Safer • Healthier • People

U.S. Department of Health and Human Services

Centers for Disease Control and Prevention

National Institute for Occupational Safety and Health

To receive niosh documents or more information about occupational safety and health topics, 

please contact niosh:

Telephone: 1-800-cdc-info (1-800-232-4636)

TTY: 1-888-232-6348

email: cdcinfo@cdc.gov

or visit the niosh Web site at www.cdc.gov/niosh

For a monthly update on news at niosh, subscribe to niosh eNews by visiting

www.cdc.gov/niosh/eNews.

Dhhs (niosh) Publication No. 2009-144
Since the Occupational Safety and Health Act of 1970 was passed, niosh has 

worked diligently and thoughtfully to protect the U.S. working population. niosh

has relied heavily on science to guide its use of public resources, fulfill its responsibilities as outlined by Congress, and address critical occupational safety and health 

concerns. Over the years, policymakers, industry leaders, and organized labor have 

supported niosh’s mission and have agreed that scientific research is essential for 

effectively protecting workers.

We are proud that our research and recommendations are reflected in the pioneering national initiatives that have reduced occupational exposure to hazards such as 

asbestos, lead, vinyl chloride, and other industrial agents and have led to safer and 

healthier workplaces. 

As the U.S. economy moved from its predominantly manufacturing base towards 

a more service-providing economy in the 1980s and 1990s, niosh kept pace with 

its research to address issues such as indoor air quality, latex allergy, musculoskeletal disorders, and workplace violence. Around this same time, niosh also became 

keenly aware of the need to expand its partnerships, leverage its resources, and 

more effectively demonstrate the value of its research. 

Today, our programs continue to evolve to meet the complex challenges that we 

face in the 21st century, including changing workforce dynamics, new demands, 

and emerging occupational safety and health issues. Through the creation of the 

National Occupational Research Agenda (nora) we have expanded our diverse 

partnerships and leveraged resources. Every day, we strive to achieve our mission 

with the determination, commitment to sound science, spirit of partnership, knack 

for innovation, and unique understanding of the workplace that has served us and 

our stakeholders well for the past four decades.

This document presents qualities that underpin our efforts and illustrates ways in 

which we continue to drive progress in occupational safety and health. We have included our efforts in such areas as nora, research-to-practice, emergency response, 

partnership, nanotechnology, global collaborations, and other cross-cutting programs. Throughout the document we have included specific examples of how niosh

research has successfully impacted workplaces and the working population.

As the U.S. looks to the strategies that will maintain American leadership in tomorrow’s global market, it is critical to keep in mind that prevention of work-related 

injury, illness, and death is an integral part of those strategies. Keeping workers safe 

and healthy contributes to the efficiency, competitiveness, quality of service, and 

profitability of businesses. 

I hope you find this document informative and that it stimulates new ideas for ways 

in which we might collaborate to protect the U.S. workforce and keep our families, 

our communities, and our nation strong. 

Christine M. Branche, Ph.D.

Acting Director, NIOSH
About NIOSH 1

The Current State of Worker Safety & Health 7

Introduction to NORA 11

Agriculture, Forestry, & Fishing 14

Construction 16

Healthcare & Social Assistance 18

Manufacturing 20

Mining 22

Services 24

Transportation, Warehousing, & Utilities 26

Wholesale & Retail Trade 28

Partnering with NIOSH 31

Introduction to NIOSH Cross-Sectors 35

Authoritative Recommendations 36

Cancer, Reproductive, & Cardiovascular Diseases 36

Communication & Information Dissemination 37

Economics 38

Emergency Preparedness & Response 38

Engineering Controls 39

Exposure Assessment 39

Global Collaborations 40

Health Hazard Evaluations 40

Hearing Loss 41

Immune & Dermal Diseases 42

Musculoskeletal Disorders 43

Nanotechnology 43

Occupational Health Disparities 44

Personal Protective Technologies 44

Prevention Through Design 45

Radiation Dose Evaluation 46

Respiratory Diseases 47

Small Business Assistance & Outreach 47

Surveillance 48

Training Grants 50

Traumatic Injury 50

WorkLife 51

Work Organization & Stress-Related Disorders 52

Challenges About Nanotechnology 55

National Academies’ Review 56

Research-To-Practice 59

Photo by David Parker
Two roughnecks work on the rig floor to drill a new oil well. These floor hands are attaching a new length of pipe to the drill. 

Photo by Elaine Cullen
About NIOSH — 1

www.cdc.gov/niosh

NIOSH (nahy-osh), n

The National Institute for Occupational Safety and Health 

1. the only federal agency mandated to conduct research and make 

recommendations to prevent work-related injury, illness, and death; 

2. a public health science organization that provides and funds 

research, information, education, and training in the field of occupational safety and health with an annual budget of approximately 

$300 million; 3. a federal government agency that is committed to 

the development and integration of knowledge and intervention and 

is dedicated to building and maintaining productive partnerships; 4. a 

world-renowned research institute that attracts highly talented investigators from many disciplines.

Function: To protect the more than 145 million U.S. workers through 

research and education. 

Origin: Established under the Occupational Safety and Health Act 

of 1970. 
AFF Agriculture, Forestry, & Fishing

AIDS Acquired Immune Deficiency Syndrome

AIHA American Industrial Hygiene Association

ASHP American Society of Health-System Pharmacists

ASSE American Society of Safety Engineers

ASTM American Society for Testing & Materials

BLS Bureau of Labor Statistics

CDC Centers for Disease Control & Prevention

DOL U.S. Department of Labor

EHOPAC Environmental Health Officer Professional Advisory Committee

EPA U.S. Environmental Protection Agency

FAA Federal Aviation Administration

FLC Federal Laboratory Consortium

HETAB Health Evaluations & Technical Assistance Branch (within NIOSH)

HHS U.S. Department of Health & Human Services

HIV Human Immunodeficiency Virus

HSA Healthcare & Social Assistance

IARC International Agency for Research on Cancer

ILO International Labour Organization

ISO International Organization for Standardization

KOSHA Korea Occupational Safety & Health Agency

MINER Mine Improvement & New Emergency Response (Act of 2006)

MSHA Mine Safety & Health Administration

NAICS North American Industry Classification System

NASA National Aeronautics & Space Administration

NHCA National Hearing Conservation Association

NIH National Institutes of Health

NIOSH National Institute for Occupational Safety & Health

NORA National Occupational Research Agenda

NSC National Safety Council

OECD Organisation for Economic Co-Operation & Development

OSH Occupational Safety & Health

OSHA Occupational Safety & Health Administration

PAHO Pan American Health Organization

R2P Research-to-Practice

TWU Transportation, Warehousing, & Utilities

WHO World Health Organization

WRT Wholesale & Retail Trade

> Greater Than

< Less Than

≤ Less Than or Equal To

x Times (when used in Relevant Information & impact narratives)

Program Reviewed by the National Academies 

Narrative of Impact

Photo by mel0808johnson, downloaded from Flickr

About NIOSH — 2

www.cdc.gov/niosh
About NIOSH — 3

www.cdc.gov/niosh

NIOSH Mission & Responsibilities 

The mission of niosh is to generate new knowledge in the field of occupational safety and health and to transfer that knowledge into workplace 

practice to prevent work-related injury, illness, and death. To accomplish 

this mission, niosh provides national and international leadership by conducting scientific research, identifying causes of work-related disease and 

injury, identifying the potential hazards of new work technologies and practices, creating ways to prevent workplace hazards, developing guidance and 

authoritative recommendations, and delivering products and services to its 

various stakeholders. 

Section 22 of the Occupational Safety and Health Act outlines the specific 

responsibilities of niosh: 

Develop recommendations for occupational safety and health standards,

Perform all functions of the Secretary of Health and Human Services under Sections 20 and 21 of the Act, 

Sec. 20: conduct research on worker safety and health 

Sec. 21: conduct training and employee education 

Develop information on safe levels of exposure to toxic materials and 

harmful physical agents and substances,

Conduct research on new safety and health problems,

Conduct onsite investigations to determine the toxicity of materials used 

in workplaces, and

Fund research by other agencies or private organizations through grants, 

contracts, and other arrangements.

Distinguishing niosh from osha

The Occupational Safety and Health Act of 1970 created both the Occupational Safety and Health Administration (osha) and niosh. Although niosh

and osha were established by the same Act of Congress, the two agencies 

have distinct and separate responsibilities. 

osha is housed under the U.S. Department of Labor (dol), whereas niosh

is part of the Centers for Disease Control and Prevention (cdc) under the 

U.S. Department of Health and Human Services (hhs). 

osha is responsible for setting and enforcing workplace standards and regulations, whereas niosh is responsible for helping assure safe and healthful 

working conditions through research, information, education, and training 

in the field of occupational safety and health. 

osha approves and monitors state-based safety and health plans and provides up to 50 percent of an approved plan’s operating costs, whereas niosh

funds training grant programs throughout the country to develop qualified 

practitioners and researchers who will contribute to the prevention of workrelated injury, illness, and death. 

Aside from these distinctions, niosh and osha work collaboratively to 

assure the safety and health of every U.S. worker. 

With today’s economic, healthcare, and workers’ 

compensation crises challenging our country, 

prevention of work-related injury, illness, and death 

is critically important.
About NIOSH — 4

www.cdc.gov/niosh

West Lafayette, IN 

Warrensburg, MO

Iowa City, IA

Morgantown, WV (2 centers)

Washington, DC

Baltimore, MD

Blacksburg, VA

New Haven, CT

Farmington, CT

Storrs, CT

Buffalo, NY

Philadelphia, PA (2 centers) 

Columbia, SC 

Florence, AL

Atlanta, GA

Oklahoma City, OK

Tyler, TX 

Lubbock, TX 

New Orleans, LA 

Nashville, TN

Lexington, KY

Millersville, PA

Pittsburgh, PA

Columbus, OH 

Toledo, OH 

Murray, KY

Lowell, MA

Cooperstown, NY

Coral Gables, FL

Butte, MT 

Portland, OR 

Seattle, WA Spokane, WA

Davis, CA

Ft. Collins, CO

Menomonie, WI 

Marshfield, WI 

Birmingham, AL

Berkeley, CA 

Los Angeles, CA 

Cincinnati, OH 

Denver, CO 

Boston, MA 

Chicago, IL 

Ann Arbor, MI 

Minneapolis, MN

Piscataway, NJ

Chapel Hill, NC 

Tampa, FL 

Houston, TX 

Salt Lake City, UT 

San Juan, PR 

Anchorage, AK

Sitka, AK

Alaska, Hawaii, and Puerto Rico are not to scale

Serving the Nation Through Research & Education

niosh is actively engaged in and committed to training tomorrow’s leaders in occupational safety and 

health. The information below depicts locations of niosh laboratories; its Centers for Agricultural 

Disease and Injury Research, Education, and Prevention; Training Project Grants; Education and Research Centers; and WorkLife Centers of Excellence. 
NIOSH Facilities

Facilities are headquartered in Washington, District of Columbia and Atlanta, 

Georgia with laboratories, offices, and staff in Anchorage, Alaska; Cincinnati, 

Ohio; Denver, Colorado; Morgantown, West Virginia; Pittsburgh, Pennsylvania; 

and Spokane, Washington.

Centers for Agricultural Disease & Injury Research, Education, & Prevention 

Centers represent a major effort to protect the safety and health of agricultural 

workers and their families. These Centers of Excellence were established in 1990 as 

part of an Agricultural Safety and Health Initiative and are strategically located to 

be responsive to issues unique to the different regions across the country. The centers were established by cooperative agreement to conduct research, education, and 

prevention projects to address the nation’s pressing agricultural safety and health 

problems. niosh currently supports 8 centers across the country. 

Training Project Grants 

Training Project Grants are awarded to academic institutions that primarily have 

single-discipline graduate training programs in industrial hygiene, occupational 

health nursing, occupational medicine, occupational safety, and other closely-related fields. Training Project Grants provide academic and research training programs 

that develop professionals who will contribute to the prevention of work-related injury, illness, and death. niosh currently supports 32 Training Project Grants across 

the country. See Training Grants (page 50) for more information. 

Education & Research Centers 

Centers are located at academic institutions that emphasize interdisciplinary graduate 

training programs in industrial hygiene, occupational health nursing, occupational 

medicine, occupational safety, and other closely-related fields. Education and Research Centers strongly encourage collaboration among various occupational safety 

and health disciplines and provide academic and research training programs that 

develop professionals who will contribute to the prevention of work-related injury, illness, and death. niosh currently supports 17 centers across the country. See 

Training Grants (page 50) for more information.

WorkLife Centers of Excellence

Centers represent the niosh initiative to sustain and improve worker health through 

better work-based programs, policies, and practices. The overall health of workers is influenced by many factors inside and outside the workplace, such as stress, 

physical and chemical exposures, diet, exercise, smoking, medication, and alcohol 

use. niosh currently funds 3 centers located at four universities to support and 

expand multidisciplinary research, training, and education in the area of WorkLife. 

See WorkLife (page 51) for more information.

About NIOSH — 5

www.cdc.gov/niosh
About NIOSH — 6

www.cdc.gov/niosh

Division of Applied Research & Technology 

Biomonitoring & Health Assessment Branch

Chemical Exposure & Monitoring Branch

Engineering & Physical Hazards Branch

Organizational Science & Human Factors Branch

Division of Respiratory Disease Studies 

Field Studies Branch

Laboratory Research Branch

Surveillance Branch

Division of Surveillance, Hazard Evaluations, & Field Studies

Hazard Evaluations & Technical Assistance Branch

Industrywide Studies Branch

Statistical Support Most Efficient Organization

Surveillance Branch

Division of Safety Research 

Analysis & Field Evaluations Branch

Protective Technology Branch 

Surveillance & Field Investigations Branch 

Education & Information Division 

Document Development Branch

Information Resources & Dissemination Branch

Risk Evaluation Branch

Training Research & Evaluation Branch

Health Effects Laboratory Division 

Allergy & Clinical Immunology Branch

Biostatistics & Epidemiology Branch

Engineering & Control Technology Branch

Exposure Assessment Branch

Pathology & Physiology Research Branch

Toxicology & Molecular Biology Branch

National Personal Protective Technology Laboratory

Technology Evaluation Branch

Technology Research Branch

Policy & Standards Development Branch

Office of the Director

Alaska Regional Office

Denver Regional Office

Office of Administrative & Management Services 

Office of the Associate Director for Science 

Office of the Chief of Staff

Office of Compensation, Analysis, & Support

Office of Emergency Preparedness & Response

Office of Extramural Programs 

Office of Health Communication & Global Collaboration

Office of Minority Health 

National Occupational Research Agenda Coordination Office

Office of Planning & Performance

Office of Research & Technology Transfer

Office of Mine Safety & Health

Pittsburgh Research Laboratory 

Respiratory Hazards Control Branch

Hearing Loss Prevention Branch

Disaster Prevention & Response Branch

Mining Injury Prevention Branch

Surveillance & Research Support Branch

Rock Safety Engineering Branch

Spokane Research Laboratory 

Extramural Coordination & Information Dissemination Activity

Mining Surveillance & Statistics Support Activity

Mining Injury & Disease Prevention Branch

Catastrophic Failure Detection & Prevention Branch

Structural Organization of NIOSH

Strategically Located to Address Safety & Health
Facts & Figures — 7

www.cdc.gov/niosh

The Current State of Worker Safety & Health 

Understanding the Dynamics of a Changing Workforce

In 2008 more than 145 million people in the U.S. were employed in the 

civilian workforce. Every day, approximately 9,000 workers are injured on 

the job and 15 workers die from a fatal workplace injury. Work-related 

illness claims the lives of about another 135 workers and retirees daily. According to the Bureau of Labor Statistics (bls), 5,657 workers died from 

work-related injuries and more than 4 million nonfatal injuries and illnesses were reported in 2007. The economic impact of work-related injury and 

illness has been estimated to be $171 billion annually, the same as cancer or 

cardiovascular disease and much greater than the burden from hiv/aids

or Alzheimer’s disease. In 2006 employers spent an estimated $87.6 billion 

on wage payments and medical care for workers hurt on the job.

Addressing workplace safety and health poses numerous challenges. 

First, the composition of the U.S. workforce is becoming increasingly diverse; it is becoming older, more racially and ethnically diverse, and more 

women are entering the workforce. These changes reflect the changing 

social and demographic characteristics of the country but also produce 

new safety and health issues. It has become clear that certain populations 

experience an increased burden of disease, disability, and death. These 

populations also frequently have less access to quality healthcare.

Moreover, U.S. workplaces are rapidly evolving, changing the way work 

is organized. Jobs in our economy continue to shift from manufacturing 

to services, with service-providing industries now employing about 80 

percent of all workers. Longer hours, compressed work weeks, shift work, 

reduced job security, and part-time and temporary work are realities of 

the modern workplace and are increasingly affecting the health and wellbeing of workers and their families. In addition, new chemicals, materials, 

processes, and equipment with new potential occupational risks are being 

developed and marketed at an ever-accelerating pace.

The acute and long-term effects of work-related injury, illness, and death 

translate into tremendous economic and emotional costs to society. Data 

show that when interventions, such as safe work practices and engineering 

controls, are based on sound scientific research the burden of injury and 

illness is significantly reduced. Through its Research-to-Practice (r2p) initiative, niosh works closely with its partners to move research findings and 

technologies out of the Institute and into the workplace, and to promote the 

diffusion of products and information in an effort to protect workers and 

reduce cost to employers, workers, their families, and society as a whole.

Injuries and illnesses become more severe with age.

In 2007, workers aged 65 and older required a median 

of 16 days away from work after suffering a workrelated injury or illness, whereas workers aged 16-24 

years required only 4 days away from work.

In 2005, blue-collar jobs made up 23% of all jobs but 

these workers experienced 55% of all work-related 

injuries and earned an average of $15 per hour. 

White-collar workers earned more than double and 

experienced only 2% of the injuries on average. 

In 2007, the death rate from work-related injuries

for Hispanic workers was 4.6 per 100,000 workers, 

as compared with rates of 3.8 for all workers, 3.8 for 

non-Hispanic white workers, and 3.9 for non-Hispanic 

black workers. 

More than 2/3 of Hispanic or Latino workers who 

suffered a fatal work-related injury in 2007 were born 

outside the U.S.

More than 50% of the 4 million work-related injury & 

illness cases reported in 2007 required days away from 

work, job transfer, or restriction.

In 2007, 92% of work-related fatalities occurred 

among men but men represented only 54% of the 

U.S. workforce.

