Update 2003

National Occupational Research Agenda 
NORA VISION 

No single organization has the resources necessary to conduct occupational 

safety and health research to adequately serve the needs of workers in the 

United States. These constraints mandate that the entire occupational safety 

and health community engage in collaboration and coordination of its resources. 

The National Institute for Occupational Safety and Health (NIOSH) and its 

public and private partners developed the National Occupational Research 

Agenda (NORA) to provide a framework to guide occupational safety and 

health research - for NIOSH and the entire occupational safety and health 

community. 

NIOSH ISION 

Delivering on the Nation's promise: safety and health at work for all 

people...through research and prevention. 

DHHS (NIOSH) Publication Number 2003-148 

V
National Occupational 

Research Agenda 

Update 2003
 
Table of Contents
 

Message from NIOSH..........................................................................1
 

NORA History .....................................................................................2
 

Investment in NORA...........................................................................3
 

NIOSH Investment in NORA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
 

Total Federal Investment in NORA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
 

Federal Funding Partners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
 

Sector-Specific Research Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
 

NORA Partnerships ............................................................................6
 

NORA Partnership Teams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
 

Liaison Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
 

NORA Partnering Award . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
 

NORA Workshops ...........................................................................11
 

NORA Research ................................................................................13
 

Intramural Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
 

Special NORA Research Initiatives . . . . . . . . . . . . . . . . . . . . . . . . .13
 

Other NORA Intramural Research . . . . . . . . . . . . . . . . . . . . . . . . .14
 

NORA and Emergency Preparedness . . . . . . . . . . . . . . . . . . . . . . . .19
 

Extramural Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
 

FY 2001 and 2002 NORA Awards . . . . . . . . . . . . . . . . . . . . . . .20 

RFAs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
 

Progress in NORA Extramural Research . . . . . . . . . . . . . . . . . . . . .27
 

Future of NORA .............................................................................. 32
 

NORA Milestones..............................................................................33
 
Message from NIOSH Director 

This year marks the seventh year of NORA implementation. 

NIOSH remains committed to NORA, which continues to 

provide a unique vehicle for partnerships and advances in 

occupational safety and health research. The fourth 

bi-annual NORA Symposium, June 23-24, 2003, will provide an exciting forum to share scientific research in NORA 

priority areas. It will also provide us with a unique opportunity to focus on how NORA research makes a difference in the 

lives of workers. The issue of moving NORA research to public health practice is critical and something that NIOSH is 

intent upon examining as part of a larger effort to assess 

NORA's impact and future shape. NIOSH will continue to 

turn to our partners for input as we evaluate NORA and plan 

for the future. 

John Howard, M.D. 

Director 

National Institute for Occupational 

Safety and Health
 

1
 
NORA History 

Each day, an average of 9,000 U.S. workers sustain disabling 

injuries on the job, 16 workers die from an injury sustained at 

work, and 137 workers die from work-related diseases. 

In April 1996, the National Institute for Occupational Safety and Health (NIOSH) and partners 

from across the nation unveiled the National Occupational Research Agenda (NORATM) as a 

framework to guide occupational safety and health research into the next decade. NORA arose 

from the recognition of four key factors: 1) work-related injury and disease continue to have a significant human and economic toll; 2) emerging hazards have joined historical occupational safety 

and health problems to create news challenges; 3) the workforce is growing older and becoming 

increasingly diverse; and 4) occupational safety and health research in both the public and private 

sectors would benefit from targeting limited resources. Approximately 500 organizations and individuals outside of NIOSH provided input into the development of NORA. NORA has succeeded 

in addressing topics that were designated by stakeholders as those that are most pressing and likely 

to yield gains to the worker and the nation. These topics consist of 21 research priority areas, in 

three categories: 

NORA Priority Research Areas 

Disease and Injury 

Allergic and Irritant Dermatitis 

Asthma and Chronic Obstructive Pulmonary Disease 

Fertility and Pregnancy Abnormalities 

Hearing Loss 

Infectious Diseases 

Low Back Disorders 

Musculoskeletal Disorders of the Upper Extremities 

Traumatic Injuries 

Work Environment and Workforce 

Emerging Technologies 

Indoor Environment 

Mixed Exposures 

Organization of Work 

Special Populations at Risk 

Research Tools and Approaches 

Cancer Research Methods 

Control Technology and Personal Protective Equipment 

Exposure Assessment Methods 

Health Services Research 

Intervention Effectiveness Research 

Risk Assessment Methods 

Social and Economic Consequences of Workplace Illness and Injury 

Surveillance Research Methods 

2
 
Investment in NORA 

According to the 2002 Liberty Mutual Workplace Safety 

Index, the direct and indirect costs of occupational injuries 

alone are estimated at $240 billion (in 1999 dollars). 

NORA was designed to be a research agenda not only for NIOSH, but for the entire occupational 

safety and health community. Over the past seven years, NORA has energized occupational safety 

and health research at NIOSH and throughout the federal government. NORA has also been successful in uniting NIOSH and other federal partners to co-sponsor research in NORA priority areas. 

NIOSH Investment in NORA: 

NIOSH has made a strong commitment to conducting and supporting research in the 21 priority 

research areas. When NORA was unveiled in 1996, NIOSH funding (intramural and extramural) of 

the 21 NORA priority areas was $15.4 million. A refocusing of NIOSH baseline resources and targeting of Congressionally appropriated new funds brought NIOSH funding for NORA to $94.8 

million in fiscal year 2002. 

0 

20 

40 

60 

80 

100 

fy 1996 

15.4 

28.1 

46.9 

61.1 

75.5 

89.2 

94.8 

fy 1997 fy 1998 fy 1999 fy 2000 fy 2001 fy 2002 

Intramural Research 

and Cooperative 

Agreements 

Grants 

NIOSH NORA Investment 

dollars in millions 

Funding for individual NORA priority research areas has also increased. For example, from 1996 to 

2002, research conducted or funded by NIOSH to develop and evaluate the effectiveness of solutions to prevent work-related injury and illness (control technology and personal protective equipment, exposure assessment methods, and intervention effectiveness research) has increased nearly 

six-fold, from about $5.5 million to $33 million. This represents one of the most substantial shifts in 

research priorities for occupational safety and health since NORA was initiated, and responds to 

widespread support among stakeholders seeking for NIOSH-funded research to increasingly focus 

on the development and testing of practical solutions to causes of injury and illness. 

3
 
Total Federal Investment in NORA: 

As part of NORA, a survey of federal occupational safety and health research outside of NIOSH 

is conducted biennially. The first survey, covering Fiscal Year 1996, provided a baseline identifying 

a total of $15 million for NORA-related research from other federal sources. This investment 

increased to $23 million in Fiscal Year 1998 and $35 million in Fiscal Year 2000. Fiscal Year 2002 

saw a slight decrease, with federal NORA investment totaling $31 million. Four NIH institutes 

(National Heart, Lung and Blood Institute; National Institute of Arthritis and Musculoskeletal and 

Skin Diseases; National Institute of Environmental Health Sciences; and National Institute on 

Deafness and other Communication Disorders) and the Department of Veterans Affairs invested 

more than $3 million each in NORA priority research areas in FY 2002. 

Because some partners were unable to respond this year, these numbers likely underestimate the 

amount of federal dollars spent on NORA research. It is possible that some decreases are due to 

concentrated efforts on bioterrorism and other emergency preparedness and response since the 2001 

terrorists attacks on the World Trade Center and Pentagon. NIOSH remains committed to working 

with federal partners to identify areas for collaboration and funding in NORA priority areas. 

0 

20 

40 

60 

80 

100 

120 

140 

fy 1996 fy 1998 fy 2000 fy 2002 

Federal NORA Spending 

69.9 

30.4 

110.5 

125.8 

NIOSH 

Other Federal 

Agencies 

dollars in millions 

Federal Funding Partners: 

NORA has made possible the largest infusion of federal government funding for extramural occupational safety and health research ever. The number of federal partners funding NORA research 

collaboratively with NIOSH has increased steadily since fiscal year 1996. In fiscal year 2002, 14 federal agencies - including 12 partners at the National Institutes of Health, the Health Resources and 

Services Administration, and the Agency for Healthcare Research and Quality - co-sponsored 

extramural research announcements with NIOSH. A complete list of FY 2002 NORA funding 

partners is included here. 

4
 
NIOSH's FY 2002 Federal Funding Partners: Supporting NORA Research 

Agency for Healthcare Research and Quality 

Health Resources and Services Administration 

Maternal and Child Health Bureau 

The National Institutes of Health 

National Heart, Lung and Blood Institute 

National Institute of Child Health and Human Development 

National Institute on Drug Abuse 

National Institute on Mental Health 

National Institute on Nursing Research 

National Cancer Institute 

National Institute on Aging 

National Institute on Alcohol Abuse and Alcoholism 

National Institute of Allergy and Infectious Diseases 

National Institute of Arthritis and Musculoskeletal and Skin Diseases 

National Institute on Deafness and Other Communication Disorders 

National Institute of Environmental Health Sciences 

Sector-Specific Research Funding: 

To most effectively address research needs in specific sectors (such as construction, mining, agriculture, and health care), NIOSH applies a matrix approach of coordinated research in some or all of 

the 21 priority areas, as appropriate for each sector. As such, it is clear that NORA has increased sector-focused research. In FY 2002, over $48 million of NIOSH's $95 million investment in NORA is 

being allocated to NORA research in agriculture ($11.0 million), construction ($13.5 million), mining 

($16.9 million), and health care ($7.6 million). These figures do not include NIOSH's nonresearch 

activities in these sectors (e.g., funding of the nine Centers for Agricultural Disease and Injury 

Research, Education, and Prevention, that are involved in both research and non-research activities). 

0 

5 

10 

15 

20 

Agriculture 

Construction 

Mining 

Health Care 

Intramural Research & 

Cooperative 

Agreements 

Grants 

NORA Investments by Sector, FY 2002 * 

11.0 

13.5 

16.9 

7.6

dollars in millions 

* Graph reflects investment in NORA research, not total NIOSH investment in sector. 

5
 
NORA Partnerships 

Partnership is an essential element of NORA’s approach to 

research and prevention 

Partnerships are the cornerstone of NORA. Public-private collaboration resulted in strong consensus about which priority areas to include in the agenda. Moreover, partnerships have continued to 

play a vital role in NORA implementation. For example, NORA has created research partnerships, 

where NIOSH and other researchers share scientific expertise and creative problem-solving skills, 

while partners in labor and industry provide the laboratories for evaluating interventions in real 

work settings. Instances of these partnerships appear throughout descriptions of NORA research, 

which begins on page 13. Other key NORA partnerships include the NORA Partnership Teams 

and the NORA Liaison Committee. 

NORA Partnership Teams: 

The NORA priority areas are represented by NORA Partnership Teams, which help guide implementation efforts and identify potential research partners. The NORA Teams are partnerships in 

and of themselves, consisting of NIOSH scientists and external partners from the academic community, industry, trade organizations, labor unions, and other federal agencies. NORA Teams better 

define the research needs of each particular priority area by establishing partnerships, sponsoring 

meetings to address their issues, and publishing research white papers in their areas. The white 

papers use variable approaches to advance issues in each priority area, such as summarizing the 

research in a priority area, defining gaps, and identifying opportunities for collaboration. Several 

Teams, including Infectious Diseases and Mixed Exposures, are finalizing such papers. Recently 

published white papers include: 

Exposure Assessment Methods: Exposure assessment is an essential tool for understanding, 

managing, controlling, and reducing occupational health risks in large and small workplaces. Data 

from exposure assessments are used in toxicology, epidemiology, and engineering studies. 

