in the next few years. Based on the

survey findings, the factor most likely to increase

use of genetic monitoring or screening in the

workplace is demonstrations that they can identify

health insurance risks.

CHAPTER 4 REFERENCES

1. U.S. Congress, Office of Technology Assessment,

Genetic Monitoring and Screening in the Workplace,

OTA-BA-455 (Washington, DC: U.S. Government

Printing Office, October 1990).

2. U.S. Congress, Office of Technology Assessment, The

Role of Genetic Testing in the Prevention of Occupational Disease, OTA-BA-194 (Washington, DC: U.S.

Government Printing Office, April 1983).
Appendixes
Appendix A

Survey Methodology

Study Design

The survey was conducted for the Office of Technology

Assessment (OTA) from March 24 to July 15, 1989, by

Schuhman, Ronca, & Bucuvalas, Inc. (SRBI). The core of

the 1989 survey remained a national survey of the 500

largest U.S. industries, 50 largest utilities, and 33 major

unions. The 1989 survey contained comparable questions

to core survey items from the 1982 survey. (See table A-1

for a summary of the methodology of the 1989 and 1982

surveys.)

Sampling Design

The purpose of the sampling design was to provide

comparability with OTA’s 1982 survey, while expanding

the ability to generalize the results to a broader population. The 1989 survey results were based on four samples.

First, all Fortune 500 companies were selected to provide

information on genetic monitoring and screening at large

corporations in the United States. The procedure for

specifying this population was to use the Fortune 500

listing of manufacturers and utilities from the previous

year. This procedure, which was identical to the procedure

used in the 1982 survey, produced an independent census

of the current Fortune 500 population rather than a panel

of previously surveyed organizations.

Second, the 50 largest private utility companies in the

United States were surveyed to provide coverage of large

utilities. This sampling was based on the most recent

Fortune Magazine listing prior to the survey. As with the

Fortune 500 listing, this produced a current census of the

50 largest utilities.

Third, a sample of large unions was developed by OTA

to provide broad coverage of a wide variety of unions. The

1982 sample of unions was based on 11 unions with the

largest number of members working for Fortune 500

companies, identified from the 1979 Directory of National Unions and Employees Association published by

the U.S. Department of Labor. This publication was

discontinued in the early 1980s, so no comparable list was

available for the 1989 survey. A broader sample of unions

was desired in any case, since the 1989 survey had been

expanded to include a cross-section of medium and large

companies with 1,000 or more employees. Therefore, a

sample of 33 large unions was identified by OTA for the

1989 survey.

Fourth, the 1989 survey added a stratified cross-section

sample of large- and medium-sized companies with at

least 1,000 employees that did not belong to the Fortune

500 group, to provide results protectable to the universe

of companies with 1,000 or more employees. Public

organizations, such as nonprofit groups and governmental

organizations, were excluded. The number of employees

in the company was defined as the total number of persons

employed company-wide in the United States, rather than

the number of employees at company headquarters or at

a particular establishment.

The sample of companies with 1,000 or more employees was stratified by company size. The sample was

divided into four size strata: companies with 10,000 or

more employees, companies with 5,000 to 9,999 employees, companies with 2,500 to 4,999 employees, and

companies with 1,000 to 2,499 employees. Companies

were randomly selected within each strata from Dun &

Bradstreet lists. The final sample consisted of 100

companies with 10,000 or more employees, 100 companies with 5,000 to 9,999 employees, 300 companies with

2,500 to 4,999 employees, and 350 companies with 1,000

to 2,499 employees. Such division by size allowed the

survey to oversimple the largest companies and obtain a

relatively high sampling incidence of these firms.

Table A-l-Summary of Methodology

Samples

Fortune 500 companies . . . .

50 largest utilities . . . . . . . . . .

Unions . . . . . . . . . . . . . . . . . . .

Companies with 1,000+

employees . . . . . . . . . . . . .

Designated respondent

Private companies:

Chief health officer . . . . . . .

Chief personnel officer . . .

Unions:

Union president . . . . . . . . .

Sampled in 1989 and 1982.

Sampled in 1989 and 1982.

30 unions in 1989 and 11 unions in

1982.

1,000 sampled in 1989. Not

sampled in 1982.

Designated respondent in 1989

and 1982.

Received version of questionnaire

for health officers.

Designated respondent in 1989

only.

Received different questionnaire

version for personnel officers.

Designated respondent in 1989

and 1982.

Follow-up methodology

Reminder letters . . . . . . . . . . . Sent in 1989 and 1982.

Remailing questionnaires to Sent to all nonresponders in 1989

nonresponders . . . . . . . . . and 1982.

Telephone followup to All Fortune 500 and utilities in

nonresponders . . . . . . . . . . . . 1989.

Only 200 largest companies in

1982.

Actual telephone interviews

with nonresponders to

mail survey . . . . . . . . . . . . . Done as a last resort in 1989 and

1982.

SOURCE: Offics of Technology Assessment, 1991.

49-
50 ● Medical Monitoring and Screening in the Workplace: Results of a Survey

In addition, companies with certain standard industrial

code (SIC) groups were oversampled to obtain sufficient

numbers of oversampled companies and permit analysis

of certain types of SIC groups. The oversampled SIC code

groups covered pharmaceuticals (SIC 2834), other chemical companies (rest of SIC group 28), petroleum (SIC

group 29), semiconductors (SIC 3674), other electronics

companies (SIC 3675-3679), and electric utilities other

than the 50 largest utilities (SIC 4911 and 4931). A target

subsample size of 50 companies was adopted for each of

the oversampled industry groups. In order to achieve this

subsample size, a sufficient number of companies with

1,000 or more employees in each oversampled group were

randomly selected to supplement the core cross-section

sample so that the final sample included 50 companies in

the oversampled group. In cases where there were 50 or

less U.S. companies in an oversampled group with 1,000

or more employees, all companies in that group with

1,000 or more employees were included in the final

sample.

Questionnaire Development

A survey questionnaire was developed by the contractor in concert with OTA according to the detailed research

objectives set forth by OTA. The OTA advisory panel

reviewed the questionnaire at the February 1989 panel

meeting after a pretest was conducted between February

17 and March 1, 1989. The findings of the pretest were

used to revise the questionnaire.

The 1989 survey contained comparable questions to

core survey items from the 1982 survey. This provided

OTA with the necessary comparability to the 1982 survey

so that changes in the workplace over time could be

assessed. However, the method was altered to increase the

usefulness of the information. The central components

were:

1. The content of the questionnaire was broadened to

include the use of genetic monitoring and screening in the

workplace in the context of other types of employee

testing. The survey was expanded to deal with attitudes of

employers toward the proper and improper uses of genetic

monitoring and screening in the workplace. The survey

also covered more areas related to the applications of

genetic monitoring and screening in personnel matters, as

well as applications for employee health.

2. As in 1982, the survey was directed to the chief

health officer, to answer questions dealing with the

medical applications of genetic monitoring and screening.

A different questionnaire was also directed to the chief

personnel officer focusing on personnel applications (e.g.,

recruitment, placement, advancement, and retention) of

genetic monitoring and screening.

3. The universe of Fortune 500 companies was

supplemented by a sample of non-Fortune 500 large-and

medium-sized employers so that the extent of genetic

monitoring and screening in the workplace could be

examined more broadly.

4. Telephone recontact was attempted with all nonrespondents in the Fortune 500 and 50 largest utility

companies.

5. The identity of companies returning questionnaires

was anonymous in 1982. In order to improve tracking of

the sample and prevent duplicate responses, the 1989

survey used questionaires with identification numbers

on peel-off labels. The respondent was encouraged to

leave the label on the questionnaire when it was returned,

but this was voluntary. All labels were removed after

receipt of the questionnaires, making the data both

anonymous and confidential.

Confidentiality

The 1982 survey used a postcard system to verify

which companies had returned questionnaires. Each

questionnaire was sent to the company along with a

postcard. Substantially more questionnaires were returned (n=373) than postcards (n=307). This raised the

possibility that more than one survey was completed by

the same organization, since respondents are normally

more likely to return a postcard without a questionnaire,

so that he or she would not be subject to follow-up. In fact,

a few organizations returned more than one questionnaire

in 1989, i.e., the original questionnaire and a questionnaire sent in a follow-up mailing. These were identified

and removed from the 1989 sample.

Because there appeared to be a problem with the use of

a separate postcard to track anonymous questionnaire

returns, a respondent identification number was proposed

for the 1989 questionaires. This permitted improved

sample tracking and allowed identification of duplicate

returns. Due to concerns about the anonymity of the

questionnaires, a compromise solution was to affix the

identification number to the 1989 questionnaires on a

peel-off label that could be removed by respondents who

wished to remain anonymous. Respondents were encouraged to leave the peel-off label on the survey, which

explained would be removed after receipt. After SRBI

received the questionnaires, the peel-off labels were

removed, making the data both anonymous and confidential.

Nine out of 10 survey participants left the peel-off label

on the questionnaire. The peel-off labels were removed

from 11 percent of the health officer questionnaires, and

10 percent of the personnel officer questionnaires returned to SRBI. Only 5 of 59 health officers reporting any

type of genetic monitoring and screening removed the

label before returning it.
Appendix A-Survey Methodology .51

Table A-2-Sample Disposition for 1989 Survey:

Fortune 500 and 50 Largest Utilities

Sample mailing and eligibility Number

Drawn sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Companies ineligible before mailing:

merged/out of business/bought by

other company in sample . . . . . . . . . . . . . . . . . . .

Companies mailed questionnaires . . . . . . . . . . . . . .

Companies ineligible to complete survey. . . . . . . . .

Merged/out of business/bought

by other company in sample . . . . . . . . . . . . . . .

Noncontactable by mail and telephone,

no forwarding address and nonlocatable . . . . .

Companies eligible to complete survey . . . . . . . . . . .

Participation in survey

Total questionnaires received during field period . . .

Health questionnaires received. . . . . . . . . . . . . . .

Personnel questionnaires received. . . . . . . . . . . .

Companies returning at least one

questionnaire during field period . . . . . . . . . . . .

Companies returning both questionnaires. . . . . .

Companies returning only health questionnaire. .

Companies returning only personnel

questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . .

Companies returning questionnaires after

close of field period . . . . . . . . . . . . . . . . . . . . . . . . .

Total companies returning questionnaires . . . . . . . .

Nonparticipation in survey

Companies refusing to participate . . . . . . . . . . . . . . .

Too busy to complete survey . . . . . . . . . . . . . . . . .

Participation against company policy.. . . . . . . . .

Company too decentralized for someone

to do survey . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other refusals . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Companies in callback status: had been remailed

questionnaires . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other companies not returning questionnaires. . . . .

Completion rate (Total companies returning

questionnaires/eligible companies) . . . . . . . . . . . .

550

3

547

18

15

3

529

453

250

203

325

128

122

75

5

330

150

41

51

5

53

45

4

62.4%

SOURCE: Office of Technology Assessment, 1991.

Field Procedures

The field procedures used in this study included:

●

●

●

●

●

an advance letter, produced on OTA stationery and

signed by OTA Director, John H. Gibbons, sent to

the Chief Executive Officer (CEO) of each sampled

company and union Presidents prior to mailing the

questionnaire;

a first mailing of the questionnaire with a cover letter

to the CEO, asking that one questionnaire be directed

to the firm’s chief executive for health affairs and a

second one to the chief personnel officer,

a follow-up letter to individuals whose replies were

not received within 2 weeks of the first mailing;

a second questionnaire mailing approximately 3

weeks after the follow-up letter,

a telephone follow-up of all Fortune 500 companies

and the 50 largest utility companies that did not

return both questionnaires; and

Table A-3-Sample Disposition for Survey:

Non-Fortune 500 Companies

Sample mailing and eligibility Number

Drawn sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Companies ineligible before mailing: merged/

out of business/bought by other company

in sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Companies mailed questionnaires . . . . . . . . . . . . .

