NIOSH EXTRAMURAL RESEARCH 

AND TRAINING PROGRAM

ANNUAL REPORT OF FISCAL YEAR 2019

Prepared by the Office of Extramural Programs

National Institute for Occupational Safety and Health
Cover image components by ©Thinkstock.
NIOSH EXTRAMURAL RESEARCH 

AND TRAINING PROGRAM

ANNUAL REPORT OF FISCAL YEAR 2019

Prepared by the Office of Extramural Programs

National Institute for Occupational Safety and Health

William A. Robison, PhD; Donjanea F. Williams, EdD; and Peter Grandillo, MBA 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Institute for Occupational Safety and Health
ii NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019

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content of these websites. All web addresses referenced in this document were accessible as of 

the publication date.

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SUGGESTED CITATION

NIOSH [2020]. NIOSH extramural research and training program: annual report of fiscal year 

2019. By Robison WA, Williams DF, Grandillo P. Cincinnati, OH: U.S. Department of Health and 

Human Services, Centers for Disease Control and Prevention, National Institute for Occupational 

Safety and Health, DHHS (NIOSH) Publication No. 2021-108, https://doi.org/10.26616/

NIOSHPUB2021108. 

DHHS (NIOSH) Publication No. 2021-108

DOI: https://doi.org/10.26616/NIOSHPUB2021108

December 2020
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019 iii

FOREWORD

I am pleased to deliver the FY 2019 annual report on the National Institute for Occupational Safety 

and Health (NIOSH) Extramural Research and Training Program. The data in this report reflect the 

exceptional work of the extramural community of researchers supported by NIOSH and the Office 

of Extramural Programs.

In this report, we look at how NIOSH invested in our multidisciplinary centers, investigator-initiated 

research projects, and cooperative research agreements. We also report on our training project 

grants, state surveillance programs, and small business innovation research. We include links to 

the NIOSH website throughout the report for direct access to additional data and information.

Section III describes the public health relevance and accomplishments of our varied and 

multidisciplinary portfolios with program highlights from FY 2019. In addition, this report now 

includes data on the World Trade Center Health Program’s extramural portfolio of cooperative 

agreements, which is shown in Section IV.

I would like to acknowledge the work of the NIOSH Office of Extramural Programs in compiling this 

report and the contributions of the extramural research community in protecting the workforce 

by producing new occupational safety and health knowledge and transferring it into practice.

John Howard, MD

Director, National Institute for

Occupational Safety and Health

Centers for Disease Control and Prevention
iv NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019

EXECUTIVE SUMMARY

In FY 2019, which was the year from October 1, 2018, through September 30, 2019, the National 

Institute of Occupational Safety and Health (NIOSH) funded 167 extramural awards totaling 

$94,896,043 for extramural research and training. This compares with the FY 2018 figure of 

$92,151,881 for 151 awards. This year’s figures include multidisciplinary centers receiving 36 

awards totaling $59,354,207 (62.5%) in these program areas: 

■ $28.4 million for 18 Education and Research Centers 

■ $18.7 million for 11 Centers for Agricultural Safety and Health 

■ $6.5 million for 6 Centers of Excellence for Total Worker Health® 

■ $5.8 million for the National Center for Construction Safety and Health Research and Translation 

Investigator-initiated and career development research received 57 awards totaling $17,185,978 

(18.1%). Cooperative research agreements received 32 awards totaling $9,348,320 (9.9%). Specialty 

training programs received 35 awards totaling $7,154,573 (7.5%), and 7 small business innovation 

research projects received a total of $1,852,965 (2%). 

In addition to extramural research and training, the NIOSH Office of Extramural Programs manages 

the extramural activities of the World Trade Center (WTC) Health Program. So, for the first time, we 

include data on the WTC Health Program’s extramural portfolio of cooperative agreements in this 

report. This portfolio includes the WTC Health Registry and research projects. Data for the WTC 

Health Program for 2011–2019 are in Section IV of this report, separate from all other extramural 

data. The total research funding for the WTC Health Registry and the 77 research projects was 

$171.2 million for 2011–2019. Specifically, for FY 2019, that figure was $24.1 million for the WTC 

Health Registry and 29 research projects. 

In FY 2019, NIOSH extramural researchers wrote 498 peer-reviewed articles in 201 journals. 

Education and Research Centers published the most articles (253), followed by investigatorinitiated (R01) research (90). These articles appeared most often in the Journal of Occupational and 

Environmental Medicine.

Section III has information on publications and program successes from extramural research and 

training, not including those from the WTC Health Program. For information on peer-reviewed 

publications and other outputs or products from the WTC Health Program, see Section IV of 

this report. 
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019 v

TABLE OF CONTENTS

FOREWORD  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  III

EXECUTIVE SUMMARY  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  IV

LIST OF ABBREVIATIONS  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  VII

Sector Programs  .....................................................  vii

Cross-Sector Programs  ...............................................  vii

LIST OF FIGURES  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  VII

LIST OF TABLES  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  VIII

LIST OF MAPS  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  VIII

I. NIOSH EXTRAMURAL RESEARCH AND TRAINING PROGRAM  . . . . . . . . . . . . . . . .  1

National Occupational Research Agenda  ................................  1

NIOSH Program Areas  ................................................  1

II. NIOSH EXTRAMURAL RESEARCH  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  3

Funding Distribution FY 2019  ..........................................  3

Summary of All Awards by Type of Funding  ..............................  4

Extramural Research Portfolio FY 2019 ..................................  5

Multidisciplinary Centers  ..........................................  5

Investigator-initiated Research  .....................................  6

Cooperative Agreements  ..........................................  7

Specialty Training Programs ........................................  10

Small Business Innovation Research  ................................  11

Extramural Research Activity by NIOSH Program Area .....................  12

Success Rates for Research Project Grants, FY 2009–2019  .................  13

III. FY 2019 EXTRAMURAL RESEARCH PROGRAM HIGHLIGHTS  . . . . . . . . . . . . . . . .  16

Multidisciplinary Centers ..............................................  17

Centers for Agricultural Safety and Health   ...........................  17

National Center for Construction Safety and 

Health Research and Translation   ...................................  22

Centers of Excellence for Total Worker Health®  ........................  25

Education and Research Centers ....................................  30

Investigator-initiated Research .........................................  35

Research Grants ..................................................  35

Cooperative Research Agreements  .....................................  40

State Surveillance Program  ........................................  40

Specialty Training Programs  ...........................................  47

Training Project Grants  ............................................  47

Emergency Responder Training Program  ............................  52

Miner Safety and Health Training Program  ...........................  53
vi NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019

IV. WORLD TRADE CENTER (WTC) HEALTH PROGRAM  . . . . . . . . . . . . . . . . . . . . . . .  55

WTC Health Program Research Portfolio   ................................  56

WTC Health Registry ..................................................  59

APPENDIX   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  61
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019 vii

LIST OF ABBREVIATIONS

SECTOR PROGRAMS

AFF Agriculture, Forestry, and Fishing

ALL All Sectors or Multiple Sectors

CON Construction

HSA Healthcare and Social Assistance

MIN Mining

MNF Manufacturing

OGE Oil and Gas Extraction

PSS Public Safety

SRV Services

TWU Transportation, Warehousing, and Utilities

WRT Wholesale and Retail Trade

CROSS-SECTOR PROGRAMS

CRC Cancer, Reproductive, Cardiovascular, and Other Chronic Disease Prevention

HLP Hearing Loss Prevention

HWD Healthy Work Design and Well-Being

IID Immune, Infectious, and Dermal Disease Prevention

MUS Musculoskeletal Health

RHP Respiratory Health

TIP Traumatic Injury Prevention

LIST OF FIGURES

Figure 1. NIOSH extramural grant distribution, FY 2019  ...............................  3

Figure 2. Multidisciplinary center awards, FY 2019   ...................................  6

Figure 3. Cooperative agreements, FY 2019  .........................................  8

Figure 4. Research funding by sector program, FY 2019  ...............................  12

Figure 5. Overall success rates for research project grants, FY 2009–2019  ...............  13

Figure 6. Success rates for R01 applications, FY 2009–2019  ............................  14

Figure 7. Success rates for R03 applications, FY 2009–2019  ............................  14

Figure 8. Success rates for R21 applications, FY 2009–2019  ............................  15

Figure 9. Research Funding for 2011–2019 Research Cooperative

Agreements, WTC Health Registry, and Research Contracts  ...................  57

Figure 10. Research studies and publications by primary focus area  ....................  58

Figure 11. WTC Health Registry key scientific outputs  .................................  60
viii NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019

LIST OF TABLES

Table 1. NIOSH program areas  ....................................................  2

Table 2. Summary of all awards by type of funding in FY 2019  .........................  4

Table 3. Investigator-initiated research and conference grant funding, FY 2019  ..........  7

Table 4. ERC trainees, graduates, and employment, FY 2019  ...........................  32

Table 5. ERC graduate employment by work setting, FY 2019  ..........................  32

Table 6. Continuing education courses by discipline, FY 2019  ..........................  33

Table 7. Training project grant trainees, graduates, and 

employment by discipline, FY 2019  .........................................  49

Table 8. Emergency responder training classes, FY 2019  ..............................  52

Table 9. World Trade Center Health Program funding, FY 2019  ........................  56

Table 10. FY 2019 NIOSH Funding Opportunity Announcements by Mechanism .......... 61

LIST OF MAPS

NIOSH Centers for Agricultural Safety and Health  ....................................  18

Centers of Excellence for Total Worker Health® .......................................  26

NIOSH Education and Research Centers  ............................................  31

NIOSH Sponsored State Occupational Health & Safety Surveillance Program  ............  41

NIOSH Training Project Grants by Discipline  .........................................  48
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019 1

I. NIOSH EXTRAMURAL RESEARCH 

AND TRAINING PROGRAM

NIOSH Extramural Research and Training Programs include multidisciplinary research and training 

centers, investigator-initiated research, mentored research scientist development awards, training 

project grants, and small business innovation research projects in occupational safety and health. 

State surveillance programs and a new Commercial Fishing Occupational Safety Research and 

Training Program enhance the breadth and depth of extramural research and training at NIOSH. 

The NIOSH Research and Training Program webpage describes these programs. The peer review 

and program management of the extramural research and training program portfolios are 

managed by the Office of Extramural Programs (OEP). The office also manages the extramural 

portfolio of cooperative agreements for the WTC Health Program. This portfolio includes the WTC 

Health Registry and research projects and is discussed separately in Section IV of this report. The 

National Institutes of Health (NIH) publishes extramural funding opportunity announcements in the 

NIH Guide for Grants and Contracts. This information also appears in the Funding Opportunities

listed on the NIOSH Extramural Research and Training Programs webpage. The Appendix of this

report lists all the NIOSH funding opportunity announcements published in FY 2019.

NATIONAL OCCUPATIONAL RESEARCH AGENDA

The National Occupational Research Agenda (NORA) is a partnership program to stimulate 

new research and improved workplace practices. Unveiled in 1996, NORA serves as a research 

framework for the nation and for NIOSH that identifies and speaks to the most pressing issues in 

work-related safety and health. As steward of NORA, NIOSH launched the third decade in FY 2017, 

which consists of ten industry sectors and seven cross-sectors representing major occupational 

safety and health issues and outcomes. NORA partners develop broad strategic objectives for 

research in each of those sectors and cross-sectors, and then work on those areas through 

information sharing, partnerships, and enhancing dissemination and implementation of evidencebased practices. 

NIOSH PROGRAM AREAS

NIOSH organizes its research portfolio according to the NORA framework, with ten sector programs 

and seven cross-sector programs. In addition, NIOSH has core and specialty program areas, which 

represent essential activities, mandates, special focus areas, and methods to use in research that 

support the sector and cross-sector programs. Each program area has research priorities and 

goals. This includes the primary goals for the extramural program and projects by researchers 

outside of NIOSH, with the exception of those under the WTC Health Program. In FY 2019, NIOSH 

Strategic Plan for FY 2019–2023 was launched with new goals for all NIOSH-funded research. 

However, these goals are not discussed in this report as NIOSH determines how existing grantfunded projects align with the goals. 

Table 1 provides links to more information about these program areas and research priorities. 
2 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019

Table 1. NIOSH program areas

NIOSH Sector Programs

Agriculture, Forestry, and Fishing Oil and Gas Extraction

Construction Public Safety

Healthcare and Social Assistance Services

Manufacturing Transportation, Warehousing, and Utilities

Mining Wholesale and Retail Trade

NIOSH Cross-sector Programs 

Cancer, Reproductive, Cardiovascular, 

and Other Chronic Disease Prevention 

Respiratory Health

Hearing Loss Prevention Traumatic Injury Prevention 

Immune, Infectious, and Dermal Disease Prevention Healthy Work Design and Well-Being

Musculoskeletal Health

NIOSH Core and Specialty Programs 

Authoritative Recommendations Nanotechnology

Center for Direct Reading and Sensor Technologies National Center for Productive Aging and Work

Center for Maritime Safety and Health Studies Occupational Health Equity

Center for Occupational Robotics Research Personal Protective Technology

Center for Motor Vehicle Safety Prevention through Design

Center for Workers’ Compensation Studies Safe • Skilled • Ready Workforce

Emergency Preparedness and Response Small Business Assistance

Engineering Controls Surveillance

Exposure Assessment Translation Research

Health Hazard Evaluations
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019 3

II. NIOSH EXTRAMURAL RESEARCH

FUNDING DISTRIBUTION FY 2019

In FY 2019, NIOSH awarded $94,896,043 in extramural funding for 167 projects. Data for the 

WTC Health Program are reported separately in Section IV. Figure 1 shows the distribution of 

awards by activity for FY 2019. The majority (62.5%) of extramural funding went to multidisciplinary 

centers, followed by 18.1% for investigator-initiated and career development research grants. 

Other cooperative research agreements made up 9.9% of the FY 2019 grant distributions, followed 

by specialty training programs (7.5%), and small business innovation research projects (2%).

Extramural Awards (in millions of dollars), FY 2019

Figure 1. NIOSH extramural grant distribution, FY 2019

In FY 2019, NIOSH presented 167 awards: 51 (31%) for new projects and 116 (69%) for continuing 

awards. Table 2 summarizes all NIOSH extramural awards for FY 2019. Of these awards, 

■ 57 (34%) funded investigator-initiated research and career development; 

■ 36 (22%) funded multidisciplinary research and training centers, which include Education and 

Research Centers (ERCs), Centers for Agricultural Safety and Health (Ag Centers), National Center 

for Construction Safety and Health Research and Translation (NCC), and Centers of Excellence 

for Total Worker Health®; 

■ 35 (21%) funded specialty training programs; 

■ 32 (19%) funded cooperative research agreements; and 

■ 7 (4%) funded small business innovation research. 