Advancing the science of exposure assessment can lead to: 1) better identification of at-risk workers; 2) better identification of the most cost-effective control and intervention strategies; 3) better 

understanding of exposure-response relationships; and 4) improved baseline data for standard setting and risk assessment. While important gains have been made in creating new methods and 

detecting even lower exposures for some substances and agents, important challenges remain. The 

NORA Exposure Assessment Team prioritized the research needs, which fall into four areas: study 

design, monitoring methods, applied toxicology, and education. Specific recommendations are discussed in the document, Exposure Assessment Research Needs and Priorities which is available on the 

NIOSH web site at http://www.cdc.gov/niosh/docs/2002-126/2002-126.pdf. 

Woebkenberg ML, Abell M, Armstrong T, DeBord G, Groce D, Keane M, Knechtges P, Pegram 

D, Reh B, Rogers B, Stenzel M, Utterback D, Weeks J, Williams K [2002]. Exposure assessment 

needs and priorities. Cincinnati, OH: U.S. Department of Health and Human Services, Public 

Health Service, Centers for Disease Control and Prevention, National Institute for Occupational 

Safety and Health, DHHS (NIOSH) Publication No. 2002-126. 

6
 
Indoor Environment: The multidisciplinary NORA Indoor Environment Team used member 

consensus and quantitative estimates, with extensive external review, to develop a specific research 

agenda for indoor nonindustrial work environments. The Team outlined the following priority 

research topics: building-influenced communicable respiratory infections, building-related 

asthma/allergic diseases, and nonspecific building-related symptoms; indoor environmental science; 

and methods for increasing implementation of healthful building practices. Available data suggest 

that improving building environments may result in health benefits for more than 15 million of the 

89 million U.S. indoor workers, with estimated economic benefits of $5 to $75 billion annually. 

Research on these topics, requiring new collaborations and resources, offers enormous potential 

health and economic returns. 

Mendell MJ, Fisk WJ, Kreiss K, Levin H, Alexander D, Cain WS, Girman JR, Hines CJ, 

Jensen PA, Milton DK, Rexroat LP, Wallingford KM [2002]. Improving the health of workers in 

indoor environments: priority research needs for a national occupational research agenda. Am J Public 

Health 92:1430-40. 

Organization of Work: Over the past two decades, the face of the American workforce has 

changed dramatically. Both employers and employees are now faced with downsizing, restructuring, 

contracting out, longer working hours, telecommuting, flextime, and an aging and more diverse 

workforce. These changes have occurred quickly, outpacing scientists' ability to gauge their implications for work life quality, job-related stress, and workplace safety and health. A document by the 

NORA Organization of Work Team, The Changing Organization of Work and the Safety and Health of 

Working People: Knowledge Gaps and Research Directions, is the first national attempt to develop a comprehensive research agenda for addressing these issues. Key needs targeted by the agenda include 

improved surveillance of changes in the organization of work, accelerated research on safety and 

health effects of these changes, intervention research to prevent adverse effects, and more formal 

attention to organization of work in the occupational safety and health field. Future work in this 

area will serve to further define and leverage critical research needs such as studies on the safety 

and health effects of long work shifts. The report has already made a significant contribution to 

training efforts by recognizing that training venues were absent for equipping researchers and practitioners in methods and knowledge in work organization as it relates occupational safety and 

health. Although NIOSH had already taken the first steps to provide this type of training, recognition of this training gap by the NORA Team served to fortify NIOSH efforts in this area, and 

presently graduate level training programs in work organization and health have been seeded by 

NIOSH at 11 universities nationwide. The document is available on NIOSH's web site on-line at 

http://www.cdc.gov/niosh/02-116pd.html. 

Sauter S, Brightwell WS, Colligan MJ, Hurrell JJ, Katz TM, LeGrande DE, Lessin N, Lippin 

RA, Lipscomb JA, Murphy LR, Peters RH, Keita GP, Robertson SR, Stellman JM, Swanson 

NG, Tetrick LE [2002]. The changing organization of work and the safety and health of working 

people. Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, 

Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, 

DHHS (NIOSH) Publication No. 2002-116. 

Cancer Research Methods: Focus on occupational cancer research methods is important both 

because occupational factors play a significant role in a number of cancers, resulting in significant 

7
 
morbidity and mortality, and also because occupational cohorts (because of higher exposure levels) 

often provide unique opportunities to evaluate health effects of environmental toxicants and 

understand the carcinogenic process in humans. Despite an explosion of new methods for cancer 

research in general, these have not been widely applied to occupational cancer research. In this 

paper published in Environmental Health Perspectives, the NORA Cancer Research Methods Team 

identifies needs and gaps in occupational cancer research methods in four broad areas: identification of occupational carcinogens, design of epidemiologic studies, risk assessment, and primary 

and secondary prevention. Progress in occupational cancer will require interdisciplinary research 

involving epidemiologists, industrial hygienists, toxicologists, and molecular biologists. 

Ward EM, Schulte PA, Bayard S, Blair A, Brandt-Rauf P, Butler MA, Dankovic D, Hubbs 

AF, Jones C, Karstadt M, Kedderis GL, Melnick R, Redlich CA, Rothman N, Savage RE, 

Sprinker M, Toraason M, Weston A [2003]. Priorities for development of research methods in 

occupational cancer -- National Occupational Research Agenda Team. Environ Health Perspect 

111:1-12. 

Fertility and Pregnancy Abnormalities: There is a significant public health concern about the 

potential effects of occupational exposure to toxic substances on reproductive outcomes. Several 

toxicants with reported reproductive and developmental effects are still in regular commercial or 

therapeutic use and thus present potential exposure to workers. Examples of these include heavy 

metals, organic solvents, pesticides and herbicides, and sterilants, anesthetic gases, and anticancer 

drugs used in health care. Many other substances are suspected of producing reproductive or 

developmental toxicity but lack sufficient data. Progress has been limited in identifying hazards and 

quantifying their potencies and in separating the contribution of these hazards from other etiologic 

factors. Identifying the causative agents, mechanisms by which they act, and any potential target 

populations, present the opportunity to intervene and protect the reproductive health of workers. 

The pace of laboratory studies to identify hazards and to underpin the biologic plausibility of 

effects in humans has not matched the pace at which new chemicals are introduced into commerce. 

Though many research challenges exist today, recent technologic and methodologic advances have 

been made that allow researchers to overcome some of these obstacles. This paper, written by the 

NORA Fertility and Pregnancy Abnormalities Team, recommends future directions in occupational 

reproductive health research including prioritization of research needs, potential surveillance activities, new studies on gene-environment interaction and effects of chemical mixtures, and communication. 

Lawson CC, Schnorr TM, Datson GP, Grajewski B, Marcus M, McDiarmid M, Murono E, 

Perreault SD, Shelby M, Schrader SM [2003]. An occupational reproductive research agenda for 

the third millennium. Environ Health Perspect 111:584-92. 

Liaison Committee: 

The NORA Liaison Committee, chaired by Dr. Bonnie Rogers, consists of 24 members representing industry, labor, academia, professional organizations, and government (see membership listed 

below). The NORA Liaison Committee is charged with assisting in the successful implementation 

8
 
of NORA by activities such as providing comments to NIOSH and its partners on the progress of 

NORA, providing outreach to interested stakeholders, encouraging participation in research and 

implementation teams, and facilitating appropriate avenues for initiating the proposed research. In 

1999, the Liaison Committee undertook a survey of key occupational safety and health stakeholders to gauge their opinions regarding NORA and to measure progress in NORA implementation. 

The Liaison has repeated this survey in 2003, with results to be presented at the 2003 NORA 

Symposium. 

Beginning in 2000, the Liaison Committee is also responsible for administering the NORA 

Partnering Award for Worker Safety and Health, which is described below. 

Committee Members 

Bonnie Rogers, DrPH, COHN-S, LNCC, FAAN (Committee Chair) 

Past President, American Association of Occupational Health Nurses 

The University of North Carolina at Chapel Hill 

Jacqueline Agnew, PhD, MPH, COHN-S, FAAN 

Association of University Programs in Occupational Health and Safety 

Henry Anderson, MD 

Council of State and Territorial Epidemiologists 

James August, MPH 

American Federation of State County and Municipal Employees 

Edward J. Bernacki, MD, MPH 

American College of Occupational and Environmental Medicine 

Carol Boraiko, CIH, CSP, MPH 

American Chemistry Council 

Thomas F. Bresnahan, CSP 

American Society of Safety Engineers 

William B. Bunn, MD, JD, MPH 

International Truck and Engine 

Leo Carey 

National Safety Council 

Tai Chan, PhD, CIH 

General Motors 

Harry Ettinger, PE, CIH 

American Industrial Hygiene Association 

Janie Gittleman, PhD, MRP 

Center to Protect Workers' Rights 

Gwendolyn Keita, PhD 

American Psychological Association 

Tom B. Leamon, PhD 

Liberty Mutual Insurance Company continued 

9
 
Wayne Lednar, MD, PhD 

Eastman Kodak Company 

Pamela Tau Lee 

Environmental Justice Committee 

Mei-Li Lin, PhD 

National Safety Council 

Jane Lipscomb, RN, PhD, FAAN 

American Public Health Association 

University of Maryland 

Joseph Main 

United Mine Workers of America 

Franklin Mirer, PhD 

International Union, United Auto Workers 

Grace Paranzino, MS, RN, CHES, FAAOHN 

Association of Occupational and Environmental Clinics 

Margaret M. Seminario 

AFL-CIO 

Michael A. Silverstein, MD, MPH 

Washington State Department of Labor and Industries and OSHSPA 

Frank White 

Organization Resources Counselors, Inc. 

NORA Partnering Award: 

The first NORA Partnering Award for Worker Safety and Health was presented at the 1999 

NORA Symposium. This award honors exemplary teamwork, innovative thinking, and strong science in the interest of worker safety and health. It was created to recognize those organizations 

participating in NORA-related collaborative research partnerships that result in the development of 

new equipment, practices, products, procedures, or policies that reduce hazardous exposures 

and/or adverse outcomes in order to protect worker health and safety. The NORA Liaison 

Committee is responsible for soliciting nominations for the award and selecting the winner. 

For 2003, the winning partnership project is "Evaluation of a Best Practices Back Injury 

Prevention Program in Nursing Homes." This research project was a collaborative effort between 

BJC Health Care, employees of BJC Health Care through the Occupational Health Nurse Council, 

Washington University, West Virginia University, EZ Way, Inc., Arjo, Inc., and NIOSH. This 

research partnership consisted of a laboratory study and a field study, designed to develop and 

evaluate the effectiveness of a "best practices" injury prevention program for reducing the incidence, severity, and cost of low back and other musculoskeletal injuries to workers in nursing 

homes. The best practices program included the use of mechanical patient lifting devices, worker 

training on how to use the devices, a zero-lift policy prohibiting manual lifting of non-weight bearing patients, and medical management of injured workers. The field study, which was conducted in 

partnership with BJC Health Care, documented a 57% reduction in injury frequency, a 58% reduc10
 
tion in injury rates, and a 71% reduction in workers' compensation medical and indemnity expenses 

related to patient lifting and transferring injuries among nursing staff. The laboratory study determined that lifting equipment manufactured by Arjo, Inc. and EZ Way, Inc. removed two-thirds of 

the lifting-stress exposure, while demonstrating efficiency and comfort. 

Based on the positive results of this collaborative study, BJC Health Care (one of the largest nonprofit health care systems in the United States) is implementing the best practices program in their 

acute care hospitals. In addition, NIOSH is preparing a scientific article summarizing the results of 

the study and is developing a practical users' guide, which will be widely disseminated to other 

health care providers for use in developing and implementing effective programs to reduce injuries 

during patient handling activities. 