Companies ineligible to complete survey:

merged/out of business/bought by

other company in sample . . . . . . . . . . . . . . . . . .

Companies eligible to complete survey.. . . . . . . .

Participation in survey

Total questionnaires received during field period .

Health questionnaires received . . . . . . . . . . . . . . . .

Personnel questionnaires received . . . . . . . . . . . .

Companies returning at least one questionnaire

during field period . . . . . . . . . . . . . . . . . . . . . .

Companies returning both questionnaires. . . . .

Companies returning only health questionnaire.

Companies returning only personnel

questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . .

Companies returning questionnaires after close

of field period. . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total companies returning questionnaires . . . . . . .

Nonparticipation in survey

Companies refusing to participate . . . . . . . . . . . . .

Companies requesting mail to different address. .

No response after 2 mailings . . . . . . . . . . . . . . . . .

Completion rate

(Total companies returning questionnaires/

eligible companies) . . . . . . . . . . . . . . . . . . . . .

. --- 1,039

0

1,039

40

999

667

301

366

460

207

94

159

10

470

22

19

488

47.0%

SOURCE: Office of Technology Assessment, 1991.

. telephone interviews after repeated telephone follow-up and remails.

Sample Disposition

A total of 330 organizations in the Fortune 500 and 50

largest utilities categories completed and returned at least

one questionnaire for the 1989 survey (table A-2). An

additional 21 organizations in these groups were classified as ineligible for the survey because they had merged,

were no longer in business, or had been bought by another

Fortune 500 company or by one of the 50 largest utilities.

The overall response rate among the 529 eligible

organizations was 62.4 percent

By comparison, the 1982 survey on genetic monitoring and screening reported a 65.2 percent response rate

among the Fortune 500 companies, 50 largest utilities and

11 unions, based on 366 organizations returning questionnaires. One four-page questionnaire was mailed to CEO’s

and directed to chief health officers in 1982. In 1989, two

questionnaires totaling 20 pages were mailed to CEO’s,

including a 12-page instrument for chief health officers

and an 8-page questionnaire for chief personnel officers.

The 62.4 percent response rate was achieved after

repeated follow-up telephone calls and remails of the
52 ● Medical Monitoring and Screening in the Workplace: Results of a Survey

questionnaires. A total of 150 companies refused to

participate in the 1989 survey, or 28 percent of the Fortune

500 companies and 50 largest utilities.

A total of 470 additional organizations from a national

sample of non-Fortune companies with 1,000 or more

employees completed and returned at least one questionnaire for the 1989 survey. No telephone followup efforts

were conducted among this additional sample because

response rate comparability was not sought. Hence, the

response rate to the survey was somewhat lower among

the additional sample of non-Fortune companies with

1,000 or more employees (47 percent) than was achieved

among the Fortune companies (62.4 percent).

Both Fortune and non-Fortune samples represent

proper and exclusive subsets of the universe of companies

with 1,000 or more employees. However, since the

sampling was conducted disproportionately by company

size and industry classification, the completed sample was

weighted to the population distribution of the universe on

these two characteristics. The tables present the weighted

sample proportions, along with the unweighed sample

sizes.
Appendix B

Qualitative Comments About the Survey

Space was provided on the last page of all questionnaires for respondents to volunteer any opinions, concerns, or suggestions related to genetic monitoring and

screening in the workplace that they felt the survey did not

address. In addition, respondents were encouraged to

comment on any survey questions they found confusing

or difficult to answer. A total of 78 health officers and 50

personnel officers volunteered comments on the last page

of the questionnaire. Most comments volunteered dealt

with views on the subject of genetic monitoring or

screening. A handful volunteered criticism of the survey

or qualified answers to individual questions.

The open-ended comments of survey participants

provide additional detail and context on current attitudes

and concerns among employers about the use of genetic

monitoring and screening in the workplace. Although

they may qualify individual responses, the comments are

consistent with the quantitative findings of the survey.

Comments on Genetic Monitoring

or Screening

Health and personnel officers who volunteered comments offered much more criticism than support for

genetic monitoring and screening. However, several

indicated that monitoring and screening may be acceptable under certain circumstances. Many of those critical

of such testing objected more on practical than philosophical grounds. No health or personnel officer volunteered comments dealing with corporate plans to implement genetic monitoring or screening in the future.

Support for Monitoring or Screening

No health officer volunteered comments giving unqualified support to genetic monitoring and screening.

The health officer who gave the most supportive statement regarding genetic monitoring or screening wrote the

following:

Genetic testing is an excellent clinical tool. It is very

sensitive and very specific, but is not practicable when you

try and relate an abnormality to workplace hazards.

Another health officer wrote:

I support any mechanism which would protect the

health and safety of our employees. I feel employees

should be well informed and the business should have a

responsibility for providing a safe working place.

The two personnel officers who volunteered the most

supportive comments of genetic monitoring or screening

wrote:

I am of the opinion that genetic screening is the answer

to protection from occupational disease for the individual

and for liability control for the employer. I am an

occupational health professional, and a minority, in a

Fortune 500 firm that has difficulty condoning preemployment physicals. It will take OSHA [Occupational Safety

and Health Administration] to cause it to happen here!

Genetic monitoring or testing can be a valuable tool for

both the individual and the company. Neither party is well

served by an inappropriate employment situation. There

are times, of course, when it may be difficult for certain

high-risk individuals to be employed in almost any

situation; that issue is a moral and ethical one that does

require further study. As indicated in an earlier response,

if genetic technology is better perfected, laws are not

prohibitively restricted and if society accepts the concept,

I would feel that genetic monitoring and testing will occur

with more frequency in the future.

Qualified Views on Genetic Monitoring

or Screening

However, a number of health officers suggested that

guidelines would need to be established for genetic

monitoring or screening, with some calling for the

development of guidelines as a prerequisite for their

companies to consider the use of genetic monitoring or

screening. One health officer stated that access to any

employee medical information is a very sensitive area for

which some guidelines would be helpful. Comments by

health officers who volunteered support for genetic

monitoring or screening guidelines are given below:

Because of the nature of the subject it is imperative that

guidelines, legality, and accuracy of genetic screening and

monitoring be well established before our company would

consider the use of these tools.

Monitoring should be done only on established guidelines affecting usage. More research is needed in this area

before proper implementation can be done.

Collecting data is not problematic. The important and

often controversial topic is how that data is used. Genetic

information is often not as useful as some may believe,

therefore stringent guidelines on how the data may be used

should be developed.

Guidelines are needed before testing. Employer and

employee must work this testing out together unless it is

mandated.

Our industrial exposures are unrelated to illness identifiable with known genetic-related factors. However, unless

safeguards are available to protect genetically vulnerable

employees it would be appropriate to identify them for

proper placement.

–53–
54 ● Medical Monitoring and Screening in the Workplace: Results of a Survey

Too much work remains to be done at the bimolecular

and biochemical level to elucidate the association between

genetic testing and specific syndromes, deficiencies or

disease states, i.e., elucidate the associations with an

acceptable accuracy. Additional R&D should proceed

because there are many potential benefits to health

promotion and protection, provided a suitable educational

program is developed in tandem: one that explains the

issues in realistic terms. . . .

Genetic screening and monitoring viewed as primarily

a research tool at this time.

Key questions or concerns: Testing has to be related to

job performance and be documented by objective studies

or at least consensus expert opinion, All reasonable (e.g.,

as OSHA defined) steps to alter jobs should be carried out

before applicants are excluded from them. In this state, any

condition affected by the workplace, even minimally, is

fully compensable. That puts extra incentives on business

if we are held financially responsible for a minimal

aggravation of an at-risk employee’s condition.

I favor genetic testing only if such a test would identify

an individual at risk of developing a significant illness if

exposed to a particular agent in the workplace.

Genetic screening or monitoring would be considered

for use if justified to prevent or monitor occupational

illness but only if it met criteria applied to nongenetic tests.

Criteria would include cost, scientific validity, and ethical

considerations.

Genetic screening and monitoring is a technique that can

now be used to assess and warn an employee of potential

harm greater than the general workforce, but should not be

used at this time to displace workers or deny employment.

A number of personnel officers volunteered comments

on genetic monitoring or screening that can be classified

as qualified views on the subject. Like the health officers

who supported the development of guidelines, some of

these personnel officers indicated the tests may be usable

under certain circumstances:

While I believe it to be generally inappropriate to test,

I believe that some specific risks dictate wise use of

screening.

Definitely can have its value in appropriate (high

risk-you define) industries; e.g., chemical. Probably not

appropriate- or “cost-effective’ ’-in the great majority

of industries. Obvious potential for serious Misuseperhaps, even abuse.

We believe genetic testing may develop into a very

valuable human resource management tool as well as an

important guide for personal career and life planning for

individuals; we are concerned about the potential social/

political (mis)use of the information.

Genetic screening presents a real dilemma in that it can

aid in the protection of employees and employers by

minimizing exposure to what, for some, are hazardous

conditions. If in this context it is used to match people and

jobs there is nothing wrong with it. If on the other hand

genetic testing is used to simply exclude people from

employment, it doesn’t really solve the problem at all. It

just swaps one for another.

Only in very select situations can genetic monitoring/

counseling/screening be justi.tied as a corporate expense.

Even then the individual must be allowed some degree of

‘‘free’ choice provided that he/she will accept responsibility for the outcome.

I feel to have knowledge of genetic tests incurs amiability

on the employer that goes far beyond the employee/

employer relationship. Our role is to focus on job

performance. Other issues that don’t effect that are none of

our business. However, we are also concerned with helping

our employees stay healthy so they can be productive.

Provided employment/employability is totally a function of the ability to do the job-then any testing that would

document that the job assignment is a health risk is

appropriate. But only to exclude a specific assignment—

not to exclude employment.

Genetic screening and monitoring activities should only

be used when there is a clear expectation of what will be

done with the results, i.e.,-there is a specific treatment. If

information/purpose has not been proven, then telling an

employee that he/she has an ‘‘abnormal’ test (and no one

knows what to do with it) only leads to a feeling of

hopelessness and suspicion on the part of the employee

who holds the employer liable for any possible outcome.

Unless the program of screening has been proven, then any

data collected should be considered a research project and

information not given to employees unless done in such a

way that no one is held liable for outcomes. It is not fair to

hold employers liable for unknown outcomes (known

outcomes is a different issue). Standard research protocols

should be used and rigorously assessed-if not will have

the same problem as when the AIDS [acquired immunodeficiency syndrome] test was inappropriately first released.

Criticisms of Genetic Monitoring or Screening

Health officers volunteered several general criticisms

of genetic monitoring or screening, including explanations of why such tests were not being conducted. The

criticisms of genetic monitoring or screening focused on

the perceived lack of practical value and accuracy of the

tests; possible problems with actual or perceived discrimination stemming from using genetic monitoring or

screening; and even possible abuse of the tests. It should

be noted that some of those offering reservations or

opposition to genetic monitoring or screening based their

objections on primarily practical grounds.