Data used in this document were obtained from the following external sources: the Bureau of Justice Statistics, 

Bureau of Labor Statistics, International Labour Organization, Lux Research Inc., National Academy of Social 

Insurance, and the World Health Organization.
Facts & Figures — 8

www.cdc.gov/niosh

Annual Work-Related Fatalities by Occurrence, 2007

Construction 1,204 10.5

16.9

27.9

2.5

2.5

2.1

2.2

4.7

25.1

2.5

0.7

1.2

2.3

4.0

3.1

890

585

545

476

400

348

260

207

183

175

149

119

79

34

Transportation & Warehousing

Agriculture, Forestry, Fishing, & Hunting

Government

Professional & Business Services

Manufacturing

Retail Trade

Leisure & Hospitality

Wholesale Trade

Mining

Other Services (except public administration)

Educational & Health Services

Financial Activities

Information

Utilities

Annual Work-Related Fatalities by Industry Sector, 2007

Number of worker fatalities Rate of fatality per 100,000 workers

Total worker fatalities = 5,657 3.8 = Fatality rate for all workers

➝

Transportation incidents—42%

Fires & 

explosions

3%

Falls—15%

Exposure to harmful substances 

or environments—9%

Assaults & violent acts—15%

Contact with objects & 

equipment—16%

Bureau of Labor Statistics, 2009

13% were falls to a lower level

1 %1 we er hom ci di es

25% occurred on a highway

➝

➝

%9 er e w

yb- kcurt s
Facts & Figures — 9

www.cdc.gov/niosh

Annual Injury & Illness Cases Involving Hispanic or

Latino Workers by Industry Sector, 2007

Bureau of Labor Statistics, 2009

34,290

29,990

25,480

18,480

15,580

14,600

10,300

3,770

3,690

1,130

10%

16%

19%

20%

18%

8%

38%

11%

12%

6%

16

12

10

8

6

4

4

65 years & older

55–64 years

45–54 years

35–44 years

25–34 years

20–24 years

16–19 years

Days Away from Work due to Injury & Illness by Age Group, 2007

96

120

123

124

118

134

124

Median days away from work Incidence rate per 10,000 workers

0.9

2.6 3.0 3.1

3.4

4.1

4.6

10.2

All worker fatality rate = 3.8

65 & older

16–17

18–19

20–24

25–34

35–44

45–54

55–64

Annual Rates of Fatal Work Injuries by Age Group, 2007

➝

Information

Trade, Transportation, & Utilities

Manufacturing

Construction

Leisure & Hospitality

Professional & Business Services

Educational & Health Services

Natural Resources & Mining

Financial Activities

Other Services

Number of cases Percent of cases
This diagram depicts the blind area of a Ford 880 construction vehicle. The truck is indicated by the black rectangle. The radial grid illustrates the 360o field of vision from 

the driver’s seat, which is indicated by the gold dot. In the blind area, shown in grey, a driver can see nothing below the height of 4 feet 11 inches.

Illustration by David Fosbroke
NORA — 11

www.cdc.gov/niosh

Tailoring our 

organizational 

framework to fit 

the way people work 

and seek out 

information 
NORA — 12

www.cdc.gov/niosh

National Occupational Research Agenda

Created for Stakeholders by Stakeholders

Workplace settings vary widely in size, design, location, work processes, 

workplace culture, resources, and workforce characteristics such as age, 

gender, training, education, cultural background, and health practices. 

This translates to broad diversity in the unique safety and health risks for 

each industry sector and the need for tailored interventions. 

As a leader in occupational safety and health, niosh created the National Occupational Research Agenda (nora) in 1996 as a stakeholder-driven 

process designed to stimulate innovative research and improved work practices. It is the framework that guides prevention efforts of the occupational 

safety and health community in selected priority research areas. niosh and 

its partners have been actively collaborating in this process to define research priorities for the nation and achieve impact in the prevention of 

work-related injury, illness, and death. nora is a national partnership effort that has sparked unprecedented public-private accord and has created 

a culture of priority-driven research in occupational safety and health. 

In the first decade of nora, niosh and its partners developed a research 

agenda focused on 21 public health science priority areas that reflected 

considerable consensus among more than 500 groups and individuals who 

participated in the nora priority-setting process. 

Before entering its second decade nora was restructured as a result of 

stakeholder input. nora is now pursuing an industry sector-based approach 

to prioritize research needs at the national level. The North American Industry Classification System (naics) provides definitions for 20 sectors 

in order to classify businesses for the purposes of collecting, analyzing, 

and publishing data (visit the U.S. Census Bureau Web site for more information about naics). niosh aggregated these sectors into eight groups 

based on similarities in workplace safety and health issues. The eight nora

sectors are Agriculture, Forestry, and Fishing; Construction; Healthcare 

and Social Assistance; Manufacturing; Mining; Services; Transportation, 

Warehousing, and Utilities; and Wholesale and Retail Trade. niosh and 

its partners use this sector-based approach to move research results into 

workplace practice and to ensure a direct link between businesses, workers, researchers, and other partners to reduce work-related injury, illness, 

and death and improve the overall safety and health of workers.

Each nora sector consists of a council of approximately one-third niosh

researchers and two-thirds external partners from areas such as academia, 

industry, labor, and government. Each council identifies and promotes 

priority research needs, critical knowledge needed to fill gaps in occupational safety and health, and innovative partnerships within their sector. 

Currently, the councils are developing and implementing sector-based research goals, objectives, and action plans for the nation. 

A quick search of this document will find more than 

80 instances where partnership is mentioned. Partnership is a key component of NIOSH research. To date, 

NIOSH has entered into more than 145 formal memoranda of understanding and has engaged thousands 

of informal partners to assist in achieving its mission.
NORA — 13

www.cdc.gov/niosh

niosh manages the day-to-day operations of nora and facilitates the work 

of the sector councils. In addition, niosh uses the knowledge, expertise, 

and experience of the council members to guide its internal portfolio of 

research programs. nora sector programs will be assessed in light of the 

ongoing review of niosh research programs from the National Academies. 

For more information see pages 56 and 57.

Guiding the Implementation of the NORA Sector Approach

Strong partner involvement throughout the entire research continuum 

(developing a concept, planning, conducting, implementing, disseminating, and evaluating) to ensure that research is focused on achieving 

relevance, quality, and impact. 

Access to and use of the best available surveillance data to drive research 

efforts, however, there is no national surveillance system in place for occupational safety and health. 

A multidisciplinary approach to generate new knowledge. 

The transfer and translation of research findings, technologies, and information into highly effective prevention practices and products that can 

be adopted immediately into the workplace. 

The person symbol marks specific narrative examples 

of how a NIOSH or NIOSH-funded project made an 

impact on worker safety and health.

The clipboard symbol marks NIOSH programs that 

have been reviewed by the National Academies for 

relevance and impact. More information about the 

reviews can be found on pages 56–57.

Aggregating NAICS Codes into NORA Sectors

Agriculture, Forestry, & Fishing 11

Construction 23

Healthcare & Social Assistance 62

Manufacturing 31-33

Mining 21

Information 51

Finance & Insurance 52

Real Estate, Rental, & Leasing 53

Professional, Scientific, & Technical Services 54

Management of Companies & Enterprises 55

Administrative, Support, Waste Management, & Remediation 56 

Educational Services 61

Arts, Entertainment, & Recreation 71

Accommodation & Food Services 72

Other Services (except public administration) 81

Public Administration 92

Transportation & Warehousing 48-49

Utilities 22

Retail Trade 44-45

Wholesale Trade 42

Services

Transportation, Warehousing, & Utilities

Wholesale & Retail Trade
This advertisement was created with social marketing techniques that identified protecting the next generation as an important issue for farmers. It was distributed 

through print media in 5 New York counties. For more information visit www.cdc.gov/niosh/programs/agff/insights/insightsagrops.pdf.

Agriculture, Forestry, & Fishing 

The Agriculture, Forestry, and Fishing sector is the cornerstone of industries that 

produce and market food, fiber, and fuel. Each year it generates more than $1 trillion 

in economic activity, creates exports exceeding $68 billion, and provides jobs to over 

2.1 million workers. In 2007 workers in this sector suffered the highest rate of fatal 

occupational injuries of all sectors with 27.9 deaths per 100,000 workers.

NORA — 14

www.cdc.gov/niosh
Using Marketing Research to Impact 

the Farming Community

One of the biggest risks to farmers is 

tractor overturns. Rollbars can prevent deaths 

from tractor overturns, however, U.S. tractors 

manufactured before 1985 generally do 

not have them. Researchers at the NIOSHfunded Northeast Center for Agricultural 

and Occupational Health, in partnership with 

the New York State legislature, implemented 

a rebate program and social marketing 

campaign (see photo on opposite page) 

that studied risk perceptions, barriers, and 

motivations to retrofitting tractors with 

rollbars. The campaign was effective. In the 

program’s first 6 months, tractor dealers in 

5 targeted counties sold 10x more rollbars 

than the previous 6 months and 8x more than 

dealers in counties without such a campaign.

The NIOSH Agriculture, Forestry, & Fishing Research 

Program has been reviewed by the National Academies 

(pages 56–57).

Workers in the Agriculture, Forestry, and Fishing (aff) sector perform intense seasonal work, putting in long hours in harsh physical environments, often using large 

machinery or being in close contact with animals. These intense working conditions lead to work-related fatality rates that are more than seven times higher for 

aff workers than for workers in all industry sectors. Workers in this sector also 

experience a higher incidence of many adverse occupational health outcomes, including hearing loss, respiratory conditions, and skin disorders. 

niosh and external partners have produced a formal national research agenda for 

occupational safety and health for the aff sector. This agenda is based on scientific 

evidence, public testimonies, peer reviews, and expert consultation. It aims to highlight the most important research questions, recognize priority safety and health 

concerns, understand effective intervention strategies, and disseminate information 

on ways to achieve sustained improvements in workplace safety and health practice. 

The agenda outlines five strategic goals to improve worker safety and health.

Improve surveillance within the aff sector to describe occupational hazards, 

worker populations at risk for adverse health outcomes, and the nature, extent, and 

economic burden of occupational illness, injury, and death. There is a lack of surveillance data concerning nonfatal injuries and characteristics of the workforce. 

Enhanced surveillance will help define specific populations at risk, injuries and illnesses of greatest concern, and the effectiveness of prevention efforts. 

Reduce excessive adverse outcomes in workers who have real limits to safeguarding their own safety and health. These limits may be social factors, such as low 

English proficiency and literacy; socioeconomic factors; the temporary or seasonal 

nature of aff work; or physiologic factors surrounding young and older workers, 

recent immigrant workers, and workers with physical or cognitive disabilities. 

Move proven safety and health strategies into workplaces by disseminating 

information about relevant interventions and promoting the adoption of best practices through partnerships and collaborations. 

Reduce the number, rate, and severity of traumatic injuries and deaths involving hazards of forestry, commercial fishing, and production agriculture and its 

support activities. In addition to more than 400 deaths, an average of 93,000 nonfatal osharecordable injuries occur on U.S. farms each year. Effective measures to 

prevent some of these injuries are known but not widely practiced. In the forestry 

industry, comprehensive baseline data are needed to monitor safety conditions and 

track improvements. In the fishing industry, competition for a tightly controlled 

resource increases the likelihood that workers will take risks that could lead to injury, illness, and death. Reducing fatalities associated with vessel sinkings and falls 

overboard is a high priority. 

Improve the health and well-being of aff workers by reducing work-related 

causes or factors that contribute to acute and chronic illness and disease. Agricultural and forestry work can be repetitive, thereby leading to musculoskeletal strains 

and sprains. In addition, respiratory hazards, toxic chemicals, psychological stresses, 

and animal-borne diseases are all hazards associated with the aff sector. New production methods and technologies, environmental issues, and changing workforce 

demographics continually present emerging challenges. Commercial fishing workers also face many work-related acute and chronic health exposures. More research 

is needed on these health issues and their prevention.

NORA — 15

www.cdc.gov/niosh
Construction

In 2008 nearly 11 million people worked at construction sites across the U.S. 

on any given day. Construction workers have high rates of work-related injury 

and death compared with other sectors. Workers in the construction sector 

experience the second highest rate of nonfatal injuries resulting in days away 

from work and the fourth highest fatality rate. They represent only about 8

percent of the U.S. workforce but experience 21 percent of the fatal injuries. 

Leading causes of death among construction workers are falls to a lower level; 

electrocutions; and struck-by, caught-in, or crushed-by incidents.

niosh convened a group of internal and external stakeholders from academia, industry, professional associations, labor 

groups, and government and nongovernment organizations 

to serve as council members of its nora Construction sector research program. The mission of the Construction sector 

program is to eliminate occupational disease, injury, and death 

among workers in this industry through a focused program of 

research and prevention.

With guidance from available data, stakeholder input, and 

member expertise, the sector council identified information 

gaps that need to be addressed in order to protect the safety, 

health, and well-being of workers in the construction industry. After extensive review and discussion, the sector council 

developed a national agenda identifying several priority areas 

where focused attention is needed. 

The aim of these priority areas is to reduce injury and 

illness from traumatic injuries, hearing loss, silica exposure, 

welding fume exposure, and musculoskeletal disorders; improve understanding of factors related to work organization, 

organizational culture, safety and health management systems, 

and occupational health disparities; develop, strengthen, and 

expand training and education; increase the use of prevention 

through design strategies; and improve surveillance at the federal, state, and private levels. 

The national agenda provides a framework for sector stakeholders to share what they believe are the most relevant issues, 

gaps, and safety and health needs in the construction industry 

and provides guidance to prioritize their work among the many 

competing safety and health concerns. It is intended to inspire 

decision makers to adopt these issues as their top priorities, 

steer researchers to cohesive topic areas for research proposals, 

and encourage dialog and partnering among stakeholders on a 

subset of key issues—thus ensuring an increased focus on reducing injury, illness, and death among construction workers. 

Stakeholder audiences that may be particularly interested 

in the Construction sector national agenda include research 

funding sources, such as federal and state research agencies, 

building-owner associations, and research organizations for 

workers’ compensation insurance companies; public and private researchers; construction industry organizations, such as 

tool, equipment, and material manufacturers and distributors, 

trade associations, apprenticeship training organizations, and 

management firms; and safety and health practitioners.

The nora Construction sector council encourages stakeholders in the construction industry to collaborate with niosh

and the council to address the strategic goals outlined in its 

national agenda. Several opportunities are available for collaboration, including identifying, developing, and implementing 

safety-related devices, methods, or systems through partnerships with organizations and companies that will actively 

support these solutions during normal construction activities. 

A well-designed and facilitated approach to address these important safety and health issues can increase the likelihood of 

reducing risks faced daily by construction workers.

NORA — 16

www.cdc.gov/niosh
Impacting Worker Safety Through Intervention & Product Design

Current fall protection products in the construction industry are limited to flat surfaces, are adjustable 

only for a few roof pitches, or are lacking components to support a horizontal guardrail. niosh

engineers designed an adjustable roof bracket-safety rail assembly that can prevent construction 

workers from falling from roof edges or through roof openings and skylights. The adjustable design 

allows for installation of a protective guardrail system on flat commercial and industrial roofs and 

on residential roofs with 7 different slopes ranging from 27°–63°. Two OSHA regulations were the 

basis for the initial design. The prototype was improved using laboratory performance testing and 

user feedback and is patent-pending in the U.S. and Canada. Once commercially available, this fallprevention technology will have immediate potential to reduce the frequency of traumatic injuries 

experienced by those working at heights. Approximately 37% (447) of the work-related deaths 

among construction workers resulted from a fall in 2007.

The NIOSH Construction Research Program has been reviewed by the National Academies (pages 56–57).

A construction worker leans against the guardrail during a field trial of the Adjustable Guardrail Bracket. The unit is attached to a sloped residential roof.

Photo by Thomas G. Bobick

NORA — 17

www.cdc.gov/niosh

Relevant Information

In 2007, > 1,200 construction workers died from a 

work-related injury and > 380,000 nonfatal injuries and 

illnesses were recorded.

Falls, electrical hazards, and contact with objects

and equipment account for about 63% of fatalities 

among construction workers.

In 2007, approximately 200,000 cases of nonfatal 

injury and illness were reported among construction 

workers that resulted in days away from work, job 

transfer, or restriction. 42% of these workers were 

laborers and carpenters.
Healthcare & Social Assistance

Many people think of the Healthcare and Social Assistance industries as being clean, 

sterile, and safe places to work. In reality, workers in this sector are exposed to many 

hazards that can adversely affect their health and well-being. Long hours, changing 

shifts, physically demanding tasks, violence, and exposures to infectious diseases and 

harmful chemicals are examples of hazards that put these workers at risk for illness 

and injury. More than 18 million workers in the Healthcare and Social Assistance 

sector face hazards as they work to serve the sick and those in need.

NORA — 18

www.cdc.gov/niosh
NORA — 19

www.cdc.gov/niosh

Research & Recommendations Impact 

the Healthcare Industry

Because of the HIV epidemic, healthcare 

workers used far greater numbers of 

powdered latex gloves in the 1990s than in 

previous years. This increased use resulted in 

many more workers exposed to powders that 

carried latex allergens. Healthcare workers 

presented with latex allergies in epidemic 

proportions: hives, work-related asthma, 

and even anaphylaxis. In an Alert NIOSH 

advised, among other recommendations, that 

healthcare establishments and healthcare 

workers reduce the use of powdered latex 

gloves to minimize latex allergen exposure. 

NIOSH evaluated the effectiveness of the 

Alert and found that hospitals that received 

the Alert were more likely to have progressed 

from a position of “inaction” to “advocacy” 

on the issue of latex and latex use. Directors 

who had seen the Alert were more likely 

to report that they intended to implement 

an employee health education program, 

replace powdered latex gloves, and restrict 

latex glove use as compared with directors 

who had not seen it. NIOSH was one of the 

first organizations to recommend avoiding 

powdered latex gloves. Eventually many 

other organizations called for this change in 

the healthcare industry. Research has shown 

a shift away from the use of powdered latex 

gloves to nonpowdered latex or nonlatex 

gloves. As a result, allergic reactions to 

latex among healthcare workers have been 

markedly reduced.

The Healthcare and Social Assistance (hsa) sector, as defined by nora, includes 

workplace establishments that provide healthcare and social assistance for individuals. Because it can be difficult at times to clearly define the boundaries between 

healthcare and social assistance, the sector combines them. The industries in this 

sector are arranged on a continuum starting with those that provide medical care 

exclusively, to those that provide both healthcare and social assistance, to those that 

provide social assistance only.

The mission of the nora hsa sector is to eliminate occupational disease, injury, 

and death among individuals working in this sector through a focused program of 

research and prevention. To accomplish this mission, niosh developed a council of 

experts from inside and outside its Institute. The council developed six strategic goals 

as part of its agenda for the nation.

Conduct surveillance to better understand exposure to hazards, injuries, illnesses, and “near-misses.” This information should routinely be collected and 

analyzed because it is very important for setting priorities and making improvements to protect workers within this sector.

Promote the use of existing approaches, techniques, and safe work practices, 

such as lifting equipment to aid with patient transfers, safer medical devices, and 

reasonable work schedules and workloads, to protect hsa workers from injury and 

illness. These techniques can protect workers from back and shoulder injuries, reduce the likelihood of suffering a sharps injury, or reduce stress and medical errors. 

Safe work practices can be promoted through demonstration projects, intervention 

effectiveness studies, and public health marketing. These approaches aid in learning and refining best practices for specific work settings, show financial benefits 

and patient safety improvements, and raise awareness of ways to address occupational safety and health issues. 

Promote safety and health management programs to reduce injury and illness 

rates. Comprehensive safety and health programs can also realize a return-on-investment of more than $3 for every $1 invested. All hsa sector employers should 

have such a program in place.

Conduct research and develop safe approaches to protect hsa workers. Improvements, such as eliminating hazardous materials, using safer equipment and 

work practices, and taking advantage of new vaccines and preventive treatments 

for infectious exposures, are needed to ensure the safety and health of workers in 

this sector.

Address all healthcare settings to ensure workers employed in nonhospital 

settings are also protected from injury and illness. About half of all healthcare workers 

are employed in nonhospital settings, half of which are small businesses with fewer 

than 20 employees. In addition, care is often provided in homes. These environments 

are frequently more uncontrolled and can lead to worker injury, illness, or death. 