The OEP webpage has a searchable list of all active awards funded by NIOSH and NIOSH funding 

opportunity announcements.
4 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019

SUMMARY OF ALL AWARDS BY TYPE OF FUNDING

Table 2. Summary of all awards by type of funding in FY 2019

Award Category Award Mechanism

Number of 

Awards Funding

Multidisciplinary Centers 36 $59,354,207

Education and Research Centers Training Grant (T42) 18 $28,380,942

Centers for Agricultural Safety and 

Health

Cooperative Research Agreement 

(U54)

11 $18,739,554

National Center for Construction 

Safety and Health Research and 

Translation

Cooperative Research Agreement 

(U60)

1 $5,750,000

Centers of Excellence for Total 

Worker Health®

Cooperative Research Agreement 

(U19)

6 $6,483,711

Investigator-initiated Research Grants 57 $17,185,978

Research Grants Investigator-initiated (R01, R03, 

R21, R13, U13)

47 $16,114,847

Career Developmental Research Mentored Career Scientist (K01) 10 $1,071,131

Cooperative Research Agreements 32 $9,348,320

State Surveillance Program Cooperative Research Agreement 

(U60)

26 $6,816,681

Occupational Safety & Health 

Surveillance Collaboration, 

Education & Translation

Cooperative Research Agreement 

(U24)

1 $225,000

National Mesothelioma Virtual Bank Cooperative Research Agreement 

(U24)

1 $1,081,283

Commercial Fishing Occupational 

Safety Research

Cooperative Research Agreement 

(U01)

4 $1,225,356

Specialty Training Programs 35 $7,154,573

Training Project Grants Training Grant (T03) 28 $4,786,981

Miner Safety and Health Training 

Program

Cooperative Research Agreement 

(U60)

2 $968,000

Commercial Fishing Occupational 

Safety Training

Training Grant (T03) 5 $1,399,592

Small Business Innovation Research 7 $1,852,965

Small Business Innovation Research Phase I (R43) & Phase II (R44) 7 $1,852,965

Total Extramural Funding 167 $94,896,043

*This summary of awards by funding type does not include information for the World Trade Center Health Program. These 

data are shown in Section IV of this report.
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019 5

EXTRAMURAL RESEARCH PORTFOLIO FY 2019

NIOSH extramural research includes multidisciplinary centers, investigator-initiated research, and 

cooperative agreements. All applications for extramural funding are peer-reviewed for scientific 

merit and reviewed internally for programmatic relevance. Descriptions of these NIOSH extramural 

research elements follow:

Multidisciplinary Centers

NIOSH funds targeted research and outreach activities through multidisciplinary centers, which 

focus on high-risk industries that contribute disproportionately to work-related injury and illness in 

the United States. A variety of grant mechanisms, including cooperative research agreements and 

center training grants, fund these centers. The Ag Centers and the NCC perform critical research 

and training into the many safety and health hazards in agriculture and construction. 

Other centers, the Centers of Excellence for Total Worker Health (TWH) conduct research on the 

TWH concepts. The Centers of Excellence advance TWH knowledge by building the scientific 

evidence base through multidisciplinary research, intervention, and outreach that aims to improve 

the overall safety, health, and well-being of the diverse worker population in our nation. Their 

research examines the integration of occupational safety and health protection with workplace 

policies, programs, and practices to advance worker safety, health, and well-being.

A national network of ERCs carries out multidisciplinary education and research training activities. 

These university-based centers offer graduate and postgraduate training in the core and allied 

fields of occupational safety and health. Along with degree training, ERCs deliver continuing 

education and outreach to the occupational safety and health community throughout the federal 

health region they serve. 

NIOSH awarded approximately $59.4 million to 36 multidisciplinary centers in FY 2019 (see 

Figure 2).

Section III describes each of these center portfolios and lists individual center grants. 
6 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019

Funding for Center Grants: $59.4 Million in FY 2019

Figure 2. Multidisciplinary center awards, FY 2019 

Investigator-initiated Research

Research Grants

Through its funding awards for investigator-initiated research, the NIOSH extramural research 

program supports relevant, quality scientific investigations that aim to help reduce job-related 

injuries and illnesses. These diverse awards include 

■ Funding for large occupational safety and health research projects (R01),

■ Small occupational safety and health research grants (R03),

■ Exploratory occupational safety and health research grants (R21), and

■ Research scientist career development awards, offering up to 3 years of funding and a scientific 

focus and training designed to develop the skills and productivity of new career scientists (K01). 

Conference Grants

NIOSH values quality scientific meetings, which often result in new information to help prevent 

injuries, illnesses, and fatalities caused by workplace hazards. NIOSH awards conference grants 

under research grant mechanisms (R13 and U13). In FY 2019, NIOSH funded three R13 conference 

grants and four U13 cooperative agreement conference grants (see Table 3).
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019 7

Table 3. Investigator-initiated research and conference grant funding, FY 2019

Grant 

Type

New

 Awards

New 

Funding

Continuing 

Awards

Continuing 

Funding

Total 

Funding

R01 11 $5,958,031 14 $7,367,135 $13,325,166

R21 4 $835,132 8 $1,491,831 $2,326,963

K01 7 $751,399 3 $319,732 $1,071,131

R03 0 $0 3 $234,874 $234,874

R13 2 $39,779 1 $20,000 $59,779

U13 3 $138,065 1 $30,000 $168,065

Total 27 $7,722,406 30 $9,463,572 $17,185,978

NIOSH awarded $17.2 million to new and continuing research projects, mentored scientist 

grants, and conference grants in FY 2019 (see Table 3). Section III describes investigator-initiated 

research outputs.

Cooperative Agreements

NIOSH uses cooperative agreements to partner with state health departments, universities, labor 

unions, and nonprofit organizations in a variety of surveillance and research opportunities. NIOSH 

funds a broad array of cooperative agreements to develop knowledge for preventing work-related 

diseases and injury.

Unlike grants, which are conducted independently of the sponsoring agency, cooperative 

agreements combine the knowledge of federal and nonfederal researchers to achieve public 

health efforts that would not otherwise occur. A cooperative agreement requires a clear need 

for a program’s staff to do the proposed project. NIOSH evaluates if the cooperative agreement 

has enough importance to deserve committing the staff resources needed during the term of the 

cooperative agreement award.

Cooperative research agreements funded in FY 2019 totaled $9.3 million and included longstanding state surveillance programs and first-year funding for Occupational Safety and Health 

Surveillance Collaboration, Education, and Translation. The National Mesothelioma Virtual Bank 

and the new Commercial Fishing Occupational Safety Research and Training Program also received 

funding. Figure 3 shows how NIOSH distributed funds and how many cooperative research 

agreements received funding.
8 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019

Funding for Cooperative Research Agreements: $9.3 Million in FY 2019

Figure 3. Cooperative agreements, FY 2019

State Surveillance Program

The state surveillance program supports states to develop their ability to monitor work-related 

injuries, illnesses, exposures, and fatalities. This program helps expand the role of states in 

conducting in-depth surveillance and follow-up through investigations and interventions. These 

26 NIOSH-sponsored programs contribute to a national occupational health surveillance strategy 

and create opportunities for research and intervention. The State Surveillance Program webpage 

focuses on these state-based initiatives. Table 2 reports the total number and funding for all state 

surveillance awards for FY 2019. 

Occupational Safety and Health Surveillance Collaboration, Education, and 

Translation 

This cooperative agreement focuses on communication, education, and translational practice 

for occupational safety and health surveillance through a mix of approaches and strategies. The 

recipient of this funding is expected to lead the United States in the coordination and collaboration 

of occupational safety and health surveillance and communications, in partnership with federal 

and state agencies. Examples include managing an open-access, online repository for occupational 

safety and health information and surveillance data and resources. Through this funding, states, 

nongovernmental organizations, and tribes are also able to leverage current relationships 

and new partnerships to use and promote surveillance data for action. For example, these 
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019 9

nongovernmental organizations and tribes will monitor statistical and other trends and progress 

over time (i.e., burden and impact); propose pilot and evaluation activities for addressing disease, 

burden, or impact; conduct educational and outreach activities; and develop targeted prevention 

and intervention recommendations.

In FY 2019, NIOSH funded one cooperative agreement related to occupational safety and health 

surveillance collaboration, education, and translation for $225,000 (Table 2). 

National Mesothelioma Virtual Bank 

The National Mesothelioma Virtual Bank advances translational research for the scientific 

community by collecting quality data and biospecimens for mesothelioma research. This resource 

gives researchers access to de-identified clinical data associated with a multitude of biospecimens. 

It supports scientific discovery, improves detection, and helps develop effective treatments 

for mesothelioma. This work supports research that addresses the complex mechanisms and 

biological changes associated with mesothelioma and its disease progression. The National 

Mesothelioma Virtual Bank may ultimately help improve the quality of life of current and former 

workers who have malignant mesothelioma. 

Commercial Fishing Occupational Safety Research and Training Program 

Commercial fishing is one of the most dangerous occupations in the United States, but the hazards 

that fishermen face can vary widely by vessel and fishery. Research and training that address what 

works best in a specific fleet or region is critical to ensuring U.S. fishermen are getting the best 

possible occupational safety information and training. Despite some recent successes in reducing 

fatal work-related injuries within the commercial fishing industry, the need for targeted safety 

research and training remains essential.

The Commercial Fishing Occupational Safety Research and Training Program is a partnership 

between the U.S. Coast Guard and NIOSH that provides funding to qualified individuals in 

academia, members of nonprofit organizations, municipalities, and businesses involved in the 

U.S. commercial fishing industry. The funding supports research on improving the occupational 

safety of commercial fishermen and provides critical training for this high-risk occupation. The 

Commercial Fishing Occupational Safety Research and Training Program pays up to 50% of an 

organization’s costs. Each award ranges from $150 thousand to $650 thousand over a 2-year 

funding period. In FY 2019, NIOSH and the U.S. Coast Guard announced nine funding recipients, 

which included four research cooperative agreements and five training projects. The four research 

projects are identified below and the five training projects are discussed at the end of the next 

section under Specialty Training Programs.

■ Mary Imogene Bassett Hospital (Cooperstown, NY) 

Project Title: Assessments of Sleep Deprivation and Associated Health and Cognitive 

Impacts in Commercial Fishermen

■ Mississippi State University 

Project Title: Trawler Fishermen’s Personal Flotation Devices: Wear Assessment and 

Prototype Development 
10 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019

■ Oregon State University 

Project Title: Improving Vessel Equipment: Evaluating Fishermen-led Safety Design 

Ideas

■ University of Texas Health Center at Tyler 

Project Title: Improving Crew Overboard Recovery for Commercial Fishing Vessels in 

the Gulf of Mexico

Specialty Training Programs

NIOSH supports training in occupational safety and health through Training Project Grants

(TPGs). While the majority of TPGs are academic programs that support undergraduate, graduate, 

and postgraduate training, NIOSH also supports training programs to reach targeted worker 

populations and to meet the educational needs of the occupational safety and health workforce. 

The Emergency Responder Training Program is a TPG through the International Association of Fire 

Fighters. This grant supports a comprehensive, nationwide hazardous materials training program 

for firefighters, paramedics, and other emergency responders across the United States.

The Miner Safety and Health Training Program–Western United States, which is also a funded 

cooperative agreement, enhances the quality and complements the availability of health and 

safety training for mineworkers in the Western United States. The Western Mining Safety and 

Health Training Resource Center provides these programs and activities at the University of 

Arizona, along with the Energy, Mining, and Construction Industry Safety Program at the Colorado 

School of Mines.

In the partnership with NIOSH and the U.S. Coast Guard on the Commercial Fishing Occupational 

Safety Research and Training Program described under Cooperative Agreements, the following five 

training projects are funded. You can find more information on this program, which also includes 

research projects, under Cooperative Agreements.

■ Alaska Marine Safety Education Association

Project Title: National Fishing Safety Training Infrastructure

■ Fishing Partnership Health Plan (Burlington, MA) 

Project Title: Community-based Safety Training for the Mid-Atlantic Fishing Industry

■ Fishing Partnership Health Plan (Burlington, MA) 

Project Title: Community-based Safety Training for the New England Fishing Industry

■ Maine Center for Coastal Fisheries 

Project Title: A Comprehensive Safety, Wellness, and Change Program for New Entrants and 

Existing Persons in the Commercial Fishing Industry in Down East Maine

■ Oregon State University 

Project Title: Building Capacity for Fishermen First Aid Safety Training (FFAST)

Table 2 shows the number and funding of all specialty training grants (new and continuing) 

awarded in FY 2019.
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019 11

Small Business Innovation Research

The Small Business Innovation Research (SBIR) program stimulates the private sector to innovate 

technology. The SBIR program also helps small businesses to commercially apply federally 

supported research. In this process, they meet federal research needs as well as their own 

research and development needs. 

The SBIR program funds small businesses in their early stages as they commercialize novel 

technologies for occupational safety and health. This competitive program helps small businesses 

join in federal research and development, produce life-saving technologies, and create jobs. 

Improving the return on investment from federally funded research boosts the nation’s economy 

and improves society. 

NIOSH solicits Phase I and Phase II research proposals from science and technology-based firms. 

Phase II proposals are limited to small businesses that complete their Phase I projects. Table 2 

shows awards and funding for all FY 2019 SBIR grants.
12 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019

EXTRAMURAL RESEARCH ACTIVITY BY NIOSH 

PROGRAM AREA

NIOSH has research programs for each of the ten industry sectors of NORA. Figure 4 shows FY 

2019 funding for investigator-initiated research and career development research across the 

sectors. Extramural research in FY 2019 took place across most of the NIOSH sector program areas 

except Oil and Gas Extraction (OGE). Manufacturing (MNF) received the most funding, followed by 

Agriculture, Forestry, and Fishing (AFF) and then All Sectors* (ALL). 

Investigator-initiated research and career 

development funding across sectors, FY2019

*Shows projects that contribute to advancing all or most of the NIOSH sector programs, including public 

health activity tools that cut across industry sectors.

Figure 4. Research funding by sector program, FY 2019
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019 13

SUCCESS RATES FOR RESEARCH PROJECT GRANTS, 

FY 2009–2019

The success rate of reviewed new applications that receive funding in a fiscal year, calculated as 

a percentage, helps measure the viability of the research grants program. Success rates for new 

awards are calculated for the investigator-initiated research only, which includes the R01, R03, and 

R21 grant mechanisms. The success rate is a function of the number of applications received and 

the number of applications funded.

Figure 5 shows that throughout FY 2009–2019, the success rate remained stable until FY 2014, 

when it decreased from 17% to 1% in FY 2017 due to funding shortages. However, in FY 2018, the 

success rate increased to 10% and has remained stable through FY 2019. For FY 2009–2019, the 

mean annual number of applications was 169, the mean number of awards was 23, and the mean 

annual success rate was 14%. Figures 6–8 show the success rates for each research mechanism. 

Figure 5. Overall success rates for research project grants, FY 2009–2019
14 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019

Figure 6. Success rates for R01 applications, FY 2009–2019

Figure 7. Success rates for R03 applications, FY 2009–2019
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019 15

Figure 8. Success rates for R21 applications, FY 2009–2019
16 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019

III. FY 2019 EXTRAMURAL RESEARCH PROGRAM 

HIGHLIGHTS

Selected outputs, outcomes, and accomplishments 

of NIOSH-funded extramural research during FY 2019 

are described in this section. The outputs or products 

include publications, reports, conference proceedings, 

presentations/posters, databases, tools, methods, 

guidelines, recommendations, education and training 

materials, inventions, and patents. 

From October 1, 2018, through September 30, 2019, 

NIOSH-funded extramural research led to 498 peerreviewed publications in 201 journals. Researchers 

published their NIOSH-funded studies in an array of 

journals related to occupational safety and health. Most often, they published in the Journal of 

Occupational and Environmental Medicine (n=41), followed by the American Journal of Industrial 

Medicine (n=34), the Journal of Agromedicine (n=28), and the International Journal of Environmental 

Research and Public Health (n=21).

OEP collected publications by extramural researchers from principal investigator reports to NIOSH, 

the NIH Reporter database, the NIOSHTIC-2 database, and the PubMed database. NIOSHTIC-2 is a 

searchable database of NIOSH publications, which includes grantee final reports and publications.

In addition, altmetrics are data that are complementary 

to traditional, citation-based metrics and are an 

emerging measure of research outcomes. These data 

give insight into the extent that the general public is 

influenced by, exposed to, promotes, and engages with 

research online, in the media and beyond. Examples 

of altmetric data include the number of times a 

journal article is discussed in online research forums, 

blogs, and social media sites like Twitter, as well as in 

mainstream media coverage. Altmetrics also include 

data on the numbers of times an article has been viewed and cited in other research articles 

and policy documents. Three hundred and sixty-six (73%) of the 498 extramural articles were 

mentioned or cited in the above ways 4,878 times, and 39 (8%) of the articles ranked in the top 

5% of more than 15.5 million research publications scored by altmetric.com. Data from altmetric 

were obtained September 21, 2020.