The 2003 Partnering Award will be presented at the NORA Symposium 2003: Working 

Partnerships Research to Practice on June 23-24, 2003. 

NORA Workshops 

Throughout the implementation of the agenda, NORA Partnership Teams have sponsored numerous workshops and conference to focus on priority research areas. Highlighted here are a few 

examples of upcoming and recent workshops. 

The Third National Occupational Injury Research Symposium (NOIRS) will be held on October 

28-30, 2003, in Pittsburgh, PA. NOIRS is a national forum for the presentation of latest findings 

and methods in occupational injury research and a major focus for the NORA Traumatic Injuries 

Team. It will consist of presentations on research studies, methods, and findings related to traumatic work-related injuries. For more information, visit the NIOSH web-site at 

www.cdc.gov/niosh/noirs/noirsmain.html or call NIOSH at 1-800-35-NIOSH (1-800-356-4674). 

The NORA Special Populations at Risk Team is joining the NIH's National Institute for Child 

Health and Development (NICHD) and the Sloan Family Foundation in cosponsoring a June 2003 

conference entitled Workforce/ Workplace Mismatch: Work, Family, Health, and Well-Being. The 

conference is the first step in a 5-year initiative by NICHD to develop workplace based intervention programs. The conference will review the state of science pertaining to how different dimensions of work and family act independently and interact to affect the health and well-being of 

workers, families, children, communities and workplaces from numerous disciplinary perspectives. 

The NORA Hearing Loss Team and the National Hearing Conservation Association have cosponsored three best practices workshops. The most recent, Best Practices Workshop: Impulsive 

Noise, occurred in May 2003. Leading national and international experts on impulsive noise from 

labor, industry, academia, and government provided updates of the current state of the art concerning the effects of impulsive noise on the auditory system, techniques for capturing and analyzing impulsive noise, and the relevancy of present federal exposure limit guidelines. Working groups 

developed strategies for the measurement and characterization of impulsive noise, identified gaps 

in knowledge and measurement capabilities, and established specific future goals and research priorities. The presentation materials are being finalized and will be posted on the NIOSH website, 

with a publication of the proceedings to follow. 

11
 
The NORA Organization of Work Team provided technical and financial support for the 5th 

International Conference on Work, Stress and Health, which is the only international scientific conference worldwide to examine occupational safety and health risks of changing organizational practices. This conference, conducted in Toronto in March 2003, attracted nearly 700 scientists from 22 

countries and every continent. 

In May 2002, the Cancer Research Methods Team, in conjunction with the NIH's National 

Cancer Institute and National Institute of Environmental Sciences and the American Chemistry 

Council, held a two-day workshop entitled Applying New Biotechnology to the Study of 

Occupational Cancer. The workshop brought together researchers who study worker populations 

and those who are developing and validating new biotechnologies. The event fostered collaborations and promoted discussion and exploration of current and future directions of research to prevent occupational cancer. Abstracts are available on the NIOSH web site at 

http://www.cdc.gov/niosh/crmw.html. 

The NORA Mixed Exposures Team sponsored and led a session at the International Conference 

on Chemical Mixtures in September 2002. The conference was sponsored by the Agency for Toxic 

Substances and Disease Registry, the Food and Drug Administration, the U.S. Environmental 

Protection Agency, the NIH’s National Institute of Environmental Health Sciences, NIOSH, the 

Health Council of the Netherlands, the International Joint Commission, and the Society for 

Toxicology. The conference addressed issues pertaining to chemical mixtures research, mixtures 

health risk assessment, and computational modeling of chemical mixtures. The NORA session 

focused on the priorities for mixed exposures research and risk assessment approaches. 

In September 2002, as part of the special NORA research initiative Development of Dermal 

Policy Based on Laboratory and Field Studies (see page 14), NIOSH co-sponsored the 

International Conference on Occupational and Environmental Exposures of Skin to Chemicals: 

Science and Policy. This was the first conference to bring together dermatologists, occupational 

hygienists, engineers, laboratory researchers, policy makers, and others to focus on the science, 

knowledge gaps, and policy opportunities related to occupational and environmental exposures of 

the skin to chemicals. Conference sessions discussed the challenges of defining and identifying hazards of skin exposures, developing policies for prevention, and effectively communicating methods 

to protect workers from dermal exposures. Approximately 135 individuals attended, including 

many from outside of the U.S. The Proceedings are available on the NIOSH website at 

www.cdc.gov/niosh/topics/skin/conference/index.html. A second conference is scheduled for 

2004. 

12
 
NORA Research 

Over the past seven years, NORA has energized occupational safety and health research. NIOSH 

has aggressively aligned its intramural research program with NORA and has made scientific 

progress in many of the priority research areas. NIOSH's NORA intramural research budget has 

risen from $8.7 million in Fiscal Year 1996 to $50.7 million in Fiscal Year 2002. NIOSH has also 

increased its funding of extramural NORA projects and allocates three-quarters of new NORA 

funding to expand extramural research. 

Intramural Research: 

NIOSH conducts a diverse program of scientific research to prevent or reduce work-related illnesses and injuries. Highlighted here are recent accomplishments from some of the projects in 

NIOSH's NORA intramural research portfolio. Of note is the role of partnerships in many of 

these efforts. 

Special NORA Research Initiatives 

NORA has helped NIOSH focus its intramural research to create large programmatic initiatives 

composed of interrelated and coordinated research projects aimed at high-priority occupational 

topics of national importance. This multidisciplinary effort, referred to as "Big NORA," has resulted in increased collaboration, intensive peer review of internal research, and integration of projects 

and resources. These initiatives focus on the following areas: 

¿Organizational Risk Factors for Depression and Cardiovascular Disease 

¿Occupational Traumatic Injury Prevention 

¿Identifying Effective Hearing Loss Prevention Strategies 

¿Strategies to Prevent Injuries among Nurses 

¿Research for Occupational Asthma Reduction 

¿Exposure-response and Intervention Program for the Prevention of Work-related 

Musculoskeletal Disorders
 

¿Development of Dermal Policy Based on Laboratory and Field Studies 

These initiatives encompass a variety of projects, which are currently at different stages. 

For example: 

Research for Occupational Asthma Reduction is monitoring the occurrence of occupational asthma, evaluating the effectiveness of interventions, developing new methods for monitoring work environments, reviewing asthma cases from field investigations and surveillance 

systems, and encouraging interaction and communication among NIOSH investigators and 

extramural scientists. 

Exposure-response and Intervention Program for the Prevention of Work-related
 

Musculoskeletal Disorders is designed to quantify risk for work-related MSDs at varying
 

levels of exposure to job physical stressors and to evaluate interventions to reduce exposure and prevent musculoskeletal disorders. The program goals also include developing and
 

testing practical exposure and health assessment methods. NIOSH is collaborating with
 

four external partners to conduct cohort studies at a variety of worksites. This large, coordinated research program will be carried out over a 5-year period.
 

13
 
Development of Dermal Policy Based on Laboratory and Field Studies encompasses 11
 

projects, with a focus on gathering data to make recommendations for conducting effective
 

occupational hygiene investigations of potential skin exposure hazards, including a special
 

emphasis on improved skin notations. One recent study in this area used mathematical
 

approaches to better understand how the components of the stratum corneum (the outermost skin layer) and their geometrical arrangement provide the barrier properties of skin.
 

This work provides a way to understand the details of chemical transport through the skin
 

even for complex exposures, such as intermittent exposure. In addition, last year NIOSH
 

established a unique occupational skin research laboratory, using state-of-the-art instrumentation to objectively measure damage to the skin, secondary to chemical and physical trauma. For example, it is now possible to conduct digitized image analysis of the surface of
 

the skin to assess its physical properties. Such highly sensitive and objective means to assess
 

skin condition can be used to supplement more traditional, subjective evaluations. This
 

combined approach to analyzing the skin has never been previously utilized in occupational
 

health studies.
 

Other NORA Intramural Research 

Disease and Injury 

Assessing the Effectiveness of Hearing Loss Prevention for Carpenters 

Currently, estimated figures show that 2.9 million workers in the construction industry are exposed 

to potentially damaging noise levels, and that only 17% of carpenter apprentices wear hearing protectors properly. A NIOSH study of over 600 carpenters found that by age 25, carpenters have 

hearing equivalent to that of a 50-year-old non-noise exposed worker and by 55 years of age, most 

carpenters need hearing aids. To help reduce the incidence rate of hearing loss, NIOSH researchers 

have developed training methods to help carpenter apprentices understand their risk of occupational hearing loss and learn ways to protect their hearing from hazardous noise. Future evaluations 

of these training methods will help NIOSH researchers develop effective, efficient hearing loss 

prevention programs not only for carpenters, but the entire construction industry. 

Female Reproductive Effects of Exposure to Jet Fuel 

Approximately 116,000 women work for the United States Air Force (USAF) as officers, enlisted 

personnel, and civilians. Women in the USAF hold jobs that involve handling jet fuel, of which 

over three billion gallons have been issued annually to the Department of Defense. Evidence has 

accumulated that hydrocarbons, such as those found in jet fuel and solvents, are reproductive toxicants that have been shown to reduce female fertility. NIOSH researchers, in collaboration with the 

University of Cincinnati and USAF, conducted a controlled, cross-sectional, prospective study of 

women's reproductive health among USAF personnel working with jet fuel and solvents. The principal finding of the study is that women with increased exposure to jet fuel experience a 32% 

reduction in the preovulatory lutenizing hormone (LH) surge, the endocrine signal that triggers 

ovulation. While more research is needed to determine if these effects are temporary or long-lasting, and what role they may have in impeding women's reproductive ability, the new findings are 

consistent with data relating to other types of hydrocarbons, and will help scientists focus further 

studies that would be needed to make a conclusive link. 

14
 
Reducing Traumatic Injuries from Off-Highway Dump Trucks 

Blind spots around haulage equipment were identified as the cause of five worker fatalities at surface mines in 2000. To address this problem, NIOSH is investigating methods to monitor blind 

spots and alert operators to objects, people, and sudden changes in terrain. Partnerships have been 

established with Phelps Dodge, Inc., and Trimble Navigation, Inc., to develop and test various 

technologies, such as video cameras, radar, and Global Positioning Systems (GPS). This year, a collision warning system based on GPS technology was developed and tested for the first time on an 

off-highway dump truck. Other systems based on video cameras and radar are also being tested in 

a production setting at a Phelps Dodge copper mine in Morenci, Arizona. 

Slips,Trips, and Falls Prevention in Health Care Workers 

Slips, trips, and falls (STF) in the workplace represent a significant burden of injury and disability 

on American workers. The STF incidence rate for hospitals is 50% higher than the rate for all private industry. NIOSH researchers are leading a collaborative study with the Liberty Mutual 

Research Center for Safety and Health (LMRCSH), the Finnish Institute for Occupational Health 

(FIOH), BJC Health Care, and the Department of Veterans Affairs (VA) to develop and implement a STF prevention program in six hospitals and evaluate the impact of the program in a longitudinal study. NIOSH will disseminate the results of this study through all appropriate channels to 

health care workers, policy makers, standards organizations, unions, and flooring and shoe manufacturers involved with the prevention of STF incidents. 

Virtual Reality Technology Application for Fall Prevention Research 

Falls from elevation are a persistent occupational hazard, accounting for approximately 10% of all 

occupational fatalities, and for more than one third of fatal incidents in the construction industry. 

NIOSH researchers are using virtual reality technology to simulate elevated workplaces and study 

the risk factors for falls. Instability when working at heights is increased by other conditions in the 

work environment such as decreased surface firmness and increased slope. Because the increased 

instability on elevated and sloped surfaces is not adequately perceived by workers, the risk of lossof-balance incidents and falls is increased. In addition, research demonstrated that close visual references improve balance at elevation. The results from these groundbreaking studies provide the 

scientific basis for further applications of virtual reality simulations in fall prevention research. 