Build strong partnerships among industry, labor, academia, government, and 

those who have a stake in protecting the safety, health, and well-being of patients 

and workers in the hsa sector. The sector council encourages interested stakeholders to collaborate with niosh and the council to advance the mission of the nora 

hsa sector program.

Photo by House of Sims, downloaded from Flickr
Manufacturing

The Manufacturing sector, made up of 21 industries, has a national focus 

on becoming more competitive at home and abroad. Of the 8 nora sectors, 

manufacturing faces the most diversity in workplace safety and health 

challenges. Hearing loss, nanotechnology, chemical process safety, management 

systems, and special populations are some of the priority research needs to 

protect the nearly 16 million U.S. workers in this sector.

Many corporations recognize the significance of including 

workplace safety and health in their corporate strategy for 

producing better products, improving the global economy, 

and maintaining a healthy workforce.

Women make up 29 percent of workers in the Manufacturing sector. About 31 percent are ethnic minorities (15 percent 

Hispanic or Latino, 10 percent Black or African American, and 

6 percent Asian). Occupations include production workers, inspectors, machinists, purchasing agents, and assemblers. 

In 2007 work-related injuries claimed the lives of 400 workers in the Manufacturing sector. The leading causes of death 

were contact with objects and equipment, transportation incidents, and falls. About 783,000 nonfatal injuries and illnesses 

were reported. Of these, more than 187,000 resulted in days 

away from work and an additional 239,900 required a job 

transfer or restriction. 

The leading causes of days away from work were contact 

with objects or equipment, overexertion, repetitive motion, 

and falls. Of all industries, 14 reported more than 100,000 nonfatal injuries and illnesses; 3 of these were among the largest 

of the manufacturing industries—transportation equipment 

manufacturing, fabricated metal product manufacturing, and 

food manufacturing. 

To address these and other worker safety and health concerns, niosh developed a coordinated research program in 

2006 as part of its nora framework. The mission of the nora

Manufacturing sector program is to eliminate occupational 

disease, injury, and death among people working in the Manufacturing sector. niosh established a council of external and 

internal experts to identify the top occupational safety and 

health problems, research gaps, emerging issues, and relevant 

priority populations.

The sector council is made up of stakeholders from industry, 

government, labor, and academia. With guidance from available data; council member expertise; and input from workers, 

employers, professional associations, and other stakeholders, 

the sector council is developing a research agenda for the nation that identifies priority goals to protect the safety, health, 

and well-being of workers in the manufacturing sector. 

Priority areas of research and translation identified by the 

Manufacturing sector council include contact with equipment 

and objects; slips, trips, and falls; ergonomics that can lead to 

musculoskeletal disorders; hearing loss prevention; chemical 

exposure; work organizational systems and stress; special populations such as contract workers, younger and older workers, 

immigrants, and women of child-bearing age; nanotechnology; and small business. 

The Manufacturing sector council encourages stakeholders 

in the manufacturing industry to collaborate with niosh and 

the council to address the strategic goals outlined in its national agenda. Partners are essential to conducting new research, 

assessing the state of the field, and communicating findings to 

those in positions who can make positive changes in the workplace and reduce injury, illness, and death.

NORA — 20

www.cdc.gov/niosh Photo by Lauralynn Taylor McKernan
Identifying Emerging Hazards & Impacting Worker 

Health Through State-Based Partnerships

Bronchiolitis obliterans, a rare and life-threatening 

lung disease, was found among microwave popcorn 

manufacturing workers and linked by NIOSH to the 

chemical diacetyl, an ingredient in artificial butter 

flavorings. At the annual meeting of the Council of 

State and Territorial Epidemiologists in June 2006, the 

California state health department and NIOSH officials 

reported a similar outbreak of lung disease among 3 

food flavorings manufacturing workers exposed to 

diacetyl. To respond to this emerging hazard, members 

of NIOSH’s 15-state Consortium of Occupational 

State-based Surveillance group conducted an array 

of occupational public health activities. State health 

officials have informed workers, employers, and 

healthcare providers of the risks from work-related 

exposure to food flavorings; have conducted worksite 

visits or employer surveys to assess diacetyl and the use 

of food flavorings; have helped state OSHA programs 

identify worksites that are using food flavorings; and 

have responded to reports of possible health risks from 

use of diacetyl-containing oils in restaurants.

North American Industry Classification System 

(codes 31-33)

311 -- Food Manufacturing

312 -- Beverage & Tobacco Product Manufacturing

313 -- Textile Mills

314 -- Textile Product Mills

315 -- Apparel Manufacturing

316 -- Leather & Allied Product Manufacturing

321 -- Wood Product Manufacturing

322 -- Paper Manufacturing

323 -- Printing & Related Support Activities

324 -- Petroleum & Coal Products Manufacturing

325 -- Chemical Manufacturing

326 -- Plastics & Rubber Products Manufacturing

327 -- Nonmetallic Mineral Product Manufacturing

331 -- Primary Metal Manufacturing

332 -- Fabricated Metal Product Manufacturing

333 -- Machinery Manufacturing

334 -- Computer & Electronic Product Manufacturing

335 -- Electrical Equipment, Appliance, 

 & Component Manufacturing

336 -- Transportation Equipment Manufacturing

337 -- Furniture & Related Product Manufacturing

339 -- Miscellaneous Manufacturing

NORA — 21

www.cdc.gov/niosh
Mining

Despite the significant progress made to protect the safety and health of miners, 

to date the mining industry’s fatality rate remains more than 6 times the national 

average for all occupational sectors. High rates of lost work time and permanently 

disabling injuries plague the industry as do diseases from long-term exposure, such as 

respiratory illness and hearing impairment. 

NORA — 22

www.cdc.gov/niosh
NORA — 23

www.cdc.gov/niosh

Impacting the Mining Community Through 

Extensive Research & Intervention Efforts

The National Academies’ review of the NIOSH 

Mining Program underscores its significant 

contributions to improving mine worker safety 

and health. The research, technology, and training 

products developed by NIOSH have been 

widely adopted and used in mines throughout 

the country. This program has a long history 

of meeting the safety and health needs of its 

customers and stakeholders and continues to 

receive strong support from its labor and industry 

constituents. Notable examples of the range of 

NIOSH’s impact include computer models that 

underground mining companies use to safely 

design mine openings; a training program for 

safely donning self-contained self rescuers; 

newly developed engineering controls for mining 

machines that are being adopted by manufacturers 

for reducing noise levels; scientific studies that 

have formed the basis for new safety and health 

regulations in critical areas such as mine seals and 

refuge chambers; design guides and tools that are 

widely applied in underground mines for reducing 

harmful diesel emissions; real-time monitoring 

instruments; and the recently developed 

postaccident communication technologies that are 

enabling the underground coal industry to comply 

with requirements of the MINER Act of 2006.

The NIOSH Mining Research Program has been reviewed by the 

National Academies (pages 56–57).

Mining, as a basic industry, provides the foundation for our nation’s economy, 

national defense, and standard of living. The mining industry spans all 50 states 

and our country depends heavily upon it for raw materials and energy. Wire, 

pipe, concrete, steel, and glass serve as examples of society’s reliance on minerals. Many of us, however, fail to realize that hundreds of mined commodities play 

integral roles in everyday products, from medicines to computers. Furthermore, 

coal supplies a large portion of our nation’s energy requirement, accounting for 

more than 50 percent of all generated electric power. Domestic mining also provides strategic minerals that are important for our national security.

Extracting minerals from the earth involves complex, unpredictable, and often 

labor-intensive processes. As a result, the mining industry historically experiences high risks of injury and death. The most challenging working conditions 

occur in the industry’s underground sector and often include confined spaces, 

interactions with large mobile equipment, poor lighting, wet surroundings, 

explosive gas, airborne dust, high noise levels, and uncertain roof conditions. 

Despite significant advancements through the decades, there remains room for 

improvement as mining conditions become more complex. Adding to the challenge is the fact that a generation of seasoned miners is retiring. 

The recent disasters at the Sago, Alma, and Crandall Canyon Mines further 

exemplify the safety hazards and challenges associated with mining. The miner

Act of 2006 created the Office of Mine Safety and Health Research within niosh, 

providing a focused structure for the Institute’s research in the Mining sector.

The mission of the nora Mining sector research program is to eliminate workrelated disease, injury, and death from the mining workplace. In collaboration 

with external partners, niosh developed a set of priority research goals to achieve 

this mission. Priorities were established using surveillance data, stakeholder input, loss control, and the Mining Safety and Health Research Advisory Council. 

Priority research goals are aimed at reducing health hazards in the workplace to reduce respiratory disease; noise-induced hearing loss; repetitive and 

cumulative musculoskeletal injuries; traumatic injuries; the risk of mine disasters, such as fires, explosions, and inundations; and ground failure injury 

and death. Minimizing the risk and enhancing the safety and effectiveness of 

emergency responders is also of high importance. It is essential to determine 

the impact of changing mining conditions, new and emerging technologies, and 

the shifting patterns of work on worker safety and health to prevent potentially 

adverse outcomes. 

One significant change in the Mining sector is the growth in production and 

the number of operations resulting from the rapidly increasing demand for affordable energy. For example, the oil and gas subsector, in 2003—at the beginning 

of the current boom cycle—employed 292,846 workers. By 2007 employment 

had grown more than 46 percent and the annual number of drilling and workover rigs increased by 39 percent. Unfortunately the number of deaths in that 

same period also increased from 85 to 122. Despite this significant increase, the 

fatality rate remained steady at 30 deaths per 100,000 workers. This is almost 8

times the rate for all U.S. workers and represents about two-thirds of all mining 

fatalities. This is a high-risk industry; if the demand for oil and gas remains high 

the death rate will also remain high unless effective safety programs are implemented. niosh is working collaboratively with industry and others to identify 

and solve safety problems through research and prevention activities. 

Relevant Information

More than 75% of mine workers suffer from occupational 

hearing loss by the time they retire; many of these workers also 

suffer from chronic musculoskeletal disorders. 

The average age of mine workers is approaching 50 years.

An influx of inexperienced miners creates its own set of challenges and opportunities with respect to safety.

Photo by Elaine Cullen
Services

In 2008 the nora Services sector employed nearly 69 million workers. This 

sector is the most diverse in its job categories and includes industries such as 

public safety and other government services, automotive repair, hotels and 

restaurants, education, recreation, and waste collection. U.S. workers in the 

Services sector are exposed to a variety of substances such as asbestos, cleaning 

solvents, carbon monoxide, diesel exhaust, and tobacco smoke; physical 

stressors such as temperature extremes, overexertion, assaults, and other forms 

of violence; and safety hazards such as electrocution, motor vehicle crashes, 

and slips, trips, and falls. 

Work environments vary widely in the Services sector and include offices, hotel rooms, indoor and outdoor entertainment 

facilities, restaurant kitchens, classrooms, automotive garages, 

public roads, and private households. These varied—and often 

uncontrolled—environments put workers at increased risk of 

workplace injury and illness. 

From 2003–2007 homicides and other violent acts were 

the leading causes of death among workers in food and 

alcohol service, hotel and motel, and residential leasing. In 

2006 lost workday injury rates were greatest for landscapers, 

waste collectors, professional athletes, and those employed in 

consumer electronics and appliance rental; musculoskeletal 

disorders from workplace activity were elevated for workers 

in residential real estate leasing, building services, landscape, 

and laundry services; and fatalities among public safety 

workers from vehicle crashes, homicides, and heart disease 

had risen.

To address occupational safety and health issues in the Services sector, niosh established a nora sector council in 2006

that is comprised of industry experts, labor representatives, academic investigators, and public health practitioners. Because 

public safety workers experience many unique occupational 

hazards, a separate council was convened with experts from 

law enforcement, fire fighting, corrections, and emergency 

medical services. Each council has identified gaps in research, 

knowledge, and interventions that were used to develop a 

national agenda. This agenda includes priority research and 

prevention goals for each of the 14 industries encompassed 

within the nora Services sector. 

Priority goals address important safety and health issues, 

such as roadway hazards and vehicle crashes for outdoor 

workers; workplace violence and stress for law enforcement, 

corrections, and restaurant workers; overexertion and falls 

from heights for solid waste and landscape workers; effective training programs for youth and immigrant workers and 

workers with disabilities; fire ground exposures and chronic 

disease among fire fighters; and patient transfer equipment for 

emergency medical service workers. 

These goals and other Service sector activities will be accomplished through internal and external—and new and 

existing—partnerships. Through the cooperative efforts of 

workers, management, labor, practitioners, and scientists, 

niosh will continue to reduce the economic and personal 

impact of occupational disease, disability, and death through 

high-quality research and effective prevention strategies, as 

well as help ensure the success of research translation, reduce 

work-related hazards and exposure, and protect workers in 

the Services sector.

NORA — 24

www.cdc.gov/niosh Photo from the Getty Image Bank
Protecting & Impacting Those Who Protect Us

NIOSH occupational research and prevention products have 

impacted many of the industries within the NORA Services 

sector. For example, Health Hazard Evaluations have resulted 

in a manual developed by the U.S. Fire Administration 

on hearing loss prevention during response and training 

exercises, in a Vermont Public Service Board agreement to 

eliminate worker exposure to creosote through substituting 

creosote-treated electrical poles with pressure-treated 

ones, and in a training course required for Canadian Boat 

Licensure. In addition, the Fire Fighter Fatality Investigation 

and Prevention Program at NIOSH has contributed to the 

development of a National Fire Protection Association 

Standard on fire fighter staffing levels and an investigation 

cited as justification for passing the Bradley Law, which 

changed fire fighter training procedures in New York State.

See page 40 for more information about Health Hazard Evaluations and page 

61 for the Fire Fighter Fatality Investigation and Prevention Program.

Relevant Information

In 2007, > 1.5 million nonfatal injuries and illnesses were reported among 

Service sector workers; 18% of these cases resulted in days away from work.

The number of fatal workplace injuries among protective service workers 

rose 19% to 337. This was led by an increase in the number of police officers 

fatally injured on the job.

In 2007, homicides (628) were the 3rd leading cause of work-related fatalities and outnumbered struck-by fatalities (504) for the first time since 2003. 

Throughout the next decade, U.S. employment growth in education 

(32%), professional and business services (28%), and leisure and hospitality 

(18%) are projected to be well-above the national projection of 15%.

NORA — 25

www.cdc.gov/niosh
Transportation, Warehousing, & Utilities

In 2007 the nora Transportation, Warehousing, and Utilities sector accounted 

for 16 percent of all workplace deaths. Transportation incidents accounted for 

71 percent of the fatalities in this sector. The subsectors of air transportation, 

couriers, truck transportation, and warehousing had rates of lost-workday 

injuries from overexertion that were 2–8 times higher than those for all 

U.S. workers. Traumatic injuries, musculoskeletal disorders, and hazardous 

exposures are the primary concerns for affecting the safety and health of 

workers in this sector.

NORA — 26

www.cdc.gov/niosh
NORA — 27

www.cdc.gov/niosh

Impacting the Safety of Transportation 

Workers in the U.S. and Globally

The twu research program is young in comparison 

with many other niosh programs. Consequently, 

many of the TWU projects are focused on 

identifying and understanding injuries and illnesses 

to support the development of prevention efforts. 

Efforts have been made, however, to positively 

impact and reduce injuries and illnesses in this 

sector. For example, the TWU program was 

represented during the development of the 

American National Standards Institute standard 

Z15.1, Safe Practices for Motor Vehicle Operations, 

which delineates minimum requirements for 

workplace traffic safety programs. From an 

international perspective, TWU representation 

provided input into a United Nations General 

Assembly Resolution on “Improving Global Road 

Safety.” This resolution was adopted on March 31, 

2008 with full U.S. support.

The Transportation, Warehousing, and Utilities (twu) sector is very diverse in 

its workforce, job responsibilities, and hazards. The sector covers all modes of 

transporting passengers and cargo—air, rail, water, road, and pipeline—as well 

as support activities related to all modes; establishments engaged primarily in 

warehousing and storage of goods; and electric power, natural gas, water, sewage, and other systems.

niosh convened a nora sector council to assist in identifying the highest priority research areas within the twu sector to improve the safety and health of its 

workers. The mission of the twu sector program is to implement a focused program of surveillance, research, and prevention that leads to a sustained reduction 

in work-related injury, illness, and death among the twu workforce. In striving 

to achieve this mission, the council created a research agenda that delineates national priorities for the twu sector. The agenda identifies research, information, 

and actions most urgently needed to further prevention of work-related injury 

and illness, and it provides a vehicle for stakeholders to describe the sector’s most 

relevant issues, gaps, and safety and health needs.

Four research areas were identified where focused efforts are needed: traumatic injury and death rates that result in lost workdays; incidence and severity 

of work-related musculoskeletal disorders; workplace programs and practices 

that enable workers to engage in healthy behaviors to reduce work-related physiological and psychological stressors, improve the use of healthcare services, and 

reduce premature death; and chemical, biological, physical, and psychosocial 

work-related hazards and exposures. 

Within each priority area, the twu sector council identified goals and projects 

to address safety and health issues more specifically within its many subsectors. Examples involving workers in air transportation, ground transportation, 

storage operations, and utilities include investigating the relationship between 

breast cancer and female flight attendants, worker exposure to jet fuel, and the 

relationship between airflow in commercial aircraft cabins and potential diseasecausing particles; investigating truck driver fatigue and mortality of independent 

owner-operator truck drivers, and developing methods to allow taxi drivers to 

warn others that they are in danger of assault; incorporating effective interventions into industry policies and procedures to prevent injuries from contact with 

objects and equipment or slips, trips, and falls on working surfaces, and establishing effective interventions and best practices to prevent work-related 

musculoskeletal disorders; and identifying risk factors for electrical and chemical 

burns from working with high or low-voltage panel apparatus and conductors, 

cut, crush, and amputation injuries from energized equipment and tools, and 

injuries from falls to a lower level while working on poles, towers, platforms, 

ladders, and scaffolding. 

The twu sector agenda is intended to assist stakeholders, such as industry, 

labor, safety professionals, and academics, in prioritizing their work among the 

many safety and health issues of interest; inspire decision makers and program 

planners to include these topics in their top priorities; guide researchers to relevant 

topic areas for research proposals; and encourage dialogue and partnering among 

stakeholders on a subset of key issues—thereby increasing our collective ability to 

effectively reduce injuries and illnesses among workers in the twu sector.

Relevant Information

In 2007, > 7.7 million people worked in the TWU sector. Of 

these workers 924 fatalities from work-related injury or illness, 

and more than 289,500 nonfatal injuries and illnesses were 

reported among TWU workers.

Approximately 65% of the nonfatal injuries and illnesses

reported among workers in the TWU sector in 2007 resulted in 

days away from work, job transfer, or restriction.

The twu program is closely linked with the niosh Global 

Collaborations Program, which focuses on reducing work-related 

disease, injury, and death among all workers employed globally.

Photo from the Getty Image Bank
Wholesale & Retail Trade

The Wholesale and Retail Trade sector, as defined by nora, employs 

approximately 20.5 million workers and is expected to grow by 12 percent 

throughout the next decade. In 2007 555 workers died in the Wholesale and 

Retail Trade sector and more than 822,000 cases of nonfatal injury and illness 

were reported. Approximately 54 percent of these cases required days away from 

work, job transfer, or restriction. The sector’s cumulative burden of occupational 

injury, illness, and death is among the largest in the U.S.