Health officers objecting to genetic monitoring or

screening tests as potentially discriminatory or unethical

wrote the following:

On a theoretical, altruistic level, I can see the advantages of genetic screening and monitoring; however, on a

practical level the potentials for abuse far outweigh the

advantages. Furthermore, with a shrinking workforce in
Appendix B-Qualitative Comments About the Survey ● 55

the years to come, such testing would increase the costs of

products tremendously.

At present, our corporation has a good risk assessment

and reduction program. Any genetic pre- or post-screening

is not envisioned. Any genetic monitoring during employment would be viewed as potentially discriminatory and

against all corporate philosophy.

I have grave reservations as to whether our medicallegal-social-financial structure can deal rationally to

genetic screening and/or monitoring. Our track record

regarding women and minorities gives me little comfort to

believe we could handle a genetic tool in the workplace.

The more testing that is done results in more chances of

denying an applicant employment because they can’t be

placed. This then is often grieved as discrimination. How

do you propose to handle this ‘Catch 22’ situation?

I find the concept of genetic screening as a workplace

requirement inappropriate at best and abhorrent at worst.

It is a sad commentary on the state of our national ethics.

Genetic screening must never be used to select for those

capable of withstanding environmental conditions, as an

alternative to making the workplace safe for everyone (or

most workers).

Current law requires employers not to discriminate in

hiring the handicapped. I assume this includes the use of

genetic testing.

Similarly, some health officers noted that genetic

monitoring or screening could pose problems related to

individual rights:

We must be ever vigilant that individuals are not

disadvantaged because of their henedity or environmental

circumstances.

In theory business programs involved in using genetic

screening and monitoring would appear to be helpful;

however, with the present wave of citizens involving

themselves with individual rights such programs could

present many problems. . .There are few people now who

are not aware of their familial health problems and their

potential for developing such problems themselves . . . .

Genetic screening and monitoring seem to be in direct

conflict with the Rehabilitation Act, etc.

Other health officers objected primarily to the perceived lack of practical value of genetic monitoring or

screening:

We do not believe the science pertaining to genetic

testing is sound enough at this time. Strong consideration

of the value of genetic testing is contingent on the

reliability of the tests. This testing is not reliablecurrently.

In the future genetic screening will be sufficiently

developed technically to apply as a screening tool. Not yet.

Biggest problem is absence of studies correlating findings

with health outcomes.

At the present time I have no confidence in state-of-theart genetic testing and/or interpretation of test results.

You will observe from my responses that I have an

objection IN PRINCIPLE with many aspects of genetic

screening or monitoring. However, the reason my company has not and does not plan to implement such

procedures in the future is that the state-of-the-art, validity

of interpretation of many of the tests is still unclear. . . .

Genetic testing does not currently appear to have much

practical value in protecting persons or reducing their risk

of harm. We have no moral or ethical opposition to testing

that is useful in promoting health. If we had full testing of

all employees, placement would be about as it is now.

We do have exposures to mutagenic agents. However,

consultation with our genetics department reveals the

conditions mentioned in question 2 above are not presently

met. Such testing has no merit; the goals are achievable by

conventional industrial hygiene measures.

Personnel officers also offered a range of criticisms of

genetic monitoring or screening. A number were strongly

opposed to conducting genetic monitoring or screening:

I believe that genetic testing for any reason is morally

wrong and an infringement on privacy rights. I have a fear

it will lead to a ‘super race’ philosophy. Our country was

founded on principles of privacy, equal rights. I feel this is

a step to destroy those rights. The only exception to this is

if it violates safety rules.

From a personal, professional and employee relations

point-of-view, I would oppose any form of genetic

screening and/or testing! !!! A total and complete invasion

of privacy!!

I don’t believe the efficacy or reliability of genetic

testing is sufficiently proven to warrant mandated genetic

testing programs. I have concerns about the abuse of

testing results which potentially could involve employers

in areas beyond their need to know resulting in invasion of

privacy, employment discrimination, scaring employees

with incomplete or incorrect medical information.

Genetic screening belongs in Star Wars. To our knowledge, no reliable cost-effective screening exists for such

screening.

I think that genetic testing is too new a concept for us to

properly evaluate. It conjures images of the “dark” side of

science. If it is appropriate, much is needed by many of us

in the way of understanding the implications.

There would be a reluctance to make employment

decisions based on genetic testing because of antidiscrimination laws.

We are unaware of the use/benefit of such testing. I am

sure cost considerations and EEO [equal employment

opportunity] (handicap) legislation could be problem.
56 ● Medical Monitoring and screening in the Workplace: Results of a Survey

You should consider the impact of screening as another

possible cause for discrimination in the workplace, and the

cost of such screenings to the employer.

What is the reliability level of this type monitoring/

screening? What are the costs? Since I am unfamiliar with

the efficacy of such tests my perception is shaped by a

“Star Wars” image. You have also not asked questions

about privacy and legality and conflict with handicap

antidiscrimination laws.

I’m not familiar with genetic testing but would be

concerned about legal issues that will inevitably arise.

I have a problem with the morality of such testing—

“Big Brother” is too much a part of our lives already.

Carry genetic engineering to its logical conclusion, and

we’ll be breeding engineers, MD’s, research scientists,

etc., like we breed race horses.

I wonder if the collection of this type of data doesn’t

ultimately lead to further unnecessary government intrusion into the workplace!

The use of genetic monitoring/screening will become

more evident when the results and studies can be directly

linked to the prevention or reduction of liability in the

workplace. The current use of genetic testing does not

appear to be ‘socially’ acceptable and will require education of employers either through insurance companies or

legislative initiatives.

I am decidedly against genetic interference. Products

should be designed with humans in mind not vice versa.

Comments on the Lack of Information About

Genetic Monitoring or Screening

Several health officers stated that they lacked information on genetic monitoring or screening. One attributed

the paucity of information to the technology’s newness.

This person said that the company should do everything

reasonable to protect the employee and, “must change

attitude of public that this is an invasion of privacy any

more than a H&P [History and Physical]. Others wrote:

Not enough information available tome to know value

and costs of genetic evaluations.

A most difficult area.

We have not as yet seriously considered or researched

the matter of genetic screening/monitoring.

It’s never been discussed as an option” in our company.

Genetic screening does not apply to this industry.

Considering our type of operation this has little relevance to us.

Similarly, one personnel offficer reported working for a

very sophisticated employer who lacked experience with

the subject. Other personnel officers wrote that:

The entire area of genetic testing in the workplace is a

new one and one which has not been widely discussed or

presented in HR [human resources] type publications. I

feel a total educational process will be required.

We have not, as a company, explored the ethical and/or

philosophical considerations of genetic testing.

Difficult to respond because of a lack of information

regarding genetic and biochemical testing.

It’s difficult to answer many of the questions when I

have little or no knowledge of biochemical genetic

screening, cytogenetic monitoring or DNA-based screening or monitoring techniques.

At this point in time I do not possess enough information

or knowledge with respect to genetic screening to make

informed judgments or recommendations to corporate

management.

Need to know a great deal more about this type of

testing.

Many compensation/benefits practitioners will need

more information on genetic testing and how it would be

administered before they can provide meaningful input on

this topic.

At this point we have not made an intensive examination

of the issue of mandatory testing of the type(s) outlined in

this questionnaire. We will continue to review this issue in

future Benefit/Health committee meetings held at the

management level of the company.

Some difficulty in truly understanding the specific

testing suggested and scope because of the huge controversy re: genetic testing and implications of judgments and

decisions which might be made re: results, discrimination,

etc.

General Comments on Testing

Two health officers wrote that any practical tests that

would identify applicants or employees at greater health

risk would be helpful, with one stating “all practical

technology” should be employed One health officer

simply stated support for proceeding deliberately to

protect employees and companies. One personnel officer

volunteered opposition to medical testing that attempts to

limit an individual’s employment on the basis of predisposition or susceptibility to a specific medical condition,

although that officer noted some use of tests in hazardous

job environments. Another personnel officer volunteered

opposition to additional Federal legislation to cover any

additional testing, national health care and/or the employment of persons with physical limitations.

Comments on the Survey

Several health officers volunteered comments on the

last page of the survey that explained or modified their

answer to specific questions. One explained cytogenetic

monitoring was not conducted because the technology

was considered unsatisfactory. Two felt that “exposure”

means the potential for exposure, with one volunteering
Appendix B-Qualitative Comments About the Survey ● 57

that chest x-rays are not usually required and that rotating

employees to prevent exposures was not necessary in

most instances. One health officer wrote this comment to

explain how the company performs genetic screening:

The only genetic screening we perform is to diagnose;

such as for sickle cell disease/trait, or thalassemia or

G-6-PD [glucose-6-phosphate-dehydrogenase] deficiency

to aid us in the diagnosis of an anemia. The only blood test

performed on our preemployment form is hemoglobin/

hematocrit/white blood cell count.

This was the only comment volunteered by a health

officer dealing with actual use of genetic monitoring or

screening.

In addition, a number of health officers volunteered

criticisms of the questionnaire or found some items

difficult to answer, including two with objections that the

questionaire contained questions that were poorly

worded, simplistic, loaded, and skirted the law on

affirmative action. For example:

Many of the survey questions are difficult to answer yes

or no. There are questions of definitions that apply to

almost all.

Some questions were left unanswered mainly due to lack

of understanding of the terminology involved.

Some questions difficult to understand.

One health officer wrote that broader answers are

needed on questions dealing with workplace exposures.

One found the attitudinal questions difficult primarily

because they did not take “good faith efforts” at

accommodation into account. One health officer wrote

that one question (Q.29) is confusing and had some

“ambivalence’ about some of the general attitude items

because genetic monitoring or screening was “not bad

per se” but there was “a potential for misuse.”

In addition, one health officer commented that positive

genetic tests do not translate into poor performance. This

person wrote that such tests were not totally accurate, but

were discriminatory. Finally, one respondent wrote that

“care must be taken in interpreting and conveying the

results of the survey responses. ”

Several personnel officers also volunteered criticisms

of the surveyor offered criticisms to individual questions.

Two personnel officers called the survey a waste of

money and one thought the questionnaire assumed a

higher level of sophistication than corporations have. One

personnel officer reported difficulty in answering some

questions because of a lack of information on the costs

associated with genetic testing. Two objected to the way

question 9 was framed, including one who wrote that the

answers to question 19 are inappropriate. One stated that

questions regarding ‘risk” were vague and made suggestions for related concepts that should have been included.

Two respondents to the health officer questionnaire

noted that their companies have no health officer. One

health officer indicated that the company is decentralized,

so the answers might not reflect company policy, while

one personnel officer simply noted that the organization

was highly decentralized. Finally, one health officer

indicated that the survey was difficult to fill out because

the scope of the “company” was not easily defined.
Appendix C

Acronyms and Glossary of Terms

AIDS

CDC

DHHS

DNA

DOL

EEO

EKG

G-6-PD

HR

NIOSH

OSHA

OTA

PHS

SIC

SRBI

List of Acronyms

—acquired immunodeficiency syndrome

-Centers for Disease Control (PHS, DHHS)

—U.S. Department of Health and Human

Services

-deoxyribonucleic acid

—U.S. Department of Labor

-equal employment opportunity

electrocardiogram

—glucose-6-phosphate dehydrogenase

—human immunodeficiency virus

—human resources

—National Institute for Occupational Safety

and Health (CDC, PHS, DHHS)

-Occupational Safety and Health Administration (DOL)

-Office of Technology Assessment

—U.S. Public Health Service (DHHS)

—standard industrial code

-Schulman, Ronca, & Bucuvalas, Inc.