Future research may include dose-response studies using hybrid virtual environments (simulated 

and real structures) to further evaluate the stabilizing effects of close visual references; and studies 

to evaluate other potential contributing factors for loss of balance at height such as the effect of 

footwear type on balance control while working on roofs. Ultimately, findings from this and future 

research should lead to changes in the work environment, procedures, and protective equipment 

which should reduce the incidence of fall-related injuries and fatalities. 

Occupational Asthma and Skin Exposure to Isocyanates 

Public health surveillance systems have indicated that isocyanate compounds are the most commonly identified causes of occupational asthma. In cooperation with partners in industry, labor, 

and academia, NIOSH has developed a collaborative research and intervention activity directed at 

isocyanate asthma. Recently, a significant relationship was observed between the development of 

asthma-like symptoms and reports of skin staining with isocyanate, suggesting skin contact can be 

15
 
an important risk factor for isocyanate asthma. This is consistent with results of several prior animal exposure studies. These findings were communicated to isocyanate manufacturers who will 

include information on the concerns NIOSH identified in their product guidance. 

Work Environment and Workforce 

Lung Infections and Mixed Dust Exposure 

Epidemiological studies have reported increased lung morbidity and mortality in populations 

exposed to increased levels of particulate matter that has high metal content. In addition, studies 

have suggested that welders, boilermakers, and construction workers who have inhaled metal-containing particles of mixed composition such as diesel exhaust particles, residual oil fly ash, or welding fumes may be more susceptible to lung infections than the general population. To date, the 

mechanisms of the effects of these particles and fumes on lung defense are largely unknown. 

NIOSH conducted an animal study to assess the role by which metals may alter host defense 

mechanisms. It was demonstrated that different occupational particles have vastly different effects 

on host pulmonary defense mechanisms. Metal composition and particle solubility played important roles in particle-induced effects on macrophage function and lung defense mechanisms. Better 

understanding the mechanisms by which the occupational exposure to metal particles increases 

worker susceptibility to infection will lead to the development of effective interventions to protect 

workers at risk. 

Work Organization and Depression in Women 

Depression exacts an enormous toll on workers, their families, and their employers-both personally 

and economically. Working women suffer from depression at nearly twice the rates of working 

men. Work organization factors such as harassment, discrimination, and balancing work and family 

responsibilities may contribute to the higher levels of depression among women. A NIOSH study 

is examining the relationship between work organization stressors and depression. Study findings 

will provide valuable knowledge of workplace factors that may lead to depression among working 

women, as well as information on workplace policies and programs that can reduce the prevalence 

of the disease in this population. 

Assessment of Health Issues in Minority Farm Operators 

Some diseases are less prevalent in various racial and ethnic groups of minority farm operators 

than in white farm operators, but others are more prevalent, according to a recent NIOSH study. 

The findings, which were reported at the American Public Health Association's Annual Meeting in 

November 2002, were drawn from a survey conducted by NIOSH and the U.S. Department of 

Agriculture's (USDA) National Agricultural Statistics Service. The survey used a population sample 

from USDA's Census of Agriculture. For the first time, this study provides researchers with a large 

enough data base for analyzing health status of farm operators by gender, race, and ethnicity. The 

study showed that fewer Hispanic farm operators reported health problems than white, nonHispanic farm operators - except for diabetes, which was reported by more Hispanic men and 

women. Fewer Asian American farm operators reported health problems than white farm operators - except for diabetes in both genders and dermatitis in women, where Asian Americans reported a greater prevalence of each condition, but not at statistically significant rates. In addition, 

16
 
African American farm operators reported a greater variability of health problems by gender and 

type of health problem than did white farm operators. American Indian and Alaska Native farm 

operators had a higher prevalence of respiratory problems, hypertension, and diabetes than white 

farm operators did. American Indian and Alaska Native men reported a greater prevalence of musculoskeletal problems. The study points to areas where additional, focused research will be critical 

for determining whether various illnesses in those occupational groups are job-related, and for 

identifying ways to keep the growing number of minority and female operators healthy and safe. 

Research Tools and Approaches 

EarTalk:An In-The-Ear Communication System for First Responders 

NIOSH researchers designed and patented a communication system, EarTalk, that is built into a 

hearing protector. The EarTalk device uses subminiature microphones and speakers that are 

embedded inside an earplug or an earmuff to pick up the speech signal from the ear canal. The 

speech is transmitted via radio and is electronically processed to restore its natural sound quality. In 

tests of speech intelligibility in noise conducted at an air force base, EarTalk demonstrated excellent performance when compared to much bulkier commercial and military communication headsets. NIOSH researchers also have been working with the Federal Laboratory Consortium for 

Technology Transfer to showcase EarTalk to firefighters, law enforcement, and the military. 

Employer Survey of Respirator Research Needs 

NIOSH and the Department of Labor's Bureau of Labor Statistics (BLS) collaborated to design 

and launch a new voluntary survey of employers' use of respirators as part of ongoing occupational safety and health programs. Employers from private industry in manufacturing, construction, 

mining, agriculture, health care, and services responded to the survey. The survey found that in the 

previous 12 months, respirators were used by 3.3 million employees in 281,800 business establishments, which represents 3.1 percent of all employees and 4.5 percent of all business establishments 

in the United States. Dust masks were the most commonly used respirator, comprising 71 percent 

of all respirators used. Air-purifying respirators were most commonly worn to protect workers 

from exposure to paint vapors and dust, while air-supplied respirators were most commonly worn 

to protect workers from paint vapors and solvents. The findings of the survey will help NIOSH 

and its partners target respirator research to address the greatest areas of need. 

Safe and Effective Method for Cleaning Soiled Work Clothing 

Dust-contaminated work clothing is a constant source of increased dust exposure to a worker until 

it is cleaned or removed. Previous studies have shown that heavily soiled work clothing, a common 

problem in many industries, can cause a tenfold increase in a worker's respirable dust exposure. 

NIOSH, working in cooperation with a mineral-processing corporation, has developed a quick and 

effective system for cleaning soiled work clothing. The system uses a compressed air nozzle manifold to blow dust from the clothing in an enclosed booth, which is connected to a dust collector. 

Testing of the system at a silica sand operation showed that it quickly and effectively cleans clothing with minimum exposure to respirable dust when the worker wears properly fit-tested respiratory personal protective equipment. The new method could markedly reduce silicosis and other related chronic lung diseases by directly reducing exposures for as many as 128,000 workers in stone, 

17
 
nonmetal, and sand and gravel operations. Possibly, this method also could be used in surface coal 

mines, reducing exposures for another 40,000 workers, or any other industry where worker's clothing becomes contaminated with product or dust. 

A Method for Assessing Exposure to Anthrax or Multiple Pesticides 

NIOSH developed and validated a new, faster, and less costly method for analyzing urine and 

blood to determine whether decontamination workers are exposed to anthrax, and whether agricultural workers are exposed to potentially hazardous pesticides. Existing methods required separate 

analyses for individual samples. The new NIOSH method can be used to identify and measure four 

pesticides simultaneously in a urine sample, and to detect anthrax antibodies in a blood specimen. 

In a study designed to evaluate the validity of the new test for anti-anthrax antibodies, the new test 

was shown to be accurate. 

New Method to Identify Risk for Job-Related Histoplasmosis 

A new method developed and patented by NIOSH offers an inexpensive, fast way to determine if 

workers are at risk of exposure to fungal spores that cause histoplasmosis, a respiratory infection. 

Histoplasmosis produces flu-like symptoms such as fever, chest pain, chills, cough, and joint or 

muscle pain. It also can result in chronic lung disease. In its severest form, the infection can cause 

fatal illness. The fungus that causes histoplasmosis, Histoplasma capsulatum, is found widely in 

soil. Workers at risk of exposure include construction workers, bridge inspectors and painters, 

farmers, gardeners, chimney cleaners, workers who install and service heating and air conditioning 

systems, roofers, and pest control workers. The new analytical method developed by NIOSH 

employs a DNA analytical technique, polymerase chain reaction (PCR), to identify the fungus in a 

laboratory sample that can be soil, dust, or other environmental materials from a work area suspected of being contaminated. A laboratory analysis using PCR can be completed in less than two 

days at a cost of $60. The traditional, multi-step method requires the analysis of tissue cultures 

from laboratory mice, takes several weeks to complete, and typically costs several hundred dollars. 

New Method for Detecting the Presence of Lead 

Workers involved in the renovation of building, removal of lead-based paint, or metal industries 

may be exposed to lead. NIOSH developed a new assessment method to detect worker exposure 

to this environmental hazard: a handwipe that can quickly and easily detect the presence of lead on 

skin, vehicles used in industries where lead is produced or used, and surfaces such as tables, floors, 

walls, and window sills. The handwipe, which was recently patented, indicates the presence of lead 

through a simple color change, thus alerting workers that there is some level of lead contamination 

and that he or she should perform more thorough hand washing. 

Assessment of Engineering Noise Controls in Underground Metal Mines 

Noise-induced hearing loss is the most common occupational illness in the United States today. 

More than 30 million workers are exposed to excessive noise levels. Engineering controls for noise 

can address the problem of occupational hearing loss, but applying these controls to the mining 

industry has been difficult. NIOSH researchers have been assessing the effectiveness of existing 

noise controls and have found that many of them are ineffective. An example of an effective control is a "windshield" used on roof bolters that reduces noise levels by 5 dB(A) on average. The 

18
 
findings of this study will be disseminated to the mining industry through handbooks and seminars 

to help focus noise control efforts on areas where they will have the most impact. 

NORA and Emergency Preparedness 

The terrorist attacks of September 11, 2001 the anthrax attacks of October 2001 presented 

unprecedented levels of occupational safety and health risks to rescue and recovery workers, postal 

workers, government employees, and news media offices. In addition to providing immediate onsite technical expertise at the sites involved in these critical public health events, NIOSH initiated 

new research activities to address long-term needs and strengthen preparedness. Many of these 

activities address NORA priority research areas, such as Traumatic Injuries, Asthma and Chronic 

Obstructive Pulmonary Disease, Musculoskeletal Disorders, Emerging Technologies, Mixed 

Exposures, Special Populations at Risk, Control Technology and Personal Protective Equipment, 

and Exposure Assessment Methods. 

Highlights include: 

¿Needs for research on approaches to help protect emergency responders in a terrorist attacks 

were identified by stakeholders at a national workshop convened by NIOSH in December 2001 to 

gather information and recommendations on the performance, availability, and appropriateness of 

personal protective equipment for emergency responders in terrorist attacks. The workshop drew 

more than 150 participants, including fire fighters, fire fighting special operations, emergency medical services, law enforcement, construction and other trade services, and health and safety professionals, including state and federal agencies, and focused on lessons learned from the terrorist 

attacks on the World Trade Center and the Pentagon last September and from the bombing of the 

Alfred P. Murrah Federal Building in Oklahoma City in 1995. NIOSH funded a report of the 

workshop, which was released by RAND and is available on-line at www.cdc.gov/niosh/npptl. The 

report shows a need for research, training and other strategic approaches to help protect emergency responders in terrorist attacks. The report also highlights the need for a research agenda that 

outlines comprehensive personal protective technology, and improved federal education and training programs and other activities pertaining to the health and safety of emergency responders in 

rescue, recovery, and restoration efforts. In combination with other information such as injury and 

exposure data, NIOSH is using the report in working with partner organizations to plan new 

research on emergency responder safety and personal protective technologies, identify priority 

needs for guidelines, develop guidelines in forms that will be most useful, and disseminate guidelines broadly. 