The Wholesale and Retail Trade (wrt) sector is comprised 

of approximately 1.6 million businesses that range from oneperson, one-location worksites to a 1.7 million-employee chain 

store with more than 3,000 worksites. Changes in the business 

climate, consumer demands, and new technologies lead to frequent changes in job conditions. wrt workers are increasingly 

contract, temporary, or part-time. More than 70 percent of wrt

workers are employed with small businesses. The sector typically employs the youngest and oldest workers, many of whom 

are culturally and linguistically diverse. Jobs in wrt often have 

significant turnover, require little or no education, are entrylevel, and offer low wages. In addition, people perceive jobs in 

this sector to be safe, which undermines the need for safety 

training. These and other characteristics of the wrt sector can 

negatively affect the safety and health of workers and put them 

at increased risk of workplace injury and illness.

The mission of the nora wrt sector program is to promote 

a safe and healthy workplace for all wrt workers by preventing work-related injury and illness through research and 

public health practices. In 2006 niosh convened a wrt sector 

council comprised of industry experts, labor representatives, 

academic investigators, and public health practitioners. After 

the council’s review of available occupational safety and health 

surveillance data and input from stakeholders, it identified existing gaps in knowledge and interventions and addressed the 

question “what information is needed to more effectively prevent injury and illness in the wrt sector?” As a result of these 

efforts, the council developed six strategic goals designed to 

address the sector’s primary safety and health concerns. 

The strategic goals aim to reduce chronic musculoskeletal 

disorders, traumatic injuries caused by slips, trips, and falls, 

acute injuries from contact with hard objects, workplace violence, and motor vehicle-related injury and death; improve 

outreach to small businesses; increase understanding of how 

vulnerable populations experience disproportionate risks; and 

expand the availability and use of effective interventions to reduce injury and illness among this population. 

A comprehensive and focused effort involving surveillance, 

needs assessment, data management, economic analyses, 

research, interventions, information dissemination, and evaluation is needed to accomplish the goals identified by the wrt

sector council. These goals are intended to be accomplished 

through new and existing partnerships between niosh and its 

stakeholders over the course of the next decade.

Within the wrt sector, workers are potentially exposed to 

an assortment of occupational hazards including psychosocial 

factors (i.e., stress from lack of job security and frequent interaction with the public), long workdays, shift work, violence, 

materials handling, static posture, prolonged standing, repetitive motion, and heavy lifting. Although the potential hazards 

are varied and the incidence rates are high, bls suggests that 

the overall number of injuries and fatalities within the wrt

sector may be attributed to a specific subset of high-risk workplaces such as mail order, home stores, and gas stations.

NORA — 28

www.cdc.gov/niosh Photo by Goldberg, downloaded from Flickr
Impacting a Workforce Exposed to a Variety 

of Diverse Hazards

NIOSH occupational research and prevention 

activities have led to several successful outcomes 

in the wrt sector. Examples include violence 

prevention programs, which provided training and 

information to small businesses to reduce injury 

and illness from workplace violence and reduced 

fatalities by 60% among gas station workers; 

research on slips, trips, and falls in warehouse 

distribution centers, which reduced injuries among 

order pickers in grocery warehouses by 40%; and 

ventilation studies, which led to the installation 

of improved dust exhaust hoods in retail lumber 

stores and reduced reports of lung disorders by 

40% among workers.

Relevant Information

About 90% of Wholesale establishments employ < 20 workers.

Workers from 16–19 years of age have 2x the injury rate of all 

workers. Many in this age group work in the WRT sector.

From 1992–2001, 46% (3,637) of all homicides occurred in Retail 

Trade. The cost to society was estimated at $2.6 billion.

NORA — 29

www.cdc.gov/niosh

Partnering — 31

www.cdc.gov/niosh

on partnership

Enhancing & Advancing NIOSH Research Through Partnerships

NIOSH is dedicated to developing and maintaining long-lasting and 

productive partnerships with people and organizations committed to 

protecting the safety, health, and well-being of workers and with those 

whose efforts help to promote the movement of NIOSH research into 

practice to prevent work-related injury, illness, and death. Partnerships 

are essential in demonstrating and sustaining positive impact.

“What does it mean to you to partner with NIOSH?” 

We asked 12 of our partners to share their thoughts on this question. 

Their candid responses are provided on the following pages.

Partners are pictured from left to right, then top to bottom

Melissa McDiarmid, Professor—University of Maryland School of Medicine | Bruce Watzman, Senior Vice President for Regulatory Affairs—National Mining Association | Mei-Li Lin, Senior Director—National Safety Council and Editor—Journal of Safety Research | Joseph Fowler, Jr., Executive Director—Laborers’ Health and Safety Fund of North America | Nicholas Mastrodicasa,

Project Manager for the State of Alaska Department of Transportation—Aviation Division | Peter O’Neil, Executive Director—American Industrial Hygiene Association | Tom Leamon, Adjunct 

Professor of Occupational Safety—Harvard School of Public Health | Ginny Frings, Visiting Professor—Xavier University and President—Concerned Angels, Inc. | James Koskan, Corporate 

Director Risk Control—SUPERVALU INC | Dave Heidorn, Manager for Government Affairs and Policy—American Society of Safety Engineers | Frank Renshaw, Senior Environmental Health and 

Safety Leader—The Dow Chemical Company | Barbara Lee, Director—National Children’s Center for Rural and Agricultural Health and Safety
Partnering — 32

www.cdc.gov/niosh

Barbara Lee—In 1992 the Director of niosh participated in the first national symposium addressing childhood 

agricultural injury prevention. Since then, every niosh

leader has supported interventions that address children 

on farms regardless of their work or residency status. 

Data now confirm that the rate of childhood agricultural 

injuries has dropped by nearly 50 percent. niosh leadership, combined with private-sector commitment and 

influence, should be credited for this success. It is personally and professionally rewarding to be a part of this 

movement impacting the well-being of children. 

Dave Heidorn—The relationships that have been developed between niosh, asse, and its members through 

our partnership have fostered an increased sense of 

shared responsibility for the role that safety plays in 

niosh research and education. Our members are now 

far more engaged in the nora research agenda activities. 

They have participated on the niosh Board of Scientific Counselors, have been involved in determining the 

direction of training grants, and have benefitted from increased involvement of niosh staff in asse educational 

programs. Members have also benefitted from niosh 

staff publishing in asse communications. In return, 

asse’s members have developed a greater understanding 

and increased support for niosh’s valuable role in preventing work-related injury, illness, and death. I believe 

niosh has also benefitted through increased exposure 

to our members’ experience in facing safety and health 

risks on the job, particularly in areas such as ergonomics and design. asse has also provided niosh staff the 

opportunity to be a part of the safety and health professional community where they belong. We look forward 

to future opportunities to build on this partnership. 

Joseph Fowler, Jr.—For the past 21 years, the Laborers’ Health and Safety Fund of North America has had 

an active and very productive partnership with niosh. 

The Fund has collaborated with niosh to reduce fumes 

from asphalt pavers, prevent hearing loss among construction workers, prevent run-overs and back-overs of 

workers by construction vehicles, and respond to toxic 

exposures. The Fund also works actively with niosh on 

medical surveillance efforts for workers who responded 

to the World Trade Center disaster, dose reconstructions 

to help energy workers receive the compensation they deserve, and research activities for the nora Construction 

sector program. These efforts are just beginning to pay 

off as more research will focus on broad issues, such as 

how the structure of the industry (i.e., low-bid contracts) 

affects the safety and health of workers and how interventions can be designed for maximum impact.

Melissa McDiarmid—Almost 25 years ago I received 

scholarship support from niosh for my Master of Public Health degree and Occupational Medicine training 

through the Johns Hopkins Education and Research 

Center. I have continually benefitted from niosh’s 

investment in me becoming a physician-scientist in occupational health. Whether in a clinical encounter with 

an exposed worker, collaborating in field studies, or 

slogging through the give and take of the participatory 

nora process to keep the nation’s occupational research 

agenda potent and relevant, partnering with niosh colleagues has been an essential and sustaining aspect of 

my professional life. Overall, partnering with niosh has 

made a critical difference to the safety, health, and security of the working people we serve.

Tom Leamon—While partnering with niosh implies 

making a contribution to the Institute, it also provides an 

opportunity to see the vital processes the Institute uses to 

advance its mission. The necessary compromises behind 

the public face—as seen on the Web site—involve matching the needs and positions of multiple stakeholders, 

policies, science, and budgetary considerations to provide the leadership it takes to discover and disseminate 

safety and health knowledge. Being a part of this process 

has given me a far better and more rewarding view of 

niosh and its people, many of whom I call friends. Partnering with niosh has also increased my commitment 

to improving the safety and health of Americans who go 

to work and deserve to return home each day uninjured 

and healthy.

Nicholas Mastrodicasa—niosh’s contribution is invaluable to a joint aviation safety project between nasa, 

the faa, the Medallion Foundation, and the Alaska Aviation Safety Project (State of Alaska). niosh provided the 

seed money that resulted in this project, as well as its expertise in human factors and statistical data. This project 

is now developing what is anticipated to be the next major breakthrough in aviation safety training products for 

use in aviation simulators located throughout Alaska. 
Partnering — 33

www.cdc.gov/niosh

Bruce Watzman—The National Mining Association 

has been an active participant in several research partnerships sponsored by niosh. These partnerships have 

served to bring together disparate interests to advance 

the understanding and development of technologies to 

improve miner safety and health. In so doing, niosh has 

filled a critical void to advance stakeholder understanding of the barriers that must be overcome to develop and 

introduce new technologies into our nation’s mines.

Frank Renshaw—My perspective on partnering with 

niosh stems from serving on niosh’s Board of Scientific 

Counselors, the nora Manufacturing sector council, and 

years of practice in osh. niosh has earned and sustained 

its reputation as our nation’s premier osh research and 

training institute. It has skillfully leveraged its intramural 

research through extramural grants with leading academic and other organizations. 

The Institute is committed to 

serving all working populations 

as evidenced by its nora sector-approach. niosh is the most 

significant and reliable contributor to graduate-level training 

of osh professionals through 

its network of Education and 

Research Centers. From its national emphasis on emerging 

issues, like nanotechnology, to 

its Research-to-Practice initiative, niosh is a key partner in ensuring the viability and 

competitiveness of America’s workforce.

James Koskan—Our industry relies on the development, implementation, and monitoring of sound 

research-based management practices to positively impact employee well-being and lower operating expenses. 

niosh has been an ideal partner in this endeavor. niosh

has been diligent in the design and execution of quality 

peer-reviewed research and has developed control tools 

that have given our company and our industry the confidence we need to meet safety challenges that arise.

Mei-Li Lin—niosh has done significant, relevant, and at 

times groundbreaking research that has had tremendous 

value in enhancing osh. For not-for-profit safety and 

health organizations, like the nsc, niosh has been an 

invaluable resource. Our collaboration allows for more 

effective translation of evidence-based research and expanded outreach to leaders and osh professionals. The 

rich and active dialogue between our organization and 

niosh has resulted in more focused, guided research and 

dissemination efforts that directly address industry needs. 

Through initiatives such as nora, Research-to-Practice, 

and Prevention through Design, niosh continues to 

transform—engaging constituents and osh professionals on a more meaningful level. nsc is very glad to be a 

part of these endeavors.

Peter O’Neil—Many of niosh’s initiatives, such as Prevention through Design, directly complement, enhance, 

and support aiha’s strategic initiatives in the areas of 

information, learning, and knowledge. The niosh/

aiha Alliance has expanded and improved our ability to develop and disseminate 

information on worker safety 

and health through print and 

electronic media, has provided 

opportunities for participation 

at conferences and meetings 

where safety and health issues 

are proactively addressed, has 

advanced the effectiveness of 

occupational safety and health 

research, has promoted and facilitated the transfer of research 

results to practice to prevent 

work-related illness and injury, and has strengthened recruitment efforts for students to enter occupational and 

environmental safety and health graduate and undergraduate training programs.

Ginny Frings—I am educating students and the community on how to keep themselves, their families, their 

workplaces, and the environment safer and healthier 

through the Research-to-Practice partnership with 

niosh as well as through my roles as Professor of Business of Health and Safety at Xavier University, President 

of Concerned Angels, Inc., and host of the Safety Corner 

television show. In addition, Concerned Angels, Inc. is 

coordinating with the Centers for Disease Control and 

Prevention and hospitals in the Cincinnati, Ohio 

area to disseminate the new Child Passenger 

Safety Instructional dvd. 

partnering 

with niosh ... has been 

an essential and 

sustaining aspect 

of my professional life
Photo by Kimberly Clough Thomas
Cross Sectors — 35

www.cdc.gov/niosh

networking by design

Creating a Culture that Nurtures Interdisciplinary Research & Prevention Efforts

To enhance the eight NORA sector programs, NIOSH created 24 cross-sector programs 

organized around surveillance, hazard exposure, interventions, adverse health outcomes, 

information dissemination, and statutory programs. Cross-sector programs are intended 

to support the sectors in accomplishing their goals for the nation, coordinate priorities 

that affect multiple sectors, and are managed solely by NIOSH researchers through 

interdisciplinary steering committees.
Draft Version — 36

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Voluntary Initiatives Impact Safety & 

Health within Industry

NIOSH developed a comprehensive safety 

and health initiative in partnership with OSHA 

and the Refractory Ceramic Fibers Coalition 

that helped reduce occupational exposure to 

refractory ceramic fibers (RCF) among more 

than 31,000 U.S. workers. It has served as a 

model for protecting RCF workers in more 

than 12 countries. In 2006 NIOSH published a 

recommended exposure limit for RCF that has 

become the industry standard. As a result of 

these efforts, the RCF industry has expressed 

many benefits of partnering with NIOSH, stating that voluntary initiatives can be a successful and cost-effective alternative to regulation and that cooperation is greatly superior 

to confrontation.

❡ Authoritative 

Recommendations 

External stakeholders within industry, 

labor, professional associations, and 

other government agencies use niosh

recommendations to protect workers 

from injury, illness, and death. 

Functions of the niosh Authoritative Recommendations cross-sector 

program include scientifically assessing workplace risks and hazards; 

developing, disseminating, and 

evaluating recommendations; providing responses to other government 

agencies on issues of rule-making that 

may affect workers; and managing the 

niosh respirator certification program.

niosh develops several types of authoritative recommendations, the most 

recognized include recommended 

exposure limits, immediately dangerous to life or health (idlh) values, and 

respirator certifications. niosh bases 

its recommendations on comprehensive evaluations of available scientific 

data, which may include exposureresponse modeling or quantitative 

risk assessment. Evaluations undergo 

rigorous scientific peer review before 

being used as the basis of a niosh

authoritative recommendation. 

Authoritative recommendations 

are communicated through a variety 

of mechanisms to multiple audiences 

including employers, employees, policymakers, the scientific community, 

and the general public to prevent or 

reduce occupational hazards and to 

regulatory agencies for considering the 

promulgation of legal standards.

Relevant Information

NIOSH recently proposed new and improved skin notations for approximately 120 chemicals. These notations will 

provide workers and employers with critical information 

about the dermal hazards of chemicals in the workplace. 

The occupational safety and health community relies heavily 

on niosh skin notations to protect workers from hazards 

associated with dermal exposure to chemicals. 

niosh published 15 Alerts on topics including bird flu, 

fire fighter fatalities, young-worker safety and health, and 

flavoring-induced lung disease from 2000–2008. 

NIOSH is developing Recommended Exposure Limits

for several high-profile occupational exposures, including 

diacetyl (butter flavorings), hexavalent chromium, manganese in welding fume, 1-bromopropane, pigment-grade and 

nano-sized titanium dioxide, and ionizing radiation.

NIOSH is developing idlh values for > 100 chemicals identified as high-priority for emergency responders.

❡ Cancer, Reproductive, & 

Cardiovascular Diseases 

Approximately 40,000 new cases of 

cancer in the U.S. are attributable to 

work each year. Millions of U.S. workers are exposed to substances that 

have tested as carcinogens in animal 

studies. Less than 2 percent of chemicals in commerce have been tested for 

carcinogenicity. 

There is significant public health 

concern about potential effects of 

workplace exposures on reproductive 

outcomes. Heavy metals, solvents, and 

pesticides are examples of substances 

in regular commercial use with reported reproductive or developmental 

effects. Estimates of adverse outcomes 

demonstrate the widespread impact 

that workplace exposure can have on 

reproductive health.

Carbon monoxide, nitroglycerin, 

and environmental tobacco smoke 

are other toxins encountered in the 

workplace that are known to affect 

the heart. Heart disease is the chief 

single cause of death in the U.S. Little 

is known about occupational risks for 

heart disease though numerous studies show a relationship between heart 

disease, depression, and exposure to 

stress at work. Other occupational 

exposures potentially related to cardiovascular disease include noise, shift 

work, and physical activity. 

The chief health areas of concern 

for the Cancer, Reproductive, and 

Cross Sectors — 36

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Cardiovascular Diseases cross-sector 

program are cancer, reproductive 

health, heart disease, and evolving 

areas of occupational neurological and 

renal disease. The program addresses 

these by conducting health and exposure research in working populations, 

providing data for the development 

of standards and recommendations 

to control health hazards, conducting 

basic and applied laboratory research 

to investigate precursors of occupational disease, developing engineering 

controls and interventions for workplace hazards, and developing and 

disseminating information to foster 

prevention of occupational disease. 

Relevant Information

10%–20% of all recognized pregnancies in the U.S. end in 

miscarriage. 3% of all live births have significant malformations; 3% of these malformations are due to toxicant exposure. 7.2 million people die each year from heart disease.

❡ Communication & 

Information Dissemination 

Despite efforts to reduce or eliminate 

work-related injury and illness, challenges still exist in the dissemination 

and use of scientific information products. niosh is committed to position its 

research activities as the most relevant 

and impactful source of occupational 

safety and health information. niosh

communication specialists developed a 

set of priorities to guide this effort and 

ensure that niosh communicates the 

most valued and up-to-date sciencebased information in a timely and 

effective manner to protect workers.

Communication at niosh is carried out through its Communication 

and Information Dissemination 

(cid) cross-sector program. Working throughout and across niosh, cid

brings together the expertise, resources, and strategies to serve the Institute’s 

varied communication needs. This 

enhanced communication management approach ensures accuracy and 

consistency, reduces duplication, and 

achieves economies of scale. 

cid established a core set of goals as 

its groundwork for tracking and servicing the Institute’s communication 

activities. Its goals are to ensure the 

timely dissemination and translation 

of evidence-based research; support 

and promote the adoption of evidence-based practices; foster strategic 

partnerships and collaborations to disseminate and diffuse evidence-based 

practices; evaluate communication 

materials, strategies, and interventions; 

and advance communication research 

to drive the effective dissemination, 

diffusion, and adoption of evidencebased practices. 

Well-designed and implemented 

health dissemination strategies supply workers and employers with the 

most current information to better 

understand health issues that could 

potentially impact them and the most 

appropriate avenues to take for direct 

action to protect their health. 

niosh is committed to creating, 

communicating, and delivering value 

to our customers and encourages 

and assists Institute staff to employ 

well-designed health communication 

approaches to improve intervention 

effectiveness. This commitment drives 

how the Institute approaches organizational and behavior change; the 

products and services we market; the 

incentives and costs we focus on; the 

opportunities we select; and the places 

and partnerships where we interact 

with our audience.

niosh is also committed to developing new techniques for reaching 

potential partners. Fundamental organizational and behavioral influences 

offer considerable benefits to partners 

who actively participate in the design, 

implementation, and evaluation of 

scientific information products.