In addition to publications, the following sections 

describe other significant outputs or products and 

successes of NIOSH-funded extramural research 

funded by grant mechanism during FY 2019. 
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019 17

MULTIDISCIPLINARY CENTERS

NIOSH funds multidisciplinary centers that focus 

on industries with an excessive share of job-related 

injury and illness. Various grant mechanisms, 

including cooperative research agreements and 

center training grants, fund these centers.

CENTERS FOR AGRICULTURAL 

SAFETY AND HEALTH 

The Ag Centers, established as part 

of the NIOSH Agricultural Safety and 

Health Initiative through a cooperative 

agreement, represent a major NIOSH 

effort to protect the safety and health 

of farm workers and their families. 

These centers conduct research, 

education, and prevention projects 

to respond to the nation’s pressing 

agricultural safety and health problems. 

Currently, 10 regional Ag Centers 

throughout the country work on 

regional safety and health issues unique 

to each area. NIOSH also supports the 

National Children’s Center for Rural 

and Agricultural Safety and Health 

(Child Ag Center) within the National 

Farm Medicine Center in Marshfield, 

Wisconsin. With a national focus, the 

Child Ag Center strives to enhance the 

safety of all children exposed to hazards 

associated with agricultural work. 

 Public Health Relevance

In 1990, Congress established a national 

initiative in agricultural safety and health 

under Public Law 101-517. The intention 

of this initiative, “... when sustained over a 

period of time, would result in a significant 

and measurable impact on ... health effects 

among rural Americans.” In response, NIOSH 

began funding Ag Centers in 1991. These 

centers strive to improve worker safety and 

health in the agriculture, forestry, and fishing 

industries—jobs that consistently ranked 

among the most dangerous in the United 

States. Although they still rank as some of 

the most dangerous, in the 25 years since 

the initiative took effect, there have been 

significant decreases in injuries, illnesses, and 

fatalities among farm workers. The work of 

the Ag Centers has contributed to this decline 

in injuries and deaths.

The Ag Centers’ work spans the full researchto-practice continuum. First, they conduct 

basic science to evaluate and quantify an 

issue. Researchers then transfer the results 

into engineering controls, educational 

outreach efforts, or policy changes aimed at 

preventing or mitigating the problem. The Ag 

Centers’ research helps create and validate 

evidence-based approaches. However, the 

real impact occurs by application of these 

approaches through practical education, 

outreach, and prevention projects within their 

regions. Geographic diversity in agriculture, 

forestry, and fishing activities drives the need 

for regional engagement by the centers.
18 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019

NIOSH Centers for Agricultural Safety and Health

The Ag Centers made significant contributions 

to public health in FY 2019:

■ Integrating skill and know-how from 

multiple disciplines, institutions, 

and community partners to solve 

complex problems.

■ Providing a continuum of basic research 

through translation and outreach 

activities that turn findings into 

evidence-based prevention programs.

■ Responding to the many cultural, 

ethnic, educational, and language 

differences that are significant barriers 

to safety and health for many laborers 

in this workforce.

■ Contributing knowledge to agricultural 

industries in the fields of medicine, 

nursing, industrial hygiene, 

epidemiology, engineering, and 

education. 
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019 19

 Research Outputs: 

Publications in FY 2019

Ag Center outputs are the products of 

research activities and include publications. 

We collected publications by NIOSH-funded 

extramural researchers from principal 

investigator reports to NIOSH, the NIH 

Reporter database, the NIOSHTIC-2 database, 

and the PubMed database. From October 

1, 2018, through September 30, 2019, Ag 

Centers published 74 articles in peer-reviewed 

journals. Find a searchable database of 

NIOSH publications, which includes grantee 

final reports and publications, by using the 

NIOSHTIC-2 publications search.

 Program Highlights in FY 2019

Surveillance and Research to Prevent 

Biological Exposures and Potential 

Zoonotic Diseases 

Zoonotic diseases, also known as zoonoses, 

are caused by the spread of infectious agents 

between animals and people, including 

bacteria, fungi, viruses, and parasites. Workers 

involved with animal husbandry during their 

daily activities have an elevated exposure 

risk to zoonoses. Multiple NIOSH-supported 

Ag Center projects are involved with these 

efforts, including the examples below. By 

protecting workers and minimizing their 

exposure risks, our society at large benefits. 

Mitigation efforts to protect populations from 

this type of cross-species transmission and the 

associated public health impacts may include 

(1) viral sampling and assessment for worker 

exposures and (2) studying the microbiome 

or the genetic material of bacteria, fungi, 

protozoa, and viruses in workers and their 

environments to better understand their 

exposures and associated risks.

Colorado: Antimicrobial Exposures Within 

Livestock Operations

Antibiotics have been in use for almost 

a century to stop or slow down bacterial 

infections. Their use in production agriculture 

closely parallels that in human populations 

during this span. However, heavy reliance 

on antibiotics, for both people and animals, 

inevitably leads to a small fraction of bacteria 

surviving and becoming resistant, which is 

known as antimicrobial resistance. The World 

Health Organization identified this issue as 

one of the most urgent health threats of 

our time.

This project aimed to identify and measure the 

level of antimicrobial-resistant bacteria within 

agricultural environments where workers 

handle, manage, and apply liquid manure 

slurry. Samples from fecal-amended crop 

fields of fresh manure, stored dairy and swine 

manure slurry, and soil cores indicated a rich 

bacterial microbiome. Researchers focused 

on the diverse microbiome and found manure 

contained a significant number of species 

reflecting what might be found inside the 

guts of cattle. They also noted a change in the 

microbiome composition or makeup between 

fresh manure and the manures stored in 

on-farm holding structures. Scientists found 

high rates of tetracycline resistant genes 

present in both manure and soil samples 

although the latter group had comparatively 

lower rates. Based on DNA sequencing, 

these genes seem identical to those found 

in common human pathogens or diseasecausing organisms in people. 

Details:

• High Plains Intermountain Center for 

Agricultural Health and Safety (HICAHS)

Minnesota: Optimizing the Assessment 

of Virus-containing Particles in Animal 

Agriculture 

Workers in animal agriculture face the risk 

of airborne exposure to infectious viruses, 
20 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019

like zoonotic influenza viruses. Measuring 

the concentrations and sizes of particles with 

which these infectious airborne viruses are 

associated is essential to assess exposures to 

viral aerosols and manage them effectively. 

However, only a few studies have investigated 

airborne levels of viral ribonucleic acid, or 

RNA, in terms of particle diameter, and almost 

no data exist on the sizes of particles that 

contain infectious viruses. 

Past research showed that large volumes of 

air must be sampled for enough live virus to 

be picked up for detection and quantification 

in workplaces, and that sampling methods 

(e.g., filters, impingers, impactors, cyclones, 

and electrostatic precipitators) have different 

strengths and weaknesses. To address 

this issue, researchers at the University of 

Minnesota focused on developing a viralaerosol sampler that is high volume, field 

portable, and size differentiating to measure 

worker exposures to live airborne influenza 

viruses in animal agriculture facilities. 

These scientists evaluated current 

sampling approaches by testing a range 

of samplers side-by-side to find the best 

combination of sampler properties for 

airborne viruses in animal agriculture. Using 

these comparisons, they established the 

essential design parameters and are now 

determining the specific sampler design 

based on computational fluid dynamics 

modeling. Results show that a two-stage 

sampling strategy could be optimal during 

investigations of zoonotic influenza outbreaks 

in animal agriculture facilities. The initial use 

of a high flow, non-sizing sampler may be best 

for detecting viruses at low concentrations. 

If detected, a medium flow, size-separating 

sampler may then be most appropriate. 

Researchers are currently evaluating this twostaged approach. The tests will demonstrate 

how data from the new sampler and strategy 

can assess and manage risks of airborne virus 

transmission in animal agriculture workplaces. 

Details:

• Upper Midwest Agricultural Safety and 

Health Center (UMASH)

Minnesota: Long-term Study of Infectious 

Disease Risks at the Human-swine Interface

The role of human interactions with animals 

as a source of emerging infectious diseases 

is universally recognized. People having 

regular animal contact are at the front line for 

exposure to known and emerging pathogens 

or disease-causing organisms, therefore, 

veterinarians provide a unique window into 

occupational risks for emerging zoonotic 

diseases. This 5-year longitudinal or long-term 

study of a cohort of U.S. swine veterinarians 

will aid in understanding the exposure 

and health risks related to pigs for three 

widespread emerging zoonotic pathogens in 

the U.S. swine industry: (1) livestock associated 

Staphylococcus aureus (including Methicillinresistant S. aureus [MRSA] and multidrug 

resistant S. aureus), (2) influenza A viruses, and 

(3) hepatitis E virus.

The study compared a group of companion 

animal veterinarians without contact with 

swine or pigs with veterinarians who interact 

with swine or pigs to look at pathogen 

exposure and health risks. University of 

Minnesota researchers aimed to determine 

the exposure risk of these groups to the 

following and associated health effects: (1) 

MRSA and multiple drug resistant S. aureus, 

(2) influenza A virus exposure and disease, 

and bidirectional transmission of the virus 

between humans and pigs, and (3) hepatitis 

E exposure and seroconversion. Researchers 

found a substantial increase in exposure to 

livestock associated S. aureus and MRSA in 

swine veterinarians. Preliminary findings also 

suggest elevated exposure to hepatitis E virus, 

which is like other study findings focused 

on veterinarians.
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019 21

Washington: The Healthy Dairy 

Worker Study

While workers on dairy farms have multiple 

occupational exposures, including allergens 

like dust, microbes, and endotoxin or toxins 

inside of bacterial cells, some studies report 

low rates of certain health issues among 

people living and working on farms associated 

with these exposures, like asthma, atopy, 

and symptomatic diarrhea. The “hygiene 

hypothesis” or “farm effect” suggests 

exposures to microbes and allergens on farms 

may result in individuals becoming immune 

to them and could be a critical determinant of 

whether farmworkers stay healthy or develop 

issues like infection and airway inflammation. 

This study explores the “hygiene hypothesis” 

by recruiting new hires on a dairy farm, along 

with existing workers and individuals from 

the community, and observed changes in 

their gut and nasal microbiome and health for 

two years. 

University of Washington researchers want 

to better understand particular exposures 

in the dairy work environment and whether 

certain individuals have immunity to them. 

This knowledge could lead to more effective 

interventions like early detection of those 

at risk of developing health problems. 

Investigators also hope to prioritize preventive 

interventions, including infection control 

practices, and to understand vulnerable 

worker populations with a research to 

practice approach.

Details:

• The Healthy Dairy Worker Study
22 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019

NATIONAL CENTER FOR 

CONSTRUCTION SAFETY AND 

HEALTH RESEARCH AND 

TRANSLATION 

CPWR—The Center for Construction 

Research and Training received a 

NIOSH cooperative agreement for 

2014–2019 through an extramural 

competition and has been funded 

for the past 25 years through a 

series of competitive NIOSH funding 

announcements. The center, with 

its diverse construction community, 

leads in applied construction research, 

making effective interventions available 

to the construction industry. Along with 

its consortium of six academic partners, 

CPWR researches safety and health risks 

that construction workers face on the 

job, including their causes and solutions. 

Their research projects support 

Construction Sector Program research 

goals as well as emerging issues.

 Public Health Relevance

CPWR’s work has included applied research 

for hazards and health conditions, emerging 

issues research in nanomaterials, construction 

industry data and tracking, and the 

distribution and transfer of research. Research 

projects also responded to the National 

Academy of Sciences’ recommendations for 

the NIOSH construction research program, 

including distributing research-to-practice 

solutions. CPWR has cultivated and optimized 

external partnerships for prevention, 

protections, research, and research translation 

for protecting U.S. construction workers.

 Research Outputs: 

Publications in FY 2019

CPWR outputs are the products of research 

activities and include publications. We 

collected publications by NIOSH-funded 

extramural researchers from principal 

investigator reports to NIOSH, the NIH 

Reporter database, the NIOSHTIC-2 database, 

and the PubMed database. From October 1, 

2018, through September 30, 2019, CPWR 

published 15 articles in peer-reviewed 

journals. Find a searchable database of 

NIOSH publications, which includes grantee 

final reports and publications, by using the 

NIOSHTIC-2 publications search.

 Program Highlights in FY 2019

New Technologies for Safer Concrete 

Drilling

Commercial construction workers frequently 

drill holes into concrete to insert anchor bolts 

for hanging pipes, conduit, or equipment, 

and for structural upgrades. This concrete 

drilling can produce respirable silica dust at 

concentration levels that can harm the lungs. 

Some drills also vibrate so intensely that 

they can damage the small nerves and blood 

vessels in the fingers, leading to permanent 

hand injuries. Two new drilling technologies, 

evaluated by CPWR in the past 10 years, have 

been shown to protect workers from these 

dangerous exposures while maintaining or 

improving workplace productivity. CPWR 

evaluated new bit designs with hollow 

cores that remove dust through the drill 

bits’ center. These drill bits can control dust 

exposure while drilling concrete and also can 

reduce the time required to clean out the 

drilled hole. The center also evaluated new 

powerful electric rotary hammer drills that 

can reduce vibration compared with older 

pneumatic or air-powered technology. All 

major drill manufacturers now sell these new 

technologies, and they are being adopted by 

mid- and large-sized construction contractors. 

Details:

• Test Bench for Evaluating Concrete Drilling 

Methods
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019 23

Reducing Musculoskeletal Disorders 

by Moving Ergonomics Research into 

Practice 

At the top of the list of disabling injuries in 

construction are musculoskeletal disorders 

(MSDs). MSDs, also called soft tissue injuries, 

are caused by the body being overexerted 

from working in awkward postures, or lifting, 

pushing, and pulling objects. While there is 

significant research on ways to prevent these 

injuries, adoption of safer practices has been 

slow in the construction industry. To address 

this issue, CPWR established an Ergonomics 

Community of Practice (ECoP) to explore ways 

to increase awareness and use of ergonomic 

research findings and interventions in 

construction that could reduce the risk 

for MSDs. Consisting of researchers and 

representatives from the construction and 

insurance industries, the ECoP conducted 

formative research from 2015 through 2019 

on common materials handling practices 

in the construction industry and related 

barriers and motivators to engaging in safer 

practices. The group used a social marketing 

approach to identify and then create 

resources to help construction employers 

and workers overcome these barriers and 

increase the use of ergonomic research 

findings and interventions. These activities 

led to the development of Best Built Plans—a 

comprehensive program focused on reducing 

MSDs caused by manual materials handling.

Best Built Plans provides construction 

contractors and workers with free, practical, 

online tools and resources to help plan for 

safe materials handling while remaining 

productive on the job. The program can be 

accessed online, downloaded to a computer, 

or accessed through a mobile app. It includes 

a planning tool tailored for each stage of a 

project, along with training and coaching 

resources like smartphone games and a 

toolbox talk. A recent pilot test of this program 

led to the Best Built Plans Ergonomics Training 

Program—a new labor-management driven, 

comprehensive training component. This 

program includes modules for workers and 

their employers and covers topics such as the 

connection between soft tissue injuries and 

opioid use. 

Best Built Plans launched in July 2018, and 

by September 2019, the online website had 

recorded more than 10,700-page views, 

and more than 600 users had downloaded 

the entire program or used the mobile app. 

In addition, the toolbox talk was accessed 

more than 14,600 times, the smart phone 

games more than 2,600 times, the planning 

worksheets more than 900 times, and over 

20,000 copies of a related hazard alert card 

had been distributed both electronically and 

in print. 

Details:

• Best Built Plans

Partnerships to Advance Research to 

Practice (r2p) 

Partnerships play a critical role in moving 

research findings into practice on construction 

job sites. This is why the CPWR Research to 

Practice (r2p) initiative has made significant 

progress in building industry collaborations. 