Glossary of Terms

Acquired immunodeficiency syndrome: The most severe clinical manifestation of immune dysfunction

caused by the human immunodeficiency virus (HIV).

Biochemical genetics: The analysis of mutant genes on

the basis of altered proteins or metabolizes.

Chromosome: A threadlike structure that carries genetic

information arranged in a linear sequence. In humans,

it consists of a complex of nucleic acids and proteins.

Cytogenetics: The study of the relationship of the

microscopic appearance of the chromosomes and their

behavior to the genotype and phenotype of the

individual.

Deoxyribonucleic acid (DNA): The molecule that encodes genetic information. DNA is a double-stranded

helix held together by weak bonds between base pairs

of nucleotides.

DNA: See deoxyribonucleic acid.

Genetic monitoring: Involves periodically examining

employees to evaluate modifications of their genetic

material-e.g., chromosomal damage or evidence of

increased occurrence of molecular mutations-that

may have evolved in the course of employment. It

ascertains whether the genetic material of the group of

individuals has altered over time.

Genetic screening: A process to examine the genetic

makeup of employees or job applicants for certain

inherited characteristics. It can be used to detect

occupationally and nonoccupationally related tits.

Genetic testing: Technologies that determine a person’s

genetic makeup or that identify changes (damage) in

the genetic material of certain cells. As used in the

workplace, it encompasses both genetic monitoring

and screening.

Human immunodeficiency virus (HIV): A retrovirus

that is the etiologic agent of AIDS.

Mutagen/mutagenicity: A substance capable of inducing a heritable change in the genetic material of cells.

Reliability: Measured by the ability of a test to accurately

detect that which it was designed to detect and to do so

in a consistent fashion.

Trait: A distinguishing feature; a characteristic or property of an individual.

Validity: The extent to which a test will correctly classify

true susceptible and true nonsusceptible individuals;

sensitivity and specificity are components of validity.

–58–
Appendix D

Survey Instrument: Corporate Health Officers

SURVEY OF WORKPLACE HEALTH AND

GENETIC SCREENING AND MONITORING

CORPORATE HEALTH OFFICER VERSION

The Congressional Office of Technology Assessment is conducting a national survey of the opinions and experiences of employers related to the usc of genetic screening and monitoring in the workplace. This questionnaire has been directed to you as the person in your organization whose responsibilities include employee

health. We need your assistance in answering, as best you can, some questions about workplace testing and

employee health in your company.

For the purposes of this survey and the subsequent report, OTA has adopted the following definitions. By

genetic monitoring we mean periodically examining employees to evaluate modifications of their genetic material via tests such as cytogenetic or direct-DNA tests. By genetic screening wc mean screening job applicants or

employees for certain inherited characteristics. Screening tests may be biochemical tests or direct-DNA tests.

They can be used to indicate a predisposition to an occupational illness if exposed to a specific environmental

agent, or they could be used to detect any inherited characteristic such as Huntington’s disease. In contrast to

periodic monitoring screening tests are generally performed only one time per charactcristic.

This is an important study, which has been requested by the Congress of the United States, designed to represent the opinion and experience of the employer. We need to know how employers view the technologies of

genetic screening and monitoring in terms of their current and future applications to the workplace. We also

want to know how these technologies arc seen in the broader context of more common forms of employee

health screening and monitoring in the workplace.

Your responses are very important, regardless of whether you have had any experience with genetic screening

or monitoring. If your company has never explored the technology, the questionnaire will only take ten

minutes. If you have some experience with the technology, it may take a little longer to complete the questionnaire. In either case, your experiences and opinions will help to inform congressional, opinion about this area.

Please read each question and mark the box(es) that most nearly corresponds to your answer. After each

answer continue with the next question unless there is an instruction to skip to a particular question. Please

feel free to qualify your answers if you feel it is necessary. Space has been provided at the end for comments

and opinions that you feel arc not adequately represented by the survey questions.

You arc free to decline to answer any questions that you consider inappropriate. The questionnaire and any

identifying information will be destroyed after data entry, so that all responses will be anonymous as well as

confidential.

L h your company, are pm-employment health examinations mquimd of all, mos~ some, few, or no

job applicants?

cl

All nest

a

Few

El

None~SKIP to (?.6

–59-
60 ● Medical Monitoring and Screening in the Workplace: Results of a Survey

2. Would your company consider it acceptable or unacceptable to conduct a pre-employment health cxamination in order to:

ACCEPTABLE UNACCEPTABLE

- n

Identify job applicants who are physically unfit for employment. . . . . . . . . . . . . . . U

u

Identify job applicants

Identify job applicants

Identify job applicants

Identify job applicants

Identify job applicants

who are emotionally or psychologically unstable... . . . . ❑ ❑

who are currently using drugs. ....................= . . . ❑ n

who are at Increased risk to workplace hazards . . . . . . . .❑ ❑

with genetic susceptibility to workplace exposures....❑ ❑

who represent high insurance risks.................=.= ❑ c1

3.Which of the following are normally part of the pre-employment examination inyourcompanyfor

non-administrative position? (MARK ALL APPLY)

Personal medical history . . . . . . . . . . . . . . n

Family medical history. . . . . . . . . . . . . . . . ❑

Simple physical examinations. . . . . . . . . . ❑

Standard blood chemistry tests . . . . . . . . n

EKG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑

Chest X-ray . . . . . . . . . . . . . . . . . . . . . . . . . . .❑

Pulmonary f unction test. . . . . . . . . . . . . . .❑

Eye and hearing exam. . . . . . . . . . . . . . . . .❑

Urinalysis for drug use. . . . . . . . . . . . . . .• 1

Lower back X-ray . . . . . . . . . . . . . . . . . . . . . . ❑

4. Which of the following types of results of pre-employment examinations would normally be released to job

applicants?

Normal results (negative findings) .0,..... ● ..0...0.. . . . . . . . . . . . . . . ❑

Positive findings already indicated in medical history . . . . . . . . . . . . ❑

Positive findings not reflected in medicall history . . . . . . . . . . . . . . . . El

Positive findings which disqualify them for employment. . . . . . . . . . . . ❑

Positive findings which affect position/site eligibility . . . . . . . . . .• 1

All of the above . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● .0....0.. . . . . . . . . . . ● ❑

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

• 1~SKIPTOQ.6

S. How would that information normally be released to job applicants?

❑ ❑

Letter Consultation with Both

medical staff

❑

Other
Appendix D-Survey Instrument: Corporate Health Officers ● 61

6. Are there any specific medical criteria, other than those mandated by regulation, that would exclude individuals from eligibility for certain positions, jobs or sites in your company (e.g., hypersensitivity to dust or

platinum, pregnancy)?

❑ ❑

Yes No SKIP TO Q.7

6a. Which medical criteria would exclude employment in which jobs?

Medical Criteria Excluded Position/Job/Site

1.

2 .

3.

7. Are any employees in your company exposed to chemicals or ionizing radiation in the workplace setting?

❑

Yes No SKIP TO Q.8

7a. Are those employees who are exposed to chemicals or ionizing radiation routinely rotated to avoid

prolonged exposure?

❑ ❑

Yes No

7b. Does your company conduct any form of medical surveillance of employees whose job may expose

them to environmental health risks, other than testing required by OSHA?

Yes No

8. Are any employees in your company exposed to any known workplace condition where there is a greater risk

of negative health outcome, depending upon individual susceptibilities?

Yes Ho SKIP TO Q.9

8a. Do you conduct any form of screening to identify employees or job applicants at increased risk for

these jobs?

❑

Yes No SKIP TO Q.9

8b. Which, if any, of the following types of screening are conducted to identify increased individual susceptibility to workplace risk?

❑ ❑

Medical History Non-genetic screening Genetic screening None

(e.g., lower back X-ray,

allergy testing)
62 . Medical Monitoring and Screening in the Workplace: Results of a Survey

9a. As part of ongoing worker health ● valuation does the company require, as a condition of continued employment all employees, only those in certain plants or jobs, only employees with certain medical conditions or histories, or no employees to have

a .

b.

c .

d.

e.

f.

9“

I

9b. Which of these tests (in Q.9a-g), if any, do you offer to employees

on ● voluntary basis as part of a corporate wellness program?

-------- Q. 9a

ALL PLANTS/

JOBS

Routine physical examination.... DO

Test for hypersensitivity . . . . . . .❑ n

Hearing tests . . . . . . . . . . . . . . . . . . .❑ n

Pulmonary function tests.. .... O

. ❑ n

Vision tests . . . . . . . . . . . . . . . . . . . . ❑ n

Chest X-rays . . . . . . . . . . . . . . . . . . . .❑ n

Blood chemistry tests . . . . . . . . . . .on

REQUIRE --------

CONDITIONS/

HISTORIES NONE

❑ 0

❑ n

❑ 0

❑ IR

❑ ci

❑ n

❑ o

1 --- Q.9b-----

OFFER VOLUNTARY

YES NO

❑

❑ 0

❑ n

-10. ‘ - Would your company consider the use of genetic screening or monitoring of employees or job applicants as

11.

12.

generally acceptable or generally unacceptable to:

GENERALLY

ACCEPTABLE

Make a clinical diagnosis of a sick employee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D

Establish links between genetic predisposition and workplace hazards . . . . . . . . . . .❑

Inform employees of their increased susceptibility to workplace hazards . . . . . . . . ❑

Exclude employees with increased susceptibility from risk situations . . . . . . . . . . . ❑

Monitor chromosomal changes associated with workplace exposures . . . . . . . . . . . . . . . . ❑

Establish evidence of pre-employment health status for liability purposes . . . . . . ❑

GENERALLY

UNACCEPTABLE

❑

13

Does your company have a formal policy related to the use of genetic tests in the screening of job applicants

or employees?

❑ ❑

Yes No

Does your company have a formal policy related to the use of genetic tests in the monitoring of employee

health?

❑ ❑

Yes No
Appendix D-Survey Instrument: Corporate Health Officers 63

13. Is your company currently conducting biochemical genetic screening of any employees or job applicants, for

research or any other reason?

El a Q

Yes No Not Sure

14. Has your company conducted any biochemical genetic screening of any employees or job applicants, for

research or any other reason in the past 19 years?

El Cl • l

Yes No Not Sure

I5. Is your company currently conducting cytogenetic monitoringofany employees or job applicants, for research or any other reason?

El El ❑

Yes No Not sure

16. Has your company conducted any cytogenetic monitoring of any employees or job applicants, for research

or any other reason in the past 19 years?

El El ‘Cl

Yes No Not sure

17. 1s your company currently conducting direct-!DNA screening or any employees or job applicants, for research or any other reason?

a Z1 n

Yes No Not sure

18. ls your company currently conducting direct-DNA monitoring of any employees or job applicants, for

research or any other reason?

a a a

Yes No Not Sure

19. Has your company conducted any of the following tests, either currently or in the past of a voluntary wellness program, at the request of an employee, or for diagnosis? (MARK ALL THAT APPLY)

a. As part of a voluntary

wellness program: Currently. . . . . . . . . . . . . . .

a

In past 19 years. * . . . * o ‘, a

No . . . . . . . . . . . . . . . . . . . . . , El

Not sure . . . . . . ....0.... , a

b. At the request of the

employee: Currently. . . . . . . . . . . . . . . a

In past 19 years . . . . . . . . Z1

No. ..* . ● * . . . . . . . . . . . . . . . n

Not sure. . . . . . . . . . . . . . . . El

.