¿NIOSH is evaluating research to develop and evaluate technologies for better protecting emergency responders and other workers in terrorist attacks. 

¿NIOSH is developing guidelines for emergency responders on the selection, use, and maintenance of respirators and other personal protective equipment in disaster situations. 

¿NIOSH is examining ways to use sampling technologies in innovative ways. For example, during 

the October 2001 anthrax attacks, NIOSH adapted a vacuuming technique using an "allergy sock," 

a method originally developed to measure allergens, to provide a more sensitive, comprehensive 

way to collect anthrax samples at large postal facilities. 

19
 
¿NIOSH engineering experts and scientists evaluated 65 buildings to assess the vulnerabilities of 

building air environments, including heating, ventilation, and air-conditioning (HVAC) systems, to a 

terrorist attack with chemical, biologic, and radiologic agents and to develop cost-effective prevention and control strategies. NIOSH used the results of these assessments to develop guidelines for 

safeguarding building ventilation systems, which were published in May 2002. NIOSH published a 

companion document providing guidance for filtration and air-cleaning systems in May 2003. Both 

sets of guidelines were developed in conjunction with the Department of Homeland Security and 

are available on-line at www.cdc.gov/niosh/topics/emres/default.html. 

Extramural Research: 

NORA has allowed NIOSH to diversify its research portfolio to fund research on the numerous 

occupational safety and health issues affecting workers. Each year NIOSH awards new grants in 

NORA priority research areas, frequently in conjunction with federal funding partners. In FY 2002, 

14 federal agencies - including 12 partners at the National Institutes of Health, the Health 

Resources and Services Administration, and the Agency for Healthcare Research and Quality - cosponsored announcements with NIOSH. NIOSH funded 71 new NORA awards in FY 2001 and 

65 in FY 2002 (see listings below). 

FY 2001 NORA Awards 

Allergic and Irritant Dermatitis 

Dermal Hazards in the Workplace: Assessment of 

Protection & Exposure 

Timothy Buckley, Ph.D.
 

The Johns Hopkins University
 

Dermatopharmacokinetics and Pharmacodynamics: 

In Vivo Analysis of Common Paint Product 

Karla D. Thrall, Ph.D. 

Battelle Memorial Institute 

Asthma & Chronic Obstructive Pulmonary 

Disease 

Disease in Chinese Textile Workers 

David C. Christiani, M.D. 

Harvard School of Public Health 

Validated Asthma Questionnaire for Healthcare 

Workers 

George L. Delclos, M.D. 

University of Texas 

PNOR/PNOC Exposures & the Development of 

COPD 

Henry Glindmeyer, D.Engr. 

Tulane University 

Pulmonary Effects of Machining Fluid Aerosols 

Terry Gordon, Ph.D. 

New York University 

Environmental Factors in PI*Z Alpha 1-Antitrypsin 

Deficiency 

Lee S. Newman, M.D.
 

National Jewish Medical & Research
 

Fertility & Pregnancy Abnormalities 

Endocrine Disruptors and Neurodevelopmental 

Outcome 

Brenda Eskenazi, Ph.D. 

University of California, Berkeley 

Reproductive Effects from Occupational Exposure to 

Boron 

Wendie A. Robbins, Ph.D. 

University of California 

20
 
Hearing Loss 

Adverse Effects of Noise on Hearing: Basic 

Mechanisms 

Barbara A. Bohne, Ph.D. 

Washington University 

Musculoskeletal Disorders: Low Back 

Occupational Low Back Pain in Residential 

Carpentry: Elements of Posture and Strain 

Robin E. Herron, Ph.D. 

Colorado State University 

Biomechanical and Psychosocial Risks for Low Back 

Disorders 

William S. Marras, Ph.D. 

Ohio State University 

Floor Slope Effects on Lifting Kinematics and 

Kinetics 

Raoul F. Reiser, II, Ph.D. 

University of Wyoming 

Musculoskeletal Disorders: Upper Extremities 

Effects of Repetitive Work on Fatigue of Long 

Duration 

Steven L Lehman, Ph.D. 

University of California 

Musculoskeletal Disorder Follow-up in Automobile 

Manufacturing 

Laura Punnett, Sc.D. 

University of Massachusetts 

A Model for Wrist and Elbow Musculoskeletal 

Disorders 

David Michael Rempel, M.D. 

University of California 

Cumulative Trauma Disorder: Skeletal Muscle 

Dysfunction 

William T. Stauber, Ph.D. 

West Virginia University 

Traumatic Injuries 

Wisconsin Dairy Traumatic Occupational Injury 

Intervention 

Larry John Chapman, Ph.D. 

University of Wisconsin 

Evaluation of Traumatic Injuries in Health Care 

Workers During Surgery 

Denise M. Korniewicz, DNSc 

University of Maryland 

Work-Related Assault: Impact of Training and Policy 

Nancy Nachreiner, M.P.H. 

University of Minnesota 

Trucking Firm Characteristics, Driver Injury and 

Outcome 

Arthur Oleinick, M.D. 

University of Michigan 

Work-Related Motor Vehicle Crashes: Reducing the 

Burden 

Pamela B. Peele, Ph.D. 

University of Pittsburgh 

A Strong Construction Injury Prevention Intervention 

at the Subcontractor Level 

Robert J. Pleasure, J.D.
 

Centers to Protect Workers' Rights
 

Indoor Environment 

Floor-Supply Displacement Ventilation System 

Qingyan Chen, Ph.D.
 

Massachusetts Institute of Technology
 

Health and Socioeconomic Consequences of NonSpecific Building-Related Illness 

Carrie Redlich, Ph.D. 

Yale University 

An Indoor Environment Design Tool for Entire 

Buildings 

Jelena Srebric, Ph.D. 

Pennsylvania State University 

Mixed Exposures 

Organic Solvent Mixtures & Neuropsychological 

Outcomes 

Ellen Kirrane, M.S. 

University of North Carolina 

Silica Exposure & Silicosis: 

Effect of Mixed Exposures 

Gurumurthy Ramachandran, Ph.D. 

University of Minnesota 

Microbiological Air Contamination from 

Machining Fluids 

Tiina Reponen, Ph.D. 

University of Cincinnati 

Experimental and Computational Methods for 

Quantitating the Absorption of Complex Chemical 

Mixtures Through Skin 

Jim Riviere, D.V.M., Ph.D. 

North Carolina State University 

21
 
Complex Mixture Modeling of 

Organophosphate Pesticides 

Charles Timchalk, Ph.D. 

Battelle Memorial Institute 

Organization of Work 

Extended Work Schedules and 

Health Outcomes in the US 

Fabio Barbone, M.D., Ph.D. 

University of Alabama 

Effects of Extended Work Hours on 

Intern Health and Safety 

Charles Andrew Czeisler, M.D., Ph.D. 

Brigham and Women's Hospital 

Impacts of Demanding Work Schedules: 

National Survey Findings 

Allard E. Dembe, Sc.D. 

University of Massachusetts 

Work Hours, Musculoskeletal Disorders and 

CVD Risk 

Paul A. Landsbergis, Ph.D. 

Mount Sinai University 

Work Organization and Health Among 

Home Care Workers 

Carles Muntaner, M.D. 

University of Maryland 

Difficult Work Conditions and Youths' Mental Health 

Elizabeth M. Smailes, M.P.H.
 

Research Foundation for Mental Hygiene, Inc.
 

Extended Work Schedules and 

Workplace Injury in Nurses 

Alison M. Trinkoff, Sc.D., 

University of Maryland 

Special Populations at Risk 

Casa A Campo: 

Pesticide Safety for Farmworkers' Families
 

Thomas Arcury, Ph.D. 

Wake Forest University 

Worker Genetic Susceptibility to Mutagenic Risk 

Paul Wesley Brandt-Rauf, M.D. 

Columbia University 

Effects of Aging on the Biomechanics of 

Slips and Falls 

Thurmon Eddy Lockhart, Ph.D. 

Virginia Polytechnic Institute 

Sustained Work Indicators of Older Farmers 

Deborah B. Reed, Ph.D. 

University of Kentucky 

Cancer Research Methods 

Development of a Simplified 2-Stage Cancer Model 

David Kriebel, Sc.D.
 

University of Massachusetts at Lowell
 

Control Technology and 

Personal Protective Equipment 

Field Studies with Innovative Safe 

Excavation Technologies 

Leonhard E. Bernold, Ph.D. 

North Carolina State University 

Sunscreens, Agricultural Chemicals & 

Dermal Absorption 

Rhonda Brand, Ph.D. 

University of Nebraska 

Safe Alternative Solvents for Antibiotics Extraction 

Jennifer F. Clark, Ph.D. 

Eltron Research, Inc. 

Respiratory Protection Against 

Bioaerosols in Agriculture 

Tiina Reponen, Ph.D. 

University of Cincinnati 

Hearing Protector Allowing Acoustic Communication 

Patrick M. Zurek, Ph.D. 

Sensimetrics Corp. 

Exposure Assessment Methods 

Investigating Principles of Workroom Exposure 

Charles E. Feigley, Ph.D. 

University of South Carolina 

Numerical Modeling of Size-Specific Aerosol 

Concentration 

Michael Riordan Flynn, Sc.D. 

University of North Carolina 

Comparison of Concentrations at Personal Exposure 

Sampling Locations 

Steven E. Guffey, Ph.D. 

West Virginia University 

Evaluation of Air Samples with 

Field Analysis for Lead 

Martin Harper, Ph.D. 

University of Alabama 

22
 
Germicidal UV Occupational 

Exposure Personal Monitoring 

Gary D. Havey, MEE
 

Advanced Medical Electronics Corp.
 

Novel Hydrogen Sulfide Sensors for 

Portable Monitors 

Matthew Hooker, Ph.D. 

Nanomaterials Research Corporation 

Workplace Surface Contamination & Dermal 

Exposure to Isocyanate 

Roy Rando, Sc.D. 

Tulane University 

Real-Time Personal Monitor for the 

Drycleaning Industry 

Ross C. Thomas, Ph.D. 

Eltron Research, Inc. 

Electrostatic Sampling of Airborne Microorganisms 

Klaus Willeke, Ph.D. 

University of Cincinnati 

Molecular Analysis of Mycobacteria in Cutting Fluids 

Jagjit S. Yadav, Ph.D. 

University of Cincinnati 

Intervention Effectiveness Research 

Effectiveness of Computer-Based Training: cTRAIN 

Kent W. Anger, Ph.D. 

Oregon University 

Innovative Health Care Worker Training: 

Infectious Disease Risk 

Robyn Gershon, DrPH 

Columbia University 

Effects of Physical Conditioning on 

Lifting Biomechanics 

Kevin P. Granata, Ph.D. 

University of Virginia 

Occupational Safety and Health 

Training for Teleworkers 

Susan Shemanski Harrington, M.S. 

Harrington Software 

Control of Workplace Noise Exposure 

Murray R. Hodgson, Ph.D. 

University of British Columbia 

Effectiveness of Farm Safety Day Camps for Children 

Debra Moehle McCallum, Ph.D. 

Institute for Social Science 

Effectiveness of a Machine Guarding Intervention 

David L. Parker, M.D.
 

Minnesota Department of Health
 

Evaluation of Farm Safety 4Just Kids Day Camps 

Deborah B. Reed, Ph.D. 

University of Kentucky 

Risk Assessment Methods 

Physiologically-Based Pharmacolinetic/Clonal 

Growth Modeling: Predicting Cancer 

Potential of Chemical Mixtures 

Raymond S.H. Yang, Ph.D. 