Since its launch in 2010, the r2p program 

has established partnerships positioned 

to support research and to disseminate 

findings or outputs to target audiences. These 

partnerships also support communities of 

practice that link researchers and construction 

industry stakeholders with a shared focus 

on certain occupational hazards and that 

also connect interagency working groups 

and alliances with government agencies to 

enhance the impact of priority activities.

CPWR has also developed networks, including 

the Trainers & Researchers United Network 

(TRU-Net) and the Construction Safety and 

Health Network, which allow participants 
24 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019

to find new research partners, engage a 

broader audience of industry stakeholders 

in identifying research needs, start new joint 

initiatives, and promote safer workplace 

practices. A recent evaluation of the NIOSH 

Construction Program recognized CPWR for 

the value of its r2p focused partnerships. 

In FY 2019, CPWR used its partnerships to 

engage the construction industry in NIOSH 

and CPWR research projects focused on these 

objectives: reducing silica exposure during 

masonry restoration, improving recognition 

of ergonomic hazards, and developing labormanagement driven r2p products, including 

a ladder safety video. Through interagency 

workgroups, CPWR played a lead role in 

national campaigns with the Occupational 

Safety and Health Administration (OSHA) and 

NIOSH, such as the National Fall Prevention 

campaign, the My Safe Summer Jobs 

campaign, and the Safe + Sound campaign. 

CPWR also used its partnerships to share 

research findings with other sectors, such 

as the Oil and Gas Extraction Sector. In 

addition, through the CPWR-OSHA Alliance, 

manufacturers, OSHA staff, and researchers 

in the NIOSH Construction Program and 

NIOSH Mining Program joined together to 

fill gaps in the awareness and use of select 

silica controls. Ongoing collaborations with 

OSHA’s Construction Directorate and NIOSH’s 

Construction Program also supported the 

development of a survey that will inform 

future research and dissemination efforts on 

OSHA’s priority to reduce trench incidents 

and fatalities.

Details:

• CPWR–Research to Practice (r2p)
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019 25

CENTERS OF EXCELLENCE FOR 

TOTAL WORKER HEALTH®

In FY 2019, NIOSH funded six Centers of 

Excellence for TWH, located throughout 

the United States, to explore and 

research the concepts of TWH. NIOSH 

defines TWH as policies, programs, and 

practices that integrate protection from 

work-related safety and health hazards 

with the promotion of injury and illness 

prevention efforts to advance worker 

well-being. TWH principles aim to 

broadly integrate workplace systems 

to control hazards and exposures, 

organization of work, compensation 

and benefits, work-life balance, and 

organizational change management. 

Their approach works toward a hazardfree workplace for all workers. 

The centers made important efforts 

toward TWH:

■ Pilot testing of promising workplace 

policies and programs.

■ Developing and distributing best 

practices and tool kits. 

■ Creating strategies to overcome 

barriers for adoption of workbased interventions to protect and 

promote health.

■ Investigating costs and benefits 

associated with integrated programs. 

■ Promoting increased development and 

application of biological markers of 

stress, sleep, and depression to protect 

workers and improve worker health.

■ Examining the relationships between 

workplace policies and practices and 

worker health outcomes.

 Public Health Relevance

The Centers of Excellence develop and 

evaluate interventions to improve safety, 

health, and well-being—TWH approaches—

in high-risk industries that can reduce 

healthcare costs when adopted on a broad 

scale. The centers engage in the following: 

■ Multidisciplinary research on the effects 

and outcomes of policies, program, and 

practices that integrate protection from 

work-related safety and health hazards 

with promotion of injury and illness 

prevention efforts to advance worker 

well-being;

■ Development and dissemination 

of evidence-based research and 

recommendations for workplace 

programs, policies, and practices;

■ Production of audience-specific 

educational materials, outreach, 

and capacity-building resources for 

optimizing their uptake or adoption or 

adaptation for protecting workers and 

improving worker well-being; and 

■ Evaluation of results to determine the 

impact on occupational safety and 

health and reduction in burden. 

 Research Outputs: 

Publications in FY 2019

The Centers’ outputs are the products of 

research activities and include publications. 

We collected publications by NIOSH-funded 

extramural researchers from principal 

investigator reports to NIOSH, the NIH 

Reporter database, the NIOSHTIC-2 database, 

and the PubMed database. From October 

1, 2018, through September 30, 2019, the 

Centers of Excellence for TWH published 

34 articles in peer-reviewed journals. Find a 

searchable database of NIOSH publications, 

which includes grantee final reports and 

publications, by using the NIOSHTIC-2

publications search.
26 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019

Centers of Excellence for Total Worker Health®

 Program Highlights FY 2019

Reaching Hundreds in Healthcare: 

New Ergonomics Training for Nursing 

Professionals 

In FY 2019, more than 800 nurses and other 

healthcare professionals participated a new 

online training called Ergonomics in Healthcare. 

This free program for nurses, which offers 

five continuing education (CE) hours, was 

developed by the Center for the Promotion 

of Health in the New England Workplace. The 

program aims to prevent soft tissue injuries 

and MSDs caused by sudden or frequent 

exposure to force, vibration, repetitive motion, 

and awkward bodily positions. Preventing 

soft tissue injuries is important for nurses 

because, in 2017, nursing ranked among the 

top three occupations with the highest rates 

of MSDs. The National Safety Council featured 

the training in its Safety+Health magazine. 

The program was also highlighted by the 
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019 27

Hospital Employee Health magazine and the 

Massachusetts Association of Occupational 

Health Nurses. In addition, two major 

healthcare organizations in Massachusetts—

the Massachusetts Hospital Association 

and University of Massachusetts Memorial 

Healthcare system—hosted the Ergonomics in 

Healthcare program on their CE portals. 

Details:

• Center for the Promotion of Health in the 

New England Workplace (CPH-NEW)

• New for Nurses: Online Continuing 

Education on Preventing MSDs

• Massachusetts Association of Occupational 

Health Nurses Free CNE: Ergonomics in 

Healthcare

Veterinarians and the Opioid 

Epidemic

Many current initiatives related to the opioid 

crisis focus on the pharmaceutical industry 

and healthcare providers for human patients. 

Veterinarians are generally overlooked 

although many can legally prescribe, 

distribute, carry, and store narcotics, which 

include opioids. While these drugs are 

prescribed to treat animals, they have the 

potential to be diverted or used illegally and 

abused by people. 

To understand this issue, the Center for 

Health, Work & Environment partnered with 

a Colorado veterinary society to administer 

an online survey to 189 of their veterinarians. 

The survey focused on animal owners’ abuse 

and misuse of opioids. In particular, the 

survey asked about the role of veterinarians in 

preventing diversion, their use of Colorado’s 

prescription drug monitoring program, their 

awareness of abuse and misuse in their 

clinic, and about their need for resources. 

Researchers found that 13% of surveyed 

veterinarians knew an animal owner had 

injured or intentionally made an animal sick 

or even made the animal seem ill or hurt to 

get opioid medications. In addition, 44% of 

the veterinarians were aware of opioid abuse 

or misuse by either a client or a veterinary 

staff member. 

The Center for Health, Work & Environment 

staff presented these findings to the 

American Veterinary Medical Association, 

the Colorado Department of Regulatory 

Agencies–Veterinary Medicine, and more than 

300 Colorado veterinarians via a townhall. 

In addition, presentations were given to the 

Centers for Disease Control and Prevention’s 

One Health program, and the study findings 

were highlighted in the American Journal of 

Public Health.

Details:

• Prescription Opioid Epidemic: Do 

Veterinarians Have a Dog in the Fight?

• NIOSH Science Blog: The Role of 

Veterinarians in the Opioid Crisis

• Opioids in the Workplace: NIOSH 

Extramural Research

• Colorado School for Public Health: Center 

for Health, Work & Environment

Understanding Occurrences of PTSD 

in Correctional Officers

Workers in the Public Safety Sector, like 

correctional officers, often face situations 

that are stressful, potentially unpredictable, 

and traumatic. These incidents can lead 

to mental health issues like substance use 

disorders, depression, and even posttraumatic 

stress disorders (PTSD). Funded through a 

pilot grant from the Healthier Workforce 

Center of the Midwest, a St. Louis University 

researcher looked at the occurrence of 

PTSD among jail correctional officers in the 

Midwestern United States and any associated 

health characteristics. The study found a 

relationship between PTSD and an anxiety or 

depression-related diagnosis, burnout, and 

emotional labor. 

The Journal of Occupational and Environmental 

Medicine and other academic publications 

highlighted these research findings in FY 2019. 

The investigator on this project also presented 
28 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019

at the American Correctional Association 

conference and is using partnerships to 

increase awareness of the study and develop 

other initiatives to support well-being within 

the correctional system. These includes 

collaborations with the American Occupational 

Therapy Association, community organizations 

like the St. Louis Alliance for Reentry, and 

other programs at St. Louis University like the 

Health Criminology Research Consortium and 

Transformative Justice Initiative.

Details:

• Posttraumatic Stress Disorder and Job 

Burnout Among Jail Officers

• Healthier Workforce Center of the Midwest

Increasing Workplace Physical 

Activity Among Call Center Workers 

Call center workers are among the most 

sedentary, or inactive, workers in the United 

States. On average, call center workers spend 

a higher percentage of their time sitting than 

any other occupational group.

Sedentary behavior is related to an increased 

risk of obesity, diabetes, heart disease, 

and musculoskeletal or muscle and bone 

injury. Sedentary behavior is also linked 

to a greater risk of death from any cause. 

Prior research found that standing desks 

and walking workstations reduce back pain, 

musculoskeletal complaints, and overall 

sedentary time, which relates positively to 

improved mood, job satisfaction, and general 

well-being.

Researchers at the Oregon Healthy Workforce 

Center are evaluating interventions, both 

organizational and individual, to decrease 

sedentary work and improve health in call 

center workers. Organizational interventions 

include physical workplace alterations and 

changes in the way supervisors interact 

with employees. Individual interventions 

include changing employee health and safety 

behaviors through training, monthly safety 

and health activities, and active workstations. 

Preliminary results from the self-reports of call 

center workers linked more musculoskeletal 

pain and lower life satisfaction to time spent 

sitting at work. 

Workers in other occupations and industries 

could benefit from the findings of this 

research as the number of sedentary workers 

continues to rise in the United States. This 

study was mentioned in The Society for 

Occupational Health Psychology newsletter, in 

addition to the researchers’ other projects 

related to sedentary behavior and work.

Details:

• Hold the Phone: Increasing Physical Activity 

at Work

• Society for Occupational Health Psychology 

Newsletter Summer 2019 (Vol. 21)

• Oregon Healthy Workforce Center: Active 

Workplace Study

Effectiveness of Safety Interventions 

for Low-wage Healthcare Workers 

A safe patient-handling intervention 

decreased injuries among nurses, but not 

among lower-wage workers employed as 

patient care associates, according to a recent 

study in the American Journal of Public Health.

Researchers at the Harvard T.H. Chan School 

of Public Health compared self-reports of 

safe patient-handling practices and hospital 

injury rates at two large Boston area hospitals 

from 2012 through 2014. The purpose of the 

study was to investigate how results at the 

population level may not show the full picture.

In 2013, nurses and patient care associates at 

one hospital received the same safe patienthandling intervention while workers at the 

other hospital did not. The intervention 

included initial and ongoing training on 

using new equipment to help move patients 

safely, such as slings and special devices. 

Study participants involved 482 nurses and 

96 patient care associates at the intervention 
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019 29

hospital and 915 nurses and 94 patient care 

associates at the comparison hospital.

After the intervention, lifting and exertion 

injuries among nurses decreased by about 

a third, however, no decrease in injuries 

occurred among patient care associates. At 

the same time, both groups reported similar 

improvements in their own safe handling of 

patients. These findings are an example of the 

“inequality paradox,” which is the tendency of 

some interventions to unintentionally widen 

the gap between less and more advantaged 

workers. Subsequently, the results highlight 

the importance of accounting for differences 

among workers when designing and 

evaluating health and safety interventions.

Details:

• Paradoxical Impact of a Patient-Handling 

Intervention on Injury Rate Disparity Among 

Hospital Workers

• Safety Intervention Less Effective for Lowwage Workers

• Harvard T.H. Chan, School of Public Health: 

Center for Work, Health & Well-being

Developing Safer and Healthier Work 

Through Communities 

The University of Illinois at Chicago (UIC) 

Center for Healthy Work continues to 

explore how to implement safer and 

healthier approaches to work that extend 

into the community through the Greater 

Lawndale Healthy Work Project. UIC 

researchers are collecting data from two 

Chicago neighborhoods with high levels of 

unemployment and/or residents in precarious 

work, to find ways to improve worker health 

at the community level. They are using 

existing neighborhood data, a community 

health survey, focus groups, interviews, 

and an approach called concept mapping 

to identify what works. Concept mapping is 

a way to understand data, collected from 

qualitative sources, where ideas are put into a 

picture or map.

To date, scientists have used the 

neighborhood level data to create a 

community health profile on work. They 

found that, compared with the city of Chicago 

overall, the residents in their study are 

younger, mostly racial and ethnic minorities, 

less likely to have a high school education, 

and have higher rates of unemployment. For 

working residents, there is a greater likelihood 

of employment in low-skill and low-wage 

jobs and with higher rates of poverty even 

when working year-around. Furthermore, 

these residents are less likely to have health 

insurance, but work in occupational industries 

with high injury rates. 

Investigators also looked at workplaces 

within these communities and found that 

of 1,127 employers, more than half were 

in the retail, food, and service industries. 

The researchers used these data findings to 

develop a theory of change and identify three 

strategic areas to direct the project’s focus: (1) 

community norms that support healthy work 

(people and networks), (2) strong system of 

community resources that support healthy 

work (community capacity), and (3) equitable 

opportunity for work exists (policy and 

systems). 

Investigators also plan to analyze community 

health survey data collected from 488 

residents of the neighborhoods in the study. 

By engaging directly with communities and 

their workers, researchers aim to raise 

awareness of the relationship between 

communities, work, and health, as well as 

develop new TWH interventions.

Details:

• Greater Lawndale Healthy Work Project

• Study Focuses on Community to Improve 

Worker Health
30 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019

EDUCATION AND RESEARCH 

CENTERS

NIOSH supports professional training 

in occupational safety and health (OSH)

through training programs in ERCs. ERCs 

are university-based multidisciplinary 

centers that offer graduate, postgraduate, and research training in the 

core and allied fields of occupational 

safety and health. ERCs also supply 

continuing education and outreach to 

the OSH community throughout the 

federal health region they serve. ERCs 

are interdisciplinary programs and a 

major part of a network of training 

grants that help ensure an adequate 

supply of qualified professional 

practitioners and researchers. Essential 

ERC components are outreach and 

research-to-practice activities with other 

institutions, businesses, community 

groups, and agencies within their 

region, as well as academic programs. 

Programs respond to area needs and 

carry out new strategies and initiatives 

to meet those needs, with a focus on 

worker health and safety. 

 Public Health Relevance

The Occupational Safety and Health Act 

of 1970 (Public Law 91-596) directs NIOSH 

to ensure an adequate supply of qualified 

occupational safety and health personnel. 

NIOSH responded to this mandate by funding 

training programs to provide the nation with a 

competent, highly skilled occupational safety 

and health workforce. NIOSH-funded ERCs 

serve a vital role in protecting the health and 

safety of the nation’s workforce. Aligning with 

the goals of Healthy People 2020—to prevent 

diseases, injuries, and deaths due to working 

conditions—ERCs improve occupational safety 

and health through education, research, and 

collaboration. They serve as regional, national, 

and global resources for business, labor, 

government, and the public. 