Currently . . . . . . . . . . . . . . . El

In past 19 years . . . . . . . . El

#to. . . . . . . . . ● . . . . . . . . . . . . El

Not sure.. . . . . . . . . . . . . . . . c1

c. For diagnosis :

c1

a c1

c1

c1

El

cl

c1

a

‘a

a

a

Cl

c1

c1

13

c1
64 ● Medical Monitoring and Screening in the Workplace: Results of a Survey

IF YOUR COMPANY HAS NEVER DONE BIOCHEMICAL GENETIC SCREENING, CYTOGENETIC

MONITORING, DIRECT-DNA SCREENING, OR DIRECT-DNA MONITORING, SKIP TO QUESTION 28

ON PAGE 8

IF YOUR COMPANY HAS DONE CYTOGENETIC MONITORING, DIRECT-DNA SCREENING, OR

DIRECT-DNA MONITORING OF EMPLOYEES, FOR ANY PURPOSE, BUT NOT BIOCHEMICAL

GENETIC SCREENING, SKIP TO QUESTION 21 ON PAGE 7

IF YOUR COMPANY HAS EVER DONE BIOCHEMICAL GENETIC SCREENING OF ANY EMPLOYEE,

FOR ANY PURPOSE, PLEASE CONTINUE WITH QUESTION 20

20. Which of the followlng types of biochemical screening tests are being conducted by your company of any

employees or job applicants? (MARK ALL THAT APPLY)

FOR EACH TEST CONDUCTED, MARK( WHETHER THE TESTING IS BEING DONE ON A ROUTINE BASIS FOR HEALTH

SURVEILLANCE. AS PART OF A VOLUNTARY RESEARCH PROGRAM. AS PART OF FOLLW-UP DIAGNOSIS, OR AS

PART OF A VOLUNTARY WELLNESS PROGRAM, OR ONLY Al THE REQUEST OF AN EMPLOYEE

NOT

DONE

Sickle cell trait . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑

Glucose-6-phosphate dehydrogenase

def iclency (G-6-PO) . .*.**..** . . . . . . . * .***...** ❑

Methemaglobin reductase deficiency . . . . . . . . . . . .❑

Serum alpha-1 -antitrypsin deficiency. . . . . . . . . .❑

Alpha and beta thaiassedas. . . . . . . . . . . . . . . . . . .• 1

Aryl hydrocarbon hydroxylase

inducibility (AHH) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

• 1

Slow vs. fast acetylation. . . . . . . . . . . . . . . . . . . . . ❑

Allergic respiratory disease . . . . . . . . . . . . . . . . . ❑

Contact dermatitis ● . . . . . . . . . . . . . . . . . . . . . . . . . . .

• 1

Histocompatibility markers (HLA). . . . . . . . . . . . . . ❑

Other immune system markers . . . . . . . . . . . . . . . . . . .• 1

Bloom syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑

Fanconi syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

• 1

Ataxia-telangiectas ● . . . . . . . . . . . . . . . . . . . . . . .

• 1

Xeroderma pigmentosum . . . . . . . . . . . . . . . . . . . . . . . . n

Other heterozygous chromosomal

Instabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑

ROUTINE

HEALTH

SURVEILLANCE

❑

❑

❑

❑

El

❑

13

El

❑

❑

VOLUNTARY FOLLOW-UP

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

FOLLOW-UP

DIAGNOSIS

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

VOLUNTARY AT

WELLNESS

PROGRAM

❑

❑

❑

❑

❑

❑

n

❑

❑

❑

❑

EMPLOYEE

REQUEST

❑

❑

❑

c1

c1

K1

❑

c1

❑

n

c1

❑
Appendix D-Survey Instrument: Corporate Health Officers ● 65

21, Which of the following types of cytogenetic monitoring are being conducted by your company of any employees? (MARK ALL THAT APPLY)

FOR EACH TEST CONDUCTED, MARK WHETHER THE TESTING IS BEING ON A ROUTINE BASIS FOR HEALTH SURVEILLANCE,

AS PART OF A VOLUNTARY RESEARCH PROGRAM. AS PART OF FOLLOW-UP DIAGNOSIS, AS PART OF A VOLUNTARY WELLNESS

PROGRAM, OR ONLY AT THE REQUEST OF AN EMPLOYEE

NOT

DONE

Chromsomal aberrations . . . . . . . . . . . . . . . . . . . . ❑

Sister chromatid exchanges . . . . . . . . . . . . . . . . . ❑

Mutations by assaying the ONA. . . . . . . . . . . . . . ❑

Mutations by assaying the enzyme/protein . . .• 1

HPRT mutation rate. . . . . . . . . . . . . . . . . . . . . . . . .• 1

DNA adduct formation. . . . . . . . . . . . . . . . . . . . . . .• 1

Other (SPECIFY)

● ✎✎✌✎✎✎✎✎ ● ✎✎✎☛ ❑

ROUTINE

HEALTH

SURVEILLANCE

❑

El

!(3

El

VOLUNTARY

RESEARCH

PROGRAM

❑

❑

❑

❑

❑

❑

22. Has genetic screening or monitoring ever been done in your company based on:

YES

Family history ● 0....0.. . . . . . . . . . . . . . . . . . ❑

Gender .....00. . . . . . . . . . . . . . . . . . . . . . . . . . .❑

Ethnic or racial background . . . . . . . . . . . . .❑

Co-factors (e.g., smoking). . . . . . . . . . . . . . ❑

Job exposures . . . . . . . . . . . . . . . . . . . . . . . . . . .

• 1

No

in

FOLLOWUP

DIAGNOSIS

El

❑

❑

❑

El

VOLUNTARY

WELLNESS

PROGRAM

❑

El

El

EMPLOYEE

REQUEST

❑

❑

❑

❑

❑

❑

❑

23. &e all employees routinely informed of abnormal (positive) findings, normal (negative) findings, both or

neither from genetic screening and monitoring tests?

Abnormal (positive). . . . . . . . . . . . Q

Normal (negative). . . . . . . . . . . . . .❑

Both ....0..0 . . . . . . . . . . . . . . . . . . . Q

Neither . . . . . . . . . . . . . . . . . . . . . . . .• 1

24. Is counseling offered to all employees with abnormal (positive) genetic test results by the company or are

they referred to their own physicians?

Company counseling . . . . . . . . . . . . . . ❑

Referred to own physicians . . . . . .• 1
66 ● Medical Monitoring and Screening in the Workplace: Results of a Survey

25. Does your company employ or contract with a genetic counselor?

cl! 13 cl

Employ Contract with Neither

26. Has an employee ever been referred for genetic counseling by your company’s medical staff as a result of

any medical or genetic testing?

❑ ❑

Yes Ho

27. As a result of a genetic screening or monitoring program. has your company ever.-?

YES

Suggested an employee seek job elsewhere . . . . . . . . . . n

Placed an employee or transferred an

employee to a different job in the many. . . . . . . . ❑

Implemented engineering control . . . . . . . . . . . . . . . . . . . ❑

Recommended personal protection devices . . . . . . . . . . . ❑

Implemented a research program . . . . . . . . . . . . . . . . . . . ❑

Discontinued a product or changed

materials In a product* . . . . . * * ****.*..* . ****.***** ❑

NO

la

❑

c1

13

28. Has your company ever instituted or changed a workplace practice or exposure level due to the

results of:

YES No

Genetic monitoring in your own establishment(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

• 1 1

Other non-genetic medical monitoring in your own establishment(S) . . . . . . . . . . .•❑ 1

Genetic monitoring in another company’s establishment s... . . . . . . . . . . . . . . . . . ❑ ❑

Other non-genetic medical monitoring in another company’s establishments.... ❑ ❑

Information published by federal agencies, including NIOSH and OSHA. . . . . . . . . ❑ ❑

29. In the past 10 years has your company chosen not to use genetic screening or monitoring due to the remits

of:

Genetic

Genetic

Genetic

Genetic

YES NO

monitoring in your own establishment(s). . . . . . . . . . . . . . . . . . ❑ ❑

monitoring in another company’s establishments . . . . . . . . . . . ❑ ❑

screening In your own establishment(s). . . . . . . . . . . . . . . . . . .• 1 ❑

screening in another company’s establishments . . . . . . . . . . . .• 1 ❑
Appendix D-Survey Instrument: Corporate Health Officers . 67

30a. Which office determines whether or not a specific test will be conducted as part of pre-employment

screening?

1

30b. Which office determines whether or not a specific test will be conducted

as part of employee health surveillance?

1

PRE-EMPLOYMENT EMPLOYEE HEALTH

SCREENING SURVEILLANCE

Corporate personnel . . . . . . . . . . . . . .• 1 1

Corporate health.... ............0 ❑ ❑

Location personnel.. . . . . . . . . . . . . .• 1

Location health . . . . . . . . . . . . . . . . . .❑ ❑

Other (SPECIFY)

. . . . . . . . . . ❑ ❑

31. 31. Is your company currently considering conducting direct-DNA screening of employees or job applicants for

any reason?

❑

Yes No Not Sure

32. Is your company currently considering conducting direct-DNA monitoring of employees or job applicants

for any reason?

❑ ❑

Yes No Not Sure

33. Does your company anticipate conducting any biochemical genetic screening for any Hen, in the next five

years?

❑

Yes No Not Sure

34. Does your company anticipate conducting any cytogenetic monitoring for

years?

any reason, in the next five

n

Yes

❑ ❑

No Not sure

35. Does your company anticipate conducting any direct-DNA screening for any reason, in the next five years?

Yes No Not Sure
68 ● Medical Monitoring and Screening in the Workplace: Results of a Survey

36. Does your company anticipate conducting any direct-DNA monitoring for any reason, in the next five

years?

❑ ❑ ❑

Yes No Not Sure

37. Which office/division within the company is/will be responsible for administering genetic tests?

38. Which position/office within the company is/will be responsible for interpreting genetic test results?

39. Which office in your company is responsible for employee health records?

Hedlcal/Occupational health . . . . . . . . . .• l

Personnel ● - 0 . . . 0000 . . . . . . . . . . . . . . . . . ❑

Other (SPECIFY)

40. Does your company permit access to employee medical records -- at company discretion, with employee

permission, or both, to:

AT COMPANY

DISCRETION

Personnel department . . . . . . . . . . . .❑

Health Insurance carriers . . . . . . . . ❑

Life Insurance carriers . . . . . . . . . . o

Disability insurance carriers

Unions . . . . . . . . . . . . . . . . . . . .

Other companies. . . . . . . . . .

.. . .

• 1

. . . . . . . c1

. . . . . . . ❑

Employee. . . . . . . . . . . . . . . . . . . . . . . . . ❑

Employee’s spouse . . . . . . . . . . . . . . . . ❑

Other family . . . . . . . . . . . . . . . . . . . . . • 1

EMPLOYEE

PERMISSION

❑

❑

❑

❑

❑

❑

BOTH

❑

u

❑

❑

❑
Appendix D-Survey Instrument: Corporate Health Officers ● 69

GENERAL ATTITUDES

41. How do you feel about the following general statements concerning genetic screening and monitoring in the

workplace? For each statement, please indicate whether you agree strongly, agree somewhat disagree

somewhat, or disagree strongly.