Colorado University 

Social and Economic Consequences of 

Workplace Illness and Injury 

Disability Risk in Work-Related 

Musculoskeletal Injuries 

Gary Michael Franklin, M.D. 

University of Washington 

Social/Economic Impact of Injury/Illness in 

Career Roofers 

Laura S. Welch, M.D. 

MedStar Research Institute 

Surveillance Research Methods 

Occupational Surveillance Modules for Prevention 

David Bonauto, M.D., M.P.H. 

Washington Department of Labor and 

Industries 

Core Occupational Health Surveillance in 

Massachusetts 

Letitia K. Davis, Sc.D.
 

Massachusetts Department of Public Health
 

FY 2002 NORA Awards 

Asthma & Chronic Obstructive 

Pulmonary Disease 

COPD Risks in Carpenters 

David Wegman, M.D. 

University of Massachusetts 

Isocyanate Exposure Intervention Study in 

Body Shops 

Youcheng Liu, M.D., Sc.D. 

Yale University 

23
 
Longitudinal Study of Isocyanate Asthma in 

Body Shops 

Mark R. Cullen, M.D. 

Yale University 

Physiologic Characterization of Occupational Asthma 

Susan Sama, Sc.D. 

Harvard University 

Fertility & Pregnancy Abnormalities 

Developmental Immunotoxicity of Atrazine 

John B. Barnett, Ph.D. 

West Virginia University 

Hearing Loss 

Development of A School-Based Hearing 

Conversation Program for Use in Rural Areas 

Gregory A. Flamme, Ph.D. 

University of Iowa 

Models for Assessing Risk of 

Occupational Hearing Loss 

Laurence D. Fechter, Ph.D. 

University of Oklahoma 

Noise, Solvents, and Hearing Loss 

Peter M. Rabinowitz, M.D. 

Yale University 

Infectious Diseases 

A Case-crossover Study of Sharps-related Injuries 

Murray A. Mittleman, M.D., DrPH 

Beth Israel Deaconess Medical Center 

Body Substance Exposures: 

Risk Factors and Psychological Impact
 

Hilary M. Babcock, M.D. 

Washington University 

Musculoskeletal Disorders: Low Back 

Lift Aid Use in Reducing Injuries in 

Nursing Personnel 

Paula Christine Bohr, Ph.D. 

Maryville University 

Neuro-Fuzzy Prediction of Spine Loads in 

Response to Risk Factors 

William S. Marras, Ph.D. 

Ohio State University 

Reducing Low-Back Disorders Using a 

New Sitting Design 

Mohsen Makhsous, Ph.D. 

Rehabilitation Institute of Chicago 

Musculoskeletal Disorders: Upper Extremities 

Biomechanical Effects of Industrial 

Eccentric Exertions 

Robert G. Radwin, Ph.D. 

University of Wisconsin 

Computer Use and Musculoskeletal Disorders 

Carolyn P. Monteilh, M.D., Ph.D. 

Emory University 

Ergonomic Interventions for Garment Work 

Beate R. Ritz, M.D., Ph.D. 

University of California 

Musculoskeletal Stress in Repetitive Precision Tasks 

Victor Paquet, Sc.D. 

University of Buffalo 

Prevention of MSDs in Plant Nursery Work 

John A. Miles, Ph.D. 

University of California 

Upper Limb Musculoskeletal Disorders: 

Quantifying Risk 

Arun Garg, Ph.D.
 

University of Wisconsin-Milwaukee
 

Traumatic Injuries 

Adolescent Farm Work, Fatigue and 

Injuries in Colorado 

Lorann Stallones, Ph.D. 

Colorado State University 

Auditory Motion and Pedestrian-Motor 

Vehicle Collisions 

John G. Neuhoff, Ph.D. 

College of Wooster 

Evaluation of California Initiatives to Reduce 

Violence in Health Care Settings 

Corrine Peek-Asa, Ph.D. 

University of Iowa 

Evaluation of Workplace Violence 

Prevention Intervention 

Jane A. Lipscomb, Ph.D. 

University of Maryland 

24
 
Organizational Factors Affecting Police Victimization 

Lorie Ann Fridell, Ph.D.
 

Police Executive Research Forum
 

Risks for Workplace Violence in Long-Haul Truckers 

Debra G. Anderson, Ph.D. 

University of Kentucky 

Spokane Workplace Domestic Violence Initiative 

Christopher Jay Blodgett, Ph.D. 

Washington State University 

Surveillance Research Methods in 

Construction Injury 

Judith E. Glazner, M.S. 

University of Colorado 

Workplace Violence Risk in the 

Home Health Work Place 

Jane A. Lipscomb, Ph.D. 

University of Maryland 

Indoor Environment 

Microanalytical System for Indoor VOC Monitoring 

Edward T. Zellers, Ph.D. 

University of Michigan 

Organization of Work 

Management Practices as a Factor in 

Workplace Violence 

Tony B. Lowe, MSW 

University of Pittsburgh 

Work Organizational Factors and 

Psychological Distress 

Omowunmi Y. Osinubi, M.D.
 

University of Medicine and Dentistry of New Jersey
 

Special Populations at Risk 

Biomechanics of Human Reactions to Slip Events 

Cham Dit Tham Rakie, Ph.D. 

University of Pittsburgh 

Biomechanics of Slips in Older Adults 

Rakie Cham Dit Tham, Ph.D. 

University of Pittsburgh 

Pilot Study of Ag-related Injuries 

Impacting Amish Community 

William E. Field, Ed.D. 

Purdue University 

Cancer Research Methods 

P53 Biomarker and Intervention in 

Occupational Cancer 

Paul W. Brandt-Rauf, M.D. 

Columbia University 

Susceptibility and Occupational Radiation Risks 

David B. Richardson, Ph.D. 

University of North Carolina 

Time-Factors in Exposure Effects Among 

Uranium Workers 

David B. Richardson, Ph.D. 

University of North Carolina 

Control Technology and 

Protective Equipment 

Bioelectronic Telemetry System for Firefighter Safety 

Michael Fred Masterman 

Extreme Endeavors and Consulting 

Control Measures for Silica 

Exposures for Tuckpointing 

William A. Heitbrink, Ph.D. 

University of Iowa 

Engineering Control of Longwall Machine Noises 

Yi Luo, Ph.D.
 

West Virginia University
 

Improved Health and Safety in Mining through 

Helical Drilling and Rock Bolt Anchoring 

John L. Hill, M.S. 

UTD Incorporated 

Integrated Stability Mapping System for Mines 

Keith A. Heasley, Ph.D. 

West Virginia University 

Measurements and Control of Diesel Emissions in 

Underground Mines 

Mingming Lu, Ph.D. 

University of Cincinnati 

On-Board Diagnostic Sensor for 

Respirator Breakthrough 

Debra J. Deininger, B.S. 

Nanomaterials Research Corporation 

Use of Digital Imagery to Characterize Rock Masses 

John M. Kemeny, Ph.D. 

University of Arizona 

25
 
Exposure Assessment Methods 

A Novel and Non-Invasive Method of Dermal 

Sampling for Exposure Assessment 

Samir Mitragotri, Ph.D. 

University of California 

Biological Monitoring of Woodsmoke Exposure 

Christopher D. Simpson, Ph.D. 

University of Washington 

Field Glove Permeation Instrumental 

Methods Development 

Shane Que Hee, Ph.D. 

UCLA 

Health Effects of Occupational Exposures in 

PGDP Workers 

David J. Tollerud, M.D., M.P.H. 

University of Louisville 

Improved Methods for Dermal Exposure Estimation 

Gerald B. Kasting, Ph.D. 

University of Cincinnati 

Inhalation Dosimetry/Exposure Index of Fiber 

Aerosol in Human Respiratory Tract 

Yung-Sung Cheng, Ph.D.
 

Lovelace Biomedical & Environmental Research Institute
 

New Methods for Evaluation of Organic Dust 

Aerosols-Colorado 

Stephen J. Reynolds, Ph.D. 

Colorado State University 

Pesticide Dose Monitoring in Turf Appplicators 

Shelley A. Harris, Ph.D.
 

Virginia Commonwealth University
 

Predicting Relative Workload During Physically 

Demanding Work 

Tariq Abdelhamid, Ph.D. 

Michigan State University 

Real-time In Situ Aerosol Monitoring in 

Mine Atmospheres 

Marc M. Baum, Ph.D.
 

Oak Crest Institute of Science
 

Real-Time, In-Use PM Measurement from 

Diesel Engines 

Mridul Gautam, Ph.D. 

West Virginia University 

Validation of Biomarkers in Humans 

Exposed to PAHs 

Qingshan Qu, M.D. 

New York University 

Intervention Effectiveness Research 

Designing Ergonomic Interventions 

for the Fire Service 

Karen Conrad, Ph.D. 

University of Illinois 

Effectiveness of Intervention on Health 

Lisa M. Brosseau, Sc.D. 

University of Minnesota 

Evaluating Preassembly of 

Roof Structural Components 

Pamela A. Kidd, Ph.D. 

Arizona State University 

Intervention Research on Work 

Organization Factors and Health 

Chantal Brisson, Ph.D. 

University of Quebec 

Risk Assessment Methods 

Stochastic Models for Radiation Carcinogenesis: 

Temporal Factors and Dose-Rate Effects 

Suresh H. Moolgavkar, Ph.D.
 

Fred Hutchinson Cancer Research Center
 

Social and Economic Consequences of 

Workplace Illness and Injury 

Unclaimed Injuries and Workers' 

Compensation Adequacy 

Darius N. Lakdawalla, Ph.D. 

RAND 

Surveillance Research Methods 

Capture-Recapture Estimates of 

Workplace Injury Rates 

Leslie I. Boden, Ph.D. 

Boston University 

Connecticut: Occupational Disease Surveillance 

Enhancement Project 

Mary Lou Fleissner, Dr.PH 

State of CO 

26
 
RFA’s 

In Fiscal Years 2002 and 2003, NIOSH announced the following Requests for Applications (RFAs) that target 

NORA-related areas of research. Note that two of the RFAs were funded collaboratively with NIH partners. 

FY 2002 

¿Mining safety related to hearing loss, particulate dust exposure, ground failure, large equipment operation, diesel 

exhaust exposure, and chemical hazards in mines. 

¿Hearing sensitivity and exposure to noise and/or chemicals. 

¿Exploratory/developmental grants in work organization: cardiovascular disease, work organization: depression, 

health care workers including violence, chronic obstructive pulmonary disease (COPD) and work, traumatic injury, 

hearing loss, agricultural injuries to children, and intervention effectiveness research in occupational health. 

¿Prevention and treatment of musculoskeletal disorders, funded collaboratively with the NIH's National Institute 

of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). 

¿Workplace Violence Prevention Research related to risk factors and the development and evaluation of 

new/existing interventions (see page 28 for more information). 

FY 2003 

¿Environmental justice and building partnerships for communication, funded collaboratively with the NIH's 

National Institute of Environmental Health Sciences' (NIEHS) (see page 31 for more information). 

¿Childhood Agricultural Safety and Health Research for development and implementation of intervention strategies for youth, children and adolescents who are exposed to agricultural hazards. NORA targeted areas: traumatic 

injuries, special populations at risk, intervention effectiveness and social and economic consequences of workplace illness and injury. 

¿Community Partners program to conduct community-based pilot intervention /prevention research. NORA 

targeted areas: traumatic injuries, special population at risk, intervention effectiveness, and social and economic 

consequences of workplace illness and injury. 

¿Using exposure assessment methods to identify musculoskeletal disorders, specifically low back disorders. 

Progress in NORA Extramural Research 

The following examples highlight research accomplishments in NORA priority areas made by some 

NIOSH-funded investigators, as well as some new NORA extramural research initiatives. 