ERCs meet the critical need to produce 

researchers and practitioners—vital to 

maintaining workplace health and safety—

and reduce the burden of preventable workrelated injury, illness, and death by performing 

the following actions: 

■ Providing the necessary knowledge to 

the U.S. workforce to reduce the burden 

of work-related injury, illness, and death.

■ Developing the major research advances 

needed to prevent occupational 

injuries, illnesses, and fatalities in the 

United States.

■ Providing regional and industry-specific 

outreach and consultation to more than 

5,000 small-, medium-, and large-sized 

U.S. businesses annually.

■ Serving as the primary knowledge 

source for public and government 

leaders for job-related safety issues 

without duplicating other government 

programs. 

 Research Outputs: 

Publications in FY 2019

ERC outputs are the products of research 

activities and include publications. We 

collected publications by NIOSH-funded 

extramural researchers from principal 

investigator reports to NIOSH, the NIH 

Reporter database, the NIOSHTIC-2 database, 

and the PubMed database. From October 

1, 2018, through September 30, 2019, ERCs 

published 253 articles in peer-reviewed 

journals. Find a searchable database of 

NIOSH publications, which includes grantee 

final reports and publications, by using the 

NIOSHTIC-2 publications search.
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019 31

NIOSH Education and Research Centers

 Program Highlights FY 2019

Trainees, Graduates, and 

Employment of Graduates

In academic year 2018–2019, more than 340 

students graduated from ERC programs with 

specialized training in disciplines including 

industrial hygiene, occupational health 

nursing, occupational medicine, occupational 

safety, and other closely related occupational 

safety and health fields. The number of 

students enrolled decreased slightly from 993 

in FY 2018 to 978 in FY 2019. Table 4 shows 

the number of students enrolled, graduates, 

and employment status during FY 2019.
32 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019

Table 4. ERC trainees, graduates, and employment, FY 2019

Program Area Enrolled Graduates

Employed or seeking occupational 

safety and health employment (%)

Industrial Hygiene 312 115 114 (99)

Occupational Health Nursing 117 41 38 (93)

Occupational Medicine 134 64 64 (100)

Occupational Safety 150 61 56 (92)

Other Related Disciplines 265 64 59 (71)

Total 978 345 331 (96)

Table 5. ERC graduate employment by work setting, FY 2019

Work Setting/ 

Program Area

Industrial 

Hygiene 

Occupational 

Health Nursing 

Occupational 

Medicine 

Occupational 

Safety Other Total 

Private Industry 73 4 4 35 22 126

Federal/State/Local 

Government

14 5 4 7 10 40

Academic Institution 14 2 5 5 11 37

Clinic/Hospital 0 14 40 1 2 54

Other OSH 

Employment

4 0 0 1 5 10

Seeking Advanced 

OSH Degree

3 0 5 3 6 17

Seeking OSH 

Employment

6 13 6 4 3 32

Total 114 38 64 56 59 331

Table 5 shows the placement of FY 2019 

graduates by program area and work 

setting. We consider graduates looking for 

occupational safety and health employment 

and not working outside their field as 

remaining in the field.

Continuing Education Outputs

Continuing education of occupational safety 

and health professionals is a required part 

of ERC funding. Each year, NIOSH ERCs train 

thousands of these professionals around the 

United States through course offerings in 

the occupational safety and health core and 

related disciplines. The following table shows 

the continuing education activity by discipline. 

In FY 2019, ERCs provided 348,390 person 

hours of training to 51,153 occupational 

safety and health professionals who took 

1,562 courses.
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019 33

Table 6. Continuing education courses by discipline, FY 2019

Discipline

Number of 

Courses

Number of 

Trainees

Person-Hours 

of Training

Industrial Hygiene 199 4,579 39,137

Occupational Health Nursing 235 9,758 36,322

Occupational Medicine 209 7,864 24,921

Ag Safety and Health 21 1,413 2,459

Other 183 6,087 74,901

Total 1,562 51,153 348,390

ERC Program Achievements

Speaking on the Future of Work: The 

Centennial Celebration of the International 

Labour Organization

For the 100th anniversary of the International 

Labour Organization, the UN recognized its 

agency with a panel discussion on the future 

of work and the role of safety and health. The 

event addressed challenges related to the 

future of work including technology, changing 

demographics, and work organization. Among 

the featured panel of experts were two faculty 

from the New York and New Jersey ERC. They 

spoke to the UN audience about key issues 

facing vulnerable and migrant workers, 

including precarious, unhealthy, and unsafe 

working conditions characterized by low 

wages and few or no benefits. They ended 

the panel session with a discussion on why 

occupational safety and health is critical to 

the future of work and how the International 

Commission on Occupational Health impacts 

work, the workforce, and the workplace. The 

panel session took place in May 2019 at the 

UN Headquarters in New York City. 

Details:

• New York-New Jersey Occupational Safety & 

Health Center

Development of TWH Graduate Certificate 

Program

The North Carolina Occupational Safety 

and Health ERC developed a graduate 

certificate course in TWH. The goal of the TWH 

program is to prepare trainees to respond 

to the changing nature of work, including 

technology shifts, globalization, alternative 

work arrangements, and shifting workforce 

demographics. The nine-credit hour certificate 

program addresses these issues through 

the interdisciplinary and comprehensive 

approach of TWH. The program offers three 

courses focused on (1) critical issues in work, 

worker, and workplace health, (2) essential 

methods for evaluating worker and workplace 

health, and (3) planning and evaluating TWH 

interventions. In FY 2019, eight students from 

multiple academic disciplines completed TWH 

coursework, while two students earned a TWH 

graduate certificate. The ERC plans to offer 

the courses online in FY 2020. This move will 

open the certificate program beyond degreeseeking students to working professionals 

across the United States and internationally. 

Details:

• Graduate Certificate in Total Worker Health®

• North Carolina Occupational Safety and 

Health Education and Research Center
34 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019

Return to Work Predicators for Stroke 

Survivors

Nearly 800,000 Americans have either a firsttime or a repeated stroke annually, with many 

of them experiencing mental, emotional, and 

physical injuries despite improvements in 

treatment. In fact, stroke is a leading cause 

of long-term disability and failure to return to 

work for employees.

Researchers at the University of Alabama 

at Birmingham ERC reviewed 2,586 journal 

articles and selected 19 relevant studies to 

identify factors that affect stroke survivors’ 

return to the job. These factors included 

stroke severity, disability, race and ethnicity, 

occupation, level of education, and the 

existence of mood disorders like anxiety and 

depression. Workers were more likely to work 

again after a mild or moderate stroke than a 

severe stroke. They also were more likely to be 

Caucasian and of higher socioeconomic status 

than those who did not return to work. Other 

findings showed that occupational health 

nurses can help stroke survivors who return 

to work by monitoring their health history 

related to stroke and ensuring the availability 

of necessary resources, like support for 

anxiety and depression and the opportunity 

for rest breaks. African Americans are much 

more likely to have a stroke than other racial 

and ethnic groups, yet few of the studies 

focused on them. 

These results show the importance of 

future research looking into factors that 

predict return to work for African American 

stroke survivors. The research findings were 

published in the journal Workplace Health 

& Safety. 

Details:

• Return to Work Among Stroke Survivors

• Stroke Severity, Race, and Socioeconomic 

Status Predict Return to Work for Stroke 

Survivor

Addressing Critical Mental Health Issues 

in Agriculture

The University of Iowa ERC focuses on 

research and training that target critical issues 

in agricultural safety and health, including 

increasing suicide rates. Farm workers are 

employed in a high-risk industry where 

they deal with stressors including financial 

challenges like market prices and physical 

risks like heat-related illness. In addition, 

they face stigma along with limited access to 

mental health treatment. 

To address these problems, an ERC trainee 

studied the relationship between health 

insurance and healthcare-seeking behaviors 

among Midwestern farmers. The study 

identified a lack of health insurance as a 

stressor for farmers and the type of insurance 

influenced when they would visit a healthcare 

provider. In addition, another trainee 

investigated the association between farmer 

suicides in Iowa and access to certified mental 

health centers. These research findings 

showed that counties with certified mental 

health centers had an increased risk of having 

one or more farmer suicides. This suggests 

that access to care, alone, is not enough for 

prevention. Both studies demonstrate the 

need to better understand barriers to farmers 

receiving mental health services to improve 

their well-being and minimize suicide rates. 

Details:

• Heartland Center for Occupational Health 

& Safety

• NIOSH: Keep Farmers Safe
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019 35

INVESTIGATOR-INITIATED RESEARCH

The NIOSH extramural research program supports 

relevant, high-quality scientific investigations 

that help reduce work-related injuries, illnesses, 

and fatalities. These awards include funding 

for large projects (R01) as well as small projects 

(R03) and exploratory research grants (R21). 

RESEARCH GRANTS

The R01 funding opportunity focuses 

on developing an understanding of 

the risks and conditions associated 

with job-related injuries, illnesses, and 

fatalities. These projects also explore 

methods to reduce risks and prevent 

or lessen exposure to hazardous 

workplace conditions. The R03 funding 

mechanism supports research projects 

that can be completed in 2 years with 

limited resources, including pilot and 

feasibility studies, secondary analysis of 

existing data, and small, self-contained 

research projects. The R21 mechanism 

encourages research to explore 

novel scientific ideas or develop new 

techniques, methods, model systems, 

tools, or other applications with the 

potential for significant impact on workrelated safety and health.

The extramural research portfolio also 

includes mentored research scientist 

development (K01) awards that offer 

postdoctoral training for the next generation 

of occupational safety and health scientists. 

These highly competitive K01 awards give up 

to 3 years of funding and a scientific research 

focus designed to develop the skills and 

productivity of new research scientists as they 

transition between postdoctoral training and 

independent research careers.

NIOSH awards conference and scientific 

meeting grants under two research grant 

mechanisms: R13 and U13. Both grants 

support high quality, scientific conferences/

meetings relevant to the safety and health 

of workers, including symposia, seminars, 

and workshops.

 Public Health Relevance

The mission of NIOSH is to develop new 

knowledge in the field of occupational safety 

and health and then transfer it to practice. 

The extramural research program advances 

this mission through its research. This work 

helps in identifying workers at risk, developing 

methods for measuring hazard exposures, 

and detecting adverse health effects. The 

program also helps in determining the 

frequency of job-related hazards, increasing 

understanding of the causes of workrelated diseases and injuries, and reducing 

or eliminating hazard exposures. Grantees 

share research results through diverse 

communication channels, including scientific 

meetings, conferences, and workshops.
36 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019

 Research Outputs: 

Publications in FY 2019

Investigator-initiated research outputs are the 

products of research activities and include 

publications. We collected publications by 

NIOSH-funded extramural researchers from 

principal investigator reports to NIOSH, the 

NIH Reporter database, the NIOSHTIC-2 

database, and the PubMed database. From 

October 1, 2018, through September 30, 2019, 

R01 grant-funded researchers published 

90 articles in peer-reviewed journals. The 

numbers of peer-reviewed publications for 

the other investigator-initiated research 

mechanisms are 6 (R03), 1 (R13), 10 (R21), 

and 12 (K01). Find a searchable database of 

NIOSH publications, which includes grantee 

final reports and publications, by using the 

NIOSHTIC-2 publications search.

 Program Highlights FY 2019

Combined Tools Estimate Carpal 

Tunnel Syndrome Risk

Project Title: Developing a General 

Population Job Exposure Matrix for Studies 

of Work-related MSD (R01 Grant). 

Principal Investigator: Bradley Evanoff

Estimating the risk of exposure to safety 

and health hazards is critical to preventing 

work-related injuries, illnesses, and deaths. 

Exposure data can be difficult and expensive 

to get, making it hard to connect illnesses 

and injuries to specific tasks. An efficient way 

to assess risks is with a job exposure matrix 

(JEM), which estimates individual workers’ 

exposures based on their job titles or tasks. 

Rather than measuring individual workers’ 

exposures, a JEM focuses on large groups 

of workers across multiple industries and 

occupations. Because of the tool’s relatively 

low cost and ability to estimate past 

exposures, interest is growing in using it to 

estimate risk for common musculoskeletal 

disorders like carpal tunnel syndrome (CTS). 

This painful disorder of the hands and wrists 

can occur with tasks involving repetitive or 

awkward motions.

To test whether a JEM effectively estimates 

CTS risk, and to examine the association of 

exposure estimates from different countries, a 

recent NIOSH-funded study at the Washington 

University School of Medicine in St. Louis 

compared the U.S. O*NET, with more than 800 

occupations, and the French CONSTANCES, 

with more than 400 occupations—see 

the journal article below under Details. 

Researchers then compared the findings to 

actual CTS cases among 2,393 U.S. workers 

who participated in a previous NIOSH study of 

musculoskeletal disorders.

O*NET was comparable to individual 

worker reports in predicting the CTS risks 

of certain tasks, while CONSTANCES was 

slightly less accurate, according to the 

study published in the Scandinavian Journal 

of Work, Environment & Health. However, 

combined estimates—using exposures 

from both tools or exposures from either 

tool combined with individual worker 

reports—were the most accurate predictors 

of CTS. These findings show that combined 

tools like JEMs, including international 

ones, can help pinpoint risks for common 

musculoskeletal disorders and can allow 

studies of large worker populations where 

other exposure information is unavailable.

Details:

• Applying Two General Population Job 

Exposure Matrices to Predict Incident 

Carpal Tunnel Syndrome: A Cross-National 

Approach to Improve Estimation of 

Workplace Physical Exposures 

• Better Together: Combined Tools Estimate 

Carpal Tunnel Syndrome Risk
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019 37

New Cost-effective Technology for 

Assessing Workplace Exposures

Project Title: A Citizen-Science Approach 

to Occupational Hazard Assessment 

(R01Grant).

Principal Investigator: John Volckens

Assessing workers’ exposure to occupational 

safety and health hazards has limitations 

such as cost and technological constraints, 

among other factors. These challenges 

make it difficult to identify workers at risk 

for overexposure to various hazards, like 

air pollutants, and can hinder workplace 

epidemiology studies, leading to imprecise 

data analysis.

Researchers at Colorado State University 

at Fort Collins aim to develop a new, cost 

effective technology that will effectively assess 

workers’ exposure to air pollutants. Scientists 

expect for this wearable exposure monitor 

to be inexpensive, easy to use with minimal 

instruction, and measure potentially up to 

hundreds of different airborne compounds. 

Employees will wear the device, allowing 

them to become more involved in recognizing 

hazards and exposure assessment. In 

FY 2019, researchers started designing a 

protype for the monitor (called the “Airpen”) 

and submitted a patent application for 

this technology. The monitor is expected 

to allow greater sample sizes for personal 

exposure measurements, and result in better 

hazard control on the job, more powerful 

epidemiology, and improved worker health.

Details:

• Wearable Air Pollution Monitors to 

Record What Workers Are Breathing to Be 

Developed at CSU

The Long-term Effects of Shift Work 

for Pregnant Workers and Their 

Children

Project Title: Adverse Health Effects of Shift 

Work (R01 Grant).

Principal Investigator: Eva Schernhammer

In the United States, 15 million workers have 

either full-time evening or night shifts, rotating 

shifts, or other irregular work schedules 

outside of traditional daytime hours. For 

women, past research has linked long hours 

and this type of shift work to reproductive 

issues like menstrual disorders, miscarriages, 

and premature birth. Women who work nights 

or long hours often lack enough sleep, and 

night work can alter their circadian rhythm 

or internal biological clock that regulates 

sleep. The circadian rhythm also regulates the 

menstrual cycle and pregnancy hormones. 

But while there is research on how shift 

work impacts the reproductive system, what 

happens to the children of women who did 

shift work before and while pregnant with 

them? NIOSH-funded researchers at Brigham 

and Women’s Hospital aimed to find out by 

studying these children’s health outcomes as 

they age. 