AGREE

STRONGLY

It’s fair for employers to use

genetic screening to identify

Individuals whose Increased risk

of occupational disease poses the

potential for greater costs to the

employer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

• 1

The employer should have the option

of deciding how to use the Information

obtained through genetic screening

and monitoring. . . . . . . . . . . . . . . . . . . . . . . . n

The decision to perform genetic

screening of job applicants and employees should be the employer’s. . . . . .❑

The declslon to perform genetic

monitoring of employees should be

the employer’s. . . . . . . . . . . . . . . . . . . . . . . . ❑

Government agencies should provide

guidelines for genetic screening of

job applicants and employees.. . . . . . . . .❑

Government agencies should provide

employees for genetic monitoring of D

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

Genetic screening in the workplace

represents a potential threat t o

the rights of employees . . . . . . . . . . . . . . . n

AGREE

SOMEWHATl

❑

❑

n

❑

❑

❑

DISAGREE DISAGEE

SOMEWHAT STRONGLY

• 1

❑

❑

5

❑

❑

n

❑

❑

❑

❑

DEMOGRAPHICS

D1. What is the magjor Industrial classification of your company (such as chemicals, food, textiles, ?

D2. Approximately how many persons are employed in the United States by your company?

u u ❑

Less than 1,000 1,000-4,999 5,000-9.999 10.000 or more

D3. What proportion of the establishments in your company have occupational health care professionals on

premises?

c1 u ❑ 00

All Host Few None 

D4. Which of the following types of health professionals are employed, either full or part time, as part of the

occupational health staff of this company?

❑ ❑ ❑ 0

Physicians Physician Nurse Registered

MD/DO)

Industrial Other health

assistants practicioners nurses hygienists professionals
70 ● Medical Monitoring and Screening in the Workplace: Results of a Survey

D5. What is your job title?

D6. What arc your main job responsibilities?

Thank you very much for your cooperation in answering our questions. We would also like to giVe YOU an

opportunity to give us any other opinions, concerns or suggestions related to genetic testing in the workplace

that you feel our questions did not address. These comments may be incorporated in our report to Congress.

We would also appreciate your comments on any survey questions that you found confusing or difficult to

answer, to help us analyze the results. Please write these comments below.

We have attached a peel-off identification number on the questionnaire. This is the only link between the

companies who were sampled and the questionnaires returned. We would prefer that you leave the identification number on the questionnaire when you return it. Our staff will removc the label upon receipt, making the

questionnaire completely anonymous. No linkage between companies and questionnaires will be retained. The

label from the completed questionnaire will allow us to eliminate your company from those that wc have to

recontact.

However, if you feel that you cannot complete the questionnaire if there is even temporary identification, then

peel off the label before returning the questionnaire. Wc appreciate your help and wc want you to be comfortable with doing the survey.

PLEASE RETURN

IF THE RETURN

PEEL OFF LABEL WITH SAMPLE

IDENTIFICATION NUMBER HERE

IN THE POSTAGE PAID RETURN ENVELOPE SENT WITH THE QUESTIONNAIRE.

ENVELOPE HAS BEEN LOST, THE RETURN ADDRESS IS:

Schulman, Ronca and Bucuvalas, Inc.

444 Park Avenue South

New York, New York 10016

(212) 481-6200 Attn: Dr. Mark Schulman
Appendix E

Survey Instrument: Corporate Personnel Officers

SURVEY OF WORKPLACE HEALTH AND

GENETIC SCREENING AND MONITORING

CORPORATE PERSONNEL OFFICER VERSION

The Congressional Office of Technology Assessment is conducting a national survey of the opinions and experiences of employers related to the usc of genetic screening and monitoring in the workplace. This questionnaire has been directed to you as the person in your organization whose responsibilities include personnel

issues. We need your assistance in answering, as best you can, some questions about workplace testing and

employee health in your company.

For the purposes of this survey and the subsequent report, OTA has adopted the following definitions. By

genetic monitoring we mean periodically examining employees to evaluate modifications of their genetic material via tests such as cytogenetic or direct-DNA tests. By genetic screening wc mean Screening job applicants or

employees for certain inherited characteristics. Screening tests may be biochemical tests or direct-DNA tests.

They can be used to indicate a predisposition to an occupational illness if exposed to a specific environmental

agent or they could be used to detect any inherited characteristic such as Huntington’s disease. In contrast to

periodic monitoring screening tests arc generally performed only one time per characteristic.

This is an important study, which has been requested by the Congress of the United States designed to represent the opinion and experience of the employer. We need to know how employers view the technologies of

genetic screening and monitoring in terms of their current and future applications to the workplace. We also

want to know how these technologies are seen in the broader context of more common forms of employee

health screening and monitoring in the workplace.

Your responses are very important regardless of whether you have had any experience with genetic screening

or monitoring. If your company has never explored the technology, the questionnaire will only take ten

minutes. If you have some experience with the technology, it may take a little longer to complete the questionnaire. In either case, your experiences and opinions will help to inform congressional opinion about this area.

Please read each question and mark the box(es) that most nearly corresponds to your answer. After each

answer continue with the next question unless there is an instruction to skip to a particular question. Please

feel free to qualify your answers if you feel it is necessary. You are free to decline to answer any questions that

you consider inappropriate. The questionnaire and any identifying information will be destroyed after data

entry, so that all responses will be anonymous as well as confidential. Space has been provided at the end for

comments and opinions that you feel arc not adequately represented by the survey questions.

We would like to begin with a few questions about your views on the appropriateness of employee testing in

certain workplace situations.

1. Do you think that it is generally appropriate or generally inappropriate for a company to require prcemployment health examinations of job applicants in workplace settings where there are no known health

risks?

— — —

Appropriate . . . . . . . . .• 1 Inappropriate . . . . . . . . .• 1

2. Do you think that it is generally appropriate or generally inappropriate for a company to require pre-employment health examinations of job applicants in workplace settings where there are known health risks? ———— —

Appropriate . . . . . . . . ❑ Inappropriate . . . . . . . . . . ❑

IF “lNAPPROPRIATE" IN BOTH CL 1 AND Q. 2, SKIP TO Q. 4.

–71–
72 . Medical Monitoring and Screening in the Workplace: Results of a Survey

3. Would your company consider it acceptable or unacceptable to conduct a preemployment health examination in order to:

Identify job applicants who are

Identify job applicants who are

Identify job applicants who are

Identify job applicants who are

ACCEPTABLE UNACCEPTABLE

physically unfit for employment. . . . . . . . . . . . . . . . . ❑ ❑

emotionally or psychologically unstable . . . . . . . . .• 1 1

currently using drugs . . . . . . . . . . . . . . . . . . . . . . . . . . .• 1 1

at increased risk to workplace hazards . . . . . . . . . .❑ ❑

Identify job applicants with genetic susceptibility to workplace exposures . . . . . . ❑ ❑

Identify job applicants who represent high Insurance risks . . . . . . . . . . . . . . . . . . . . . .❑ ❑

4. Do you think that it is generally appropriate or generally lnappropriate for a company to require periodic

medical testing of employees in workplace settings where there are no known health risks? ——— —

Appropriate. . . . . . . . .• 1 lnappropriate. . . . . . . . . ❑

5. Do you think that it is generally appropriate or generally in appropriate for a company to require periodic

medical testing of employees in workplace settings where there are known health risks? ———— —

Appropriate . . . . . . . . .• 1 Inappropriate . . . . . . . . . ❑

IF ‘INAPPROPRIATE” IN BOTH Q. 4 AND Q. 5, SKIP TO Q. 7.

6. DO you think that it is generally cost-effective or not cost-effective for a company to conduct periodic medical

testing of employees for:

NOT

COST EFFECTIVE COST EFFECTIVE

High blood pressure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .• 1 ❑

Respiratory function . . . . . . . . . . . . . . . . . . . . . . . . . . . . .•❑ 1

Malignancies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ ❑

Hearing function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .•❑ 1

Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .•❑ 1

Chroaosomal abnormalities. . . . . . . . . . . . . . . . . . . . . . . . ❑ ❑

Drug abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .•❑ 1

7. Do you think it is curently cost-effective or not cost-effective for a company like yours to:

COST NOT COST NOT

EFFECTIVE EFFECTIVE SURE

Conduct biochemical genetic tests as part of pre-employment screening. . . . . . . . . . ❑ un

Conduct direct-DNA tests as part of pre-employment screening . . . . . . . . . . . . . . . . . . . !300

Conduct genetic monitoring of all workers exposed to workplace hazards . . . . . . . . .❑ 00

Conduct genetic screening of workers to detect

genetic susceptibilities to workplace hazards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ ao
Appendix E-Survey Instrument: Corporate Personnel Officers ● 73

8. Would your company consider the use of genetic @&for employees or job applicants generally acceptable

or generally unacceptable to:

Rake a clinical diagnosis of a sick

Establish links between genetic pre

Inform employees of their Increased

ACCEPTABLE UNACCEPTABLE

employee . ,0 . ., . 0 . . . 00 . . 0 . . . . . . . . . . . . . . . . . ❑

disposition and workplace hazards . . . . . . . .• 1 ❑

susceptibility to workplace hazards . . . . . .•❑ 1

Exclude employees with increased susceptibility from risk situations . . . . . . . . . ❑ ❑

Monitor or chromosomal changes associated with workplace exposure. . . . . . . . . . . . . . ❑ ❑

Establish evidence of pm-employment health status for liability purposes.... • 1 ❑

9.If an employer becomes aware that an employee has a genetic susceptibility to serious illness if he or she is

exposed to substances in the workplace do you think the employer should exclude that employee from those

jobs for which he/she is at increased risk or do you think the employer should allow the employee to take

those jobs, if he/she waives corporate liability?

Should be excluded . . . . . . . .• 1 Allowed to take. . . . . . . . . . .• 1

10. As part of your pre-employment hiring practices, do you currently require each of the following as a condition of employment for all applicants, only applicants for certain plants or job classifications, only applicants with certain medical conditions or histories, or for no applicants?

ALL

Routine physical examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • 1

Biochemical genetic screening tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

• 1

Cytogenetic monitoring tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .❑

Other medical criteria, e.g., lower back X-ray, allergy testing . . . . . ❑

Personality/psychological testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑

Drug testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .❑

PLANTS/

JOBS

❑

❑

❑

CONDITIONS/

HISTORIES

❑

❑

❑

❑

NONE

❑

❑

❑

IF “NONE” TO ALL IN Q. IO, SKIP To Q.12

11. Is it company policy to inform applicants of positive test results?

Yes. . . . . . . . . .❑ NOU. . . . . . . . . .

ha. Is it company policy to refer applicants to appropriate health care providers If positive test results

are obtained?

Yes. . . . . . . . . . El No. . . . . . . . . .• 1
74 ● Medical Monitoring and Screening in the Workplace: Results of a Survey

12a. Does your company have ● policy concerning hiring....

1 FOR EACHnYESn IN Q. 12a

12b. Generally speaking, would you say it is against

company policy to hire..... I

I

Q.12a

HAVE POLICY

nO YE S

Cigarette smokers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ 0

Persons with criminal records . . . . . . . . . . . . . . . . . . . . . . .❑ u

Persons with pre-existing medical conditions. . . . . . . .❑ 0

Q.12b

AGAINST POLICY TO HIRE

YES NO DEPENDS

❑ 0 0

!300

❑ 0 0

Persons with Increased genetic

susceptibility to substances

or conditions in the workplace . . . . . . . . . . . . . . . . . . . . ❑ 0 I ❑ 0 0

IF YOUR COMPANY HAS NEVER DONE ANY BIOCHEMICAL GENETIC SCREENING, CYTOGENETIC MONITORING, DIRECT-DNA SCREENING, OR DIRECT-DNA

MONITORING, SKIP TO QUESTION 19.

13. To the best of your knowledge, which of the following were important factors in the decision to conduct

genetic screening or monitoring of employees in your company?