Reaching & Impacting New Audiences 

Through the Latest Social Media Channels 

In 2008 NIOSH enhanced its leadership role 

within the public health community by implementing Web 2.0 applications. These applications provide opportunities for NIOSH 

researchers to truly engage with audiences in 

ways unimaginable just a few years ago. The 

Web 2.0 revolution is as much about changing communication culture as it is about using 

social networking sites, such as MySpace, Facebook, Wikipedia, Flickr, Twitter, and blogs, 

to reach diverse audiences with safety and 

health information.

The NIOSH Science Blog—the first truly external blog at CDC—provides NIOSH with an 

opportunity to engage in scientific discussions 

with its partners and the public. The blog includes 44 unique topics and has generated 

more than 400 comments. Since its inception, 

the blog has been visited more than 100,000 

times. In 2008 it averaged 156 visits per 

day and has risen to 245 visits per day from 

01/01/09–05/27/09. 

Cross Sectors — 37

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these hours and can result in fatigue and lead to increased 

incidence of injury and illness;

Paying workers by the job or in proportion to the quantity 

of their work outputs, which may tempt them to cut corners 

on safety in order to collect a paycheck quicker; and

Using Just-in-Time or Lean Manufacturing to reduce 

overhead cost and improve process coordination, which can 

place increased stress on workers who deliver raw materials, 

plan production needs, or complete manufacturing tasks 

under strict timelines. 

❡ Emergency Preparedness

& Response

Police, fire fighters, and emergency 

medical service providers are in the 

top 15 occupations for risk of dying 

from a work-related injury. 

In addition to their routine work 

duties, emergency responders face 

intense hazards from situations such 

as natural disasters, major hazardous 

materials emergencies, structural collapse, civil disturbance, bomb disposal, 

hostage situations, and terrorism 

response. Plus, the consequences of 

other potential hazards that have not 

yet been realized, such as large-scale 

terrorist attacks involving biological or 

chemical weapons, may be significant 

but cannot be effectively captured.

Emergency response work includes 

activities involving search, rescue, recovery, cleanup, and restoration. It is carried 

out by individuals from emergency management, fire service, law enforcement, 

emergency medical services, public 

health, construction and other skilled 

support, disaster relief, mental health, 

and volunteer organizations. 

The niosh Emergency Preparedness 

and Response cross-sector program 

was developed to advance research and 

collaborations to protect the safety and 

health of emergency response providers and recovery workers. The current 

research priorities of this program are 

based on lessons learned and feedback received from government and 

❡ Economics

The application of economics in occupational safety and health provides a 

framework to identify economic inefficiencies associated with poor safety 

and health and points to prevention 

opportunities with the greatest impact.

Studying the economic conditions that influence the incidence 

and severity of work-related injury 

or illness—and the economic consequences for workers, employers, and 

society overall—provides guidance for 

optimally allocating limited resources 

in occupational safety and health. 

Economic research also provides 

guidance for designing practical 

interventions and can underscore 

their cost-effectiveness. Furthermore, 

economics focuses on how investing 

in worker knowledge, skills, safety, and 

health influences outcomes such as 

productivity, earnings, and the overall 

welfare of employers, employees, organizations, and nations.

The niosh Economics cross-sector 

program is working diligently to 

advance the field of economics in 

occupational safety and health. The 

program has identified several priority 

areas where focused efforts are needed. 

Priority research efforts include 

studying economic factors that may 

affect work and workplace characteristics and impact injury or illness rates; 

estimating the economic impact of 

injury and illness on small businesses; 

and understanding how injuries 

and illnesses that are only partially 

paid—or missed entirely—by workers’ 

compensation contribute to the cost of 

programs, such as short-term disability and group medical insurance.

Relevant Information

Examples of economic factors that may affect the risk of 

work-related injury and illness include: keeping operations 

open 24 hours a day 7 days a week, which requires more 

individuals to work on rotating or permanent shifts across 

Best Practices Impact Workers & Reduce 

Injury Compensation Costs

Staff at nursing homes implemented best 

practices to prevent musculoskeletal injuries 

while lifting physically dependent residents. 

The cost effectiveness of this practice was 

evaluated for a 3-year period. Nursing staff 

experienced substantially fewer injuries from 

lifting residents and fewer of the actual injuries suffered required them to miss work as 

compared with the 3 years prior. Workers’ 

compensation costs were also reduced as a 

result of these best practices. The participating nursing homes saved about $55,000 annually in workers’ compensation costs, which 

led to the recovery of their initial investment 

in lifting equipment and worker training in 

less than 3 years.

Cross Sectors — 38

www.cdc.gov/niosh
nongovernment stakeholders during 

a series of public meetings held by 

niosh. Priority areas address safety 

climate, personal protective equipment, 

surveillance, hazard characterization, technological interventions and 

engineering controls, environmental 

microbiology, and biological monitoring of terrorism agents.

Chief objectives within each research priority have been identified to 

reduce injuries and enhance the safety, 

health, and resilience of emergency 

responders. Objectives include improving the organization of work; reducing 

exposure to inhalation and dermal 

hazards; developing a surveillance 

system to identify problems for corrective action; developing methods that 

emergency responders and remediation workers can use to better evaluate 

the spatial and temporal distribution 

of potential hazards; reducing various 

hazards to responders by improving 

engineering controls, technologies, and 

tools; improving the understanding of 

environmental microbiology, including 

factors that influence the introduction, 

spread, and control of threat agents; 

and reducing the potential impact of 

exposure to terror agents through improved biological monitoring methods.

Expected outcomes include generating new research ideas and 

hypotheses to address the leading 

causes of injury, illness, and death to 

emergency response workers; developing key research partnerships and 

collaborations; and increasing awareness of occupational safety and health 

problems in the Emergency Response 

and Preparedness cross-sector.

Relevant Information

Fatality rates for police, fire, and emergency medical 

workers are approximately 3x higher than the average for 

all other occupations. In 2006, > 2 million people served in 

these roles.

Approximately 88,000 fire fighters are injured each year; 

about 2,000 of these injuries are life-threatening.

❡ Engineering Controls

Engineering controls of work-related 

hazards is a continually developing 

field due to changes in the workplace. 

Engineering controls are used to remove workplace hazards or lessen the 

negative effects of exposure to them. 

In recent years the emerging threat of 

terrorism has blurred the line between 

controls to protect workers and controls to protect public health. 

Current research on engineering controls is being conducted in 

multiple niosh programs including 

Construction, Healthcare and Social 

Assistance, Hearing Loss, Manufacturing, Nanotechnology, Prevention 

through Design, and Services. Traditionally, a hierarchy of controls has 

been used as a means of determining 

how to implement feasible and effective control solutions. 

Efforts of the Engineering Controls cross-sector program include 

promoting, planning, and conducting research on engineering control 

technology; providing expertise in 

formulating effective and credible 

workplace standards; and consulting 

in the application of effective control 

solutions and techniques for hazard 

prevention. Efforts may also include 

providing resources and information 

necessary to protect the safety and 

health of workers during public health 

emergency response activities. 

Regulatory agencies, such as 

osha, use niosh engineering control 

research for their regulatory and enforcement activities.

Relevant Information

Engineering control research and use has reduced harmful 

exposures to volatile compounds during flavorings production activities, carbon monoxide from marine vessels, and 

infectious-size-surrogate aerosols in healthcare isolation 

beds by up to 99% each; respirable dust from jack hammer 

operations on concrete by up to 90%; and asphalt fumes

during road paving by up to 80%.

❡ Exposure Assessment

The workplace can present an abundance of health hazards and exposures 

that can lead to illnesses and injuries that cause disability, death, and 

immense cost to society. Exposure 

assessment identifies and characterizes 

hazards in the workplace and prevents 

disease by making it possible to anticipate, recognize, evaluate, and control 

these hazards.

The niosh Exposure Assessment 

cross-sector program provides national and international leadership in 

the development and use of effective 

exposure assessment tools. Expanded 

use of these tools has led to cost-effective environmental determinations, 

including which workers are exposed 

to hazards, routes of exposure, extent, 

frequency, and duration of exposure, 

and the effectiveness of interventions. 

Program priorities include fostering research and providing guidance 

to develop or improve exposure assessment strategies and developing 

or improving specific tools to assess 

worker exposures to critical occupational agents and stressors. 

Increased visibility and coordination of exposure assessment 

throughout niosh and across a broad 

spectrum of government, industry, 

labor, academic, and international 

partnerships is the aim of the niosh

Exposure Assessment program. The 

program accomplishes this through 

intramural and extramural activities, 

such as its initiative on direct-reading 

exposure-assessment methods.

Relevant Information

Exposure assessments are used by government and nongovernment agencies, including OSHA, MSHA, and NIOSH, 

to document the degree to which workers are exposed to 

health hazards, to determine what exposure levels cause 

adverse health effects, and to assess whether exposure 

levels fall within the recommended or required occupational 

exposure limits. 

Cross Sectors — 39

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❡ Global Collaborations

The burden of work-related injury and 

illness is on the rise in many countries, and the cost is immense. The ilo

estimates that the total cost of global 

work-related injury and illness is currently about 4 percent of the world’s 

Gross Domestic Product.

To improve global occupational 

safety and health, niosh established 

its Global Collaborations cross-sector 

program to enhance global occupational safety and health through 

international collaborations. These 

strategic collaborations with public 

and private-sector-based partners 

provide niosh with opportunities to 

better conduct innovative research, deliver expert findings, and receive new 

information to protect the safety and 

health of workers worldwide. 

niosh provides sound scientific 

research, recommendations, and interventions to its partners and actively 

participates in the global dialogue concerning occupational safety and health 

issues, including silicosis, bloodborne 

pathogens, hearing loss, nanotechnology, radiation, and mining hazards. 

niosh conducts activities in close 

partnership with several national and 

international organizations, including 

who, ilo, paho, nih, iso, iarc, and 

the U.S. State Department. Examples 

of recent activities include chairing 

the who Global Network of 65 Collaborating Centers on all continents 

to assist countries in implementing 

the who Global Plan of Action for 

Workers’ Health; providing training in classifying chest radiographs 

according to the ilo Classification 

System; contributing to the International Program on Chemical Safety; 

participating in iso and professional 

societies to improve the quality and 

dissemination of occupational safety 

and health guidance, research, and 

applications; collecting, analyzing, and 

sharing employer practices that reduce 

injuries to workers with high exposure 

to road traffic; and supporting and 

participating in partnerships between 

universities in the U.S. and other 

countries to provide opportunities for 

training, research, and policy development to researchers in their home 

countries and abroad. 

The Korea Occupational Safety 

and Health Agency (kosha) recently 

initiated the Workplace Health Partner 

Program based on the experience of a 

kosha scientist who worked for a year 

in the niosh Health Hazard Evaluations program.

niosh is actively engaged with 

many countries, including Australia, 

Brazil, Canada, Chile, China, Columbia, Finland, Germany, India, Italy, 

Japan, Korea, Mexico, Netherlands, 

Peru, Singapore, South Africa, Sweden, 

Vietnam, United Kingdom, Venezuela, 

and Zambia.

niosh is committed to strengthening its current national and 

international partners and seeking new 

partnerships. niosh remains a leader 

in the global efforts to protect the 

safety and health of all workers. 

Relevant Information

Approximately 2.2 million people die each year from workrelated injury and illness. About 350,000 of these deaths 

result from a traumatic injury. 

The global workforce of approximately 2.8 billion people 

suffer about 270 million serious nonfatal work-related 

injuries and 160 million work-related diseases each year. This 

takes into account nonrecorded, part-time, children, and 

other informal workers.

❡ Health Hazard Evaluation

Many workers are exposed to potentially harmful conditions that could 

affect their health. The niosh Health 

Hazard Evaluation cross-sector 

program offers a unique federal government resource to employers and 

Impacting Healthcare Workers Globally

The transmission of bloodborne pathogens in 

healthcare workers is an important focus of 

NIOSH and WHO. Beginning in South Africa, 

Tanzania, and Vietnam, the project created a 

training titled, Protecting Healthcare Workers: Preventing Needlestick Injuries Toolkit. 

NIOSH, PAHO, and WHO adapted the toolkit 

to Latin America to strengthen educational 

institutions and government agencies and to 

conduct train-the-trainer workshops. In Venezuela the project has been expanded to 210 

healthcare facilities in 12 states, the toolkit 

content has been included in postgraduate 

curricula, and 30,000 healthcare workers have 

been trained. In Peru more than 1,200 healthcare workers have been trained in 8 regions. 

Training is also occurring in Colombia, Nicaragua, and Honduras.

During the celebration of World Day for Safety and Health at Work 2009, PAHO awarded 

NIOSH for its leadership and contributions to 

occupational safety and health in the region 

of the Americas. This year’s theme was protecting the health and safety of healthcare 

workers, highlighting the impact these workers have on public health.

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employees in all industry sectors of 

our nation’s economy. Occupational 

safety and health professionals evaluate potential health hazards in the 

workplace and recommend actions to 

eliminate those hazards and prevent 

adverse health outcomes. 

The program uses a practical, 

science-based approach to solve 

problems in a nonadversarial environment and provides its services free of 

charge. The Health Hazard Evaluation 

program was mandated by specific 

provisions of the Occupational Safety 

and Health Act of 1970 and the Federal Mine Safety Act of 1977. 

The mission of the Health Hazard 

Evaluation program is to respond 

to requests for worksite evaluations 

of health hazards, solve problems, 

communicate risk, and disseminate 

findings. As one of the niosh crosssectors, the program has identified 

three priorities that drive its activities: 

to prevent illness through reduced 

exposure to workplace hazards, to promote occupational safety and health 

research on emerging issues, and to 

protect the safety and health of workers 

during public health emergencies. 

Through this program, niosh determines whether workers at specific 

worksites are exposed to hazardous 

materials or harmful conditions and 

whether those exposures affect their 

health. Investigators evaluate a wide 

range of potential hazards including 

those related to chemicals, biological 

agents, work stress, noise, heat, radiation, and ergonomic stressors. 

Health hazard evaluations can be 

particularly useful when workers 

have illnesses or experience adverse 

health effects from unknown causes, 

such as exposure to unregulated 

hazards; when workers experience 

adverse health effects even though 

exposure standards have not been 

exceeded; when a hazard is new or 

previously unrecognized; or when a 

multidisciplinary public health-oriented approach is needed. 

The Health Hazard Evaluation 

program is carried out by occupational 

physicians, nurses, epidemiologists, 

industrial hygienists, engineers, 

psychologists, and statisticians. Investigators review records and conduct 

environmental sampling, epidemiologic surveys, and medical testing. niosh

involves the employer and employees 

in the evaluation process, shares its 

findings with all parties, and provides 

recommendations to reduce hazards 

and improve conditions for workers.

In addition to providing direct assistance at worksites, a health hazard 

evaluation presents niosh with the 

opportunity to gather information 

on workplace exposures where occupational standards are lacking or do 

not protect all workers, and to share 

this information with other agencies, 

occupational health professionals, and 

the general public.

Relevant Information

NIOSH has completed > 13,000 Health Hazard Evaluations

since 1971. They have identified emerging issues, such as 

a disabling lung disease from exposure to artificial butter 

flavorings used in popcorn and other products during production, have supported the development of occupational 

standards and guidance from government agencies and 

consensus standard organizations, and have led to the development of sampling and analytic methods. 

The NIOSH Health Hazard Evaluation Program has been 

reviewed by the National Academies (pages 56–57).

❡ Hearing Loss

The purpose of the niosh Hearing 

Loss Prevention cross-sector program is to provide national and world 

leadership to reduce the prevalence 

of occupational hearing loss through 

a focused program of research and 

prevention activities. niosh is the sole 

One Worker Impacting Global Change

NIOSH received a request from a worker at 

a large retail store concerning back injuries 

from changing automobile tires. In response, 

NIOSH contacted the company’s employee 

safety division to learn about its tire changing 

process. Using the NIOSH lifting equation, 

NIOSH calculated the height to which cars 

should be raised during this process and recommended the height be increased from 18 

inches to 30 inches to reduce the risk of worker injury. The company changed its policy as a 

result of this recommendation and eliminated 

the musculoskeletal hazard for workers in 

7,600 stores worldwide. Musculoskeletal disorders account for 30%–40% of workplace injuries and can become debilitating. For more 

information about musculoskeletal disorders 

see page 43.

A portion of the NIOSH lifting equation.

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❡ Immune & Dermal Diseases

Immune and skin-related diseases represent a diverse group of health effects 

that are common in the workplace, 

including asthma, allergic rhinitis, and 

contact dermatitis. These and other 

immunologic or related illnesses result 

in billions of dollars in loss of workplace productivity. The greatest impact 

of immune and dermal disease is in 

the services, agriculture, construction, 

and manufacturing industries.

Workplace exposure to certain 

chemical substances can lead to 

contact dermatitis, allergic sensitizations, impaired immune function, 

including immune suppression and 

autoimmunity, and result in uncontrolled inflammation or increased 

susceptibility to diseases. Workers 

can be exposed to hazards in various 

ways including through inhalation 

and dermal absorption. A worker’s 

skin can be exposed to hazardous 

chemicals through direct contact with 

contaminated surfaces, deposition of 

aerosols, immersion, or splashes. Skin 

exposures may cause systemic effects 

and localized skin injuries. 

The mission of the niosh Immune 

and Dermal Diseases cross-sector program is to help reduce injury, illness, 

and death from work-related immune 

and skin disease. Research priorities 

are driven by considerations such as 

surveillance data, stakeholder input, 

and emerging issues. 

Significant program activities 

include increasing the identification 

of immunologic or dermal hazards 

in the workplace; increasing awareness of occupational exposures to 

mold and other allergens; developing 

and publishing new information to 

characterize occupational chemicals 

or allergens that cause asthma; identifying and characterizing workplace 

chemicals that can cause contact 

or allergic dermatitis and systemic 

Impacting Workers & the Bottom Line

NIOSH developed 2 engineering controls to 

protect underground coal mine workers from 

noise overexposure generated by continuous 

mining machine conveyor systems, which account for most overexposures. The controls 

are currently being produced by a manufacturer and have been implemented in several 

U.S. mines. As a result, sound levels have 

been significantly reduced, the expected life 

of the conveyor chain is extended because of 

a urethane-coated flight bar, and MSHA considers the controls “technologically and administratively achievable.” Workers have said 

that these controls are easy to implement 

and highly durable. Excessive noise exposure 

in underground coal mines causes hearing 

impairment among 70%–90% of miners by 

retirement age. 

federal agency with primary responsibility for conducting research on 

occupational hearing loss, causal factors, and prevention methods.

This program is comprised of an 

interdisciplinary team of audiologists, engineers, psychologists, and 

physicists who actively work to reduce 

hearing loss—the second most reported occupational illness in the U.S. The 

program strives to meet its objective 

by conducting high-quality research, 

developing practical solutions to complex problems that cause occupational 

hearing loss, fostering partnerships 

with key stakeholders, and promoting 

the transfer and translation of research 

to practice.

The program currently focuses its 

efforts in four primary areas: prevention programs, engineering controls, 

hearing protection devices, and 

biologic and acoustic sources of hearing loss. Through targeted efforts, the 

Hearing Loss Prevention program is 

developing noise measurement instrumentation, methods, and technology; 

providing recommendations for noise 

exposure limits to form national 

and international policies; providing 

research and training opportunities; 

and conducting surveillance of noise 

hazards in the workplace.

Relevant Information

In 2008, approximately 2 million U.S. workers were 

exposed to noise levels at work that put them at risk of 

hearing loss.