The scientists used data from two prior 

studies: (1) the second phase of a longstanding Nurses’ Health Study, called 

Nurses’ Health Study II (NHS II), which 

focused on risk factors and chronic disease 

in female nurses, and (2) the Growing Up 

Today Study, which focused on the health 

behaviors and outcomes of children born to 

NHS II participants. Researchers analyzed 

data for varied connections, including the 

association between women who worked 

the night shift before and after pregnancy 

and risks of depression and anxiety in their 

adolescent and young adult children. They 

also investigated the link between night shift 

work and the women’s adolescent children’s 

response to stress, as well as their risk of 
38 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019

developing atopic diseases like dermatitis, 

asthma, and hay fever. 

While research findings did not show a link 

between women working at night before or 

during pregnancy and atopic diseases in their 

offspring, scientists found this type of work 

arrangement influenced stress levels, among 

young adult children. 

These and other research findings from 

this project have potential implications for 

organizational policies and practices related 

to work schedules for pregnant women. The 

research findings have been presented at 

multiple conferences and published in peerreviewed journals including the European 

Journal of Epidemiology, Physiology & Behavior, 

PLoS One, and the International Journal 

of Obesity.

Details:

• Adverse Health Effects of Shift Work

• Night Shift Work Before and During 

Pregnancy in Relation to Depression and 

Anxiety in Adolescent and Young Adult 

Offspring

• Maternal Rotating Night Shift Work Before 

Pregnancy and Offspring Stress Markers

• Night Shift Work Surrounding Pregnancy 

and Offspring Risk of Atopic Disease

• NIOSH: Work Schedule (Shift Work and Long 

Working Hours)

Germ-fighting Fabric Developed for 

Healthcare Settings 

Project Title: Rechargeable Antimicrobial 

Textiles to Reduce Occupational Risk of 

Healthcare Personnel (R21 Grant).

Principal Investigator: Yuyu Sun

Healthcare workers face a high risk of 

contact with infectious agents that can cause 

infections and diseases, such as bacteria, 

fungi, viruses, and parasites. To address 

this issue, scientists at the University of 

Massachusetts Lowell developed a germkilling fabric that could possibly prevent the 

spread of communicable diseases for workers 

in the healthcare field. 

To achieve this, researchers embedded a 

germ-killing agent called N-halamine into 

fabrics used for hospital garments, such 

as scrubs, worn by healthcare workers 

and patients. Preliminary findings show 

N-halamine in fabrics is effective in destroying 

Escherichia coli, Methicillin-resistant 

Staphylococcus aureus (MRSA), Staphylococcus 

aureus, Candida albicans, and other diseasecausing pathogens. 

Researchers tested the effectiveness of the 

germ-killing agent in fabrics using different 

simulated conditions like those seen in 

healthcare, and the researchers found that 

the treated fabric destroyed germs within 15 

minutes in three types of soils. In addition, 

for situations when the N-halamine levels on 

fabric become low, researchers are working 

on ways to renew its effectiveness through 

a bleach solution. Testing on the fabric will 

continue in the future to see how it protects 

against other disease-causing pathogens. 

Details:

• Scientists Invent Germ-Fighting Fabric for 

Health Care

• Rechargeable Antimicrobial Textiles to 

Reduce Occupational Risk of Healthcare 

Personnel

• Healthcare Workers: Infectious Agents

Characterizing Worker Exposure to 

Influenza D From Cattle

Project Title: Epidemiologic and Genomic 

Evaluation of Influenza D Among Cattle 

Workers and Their Community (K01 Grant).

Principal Investigator: Jessica Liebler

Livestock workers are at significant risk of 

exposure to infectious diseases through 

contact with animals, including pigs, poultry, 

and cattle. In particular, research shows that 

influenza D (IDV) has been found in pigs and 

other animals, although the virus mainly 

exists in cattle in several countries, including 
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019 39

the United States. This fairly novel influenza 

virus first emerged in 2011 in the United 

States. According to studies, IDV can cause 

mild to moderate respiratory disease in cows 

and is linked to bovine respiratory disease 

complex—the costliest disease in the U.S. 

cattle industry. However, it is not known if 

cattle are a potential source of IDV infection 

for humans. NIOSH-funded researchers at 

Boston University have a study focused on 

this topic. 

These scientists are investigating past and 

recent IDV infection among cattle workers, 

those they live with, and their community 

residents in a U.S. region with many cattle. 

Researchers aim to characterize the infections, 

along with risk factors and the health 

outcomes of IDV in humans. The future 

findings from this study could help identify 

strategies to enhance surveillance of workers 

and protect them from IDV. This research 

could also have potential relevance to other 

zoonotic infections from viruses or bacteria.

Details:

• Epidemiologic and Genomic Evaluation 

of Influenza D Among Cattle Workers and 

Their Community
40 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019

COOPERATIVE RESEARCH AGREEMENTS

Cooperative agreements allow NIOSH to partner with 

universities, state health departments, labor unions, 

and nonprofit organizations to address important 

public health problems. NIOSH funds a broad array of 

these agreements to develop knowledge in preventing 

job-related injuries, illnesses, and fatalities. 

In FY 2019, NIOSH funded the state 

surveillance program to support states in 

monitoring occupational injuries, diseases, 

exposures, and deaths. Other cooperative 

agreements awarded in FY 2019 included 

funding for occupational safety and health 

surveillance collaboration, education, and 

translation; National Mesothelioma Virtual 

Bank funding; and the Commercial Fishing 

Occupational Safety Research and Training 

Program. Selected highlights from the state 

surveillance program are provided below. 

STATE SURVEILLANCE 

PROGRAM

The state surveillance program helps 

expand the ability of states to monitor 

work-related health and safety issues. 

The program supports the role of 

states to conduct in-depth surveillance 

and follow-up investigations and 

interventions. These local state-based 

skills and abilities help NIOSH meet the 

mandate to ensure a safe workplace.

 Public Health Relevance

NIOSH values state programs and gives 

financial and technical support to state health 

and labor agencies, universities, and other 

eligible groups to develop and expand their 

occupational health surveillance programs. 

The NIOSH extramural surveillance portfolio 

includes 26 state recipients composed of 49 

projects focusing on work-related injuries and 

death, exposures and hazards, and worker 

populations of interest. These programs 

use and distribute surveillance data to 

find the incidences of job-related injuries, 

illnesses, exposures, and fatalities. They help 

to discover trends, research opportunities, 

emerging issues, and high-risk worker 

populations. The programs also create and 

send out targeted educational and prevention 

materials, adapting materials to best protect 

workers. They often engage in outreach and 

involve partners in public health and safety to 

advance “data into action.” 

 Research Outputs: 

Publications in FY 2019

State surveillance program outputs are the 

products of both nonresearch and research 

activities and include publications. We 

collected publications by NIOSH-funded 

extramural researchers from principal 

investigator reports to NIOSH, the NIH 

Reporter database, the NIOSHTIC-2 database, 

and the PubMed database. From October 

1, 2018, through September 30, 2019, the 

state surveillance program published 29 

articles in peer-reviewed journals. Find a 

searchable database of NIOSH publications, 

which includes grantee final reports and 

publications, by using the NIOSHTIC-2

publications search.
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019 41

NIOSH Sponsored State Occupational Health & Safety Surveillance Program

 Program Highlights FY 2019

Raising Awareness and Changing 

Laws: New Report on Firefighter 

Health and Safety

Firefighters work in environments and under 

conditions that are potentially risky to their 

safety and health. Firefighters participate in a 

wide variety of tasks that include search and 

rescue, emergency response and medical 

services, disaster assistance, fire prevention, 

and hazardous material response. In FY 

2019, the Montana Occupational Health & 

Safety Surveillance Program released a new 

report providing a detailed look at state 

firefighters’ injuries, illnesses, and fatalities. 

The publication highlighted various data 
42 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019

sources including the Montana Workers’ 

Compensation claims data, the Bureau of 

Labor Statistics Survey of Occupational 

Injuries and Illnesses data, death records, 

and information from the Montana Cancer 

Tumor Registry. According to the report, 

during 2007–2017, firefighters filed the most 

workers’ compensation claims related to 

emergency or medical services, and the most 

common injury they filed claims for was back 

strains from lifting. In addition, during 2011–

2015, firefighters diagnosed with cancer most 

often had the illness in their prostrate, lung, 

and bronchus. 

The Montana surveillance program shared 

these and other findings with a wide range 

of groups, including the Montana Fire Chiefs’ 

Association, Montana State Council of 

Professional Firefighters, and the Montana 

State Firemen’s Association. The surveillance 

program also distributed the report to the 

Montana Municipal Interlocal Authority, which 

provides workers’ compensation for paid 

and volunteer fire departments throughout 

the state. The surveillance program also 

widely disseminated the report findings 

and firefighter safety prevention tips to 

stakeholders via a quarterly newsletter 

written with the Forestry Division of the 

Montana Department of Natural Resources 

and Conservation that oversees the state’s 

wildland firefighter program. 

The Montana State Legislature also received 

the report during the 2019 legislative session, 

which helped inform lawmakers’ decision 

to pass Senate Bill 160. The measure allows 

presumptive coverage of certain illnesses 

for firefighters. In April 2019, the state’s 

governor signed the bill into law, known as 

the Firefighter Protection Act. 

Details:

• Firefighters in Montana: Health & Safety 

Issues

• 2019 Montana Legislature: Senate Bill 160

• Montana Worker Health

A 3-Year Look at Commercial Motor 

Vehicle Crashes in New Hampshire

The New Hampshire Occupational Health 

Surveillance Program partnered with the 

state’s Department of Safety, State Police 

Operations, to measure risks associated with 

commercial motor vehicles. They analyzed 

information from the New Hampshire State 

Police on commercial vehicle crashes from 

2015 through 2017. Using the Integrated 

Database Management System, a variety of 

data were collected, including information on 

the type of accident, location, age of driver, 

road condition, weather, day of week, time 

of day, physical condition of those in the 

vehicle (injury status), and apparent cause of 

the accident. The data specifically focused on 

commercial motor vehicles, or vehicles used 

to transport goods or passengers for business 

that weighed more than 10,000 pounds. 

According to the surveillance findings, 

most accidents happened during the week, 

in daylight hours, and in good weather 

conditions when the roads were dry. 

Crashes most often involved drivers, ages 

46 through 55 years, and involved a collision 

with another moving vehicle. The cause of 

commercial motor vehicle accidents varied 

by driving conditions, including whether the 

roads were dry versus being wet and icy. 

Driver inattention or distraction marked the 

top cause of crashes during good driving 

conditions when the roads were dry. In 

comparison, when driving conditions were 

poor, including roads being wet, icy, or 

covered with snow, traveling at unsafe speeds 

led the top cause of accidents. 

The New Hampshire Occupational Health 

Surveillance Program presented these and 

other findings at the 2019 New Hampshire 

Traffic Safety Conference, the 2019 Annual 

Public Health Association Conference, and the 
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019 43

2019 annual meeting for the Council of State 

and Territorial Epidemiologists.

Details:

• Characteristics of Commercial Motor 

Vehicle Crashes Reported in the New 

Hampshire State Police Commercial Crash 

Dataset for Years 2015 Through 2017

• New Hampshire Occupational Health 

Surveillance Program

Drug Overdose the Leading Cause 

of Death at Work in Massachusetts 

(2016–2017)

The Massachusetts Department of Public 

Health (MDPH) reported unintentional drug 

overdose as the leading single cause of fatal 

injury at work. These unintentional overdoses 

resulted in 54 deaths in Massachusetts from 

2016 through 2017. Although these deaths 

occurred across most industry sectors, 

the leading sectors were Accommodation 

and Food Service, Construction, and Real 

Estate and Leasing. In a Fatality Assessment 

and Control Evaluation (FACE) report, 

MDPH provides an overview of these fatal 

occupational injuries in Massachusetts, 

including details from both the FACE and the 

Census of Fatal Occupational Injuries projects. 

The report also examines other workplace 

deaths like falls, electrocutions, exposure to 

toxic chemicals, workplace opioid and other 

drug overdoses, homicides, suicides, and 

motor vehicle-related fatalities that occur 

while traveling on the job. 

Details:

• Fatal Injuries at Work, Massachusetts 

Fatality Update, 2016–2017

• NIOSH Science Blog: Drug Overdose in the 

Workplace and the Role of Opioids

• Mass.Gov: Occupational Health Surveillance 

Program (OHSP)

• Opioids in the Workplace: NIOSH 

Extramural Research

Evaluating Workplace Adoption 

of Health and Safety Strategies in 

Nebraska

Workplace health and wellness programs 

focus on population health strategies that 

target chronic diseases—the leading cause 

of death and disability in the United States. 

However, while there are many approaches to 

improving worker safety and health through 

workplace initiatives, limited understanding 

exists about employers’ adoption of them. 

Having a worksite health and wellness 

program integrated into an organization’s 

structure, built on a solid organizational 

foundation, can lead to success. One way to 

achieve this is through a basic organizational 

governance infrastructure, as identified in the 

Centers for Disease Control and Prevention 

Workplace Health Model. 

Focused on this topic, the Nebraska 

Occupational Health Surveillance Program 

conducted a study in partnership with the 

Nebraska Department of Health and Human 

Services’ chronic disease programs, the 

University of Nebraska-Lincoln, and the 

University of Oklahoma. They investigated 

the implementation of workplace health 

governance and planning strategies 

and safety policies among worksites in 

Nebraska. Researchers analyzed data from 

the Nebraska Worksite Wellness Survey 

for three different years (2010, 2013, and 

2016), containing information from 4,784 

worksite representatives.

Looking at data over time and by occupational 

sector, the study found adoption of workplace 

health governance and planning strategies 

increased over the years and largely 

varied across sectors. The highest level of 

implementation occurred in educational 

services. The lowest numbers were in other 

services, construction, and transportation 

and warehousing. In contrast, worksites more 
44 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019

commonly reported implementing safety 

policies than workplace health governance 

and planning strategies, but numbers varied 

by industry. According to researchers, the 

most common barrier to any type of adoption 

was time constraints, and stress marked 

the top worker health issue, negatively 

impacting business. The International Journal 

of Environmental Research and Public Health 

published the study’s findings in July 2019, 

as part of a special issue on using TWH to 

advance worker health and safety.

Details:

• Assessing Workplace Health and Safety 

Strategies, Trends, and Barriers Through a 

Statewide Worksite Survey

• Nebraska: Dept. of Health and Human 

Services: Occupational Health Surveillance 

in Nebraska

Investigation on Stone Fabrication 

Workers and Silicosis Featured in 

National News

Stone fabrication workers, especially those 

working with engineered stone, are at risk 

for silicosis, according to an investigation 

involving four state surveillance programs in 

California, Colorado, Texas, and Washington. 

Prior to this study, a number of outbreaks of 

silicosis cases were reported internationally 

among stone countertop fabrication workers, 

but only one in the United States. 

Silicosis—an incurable, disabling, and 

sometimes fatal lung disease—is caused 

by exposure to respirable crystalline silica. 

Silicosis can develop when silica particles 

trigger inflammation and fibrosis in the lungs. 

A type of crystalline silica, known as quartz, is 

commonly found in stone, and workers who 

cut, polish, or grindstone materials can be 

exposed to its dust. 

The study, published in the Centers for 

Disease Control and Prevention’s Morbidity 

and Mortality Weekly Report (MMWR), described 

18 cases of silicosis among workers in the 

stone fabrication industry in California, 

Colorado, Texas, and Washington. These 

cases included the first two deaths in the 

country and were identified through separate 

investigations in each state. The cases were 

confirmed by computed tomography scan of 

the chest, or lung biopsy findings. In addition 

to silicosis, the surveillance programs found 

several patients had autoimmune disease 

and latent tuberculosis infection. This 

project involved the California Department 

of Public Health, the Colorado Department 

of Public Health and Environment, the Texas 

Department of State Health Services, and 

Washington State Occupational Respiratory 

Disease Surveillance Program. 