Disease and Injury 

Hearing Damage in Newly-Hired Construction Workers 

Noise induced hearing loss, a common occupational disorder of construction workers, progresses 

slowly and is often undetected until hearing impairment interferes with communication and poses a 

safety hazard issue. NIOSH is funding a prospective study at the University of Washington to 

examine the exposure-response relationships for noise-induced hearing loss, particularly high-variable noise exposures found in construction. Noise exposures were monitored in newly hired con27
 
struction apprentices in a variety of trades to characterize the effects on hearing acuity. The study 

has begun to contribute to the knowledge of dose-response relationships of occupational noise 

exposure on cochlear function, hearing sensitivity, and noise-induced permanent threshold shifts. 

Isocyanate Asthma in Auto Body Shops 

Exposure to isocyanates accounts for the highest number of reported cases of occupational asthma in developed countries. Limited knowledge of isocyanate exposure pathways and risk factors 

which lead to and exacerbate the disease, hinders diagnosis and prevention. Researchers at Yale 

University and NIOSH conducted a case-control study of auto body spray painters and co-workers 

exposed to hexamethyl diisocyanate (HDI) to develop a method for the diagnosis of isocyanate 

asthma, characterize exposure patterns and the relationship between exposure and risk for asthma 

development, and identify biomarkers of acquired and genetic susceptibility factors leading to 

improved diagnosis and prevention. Results indicate that while there was less isocyanate asthma 

diagnosed among auto body workers, more reports of symptoms and respiratory and immunological responses were observed. Understanding the mechanism of asthma due to chemicals could lead 

to strategies for control of other important causes of asthma, including factors responsible for the 

apparent epidemic of asthma in the United States and other developed countries. 

Occupational Traumatic Hand Injuries 

Information on transient factors that exist prior to traumatic injury is limited. NIOSH funded 

researchers at Harvard University to conduct a case-crossover study of occupational traumatic 

injury to the hand, wrist, and fingers to identify and evaluate the association of these traumatic 

injuries to transient features of work equipment, work practices, worker-related factors, and interactions with workplace characteristics. Significant increases in the risk of traumatic hand injuries were 

observed due to certain work equipment, practices and environment factors such as unusual work 

method or task, distractions, and being rushed. These results can be used to develop specific interventions designed to reduce hand injuries. 

Endocrine Disruptors and Neurodevelopmental Outcome 

Agricultural pesticides may be the most significant environmental endocrine disruptors in the 

United States. Although animal studies suggest that endocrine-disrupting pesticides potentially 

could affect neurodevelopment, no studies to date have examined these effects in humans. With 

support from NIOSH, researchers at the University of California, Berkeley, are conducting a 

prospective study of neurobehavioral function among children born to a cohort of Latino farm 

workers living in the Salinas Valley of California. The purpose of the study is to: 1) determine 

whether in utero exposure of children of women exposed to endocrine-disrupting pesticides is 

associated with adverse effects on the offspring's neurobehavioral development and 2) to develop 

appropriate interventions to reduce exposures to endocrine-disrupting pesticides. 

Workplace Violence Research Initiative 

Workplace violence is a compelling safety and health problem, with 677 workplace homicides 

occurring in 2000. From 1993-1999, there were an estimated 1.7 million nonfatal victimizations at 

the workplace, accounting for 18% of all violent crime during that period. Acknowledging 

NIOSH's longstanding commitment to research on workplace violence, Congress appropriated $2 

28
 
million for this purpose in December 2001. Approximately $1.8 million of these funds were targeted to support extramural research activity. In Fiscal Year 2002, NIOSH funded five new research 

grants that will add to the existing body of knowledge and improve the recommendations for prevention of workplace violence in various settings. Four will focus on identifying risk factors for 

workplace violence in four diverse occupational groups (social service workers, healthcare employees, police officers, and long-haul truckers), and the fifth will focus on research to increase the 

identification of domestic violence in the workplace. Also as part of the initiative, NIOSH will be 

conducting outreach to other federal agencies as well as a broad range of researchers, industry 

groups, union and worker representatives, and violence prevention groups. All projects address 

research priorities identified in recommendations from a workshop of experts from industry, labor, 

government, and academia held in April 2000. The workshop was co-sponsored by the University 

of Iowa Injury Prevention Research Center and NIOSH. 

Musculoskeletal Disorders in Nurses 

Health care workers, especially nurses, are at increased risk for developing neck, shoulder, and back 

disorders. Through NIOSH funding, researchers at the University of Maryland examined the relationship between musculoskeletal disorders (MSDs) and physical work factors, as well as the effect 

of modifying the organization of work factors in particular work settings. Data on neck, shoulder 

and back MSDs were analyzed in 1,163 working nurses. It was shown that nurses performing tasks 

with high physical demands, such as use of force, awkward postures, and heavy lifting were more 

likely to experience MSDs than nurses performing tasks with low or moderate demands. In addition, individual and organizational factors were identified that affect the relationship between physical factors and MSDs. For example, modifying certain administrative procedures reduced the risk 

of disorders in nurses. These findings can be used to establish intervention strategies in health care 

and other industries. 

Symptoms of Musculoskeletal Disorders (MSDs) Among Apprentice Construction Workers 

MSDs are a major cause of work-related disability and lost-time illnesses for many occupational 

groups. Through a cooperative agreement with NIOSH, the Center to Protect Workers' Rights (the 

research, development, and training arm of the Building and Construction Trades Department of 

AFL-CIO) gave a self-administered survey of related symptoms was to apprentice construction 

workers in four trades in four states. A high prevalence of low back (54%) and wrist symptoms 

(43%) was documented which resulted in lost work time. These results have identified the need to 

target apprentice training programs to provide young workers prevention strategies, ergonomic education, and encouragement to seek early medical intervention to reduce chronic problems. 

Work Enforcement and Workforce 

Work Organization Factors and Life Expectancy 

A study conducted by researchers at the University of Texas and jointly funded by NIOSH and the 

NIH's National Institute of Aging is the first to demonstrate a link between cumulative work experience in "passive" jobs and a risk of shortened life expectancy. Passive jobs were defined as those 

in which the individual has both few psychological demands and little job control. The study examined data from the Panel Study of Income Dynamics (PSID), an ongoing longitudinal study of a 

29
 
representative sample of United States residents. The working conditions of over 8000 workers 

were assessed from 1968 through 1992. The study found that people who worked at jobs with little 

decision-making opportunities for their entire working life were 43% more likely to die than those 

with more of these opportunities. This effect could be seen even after adjusting for other significant stressors such as baseline health problems, retirement and periods of unemployment. In addition, the study demonstrated that for persons in passive jobs with low psychosocial demands and 

low control for their working life, the increased risk was 35% and could continue for up to 10 years 

after leaving the job. Another key finding is that income does not contribute to the worker's shortterm mortality experience. 

Impact of Low-Emission Diesel Engines on Underground Mine Air Quality 

Diesel exhaust, a complex mixture of noxious gases and diesel particulate matter, is classified as a 

potential carcinogen. Exposure to diesel exhaust is especially problematic in underground mines, 

where large diesel engines are used with minimal ventilation. To reduce emissions, some mine operators are adopting low-emission diesel engines and fuel with low sulfur content. NIOSH funded 

researchers at Michigan Technological University to investigate whether adoption of this new technology could inadvertently introduce new occupational health hazards. After measuring mass concentration, chemical composition, and physical characteristics of diesel particulate matter in an 

underground mine, it was concluded that electronically controlled, low-emission, low-sulfur engines 

significantly reduced levels of diesel particulate matter and other potentially hazardous components 

of diesel exhaust, without causing adverse health effects. This research has broad application for 

reducing occupational exposure to diesel emissions. 

Assessing the Effectiveness of Pesticide Training for Adolescent Migrant Farmworkers 

Historically, both traditional agricultural youth activities and health/safety training programs for 

adult farmworkers often neglect the teen farm worker population. With NIOSH support, the 

University of California at Berkeley's Labor Occupational Health Program and its partners are 

assessing the effectiveness of training programs, specifically studying the effect of teaching teen 

farmworkers about agricultural health and safety through school-based ESL (English as a Second 

Language) classes. This study primarily focuses on Latino adolescent farmworkers living in 

California's San Joaquin Valley, and will focus on evaluating whether (1) exposure the an existing 

school-based curriculum increases agricultural safety and health knowledge among young farmworkers and (2) whether community-based curriculum increases these outcomes. Intervention findings from this study will be integrated into ESL curriculum with the intention of decreasing potential work-related illness and injury among adolescent migrant farmworkers through targeted occupational safety and health training in the classroom. 

Extended Work Schedules and Health Outcomes 

Data from the Bureau of Labor Statistics (BLS) show that the proportion of persons working 

more than 40 hours per week increased during the 1990s. The National Sleep Foundation reports 

that in year 2000 Americans slept less, worked more, and spent less time to conduct leisure activities than ever before. Extended work schedules may result in adverse health outcomes, yet limited 

scientific evidence exists to support this hypothesis. NIOSH is funding researchers at the 

University of Alabama to assess the relationship between overtime work and worker health and 

30
 
safety in various industries, controlling for other risk factors such as existing medical conditions 

and lifestyle choices. A nationally representative sample will be used from the Medical Expenditure 

Panel Survey. Results may be useful for the prevention of specific occupational safety and health 

hazards on a regional or national basis. 

Environmental Justice and Special Populations 

NIOSH has joined the NIH's National Institute of Environmental Health Sciences (NIEHS) in a 

grant solicitation focusing on environmental justices and special populations. The purpose of this 

program is to strengthen the support of NIEHS and NIOSH for research aimed at achieving environmental justice for socioeconomically disadvantaged and medically underserved populations in 

the United States. The program is meant to promote health research, education, and intervention 

programs that will improve ways to serve low income, immigrant, and minorities who may be disproportionately exposed to environmental and occupational hazards. 

Research Tools and Approaches 

Surveillance Research Methods: State Cancer Registries 

State cancer registries provide useful surveillance data on the incidence and mortality of cancers 

identified in state populations, but their usefulness in evaluating cancer incidence for occupational 

cohorts is relatively unexplored. With NIOSH support, the Minnesota Department of Health evaluated the use and limitations of record linkage between occupational cohort studies and the state 

cancer registry as a method for occupational cancer surveillance. Results demonstrated that 

statewide cancer registry data can be used to evaluate the incidence of cancer in two occupational 

cohorts. 

Methods for Developing and Testing Aerosol Samplers 

Respiratory allergies and infections due to airborne microorganisms can result in workers taking 

more sick days, causing economic loss due to reduced productivity. The quality of exposure assessment for bioaerosol identification and concentrations present in agricultural, industrial, and indoor 

environments depends on the type and efficiency of the sampling method or instrument used. 

Funded by NIOSH, researchers at the University of Minnesota developed a sampling technique to 

collect microorganisms using an electrostatic field that maintains biological integrity for further 

evaluation. Collection efficiency and viability compared favorably with that of other collection 

methods in various indoor and field environments. This new method can be applied in occupational environments where airborne microorganisms are naturally present or released during the industrial processes. 

Exposure Assessment Methods: Biomarkers of Smoke Exposure Among Firefighters 

A self-contained breathing apparatus, or SCBA, is standard protective equipment for firefighters. 

However, it is often not used during the cleanup "overhaul" phase of fighting a fire. Limited data 

are available about the types and levels of exposures to combustion products during the overhaul 

stage, and the potential health effects. NIOSH supported at the University of Arizona to characterize the types of contaminants present during overhaul, and assess the use of biomarkers to detect 

and measure acute pulmonary effects in firefighters after overhaul. Results demonstrated that fire31
 
fighters' exposures during this phase have potential to result in acute health effects, and also indicated that cartridge respirators were not effective in protecting firefighters from smoke exposure 

and adverse respiratory effects during overhaul activities. 