In 2007, approximately 23,000 cases were reported of 

occupational hearing loss that was great enough to cause 

hearing impairment. 

Reported cases of hearing loss accounted for 14% of 

occupational illness in 2007.

In 2007, approximately 82% of the cases involving occupational hearing loss were reported among workers in the 

manufacturing sector.

The NIOSH Hearing Loss Research Program has been reviewed by the National Academies (pages 56–57).

Dual-Sprocket Driven Chain—reduces noise by maintaining constant tension & decreasing chain slack at conveyer 

transition points.

Urethane-Coated Flight Bar Chain—urethane coating 

cushions impact blows of the bar on other parts of the conveyer & reduces noise levels.

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and illness and to explore their potential applications in occupational safety 

and health.

Nanotechnology is the manipulation of matter on a near-atomic scale 

to produce structures, materials, and 

devices that have new or unique properties. Nanoparticles are a subset of 

these new materials that have at least 

one dimension less than 100 nanometers. Nanotechnology has the ability 

to transform material science used in 

many industries and will have numerous applications to areas ranging from 

medicine to manufacturing.

With any new technology the earliest and most extensive exposures to 

hazards are most likely to occur in 

the workplace. Therefore, niosh has 

engaged in a comprehensive effort 

to fill gaps about hazards and risks 

related to occupational exposure to 

engineered nanoparticles. This effort 

includes determining whether nanoparticles and nanomaterials pose risks 

for work-related injury and illness; 

conducting research and making recommendations on effective methods 

to manage nanomaterials safely; promoting healthy workplaces through 

interventions, recommendations, 

and capacity building; and enhancing 

global workplace safety and health 

through national and international 

collaborations.

By maintaining a dynamic approach 

involving strategic planning, research, 

partnerships, and information dissemination, the niosh Nanotechnology 

cross-sector program will be able to 

anticipate challenges and provide 

sound scientific recommendations for 

safe handling of nanomaterials.

Relevant Information

The National Science Foundation estimates that nanotechnology will have a $1 trillion impact on the global economy 

and employ 2 million workers by 2015—1 million of whom 

may be in the U.S. Worldwide funding for research and 

development reached $11.8 billion in 2006.

U.S. workers in private-industry. 

The niosh cross-sector program for 

musculoskeletal disorders falls under 

a program development activity that 

acknowledges the relevance of key scientific and engineering disciplines that 

cut across the industry sectors. 

The program’s mission is to reduce 

the burden of work-related musculoskeletal disorders through research 

and prevention that protects workers, helps management mitigate 

related risks and liabilities, and helps 

practitioners improve the efficacy of 

workplace interventions. 

Two primary areas were identified 

for national studies. One is an ongoing 

national hazard survey. niosh started 

an initiative to conduct an occupational exposure survey called the National 

Exposure Work Survey, targeted to 

the healthcare industry. The study is 

designed for ongoing data collection in 

hospitals and healthcare environments 

regarding exposure to a wide range of 

occupational hazards including musculoskeletal hazards. The second area 

identified is more prospective where 

cross-sectional epidemiologic studies 

examine the dose-response relationship between psychosocial factors and 

physical loading factors, specifically 

the upper extremity and low back.

Relevant Information

In 2007, a total of 253,540 cases of work-related musculoskeletal disorders from overexertion were reported; 134,680

of these resulted from lifting. Another 33,960 cases of 

musculoskeletal disorders were reported that resulted from 

repetitive motion.

❡ Nanotechnology 

The mission of the niosh Nanotechnology cross-sector program 

is to provide national and international leadership in investigating the 

implications of nanoparticles and 

nanomaterials for work-related injury 

toxicity; and publishing niosh skin 

notations to alert workers, employers, 

risk assessors, and occupational safety 

and health specialists to the presence 

of dermal exposure hazards in the 

workplace. 

The cross-sector program is collaborating with internal and external 

partners to advance understanding 

of occupational immune and skinrelated diseases and develop strategies 

to prevent and control occupational 

exposures. It also is supporting 

laboratory and field investigations 

and promoting the development of 

science-based recommendations to 

ensure safe and healthful working 

conditions for all workers.

Relevant Information

Approximately 13 million U.S. workers are potentially 

exposed to chemicals that can be absorbed through the skin 

and cause adverse health impacts.

Contact dermatitis from workplace chemical exposure accounts for 10%–15% of work-related illness and costs society 

about $1 billion each year. 

Approximately 11 million workers are exposed to at least 1 

agent that is associated with work-related asthma.

Occupational factors are associated with up to 15% of 

disabling asthma cases in the U.S. Asthma accounts for approximately 10.1 million missed workdays for adults each year.

❡ Musculoskeletal Disorders 

Musculoskeletal disorders are among 

the most important research issues in 

terms of frequency and impact across 

all industry sectors. These disorders 

are caused by sudden exertion or 

prolonged exposure to such physical 

factors as repetition, force, vibration, 

or awkward postures. Musculoskeletal 

disorders affect the body’s connective 

tissues (e.g., muscles, nerves, tendons). 

In 2007 approximately 29 percent 

of all workplace injuries requiring 

days away from work resulted from a 

musculoskeletal disorder; more than 

335,000 cases were reported among 

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to be related in part to differences in 

socioeconomic status but may also 

result from other interacting factors, 

such as discrimination. 

Theses factors are complex and still 

not completely understood. One area 

that is receiving increased attention, 

however, is the nature of work itself 

and how it can lead to social inequalities in safety and health. Research has 

found that low-income jobs are overrepresented in occupations that may 

expose workers to chemical and physical hazards. In addition, the structure 

of these same occupations may affect 

workers’ safety and health, such as low 

levels of autonomy and moderately 

high levels of physical demands.

The Occupational Health Disparities cross-sector program is working to 

identify and eliminate health disparities by promoting effective research 

methods and disseminating tools and 

information to the occupational safety 

and health community. 

The program’s priorities are to 

improve surveillance of excess injury, 

illness, and death among priority 

working populations by enhancing 

the capacity of existing systems and 

improving survey design and administration to consider differences in 

language, literacy, and culture; 

to promote the elimination of 

occupational health disparities by 

expanding outreach to stakeholders, 

such as community-based organizations, labor unions, and government 

agencies, and expanding efforts to 

develop practical intervention programs and policies that target priority 

working populations; 

to improve occupational safety and 

health research by increasing the capacity of researchers to address social 

and cultural dimensions of occupational health; and 

to disseminate research tools and 

approaches that better consider factors 

such as language, literacy, and culture.

Relevant Information

In 2005, blue-collar jobs made up 23% of all jobs but these 

workers experienced 55% of all work-related injuries and 

earned an average of $15 per hour. White-collar workers 

earned more than double on average and experienced only 

2% of the injuries. 

In 2006, the death rate from work-related injuries for 

Hispanic workers was 4.6 per 100,000 workers as compared 

with rates of 3.8 for all workers, 3.8 for non-Hispanic white 

workers, and 3.9 for non-Hispanic black workers. 

In 2007, workers born in Mexico accounted for 44% of 

foreign-born workers who died at work in the U.S.

Workers aged 65 and older are almost 3x more likely than 

all workers to die from a work-related injury. 

❡ Personal Protective 

Technologies 

Proper use of personal protective 

equipment and personal protective 

technologies is the last line of defense 

in a hierarchy of controls used to 

reduce worker risk of potential injury, 

illness, and death from hazardous 

workplace exposures. Reliance on the 

performance of these technologies 

multiplies in emergency and disaster 

situations, such as the anticipated need 

for adequate respiratory protection for 

15 million healthcare workers in the 

event of pandemic influenza.

Personal protective technologies are 

the specialized clothing or equipment 

worn by individuals for protection 

against safety and health hazards and 

the technical methods, processes, 

techniques, tools, and materials that 

support their development and use. 

Personal protective technologies 

encompass equipment, such as respirators, gloves, protective eyewear, 

hearing protection, and protective 

clothing but also include face pieces, 

filters, guidance documents, standards, 

and test procedures.

In 2001 Congress allocated funds 

to niosh to develop standards and 

technologies for protecting America’s workers who rely on personal 

NIOSH created its Nanotechnology Research Center in 

2004 to identify critical issues, create a strategic plan for 

investigating these issues, coordinate its nanotechnology 

research effort, develop partnerships, disseminate information, and accelerate progress in nanotechnology research 

across the Institute. 

In 2006 venture capitalists invested $699 million in firms 

developing nanotechnology, up 10% from 2005.

❡ Occupational Health 

Disparities

As the U.S. workforce becomes more 

diverse, it has become clear that there 

are disparities in the burden of workrelated disease, disability, and death 

experienced by certain groups, such as 

low-income and foreign-born workers.

Priority working populations have 

certain biologic, social, or economic 

characteristics that place them at 

higher risk of developing work-related 

disease and injury. These populations 

include racial and ethnic minorities, immigrants, younger and older 

workers, workers with medical or 

genetic susceptibility, and workers 

with disabilities. Occupational health 

disparities arise in part from an overrepresentation in the most hazardous 

industries, such as agriculture and 

construction. Other social, cultural, 

economic, and political factors including language, literacy, and marginal 

economic status may compound their 

risks. These workers may also have less 

access to healthcare. 

Eliminating health disparities is 

a primary goal of the government’s 

Healthy People 2010 objectives. 

Disparities are most apparent among 

populations with varying levels of 

socioeconomic status. A direct relationship exists between socioeconomic 

status and health, such that a person’s 

overall health improves as their socioeconomic status improves. 

Health disparities between different 

racial and ethnic populations are likely 

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protective equipment, with emphasis 

on emergency responders. 

niosh established its National 

Personal Protective Technology Laboratory to provide national and world 

leadership for improved technologies, 

and to align the activities surrounding 

personal protective technologies occurring within its Institute. This effort 

was emphasized and further developed in 2005 when niosh established 

it Personal Protective Technologies 

cross-sector program. The program is 

applicable across all industry sectors 

and overlaps with niosh’s Hearing Loss program, Traumatic Injury 

program, and Respiratory Disease 

Research program. 

The Personal Protective Technologies program works to fulfill 

its mission through respirator certification as mandated in federal 

regulations; focused research on protection from inhalation, dermal, and 

injury hazards; and participation in 

standards-setting and policymaking. 

Efforts in these areas have led to 

substantial accomplishments including the development of standards 

for respiratory protection against 

chemical, biological, radiological, 

and nuclear (cbrn) agents; adoption of the cbrn standard in Europe; 

adoption of the niosh self-contained 

breathing apparatus cbrn protection 

level by the National Fire Protection 

Agency; the requirement of niosh

cbrn protection for any respirator 

purchased with Homeland Security 

funding; the demonstration of filtering face piece respirators to provide 

protection against nanoparticles; and 

mine escape strategies using new and 

emerging technologies. Improvements 

in personal protective technologies are 

realized through better standards and 

regulations and availability of personal 

protective equipment in compliance. 

The Institute of Medicine’s Committee on Personal Protective Equipment 

for Workplace Safety and Health 

(coppe) was established in 2005 at 

niosh’s request. coppe aids the Personal Protective Technologies program 

in conducting quality research by 

providing the highest-level scientific 

evaluation of its projects and activities. 

The program underwent a scientific 

evaluation recently by the National 

Academies in which the following was 

stated, “The niosh Personal Protective 

Technologies program has made effective use of its limited resources and has 

moved the research, standards-setting, 

and certification agendas forward ... 

much still has not been done due to 

serious budgetary constraints. The 

committee offers recommendations 

with the goal of improving the ability 

of the niosh Personal Protective Technologies program to broaden its scope 

and depth of responsibility in order to 

protect workers more effectively....” 

Evaluation feedback is being used to 

guide the program’s future priorities.

Relevant Information

Approximately 20 million workers routinely use personal 

protective equipment to reduce work-related exposure to 

inhalation, dermal, and injury hazards.

An estimated 5 million workers use respirators; approximately 20% are fire fighters.

The NIOSH Personal Protective Technologies Program has 

been reviewed by the National Academies (pages 56 –57).

❡ Prevention Through 

Design

One of the best ways to prevent and 

control occupational injury, illness, 

and death is to “design out” hazards 

and minimize risks early in the design 

process. Industry stakeholders who 

implement prevention through design 

during the beginning of a project will 

have substantial positive impact on the 

safety and health of workers and likely 

Assuring the Efficacy of Respirators to 

Impact Worker Health Globally 

The niosh Personal Protective Technologies program is responsible for carrying out 

the respirator certification program. niosh

certification provides respirator performance 

testing and design evaluation to assure availability of safe personal protective devices for 

the nation’s workers. A significant outcome 

of the program is an increase in the inventory 

of niosh-certified respirators for protecting 

workers from exposure to inhalation hazards. 

Since 2001, niosh has issued more than 1,600 

respirator certifications. niosh certification is 

accepted nationally and internationally as assuring the efficacy of respirators. Both osha

and msha mandate that employers with workers potentially exposed to respiratory hazards 

use NIOSH-certified respirators.

A NIOSH-certified respirator.

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ments. The steering committee will 

provide leadership in executing and 

achieving these goals. 

niosh is leading a national initiative 

called Prevention through Design to 

promote the concept of designing out 

hazards during system development 

and to highlight the importance of 

prevention through design in business 

decisions. Through strategic collaboration, support, and commitment of 

stakeholders, including prevention 

through design experts, associations, 

design engineers, business leaders, 

workers, safety and health experts, and 

finance professionals, this national 

initiative can save lives and protect 

workers. niosh will serve as a catalyst 

to establish the initiative and guide the 

concepts into workplaces in all eight 

nora industrial sectors. 

More business leaders are beginning to recognize that redesigning job 

tasks and work environments is a costeffective means to enhance workplace 

safety and health. Many U.S. companies are supporting these concepts and 

developing management practices to 

implement them. Other countries are 

actively promoting prevention through 

design concepts too. 

Relevant Information

System design is implicated in about 37% of the worker 

fatalities that occur each year. 

Prevention through design involves evaluating potential 

risks associated with processes, structures, equipment, and 

tools. It also takes into consideration the construction, maintenance, decommissioning, and disposal or recycling 

of waste materials. 

Design examples include lockout/tagout controls, hearing 

protectors, retractable needles, and latex-free gloves.

❡ Radiation Dose Evaluation

The mission of the Radiation Dose 

Evaluation cross-sector program is 

to coordinate Institute collaboration 

on the conduct of research related to 

save money rather than deal with risks 

inherent in completed systems.

The niosh Prevention through 

Design cross-sector program aims 

to achieve its mission to prevent 

work-related injury, illness, and death 

through a coordinated approach that 

addresses all design efforts that affect 

workers. This cross-sector program 

uses a coordinated approach that 

considers the unique challenges faced 

by businesses and the potential safety 

and health hazards faced by workers.

This cross-sector program established a steering committee that is 

made up of professionals from industry, organized labor, academia, 

government, and safety and health 

organizations. In July 2007 niosh

held a workshop where stakeholders 

provided input and developed priority 

goals for the program. Priority areas 

include:

researching the engineering, economic, social, and scientific methods 

and implications of employing prevention through design; 

increasing the knowledge and 

understanding of prevention through 

design principles among designers, 

engineers, safety and health professionals, business leaders, and workers; 

encouraging the use of that 

knowledge when designing facilities, 

processes, equipment, tools, and organization of work; 

identifying, developing, and sharing 

standardized processes, equipment, 

and tools; 

persuading business leaders, workers, academics, government entities, 

and standards-developing and setting 

organizations to endorse a culture that 

includes prevention through design 

principles in all designs affecting 

workers; and 

ensuring that small businesses have 

access to prevention through design 

resources adapted to the unique needs 

of their work processes and environResearch Impacts Beryllium Sensitization 

Among U.S. Workers 

It is estimated that as many as 134,000 current U.S. workers may be exposed to beryllium. Some workers who are exposed develop 

sensitization to the metal and some even go 

on to develop chronic beryllium disease, an 

incurable disease that can result in serious 

impairment and death. Beryllium sensitization has been found in 1%–10% of workers in 

cross-sectional studies, with chronic beryllium 

disease being diagnosed in 10%–100% of 

those who are sensitized. Preventive efforts 

that relied on engineering controls to reduce 

air levels of beryllium have been largely ineffective. However, in 2007 NIOSH published 

preliminary scientific evidence that new cases 

of beryllium sensitization could be reduced 

following the implementation of a Comprehensive Preventive Program in the workplace. 

Beryllium sensitization rates were reduced 

8-fold among workers exposed to this program as compared with those who were not 

exposed to the program. 

A snapshot of the NIOSH Pocket Guide to 

Chemical Hazards.

Cross Sectors — 46

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occupational radiation exposure and 

to promote radiation research within 

the Institute to establish niosh as a 

global leader in occupational radiation 

exposure evaluation.

The program has developed a set of 

priority research goals that aim to promote the development of methods and 

strategies for characterizing radiation 

exposure in the workplace; to provide 

guidance to the nora sector programs 

on the identification of potential radiation-related issues involving target 

populations; to increase cross-sector 

collaboration on radiation-related 

research within the Institute; and to 

effectively communicate information 

on radiation dose evaluation in an 

occupational setting to both the public 

and peers.

A steering committee made up 

of Institute experts will coordinate 

the development and promotion of 

the best available science involved in 

prospective and retrospective radiation 

dose evaluation in the workplace. The 

committee will determine appropriate 

projects and activities for this crosssector program and participate in the 

execution to achieve its mission.

Relevant Information

The most recent report from the National Council on Radiation Protection and Measurements indicated that > 1.5 million workers in the U.S. were employed in occupations with 

potential exposure to radiation. This data is currently being 

updated; however, it is expected that the number has grown 

substantially during the past 2 decades. 

Work Category No. of Workers 

Medicine 584,000

Industry 305,000

Government 204,000

Others (i.e., visitors) 155,000

Nuclear Fuel Cycle 151,000

Miscellaneous 76,000

Other Workers 15,000

Well Loggers 8,700

Industrial 6,900

U.S. Public Health Services 4,600

❡ Respiratory Diseases

Work-related respiratory diseases 

occur in all industry sectors and 

can affect any part of the respiratory 

tract from the nose to the deep lung. 

Disease onset can occur immediately 

following an exposure to decades later. 

Work-related respiratory diseases are 

often chronic and can lead to disability 

or death. 

The economic burden of workrelated respiratory diseases, such as 

asthma; chronic obstructive pulmonary disease; dust-induced diseases 

from asbestos, coal mine dust, and 

crystalline silica; respiratory tract malignancies; and respiratory infections 

is enormous and costs society billions 

of dollars each year.

The mission of the niosh Respiratory Diseases cross-sector program is 

to provide national and international 

leadership to prevent work-related 

respiratory diseases. The program 

fosters communication, collaboration, 

and coordination of efforts across the 

many disciplines and parts of niosh 

that work to achieve this goal. The 

program uses a scientific approach to 

gather and synthesize information, 

create knowledge, provide recommendations, and deliver products 

and services to those who can impact 

prevention.

In collaboration with other niosh

programs, the Respiratory Diseases 

program has made essential contributions to occupational respiratory 

disease surveillance, basic research 

in determining how exposures cause 

disease, and a range of areas critical to 

disease prevention, such as epidemiology, exposure assessment, engineering controls, respiratory protection, 

training, and authoritative recommendations. In addition, the program 

provides unique national resources in 

the areas of lung function testing and 

X-ray surveillance for lung disease. 