Since being published in September 2019, the 

MMWR article has been featured in 64 national 

and trade news outlets, including National 

Public Radio and Safety+Health magazine, and 

has already been cited in at least eight peerreviewed journal articles.

Details:

• Severe Silicosis in Engineered Stone 

Fabrication Workers—California, Colorado, 

Texas, and Washington, 2017–2019

Preventing Occupational Health Risks 

Associated With Class B Biosolids

The Illinois Occupational Surveillance 

Program released a report on hazards 

associated with the production and use 

of Class B Biosolids. Biosolids are the 

remains or leftovers of organic waste and 

residues from the treatment of municipal, 

commercial, and industrial wastewater—or 

sewage including toilet waste. In a typical 

wastewater treatment plant, biosolids 

are separated from wastewater and are 

sold for agricultural purposes and energy 

production. They often have large amounts 

of pathogens, or disease-causing organisms, 

but biosolids can be treated to reduce these 

levels. The U.S. Environmental Protection 

Agency (EPA) categorizes biosolids into 
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019 45

two classes: (1) Class A, which undergo a 

treatment process to decrease pathogens to 

undetectable levels—these are publicly sold 

without restrictions—and (2) Class B, which 

are not treated to the same extent as Class A, 

so are allowed to have an acceptable amount 

of pathogens. Class B Biosolids are restricted 

both to the public and on where they can 

be applied. 

A review of the literature revealed limited 

information about occupational hazards 

related to biosolids. As a result, the Illinois 

Surveillance Program investigated the 

occupational sources and hazards linked to 

Class B Biosolids, identifying the workers who 

at risk for exposure and the health hazards 

they face. The report also identified controls 

that employers can implement to reduce 

exposure. 

According to researchers, biosolids are most 

commonly used for agricultural production, 

forest reclamation, and landscaping. Class B 

Biosolids are most frequently applied on land 

in the United States, either to condition soil 

or fertilize crops. Among the workers with the 

greatest exposure risk are water treatment 

employees, who have daily contact with 

biosolids, applicators, or those who apply and 

spread biosolids, and agricultural workers. 

Individuals working with biosolids are at risk 

of physical hazards such as slips, trips, and 

falls; motor vehicle crashes while transporting 

the substance; respiratory issues; dermal or 

skin irritation; and infection caused by the 

bacteria, viruses, protozoa, and helminth 

worms in biosolids. 

Scientists identified multiple engineering, 

administrative, and personal protective 

strategies to control or limit exposure to 

biosolid-related hazards. These critical 

controls include, but are not limited to, 

maintaining worker hygiene to reduce dermal 

and respiratory exposure, using personal 

protective equipment, modifying equipment 

and practices to prevent unnecessary 

aerosolization of biosolids, and substituting 

Class B Biosolids with Class A Biosolids. 

These findings are important because EPA 

biosolids laws and regulations (40 CFR Part 

503) prohibit the public from being exposed 

to Class B Biosolids for at least a year after 

its application, and workers are not exempt. 

They have the greatest risks before, during, 

and after Class B Biosolids are applied, when 

concentrations of pathogens are the highest. 

Details:

• Occupational Health Risks From Class B 

Biosolids

• Illinois Occupational Health Surveillance 

Program 2

Injury, Hospitalization, and Fatality 

Rates Among Young New Jersey 

Workers

Around 200,000 working adolescents have 

job-related injuries or illnesses each year in 

the United States partly due to inexperience 

in the workplace, lack of job-specific training, 

and/or lack of physical or emotional maturity 

or both. New Jersey law requires all youth 

injuries related to a school-sponsored work 

activity be reported to the New Jersey Safe 

Schools Program (NJ SS)—an online reporting 

system managed by the state’s Department 

of Education. This is the only state law in 

the United States focused on surveillance 

data for young workers participating in 

school-sponsored work or secondary school 

career-technical-vocational education. 

The State of New Jersey Department of 

Health Occupational Health Surveillance 

Unit aimed to understand injuries and 

hospitalizations among adolescent workers, 

including injury types, causes, and disparities. 

The surveillance program analyzed and 

compared data from both the NJ SS and the 

state health department’s hospitalization and 
46 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019

fatality records. The latter numbers provided 

additional information on injuries related to 

secondary school career-technical-vocational 

education as well as injuries unrelated to 

this area. The project focused on injuries 

during 2007–2016 for workers 14 through 21 

years of age. 

Data were reported demographically, as 

estimated annual crude rates, which are 

calculations per 100,000 employed individuals. 

Researchers reviewed 651 job-related injury 

cases from New Jersey hospital discharge 

data and 772 cases from the NJ SS. According 

to reported findings, crude hospitalization 

rates per year gradually decreased over time, 

and there was an annual decrease in injuries 

reported in the NJ SS database. However, 

young adults, 19 through 21 years old, along 

with individuals who were white and male, 

had the highest hospitalization and fatality 

rates. Workers younger than 17 years old had 

the most injury reports in the NJ SS database. 

According to scientists, this information could 

possibly indicate a tendency for young males 

to have riskier jobs than females. In addition, 

understanding disparities in injuries could 

inform public health prevention efforts. 

The journal Injury Epidemiology highlighted 

these findings. 

Details:

• Reported Injury, Hospitalization, and Injury 

Fatality Rates Among New Jersey Adolescent 

Workers

• NJ Health: Occupational Health Surveillance
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019 47

SPECIALTY TRAINING PROGRAMS

NIOSH funds the TPGs, the new Commercial Fishing 

Occupational Safety Training Grants funded at the 

end of FY 2019, and the Miner Safety and Health 

Training Program—Western United States cooperative 

agreement. Selected highlights from TPGs and 

the Miner Safety and Health Training Program—

Western United States are provided below. 

TRAINING PROJECT GRANTS

NIOSH supports professional training 

in occupational safety and health 

through TPGs. Most TPGs are academic 

training programs that support 

undergraduate and graduate training. 

Located throughout the United States, 

these programs enrich the national 

network of graduate training the ERCs 

offer. Along with TPGs for traditional 

degree training programs, NIOSH 

supports TPGs that respond to the 

unique training needs of specialty 

groups. These include the Association 

of Occupational and Environmental 

Clinics Occupational Health Internship 

Program. This program supplies 

specialty training and increases diversity 

among health and safety practitioners 

by recruiting and mentoring 

students from underrepresented 

and underserved minorities. 

Through a TPG, the Alaska Marine Safety 

Education Association expands the network 

of port-based fishing safety instructors 

in Alaska and the United States. They 

achieve this through a train-the-trainer 

curriculum designed for the unique needs 

of the commercial fishing industry. NIOSH 

also provides funding for the Emergency 

Responder Training Program through the 

International Association of Fire Fighters 

(IAFF), which this report later discusses.

 Public Health Relevance

TPGs offer an important service by providing 

enough qualified professionals to carry 

out the Occupational Health and Safety Act 

of 1970. TPGs train in specific disciplines 

to meet the needs of a diverse workforce. 

The graduates of TPGs serve a vital role in 

protecting and promoting the health and 

safety of U.S. workers, aligning with the 

goals of Healthy People 2020—to prevent 

diseases, injuries, and deaths due to working 

conditions. TPGs also serve as important 

resources on job-related safety and health 

issues for business, labor, government, and 

the general public.
48 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019

NIOSH Training Project Grants by Discipline
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019 49

 Research Outputs: 

Publications in FY 2019

TPG research outputs are the products of 

research activities and include publications. 

We collected publications by NIOSH-funded 

extramural researchers from principal 

investigator reports to NIOSH, the NIH 

Reporter database, the NIOSHTIC-2 database, 

and the PubMed database. From October 1, 

2018, through September 30, 2019, the TPG 

researchers published 13 articles in peerreviewed journals. Find a searchable database 

of NIOSH publications, which includes grantee 

final reports and publications, by using the 

NIOSHTIC-2 publications search.

 Program Highlights FY 2019

Training Project Grant Trainees, 

Graduates, and Employment by 

Discipline

In academic year 2018–2019, the TPG 

academic training programs graduated 256 

trainees with specialized training in industrial 

hygiene, occupational safety and medicine, 

and allied disciplines. These allied disciplines 

included occupational health psychology, 

risk management, occupational ergonomics 

and engineering, environmental health, and 

occupational epidemiology.

Table 7. Training project grant trainees, graduates, and employment by discipline, 

FY 2019

Program Area Trainees Graduates

Employed in occupational safety and health 

field or seeking advanced training (%)

Industrial Hygiene 314 107 107 (100)

Occupational Safety 335 102 101 (99)

Occupational 

Medicine

31 17 17 (100)

Allied Disciplines 107 30 27 (90)

Total 787 256 252 (98)

Training Project Grant (TPG) Program 

Achievements

Mapping Tool Helps Companies Purchase 

Safe, Efficient Office Equipment

Office workers are at high risk of experiencing 

musculoskeletal, or soft-tissue, disorders from 

repeated motion and awkward positions like 

sitting long hours at a computer. Previous 

research shows that safe and efficient, or 

ergonomic, office equipment can help reduce 

the risk. But obtaining the right equipment 

can sometimes be challenging.

Researchers at the Ohio University TPG used 

a tool called value-stream mapping to collect 

information about finding and purchasing, or 

procuring, ergonomic computer workstations 

by depicting the process from beginning to 

end. They first surveyed 548 office workers at 

a large university about work-related muscle 

pain associated with computer workstations, 

including mouse controllers, keyboards, and 

adjustable chairs. Researchers also surveyed 

workers about their satisfaction with the 

equipment’s procurement process. Using the 
50 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019

survey results, the researchers created valuestream maps of the procurement process 

for the computer workstations. Next, they 

asked 331 workers for details about how they 

procured the equipment and then revised the 

value-stream maps based on these responses.

The value-stream maps helped the 

researchers collect and display information 

that improved the procurement process. The 

workers in this study also expressed much 

greater satisfaction when their departments 

consulted an expert in ergonomics before 

buying new computer workstations. These 

results highlight that value-stream maps can 

help companies find and purchase effective 

ergonomic equipment to help prevent 

work-related musculoskeletal disorders. 

The study was published in the journal 

Professional Safety.

Details:

• Mapping Tool Helps Companies Purchase 

Safe, Efficient Office Equipment

• Value Stream Maps: Improving Procurement 

of Ergonomic Office Equipment

Increasing Diversity of Trainees in 

Occupational Safety and Health

The University of Wisconsin–Stout’s 

Graduate Program in Risk Control and Safety 

Management is a unique TPG that recruits 

trainees from undergraduate programs 

in engineering, science, management, 

and business. The program has a strong 

recruitment plan to reach and retain 

underrepresented and underserved groups 

in the occupational safety and health field. 

This includes the grant’s principal investigator 

directly contacting students from groups like 

the National Black Student Union, seeking 

those who show technical and peopleoriented competencies that will benefit 

the risk control and safety management 

profession. 

Other recruitment and outreach activities 

include (1) working with multicultural offices 

at various University of Wisconsin campuses, 

and (2) using a dynamic website and other 

marketing materials, including testimonials 

from alumni from underrepresented and 

underserved backgrounds. Because of these 

recruitment efforts, during the 2019–2020 

academic year, 42% of the program’s student 

base consisted of underrepresented and 

underserved groups, as well as international 

students. Annual enrollment is generally 

between 20 to 30 students. 

The University of Wisconsin–Stout TPG’s 

curriculum reflects the needs, expectations, 

and challenges of the field of occupational 

safety and health, as well as property 

and environmental protection. The risk 

control perspective requires students to 

be competent beyond safety regulatory 

compliance. The philosophy of risk control 

attempts to extend, elevate, and integrate 

the technical areas of safety engineering, 

industrial hygiene, and environmental 

regulations from operational levels to 

managerial concerns. Classes are offered in 

the daytime and evenings to accommodate 

currently employed professionals. 

Long-standing TPG Offers Dual Training 

in Industrial Hygiene and Chemistry for 

Undergraduates

The University of North Alabama Industrial 

Hygiene Program was developed in the late 

1970s in response to the passage of the 

Occupational Safety and Health Act of 1970. It 

became a TPG in 2000 and is one of NIOSH’s 

oldest training grants. The program offers a 

double major in industrial hygiene and general 

chemistry, preparing its graduates for entrylevel positions in industry, government, and 

other organizations as industrial hygienists or 

industrial chemists or for entry into graduate 

studies in chemistry or occupational safety 

and health. 
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019 51

The academic program has a rigorous 

curriculum and aims to (1) promote and 

further the recruitment of qualified students 

into occupational safety and health, (2) 

support and strengthen continuous academic 

improvement, and (3) expand and develop 

the educational opportunities and services of 

the Industrial Hygiene Program. The program 

is accredited by the Accreditation Board for 

Engineering and Technology and is engaged 

in continuous improvement and evaluation. 

The University of North Alabama has earned 

a reputation for graduating a pool of qualified 

individuals who are providing valuable 

services to workers and employers in the 

North Alabama region and beyond.
52 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019

EMERGENCY RESPONDER 

TRAINING PROGRAM

Through the IAFF, NIOSH supports a 

nationwide program to enhance the 

capabilities of firefighters engaged in 

emergency response through training. 

The training is site- and trade-specific 

and aims to reduce on-the-job injuries, 

illnesses, and fatalities related to 

emergency response. Therefore, 

responders are better able to protect 

the communities they serve.

The IAFF has a long working relationship with 

NIOSH. IAFF’s Emergency Responder Training 

Program is part of a complete first responder 

training plan. IAFF’s teachings seek to improve 

knowledge, attitudes, and behaviors so that 

first responders adopt a safer approach to 

emergency response throughout their career. 

IAFF training is a resource that directly affects 

decisions firefighters make each and every 

day. 

 Public Health Relevance

This federally funded training program serves 

as an excellent model for an effective training 

program for first responders. With a team of 

instructors who are both certified fire service 

instructors and hazardous materials (HazMat) 

responders, IAFF provides real-world training 

in HazMat response. Furthermore, IAFF brings 

its training directly to the students in their own 

communities, developing training partnerships 

with thousands of fire departments 

throughout the United States. Because of this 

community-based learning, local responders 

receive training that addresses their unique 

concerns and challenges. 

As 9-1-1 calls for opioid-associated 

emergencies continue to increase, all levels 

of EMS providers must be properly trained to 

handle these life-threatening events, including 

the administration of naloxone (NARCAN). 

In response, IAFF developed an Opioid Crisis 

Toolkit, which uses the protocols, state-ofthe-art responses, and resources available to 

firefighters. 

 Program Highlights FY 2019

In FY 2019, IAFF delivered 58 classes to 1,158 

students, totaling 20,720 contact hours.

Table 8. Emergency responder training classes, FY 2019

Class Title

Class 

Length

 Total 

Classes

Total 

Students

Total Contact 

Hours

Confined Space Operations 24 hours 3 57 1,368

Emergency Response to Terrorism: Operations 8 hours 13 266 2,128

First Responder Operations 24 hours 33 659 15,816

Illicit Drug Labs 8 hours 9 176 1,408
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019 53

MINER SAFETY AND HEALTH 

TRAINING PROGRAM

Despite many technological and work 

environment advances, mining remains 

one of the most demanding occupations 

in the United States. Because of the 

many challenges in the mining industry, 

the focus areas for mining training must 

cover a wide range of hazards and risks.

The Mine Safety and Health Administration 

(MSHA) Training Academy in Beckley, West 

Virginia, serves the mining community in the 

Eastern United States. Because this training 

program is not easy for miners in the Western 

States to access and certain aspects of mining 

operations differ in eastern and western 

operations, NIOSH has supported miner safety 

and health training in the Western United 

States since 1999. 