IMPORTANT NOT IMPORTANT

Cost benefit analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .❑

Evidence of a possible association between chemical exposure

and illness in animal studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .❑ ❑

Evidence of a possible association between chemical exposure

and illness In epidemiological studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .• 1 ❑

Legal consequence of failure to test ● . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .❑ ❑

Union/~ employee initiative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

• 1 ❑

Something else (Please Specify)

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

• 1 1

14. To the best of your knowledge, has your company ever rejected a job applicant primarily or partly, based

on the results of genetic screening tests?

Yes. . . . . . . . . .•,01 . . . . . . . . . .• ~SKIP TO Q. 1 5

14a. When was the most recent time that occurred?

Within past month. . . . . . . . . . ❑

Within past year. . . . . . . . . . . ❑

1-2 years ago. . . . . . . . . . . . . .• 1

3 or more years ago. . . . . . . . ❑

14b. What was the condition(s)?

14c. Was the applicant informed of the reason for the rejection?

Yes. . . . . . . . . . ❑ No. . . . . . . . . .• 1
Appendix E-Survey Instrument: Corporate Personnel Officers . 75

14d. Was alternative employment within your company offered?

Yes. . . . . . . . . . ❑ No . . . . . . . . . .❑

15. Have any medical or physical criteria been specified that would disqualify individuals from:

YES

Work in the company . . . . . . . . . . . . . . . . . . . . . . . . . . . . .❑ ;

Work in specified plants or locations . . . . . . . . . . . ❑ o

Work In specified jobs . . . . . . . . . . . . . . . . . . . . . . . . . .❑ 0

16. Does your company maintain statistical data on job applications, outcomes, and reasons for rejection?

Yes. . . . . . . . . .• 1 MO . . . . . . . . . . •~SKIP TO (Q. 18

17. Are biochemical or cytogenetic tests used as rejection categories in these data?

Yes. . . . . . . . . .❑ . . . . . . . . . .

.0

18. Has your company ever transferred or terminated an employee, primarily or partly, based on the results of

genetic screening or monitoring?

Yes. . . . . . . . . .❑ IM . . . . . . . . . .SKIP TO Q.19

18a.. When was the most recent time that occurred?

Within past month. . . . . . . . . .• 1

Within past year. . . . . . . . . . .❑

1-2 years ago. . . . . . . . . . . . . . • 1

3 or more years ago. . . . . . . . ❑

18b. What was the condition?

18c. Was the employee informed of the reason for the action?

Yes. . . . . . . . . .❑ ● .....00. hn ●

19. Is it your company’s policy to conduct periodic medical testing of persons in any risk categories?

19a.

19b.

19C

Yes. . . . . . . . . . ❑ No. . . . . . . . . .•~sK/p To Q. 20

Is it company policy to inform employees of positive test results?

Yes. . . . . . . . . .❑ No . . . . . . . . . . ❑

Is it company policy to refer employees to appropriate health care providers if positive test results

are obtained?

Yes. . . . . . . . . .❑ . . . . . . . . . .

.0

Is it company policy to release positive test results to anyone outside of the company, other than the

employee?

Yes. . . . . . . . . .❑ No . . . . . . . . . .❑ —SKIP TO Q. 20

19d. Under what circumstances?
76 ● Medical Monitoring and Screening in the Workplace: Results of a Survey

19e. Was alternative employment within your company offered?

Yes. . . . . . . . . .• 1 No . . . . . . . . . .❑

19f. Does your company have a set of guidelines for this type of situation or is It left to the discretion of the

particular establishment?

Yes. . . . . . . . . .❑ No . . . . . . . . . . ❑

20. Does your company maintain statistical data on the reasons for job terminations?

Yes. . . . . . . . . .• 1 No. . . . . . . . . .❑ —wSKtP TO Q. 21

20a. Are biochemical or cytogenetic tests used as rejection categories in these data?

Yes. . . . . . . . . .•❑ . . . . . . . . . . ,.1

20b. Are other medical criteria used as rejection categories in these data?

Yes. . . ● . . . . . . ❑ No . . . . . . . . . . ❑

21. Within the next five years, do you anticipate that your company will conduct:

Mandatory

Voluntary

Mandatory

Voluntary

Mandatory

Voluntary

Mandatory

Voluntary

YES

biochemical genetic screening . . . . . . . . . . . . ❑

biochemical genetic screening. . . . . . . . . . . . ❑

cytogenetic monitoring. . . . . . . . . . . . . . . . . . . El

cytogenetic monitoring. . . . . . . . . . . . . . . . . . . ❑

DNA-basal genetic screening . . . . . . . . . . . . . . ❑

DNA-based genetic screening . . . . . . . . . . . . . .• 1

DNA-based genetic monitoring. . . . . . . . . . . . . ❑

DNA-based genetic monitoring. . . . . . . . . . . . .• 1

NO

c1

❑

El

c1

❑

22. If you were asked, would you recommend to your company that genetic screening be done as part of preemployment screening?

Yes. . . . . . .• 1 — Based on what criteria?

No. . . . . . . .• 1

23. If you were asked, would you recommend to your company that periodic genetic monitoring of employees be

done?

Yes. . . . . . .❑ ~ Based on what criteria?

No. . . . . . . . ❑

24. Approximately what proportion of your employees are covered by collective bargaining agreements?

Less than 10?. . . . . . c1

10% to 49%. . . . . . . . .• 1

50% to 75%. . . . . . . . . ❑

Bore than 75%.. . . . . ❑

25. Have union contract negotiations ever covered the topic of genetic screening and/or genetic monitoring?

Yes. . . . . . . . . . .❑ No......... .
Appendix E-Survey Instrument: Corporate Personnel Officers ● 77

26. What proportion of your company’s employees are covered by health insurance offered by the company

All . . . . .• 1 Host . . . . .❑ Some . . . . .❑ Few . . . . . ❑ None.... SKIP TO Q.27

26a. Is the company% current health insurance plan(s) purchased from a private carrier, self-insured

or both?

Private carrier. . . . . . ❑ Self-insured..... Both.......

27. If a job applicant is currently healthy and able to perform the job, but is considered to be a health insurance risks, would that consideration reduce the likelihood of his/her being hired by your company - a lot,

some or not at all?

A lot. . . . . . . .❑ Some.........U Not at all... u

28. Does your company assess the health Insurance risk of job applicants on a routine basis, sometimes or

never?

Routine . . . . . ❑ Sometimes....n Never........ a~ SKIP TO Q. D1

28a. Does the health insurance assessment of job applicants also consider the health

Yes. . ● . . . •●

.No.... 1 n

of dependents?

DEMOGRAPHIC CHARACTERISTICS

D1. What Is the major industrial classification of your company (such as chemicals, food, textiles, etc.) ?

D2. Approximately how many persons are employed in the United States by your company?

Less than 1,000 . . . . . . . .• 1

1,000 - 4,999 . . . . . . . . . .• 1

5,000 - 9.999 . . . . . . . . . . ❑

10,000 or more. . . . . . . . . . ❑

D3. What is your job title?

D4. What are your main job responsibilities?
78 ● Medical Monitoring and Screening in the Workplace: Results of a Survey

Thank you very much for your cooperation in answering our questions. We would also like to give you an

opportunity to give us any other opinions, concerns or suggestions related to genetic testing in the workplace

that you feel our questions did not address. These comments may be incorporated in our report to Congress.

Wc would also appreciate your comments on any survey questions that you found confusing or difficult to

answer, to help us analyze the results. Please write these comments below.

Wc have attached a peel-off identification number on the questionnaire. This is the only link between the

companies who were sampled and the questionnaires returned. We would prefer that you leave the identification number on the questionnaire when you return it. Our staff will remove the label upon receipt, making the

questionnaire completely anonymous. No linkage between companies and questionnaires will be retained. The

label from the completed questiomaire will allow us to eliminate your company from those that wc have to

recontact.

However, if you feel that you cannot complete the questionnaire if there is even temporary identificatio~ then

peel off the label before returning the questionnaire. We appreciate your help and wc want you to be confortable doing the survey.

PEEL OFF LABEL WITH SAMPLE

IDENTIFICATION NUMBER HERE

PLEASE RETURN IN THE POSTAGE PAID RETURN ENVELOPE SENT WITH THE QUESTIONNAIRE.

IF THE RETURN ENVELOPE HAS BEEN LOST, THE RETURN ADDRESS IS:

Schulman, Ronca and Bucuvalas, Inc.

444 Park Avenue South

Ncw York, New York 10016

(212) 4814200 Attn: Dr. Mark Schulman
Index
Index

Acquired immune deficiency syndrome (AIDS), as criterion for

excluding applicant, 13

Allergy

as criterion for excluding applicant, 4, 13, 14

preemployment testing for, 17

tests to identify individual susceptibility, 39

see also Hypersensitivity

Alpha-1 -antitrypsin, 23

Chemical companies, other

attitudes toward exclusion or employee choice if genetic

susceptibility and health risk exist, 41,42

composition in 1989 survey population of, 50

employee exposure to workplace hazards in, 23-24

employee health qualifications for employment by, 12, 13

individual susceptibility to risk in, 24-25

perceptions of cost-effectiveness of monitoring chromosomal

abnormalities, 31

periodic medical testing at, 25-26

rotation of employees exposed or potentially exposed, 23-24

see also Electrical utilities; Electronic companies;

Manufacturing companies, other; Nonmanufacturing

companies; Petroleum companies; Pharmaceutical

companies

chemicals

as hazard in workplace, 23-24

role of medical surveillance, 24, 26

sensitivity to as criterion for excluding applicant, 13, 14

Chromosomal abnormalities. See Genetic monitoring

Cigarette smoking, hiring policies and 3,4, 11, 12

Confidentiality

of medical records, 27-28

of survey results, 50

Cost effectiveness

effect of health insurance risk to mitigate attitudes toward,

44-45

personnel officer perceptions for genetic tests, 5,31,38-39,

43-44

personnel officer perceptions for specific tests, 5,30-31

criminal records, 3, 4, 11, 12

Cytogenetic testing. See Genetic monitoring

Deoxyribonucleic acid (DNA), tests for preemployment

screening, 6, 38

Diabetes, as criterion for excluding applicant, 13, 14

Disability insurers, access to medical records, 6,28

Drug testing

as part of preemployment health examination, 4, 17, 18

ongoing, 31

opinions about cost-effectiveness of, 5, 31

Drug use

as criterion for excluding applicant, 4, 13, 14, 15, 16

periodic monitoring for, 31

preemployment testing for, 4, 17, 18

E1ectrical utilities

attitudes toward exclusion or employee choice if genetic

susceptibility and health risk exist, 41, 42

composition in 1989 survey population of, 50

employee exposure to workplace hazards in, 23-24

employee health qualifications for employment by, 12, 13

individual susceptibility to risk in, 24-25

perceptions of cost-effectiveness of monitoring chromosomal

abnormalities, 31

periodic medical testing at, 25-26

rotation of employees exposed or potentially exposed, 23-24

use of genetic screening to identify individual susceptibility,

39

see also chemical companies; Electronic companies;

Manufacturing companies, other; Nonmanufacturing

companies; Petroleum companies; Pharmaceutical

companies

Electronic companies

attitudes toward exclusion or employee choice if genetic

susceptibility and health risk exist, 41, 42

composition in 1989 survey population of, 50

employee exposure to workplace hazards in, 23-24

employee health qualifications for employment by, 12, 13

individual susceptibility to risk in, 24-25

perceptions of cost-effectiveness of monitoring chromosomal

abnormalities, 31

periodic medical testing at, 25-26

rotation of employees exposed or potentially exposed, 23-24

see also chemical companies; Electrical utilities;