Relevant Information

About 70% of work-related disease mortality is from respiratory disease. Approximately 11.4 million adults in the U.S. 

have chronic obstructive pulmonary disease and about 13.8 

million have asthma. Among adults 15% of both diseases is 

attributable to work. Dust-induced diseases, such as silicosis, 

coal workers’ pneumoconiosis, and asbestosis, cause or 

contribute to > 2,500 deaths per year in the U.S. 

Work-related respiratory hazards continue to emerge. 

Recent examples include diacetyl-containing chemical butter 

flavorings; flocking materials; leather conditioners; diseases 

caused by bioterrorism agents; and respiratory infectious 

diseases, such as avian influenza, subacute respiratory syndrome (SARS), and multidrug-resistant tuberculosis

The NIOSH Respiratory Diseases Research Program has been 

reviewed by the National Academies (pages 56–57).

❡ Small Business Assistance 

& Outreach 

The mission of the Small Business 

Assistance and Outreach cross-sector 

program is to reduce occupational 

diseases, injuries, and fatalities that 

occur in small business establishments. This is accomplished through 

a comprehensive program involving 

research, prevention efforts, and public 

health activities.

The niosh Small Business Assistance and Outreach cross-sector 

program spans all workplace sectors. The program strives to fulfill its 

mission by conducting high-quality 

research; developing and disseminating practical solutions to complex 

workplace safety and health problems; 

fostering partnerships with labor, 

industry, government, and other stakeholders; and promoting the transfer of 

research to practice.

The program is prioritizing efforts 

to address the needs of businesses with 

fewer than 100 employees because 

these companies are assumed to have 

the most difficulty acquiring resources 

to manage workplace safety and health 

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issues. Workers at these small businesses also tend to suffer the highest 

rate of work-related injury and illness.

The Small Business Assistance and 

Outreach cross-sector program addresses these priority areas through 

collaboration with the small business 

community, its suppliers, service providers, and associated trade groups.

The program strives to deliver occupational safety and health information, 

recommendations, and new technologies in a manner that is relevant 

and appropriate to small businesses; 

engage in strategic partnerships to 

develop, implement, and evaluate programs that reduce workplace hazards; 

and demonstrate a positive return on 

investment for safety and health efforts 

within the small business community.

Relevant Information

About 90% of all businesses in the U.S. have < 100 workers. More than 5 million businesses employ < 20 workers.

In the private industry, workplaces with ≤ 10 employees 

experience approximately 33% of all work-related deaths but 

employ only about 5% of the workforce.

❡ Surveillance

Occupational safety and health surveillance is the ongoing systematic 

collection, analysis, interpretation, and 

dissemination of information used to 

describe workplace injury, illness, hazard, and exposure. Occupational safety 

and health surveillance information 

helps determine where work-related 

injuries and illnesses occur, how frequently they happen, and where scarce 

resources can most effectively be applied to eliminate or reduce the injury 

and illness burden to workers. 

Whether applied to known exposures or new exposures from newly 

developed products, a well-designed 

surveillance program allows researchers to recognize potential health 

hazards in industry and develop 

interventions that will eliminate or reduce the health impact upon workers. 

Additionally, the reviews conducted 

by the National Academies of niosh

programs in Agriculture, Construction, Hearing Loss, Mining, Personal 

Protective Technologies, Respiratory 

Diseases, and Traumatic Injury underscored the need for a robust occupational surveillance program.

Identifying and tracking occupational injuries, illnesses, and hazards 

for the nation is fundamental to the 

niosh mission. To this end, the Surveillance program strives to provide 

quantitative estimates of injuries, fatalities, and occupational diseases; detect 

trends, outbreaks, or epidemics of 

workplace injuries and diseases; monitor changes in known hazards; identify 

emerging hazards in the workplace; 

facilitate epidemiologic and laboratory 

research; generate new hypotheses for 

workplace safety and health; evaluate control and prevention measures 

aimed at improving safety and health; 

develop new technologies to improve 

surveillance data collection, management, and analysis; and provide results 

to the widest possible audience. 

niosh actively partners with federal 

and state agencies and private-sector 

programs to conduct studies and 

communicate findings of occupational 

health surveillance research. Examples 

of federal partners include:

the Bureau of Labor Statistics to 

analyze, interpret, and disseminate 

data on occupational deaths from 

injury collected through its Census of 

Fatal Occupational Injuries; 

the Consumer Product Safety 

Commission to use their existing 

emergency department surveillance 

system to capture data on occupational 

injuries and illnesses, including data 

not captured by the bls Annual Employer Survey, such as injuries among 

the self-employed; 

the U.S. Departments of Agriculture 

Impacting Schools Through Knowledge & 

Guidance On Safety & Health 

As part of its Safety Checklist Program, 

NIOSH developed more than 80 easy-to-use 

checklists to help teachers and administrators 

at high schools and technical schools establish effective occupational and environmental 

safety and health programs. NIOSH worked 

closely with professional organizations, administrators, and educators to notify schools 

across all 50 states about this valuable program. The program helps leaders bring their 

schools into compliance even when they have 

little safety and health experience, a busy 

schedule, and many unanswered questions. 

State departments of education and school 

districts in 8 states worked directly with 

NIOSH to get the material into classrooms 

and onto computer systems. Since 2003, 

more than 85,000 copies of this program 

have been disseminated in CD-ROM format. 

In addition, Spain’s Department of Education 

asked NIOSH for permission to translate the 

program into Spanish. 

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injury of youth less than 18 years 

of age have been used by numerous 

groups to support educational efforts 

to reduce young worker deaths from 

injury and revise child labor laws. 

In another example, for more 

than 15 years the niosh Adult Blood 

Lead Epidemiology and Surveillance 

(ables) system has worked with a 

growing partnership of states to systematically track laboratory reports of 

adult blood lead levels by industrial 

sector. In 2006 the manufacturing, 

construction, and mining sectors 

accounted for more than 94 percent 

of adults who were exposed to lead 

at work that had elevated blood lead 

levels. Industry data were submitted to 

the ables system by 35 states.

Data are used by states, industry, 

labor, hhs, and dol to understand 

trends in workplace exposure to lead, 

identify where exposures occur, and 

evaluate how well intervention and 

prevention programs work. niosh

currently supports the state-based 

collection and reporting of data on 

elevated blood lead levels in 40 states; 

however, state funding of basic occupational surveillance and other 

priority conditions is currently limited 

to 15 states. Many more states have 

expressed interest in creating occupational health surveillance programs.

Numerous partners in academic 

institutions, labor and advocacy 

organizations, government agencies, 

and others have joined niosh in addressing issues of occupational health 

disparities, particularly of workers 

with low English ability and literacy, 

who hold low-skill and low-wage jobs 

and workers who may have a mental 

or physical disability. Such workers 

occupy unique employment niches, 

such as home care or home healthcare 

for the elderly and disabled, retail, and 

manufacturing. 

niosh seeks to develop methods 

to track and prevent workplace injury 

and Labor to assess the burden, patterns, and trends in injury among 

agricultural workers and farm managers who are underrepresented in most 

data systems;

the National Center for Health 

Statistics to examine how work contributes to mortality from chronic 

disease using death records and assess 

occupational injuries and illnesses of 

living workers who are not captured by 

the bls Annual Employer Survey;

the U.S. Department of Transportation’s Federal Motor Carrier Safety 

Administration to track health and 

injuries among truck drivers;

the Environmental Protection 

Agency (epa) and state partners to 

identify and report on work-related 

pesticide poisonings and broadly disseminate this information. Data from 

the epa program have been used by 

state governments to provide broader 

protection to workers and community 

residents with potential for exposure 

to pesticides.

These and other niosh surveillance efforts are important because 

they routinely identify emerging issues 

that would otherwise be overlooked 

or not well communicated to employers or workers. niosh also provides 

funding to states to collect data not 

otherwise available at the national 

level and to foster data-driven prevention efforts. niosh supports basic 

occupational safety and health surveillance programs in several states and 

more advanced surveillance of priority 

conditions, including teen injuries, 

elevated blood lead levels, pesticide exposures, work-related asthma, silicosis, 

and deaths from injury. 

These state-based surveillance 

efforts are critical for identifying 

emerging issues and ensuring broadbased public health activities to 

improve worker safety and health. For 

example, findings from state investigations of deaths from occupational 

Comprehensive Surveillance Efforts 

Impact Worker Safety & Health

In 2008 NIOSH surveillance of coal workers’ 

pneumoconiosis revealed an increase in the 

percentage of coal workers with this preventable and devastating disease and the need 

for increased vigilance to ensure that exposure to coal and silica dust are appropriately 

controlled among miners. Other important 

surveillance findings recently reported by 

NIOSH and partners include the dramatic increase in occupational injury deaths among 

Hispanic workers, especially high rates of 

heat-related deaths among crop workers; the 

role that older tractors without rollover protective structures have in the large number 

of tractor-related deaths on farms; the large 

number of nonfatal injuries among workers 

and consumers associated with nail guns; the 

exposure of utility workers to home-applied 

bug bomb residues; and the high prevalence 

of work-related hearing loss in workers from a 

wide range of industries and occupations.

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develop practitioners and researchers 

who will contribute to the prevention 

of injury, illness, and death from exposure to safety and health hazards. 

Training Project Grants are available at academic institutions that 

primarily have single-discipline graduate training similar to those mentioned 

above. The Education and Research 

Centers are located in institutions that 

emphasize interdisciplinary training 

and strongly encourage collaboration 

among the various occupational safety 

and health disciplines. 

A few of the essential components 

of the centers include conducting 

outreach and research to practice 

activities with other institutions, 

businesses, community groups, and 

agencies located within their region. 

Also, providing continuing education 

programs and training courses for 

those involved in worker safety and 

health. Education and Research Centers address area needs and implement 

innovative strategies for meeting needs 

with a focus on impacting the practitioner environment.

Along with the Training Project 

Grants and Education and Research 

Centers, the niosh Training Grants 

cross-sector program supports 

Hazardous Substance Training programs and an Emergency Responder 

Training program conducted by the 

International Association of Fire 

Fighters. Hazardous Substance Training prepares professionals to properly 

carry out their responsibilities when 

involved in hazardous substance response and site remediation activities. 

The Emergency Responder Training 

also provides continuing education to 

help prepare responders for managing responses to hazardous substances 

effectively and provides training in 

safety and health for responders. 

The niosh training programs have 

helped establish occupational safety 

and health programs in academic 

and illness and augment the limited 

research that has been done to assess 

the occupational safety and health 

needs of these vulnerable populations 

of workers.

Relevant Information

Every day in the U.S. approximately 9,300 people are 

treated in an emergency department for a work-related 

injury or illness, about 3,175 workers sustain injuries or illnesses that require days away from work, about 15 people 

die from a traumatic injury sustained at work, and about 135 

people die from work-related diseases. 

In 2006, employers paid approximately $87.6 billion in 

compensation as a result of work-related injuries & illnesses.

❡ Training Grants

The Occupational Safety and Health 

Act of 1970 mandates the development 

and funding of education programs 

to train qualified professionals and 

researchers to meet the need for a 

workforce capable of implementing 

safety and health programs. 

Through its Training Grants crosssector program, niosh funds training 

grants throughout the country to build 

a skilled workforce that can effectively 

implement occupational safety and 

health programs. According to data 

from Liberty Mutual, the American 

Society of Safety Engineers, and other 

organizations, reduced workers’ compensation costs are directly linked to 

improved safety programs, including a 

trained workforce. 

niosh provides support for training 

in several core disciplines, including 

industrial hygiene, occupational health 

nursing, occupational medicine, and 

occupational safety. Programs are 

funded through 32 Training Project 

Grants and 17 Education and Research 

Centers across the U.S. (see page 4

for locations). Both Training Project 

Grants and Education and Research 

Centers focus on providing academic 

and research training programs that 

institutions across the country. It is estimated that the majority of academic 

and research training programs in occupational safety and health in the U.S. 

are supported by niosh funding. 

Relevant Information

From 2003–2008 an average of 501 students graduated 

each year from a NIOSH-supported Training Projects Grant 

or Education and Research Center program. 

About 30,000 safety and health practitioners receive 

continuing education training from a NIOSH-supported 

Education and Research Center each year.

❡ Traumatic Injury

Traumatic injuries have plagued 

workers around the world for centuries. Today, work-related injury and 

death from traumatic injuries resulting from such things as workplace 

violence, falls, contact with industrial 

objects and equipment, and motor 

vehicle crashes continue to claim lives, 

damage physical and psychological 

well-being, and consume the resources 

of workers and their families. The 

overall human, social, and financial 

toll of traumatic occupational injuries 

rivals the burden of health threats such 

as cancer and cardiovascular disease.

niosh has a focused program of 

surveillance, high-quality research, 

and effective translation through collaboration and practical prevention 

measures in order to prevent traumatic 

occupational injuries among the entire 

U.S. workforce. Research priorities 

of the Traumatic Injury cross-sector 

program are driven by available injury 

and fatality data. Several research and 

prevention efforts are under way that 

target sectors with high risk of traumatic injuries including agriculture, 

construction, and transportation. 

Priority areas address increasing 

the use of surveillance to guide 

research and prevention; reducing 

traumatic injuries from falls, motor 

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health, productivity, and well-being 

while at work.

There has been a longstanding 

separation in the public health and 

occupational safety and health communities between those interested in 

controlling the health hazards from 

work and those focused on individual 

and community health risk reduction 

outside the workplace. Advancing 

knowledge and practice in this area 

requires collaboration to bridge the 

divide between these focus areas.

A new approach to maintaining a 

healthy nation of people is needed that 

reflects the complexity of influences 

on worker health and the interactions 

between work-based and nonwork 

factors. A growing body of evidence 

indicates that integrated approaches 

that address both physical and organizational health risk factors from work 

and individual risk factors, such as 

smoking and diet, are more effective 

in protecting and improving worker 

health and well-being than traditional 

isolated programs.

In collaboration with its partners, 

niosh developed the WorkLife Initiative to better understand and promote 

the kinds of work environments, 

programs, and policies that result in 

healthier more productive workers, 

reduced disease and injury, and lower 

healthcare needs and costs. It is based 

on a foundational commitment to 

workplaces free of recognized hazards 

and the idea that better work-based 

health policies and practices can help 

to sustain and improve the health and 

well-being of workers.

The premise of the WorkLife Initiative is that it makes sense to address 

worker health and well-being in a 

more comprehensive way, taking 

into account the physical and organizational work environment while 

addressing the personal health-related 

decisions of individuals. The worksite 

provides an opportunity to implevehicle incidents, workplace violence, 

industrial machines and vehicles; and 

better understanding the risks and 

injuries occurring among vulnerable 

worker populations. 

The program uses a traditional 

public health model as its research 

framework involving surveillance, 

risk factor identification, prevention 

strategy and technology development, 

intervention evaluation, and information dissemination to its audience.

Relevant Information

On average, 15 U.S. workers die each day from traumatic 

injuries. In 2007, > 5,650 workers died from work-related 

injuries, a rate of 3.8 deaths per 100,000 workers. 

More than 4 million private industry workers suffered

nonfatal injuries; approximately 50% of which required days 

away from work, job transfer, or job restriction.

The NIOSH Traumatic Injury Research and Prevention 

Program has been reviewed by the National Academies 

(pages 56–57).

❡ WorkLife

Illnesses and injuries from work or 

nonwork activities reduce income, 

quality of life, and opportunities for 

both the affected workers and those 

dependent upon them. Preserving and 

improving the health and well-being 

of people who work is a goal shared by 

workers, their families, their employers, and niosh.

The health of workers is influenced by physical and organizational 

workplace exposures as well as by individual behaviors and environmental 

exposures at home and in the community. The effects of these various factors 

cannot be artificially divided between 

work and nonwork. Just as workplace 

conditions can affect health and wellbeing at home and in the community, 

exposures and activities outside of 

working hours can substantially affect 

Trends Reinforce the Need & Potential 

Impact of a WorkLife Approach 

Healthcare costs are rising faster than wages 

or profits, many employers are cutting back on 

health benefits, and families are paying more 

out-of-pocket expenses for healthcare than 

ever before. Corporate mergers, restructuring, and economic and job insecurity are leading to increased job demands and added risks 

to employee health. Chronic disease rates are 

high and treatment is costly, highlighting the 

importance of effective prevention and disease management programs. The distinction 

between illness and injury from work and nonwork risks is rapidly fading. Work is one of the 

most important determinants of a person’s 

health. Up to 70% of health determinants can 

be addressed in workplace programs. The 

U.S. workforce is aging, however, many employers are seeking ways to keep older workers on the job and continue to benefit from 

their experience, wisdom, and commitment.

Cross Sectors — 51

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ment programs and policies to prevent 

work-related risks and chronic illnesses and injuries that are linked to 

behavior-related choices.

Presently, niosh is addressing issues 

of balance between work and personal 

life more comprehensively by supporting and expanding multidisciplinary 

research, training, and education 

through the niosh-funded WorkLife 

Centers of Excellence. 

niosh is also disseminating information about proven and promising 

programs, policies, and practices 

through new and established partnerships, including the Essential Elements 

of Effective Worksite Programs and 

Policies for Improving Worker Health 

and Wellbeing—practical, evidencebased guidance to help employers 

improve their workplace health and 

wellness programs.

Employers who take a comprehensive and holistic approach to worker 

health and well-being on and off the 

job enable workers to achieve a better balance between their work life 

and home life. They provide work 

environments that are safe and free 

of recognized health hazards, seek to 

reduce work-related stress, and are 

supportive of positive health choices 

for their workers. 

The niosh WorkLife Initiative is 

committed to conducting and supporting research and outreach to 

provide employers with tools and 

model practices for creating a work 

environment that encourages worker 

health and productivity and helps 

employers promote balance between 

work and nonwork activities.

Relevant Information

Approximately 553,000 deaths from cancer and 1.3 million 

new cases of cancer occur each year. Annually, cancer costs 

society about $89 billion in medical costs and $130 billion for 

lost work days and productivity.

Diabetes-related complications lead to > 200,000 deaths, 

and > 23.6 million new cases of diabetes occur each year. 

Annually, diabetes costs society about $116 billion in medical 

costs and $58 billion for lost work days and productivity.

More than 80 million new cases of cardiovascular disease

occur each year. Annually, cardiovascular disease costs society about $448 billion in direct and indirect costs.

Approximately 438,000 deaths from tobacco use occur 

each year. Annually, tobacco use costs society about $96 billion in medical costs and about $97 billion in indirect costs.

NIOSH currently supports 3 WorkLife Centers of 

Excellence located at 4 universities:

Center for Work, Health, & Wellbeing; Harvard School of 

Public Health 

Center for the Promotion of Health in the New England 

Workplace; University of Massachusetts, Lowell and the 

University of Connecticut

Healthier Workforce Center for Excellence; 

University of Iowa

❡ Work Organization & 

Stress-Related Disorders 

Work organization and job stress are 

growing concerns in all industries. Job 

stress results from poor work organization, such as when job demands 

outweigh the capabilities, resources, or 

needs of workers. Research has linked 

stress at work to lost productivity, 

workplace injury, and serious health 

outcomes, such as depression and 

heart disease. 

A steering committee representing 

niosh divisions and offices guides the 

Work Organization and Stress-Related 

Disorders cross-sector program. The 

primary goal of the program is to 

promote and protect the safety and 

health of workers through research to 

understand work organization risk and 

protective factors related to stress, illness, and injury in the workplace. 