For FY 2019, two programs were funded in the 

Western United States: the Colorado School 

of Mines and the University of Arizona. This 

training provides a joint approach to reducing 

injuries to miners and other workers in mining 

operations. It also aims to translate research 

into workplace practices that (1) improve 

mining safety, (2) advance the safety and 

health of miners, (3) enhance the safety and 

health of other workers involved in mining 

operations, and (4) increase the quantity of 

qualified mine safety and health trainers in 

the Western United States.

Several of the main objectives of the training 

program follow: 

■ To develop, deliver, and manage the 

training needs of miners in the Western 

United States.

■ To provide qualified instructors 

and faculty.

■ To start and carry out “train the trainer” 

courses.

■ To evaluate training effectiveness and 

impact on reducing injuries and illnesses 

to miners. 

■ To coordinate with existing training 

programs, like those offered by MSHA 

and MSHA-funded state programs, and 

in partnerships with industry, miners, 

and other agencies. 

NIOSH intends for the program’s training to be 

consistent with OSHA and MSHA guidelines, 

without duplicating these agencies’ existing 

trainings. 

 Public Health Relevance

The Miner Safety and Health Training Program 

provides critical safety and health training to 

protect workers in one of the most dangerous 

industry sectors in the United States. This 

program contributes to this overall goal by 

taking the following actions:

■ Expanding the mission of NIOSH in 

protecting and promoting the health of 

mine workers. The trainings improved 

work practices, reduced work-related 

injury and illness, and increased the 

understanding of safety and health 

practices in Western mine worksites.

■ Increasing the safety focus, total health 

awareness, and leadership competency 

of miners, frontline supervisors, 

superintendents, and managers 

representing operations throughout 

the United States, spanning all major 

commodity sectors in surface and 

underground mining.

■ Directing the focus of mine-rescue 

training toward learning actual rescue 

skills, resulting in team members being 

better prepared to respond to all kinds 

of emergencies.

The Miner Safety and Health Training 

Program fills an important regional need. 
54 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019

During FY 2019, the program trained 

1,538 mine workers through 67 courses. 

Trainees included miners, supervisors, and 

undergraduate and graduate engineering 

and geology students. The program is critical 

for underserviced populations working on 

mine sites, including contractors, suppliers, 

consultants, equipment manufacturers, and 

small mine operators. The program designs 

and uses active learning strategies for mine 

safety training. Trainers across all mining 

service sectors throughout the Western 

United States have been taught ways to 

improve safety training. These activities 

improve the transfer of best safety practices 

to the workplace while increasing the number 

of workers served. 

 Program Highlights FY 2019

Educational Experiences for 

University Students, Faculty, and 

Staff

Among its various training focus areas, the 

Colorado School of Mines (CSM) educates 

future workers in the mining industry. 

CSM provided training in FY 2019 for 

undergraduate and graduate engineering 

and geology students in areas related to OSH. 

CSM aims for these students, who will work 

in extraction industries like mining, to apply 

safety and health principles to their work by 

exposing them and their faculty and staff to 

OSH courses and lectures.

Thirty students at CSM took a one semester 

credit course entitled “Introduction to Mine 

Safety and Health.” Through completing the 

class, they also fulfilled requirements for 

MSHA’s 30 CFR Part 48 New Miner Training 

for working at underground and surface 

mines. In addition, CSM provided four guest 

lectures entitled “Mining Safety 101” to 123 

mining engineering students attending three 

different universities, including CSM. The 

other institutions included the University of 

Nevada–Reno and the University of South 

Dakota. CSM is currently in talks with other 

universities to deliver guest lectures in 

FY 2020.

Sharing Knowledge Regionally and 

Nationally Through Trainings and 

Presentations

During FY 2019, the University of Arizona 

trained more than 1,000 miners, trainers, 

and supervisors related to health and 

safety for miners through educational 

resources, including its computer-based, 

serious gaming software like “Harry’s Hard 

Choices” and “Harry’s Hazardous Day.” The 

university continues to improve “Harry’s 

Hard Choices.” Although the game focuses 

on mine emergency preparedness, it 

incorporates a variety of training topics like 

hazard recognition and mitigation. Therefore, 

the game can now be used for flagging and 

decreasing hazards via a dynamic, team-based 

training activity. 

The university also delivered 11 presentations 

at national conferences and gave 16 

invitational talks to a variety of groups. 

These included the 2019 Society for Mining, 

Metallurgy & Exploration (SME) Annual 

Conference & Expo, the SME Annual Meeting, 

the 2019 Mine Safety and Health Conference, 

the New Mexico Mine Safety and Health 

Conference, and West Virginia University-Tech 

Engineering Seminar.
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019 55

IV. WORLD TRADE CENTER (WTC) HEALTH PROGRAM

The terrorist attacks of September 11, 2001, have caused an array of acute and chronic adverse 

health conditions in the exposed population. According to research, nearly 500,000 individuals are 

believed at increased risk of adverse health effects from their exposure to physical, psychological, 

and emotional stressors from the event. There is considerable comorbidity in 9/11-related 

illnesses, resulting in further reduction in the quality of life in some individuals. Illnesses related 

to the 9/11 attacks persisted in many individuals while others presented long after their exposure; 

therefore, long-term follow up is needed.

Shortly after the attacks, CDC and NIOSH provided funding to support a variety of post-disaster 

activities including medically evaluating and monitoring survivors, establishing the WTC Health 

Registry, and publishing treatment guidelines for adults and children exposed to the disaster. 

As a result of the combined efforts of researchers, physicians, responders, survivors, local 

governments, research institutions, and the community, Congress created the WTC Health 

Program with the passage of the James Zadroga 9/11 Health and Compensation Act of 2010. The 

WTC Health Program provides medical monitoring and treatment for specific symptoms and health 

conditions for people who worked in response, recovery, and cleanup operations at the WTC, the 

Pentagon, and the passenger-jet crash site near Shanksville, Pennsylvania, as well as initial health 

evaluations, monitoring, and treatment for survivors of the attacks in New York City. Furthermore, 

the Zadroga Act requires ongoing research activities, maintenance of the WTC Health Registry, and 

outreach and education activities to potential enrollees. OEP manages the extramural portfolio 

of cooperative agreements for the WTC Health Program. This portfolio includes the WTC Health 

Registry and individual cooperative research agreements, as discussed in this section. For more 

information about the WTC Health Program, see the Summary of WTC Health Program Research: 

NIOSH Research Compendium 2019.
56 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019

WTC HEALTH PROGRAM RESEARCH PORTFOLIO 

The WTC Health Program Research-to-Care Model 

conducts and assesses research in order to inform 

clinical care for the population of responders and 

survivors affected by the 9/11 attacks. To review 

the current WTC Health Program research agenda 

and the Research-to-Care Model, please visit 

the WTC Health Program Research Agenda.

Each year since late 2011, the WTC Health 

Program has solicited applications for 

scientifically rigorous research to help answer 

critical questions about physical and mental 

health conditions related to the September 

2001 terrorist attacks. From 2011 through 

2019, a total of 254 research proposals 

(including the renewal of the WTC Health 

Registry) were reviewed and 78 (31%) projects 

were selected for funding. 

During FY 2011–2019, the WTC Health 

Program funded 77 research projects 

(excluding the WTC Health Registry) for a 

total of $111.6 million. From FY 2011–2019, 

the WTC Health Program continued to fund 

the WTC Health Registry project for a total 

of $59.7 million. Prior to switching to NIOSH 

in 2009, the Registry was administered 

by the Agency for Toxic Substances and 

Disease Registry and the National Center for 

Environmental Health. The Registry sits within 

the New York City Department of Health and 

Mental Hygiene. 

In FY 2019, the WTC Health Program awarded 

a total of $24,139,713 in extramural funding 

for 29 research projects and the WTC Health 

Registry project. These data are shown below 

in Table 9. Total research funding from 2011 

through 2019 for the 77 research projects and 

the WTC Health Registry is shown in Figure 9. 

For a listing of all funded projects awarded 

and current status of funded projects, see the 

Summary of WTC Health Program Research: 

NIOSH Research Compendium 2019.

Table 9. World Trade Center Health Program funding, FY 2019

Award Category Award Mechanism

Number of 

Awards Funding

World Trade Center Health Program 30 $24,139,713

World Trade Center Research Cooperative Agreements (U01) 29 $16,339,713

World Trade Center Health Registry Health Registry 1 $7,800,000
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019 57

Figure 9. Research Funding for 2011–2019 Research Cooperative Agreements, WTC 

Health Registry, and Research Contracts

Of the 77 projects awarded since 2011, 

36 (47%) are active and 41 (53%) are 

completed (closed). Eleven of the active 

projects and thirty of the closed produced 

124 publications. The WTC Health Program 

organizes its research projects and their 

outputs or products, including publications, 

into six primary focus areas: (1) Respiratory 

Disease, (2) Cancer, (3) Adult Mental Health, 

(4) Emerging Conditions, (5) WTC Youth, and 

(6) Cardiovascular Disease (CVD). 

External program stakeholders, along 

with NIOSH leadership, contributed to the 

development of these focus areas. The 

categories were created based on 9/11-related 

illnesses identified by clinicians treating the 

impacted population, a review of research 

publications on WTC-related health conditions, 

and a review of the physical and mental 

health conditions covered by the WTC Health 

Program. These latter conditions have been 

determined to be aggravated by, contributed 

to, or caused by exposure to the 9/11 terrorist 

attacks. For more information on the areas 

of health conditions reported following the 

disaster and treatments for those conditions, 

see the Summary of WTC Health Program 

Research: NIOSH Research Compendium. This 

research compendium also includes a table 

listing of all funded projects, a listing of those 

studies with publications, and a bibliography 

of all research portfolio publications 

(excluding WTC Health Registry publications). 

See Figure 10 for data on the publications 

resulting from WTC cooperative research 

agreements. 
58 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019

Figure 10. Research studies and publications by primary focus area

*Some projects involve more than one focus area, but publications are counted only towards the main area 

of focus.
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019 59

WTC HEALTH REGISTRY

Established in 2002, the WTC Health Registry follows 

a diverse cohort of 71,431 persons who experienced 

a range of direct exposures during the September 11 

event and in its aftermath. It is one of the longest 

running post-disaster registries worldwide. Based 

in the New York City Department of Health and 

Mental Hygiene, the WTC Health Registry is an 

essential public health resource for understanding 

the long-term (almost 20 years) physical and mental 

health effects of the September 11 disaster. 

MISSION AND SERVICES

Data collected and analyzed by the Registry 

helps WTC responders, WTC survivors, and 

their clinicians make informed decisions 

about their or their patients’ health and helps 

researchers and policy makers make informed 

decisions about the 9/11-exposed population, 

in general. Health resource information is 

disseminated by Registry staff via multiple 

channels, including a comprehensive website, 

annual reports, e-newsletters, brief research 

summaries, testimonials from responders 

and survivors, informational videos, social 

media, targeted mailings, health information 

sheets, press announcements, and 

stakeholder meetings. 

Communications with registrants are 

designed to keep them engaged with the 

Registry for the long term and to obtain 

registrants’ updated contact information. 

These communications enhance registrants’ 

participation in periodic follow-up health 

surveys and nested studies to track and 

understand long-term changes in physical 

and mental health, quality of life, and gaps 

in care. The Registry staff also helps connect 

registrants and their families with the WTC 

Health Program, where they can receive 

needed healthcare. 

The Registry staff works with community, 

labor, and other stakeholders to keep them 

informed and to receive input on various 

research studies, surveys, and other activities 

related to the 9/11 community. Registry 

researchers disseminate findings at scientific 

conferences, meetings, and through peerreviewed journals. More information can be 

found at WTC Health Registry.

ENROLLMENT

The Registry enrollment is now closed, but it 

includes 30,664 rescue and recovery workers 

and 49,732 survivors who lived, worked, 

attended school, or were present in lower 

Manhattan on September 11, 2001. Nearly 

9,000 registrants are both survivors and 

rescue and recovery workers. Approximately 

2,625 children under the age of 18 were 

registered during 2003–2004; all are now 
60 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019

adults 18 years of age or older. Approximately 

1,532 child registrants who have aged 

into adulthood have consented to remain 

in the Registry as young adults, including 

174 in 2019. WTC Health Registry staff 

are conducting outreach to the remaining 

unconsented young adults. 

SCIENTIFIC OUTPUTS

As of June 30, 2019, the WTC Health 

Registry had a total of 485 scientific outputs 

(publications, presentations, published 

guidelines, etc.). The distribution of outputs 

by type is presented in Figure 11. 

A listing of the WTC Health Registry key 

accomplishments and a bibliography of 

Registry publications is available in the 

Summary of WTC Health Program Research: 

NIOSH Research Compendium 2019. For 

summaries of the Registry annual reports, 

peer-reviewed scientific publications, registry 

bibliography list, technical reports, and 

clinical guidelines, please visit WTC Scientific 

Bibliography. The listing on this site will be 

updated periodically by the Registry staff. 

For Registry highlights and other 9/11 health 

information, please visit NYC: 9/11 Health. 

Figure 11. WTC Health Registry key scientific outputs

*Number of registry outputs 2004–2019; publications resulting from registry-facilitated recruitment into 

external research studies or registry provided de-identified data. 
NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019 61

APPENDIX

Table 10. FY 2019 NIOSH Funding Opportunity Announcements by Mechanism 

Funding 

Opportunity Mechanism Title

Investigator-initiated Research

PAR-13-245

PAR-18-799

K01 Mentored Research Scientist Development Award

PAR-13-129

PAR-18-812

R01 Occupational Safety and Health Research

PAR-12-200 R03 NIOSH Small Research Program

PAR-14-246 R13 NIOSH Support for Conferences and Scientific Meetings

PAR-12-252

PAR-18-798

R21 NIOSH Exploratory/Developmental Grant Program

PAR-14-229 U13 NIOSH Support for Conferences and Scientific Meetings

Training Programs and Centers

PAR-10-288

PAR-15-352

T03 Occupational Safety and Health Training Project Grants

RFA-OH-19-005 T03 Commercial Fishing Occupational Safety Training Project Grants 

PAR-15-303

PAR-10-217

T42 Occupational Safety and Health Education and Research Centers

Cooperative Agreements

RFA-OH19-004 U01 Commercial Fishing Occupational Safety Research Cooperative 

Agreement

PAR-16-098 U01 Cooperative Research Agreements Related to the World Trade 

Center Health Programs

RFA-OH-16-001 U50 Extension of the World Trade Center Health Registry

PAR-15-361 U19 NIOSH Centers of Excellence for Total Worker Health®

RFA-OH-16-010 U24 National Mesothelioma Virtual Bank for Translational Research

RFA-OH-19-002 U24 Occupational Safety and Health Surveillance Collaboration, 

Education, and Translation

PAR-15-353 U54 Centers for Agricultural Safety and Health

RFA-OH-14-005 U54 National Center of Excellence for the Prevention of Childhood 

Agricultural Injury

PAR-14-275 U60 State Occupational Health and Safety Surveillance Program

(Continued)
62 NIOSH Extramural Research and Training Program ■ Annual Report of Fiscal Year 2019

Funding 

Opportunity Mechanism Title

RFA-OH-19-001 U60 National Center for Construction Safety and Health Research and 

Translation

RFA-OH-17-001 U60 Miner Safety and Health Training Program—Western United 

States

Cosponsored Research With the National Institutes of Health 

PA-17-302 R43, R44 PHS 2017-02 Omnibus Solicitation of the NIH, CDC, FDA, and ACF 

for Small Business Innovation Research Grant Applications

PA-18-574 R43, R44 PHS 2018-02 Omnibus Solicitation of the NIH, CDC, and FDA for 

Small Business Innovation Research Grant Applications 

FY 2019 NIOSH Funding Opportunity Announcements by Mechanism
Promoting productive workplaces through 

safety and health research

DHHS (NIOSH) Publication No. 2021-108

DOI: https://doi.org/10.26616/NIOSHPUB2021108