Personal Aerosol Sampler for Occupational Environments 

With funding from NIOSH, researchers at the University of Cincinnati have developed a personal 

aerosol sampler with low sensitivity to ambient wind conditions, such as wind speed and direction. 

Additional funding provided by NIOSH was used to evaluate the sampler's performance in occupational environments contaminated with airborne dust and microorganisms, including seven 

species of bacteria and fungi. Airborne particles were used from different sources and with different characteristics such as size distribution, concentration, and chemical composition. For example, 

metal exposure was assessed among abrasive blasting workers at four U.S. Air Force Bases and 

among workers performing lead abatement in indoor environments. The assessment showed that 

the sampler can be successfully used in occupational environments to assess worker exposures. A 

new simplified protocol also was developed for testing at low cost personal aerosol samplers in 

small wind tunnels. 

The Future of NORA 

NIOSH has begun a process to evaluate NORA. In March 2003, NIOSH leadership and the 

NORA Team Leaders created a foundation for an evaluation process. During 2003, NIOSH will 

take the opportunity at a number of scheduled conferences to gather input on ways to evaluate 

NORA and the shape of NORA's future. The June NORA Symposium, for example, will include a 

panel discussion and a working session on the past and future of NORA. During 2004, NIOSH 

will undertake a formal process for stakeholder input on both topics: an evaluation of NORA's 

effectiveness through 2002 and the future course of NORA. 

32
 
NORA Milestones 

July 1995 - June 2003 

NORA Development 

July 1995 . . . . . . . . . .NIOSH commits to lead the creation of a research Agenda for occupational 

safety and health 

September 1995 . . . . .Agenda framework developed and 50 potential topics identified by an initial 

working group of internal and external scientists 

November 1995 . . . . .First National public meeting convened to provide input into the Agenda 

and discuss criteria for priorities 

January 1996 . . . . . . . .Four additional working groups (NIOSH, external researchers, health professionals, other stakeholders) expand and prioritize research areas 

February 1996 . . . . . .Three town meetings (Boston, Chicago, and Seattle) convened 

March 1996 . . . . . . . .Second national public meeting held to review the draft Agenda 

April 1996 . . . . . . . . .Final Agenda unveiled - The National Occupational Research 

Agenda identified 21 priority research areas to guide occupational safety and 

health research (released on NIOSH's 25th Anniversary) 

NORA Implementation Year 1 

November 1996 . . . . .Partnership teams formed for each priority area to implement NORA 

February 1997 . . . . . .First ever survey conducted of federal (non-NIOSH) resources (FY 1996) 

committed to occupational safety and health research 

July 1997 . . . . . . . . . .First NORA Implementation Symposium held at the National Academy of 

Sciences, Washington, D.C. 

NORA Update 1997 document released 

NORA Implementation Year 2 

November 1997 . . . . .Congress appropriated $5 million for the implementation of NORA 

Jan-Feb 1998 . . . . . . .Three NIH Institutes each contributed $1 million to NORA research 

Priorities 

March 1998 . . . . . . . .NIOSH and NIH partners announced a Request for Applications (RFA) for 

the largest ever funding for targeted occupational safety and health research 

($8 million) 

American Association of Occupational Health Nurses and the American 

College of Occupational and Environmental Medicine established a joint 

research award, giving emphasis to NORA in the selection criteria 

33
 
April 1998 . . . . . . . . .NORA logo created 

May 1998 . . . . . . . . . .NORA and the asphalt partnership both selected as semifinalists (two of 

100 semifinalists; two of 19 federal semifinalists) for the Ford Foundation 

and Harvard University's 1998 Innovations in American Government 

Awards Program from an initial pool of 1,420 applicants 

First issue of the NORA newsletter, NORA News, distributed 

NORA Web site mounted 

July 1998 . . . . . . . . . .NORA Update 1998 document released 

September 1998 . . . . .Asphalt research partnership selected as one of 25 finalists in the 1998 

Innovations in American Government awards program First private sector 

funds (Aetna U.S. Health Care) leveraged for NORA research (musculoskeletal disorders project) 

NORA Implementation Year 3 

October 1998 . . . . . .First NORA research grants announced-50 grants totaling $8 million make 

up the single largest infusion of funding ever by the federal government for 

extramural investigator-initiated occupational health and safety research 

NIOSH received permission to trademark the NORA logo 

Congress continued to provide support for NORA through an $11 million 

appropriation in the FY 1999 NIOSH budget 

February 1999 . . . . . .The President's FY 2000 budget proposal to Congress included $12 million 

for NORA to support both intramural and extramural research and related 

activities 

March 1999 . . . . . . . .Second survey of federal (non-NIOSH) resources (FY 1998) committed to 

occupational safety and health research conducted Liaison Committee conducted two surveys to determine the effectiveness and reach of NORA 

among associations and private industry 

NIOSH/NIH invited NORA grant applications for FY 1999 ($9 million) 

April 1999 . . . . . . . . .NIOSH/EPA/NCI announced RFA for $1.5 million for research focusing 

on the development of cancer risk assessment methods and practices 

May 1999 . . . . . . . . . .NORA Update 1999 document released 

First NORA Partnering Award For Worker Health and Safety awarded to 

the Asphalt Research Partnership 

NORA Symposium 1999: Partnership for Research held at the National 

Academy of Sciences, Washington, D.C. 

34
 
NIOSH announced a cooperative agreement with the Association of 

Schools of Public Health to solicit applications for intervention effectiveness research. 

NIOSH announced an RFA to fund research on intervention Effectiveness 

August 1999 . . . . . . . .NIOSH/NIH invited applications through a general program announcement (PA) for research in the 21 NORA priority areas 

NIOSH/NCI/NIEHS announced a PA on research methods for occupational cancer 

NIOSH announced the availability of approximately $500,000 in grants to 

train occupational health services researchers 

NORA Implementation Year 4 

October 1999 . . . . . . .NIOSH awarded $5.4 million in grant funds for 23 projects in seven NORA 

areas 

November 1999 . . . . .Congress continued to provide support for NORA through a $11.3 million 

appropriation in the FY 2000 NIOSH budget 

NIOSH/NIEHS and five other NIH partners announced a $5 million RFA 

to stimulate new research on risk disparities among special Populations 

February 2000 . . . . . .The President's FY 2001 budget proposal to Congress included $4.9 million 

to support research under NORA 

March 2000 . . . . . . . .NIOSH announced RFAs for intervention effectiveness ($1.2 million); surveillance research ($2.5 million); exploratory research in allergic and irritant 

dermatitis, social and economic consequences of workplace injury and illness, health services research, and fertility and pregnancy abnormalities ($1 

million); agriculture-related injuries to children ($1.6 million) and musculoskeletal disorders ($0.9 million). 

April 2000 . . . . . . . . .NIOSH/EPA/NIEHS announced a $5 million RFA on mixed Exposures 

May 2000 . . . . . . . . . .NORA Update 2000 document released 

June 2000 . . . . . . . . . .NIOSH/NIH/EPA announced a $6 million RFA on endocrine disruptors 

and adverse health effects in humans, particularly on reproductive and 

development effects 

December 2000 . . . . .Congress continued to provide support fro NORA through a $9.2 million 

appropriation in the FY 2001 NIOSH budget 

NORA Implementation Year 5 

February 2001 . . . . . .NIOSH announced RFAs for traumatic occupational injury research ($1 

million); extended work schedules ($1 million); and reproductive/develop35
 
mental toxicants ($2 million) 

Third survey of Federal (non-NIOSH) resources (FY 2000) committed to 

occupational safety and health research conducted 

March 2001 . . . . . . . .NIOSH announced training grants for occupational injury prevention ($1 

million) 

April 2001 . . . . . . . . .NIOSH celebrated its 30th Anniversary 

NORA marked its fifth year 

The President's FY 2002 budget proposal to Congress included $1 million 

to support research under NORA 

June 2001 . . . . . . . . . .NORA Symposium 2001: Leading Research in Occupational Safety and 

Health held in Washington, D.C. 

Second NORA Partnering Award for Worker Health and Safety awarded to 

Oregon for "A Strategic Plan for Reducing Occupational Dermatitis in 

Oregon." Partners in Alaska were awarded Honorable Mention for "Crab 

Related Respiratory Illness in Dutch Harbor, Alaska." 

NORA Update 2001 document released 

September 2001 . . . . .Terrorist attacks on the World Trade Center and the Pentagon 

October 2001 . . . . . . .(and November)....Envelopes containing B. anthracis spores were mailed to 

news media companies and government officials, leading to the first bioterrorism-related cases of anthrax in the United States 

NIOSH announced RFAs for mining safety related to hearing loss, particulate dust exposure, ground failure, large equipment operation, diesel exhaust 

exposure, and chemical hazards in mines ($900,000); hearing sensitivity and 

exposure to noise and/or chemicals ($1 million); and exploratory research in 

work organization: cardiovascular disease, work organization: depression, 

health care workers including violence, chronic obstructive pulmonary disease and work, traumatic injury, hearing loss, agricultural injuries to children, 

and intervention effectiveness research in occupational health ($3.2 million) 

NIOSH/NIAMS announced a $2 million RFA on the prevention and treatment of musculoskeletal disorders 

NIOSH received $5 million in emergency supplemental funding to enhance 

initiatives on emergency worker safety, including research. 

December 2001 . . . . .Congress provided support for NORA through a $2 million appropriation 

for NIOSH-funded Education and Research Centers to expand research in 

support of NORA implementation and $2 for a workplace violence 

research initiative in the FY 2002 NIOSH budget 

36
 
NORA Implementation Year 6 

May 2002 . . . . . . . . . .NIOSH announced a RFA for workplace violence prevention research, as 

part of the FY 2002 Workplace Violence Initiative ($1.8 million) 

October 2002 . . . . . . .NIOSH/NIEHS announced a $2 million RFA on environmental justice and 

building partnerships for communication 

NORA Implementation Year 7 

February 2003 . . . . . .Due to budget constraints, NIOSH does not receive new Congressional 

appropriations for NORA in the FY 2003 budget 

March 2003 . . . . . . . .NIOSH announced a RFA for Childhood Agricultural Safety and Health 

Research for development and implementation of intervention strategies for 

youth, children and adolescents who are exposed to agricultural hazards ($1 

million). NORA targeted areas included traumatic injuries, special populations at risk, intervention effectiveness and social and economic consequences of workplace illness and injury. 

April 2003 . . . . . . . . .NIOSH announced RFAs for the Community Partners program to conduct 

community-based pilot intervention /prevention research with NORA targeted areas of traumatic injuries, special population at risk, intervention 

effectiveness, and social and economic consequences of workplace illness 

and injury ($850,000); and using exposure assessment methods to identify 

musculoskeletal disorders, specifically low back disorders ($500,000). 

June 2003 . . . . . . . . . .NORA Symposium 2003: Working Partnerships: Research to Practice held 

in Crystal City, VA 

Third NORA Partnering Award for Worker Health and Safety awarded to 

BJC Health Care, BJC Occupational Health Nurse Council, Washington 

University, West Virginia University, Arjo, Inc., EZ Way, Inc., and NIOSH 

for "Evaluation of a Best Practices Back Injury Prevention Program in 

Nursing Homes" 

NORA Update 2003 document released 

37
 
safer • healthier • people 

Department of Health and Human Services 

Centers for Disease Control and Prevention 

National Institute for Occupational Safety and Health 

DHHS (NIOSH) Publication Number 2003-148