The program encompasses a wide 

range of research, including exploring how changing organizational 

practices influence risk factors for job 

stress and other hazardous exposures; 

understanding how workplace stress 

contributes to illness, injury at work, 

and disease development; identifying 

effective multilevel intervention strategies to prevent stress at work; better 

understanding of the socioeconomic 

cost and burden of job stress; developing improved methods and tools for 

job stress research; and investigating 

stress in understudied populations.

Relevant Information

1/3 of all workers report high levels of stress. 

1/2 of U.S. employers are concerned about stressful working conditions, such as long hours and doing more with less.

The WHO estimates that heart disease and depression will 

be the leading causes of disability by 2020; both conditions 

have been linked to stress at work.

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Mark Methner

Industrial Hygienist

Several things challenge me about 

nanotechnology. These include 

keeping abreast of the constantly 

changing and new materials 

being created; identifying and 

deploying appropriate instrumentation to measure worker 

exposure; identifying appropriate 

exposure metrics; developing a 

standardized, field-deployable, 

sampling methodology and 

protocol for accurately measuring 

exposure; identifying appropriate 

analytical methods to characterize materials, process emissions, 

and potential worker exposure; 

gaining access to a variety of 

nanotechnology industries and 

materials to perform field-studies 

that reflect exposures across the 

industry; and ensuring field-study 

findings are communicated in a 

timely manner to the companies 

that collaborate with niosh.

Vincent Castranova

Pulmonology Toxicologist

Two of the greatest obstacles 

to nanotoxicology research are 

developing techniques to deliver 

nanoparticles to cellular and 

animal test systems and characterizing the physical properties 

of nanoparticles as they are 

delivered to these test systems. 

Occupational dusts are often 

delivered as particles suspended 

in an aqueous medium or by inhalation of aerosolized particles. 

Dispersion of fine-size particles 

in an aqueous medium is simple, 

but nano-size particles tend to 

agglomerate when suspended in 

physiological solutions resulting 

in structures that are no longer 

nano in size. Our research has 

shown that extensive agglomeration decreases the bioactivity of 

nanoparticles and leads to artifactual results. It has also received 

international recognition.

Vladimir Murashov

Physical Chemist

The greatest challenge and opportunity of nanotechnology that 

excites me the most is the proactive assessment and management 

of the occupational risks from 

this transformative technology. It 

is a challenge because it requires 

developing novel tools under the 

conditions of limited scientific 

data and competing priorities; it 

is an opportunity because such 

a novel occupational safety and 

health paradigm is aimed at 

prevention and will be broadly 

applicable to other emerging 

technologies. This novel approach 

requires global cooperation 

within the occupational safety and 

health community using existing 

frameworks—such as multilateral 

who, ilo, oecd, and iso and 

bilateral agreements—to leverage 

funding, as well as human and 

scientific information resources. 

Anna Shvedova

Pulmonology Toxicologist

Explosive development and 

application of nanomaterials are 

based on their unique physicochemical properties, suggesting 

that their interactions with living 

matter may also be unique and 

therefore, cannot be extrapolated 

from previous experience. This 

leads us to explore unknown and 

unpredictable effects of nanomaterials where worker exposure 

may be significant. Our studies 

have revealed that inhalation 

and aspiration of single-walled 

carbon nanotubes cause robust 

pulmonary inflammation and 

increased sensitivity to infection. 

Increased understanding of 

mechanisms underlying health 

effects of nanomaterials will allow 

us to develop effective measures 

against their toxicity and scientifically sound recommendations 

for regulation in the workplace.

The Pioneering Spirit

What challenges you most about nanotechnology?

Four NIOSH researchers dedicated to protecting workers from the potential hazards of occupational 

exposure to nanomaterials share their thoughts.

Photo by Brett Bausk, courtesy of HP, downloaded from Flickr
NA Reviews — 56

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Scientific Rigor

Understanding the National Academies’ Review

From 2005–2008 niosh had 8 of its major research programs reviewed by the National Academies: Agriculture, Forestry, and Fishing; Construction; Health Hazard 

Evaluations; Hearing Loss; Mining; Personal Protective Technologies; Respiratory 

Diseases; and Traumatic Injury. The National Academies reviewed these programs 

at niosh’s request. The National Academies are known as the Advisers to the Nation and their reviews are recognized for their independence and rigor. 

Within the National Academies, niosh program reviews were managed by the 

Institute of Medicine and the Division of Earth and Life Sciences. The National 

Academies recruited 8 separate evaluation committees; each committee was made 

up of top experts. In total, more than 200 scientists external to niosh participated 

in the reviews. 

Before the reviews began, the National Academies convened a committee of 

experts to write a framework of criteria. That framework advised the evaluation 

committees to examine each program’s inputs, activities, outputs, and outcomes; 

assess its relevance to important workplace safety and health needs; and evaluate 

its impact on improving worker safety and health. Evaluation committees were also 

directed to assess emerging issues for the program, provide recommendations to 

the programs, and score the programs on their relevance and impact. 

Recommendations and noted accomplishments varied greatly between niosh

program reviews, however, the evaluation committees did identify some commonalities. Areas for improvement included partnerships and collaborations, 

strategic planning, surveillance, dissemination and transfer activities, and extramural research activities. Noted accomplishments included conducting research in 

high-priority areas, positively affecting workforce conditions, providing excellent 

training programs for occupational safety and health professionals, and engaging 

in research translation activities.

Following the National Academies’ review, each program was charged with developing an implementation plan in response to the committee’s review. The plan 

addresses how the program intends to implement their recommendations. In addition to a public comment period, implementation plans are shared with the niosh

Board of Scientific Counselors or the Mine Safety and Health Research Advisory 

Committee for review and comment and provided to the National Academies. 

For more information about the National Academies’ review, visit www.cdc.gov/niosh/nas/.

The following page shows scores awarded 

to each of the NIOSH research programs reviewed by the National Academies’ evaluation 

committees. Programs received a numerical 

value for both relevance and impact as described in the text to the right. Each score was 

given on a scale from 1–5. 
NA Reviews — 57

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Relevance Score Key

5 Research is in high-priority subject areas and NIOSH is significantly 

engaged in appropriate transfer activities for completed research 

projects/reported research results. 

4 Research is in priority subject areas and NIOSH is engaged 

in appropriate transfer activities for completed research 

projects/reported research results. 

3 Research is in high-priority or priority subject areas but NIOSH 

is not engaged in appropriate transfer activities; or research 

focuses on lesser priorities but NIOSH is engaged in appropriate 

transfer activities. 

2 Research program is focused on lesser priorities and NIOSH is not 

engaged in or planning some appropriate transfer activities. 

1 Research program is not focused on priorities and NIOSH is not 

engaged in transfer activities. 

Impact Score Key

5 Research program has made major contributions to worker safety 

and health on the basis of end outcomes or well-accepted 

intermediate outcomes. 

4 Research program has made some contributions to end outcomes or 

well-accepted intermediate outcomes. 

Research program activities are ongoing and outputs are produced 

that are likely to result in improvements in worker safety and health 

(with explanation of why not rated higher). Well-accepted outcomes 

have not been recorded. 

Research program activities are ongoing and outputs are produced 

that may result in new knowledge or technology but only limited application is expected. Well-accepted outcomes have not been recorded. 

1 Research activities and outputs do not result in or are not likely to 

have any application. 

Agriculture, 

Forestry, & Fishing

4

3

Construction

5

4

Health Hazard 

Evaluations

4

4

Hearing Loss

3

4

Mining

4

4

Personal Protective 

Technologies

4

4

Respiratory Diseases

5

4

Traumatic Injury

4

4

3

2
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Impacting distinct

Working populations

In addition to the NORA research programs that are organized by industry sector 

and their companion cross-sector programs, NIOSH drives efforts to protect those 

who protect the public and to improve the safety and health of distinct working 

populations, including children, small businesses, emergency responders, energy 

workers, and fire fighters. This is done by leading national initiatives, funding 

research and intervention activities, contributing extensively to Congressionallymandated programs, and transferring research into practice to ensure scientific 

relevance and impact.
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Children in Agriculture

Since 1996 Congress has funded a Childhood Agricultural Injury Prevention Initiative at niosh, making niosh the leading federal agency in 

preventing childhood agricultural injury. The work of the Initiative focuses on developing a better understanding of circumstances that lead to 

youth agricultural injury and identifying effective prevention strategies 

through surveillance and research. Research priorities include understanding economic and social consequences of youth working on farms, 

developing model programs for training and supervising young agricultural workers, creating affordable and accessible childcare for children in 

farming communities, and establishing safe play and recreation areas on 

farms for resident and visiting children. In 1997 niosh began funding 

a national center for research, training, and education to prevent child 

agricultural injuries in the U.S.

Information Resource Impacts Farm Safety

For many producers, agricultural tourism—or agritourism—provides a way to supplement their income, entertain the public, and educate people about farming. An estimated 52,000 agritourism operations in the U.S. host 

more than 85 million visitors each year. In 2007 the National Children’s Center for Rural and Agricultural Health 

and Safety published Agritourism: Health and Safety Guidelines for Children, a user-friendly resource for agritourism operators that includes tips on identifying and reducing hazards found on farms. In 2008 two checklists 

were added to this booklet to allow agritourism operators to review safety and health considerations already 

incorporated into the farming operation and to inform appropriate prevention and control actions.

Workplace Violence Prevention 

An average of 1.7 million people were victims of violent crime while 

working or on duty in the U.S. each year from 1993–1999. An estimated 

1.3 million (75%) of these incidents were simple assaults and an additional 19% were aggravated assaults. Of the occupations examined, 

police officers, corrections officers, and taxi drivers were victimized at 

the highest rates. As an integral part of a broad-based initiative to reduce 

the incidence of occupational violence in this country, niosh conducts, 

funds, and publishes research on risk factors and prevention strategies 

related to workplace violence. 

Impacting the Safety of Small Businesses

NIOSH developed a worksite intervention program to reduce work-related injury from assault in high-risk 

businesses in Los Angeles. This program provided important information to small business owners who do 

not routinely receive such safety information. Results indicated that the intervention was effective in reducing 

overall crime—particularly robbery, which was the primary focus of the intervention. Several groups and organizations have received training and materials about the program to assist them in disseminating this important 

workplace violence prevention information. Efforts are now under way to increase the program’s availability.

Photo by doviende, downloaded from Flickr
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www.cdc.gov/niosh

Emergency Responders

The World Trade Center disaster triggered a massive emergency response involving tens of thousands of emergency 

responders. These workers and the community were exposed 

to known toxins. During this disaster, niosh provided technical assistance to protect workers involved in the rescue and 

recovery efforts from hazardous exposures. Following the 

cleanup efforts, niosh now provides free medical screening, 

monitoring, and treatment for workers and volunteers who 

took part in the rescue, recovery, cleanup, and restoration 

activities at the World Trade Center site, as directed by Congress. Residents, students, and others in the New York City 

Metropolitan area are also eligible to participate. Through 

a consortium of grantees and contractors, niosh oversees 

programs for assessing and treating the current physical 

and mental health conditions appearing in these populations. Through periodic surveillance, the niosh World Trade 

Center Health Program has the ability to detect longer-term 

effects in a population at high risk for potentially developing 

multiple health conditions.

Energy Workers

niosh is responsible for determining occupational radiation exposure for workers with cancer who are eligible for 

compensation under the Energy Employees Occupational 

Illness Compensation Program Act of 2000. niosh develops and applies scientific guidelines and methods and 

conducts dose reconstructions to assist dol in carrying out 

this Act. niosh’s dose reconstructions are used by dol to 

assist in determining the probability that a worker’s cancer 

was “at least as likely as not” caused by workplace exposure 

to ionizing radiation while the worker was employed at a 

Department of Energy or an Atomic Weapons Employer 

location covered under the Act. niosh’s complex work provides science-based methods to help carry out the law’s 

mandate for fair, timely, and efficient compensation benefits. 

In addition to this responsibility, niosh also conducts an 

occupational energy research program to more fully understand cancer risk factors in workers exposed to radiation and 

to recommend improved protective measures to prevent injury, illness, and death.

Fire Fighters

Every year about 105 fire fighters die in the line of duty across 

the country. niosh conducts investigations of many of these 

deaths to develop recommended steps that the fire service 

can take to prevent similar deaths. niosh’s Fire Fighter Fatality Investigation and Prevention Program has made more 

than 1,000 recommendations based on more than 300 investigations since its inception in 1998. 

Impacting Policies & Procedures in the Fire Service

In fiscal year 2009 the Fire Fighter Fatality Investigation and Prevention Program produced its 

own “greatest hits” document titled, NIOSH Fire Fighter Fatality Investigation and Prevention 

Program: Leading Recommendations for Preventing Fire Fighter Fatalities, 1998–2005. This 

document summarizes the most frequent recommendations from investigations conducted 

during the first 8 years of the program. The document was developed to provide fire departments with relevant information that they can use to develop, update, and implement policies, 

procedures, and trainings to prevent injury and death among fire fighters. The document is 

available at www.cdc.gov/niosh/docs/2009-100/pdfs.

Department of Energy workers inspect uranium metal reactor fuels as part of the final product inspection process. Plant 6, Fernald Feed Materials Production Center. 

Photo from the U.S. Department of Energy
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www.cdc.gov/niosh

Building a solid connection between scientific results and their use is an essential component of 

high-quality research organizations. In the mid1990s, niosh became keenly aware of the need 

to more effectively demonstrate the value of its 

research. Workers, employers, policymakers, and 

industry representatives began to work more 

collaboratively to improve the safety and health 

impact of the Institute’s research.

In response to our partners’ perceptions, niosh

began transitioning into a more impact-focused 

agency. We involved partners and stakeholders 

more extensively in setting research priorities; 

partnered with industry, academia, professional 

associations, labor representatives, and government and nongovernment organizations to 

accomplish priority goals; and created an office 

devoted specifically to improving the relevance of 

our science and increasing our impact on workers 

and workplaces. Relevance and impact—along 

with scientific credibility, quality, and integrity—

are of utmost importance to the Institute.

As a way to strategically conduct and support 

relevant and impactful research, niosh launched 

its Research-to-Practice (r2p) initiative in 2003. 

r2p focuses on translating and transferring niosh

research findings, technologies, and information into effective injury and illness prevention 

practices used in the workplace; emphasizes that 

research conducted or funded by niosh should 

be relevant for recognized evidence-based policy 

and practice in the field of occupational safety 

and health; effectively diffuses research outputs to 

individuals or groups most likely to adopt them; 

and ensures that outputs are usable by organizations with the power to improve workplace safety 

and health. Opinion leaders and innovators must 

be familiar with niosh research and understand 

its utility if we are to have confidence that our 

research findings and best practices will have impact and prevent work-related injury and illness.

As part of its r2p initiative, niosh is both 

demonstrating and increasing its contribution 

to science and occupational safety and health 

practice to maximize return on the nation’s investment. The Institute is collaborating with 

multiple partners to develop effective prevention 

products, translate research findings into practical 

and understandable information, guide tailored 

dissemination efforts to workers and others, and 

evaluate its effectiveness. Transparency and accountability is crucial for research organizations 

such as niosh, especially in a period of diminishing federal resources.

To ensure scientific relevance and impact, 

niosh is committed to engaging partners and 

stakeholders throughout the entire research process and continuing its comprehensive efforts in 

r2p. Also, it is essential that both internal and 

external scientists, decision makers and policymakers, and other key stakeholders understand 

and contribute to the mission of niosh to generate new knowledge in the field of occupational 

safety and health and to transfer that knowledge 

into workplace practice to prevent work-related 

injury, illness, and death.

Thanks to Dr. John Howard for his intellectual contribution 

to this section.

Design Innovation Impacts Bicycle Officers

Traditional bicycle seats (saddles) have been associated with urogenital 

problems (paresthesia) and sexual dysfunction in bicycle police officers. In a 

recent study, NIOSH provided nontraditional no-nose saddles to bicycle officers from 5 metropolitan areas to use over the course of 6 months. NIOSH 

investigators instituted a series of measures to identify improvements that 

occurred from using the saddles. Results showed a 66% reduction in saddle 

contact pressure and significant improvements in penis tactile sensation and 

erectile function. The percentage of men who reported not experiencing 

urogenital paresthesia while using the no-nose saddle for 6 months rose 

from 27% to 82%. Of 90 officers assessed, only 3 returned to a traditional 

saddle. One police department from the study ordered 400 no-nose 

saddles. The results of this research are having a demonstrable impact on 

40,000 bicycling police officers and an indirect impact on the 5 million recreational bicyclists in the U.S. as seen in many blog discussions.

Driving Change Through Research Translation

Photo by Kitseeborg, downloaded from Flickr
Since the Occupational Safety and Health Act of 1970 was passed, niosh has 

worked diligently and thoughtfully to protect the U.S. working population. niosh

has relied heavily on science to guide its use of public resources, fulfill its responsibilities as outlined by Congress, and address critical occupational safety and health 

concerns. Over the years, policymakers, industry leaders, and organized labor have 

supported niosh’s mission and have agreed that scientific research is essential for 

effectively protecting workers.

We are proud that our research and recommendations are reflected in the pioneering national initiatives that have reduced occupational exposure to hazards such as 

asbestos, lead, vinyl chloride, and other industrial agents and have led to safer and 

healthier workplaces. 

As the U.S. economy moved from its predominantly manufacturing base towards 

a more service-providing economy in the 1980s and 1990s, niosh kept pace with 

its research to address issues such as indoor air quality, latex allergy, musculoskeletal disorders, and workplace violence. Around this same time, niosh also became 

keenly aware of the need to expand its partnerships, leverage its resources, and 

more effectively demonstrate the value of its research. 

Today, our programs continue to evolve to meet the complex challenges that we 

face in the 21st century, including changing workforce dynamics, new demands, 

and emerging occupational safety and health issues. Through the creation of the 

National Occupational Research Agenda (nora) we have expanded our diverse 

partnerships and leveraged resources. Every day, we strive to achieve our mission 

with the determination, commitment to sound science, spirit of partnership, knack 

for innovation, and unique understanding of the workplace that has served us and 

our stakeholders well for the past four decades.

This document presents qualities that underpin our efforts and illustrates ways in 

which we continue to drive progress in occupational safety and health. We have included our efforts in such areas as nora, research-to-practice, emergency response, 

partnership, nanotechnology, global collaborations, and other cross-cutting programs. Throughout the document we have included specific examples of how niosh

research has successfully impacted workplaces and the working population.

As the U.S. looks to the strategies that will maintain American leadership in tomorrow’s global market, it is critical to keep in mind that prevention of work-related 

injury, illness, and death is an integral part of those strategies. Keeping workers safe 

and healthy contributes to the efficiency, competitiveness, quality of service, and 

profitability of businesses. 

I hope you find this document informative and that it stimulates new ideas for ways 

in which we might collaborate to protect the U.S. workforce and keep our families, 

our communities, and our nation strong. 

Christine M. Branche, Ph.D.

Acting Director, NIOSH
Safer • Healthier • People

U.S. Department of Health and Human Services

Centers for Disease Control and Prevention

National Institute for Occupational Safety and Health

To receive niosh documents or more information about occupational safety and health topics, 

please contact niosh:

Telephone: 1-800-cdc-info (1-800-232-4636)

TTY: 1-888-232-6348

email: cdcinfo@cdc.gov

or visit the niosh Web site at www.cdc.gov/niosh

For a monthly update on news at niosh, subscribe to niosh eNews by visiting

www.cdc.gov/niosh/eNews.

Dhhs (niosh) Publication No. 2009-144