Manufacturingg companies, other; Nonmanufacturing

companies; Petroleum companies; Pharmaceutical

companies

Employment

cigarette smoking, 3,4, 11, 12

criminal records, 3, 4, 11, 12

genetic susceptibility, 11-12, 17,38

health insurance risk as a criterion for, 44-45

medical and health criteria eligibility, 4, 12-15

preexisting medical conditions, 3-4,11, 12

qualifications on eligibility for, 3-4, 11-15

Epilepsy, as criterion for excluding applicant, 13, 14

Examination, preemployment

allergy testing, 4, 17

chest x-ray, 18

decision to use, 4, 19-20

DNA tests as part of, 6,38

drug testing, 4, 17, 18

electrocardiograms (EKGs), 18

genetic susceptibility and testing, 17,38,42-43

health insurance risk and, 44-45

hearing, 18

lower back x-ray, 17, 18

medical history, 3-4, 18

physical, 15-16, 17, 18

psychological or personality, 4, 16, 17

puhmonary function, 18

release of results to applicants, 4, 18-20

requirement for and appropriateness of, 4, 15-17

vision, 18

Fortune 500 companies

as part of 1989 OTA survey population, 3, 49

respondents to 1982 OTA survey, 3, 49, 51-52

Genetic monitoring

-81 –
82 ● Medical Monitoring and Screening in the Workplace: Results of a Survey

acceptable uses of, 6, 35-36, 53

attitudes toward, 35-38, 53-57

basis for conducting, 39-40

basis for deciding against conducting, 41,42

change in workplace practice as a result of, 41

decision to use, 37

definition, 35

dissemination of results from, 40

health insurance considerations of, 43-45

number of companies conducting based on 1989 OTA survey,

3,39

opinions about cost-effectiveness of, 5,6, 31, 38-39,43

policies related to, 35

qualitative comments from respondents about, 53-57

recommendation by personnel officer whether to conduct, 43,

44

trend data from 1982 and 1989 OTA surveys of, 3

unacceptable uses of, 35-36,54-56

use of information from, 37, 38

Genetic screening

acceptable uses of, 4, 11-12, 17, 35-36,53

attitudes toward, 36-38, 53-57

basis for conducting, 39-40

basis for deciding against conducting, 41,42

decision to use, 37

definition, 35

dissemination of results from, 40

health insurance considerations of, 43-45

number of companies conducting based on 1989 OTA survey,

3,39

opinions about cost-effectiveness of, 6, 38-39, 43

policies related to, 35

qualitative comments from respondents about, 53-57

recommendation by personnel officer whether to conduct

during preemployment screening, 42-43

trend data from 1982 and 1989 OTA surveys of, 3

unacceptable uses of, 35-36, 54-56

use of information from, 37, 38

use to identify individual susceptibility, 39

Glucose-6-phosphate dehydrogenase deficiency (G-6-PD), 40,

57

Government

role in effecting change in workplace practices, 41

role in genetic monitoring and screening, attitude of health

officers toward, 7, 37, 38

role in monitoring and screening, attitude of health officers

toward, 37,38

Hazards

employee exposure to, 5, 23-24

individual susceptibility to, 24, 25, 39

rotation of employees, 23-24

Health examination

acceptability of using to identify applicants with increased

risk to workplace hazards, 4, 15, 16

acceptability of using to identify genetic susceptibilities to

workplace hazards, 4

acceptability of using to identify potential high insurance

risks among applicants, 4, 16-17

decisions on what tests to require, 4,5, 19-20

see also Examination, preemployment

Health insurance

risks as a factor in future use of genetic tests, 7,43-45

risks as a factor in hiring applicants, 4,7, 16-17,44-45

Health insures, access to employee medical records by, 6,28

Health officers

attitudes toward genetic monitoring and screening, 6,36-38

opinions about acceptability of genetic tests, 35-36

opinions about government guidance and genetic testing, 7,

37,38

qualitative comments on survey by, 53-57

role in decision to conduct health surveillance, 30

role indecision to include tests for preemployment screening,

4,5, 19-20

views on preemployment health examination, 16-18

Health qualifications

corporate policies, 11-12

of applicant, 12-20

Human immunodeficiency virus (HIV), as criterion for

excluding applicant, 13

Hypersensitivity

employment eligibility and, 4, 13

monitoring for, 26, 27

preemployment testing for, 17

see also Allergy

Insurance. See Disability insurers; Health insurance; Health

insurers; Life insurers

Life insurers, access to employee medical records by, 6,28

Manufacturing companies, other

attitudes toward exclusion or employee choice if genetic

susceptibility and health risk exist, 41,42

employee exposure to workplace hazards in, 23-24

employee health qualifications for employment by, 12, 13

individual susceptibility to risk in, 24-25

periodic medical testing at, 25-26

rotation of employees exposed or potentially exposed, 23-24

use of genetic screening to identify individual susceptibility,

39

see also Chemical companies; Electrical utilities; Electronic

companies; Nonmanufacturing companies; Petroleum

companies; Pharmaceutical companies

Medical criteria

as part of preemployment examination, 18

eligibility and employment based on, 4, 12-15

jobs excluded by, 13-15

Medical examination. See Examination, preemployment; Health

examination; Physical

Medical history

eligibility and employment based on, 4, 12-15

pmemployment examination and, 4, 13, 18

use to screen for individual susceptibilities, 39

Medical officers. See Health officers

Medical records

access to within company, 5-6, 27-28

employee access to, 6, 28

for statistical purposes, 28-29

maintenance of, 5, 27, 28

third-party access to, 6,28

Medical surveillance. See Monitoring

Medical testing. See Examination, preemployment; Genetic

monitoring; Genetic screening; Monitoring; Screening
Index ● 83

Monitoring

appropriateness of in absence or presence of known health

risks, 5,24-25

blood chemistry, 5,26,27

blood pressure, 5,30-31

change in workplace practice as a result of, 41

chest x-rays, 5, 26, 27

cost-effectiveness of, 5, 30-31

decision to conduct, 5,30

drugs, 5,31

genetic, 5,31,3545

hearing, 5,26,27,31

hypersensitivity, 26,27

medical suweillance and, 4-6,24-31

physical examination as part of, 27

pulmonary function, 26,27,31

release of test results, 29-30

trend data from 1982 and 1989 OTA surveys of genetic, 3,

types of companies conducting, 25-26

vision, 5, 26, 27, 31

see also Genetic monitoring

National Institute of Occupational Safety and Health (NIOSH),

41

Nonmanufacturing companies

attitudes toward exclusion or employee choice if genetic

susceptibility and health risk exist, 41, 42

employee exposure to workplace hazards in, 23-24

employee health qualifications for employment by, 12, 13

individual susceptibility to risk in, 24-25

periodic medical testing at, 25-26

rotation of employees exposed or potentially exposed, 23-24

use of genetic screening to identify individual susceptibility,

39

see also Chemical companies; Electrical utilities; Electronic

companies; Nonmanufacturing companies; Petroleum

companies; Pharmaceutical companies

Occupational Safety and Health Act (OSH Act), 23

Occupational Safety and Health Administration (OSHA), 26,

41,53,54

Office of Technology Assessment (OTA)

1983 report, 3,36

1990 report, 3,36

Personnel officers

concerns about health insurance risks of applicants, 7, 16-17

opinions about acceptability of genetic tests, 35-36

opinions about cost effectiveness of genetic tests, 6,31,4344

qualitative comments on survey by, 53-57

recommendation to conduct genetic screening during

preemployment screening, 42-43

role in decision to conduct health surveillance, 30

role in decision to include tests for preemployment screening,

5, 19-20

views on appropriateness of monitoring, 24-25

views on excluding individuals with genetic susceptibilities

from positions of known risk, 41

views on preemployment health examination, 16-18

Petroleum companies

attitudes toward exclusion or employee choice if genetic

susceptibility and health risk exist, 41, 42

composition in 1989 survey population of, 50

employee exposure to workplace hazards in, 23-24

employee health qualifications for employment by, 12, 13

individual susceptibility to risk in, 24-25

periodic medical testing at, 25-26

rotation of employees exposed or potentially exposed, 23-24

see also Chemical companies; Electrical utilities; Electronic

companies; Manufacturing companies, other;

Nonmanufacturing companies; Pharmaceutical

companies

Pharmaceutical companies

attitudes toward exclusion or employee choice if genetic

susceptibility and health risk exist, 41,42

composition in 1989 survey population of, 50

employee exposure to workplace hazards in, 23-24

employee health qualifications for employment by, 12, 13

individual susceptibility to risk in, 24-25

perceptions of cost-effectiveness of monitoring chromosomal

abnormalities, 31

periodic medical testing at, 25-26

rotation of employees exposed or potentially exposed, 23-24

see also Chemical companies; Electrical utilities; Electronic

companies; Manufacturing companies, other;

Nonmanufacturing companies; Petroleum companies

Physical

examination to determine employability, 4, 15, 17, 18

fitness as qualification for employment, 4, 12-16

periodic monitoring via examination, 27

Preemployment

examination, 4, 15-20

genetic susceptibility and, 17,38

medical qualifications, 4, 12-15

nonmedical qualifications for job applicants, 3-4, 11, 12

screening, 3-4, 11-20

see also Examination, preemployment

Pregnancy, employment eligibility and, 4, 13, 14

Psychological factors, preemployment health examination and,

4, 16, 17

Radiation, ionizing

as criterion for excluding applicant, 14

as hazard in workplace, 23-24

role of medical surveillance, 24, 26

Risk

employment eligibility and health insurance, 4, 7, 16-17,

44-45

from chemicals in workplace, 23-24

from ionizing radiation in workplace, 23-24

individual susceptibility to, 24, 25, 39

periodic medical testing of employees at, 25-26

Qualifications

cigarette smoking, 3, 4, 11, 12

corporate health policies related to job, 11-12

criminal records, 3, 4, 11, 12

genetic susceptibility, 11-12, 17

medical and physical, 4, 12-15

preexisting medical conditions, 3-4, 11, 12

Schulman, Ronca, & Bucuvalas, Inc., (SRBI), 49,50

Screening

genetic, 35-45
84 ● Medical Monitoring and Screening in the Workplace: Results of a Survey

medical, 4-6, 12-15

preemployment, 3-4, 15-18

trend data from 1982 and 1989 OTA surveys of genetic, 3

see also Examination, preemployment; Genetic screening

Semiconductor companies. See Electrical companies

Statistical recordkeeping, 28-29

Surveillance. See Monitoring

Survey

population and timeframe for 1989 OTA, 3,49-50

qualitative comments about, 53-57

response rate for 1989, 51-52

results on genetic screening and monitoring of 1982 OTA, 3,

36

trend data from 1982 and 1989 OTA surveys of genetic, 3,36

Test results

release of genetic, 40

release of monitoring to third-parties, 29-30

release to employees of monitoring, 5, 29

release to job applicants of preemployment examination, 4,

18-20

Testing. See Examination, preemployment; Monitoring;

Genetic monitoring; Genetic screening; Screening

Trend data, genetic monitoring and screening 1982 v. 1989,

36

Workplace risk

individual susceptibility to, 24, 39

of chemicals or ionizing radiation, 23-24

unions

access to employee medical records by, 6, 28

composition in 1989 survey population of, 50

Urinalysis. See Drug testing

Utility companies. See Electric utilities

X-ray

chest, 5, 18, 26

lower back, 17, 18,39

3,